Appointments

866.320.4573

Request an Appointment

Questions

800.223.2273

Contact us with Questions

Expand Content

Mediterranean Diet

Ask the Dietitian: Mediterranean Diet

Q: I have just been diagnosed with hyperlipidemia. Before putting me on any medication, my doctor recommended that I try to make changes in my lifestyle in hopes that I can reduce my cholesterol on my own. My nurse told me that the Mediterranean way of eating can help reduce cholesterol. What is the Mediterranean diet and how can I incorporate it into my busy lifestyle?

A: Your nurse was on the right track. Increasing scientific evidence indicates that positive health effects, such as cholesterol reduction, results from diets rich in fruits, vegetables, legumes and whole grains and that include fish, nuts and low-fat dairy. Such diets also emphasize the use of vegetables oils rich in monounsaturated fats and low in saturated fats and void of products that contain hydrogenated and partially hydrogenated vegetable oils. These dietary patterns exemplify the traditional Mediterranean diet.

What is the Mediterranean diet?

The traditional Mediterranean diet refers to the dietary patterns typical in the early 1960's of some Mediterranean regions, including Crete and other parts of Greece and Southern Italy. The reason these dietary patterns are singled out are because the adult life expectancy of these areas were among the highest in the world; with rates of coronary heart disease among the lowest in the world during that time.

The Mediterranean diet is a centuries-old tradition that contributes to good health, provides a sense of well-being and pleasure and forms a vital part of the cultural heritage of these regions. These same practices can be adopted in our homes to enhance our well being and overall risk of heart disease and other chronic disease states.

The Mediterranean diet emphasizes the following:

  • An abundance of food from plant sources. These include vegetables, fruits, breads, potatoes, cereals and grains, nuts, beans and seeds. Whole grain instead of enriched sources of breads and cereals are preferred.
  • Minimally processed foods and whenever possible, seasonally fresh produce. Purchasing seasonally fresh produce maximizes retention of heart-disease fighting nutrients.
  • Fresh fruit as typical daily dessert with foods containing refined sugars and saturated fats eaten only occasionally.
  • Olive oil as the primary source of fat instead of butter and other undesirable fats. Olive oil is rich in monounsaturated fats, and when substituted for saturated fats, can reduce the bad (LDL) cholesterol.
  • Total daily fat intake ranging from 25% to 35% of total calories ingested, with saturated fat no more than 7% of calories.
  • Dairy products (primarily yogurt and cheese) consumed daily in moderate amounts (low and nonfat versions preferred).
  • Fish and poultry consumed in low to moderate amounts. Recent research suggests that consumption of fish is favored over poultry because of heart-protective fatty acids present in most fish. Aim for 6 ounces of fish each week.
  • Red meat consumed in very low amounts (a few times per month). Whenever possible, lean meats preferred.
  • No more than four whole eggs (egg yolks) consumed per week.
  • Wine consumed in low to moderate amounts, normally with meals. This equates to two 3 ½ oz glasses of wine for men, one 3 ½ oz glass for women.
  • An added benefit to the diet of these Mediterranean regions - regular physical activity at a level that promotes a healthy weight and physical fitness.

So, how can you start incorporating these dietary patterns into your already-too-busy lifestyle?

Try some of the following tips:

  • Replace vegetable cooking oil or animal fats with olive or canola oil. Both oils are rich sources of cholesterol-lowering monounsaturated fat.
  • Choose rolled oats, barley, buckwheat or other whole grain cereal for breakfast.
  • Substitute refined or white flour products with unrefined whole grain products.
  • Have a bean and vegetable based soup for lunch instead of your usual routine.
  • Add dried beans to your favorite casserole or dish, or use to replace your usual meat entrée at dinner.
  • Round up seasonal fruits and vegetables to have available for a snack during your break or lunch hour.
  • Enjoy fresh berries alone or with nonfat yogurt for dessert.
  • Aim to have no more than 1 red meat meal per week, 2 poultry dishes and 2 or more fish entrees each week. Have plant-based meals on other days.
  • Substitute egg substitutes or egg whites for whole eggs at breakfast and when preparing baked goods.
  • Add 2 Tablespoons of your favorite nut to hot or cold cereal, stir-fry, salad, yogurt, pasta or rice dish or trail mix.
  • Go for a brisk, 20–30 minute walk most days of the week.

