Welcome back to the Healing Pain Podcast with Steven Masley, MD, FAHA, FACN, CNS

We are talking about potentially what is the healthiest diet on the planet. We know that nutrition and diet is a form of personalized medicine. We’re going to talk about one of the most evidence-based and proven diets that can help you with chronic disease and chronic pain. My guest is Dr. Steven Masley. He is a physician, nutritionist, trained chef, bestselling author and creator of the number one all-time health program for public television. His work has been viewed over a million times on PBS, The Discovery Channel and over 700 different media outlets. His book is entitled The Mediterranean Method.

To get started with the Mediterranean diet, I have got a great download for you. You can download this for free. It’s called The Quick Start Guide to Create Your Own Mediterranean Kitchen. To download this, all you have to do is text the word, 167download, to the number 44222 or go to IntegrativePainScienceInstitute.com/167download. I’m excited to talk to Dr. Steven Masley about The Mediterranean Method, his new book, and how the Mediterranean diet can be one of the healthiest diets on the planet. Let’s get started and let’s meet Dr. Steven Masley.

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The Healthiest Diet On The Planet With Steven Masley, MD, FAHA, FACN, CNS

Steven, welcome back to the Healing Pain Podcast. It’s great to have you here again.

I’m delighted to be with you.

I’m so excited to talk to you because we are going to go deep on the Mediterranean diet and talk about all the parts and pieces and benefits for people. I’m so excited that someone is publishing a book on the Mediterranean diet and how to do it the right way. Tell us why it was important for you to publish this book at this time.

When you look at diets, there’s so much confusing information and all these things we tell you can’t eat. One of my experiences, they’re hard to follow. A lot of people end up dropping out. Even a well-intended program by 3 to 6 months, they can’t have them anymore. If you look at what’s the easiest diet to follow and which diets have the best health benefits on the planet, by and far, US News & World Report got it right. They ranked it as the number one diet overall and the easiest diet to follow. That’s important that we give some people something that’s realistic to follow and do.

What’s so important about what you said is both in clinical practice and in studies, we need to look at things on a long-term basis. What can people do long-term? There are some studies where people go on very drastic types of diets for 2 to 3 weeks and they may see metabolic improvements as well as other improvements. This diet is the one that people can do long-term. I know this is close to home for you, isn’t it?

It is. I’ve worked in Europe. I’ve worked at as a Sailboat Captain in Southern France. I spent the last seven months sailing from Spain to Turkey. Along with coastline shopping, eating out, studying what is it about the diet in the Mediterranean. They’re different. In Spain, Greece and Italy, they eat differently but they have things in common that are central to what it’s all about that makes a huge difference for people. I had this firsthand, up close, day-after-day. It was amazing.

Next time you take a trip and you do some research on diet, especially in the Mediterranean, make sure to give me a call. To get us started with this, please tell us what is a Mediterranean diet from your perspective?

It’s this incredible variety of foods that are served in Mediterranean countries all the way from Spain, France, Italy, Greece, Turkey and North Africa. Here are the things they have in common. Greek food looks different than Italian food but what they have in common is they use lots of vegetables and fruit. It’s fresh and it’s local oftentimes. The predominant oil is olive oil. They have nuts. They serve beans if not every day, 4 or 5 times a week. They drink lots of water and then they also have a little bit of red wine for protein. They tend to eat seafood 3 to 5 times a week, much more than we do here. With some clean poultry, they don’t have a lot of red meat. They don’t eat a lot of sugar and they don’t have preservatives and chemicals in their food. It’s mostly a plant-based diet with some clean animal protein. It’s real food that you make and it’s simple. It’s not complicated recipes. They’re easy things to make.

Simple, beautifully prepared, delicious whole foods, which is a good way to start to describe the Mediterranean diet. You said a whole bunch there, which is enough that people would copy down and take that to the supermarket and then put it on their plate and live a healthier life. I want to dial down to some of these topics because they’re a little controversial. The first one you said, which has been the hot topic of 2019, at least in the nutrition circles I move in, is beans. On a traditional Mediterranean diet and on the evidence-based research that you’ve looked at, how many times a week can someone or should someone consume beans? What does a portion of beans look like? 

