**Jim Hill:** Welcome to “Weight Loss And…”, where we delve into the world of weight loss. I'm Jim Hill.

**Holly Wyatt:** And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and living your best life while you're doing it.

**Jim Hill:** Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

**Holly Wyatt:** Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

**Jim Hill:** Ready for the “And” factor?

**Holly Wyatt:** Let's dive in.

**Jim Hill:** Here we go. Holly, today we're continuing our deep dive into different diets that people may want to follow, particularly for weight loss, but also for weight loss maintenance. Today we're going to talk about a diet that's become very popular.

I'm sure that most of our listeners have heard of the Mediterranean diet and to help us here is really one of the great nutrition communicators around Dr. Keith Ayoob. Keith is a pediatric nutritionist and a clinical practitioner. He's an Emeritus Associate Professor at Einstein College of Medicine. He's really interested in treating and preventing obesity and type 2 diabetes and cardiovascular disease. He's also a registered dietitian.

This combination of PhD, RD is really a terrific combination. Keith was instrumental in developing the Nuval Nutritional Scoring System, a food evaluation algorithm designed to improve consumers’ ability to quickly and accurately rate an item's health. He worked with me. Keith and I worked together on an amazing project. We co-designed the global nutrition policy for the Walt Disney Corporation. This was endorsed by First Lady Michelle Obama. This was really one of the first set of comprehensive nutrition guidelines for kids.

We had a blast doing that project together. Keith has co-authored with Barbara Hoffman, the Uncle Sam Diet, four-week eating plan for a thinner health through America, which promotes healthy eating and an active lifestyle. He's a fellow of the Academy of Nutrition and Dietetics and a co-author of its physician paper on food and nutrition myths and misinformation. Very important. I see him on TV all the time. He's called upon as a media expert because he knows what he's talking about and he has the ability to communicate it well. Keith, welcome to Weight Loss And.

**Keith Ayoob:** Thank you. And thank you for that really wonderful flattering introduction. Better than I deserve. Thank you.

**Jim Hill:** Well deserved.

**Holly Wyatt:** Thank you for joining us today. You are a fantastic communicator. Like Jim said, you're really good at what I like to say translating the science for the public. So before we get started, can you tell us a little more about how you got where you are today? How did you end up being able to do this, to translate the science in this way?

**Keith Ayoob:** Well, the population that I work with at Albert Einstein College of Medicine, I should say over 30 years, I directed a nutrition clinic as part of a large diagnostic and treatment center for children and families with special needs. So oftentimes literacy was low, education level was low, and I had to really get my nutrition to speak in real language. I had to boil down a lot of the science and communicate it to them in a way that they could understand.

So it's got to be very simple. And I don't think people, even educated people, they like simple messages. They don't need to hear the whole scientific background. If they want to, I'll happily tell them.

But in this day and age of digital everything, can you just give me the boil down, Keith? And that's what I would often hear. So that's what I did. So communicating complicated nutrition nuances in a simple way is kind of how I get my practice.

**Holly Wyatt:** So Keith, on this show, we a lot of times talk about pie in the sky. I I it because it's nutrition. Pie in the sky, which is the theory, the science, which is great.

We love to talk about it. But then you got to take the pie in the sky and put it in the plate, which is those actionable items. It is kind of making it tangible and meaningful.

**Keith Ayoob:** It is. And it’s one of the things that I like about the Mediterranean diet because other than the fact that I kind of grew up on this diet, my background is actually, Greek and Lebanese and my grandparents work from Crete. So, our ancestors are from Crete, which is kind of where the Mediterranean diet started. And so it is a simple diet. I should say before we even start, people sometimes get annoyed that it's the Mediterranean diet. And what about the other cuisines that are out there? And really, the Mediterranean diet is just a template for eating. You could apply it to any geographical area in the world and any cuisine.

So Mediterranean diet is kind of geographically where it started and where it originated, but you could apply those kinds of principles to any cuisine. So I don't want to feel like anybody's left out of here.

**Jim Hill:** Oh, you see what he did. It's a wonderful communication technique of he turned the conversation back to the focus, the Mediterranean diet. Well done, Keith.

**Keith Ayoob:** Thank you very much, but, you know, it's an easy diet, I think, to follow and stuff. And as I say, I grew up on it, so I can give you all kinds of foodie history about it.

**Jim Hill:** We're going to get into that. But before we do, one of the reasons that we're doing this series, Keith, is that we tell people there's no one diet you have to follow. You do have options in following diets. And what we want is to help people understand the different diets.