Incorporating the Mediterranean style of eating into your lifestyle will provide you with new and exciting tastes, textures and foods. Try this quick recipe, chock-full of heart-healthy nutrients.

Spinach and Rice

Makes 6, ½ cup servings

Ingredients:

  • 2 pounds fresh spinach, rinsed and drained
  • ¼ cup olive oil
  • 2 medium white onions
  • 2 small garlic cloves
  • 1 cup long grain white or brown rice
  • 2 tablespoons tomato paste
  • 2 bay leaves
  • 2 cups chicken stock (low-sodium preferred)
  • salt and pepper to taste
  1. In a large saucepan heat olive oil over medium-high heat. Add onions, garlic and rice. Saute until onions are translucent. Stir in tomato paste and then add spinach, bay leaves, salt and pepper. Mix well.
  2. Pour in chicken stock and cover saucepan. Simmer on medium heat until rice is tender and liquid is absorbed. Remove bay leaves and serve.

For more information on a heart-healthy diet plan, please contact the Preventive Cardiology and Rehabilitation Program at 216.444.9353 and we can schedule a nutrition consultation.

Mediterranean Diet Pyramid Gets a Facelift

Those who follow the Mediterranean way of eating may have noticed that the Mediterranean Diet Pyramid, which characterizes the principle diet and lifestyle practices of regions bordering the Mediterranean Sea, has had a facelift. The original pyramid, created by Oldways Preservation Trust (www.oldwayspt.org/) in 1993, has not changed much in principle: it was already based on solid scientific evidence linking diets of those in the Mediterranean region to good health, in particular heart health. The newly revised Pyramid is a result of the review of hundreds of nutrition studies conducted over the past 15 years by an international group of leading nutrition and health experts.

Although the foundation of a Mediterranean way of eating hasn’t changed, there are three principle changes that have been made to the pyramid:

  1. All plant foods are placed at the base of the pyramid. This includes fruits, vegetables, legumes, nuts, seeds, olives, olive oil and whole grains. These are at the base of the pyramid to signify that these foods should be the basis every meal.
  2. The frequency of consuming fish and shellfish was increased to at least two meals per week. This is a result of the growing body of research linking its consumption to brain and reproductive organ health.
  3. Herbs and spices have been added to reflect the growing body of evidence linking their consumption to health benefits.

The Mediterranean Diet Pyramid can be found on the Oldways Preservation Trust website, http://www.oldwayspt.org/. Due to licensing issues, we cannot post it on this website.

Below are some highlights of the Pyramid, and what you should be eating.

Base of Pyramid: Daily Physical Activity and Enjoying Meals with Others

One key message in the Mediterranean Diet Pyramid is to engage in daily physical activity for good health. This includes planned activities like running, aerobics and swimming. More importantly is the focus on being physically active in daily living: such as doing yard work, going for a short walk, parking the car further away from a destination, and taking the stairs instead of the elevator.

In addition, the base of the Pyramid supports using foods as a means to pleasure and enjoyment. Eating and drinking in the company of others, savoring meals slowly, and sitting down at a meal can help achieve this.

Fruits, Vegetables, Grains, Olive Oil, Beans, Nuts, Legumes, Seeds, Herbs and Spices

Including the above list of foods is central to a healthy diet, and that is why all of these foods fall in the same category, completing the base of the Mediterranean Diet Pyramid. These plant-based foods should be enjoyed at each and every meal, as research shows they promote heart health, overall health, and weight control.

Fruits

Fresh fruits are abundant in the Mediterranean diet. Whole fruit is preferred over fruit juice to retain health-promoting dietary fiber, although 100% fruit juice can be consumed in moderation. Enjoying fresh fruit after a meal is a terrific substitute for high-fat desserts.

Try These: Figs, pomegranates, apricots, melons, apples, pears, lemons, and grapes.

