Q&A with Kathy McManus, MS, RD, LDN (Brigham and Women’s Hospital, Boston)

BB (Bean Bulletin): Kathy, you’ve spent a large part of your career counseling patients and conducting research focused on reducing chronic diseases and achieving a healthy lifestyle. What drew you to the Mediterranean diet as a recommended dietary pattern for patients?

Kathy: The main thing that drew me to this diet is taste. In order to shift people from a diet approach to a lifestyle approach, we have to appeal to their senses, and the Mediterranean diet has exceptional flavor. I also love this diet because of the availability and familiarity of the ingredients, as well as ease in preparation. It has a great deal of variety, which makes it ideal for people cooking for themselves.

And of course as a dietitian, I am drawn to the wonderful health-promoting attributes of this diet.

BB: Yes, there are many studies that support the health benefits of the Mediterranean diet, especially cardiovascular. What emerging area of research do you find particularly interesting? Or is there any research in progress, or on the horizon, that you’re following closely?

Kathy: There is a lot of research ongoing right now to further explore the association with the Mediterranean diet and primary prevention of diabetes, improved cognitive function, certain cancers, depression and a long list of continued benefits in heart health and longevity research.

Some exciting emerging areas of research include the MIND Diet (a hybrid Mediterranean-Dietary Approach to Stop Hypertension), which takes two well-proven diets and focuses on the specific foods included in these diets that protect brain health. The foods emphasized include leafy greens (but all vegetables are important), nuts, berries, beans, whole grains, fish, poultry, olive oil and wine.  A study published in Alzheimer’s & Dementia followed 923 participants, 58 to 98 years old, for an average of 4.5 years. They found a reduced incidence of Alzheimer’s disease in those who followed the MIND dietary pattern.

Another recent study published in the International Journal of Cancer found that the Mediterranean diet may reduce the risk of a deadly form of breast cancer by nearly 40% in postmenopausal women. The study followed 62,573 Dutch women aged 55 to 69 over two decades, and the results suggest that adherence to the Mediterranean diet could significantly reduce the risk of women getting estrogen-receptor negative (ER-negative) breast cancer.

There is also the ongoing SUN Cohort Study out of Spain that’s examining the connection between the Mediterranean diet and depression.  A 2016 article published in Clinical Psychology Science showed that participants with the highest adherence to the Mediterranean diet saw a 50% relative risk reduction in depression risk compared to those with the lowest dietary adherence.

And you can just Google “Mediterranean diet research” and find something new every single month. The research for the multitude of benefits for this diet just continues to grow and grow.

BB: That’s exciting that there are continually more and more benefits found from this dietary pattern. Kathy, beans and other legumes are sometimes forgotten when people think of the Mediterranean diet. How do beans fit into this dietary pattern and are they a key component of the diet?

Kathy: Beans are absolutely a part of this diet, and they are a critical component. If you look at the traditional diets in the Mediterranean and diets of the Blue Zones (regions of the world with the highest concentration of centenarians), they all include beans. Beans can fit into practically every meal, snack, and side, and there are lots of ways that beans can be easily and deliciously incorporated.

I think the American palate just needs more education about how these foods can be easily incorporated. It’s more about showing delicious recipes and sharing simple ways for how beans can fit. There are so many choices in the Mediterranean diet, and we must show our patients and clients all of the delicious possibilities.

BB: So true! When you’re counseling patients, what are the main guidelines or key recommendations you share to encourage a Mediterranean diet?

Kathy: I like to start with simple but profound changes. At the base of the pyramid, it really start with eating lots of vegetables and that is sometimes challenging to translate. I really like to take patients where they are at: “Where are you starting today, and how can we build on that continuum so you can start to consume more vegetables?”

I also like to start with making sure they understand what are good fats, and to encourage regularly enjoying good sources, foods like extra virgin olive oil, nuts, seeds and olives.  Vegetables are really enhanced with extra virgin olive oil, so I like to help patients to discover that using healthy fats is not only good for health, but also adds great flavor.

Seafood is also very important. If they’re not eating fish, I recommend incorporating at least one serving of fish each week, and this can be fresh or canned. Canned tuna and sardines are very convenient, and both are sources of omega-3 fatty acids.

It’s also important to talk about whole grains, and making the switch from refined grains to whole grains.

I also try to begin a conversation about changing the way they think about meat, and this is where beans come in. Beans are a plant-based protein and something I encourage patients to regularly consume. I might recommend cooking a vegetarian meal 1-2 nights a week. This encourages more plant-based foods, and to find alternative sources of protein from something like beans.

Finally, I try to make a push to rethink the traditional refined, high sugar desserts and to enjoy fruit regularly and save desserts for a special treat.

It really boils down to helping them realize that small, simple changes are going to have great benefits, and that they will begin reaping benefits today, tomorrow and the rest of their life with this diet.

BB: That is all excellent advice. What are some ideas you share with patients or clients to incorporate beans into Mediterranean diet based meals?

Kathy: I like to go with user-friendly things and foods that are familiar to most Americans. I may start with a chili, possibly one that has turkey, and then recommend a vegetarian chili that incorporates more beans.

I also encourage that if they’re at a salad bar or making salads at home, use beans. It’s a great way to introduce beans as a plant-based protein.

I also think black bean burgers are delicious and go over quite well with families.

And of course, there are so many side dishes. A white bean marinated in olive oil with dill and cumin is something I love. It’s mild, tender and delicious!

I think it’s really important that we share doable, simple strategies to help people put the Mediterranean diet into action. I think people know and talk about the diet, but it’s sometimes difficult to translate. The more we can share simple tips and recipes, the more we’ll help people begin to follow and experience the benefits.

BB: Absolutely true! Now the final and most important question: what are some of your favorite Mediterranean diet based recipes?

Kathy: I love so many recipes from the Mediterranean! Some recipes I make often are Roasted Moroccan Vegetables (carrots and sweet potatoes) with extra virgin olive oil, cumin and Moroccan spices, with a few pecans added at the end. I also love farro with balsamic flavored mushrooms. In the spring I like to make whole wheat pasta with asparagus and cannellini beans. I’m a fan of red pepper hummus for a satisfying snack. I also make wheat berry pasta with black beans and edamame. And of course, pesto with fettuccini is a staple.

That’s really what I love about the Mediterranean Diet. There are so many ways to incorporate the ingredients and it really is delicious.

BB: Kathy, thank you for this wonderful information and your delicious recommendations.