And we encourage people to go and try it. Some people do well on some diets, some do well on other diets. And the other thing that we talk a lot about, Keith, is losing weight is different from keeping it off. You can lose weight with pretty much go buy a diet book in the bookstore and it works. Keeping it off is finding a way to eat forever. And it seems like the Mediterranean diet is one of those diets that might fall into both categories. It might be useful during weight loss and weight loss maintenance. Yeah, that's, that's a really, really good point. Let's start with the basics. What's the Mediterranean diet?

**Keith Ayoob:** It started in, I guess, the Mediterranean islands, but it's really focused on simple principles, which is healthier fats, lots of fruits and vegetables, fish, more than meat, probably, and people are always here, happy to hear that it did include a little bit of wine.

**Jim Hill:** That's always good.

**Keith Ayoob:** Yeah, although people are not wine drinkers, if you don't drink them, don't start. Yeah, I mean, you don't have to start. And so those, when you think of fruits and vegetables, which ones?

Basically, any ones. So that really takes it a little more globally. But as it wasn't really designed as a weight loss diet, it was designed or it was sort of discovered because it was heart healthy. And to use it as a weight loss diet, you keep those kinds of heart-healthy eating styles, have fewer calories. And I should say it does involve, at least as the Mediterranean diet originally occurred, and it included a lot of physical activity. I don't know if anybody's been to the islands in the Mediterranean, but they tend to be hilly. These were not sedentary people.

**Jim Hill:** Yeah, I've been to Crete and it's very hilly. It's actually one of the neatest places I've been to. And by the way, people in Crete live a long time, right? It's one of the places where people live a long time and we think maybe diet is part of what contributes to that.

**Keith Ayoob:** It is. And one of the other Greek islands, Icaria, is considered one of the blue zones. And I should probably say that also the diet included a lot of avoidances for religious purposes a hundred years ago. Well, it started as a religious purpose, but as it was explained to me by my relatives, it was a way to stretch out food availability. And what's that got to do with the religion, I would ask. And they say, well, if you want to get somebody to comply, you make it a religious decree. They say, okay, for this month, we're not eating meat. For that month, we're not eating olive oil, whatever the... And this diet, if you followed it from a religious standpoint, included over almost 150 days of the year where something was being avoided. And it was really to stretch out food availability. It didn't make it last. So it wasn't necessarily... They were not eating this way because they were virtuous. They were eating this way because they had to... It was kind of sustenance.

**Jim Hill:** So Keith, how does the Mediterranean diet differ from the typical American diet? If you were an ordinary person and you were going to switch and go on a Mediterranean diet, what kinds of things might change?

**Keith Ayoob:** Well, one of the things was that you probably would eat less meat, you would eat more fish, and you would focus a lot more on monounsaturated fat. Now, they used olive oil because it was all over the place, but you could certainly use canola oil or other things. But also, I should say, they did eat more nuts. That was part of their eating style. Not a lot, but it was more regular. So it wasn't that they ate tons of nuts all the time. It was a modest amount, but they had them regularly.

I'll give you an example. When I was growing up, after dinner, we didn't necessarily have dessert. We had fruit, fresh fruit, dried fruit, and there was always a big bowl of nuts in the shell. Everybody got a nutcracker, and that's what you did.

**Jim Hill:** Physical activity.

**Keith Ayoob:** Oh, yeah. And I have to tell you, even my arthritic grandmother could take two walnuts, and mash them together to crack the shell. Yep. And so that was the show, but you crack nuts in the shell, you don't eat as many of them. So it's not like they're already done for you in a bag. You can eat them like candy or something.

**Holly Wyatt:** It slows you down.

**Keith Ayoob:** It slows you down. And that was the whole point because it was part of the conversation. The dinner there, there's no TV. So dinner conversation and the dinner meal lasted.

**Jim Hill:** Oh my gosh, Holly, that's an area we could totally go into.

**Holly Wyatt:** Yeah, slowing you down and talking.

**Jim Hill:** So you looked at, say, a lifestyle on Crete, that number one, you had to be physically active. You didn't go out and exercise per se. You just had to do a lot of activity in daily living. You had access to fresh fruits and vegetables and nuts and fish, and then you enjoyed it socially. So it wasn't a go and sit at your computer and eat. It was family interactions.

