Mediterranean diet: A heart-healthy eating plan
The heart-healthy Mediterranean diet is a healthy eating plan based on typical foods and recipes of Mediterranean-style cooking. Here's how to adopt the Mediterranean diet.By Mayo Clinic Staff
If you're looking for a heart-healthy eating plan, the Mediterranean diet might be right for you.
The Mediterranean diet incorporates the basics of healthy eating — plus a splash of flavorful olive oil and perhaps a glass of red wine — among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.
Most healthy diets include fruits, vegetables, fish and whole grains, and limit unhealthy fats. While these parts of a healthy diet are tried-and-true, subtle variations or differences in proportions of certain foods may make a difference in your risk of heart disease.
Benefits of the Mediterranean diet
Research has shown that the traditional Mediterranean diet reduces the risk of heart disease. The diet has been associated with a lower level of oxidized low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol that's more likely to build up deposits in your arteries.
In fact, a meta-analysis of more than 1.5 million healthy adults demonstrated that following a Mediterranean diet was associated with a reduced risk of cardiovascular mortality as well as overall mortality.
The Mediterranean diet is also associated with a reduced incidence of cancer, and Parkinson's and Alzheimer's diseases. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer.
For these reasons, most if not all major scientific organizations encourage healthy adults to adapt a style of eating like that of the Mediterranean diet for prevention of major chronic diseases.
Key components of the Mediterranean diet
The Mediterranean diet emphasizes:
- Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Replacing butter with healthy fats such as olive oil and canola oil
- Using herbs and spices instead of salt to flavor foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
- Enjoying meals with family and friends
- Drinking red wine in moderation (optional)
- Getting plenty of exercise
Fruits, vegetables, nuts and grains
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The Mediterranean diet traditionally includes fruits, vegetables, pasta and rice. For example, residents of Greece eat very little red meat and average nine servings a day of antioxidant-rich fruits and vegetables.
Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet there. However, throughout the Mediterranean region, bread is eaten plain or dipped in olive oil — not eaten with butter or margarines, which contain saturated or trans fats.
Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat (approximately 80 percent of their calories come from fat), but most of the fat is not saturated. Because nuts are high in calories, they should not be eaten in large amounts — generally no more than a handful a day. Avoid candied or honey-roasted and heavily salted nuts.
The focus of the Mediterranean diet isn't on limiting total fat consumption, but rather to make wise choices about the types of fat you eat. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans fats), both of which contribute to heart disease.
The Mediterranean diet features olive oil as the primary source of fat. Olive oil provides monounsaturated fat — a type of fat that can help reduce LDL cholesterol levels when used in place of saturated or trans fats.
"Extra-virgin" and "virgin" olive oils — the least processed forms — also contain the highest levels of the protective plant compounds that provide antioxidant effects.
Monounsaturated fats and polyunsaturated fats, such as canola oil and some nuts, contain the beneficial linolenic acid (a type of omega-3 fatty acid). Omega-3 fatty acids lower triglycerides, decrease blood clotting, are associated with decreased sudden heart attack, improve the health of your blood vessels, and help moderate blood pressure.
Fatty fish — such as mackerel, lake trout, herring, sardines, albacore tuna and salmon — are rich sources of omega-3 fatty acids. Fish is eaten on a regular basis in the Mediterranean diet.
The health effects of alcohol have been debated for many years, and some doctors are reluctant to encourage alcohol consumption because of the health consequences of excessive drinking.
However, alcohol — in moderation — has been associated with a reduced risk of heart disease in some research studies.
The Mediterranean diet typically includes a moderate amount of wine. This means no more than 5 ounces (148 milliliters) of wine daily for women (or men over age 65), and no more than 10 ounces (296 milliliters) of wine daily for men under age 65.
If you're unable to limit your alcohol intake to the amounts defined above, if you have a personal or family history of alcohol abuse, or if you have heart or liver disease, refrain from drinking wine or any other alcohol.
Putting it all together
The Mediterranean diet is a delicious and healthy way to eat. Many people who switch to this style of eating say they'll never eat any other way. Here are some specific steps to get you started:
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- Eat your veggies and fruits — and switch to whole grains. An abundance and variety of plant foods should make up the majority of your meals. Strive for seven to 10 servings a day of veggies and fruits. Switch to whole-grain bread and cereal, and begin to eat more whole-grain rice and pasta products.
- Go nuts. Keep almonds, cashews, pistachios and walnuts on hand for a quick snack. Choose natural peanut butter, rather than the kind with hydrogenated fat added. Try tahini (blended sesame seeds) as a dip or spread for bread.
- Pass on the butter. Try olive or canola oil as a healthy replacement for butter or margarine. Use it in cooking. Dip bread in flavored olive oil or lightly spread it on whole-grain bread for a tasty alternative to butter. Or try tahini as a dip or spread.
- Spice it up. Herbs and spices make food tasty and are also rich in health-promoting substances. Season your meals with herbs and spices rather than salt.
- Go fish. Eat fish once or twice a week. Fresh or water-packed tuna, salmon, trout, mackerel and herring are healthy choices. Grilled fish tastes good and requires little cleanup. Avoid fried fish, unless it's sauteed in a small amount of canola oil.
- Rein in the red meat. Substitute fish and poultry for red meat. When eaten, make sure it's lean and keep portions small (about the size of a deck of cards). Also avoid sausage, bacon and other high-fat meats.
- Choose low-fat dairy. Limit higher fat dairy products such as whole or 2 percent milk, cheese and ice cream. Switch to skim milk, fat-free yogurt and low-fat cheese.
- Raise a glass to healthy eating. If it's OK with your doctor, have a glass of wine at dinner. If you don't drink alcohol, you don't need to start. Drinking purple grape juice may be an alternative to wine.
See more In-depth
- The traditional Mediterranean diet. Oldways Preservation Trust. http://www.oldwayspt.org/traditional-mediterranean-diet. Accessed Feb. 8, 2016.
- Sofi F, et al. Adherence to Mediterranean diet and health status: Meta-analysis. BMJ. 2008;337:a1344.
- Mitrou PN, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a U.S. population. Archives of Internal Medicine. 2007;167:2461.
- Monounsaturated fats. American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Monounsaturated-Fats_UCM_301460_Article.jsp#.VrkGZtjbJMw. Accessed Feb. 8, 2016.
- Zeratsky KA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 29, 2016.
- Mediterranean diet pyramid. Oldways Preservation Trust. http://oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview. Accessed Feb. 8, 2016.
- AHA Scientific Statement: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747.
- AHA Scientific Statement: Diet and lifestyle recommendations revision 2006. Circulation 2006;114:82.
- 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. http://health.gov/dietaryguidelines/2015/guidelines. Accessed Feb. 8, 2016.
- Colditz GA. Healthy diet in adults. http://www.uptodate.com/home. Accessed Feb. 8, 2016.
- Toledo E, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial: A randomized clinical trial. JAMA Internal Medicine. 2015;175:1752.
- Crous-Bou M, et al. Mediterranean diet and telomere length in Nurses' Health Study: Population based cohort study. Mediterranean diet and telomere length in Nurses' Health Study: Population based cohort study. BMJ. 2014;349:g6674.