Vegetables

Vegetables should form the foundation of most meals. Eating a variety of colorful vegetables, like dark leafy greens, vibrant reds, yellows and deep purple, is a sure-fire way to reap the array of nutrients and antioxidants these plant foods offer. Enjoy steamed, stir-fried, grilled, roasted or raw.

Try These: Artichokes, dandelion greens, tomatoes, cucumbers, zucchini, eggplant, cabbage, and leeks.

Grains

By making at least half of your grain choices whole grain, you’ll enjoy the health benefits of dietary fiber and a host of disease-fighting nutrients. Choose a variety of whole grains each day, from sources like oats, wheat, rice, corn, and rye.

Try These: Barley, whole wheat couscous, whole wheat pasta, crunchy whole grain bread.

Nuts and Seeds

These foods may be more calorie dense than their plant-food counterparts, but they pack a lot of nutrition in every bite. Nuts and seeds are an excellent source of healthy unsaturated fats, and pack ample protein, dietary fiber, and zinc. Just remember to enjoy them in small quantities, as a little goes a long way.

Try These: almonds, hazelnuts, pine nuts, walnuts, and chestnuts.

Legumes

Beans are high in antioxidant nutrients, dietary fiber, and plant protein. Enjoy as the basis of meatless main dishes and you won’t miss the animal protein.

Try These: lentils, broad beans, kidney, fava, chickpeas, and yellow split peas.

Herbs and Spices

The newest addition to the Med pyramid, herbs and spices are an excellent substitute for blood pressure-raising sodium, with the added benefit of adding flavor and aroma to dishes. What’s more, herbs and spices are chock full of antioxidants– key players when it comes to improving your heart health.

Try These: Oregano, fennel, parsley, basil, dill, mint and sage.

Olives and Olive Oil

Like nuts and seeds, olives and olive oil are calorie dense, but play a central role in Mediterranean cuisines. Enjoy olives whole or chopped in spreads, dishes and sauces; and enjoy olive oil in cooking, baking, marinades, and to dress vegetables.

Try These: Kalamata olives, Nicoise olives, extra virgin olive oil.

One Level Up: Fish and Seafood

An ever-growing body of research links fish consumption (an excellent source of essential fatty acids called Omega-3) to improved cardiovascular health and brain development and lower risk of chronic disease. What’s more, when compared to beef, fish is a healthier lower-saturated fat protein source. Enjoy in at least two meals per week.

Try These: Salmon, sardines, herring, mackerel, and tuna.

Next Level: Poultry and Eggs, Yogurt and Cheese

Unlike the typical Western diet, poultry, eggs, yogurt and cheese are enjoyed less frequently throughout the week. Poultry and eggs are a good source of protein, and can be consumed a few times per week. Be sure to remove skin from poultry and choose the white meat to reduce intake of saturated fat. If you have high cholesterol, consider limiting egg consumption to a few whole eggs per week. Dairy foods are consumed in moderate portions daily or weekly; be sure to choose 1% or nonfat milk, lowfat or nonfat yogurt. Good quality cheese should be limited to a few small portions per week.

Top of Pyramid: Beef and Sweets

Because beef is not as readily available in Mediterranean regions as it is in the United States, it is consumed sparingly. Because of it’s higher saturated fat content, beef should be limited, portion sizes controlled, and lean cuts chosen. Where dessert is concerned, its high sugar and fat content (and little to no nutrient value) relegates it to the “less often” recommendation for consumption. Fresh fruits are great tasting, lower in calories and have a much better nutrient profile.

Water and Wine

The Mediterranean Diet Pyramid also highlights the importance of proper hydration to good health. Drinking calorie-free water throughout the day is key to good health.

Wine is regularly consumed in Mediterranean regions – in moderate amounts. It is generally recommended that women consume no more than one five-ounce serving, and men two five-ounce servings of wine on a daily basis. Always check with your physician before incorporating alcohol into your daily eating routine. Certain health conditions, including if you are trying to lose excess weight, preclude the consumption of wine on a regular basis.