**Keith Ayoob:** Right. And I should say they did focus more on beans, lentils, and legumes. That was another part of the diet. So if you were changing from a typical American diet to a Mediterranean diet, it would include more beans, peas, legumes, lentils, and things like that. Because again, that's what they had.

**Holly Wyatt:** What would be less? So talk about sugar, carbohydrates, like it. In what way does it change? So we kind of know what it is. What does it not include maybe that the American diet tends to include a lot of?

**Keith Ayoob:** It doesn't include a lot of... Well, I mean, they never had a lot of processed food, so it just didn't exist. So they didn't have a lot of sweets also.

Sugar wasn't around. There was honey, but it was in limited supply because it was hard to come by. So they did have more honey, and there wasn't a lot of beef because cows don't do really well on islands. But they did have lamb. And even when they had lamb, they liked it. No question. But kill lamb and eat it, that means it's not going to be able to produce any milk or produce any wool. So you have to be very careful about sacrificing a lamb.

And that's one of the reasons it was a big deal at, say, Easter time. That was the spring lamb. That's where you had your lamb. And I'm telling you, what was also different is that they ate everything that was edible on that animal. So for things that would probably not be as valued by typical consumers nowadays, my grandfather cooked lamb heads and things like that. Why? Because there was edible meat there. And if there was edible meat, you didn't throw it away.

**Jim Hill:** So Keith, if someone comes in and says, hey, I've been concerned about my nutrition, I want to eat healthier, how do you get them started on this diet? What do you do? What's step one?

**Keith Ayoob:** Step one is first of all, to find out where they are. Because we can't know where to go unless we have a good starting point for where we are. So I take a dietary history on them and really get a good recall and ask them a lot of probing questions. If I don't see, for example, and when I finish taking their typical day eating stuff pattern, say, well, if I don't see a lot of fruits and vegetables, I'd say, okay, well, that's a gap there. If I don't see a lot of, say, low-fat or fat-free dairy foods, I'd see a gap there.

So I'd start by correcting some of the imbalances there and finding out how they would be most willing to change. So it might not be, I want to start eating more fruits and vegetables. It might be, look, I could have an ounce of nuts every day. I know I could do that. I could swap out one of my vending machine snacks and I could get a pack of nuts. So I thought, okay, we could do that.

That's a start. And then I'd look at the portion sizes of things that they were eating. Maybe they're eating good foods, but they're eating too much of them. So we really have to correct portion size and kind of educate people about inappropriate portion sizes for each of the items that they're eating in their meals.

**Holly Wyatt:** I like it that you said swap out because I think that's where some people make, I'm going to add nuts, but they don't necessarily swap something out for it. So I think that's a key, a key point is like, I'm going to give up this and instead I'm going to have the nuts.

**Keith Ayoob:** And one of the things that I often tell people is these are the things that you want to include in your diet, but include them first before you have anything else that you would, you know, get the basics done first. And while the Mediterranean diet focuses on olive oil in the diet, it's not a free-for-all license to start drowning everything in olive oil. So olive oil has got a lot of calories. It's got as many calories as any other fat. So you want to still use it sparingly and use it, Mediterranean diet plan is kind of a tool.

And I always think like any tool you can use it wisely or not. So it's, oh, yeah, you get to eat olive oil. It's a healthy fat. Well, yes, but too many calories or too many calories. And it doesn't really matter whether it comes from a healthy fat or from, you know, less healthy fat. For the purposes of weight loss, you've still got to watch intake there. Now, one area where I don't count a lot of calories in the beginning, Jim, I might not worry about calories.

I like to get somebody just used to eating more comfortably. And that's in the case of fruits and vegetables. Say, look, you know what? I'm not going to really worry about whether or not you have half an apple or two apples, okay? I want you to get more fruit and vegetables in your diet. We'll worry about quantity there later because I don't know too many people who get overweight eating fruit, you know. It's just not happening.

**Jim Hill:** Yeah. Lots of times you'll find vegetables in particular are counted as free. In other words, you're not going to get enough calories from vegetables to really overdo it very much. And the benefits probably outweigh any small effect that is.

**Keith Ayoob:** Yeah. And as long as you're not deep frying the vegetables, it's okay.

**Jim Hill:** Yeah. Right. That's another thing. It's how they're prepared.

**Keith Ayoob:** Battered and deep-fried kale chips. Probably not going to go there. And even then I look at how a person eats and if they even say things like, well, I like salads, but I don't like to make them. I say, well, look, what are you putting in your salad? And, you know, a salad can be something that's got 10 ingredients in it. And it can be also a place to start, even if they don't tend to cook a lot. It's a good place to start. Anything that they're willing to do.