It’s half-cup served with vegetables as a side dish or part of the main course in soup. They’re eating them almost every day. Hummus or pureed beans in a paté that goes with something or beans in soup or being sprinkled on a salad. Lentils, red beans, white beans, there’s an endless variety of them. Some of the controversies have to do with electives. Before we talk about lectins, we should mention that all the foods that have any oxidant capacity, the ability to block oxidation, beans are number one. There’s not even a close second. It’s only which bean you could fight over which might be the best foods for blocking oxidation on the planet, which is a really important part of aging. They’re loaded with protein, B vitamins, calcium and fiber. They’re a nutritional powerhouse.

People mentioned that lectins block some of the nutrient content. Spinach does too, but we don’t say don’t eat spinach. Similarly, we shouldn’t say, “You can’t have beans.” I’ll admit that some people are lectin intolerant. I would guess for my clinical practice, it’s about 10% of people, they get more than a little bit of gas. They get real discomfort. Like any food whether it’s gluten or dairy or soy, if you’re intolerant, you should avoid it. I would say to 5% to 10% of people who have real discomfort when they eat beans, don’t eat them. The other 90% to 95% who get all those health benefits should eat them more often. That’s my take and from all the research I’ve read about lectins and beans.

We’re on the same page. If a practitioner is seeing ten patients per day, you’re maybe looking at 1 to 3 max people for where beans should be eliminated from their diet. The interesting thing that I find about beans is when you do a fruit frequency questionnaire and you dial down into beans and how much people are eating it. Sometimes their portions are huge. With that, there can be lots of different digestive complaints, there can be glycemic implications. There are lots of different things with beans. 

Let me comment on glycemic, that’s important. Generally speaking, if you add beans to any meal that has any other carbs sources, whether its bread or potatoes or other vegetables, they lower and give you better blood sugar control. For diabetics and elevated blood sugar, beans are one of the best foods to give you a slight stable rise in blood sugar for many hours. When you look at the glycemic response to beans, it’s excellent and it improves the whole overall meal for blood sugar control.

Number two on my list here is seafood. If you look at most diets and most dietary recommendations, seafoods are on there twice a week. I have done a lot of research into the study around chronic pain and diets specifically. There’s some good research building that you need 4 to 5 servings of seafood per week. Some people are a little bit fearful of that because of contamination and mercury and things like that. Tell us why increasing seafood may be an important strategy for some people to optimize their health.

If it’s cold water seafood, then it provides long-chain Omega 3s, which are inflammatory. To me, three servings a week, about a 4 or 5-ounce serving is about what you get from having a gram a day of EPA and DHA, something that clearly has been shown in studies to block inflammation. The downsides to seafood are mercury and mercury contamination. I’m prone to mercury elevation and many of my patients have been over time. I’ve measured mercury in almost all my patients when they come in for an eval. We’ve done studies on which type of fish predict your mercury level and your EPA/DHA levels. It’s the big mouth fish that’s the big culprit. That’s swordfish, shark, kingfish, tuna, tuna bean, especially Ahi tuna is a major issue. Grouper, sea bass or others, all of those big mouth predatory fish, which are popular in restaurants, impact your mercury level.

I usually say avoid that. In the Mediterranean, they eat a lot of shellfish. The Mediterranean seas have been fished out. There’s not any big mouth fish hardly left, not on a regular basis. Most people are eating middle fish like sardines, what we would call bait and a lot of shellfish. They do have some other Dorado and they have a little sea bass that’s popular. They’re delicious. Some of the chemicals come from farm-raised fish. I’m never a huge farm raised fish fan because those have higher PCP levels in them than some of the other wild-caught ones. Those are my real tips for choosing the right seafood.

On this podcast, we’re focused on chronic pain. As we think about diet and the aging population and we’re talking about seafood, for those that are suffering from cognitive decline, is increasing seafood in the diet could potentially help them with that?

I’ve published studies from my clinic showing that eating more seafood clearly improves brain processing, speed memory, overall brain performance associated with less memory loss assuming you don’t have elevated mercury levels. You have to control and measure that for people who eat lots of seafood. If you eat the right types of seafood, it’s not a problem.

