Mediterranean diet for heart health

If you're looking for a heart-healthy eating plan, the Mediterranean diet might be right for you. It's less of a diet, which is a restricted way to eat, and more of a lifestyle.

The Mediterranean diet blends healthy eating with the traditional flavors and cooking methods of people in the Mediterranean region. The foods in the diet are familiar. Meals tend to be rich in vegetables and fruits. Fish, chicken and lean meats can be a part of the diet. Extra virgin olive oil is the main fat.

What you eat can affect your risk of some health conditions. Researchers have found evidence of this by comparing eating patterns among people around the world. A study from the 1960s found fewer people died of heart disease in some Mediterranean countries, such as Greece and Italy, than in the U.S. and northern Europe. The study linked the lower risk to what people commonly eat in Mediterranean countries, particularly extra virgin olive oil and other plant-based foods.

Since then, several more studies have linked the Mediterranean diet with lower risk factors for heart disease. For instance, people who follow a Mediterranean diet tend to be less likely to have high cholesterol and high blood pressure.

Studies also suggest that this type of diet may lower stress and inflammation in the body. As a result, it may lower the risk of diseases linked to inflammation. These include heart disease, diabetes, cancer and Alzheimer's disease.

Today, the Mediterranean diet is one of the healthy eating plans recommended by nutrition experts. The World Health Organization also recognizes it as a healthy-eating pattern.

Many cultures have eating patterns similar to the Mediterranean diet, including Japan, for example. Other diets also have some of the same recommendations as the Mediterranean diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet.

Research suggests that it's important to follow the Mediterranean diet over the long term for your heart to benefit.

The Mediterranean diet is a way of eating based on the traditional food of countries bordering the Mediterranean Sea, such as Italy, Greece, Tunisia, Turkey and Lebanon.

There's no single definition for the diet. But most often, it's high in:

• Vegetables.
• Fruits.
• Whole grains.
• Beans and other legumes.
• Nuts and seeds.
• Extra virgin olive oil.
• Herbs and spices.

The main steps to follow the diet include:

• Each day, eat vegetables, fruits, whole grains and extra virgin olive oil.
• Have fish, legumes, poultry, nuts and eggs a few times each week.
• Enjoy moderate portions of dairy products.
• Limit how much red meat you eat.
• Limit how many foods with added sugar you eat.

Some other elements of the Mediterranean diet are to:

• Share meals with family and friends.
• Get regular exercise.
• Drink small amounts of wine, if you choose to drink any alcohol.

Unsaturated fats are a strength of the Mediterranean diet. They're eaten instead of saturated and trans fats, which play a role in heart disease. Studies show replacing saturated fat with unsaturated fat lowers risk of heart disease events, such as heart attack and stroke, and death related to heart disease.

Extra virgin olive oil is the main source of unsaturated fat in the Mediterranean diet. Nuts are another source. When unsaturated fat comes from plant sources, it seems to lower levels of total cholesterol. It also seems to reduce low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol.

Seafood, seeds and nuts have healthy fats, including the polyunsaturated kind. Other sources of healthy fats include legumes, such as soy, and some vegetables, such as olives.

Fish also are a key part of the Mediterranean diet. Some healthy choices are:

• Mackerel.
• Herring.
• Sardines.
• Salmon.
• Anchovies.

These are known as fatty fish. The fats they contain are omega-3 fatty acids.

Omega-3s are unsaturated fats that may lessen inflammation. They also may help lower blood fats called triglycerides, and they affect blood clotting. Omega-3s may lower the risk of stroke and heart failure too.

The Mediterranean diet also includes shellfish, such as shrimp, crab, clams and scallops. Lean fish are included too, such as cod, haddock, hake and whitefish.

Choose fish that are low in mercury. This is especially important for children ages 1 to 11 and people who are pregnant or breastfeeding. Too much mercury can harm the brain and nervous system over time. If your family catches and eats fish, check local fish advisories to find out about any cases of mercury contamination.

Like people all over the world, some who live in the Mediterranean region drink alcohol and some do not. Many versions of the Mediterranean diet include some wine with a meal. Red wine tends to be included more often than white wine.

While following the Mediterranean diet, a glass of wine with a meal may be something you choose. If you don't drink, don't start for health reasons. For overall health, drink one or fewer drinks a day. Do not drink every day. The less you drink, the better. On days when you choose to drink, have only one glass, and drink it with a meal.

If you drink alcohol, talk to a healthcare professional about what amount, if any, is right for you.

Want to try the Mediterranean diet? These tips will help you get started:

• Eat more fruits and vegetables. Each day, aim for 2 to 3 servings of fruit and four or more servings of vegetables. One serving of fruit equals a medium piece of whole fruit or one cup of chopped fruit. One serving of vegetables equals two cups of leafy produce, one cup of raw veggies, or half a cup of cooked vegetables.
• Choose whole grains. Switch to whole-grain bread, cereal and pasta. You also can try other whole grains, such as bulgur, barley and farro. If you eat about 2,000 calories a day, aim to have at least 3 ounces of whole grains. You can get 1 ounce from a slice of bread, a cup of ready-made cereal, or half a cup of cooked rice or pasta.
• Use unsaturated fats from plants. Replacing saturated fats with unsaturated fats may help lower the risk of heart disease. For example, you could replace butter with extra virgin olive, canola, safflower or sunflower oil in cooking or at the table. And instead of putting butter or margarine on bread, you could use nut or seed spreads.
• Eat more seafood. Eat fish or shellfish at least 2 to 3 times a week. Children and people who are pregnant or breastfeeding may want to limit some types of fish due to mercury levels. One serving of fish is around 3 to 5 ounces for adults. That's about the size of a deck of cards. The U.S. Food and Drug Administration recommends smaller servings for children twice a week. Fresh or water-packed tuna, salmon, trout, mackerel and herring are healthy choices. Stay away from deep-fried fish.
• Get nuts. Each week, aim to eat four servings of raw, unsalted nuts. One serving is a quarter of a cup.
• Enjoy some dairy. Some good choices are skim or 1% milk, low-fat cottage cheese, and low-fat Greek or plain yogurt. Limit how much cheese you eat. One serving is about the size of four dice. And cut back on higher fat dairy. That includes whole and 2% milk, butter, margarine, and ice cream.
• Reduce red and processed meat. Eat more fish, poultry or beans instead. If you eat meat, make sure it's lean, and keep portions small. And before you cook it, try to remove any fat you can see.
• Keep an eye on eggs. Eggs can be a good source of nutrition. Since the yolk contains saturated fat, nutritionists suggest eating no more than four whole eggs a week.
• Spice it up. Herbs and spices boost flavor and lessen the need for salt.

The Mediterranean diet has a lot of flexibility, so you can make it a delicious and nutritious way to eat. Follow this eating pattern long-term to get the most out of it.