**Jim Hill:** And, you know, Keith, now you can go in the grocery store and have ready-packaged salads and other kinds of things. So you don't have to spend a lot of work on it. If that's something you're not, you don't want to spend time preparing, you can buy bags of salad spread that have different things in them.

**Keith Ayoob:** Oh, yeah. And then we do that oftentimes and use it to supplement salads that we have already. Also, things like I always have canned beans in the house. And those are always great to add to salads, whether it's salads, you can augment it. Even if you're buying, say, a minestrone soup or something like that, you can add extra beans to that. You can add, you know, extra vegetables to that. So you don't have to be a chef to eat a good healthy diet. Sometimes people watch cooking shows and they get very intimidated because everything looks like it's got to be theater. It doesn't. It just needs to be dinner.

**Holly Wyatt:** So you mentioned cardiovascular health. And I do know that originally there's a lot of good data about the Mediterranean diet and some of the benefits of cardiovascular health. But can the Mediterranean diet help with weight loss? How much weight did the studies show that you can lose on the Mediterranean diet? And how does the Mediterranean diet produce the weight loss?

**Keith Ayoob:** Well, the Mediterranean diet would produce the weight loss like any other diet. At some point, you create a calorie deficit. The diffference is that it includes foods that people tend to like, that populations tend to like, that are familiar foods. And also, as Jim mentioned, you can lose weight on any diet. Honestly, people say, oh, it's so hard to lose weight.

It might be boring, but it's not hard. You have any number of diets that will help you do that. I always want to focus on how you're going to keep that weight off. And in order to keep it weight off, you've got to have a diet that you actually like.

And you can suffer through anything for three weeks, so to speak. But I want to think of, and wherever I see diet studies, I always want to say, I want to ask how long they last. Because they might, some of them last six months, that's rare. But when they ask eight to 12 weeks, I'm thinking, okay, great, but that doesn't tell me a whole lot as a practitioner. I want to see how that person's going to be doing 12 to 18 months, because 12 to 18 months is the time when boredom sets in and sort of exhaustion and all that. And if it's not a diet that includes foods you actually like, you're going to go off of it.

**Jim Hill:** I think that's such an important part. Like, we look at some of the other diets like a low-carb diet, you and I both know you can lose weight on a low-carb diet.

You can even keep it off. But part of the problem we see is people miss the carbohydrates in their diet. And it seems like one of the advantages of the Mediterranean diet is you're giving people stuff they generally like. It's not as if you're restricting greatly one macronutrient. So you never get fat or you never get carbohydrates.

**Keith Ayoob:** Right. And you know that when people say, well, I adopted a very low carbohydrate diet and I do just fine, those are more often than not people who really don't like fruit or vegetables. So they have an easy way to not have them. And great, fine, they'll lose weight and they may keep it off. But I also think of their overall health and what's that doing to their gut microbiome. What's fruit and vegetables, for example, that you aren't going to get in other food groups? And that's why those are separate food groups. I don't get into the details with people about which fruits and vegetables.

I don't really care. And I just tell them flat out, I said, you know what, I won't eat as many fruits and vegetables as you're comfortable eating, but have them every day, preferably more than once, but you pick, you choose. I actually had a patient tell me that she was working with her daughter, getting her daughter to eat more, a wider variety of foods. And she said that her daughter, wouldn't eat any other vegetables except carrots, broccoli, and tomatoes. I said, well, full stop.

She has those every day. I said, I'm fine. I said, better red, orange, and yellow, and I'm going to agree. I said, I'm good.

It's like, those have to be two or three really, really nutrient-rich vegetables. I said, you know, every day we should be fine. Eventually, she'll probably expand that. That's fine. So the issue is, what are you going to eat? And how can we make that work for you in a way that is going to not only help you lose weight but also make you healthier in the process? It's not just about losing weight.

**Holly Wyatt:** Right. Healthier and keeping it off. But I'm going to push the envelope here just a little bit. You know, so really what you're talking about is we feel like, or it sounds like, the Mediterranean diet could be adhered to longer. And it would be healthy to adhere to it longer.

And adhering to it longer, meaning eating it longer, would produce weight loss maintenance. Any data to show that the Mediterranean diet is easier to adhere to? You know, because a lot of the studies, all diet, we lose adherence to. But is there data out there for that?

