What Healthy People Do

The “Mediterranean Diet” is widely, and scientifically, associated with excellent health. But dunking your bread in olive oil before eating a humongous plate of double-sausage, double-cheese lasagna is not a Mediterranean Diet.

The idea for the Mediterranean Diet started with the Seven Countries Study. In the 1950s, Dr. Ancel Keys traveled the world looking for populations that had varying risks of heart disease and then studied their diets, exercise habits, and cholesterol levels.

Crete was among the countries with the best health, greatest longevity, and best risk markers. So, when you think Mediterranean Diet, think of the diet eaten on the island of Crete some 60 years ago. Fish, olives, whole grains, fruits and vegetables from the garden. Not too much, eaten preferably with family and friends, and certainly without a television blaring in the background.

The best diet markers of excellent health in the 100,000 strong Nurses’ Health Study and the 100,000 strong Physicians Health Study help us identify a modern “Mediterranean Diet."

So when I say, “Eat a Mediterranean Diet,” I mean you should eat:

1. At least five colorful fruits and vegetables every day. OJ for breakfast and berries on your cereal, a salad at lunch is usually two, an apple for snack, veggie with dinner is six. Have a piece of blueberry pie for dessert and you are at seven—just eat the berries and leave the crust.
   
   
2. One or two whole grains every day. Oatmeal, wheaties, shredded wheat, Cherrios, whole wheat bread for your sandwich, quinoa for dinner.
   
   
3. Nuts. Yes nuts. A handful or two every day. Lowers heart disease by 30 percent.
   
   
4. Ocean fish a couple of times a week. Salmon, tuna, sardines. Tilapia and cat fish just don’t have much omega-3.
   
   
5. Use olive and canola oil and avoid saturated fats (e.g., the white fat on a steak). The healthiest diets get about a third of their calories from fat. (Stay tuned, I’ll blog about the evils of the low fat diets soon.)
   
   
6. And some, but not too much, alcohol. This means a glass of wine or two.

A Mediterranean Diet does not require perfection. In my opinion (not scientifically studied that I know of), the best diet includes the above foods because their provide a marvelous package of health-promoting nutrients. And once you eat all the good stuff, you can indulge moderately without much guilt.

Stay well.

Dr. Bob

Over the last week or so, I've given you links to some good health-assessment Web sites. Now I'm going to share with you where your numbers should be. It's important to know your numbers.

You know how much money is in your checking account, don’t you? Your savings account? Your 401K ? Your mortgage? Your net worth (total assets minus total liabilities)?

Knowing your health numbers is a lot like knowing your financial numbers. Both are important.

Great health is pretty simple. Don’t smoke; don’t be fat; eat a diet of lots of fruits and veggies with good proteins, good carbs, and good fats; and be active all day long.

Sometimes people who do all of these good and healthful things, yet still have funky blood pressure or lipids. Then it is time for medical therapy because maintaining good health numbers can keep you healthy for a long time.

I am not trying to give everyone a medical diagnosis to perpetuate the medical-industrial complex. I am trying to define optimal health. So here are your target health numbers for great health, even if you do everything else right.

1. Your body mass index should be between 20 and 27.9. If your BMI is above 35 or even near 40, your weight carries the same risk as smoking a pack of cigarettes a day.
   
   
2. Your blood pressure should be near 120/80. If it is 130/85, you should start to think about adopting a healthier diet and exercise plan (more exercise, less alcohol, less salt, less prepared, frozen or fast food), and if above 140/90, it is time to consider seeing your primary care provider for some medical treatment.
   
   
3. Your fasting blood sugar should be below 100. Diabetes starts at 125 and prediabetes is the area between 100 and 125. Trust me, you don’t want to be diabetic. Next week I’ll blog about what you should do if you are prediabetic.
   
   
4. Your total cholesterol should be below 200.
   
   
5. Your HDL cholesterol should be above 40 if you are a man and above 50 if you are a women. No exceptions here — low HDLs are a huge marker of increased cardiac risk.
   
   
6. Your LDL cholesterol should vary by your risk. Go to heartdecision.org to get your cardiac risk scores. If you are low risk, then your LDL goal is less than 160; if moderate risk, your goal is less than 130; if high risk, your goal is less than 100; and if very high risk, your goal is less than 70.
   
   
7. Your triglycerides should be less than 150 by national guidelines. I think this number is way too high and would like them to be below 100.

So by now, you probably want to know where I keep my own numbers; do I live up to my own standards? Well, I try (aside from eating ice cream out the carton). I have a BMI of 24.5, a BP around 120/80 on medication for the past 25 years; a fasting blood sugar of 88; and on low dose statin, a total cholesterol of 180, an HDL of 55, an LDL of 113, and triglycerides of 60.

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The following is feedback received for this blog: Dr. Bob -- Thanks for writing these articles -- very helpful to someone like me trying to keep healthy. I just got my blood numbers back and I'm very frustrated. I try to do what you say with eating and exercise, yet my total cholesterol is still high. I have a total of 211, but my LDL is 124 and my HDL is 69. Can HDL be too high? Is my high HDL, which I thought was a good thing, making my total too high? BTW, my BMI is about 25 and I'm otherwise healthy. - Don

How long are you going to live? Calculate your life expectancy at this site from Northwestern Mutual. If you don’t like the answers, you can change them as you go and watch your health improve.

In the interest of full disclosure, I need to tell you that for the last 25 years, I was the physician-owner of this site at Northwestern Mutual.
 
Next week, I'll tell you where I think your numbers should be ... and I'll share with you my numbers.

Cool site #3: What is your 10-year risk of a heart attack?

Go to heartdecision.org to assess your future risk of a heart attack. In the bottom row, click yes on “Display CHD + Angina Algorithm."

This results can be a bit confusing because the authors tried to combine the criteria of both the Framingham Risk Score and the National Cholesterol Education Program Adult Treatment Panel III on one chart. But you can take the results as accurate. A new version is due out soon to clarify the confusing results.