Going through your book, reading it, starting to look at the recipes in it and all the science, you’re someone who looks at the evidence base. I know you have a little bit of a twist to your Mediterranean diet. Tell us what that twist is.

There are two parts to this. One is think about historically who had all the benefits from a Mediterranean diet and who was following it. They were farmers, fishermen, herders, people who were active 6, 7, 8 up to 10 hours a day. I would love to have that much activity but I don’t have the time. I’m trying to get 7, 8, to 10 hours a week. I don’t get that every day. One, we have to modify it for the glycemic load because we don’t have as much activity as we saw back in the 1950s, 1960s when this study was first studied. The other aspect is in the Epic trial, there was this big trial in Greece looking at the Mediterranean diet. They looked at which components had the biggest benefit and which had the least. It turns out the grains had the least benefit of following any part of the Mediterranean diet. To me, it’s the glycemic load.

They broke it down into this other analysis they looked at, if you follow my Mediterranean diet and you had a low-glycemic version, you’ve got far more health benefit and better blood sugar or cholesterol response, better weight loss. That’s the twist for me is a low-glycemic, low sugar load version of a Mediterranean diet. There are still lots of vegetables and fruits but the grain portions are smaller or you can cut them out. I encourage people to avoid flour because it has such a high glycemic response. Sugar would be a rare treat because sugar feeds inflammation, abnormal blood sugar control. We’re supposed to eat fresh fruit for dessert, not some sugary confection.

You give people the option to either eliminate grains or the serving size. We’re talking about whole grains, correct? 

Yes, only whole grains. Anybody who’s gluten-sensitive should have nothing to do with gluten.

The serving portion is smaller.

We’re talking a half cup of whole grain. Pasta is an appetizer in Italy. It’s not the main course. You don’t have a platter of it. You get 3, 4 tops, 5 little twirls on a fork and that’s it. Then you go on and eat your vegetables and protein for the main course.

I have a friend here in New York City. He’s of Italian descent. He’s born and raised in Italy and he has an Italian restaurant here in New York City. The restaurant’s called Etcetera Etcetera. He serves incredible gluten-free pasta that he makes in his kitchen there. His serving of pasta comes on a pretty much smaller than the palm of your hand. It’s delicious and it’s satisfying. I’m of Italian descent and I’ve eaten with my family in Italy. It warms my heart that there are people like us out there who understand how food can be beautiful and healthy and how it should be served because it’s part of your family and your culture, it’s a wonderful experience. I’m sitting down, I’m building my plate out. I have the option according to Dr. Steven Masley, to either eliminate grains or my grains can be less than half a cup, ideally whole grains, gluten-free if you have gluten intolerance or if you have celiacs. You’re also saying that beans can be there too because they help buffer the glycemic load. Lots of fruits and vegetables. Do you limit the fruit servings at all based on glycemic load?

After a meal, a cup of berries or most of the fruit do have a low-glycemic load. If you’re talking a one-cup portion, 0 to 10 is considered low and a cup of watermelon is 4 or 5. Almost all the melons are 4 or 5. An apple, pear, apricot, peach is low. Berries are usually the best. They have the lowest glycemic load and the most fiber and nutrients. Potato is the only vegetable I would limit. If people do eat potatoes, it should be the little ones with the skin on and you boil them because that gives them a lower glycemic load. Even if you refrigerate them before you eat them, it’s even lower. Mostly I tend to avoid the potatoes and greens and reds. The color is the critical part. Your plate should be beautiful and colorful and I would say at least have a two-cup portion of vegetables with lunch and dinner every day. That’s an essential part of a Mediterranean diet. They eat so many vegetables that we don’t have that quantity by any stretch.

That’s the bizarre key portion of the plate and their culture in general. They crave vegetables where we’ve taught people to crave sugar.

Animal protein portions are smaller. We’re talking 3, 4, not more than 5-ounce portions of fish or poultry. It’s not like a 12 to 16-ounce steak that you might see here. They would think that was for an entire family. It would never occur to them that was for one person.

We should talk about red meat specifically. We talked about seafood. If you’re increasing your seafood then other types of meat are going to decrease. What about red meats specifically? There’s lots of controversy around that.