**Keith Ayoob:** Well, the data ultimately, you can lose weight on the diet. I mean, studies have shown you can lose over the course of say two years or so, up to eight to nine percent of your body weight and also what I love about it is it's versatile enough that includes a wide enough variety of foods that over time it is easy enough to adhere to. Because if you don't like this particular food, you can have that particular food, but you're still eating under the umbrella of a Mediterranean diet.

The big principles there are fruits, vegetables, a modest amount of healthy fat. Get beans in there, beans, peas, legumes, and how you do that is up to you. But those are the things that you want to include. And those are things that also make you feel full. It's not just you eat salads with beans and things like that.

You're not going to be hungry right away. So over the long term, it has a tendency to produce a feeling of satisfaction. People do enjoy it. It's familiar foods, so they can go out to eat. And there are usually enough items on a menu to satisfy a Mediterranean diet.

Pretty much any Italian menu, although you have to choose wisely. Also, I should say simply prepared foods. This is where I think it's good for people when they are cooking at home or eating at home.

It's okay to make it simple. You don't have to make it bland, but you can have simple preparation, and that's probably even better. Also, it is very, very strongly aligned with U.S. dietary guidelines. And that's why the federal government has chosen, you know, the Mediterranean diet as one of the examples of how you can eat according to dietary guidelines and get your nutrient needs met, but also get healthier.

**Jim Hill:** So Keith, there's a lot of information out there. There are cookbooks, there are books explaining the Mediterranean diet, and there's stuff online. Are these things helpful? Is it easy for people to go out and find some help on how to get started and continue on the Mediterranean diet?

**Keith Ayoob:** There are tons of books about how to eat healthfully on, and I should say healthfully, yes, but keep in mind for listeners, deliciously. And that's an important point too. It's easy to eat a healthy diet, but people, if you're going to adhere to it, it's got to taste good. Okay. And so I don't want to put anybody onto an eating style that isn't delicious. So they should know that, yes, you can eat a healthy Mediterranean diet, but it can also really taste good.

**Jim Hill:** So it sounds like you have a little leeway where some diet you've got to be real strict. You eat this and nothing but this, but it sounds like on the Mediterranean diet, you do have some options around different kinds of fruits and vegetables, maybe even different kinds of fats and meats.

**Keith Ayoob:** You do, and that's one of the benefits and one of the things that makes it easier to adhere to. It also means you can overlay it on other cuisines. So you can go out and eat Japanese food, you can go out and eat Chinese food or Thai food, et cetera. And it can still adhere to a Mediterranean eating style. So people think that it's not just about eating Greek and Italian food.

You can overlay it on other cuisines. The one thing I would say that if I have a bone to pick with the Mediterranean diet, it's that it doesn't include too many low-fat and fat-free dairy foods, some, but fewer, and actually the US dietary guidelines have called this out as it might be a little low in calcium and vitamin D. And I always think that, well, the other diet that they endorsed was the dash diet, which does include two to three dairy foods per day and is really designed for lowering hypertension. But I kind of did a mash-up some time back and I, with a combination of the two, and I called it the Mediterdashian diet, although no relation to that family. So, but the idea of taking a Mediterranean diet and just including an extra serving or two of low-fat or fat-free dairy foods, because I think that would bring it into even more balance and also provide some extra satiety. People like yogurt, for example. I’m a big, big fan of Greek yogurt.

So I think those are foods that could help not only provide some extra satiety, and extra protein to help feel full, but also make up that calcium, and vitamin D gap.

**Holly Wyatt:** Yeah. So I think we have some listener questions. Are you up for answering some questions from our listeners?

**Keith Ayoob:** Oh, sure. Absolutely.

**Holly Wyatt:** All right. So our first one, I think this fits in kind of what we've been talking about. So I think it's a good time to put it in there. So this came from Johanna. She says that she tried the Mediterranean diet last year. She lost about five pounds.

She says that she loves avocados and nuts and salmon and olive oil. So she thought it was a good choice, which makes sense with that adherence piece we've been talking about. Any ideas why she was not successful? She wants to know why was she not successful. She's had other people lose a lot more weight. You talked about that. She only lost five pounds and she really wants to lose 20 pounds.

