Throughout the U.S. and the rest of the developed world, cardiovascular disease remains a leading preventable cause of death and disability. It’s certainly no coincidence that over the past several decades, global dietary patterns have been increasingly characterized by a rising intake of saturated fat, sugar and other high-calorie sweeteners, and salt. The prevalence of processed foods, combined with a shift toward sedentary habits and decreased physical activity, has contributed to a higher percentage of the labor force suffering from cardiovascular ailments that are often a result of poor nutrition.
Research has confirmed the relationship between consuming certain types of foods and heart disease, obesity, and diabetes– among other cardiovascular risk factors. The Mediterranean diet, which consists of whole grains, fish, fruits and vegetables, olive oil, and nuts, has long been associated with a lowered risk of cardiovascular disease, as well as favorable health outcomes for both individuals and communities. Promoting the benefits of this diet in an occupational setting is a highly effective way to reduce the occurrence of chronic diseases within the workforce.
The origins of the Mediterranean diet
Although the “Mediterranean diet” has been consumed for thousands of years, it was formally described for the first time by physiologist Ancel Keys in the 1960s. In his research, which spanned seven countries, Keys observed that the populations with the lowest rates of heart disease consumed a diet high in unsaturated fats, as found in olive oil and fish. After defining the relationship between serum cholesterol and the composition of dietary fat, Keys found diets high in saturated fat to be a major risk factor for cardiovascular disease. He later went on to promote the health benefits of a “reasonably low-fat diet” in which unsaturated fats were emphasized over saturated, combined with a preventative approach that has since had a tremendous influence on public health programs. In general, the Mediterranean Diet is characterized by the following guidelines:
- High intake of: fruits, vegetables, nuts and legumes, unrefined whole grains, and olive oil.
- Moderate intake of: lean protein such as fish and poultry (over red meats, which contain more saturated fats), dairy, and eggs. Moderate intake of alcohol with meals.
- Low intake of: refined carbohydrates, red and processed meat, and sugar.
Since Keys’ discovery, numerous studies have demonstrated the overall cardiovascular risk reduction brought by adhering to the Mediterranean diet, which include mitigating the risk of plaque buildup in arteries as well as the risk of developing Type 2 diabetes.
One particular study compared the Mediterranean diet with two other weight loss plans (a low-fat restricted calorie diet, and a low-carb diet with no caloric restriction) over a two-year period. Compared to the first two plans, participants who followed the Mediterranean diet showed the second-highest weight loss in the first two years, and the greatest amount of weight loss over the entire six-year period. Another study tracking the dietary habits and lifestyles of over 10,000 women found that those who followed a Mediterranean diet were 40% less likely to develop chronic diseases later in life, and also showed improved physical function and memory.
Key aspects of the Mediterranean diet
- Include vegetables in every meal. The USDA recommends getting at least 3 servings of vegetables throughout the day (one serving size ranges from ½ to 2 cups, depending on the type of vegetable). Choose vegetables in a variety of colors in order to benefit from a range of vitamins and antioxidants.
- Replace butter with plant-based oils. Olive oil, canola oil, and walnut oil are all sources of monounsaturated fats and omega-3 fatty acids, and are far healthier alternatives than butter or margarine, which are high in saturated fats.
- Choose whole grains. Replace pasta, rice, and bread with unrefined whole grains such as quinoa, barley, bulgur, and oats, which will help provide part of the 25-35 grams of fiber needed by adults on a daily basis as well as aid in digestion and lower cholesterol. And remember to check the label; even if a loaf of bread appears “brown”, it could be a result of artificial coloring instead of true whole grains.
- Cut down on red (and processed) meat. Instead, use poultry, fish, and beans as your main source of protein in order to reduce your saturated fat intake. Salmon and tuna are especially rich in omega-3s, which is a type of unsaturated fat linked with improved heart health.
- Enjoy a drink or two–in moderation. Keys himself wrote extensively of the proper wine pairings to accompany Mediterranean meals. Red wine in particular contains antioxidants that prevent the arteries from taking up “bad” LDL cholesterol; nutritionists recommend no more than one or two drinks per meal.
- Replace processed snacks with nuts. Walnuts, sunflower seeds, and almonds are great alternatives to cookies or chips in between meals, and will increase the feeling of satiation instead of leading to sugar cravings. Nonfat yogurt (especially Greek yogurt) is another alternative that packs in protein and fiber without the extra calories.
- Fresh fruit. Make sure to have at least three servings of fruit per day—not only will this ensure an adequate intake of fiber, vitamin C, and antioxidants, it can also indulge a craving for sweets and makes for an excellent dessert.
- Finally, remember to savor each bite. A critical part of the Mediterranean diet is to give yourself the time to truly enjoy the food you are eating, which also means avoiding having meals in front of the TV. Not only does this help you to practice mindfulness, it also helps you gain a better sense of hunger and fullness. Knowing when to stop eating is another valuable skill that must be learned in order to maintain healthy nutritional habits.
Improving occupational health with the Mediterranean diet
Ancel Keys and his colleagues were also responsible for introducing the idea that a preventative approach can prove extremely valuable in mitigating risk factors for cardiovascular disease on a broader level; that cultural factors, diet, and physical activity are strong indicators for the overall health of the public, not just the individual. This strategy has since become prevalent in many public health campaigns and policy, which the American Heart Association attributes directly to Keys’ research. Workplace dietary interventions favoring the Mediterranean diet have shown well-documented success, bringing workers around the world significant reductions in blood pressure, body weight, BMI, and body fat, as well as an increase in healthy eating and lifestyle.
As such, adherence to the Mediterranean diet provides a solution not only to increased rates of chronic disease in workers, but also to the significant impact healthcare costs have on employer’s bottom line. There are countless ways of promoting a healthy diet within the workplace, which can be best described in terms of two complementary approaches:
- Environmental approach: It may be difficult to encourage employees to avoid processed foods and empty calories when the vending machines are perpetually stocked with potato chips and sugary snack cakes. The availability of certain foods can have an incredibly significant impact on employee nutrition. If developing a contract with a vendor to include healthier options isn’t exactly budget-friendly, consider other opportunities. The CDC recommends offering fresh fruit and vegetables in the company cafeteria, or implementing policies that require healthier options to be served at employee events or meetings; instead of ordering pizza for a celebratory event, for example, choose an alternative takeout option, such as Greek or Indian cuisine, which is based around vegetables and proteins rather than refined carbohydrates and red meat. This is an excellent way to introduce your employees to the Mediterranean diet and help them break out of unhealthy eating habits, as well as demonstrating that healthier foods can be flavorful and delicious.
- Educational approach: Another supplemental strategy is to provide clinical nutrition counseling, the purpose of which should be to assist and empower workers to select healthy foods both at home and in the workplace. The counseling may be delivered by specialists such as dietitians or nutritionists, and include behavioral strategies such as food shopping and preparation, meal frequency, and establishing personal goals. Other on-site programs offering workshops, competitions, and additional resources can also help establish a culture of health and nutrition, which may prove particularly useful to employees with high cardiovascular risk factors. The most effective programs combine nutritional education with programs that encourage and facilitate physical activity.
It is also worth noting that in order for both environmental and educational strategies to be truly effective, the employer must make a special effort to monitor and sustain their results in the long term. One way to do this is to regularly administer health risk appraisals (HRAs): a brief employee questionnaire or survey that serves to assess individual risk factors, provide customized support, and track any improvements that have resulted from these nutritional strategies. Follow-up after nutritional counseling is crucial in order to ensure each employee is able to positively use the information provided to them.