Traditionally, they only eat it if a couple of times a month. It’s not part of their culture. It’s not that they’d never have it, they do, but it’s not like a daily or even a weekly event. When they do, it’s raised on a smaller farm. It’s local. It didn’t come from a feedlot where it was given hormones, pesticide, enriched grains and herbicide enriched plants. It’s not organically certified but it was organically raised on a small puddle land and it ran around and free-range and then it shows up in the market someday. It’s clean and they would have it on occasion to celebrate with. When they use red meat, it’s more of a flavoring. They might put a little bit of bacon with their green beans or something. They don’t have a huge slab. It’s quite a different use of animal protein than we do.

Almost look at it like a condiment. 

Red meat is more of a condiment. You’ll see poultry and seafood often.

Nuts and seeds can be healthy snacks for people.

It’s very common to see people eating nuts and seeds. Olives and nuts are the most common snacks you would see people eating.

Talk to us about olive oil. It’s interesting when you look at FDA regulations and recommendations that we can make regarding olive oil here in the United States versus what they can do in Europe are quite different. How many servings of olive oil should someone include in their diet on a modified or a Mediterranean diet? What are some of the benefits of that?

In the pre-med study that was this heart cognitive weight loss, different versions of looking at the study, they gave them up to a liter per week. Generally, we’re talking anywhere from 2 to 4 up to 6 tablespoons of olive oil per person per day. I tend to think of about a tablespoon per person per meal is a portion that I would use in my recipes. They don’t cook with it at high heat. You’re using medium-low heat because if high heat, that oil gets damaged and you lose some of the beneficial properties. It turns bitter as well, so it doesn’t taste as good. Important to use low heat cooking with olive oil. If you’re going to do high heat cooking, you should use a different oil like avocado oil, almond oil or something else.

Two tablespoons of olive oil at a sitting, at your meal.

On your salad, there’s going to be a tablespoon of olive oil per person and maybe a teaspoon of vinegar. A table of olive oil drizzled over your vegetables and better being served with the same meal.

How do you respond to people with regards to lots of oils but olive oil specifically is the one that we’re talking about when they say, “That’s still processed food. If you have heart disease, you shouldn’t have any type of processed oil. If you’d like to eat a whole olive, that’s okay, but not olive oil.”

It doesn’t match the facts. When you look at what’s been published and randomized clinical trials, olive oil improves your cholesterol profile, blood sugar, blood pressure, decreases your cancer risk, lowers inflammation and has been shown to reduce your risk for heart attacks and strokes. In people following an American Heart Association Diet or a Mediterranean diet where they added extra olive oil, it lowered their rate of heart attacks and strokes. It improves their cognitive performance and it helped them lose weight. That’s what’s proven. I can’t help what people say and share. It’s hard to discredit olive oil. To me, if you squeeze it once and the oil comes out of the olive, that’s extra virgin. If you have to use heat and chemicals to get it out, that would be regular olive oil. That is processed. I do ask people to avoid what I call processed olive oil, which was something beyond mechanical pressing it. If you’re putting chemicals in it to pull out more oil, you’ve gone over the top.

Steven, you and I are out to dinner. We’re sitting down, we’re having this wonderful, beautiful Mediterranean meal. I’ve got two cups of vegetables. I’ve got some berries sprinkled on there. I’ve got some gluten-free grains. There are some beans on the salad as well. I’m having a nice piece of cold-water fish. I love fish and seafood. I eat it up to five times a week. Do I get to order wine if we’re eating together?

Yes. It should be red wine. Red wine has more medicinal benefits than white wine. Beer and hard liquor don’t have any medicinal benefits. I would say they’re more harmful than beneficial. The only alcohol I can recommend to people is red wine. The first thing we do when we sit down at that table is they’re going to give us a bottle of water. The only question is sparkling or flat. We’re going to have a bottle of water and then we’re going to get a glass or two of red wine. It’s not like we each get a bottle of red wine and we get to drink it. That’s overdoing it. The wine part does have to be in moderation than the benefit.

How big is a glass in those times?

Four and a half ounces per serving or five servings per 750 mil bottles. That’s 150 mils.

Some of our wineglasses nowadays, you can pour a whole bottle in the glass. I’ve seen people do that. 

Instead of a glass, I should say a serving and specify what a serving is.