**Keith Ayoob:** Okay. Good question. And actually, it's a common one. Sounds like she found an eating style that she really enjoys and she's mentioned the foods that she likes in particular, avocados, nuts, olive oil, etc. Those are also a little high in calories. So I would say continue to love those foods, watch those portion sizes because they're good foods. And sometimes when it tastes good, you want to eat more of it. Remind yourself you are going to be eating these foods.

These are not going away. They can stay in your diet from now until forever. So keep in mind that portion size is also important. And also look at your physical activity because you and Jim, as founders of the National Weight Control Registry, looked at people who actually lose weight and also keep it off. And while they lost it in many ways, they keep it off with very similar ways and physical activity is part of it. So I would tell you, Johanna, make sure you're moving, okay, 'cause that's what those Mediterranean folks did.

**Jim Hill:** Eat a little less and move a little more. But it sounds like the diet's probably a pretty good maintenance diet that if she can cut calories for a while and add exercise back, it may be a good long-term diet.

**Keith Ayoob:** Jim, that brings up a good point. People sometimes say on, you know, they'll try a great diet like this and they'll say, but you know, my weight plateaued. I said, you know what? First of all, you've arrested the weight gain. You're not in any way anymore.

So we have arrested that. Secondly, you've also experienced what it's like to maintain a weight. That's a good thing to remind yourself of.

You know now what you're doing. And it still sometimes takes an effort even just to maintain and to prevent weight gain. So I think with Johanna, a little bit more attention to portion size and physical activity, at least portion size of those higher calorie components of the Mediterranean diet, emphasize enough fruits and vegetables as well so that even if you're eating a little bit less of the avocados and nuts, you're eating more of the fruits and vegetables. So we don't see an empty plate.

**Holly Wyatt:** I mean, I would ask, I mean, you know, I've said people before when I said, well, how many nuts are you eating? They're eating a big bag of nuts every single day and there's a lot of calories in that. And so just not being aware maybe of how much they're eating. And so if you don't reduce the calories, if you don't watch portion size, you might not lose weight. So there is a combination of these foods and these portions that really allow you to lose the weight.

But I love your comment, then maintenance, you get to loosen that up a little bit. And that may be, this may be the perfect diet because it is one that she could adhere to long-term. She just might have to restrict at the beginning a little bit.

**Keith Ayoob:** For weight loss, you do have to restrict it. I mean, there's no question about it. People say, oh, you don't. Yes, you do.

**Holly Wyatt:** Yeah, I agree.

**Keith Ayoob:** On the other hand, it's like when you look at how many calories are in a small handful of nuts, there might be 170 calories in an ounce. That's a small handful. But that's about two apples or an apple and a pear. I think, well, if you're a volume eater and you like volume, you might be worthwhile to go for the fruit. And that way it's easier to keep those nuts to a minimum. Or you know what you can also do? Nuts, it doesn't have to be a snack. You can throw them into yourself.

**Holly Wyatt:** Yeah, that's me. I'm a volume eater. So fruits and vegetables, I have to use the volume there. And then I have to be very sparing with and I choose the good fats, but very sparing with my fats because I can eat a lot of calories trying to get to that volume that my body naturally wants me to have.

**Keith Ayoob:** Oh, yeah. I understand. We were always big salad eaters in my family growing up. So, but I put everything into the salad. I mean, that's like, I'll put leftover fish or chicken or beans, corn, everything. It goes in there and it's like one big platter. So it's kind of nice, especially now that weather's getting warmer, it can be a really nice way to have a nice meal without having to put the oven on.

**Jim Hill:** So here's a question from Sarah. I like the idea of a Mediterranean diet. I like a lot of the foods that are encouraged, but my cooking skills are not great. And I find I do not have a lot of time to cook or meal plan. Any tips or tricks for people like me on how to eat this diet if you do not like to cook or follow recipes?

**Keith Ayoob:** Oh, Sarah, absolutely. This diet is made for somebody who doesn't really do a lot of cooking. And here are a couple of tips. First of all, I mentioned salads. You can buy salad greens. You can also get some of the if you're a little more selective with those salad bar options, go for the ones that aren't kind of glopped up with a lot of extra oil and fat and things like that. And go for the things like beans, vegetables that are there, and some of the more exotic ones to make it kind of fun, you know, like the blanched snap peas and the sugar peas and things like that. So those are easy to kind of accumulate into your big salad. And then I also think about keeping canned beans like I mentioned but also play with a little bit, have a few nuts on your salad, and have a little bit of Parmesan cheese. And one of my favorite things to keep in the pantry is canned salmon. So you don't have to cook. People are used to eating tuna.