Talk to us about dairy. There are lots of intolerances out there and people are aware of these intolerances. They may or may not show up with trying out a Mediterranean diet.

Europeans and Mediterranean use dairy on a regular basis. It’s mostly a garnish. They sprinkled a little crumbled on there. They’re not large portions and they’re using minimally processed heavily probiotic-rich dairy products like Kefir or plain yogurt. When you buy yogurt in Europe, it’s mostly plain. In the US, the yogurt section is 30 feet long and it’s twenty brands with different sugar and fruit added to them, flavorings and processed stuff. I always ask my patients which has more sugar in it, yogurt with fruit or ice cream? They look at me like, “This is a trick question.” They knew it because I’m asking them. Its yogurt. It should be plain, no sugar added or skip it.

The type of dairy they eat is they don’t drink milk. They don’t put much milk in their coffee. When they use dairy, it’s either Kefir which is very probiotic-rich, plain yogurt or a little cheese grated on a dish. It’s Camembert or blue or it’s probiotic-rich. If you’re dairy intolerant then avoid it. Don’t eat dairy if it bothers you. Some people will give them all sorts of symptoms and joint aches and mucus. I would say, most people are not probiotic, dairy intolerant. They can eat plain yogurt. They can eat a little bit of garnish cheese on a dish like blue cheese or something. It’s not going to bother them and it’s nutrient-rich. That’s how it’s used in Europe. Very different than when we put these huge slabs or serve lasagna with pounds of cheese in it. They don’t do that. There’s quite a contrast in how they use dairy and how we use dairy.

They don’t have fluorescent yellow cheese either. Somehow, we have fluorescent yellow cheese in America. Whenever I counsel people on nutrition and we’re talking about the dairy aspect, the first thing they say is, “What am I going to use in my coffee? I use milk in my coffee.” If you think of the Mediterranean diet, I love visiting Spain because in Spain they have something called a Cortado, which is a single shot of espresso with a little bit of steam milk on top. It’s delicious. It gives you the caffeine fix but you’re not eating or drinking eighteen ounces of processed dairy, which can be harmful to some people. Steven, how many books have you written now on nutrition? 

This is my seventh book now.

Congratulations.

This is the first one where they put in pictures. The pictures came out nice. I was like, “These are awesome pictures.” They’re my favorite Mediterranean recipes and some photos to go with it.

Tell us what you hope will happen with this seventh book on the Mediterranean diet versus the six before it.

We could have a large-scale conversion here. Right now, we have a very small percent of the population following the Mediterranean diet. We know that regardless of your genetics or ethnicity health situation, we know if you add a Mediterranean diet, you’re going to decrease your risk for heart disease, for memory loss. It helps you lose weight. You feel better, it’s delicious food and it’s easy to follow. This is a chance to transform the health of America now. The closer we follow a Mediterranean diet, the better our health is going to be. We’re at a tipping point where so much of our food supply is processed and chemicals. Not the things that you would promote. I know I follow bunched and followed it for years. This is a realistic eating plan people could follow. I hope to spread the word and make it easy for people to eat healthy food, love it, delicious and stick with it long-term.

Talking or thinking about dietary recommendations as we head into 2020, there should be new USDA Dietary recommendations coming out. The current ones at times mimic a Mediterranean diet, but have never arrived there. Do you think we’ll see them move closer toward it? What should someone be cognizant of with our current USDA?

Remember, USDA food pyramid is designed to market US food products. It’s not designed to promote health. That’s the disconnect. People think this is what we’re supposed to recommend. No, they’re out-marketing US farmer products. They’re marketing things like sugar, sodas and grains that we produce as an economy. They’re boosting GNP and destroying the health of Americans at the same time. I have my own food pyramid in here and the grains are not at the bottom of it. It’s fruit and vegetables. The bottom of the pyramid for me is the lifestyle that goes with it. It’s the activity, the cooking, being active, being outdoors with nature and communicating being with other people. Especially over food, not eating in front of a computer, television or smartphone. It’s connecting with people over food. That’s the essential lifestyle part. To me, that’s the base of what the new food pyramid should be. I don’t expect the US food pyramid to get it. I’m not waiting for a change from them.