They get tired of tuna. Swap it out for canned salmon and it has a couple of advantages. A, it's cheaper. It's cheaper. It also contains that healthy fish fat, so to speak, the Omega 3 fats.

And the other thing, the bonus about canned salmon that is not present in tuna is includes just naturally the salmon with the bones in it, which are edible. They're soft. They're easily mashed. Treat it like tuna. You can mix them the way you would tuna salad. You don't need mayonnaise because there's already that healthy fish, you know, the Omega 3 fish fat on oil in there. So it doesn't need extra added fat. And put that on your salad as well. So it's an option. It can be a sandwich. It can be a salad.

**Jim Hill:** So it's a good diet for people that don't spend a lot of time cooking.

**Keith Ayoob:** It's excellent. And you know, the other thing is it's also where those fat and fat-free dairy foods like Greek yogurt can come in very handy. And Greek yogurt can be sweet. You can treat it like a dessert. You can also get it unflavored and treat it like a savory food. So you can add all kinds of flavorings and spices and things like that to make it more comfortable as an accompaniment.

**Holly Wyatt:** All right, we have a big question here. This is one I know some people are thinking because we think of the Mediterranean diet. We think about red wine, right? Being allowed. But John asked, can he drink beer? He doesn't like wine. He wants to drink beer on the Mediterranean diet. What about that?

**Keith Ayoob:** You can. I mean, wine was more traditional because they didn't have beer. So, but they had a lot of wine because they grew, you know, grapes all over the place. But beer is fair game. The one advantage of wine is that it does have some anthocyanins because they were red grapes typically.

And there are some of those benefits. But I wouldn't get picky about it. The question for John, though, is, well, the recommendation is to keep it to one drink. So one bottle of beer

**Holly Wyatt:** Per day or per week?

**Keith Ayoob:** Per day. If you drink, but if you don't drink, don't pile them up. So there's no abstaining during the week and then having a field day on the week.

**Jim Hill:** But there are calories in beers. So you have to keep that in mind.

**Holly Wyatt:** John's going to be happy about this.

**Keith Ayoob:** Yeah. Well, so you can have it. You can have it every day, but it's one drink a day. Use it or lose it.

**Holly Wyatt:** All right. Wait, wait, I'm going to ask now. I like margaritas. So wait, can I have a margarita? I mean, I did not know this about the Mediterranean diet. I did not know that we could have any drink with it.

**Keith Ayoob:** But it's remind yourself that it's going to be one bottle of beer, five ounce glass of wine, which is not a lot, or in terms of distilled spirits, about an ounce and a half. So you might want to just kind of keep an eye on where the tequila's going and how much is in there.

**Jim Hill:** But one of the things is that if you tell people on these diets, you can't have any wine or beer, you know they're going to do it anyway. So you might as well recognize that if John's a beer drinker, it's unlikely he's going to go cold turkey for the rest of his life. So I think you're right on, we have to have people appreciate there are calories there, but we have to be realistic to what people value in their lives.

**Keith Ayoob:** Yeah. And it might be for in the beginning that somebody has to taper down gradually. If you're used to having three or four glasses of wine…

**Jim Hill:** You can't have a six pack every day. That's not going to work.

**Keith Ayoob:** And also let's try alternating it with a non-alcoholic analogue. So non-alcoholic ale, non-alcoholic wine, some of them are getting actually much better than they used to be.

**Holly Wyatt:** And I think margaritas have a lot of sugar and other that can have a lot of sugar and other things in them too that you need to keep in mind.

**Keith Ayoob:** Well, and sometimes at least here in New York, though, I've seen frozen margaritas that look like they're coming up bucket. I mean, these things are humongous. So, you know, that's a lot of calories.

**Jim Hill:** The last question from Beth, you've already answered. I have osteoporosis and need a lot of low-fat dairy. Can I modify the Mediterranean diet to have more dairy products? And you're saying that's actually a positive to think about adding some low-fat dairy.

**Keith Ayoob:** Yeah. I think it's, you know, they call it Greek yogurt for a reason. They made that, but they probably would have had and eaten more if they could have had access to it. So I'm a big fan of including more of those low-fat and fat-free dairy foods. I will say that's the one weakness of this diet. So get those foods back into there. And if you run a risk of osteoporosis, definitely it's a must.

**Holly Wyatt:** Yeah. So vulnerability question, I'm going to ask you this. So there's not a lot of sweets in the Mediterranean. I know there's plenty, but what do you do? I'm assuming you eat a Mediterranean diet. Is that true?

**Keith Ayoob:** I do vary, but I eat a pretty good healthy diet. But I actually grew up on this so it's easy for me. You know, we didn't have a lot of choice. There was one dinner and you ate it.

**Holly Wyatt:** But do you have a choice now? And do you kind of follow the principles? Yeah.

**Keith Ayoob:** I do because I also, because you know what, I have access to pretty much any fruit and vegetable I want, pretty much any fish I want. It's really more about the method of preparation. So I'm happy there.

**Holly Wyatt:** So when you want something sweet, when you're craving something sweet, what do you go for that would be aligned to it?

**Keith Ayoob:** I'm very glad you asked this because I, when this came out and you know, many of the studies that were done, like the PREDIMED study in Spain that was very multi-centered, et cetera, I inquired about this and really investigated because I'm a dark chocolate person. And I like serious, like 70% cocoa solids is a minimum for me.

I'm happy to go 75, 80, 85. So I said, okay, am I going to be a, you know, is this consistent? Well, it is. Chocolate's allowed. So all your chocolate lovers, my comrades, yeah, chocolate's allowed on the diet. What I would say with desserts is you just have to limit quantity and frequency. It's with the Mediterranean diet, it's not a matter of yes or no or good or bad. It's a matter of how much and how often.

**Jim Hill:** So John can have some dark chocolate with his beer. This is great. He's going to be really happy.

**Keith Ayoob:** People have paired dark chocolate with certain wines.

**Jim Hill:** Well, dark chocolate is looked at. They have some health benefits of itself. So it makes sense that it could be included.

**Keith Ayoob:** Cocoa powder in particular, which has got the fat removed from it, is where most of the benefits are.

**Jim Hill:** See, that's interesting because Holly, chocolate doesn't do it for me. The dark chocolate.

**Holly Wyatt:** Me neither.

**Keith Ayoob:** Yeah. On the other hand, Holly, if you are more of a sweet eater of like desserts and, you know, cake, cookies, pine, I tell people you have to just limit quantity. But one thing I always recommend is if they're out in a restaurant or something, share a dessert. Okay. Don't necessarily eat one by yourself. Say, look, I'll order something if you're going to have it and it'll have a taste. Sometimes a taste is good enough.

**Jim Hill:** Holly's problem is potato chips. Is that okay on the Mediterranean diet?

**Holly Wyatt:** If there are chips, I have to eat the whole bag. There is no portion control. There is no portion control with chips.

**Keith Ayoob:** For potato chips, what I'd say, then, what you need to do is get those small bags and say, okay, look, I can finish this and I'm good.

**Holly Wyatt:** Oh, but no, but I can eat two or three. However, there's no stopping.

**Keith Ayoob:** Yeah, but you got to keep the rest of them out away. So you bring only one to work.

**Jim Hill:** All right, Holly, we got to wrap it up here with pie on the plate. So let me summarize and you guys can correct me if I'm wrong. The Mediterranean diet is basically a healthy diet that includes a lot of fruits and vegetables, some healthy, monounsaturated fat, fish more than meat, not very much meat, and not a lot of sweets. And it's got some flexibility in it. So there's no one way to do it. You have some options on the different fruits and vegetables. There's a lot of material out there that helps you follow it. If you're cooking, there are recipes.

If you don't cook, there's a lot of prepared stuff. And listening to you, Keith, what I come away with Mediterranean diet is probably a good way to eat forever. You can lose weight on it. And the way you lose weight is that you eat less. But looking for a diet that you can stick with, the Mediterranean diet might be a pretty good choice. And then, last of all, don't forget the exercise. These people on Creek, they get uphill, climbing, working out all day, eating a Mediterranean diet, and getting some physical activity is a pretty good strategy.

**Keith Ayoob:** It is, and it actually can be really flavorful. And I think that's what gets people to really stay with it. It tastes good. And there are a lot of ways to make it taste good.

**Jim Hill:** Thanks, Keith. This has been great. We appreciate you spending time with us. We will talk to you next time on Weight Loss And…

**Holly Wyatt:** Thank you. Bye, guys.

**Jim Hill:** And that's a wrap for today's episode of Weight Loss And… we hope you enjoy diving into the world of weight loss with us.

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**Jim Hill:** We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

**Holly Wyatt:** And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.