A little change will happen but we can keep our toes, fingers and ear lobes crossed for that. It’s interesting as you mentioned as the GDP is going up, people’s health is going down. Why they don’t see that inverse relationship and look across the pond and see all these countries that are eating this diet and quite frankly have a longer life expectancy. We’re looking at populations of people now in America that will have shorter life expectancies than potentially we have.

They don’t live 5, 6, 7 years longer. Their health span where they’re independent and active is more than a decade longer. The biggest difference isn’t how long they live, but how long they live well vibrantly. They’ve got more than a decade on us.

I have parents that are getting older and we have the Baby Boomers are the fastest-growing segment of our population. Talk to us about that. Let’s say what those last two months should look like in life versus potentially with some of the last 10 to 20 years look like for people.

In our ’90s, we should still be active in working part-time because we need something to do. We’re not disabled, we’re not in pain. We feel good each day. Do we have some health issues at 95? Probably, but not that it keeps us from going to the market, shopping, coming home, cooking food and having a joyous evening with family and working still. There’s nothing to stop any of that except for ourselves.

Holidays have passed and people may be looking back and saying, “My diet is not good. I over-indulge, I ate too much.” What can someone start to do to shift toward your Mediterranean diet?

I would look at some of the recipes in here. I’ve made it simple. I’ve got a special offer for your list. If they pre-ordered the book or buy it in the first month that’s out, I have cooking classes to give them to make it easier to follow some of these recipes. What are the tips that you can get? I’ll send you a link that you could put up and they can get my cooking classes to go with the book. That would be so helpful to what are the key points when you’re preparing food that you follow these steps. It makes it easier to cook, more delicious, more nutritious, and your family and friends will love it. That’s what I would like to offer. Some little tips and tricks that make it simpler to prepare meals. That’s something I got from traveling the Mediterranean. Don’t make it over complicated. Don’t add too many ingredients. Simple can be better when it comes to good quality food.

Five simple, delicious, healthy ingredients can make a wonderful meal. 

It doesn’t have to be hard.

What I love about your approach is you’re a physician. You’re bringing a medical approach to this with you being a nutritionist. You’re also a chef. It’s a wonderful combination of all three that always winds up in your books. Can you tell us a healthy dessert that we might find in that book of yours back there? People want to feed their sweet tooth at times, which is understandable, but something that can be healthy and not damage that glycemic response.

There are a few choices. The simplest thing we would get often would be fruit. It’s either berries or melon or something and they might put it in a glass and then they pour a little sweet wine on it, a couple of tablespoons and a little bit of mint. It takes you two minutes to prepare that. It’s so easy. Dark chocolate is very popular in the Mediterranean and they’ll frequently have dark chocolate at least 75%, preferably 80% cocoa, not milk chocolate. They’ll have that for dessert. I even have a blueberry ricotta cheesecake in here. It’s an Italian version with plain ricotta, orange rind and blueberries. That’s a huge variety of things you can make that are for dessert that is still flavorful and healthy.

I recommend everyone to check out Dr. Masley’s book, The Mediterranean Method. Steven, tell everyone how they can learn more about you, about the book and all the great things you have to offer.

They can go to my website, DrMasley.com. I’ve got a blog and pre-recipes. I have a variety of information there that I’m happy to share with people that are free to help them transform their health.

Make sure to check out www.DrMasley.com. Make sure to download his free cooking tips. Check out his book, The Mediterranean Diet. A modified Mediterranean diet is the diet that I recommend for people. Most of the time, we have chronic pain, so make sure to check it out and check out his book. I want to thank Dr. Masley for being on the Healing Pain Podcast. Once again, we appreciate his time and work. We’ll see you all next week.

Important Links:

• The Mediterranean Method
• https://integrativepainscienceinstitute.com/167download/
• www.DrMasley.com
• https://www.Facebook.com/stevenmasleyMD
  https://DrMasley.com/mediterranean-method-book-order/

About Steven Masley

Steven Masley, MD is a physician, nutritionist, trained-chef, best-selling author, and the creator of the #1 all-time health program for public television.

His work has been viewed by millions on PBS, the Discovery Channel, and over 700 media interviews. His latest book is titled: The Mediterranean Method.