It is important to point out that the Mediterranean Diet Pyramid’s guidelines are based on the diet and lifestyle practices of areas such as Crete, Greece and Southern Italy in the 1960's. Research from that time-frame indicated people in these areas had the lowest rates of chronic disease in the world, and life expectancy was of the highest at that time. This is pointed out because some people in these same Mediterranean regions today follow a more Westernized diet that includes more convenience and fast foods and have swayed from traditional practices.

Written by Melissa Ohlson, M.S, R.D., L.D., Preventive Cardiology and Rehabilitation.

What is the Mediterranean diet?

The traditional Mediterranean diet refers to the dietary patterns typical in the early 1960’s of some Mediterranean regions, including Crete and other parts of Greece and Southern Italy. These dietary patterns were singled out because the adult life expectancy in these areas was among the highest in the world and rates of coronary heart disease were among the lowest in the world during that time.

What kinds of foods are included in the Mediterranean diet?

The Mediterranean diet emphasizes an abundance of foods from plant-based sources. It is a diet rich in fruits, vegetables, legumes and whole grains, fish, nuts and low-fat dairy. This type of diet is proven to have positive health effects, such as cholesterol reduction. Vegetable oils rich in monounsaturated fats and low in saturated fats, which can also have positive effects on your health, are also included in the Mediterranean diet.

The key components of the Mediterranean diet, along with ways to incorporate them into the diet, are outlined in the chart that follows:

Key Component Ways to Incorporate
Generous amount of fruit and vegetables
  • Enjoy fresh berries for dessert.
  • Pack seasonal fruits and vegetables for snacks.
  • Include at least one serving of vegetables or fruit with each meal.
Potatoes and whole-grain breads and cereals
  • Choose rolled oats, barley, buckwheat or other whole-grain cereals for breakfast.
  • Have couscous, barley, brown rice or a potato with the skin as your dinner starch.
  • Substitute refined or white flour products with unrefined whole-grain products.
Dried beans
  • Have a bean and vegetable-based soup for lunch instead of your usual meal.
  • Add canned or dried beans to your favorite dish, or use them to replace a meat entree at dinner.
Nuts and seeds
  • Add nuts to hot or cold cereal, stir-fry dishes, salad, yogurt, pasta, rice or trail mix
  • Enjoy up to an ounce of nuts each day — they make a great mid-day snack.
Minimally processed foods
  • Choose seasonally fresh produce or frozen produce, which has plenty of heart-disease fighting nutrients.
Olive oil as primary source of fat
  • Replace vegetable cooking oil or animal fats with olive or canola oil. Both oils are rich sources of cholesterol-lowering monounsaturated fat.
Moderate consumption of dairy products (choose low-fat or nonfat)
  • Have skim milk with cereal in the morning.
  • Enjoy nonfat yogurt for dessert.
At least a total of 6 ounces of fish or shellfish at least twice a week
  • Enjoy fish in at least 2 meals each week. Try salmon, sardines, herring, mackerel and tuna.
Very low consumption of red meat (choose lean cuts)
  • Limit your red meat intake to one meal per week; limit poultry to twice weekly. Choose plant-based meals and fish or shellfish on other days.
Limit consumption of eggs to no more than 4 whole eggs (egg yolks) per week
  • Use egg substitutes or egg whites instead of whole eggs at breakfast and when preparing baked goods.
Herbs and spices instead of salt to flavor foods
  • Season foods with fresh or dried herbs, such as oregano, parsley, basil, dill, mint or sage.
Regular physical activity at a level that promotes a healthy weight and physical fitness
  • Go for a brisk, 20–30 minute walk most days of the week.
Low-to-moderate consumption of wine, usually with meals
  • Men can drink up to two 3 ½-oz glasses of wine; women can drink one 3 ½-oz glass of wine.
  • NOTE: If you do not drink alcohol, the American Heart Association cautions people NOT to start drinking alcohol. Talk to your doctor about the benefits and risks of drinking alcohol in moderation.

For More Information

Nutrition Program Preventative Cardiology and Rehabilitation
Appointments: 216.444.9353 or 800.223.2273 EXT.49353
Hearing Impaired (TTY) Assistance: 216.444.0261

Reviewed: 12/13

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

Schedule an Appointment

Toll-free 800.659.7822

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

HealthHub from Cleveland Clinic

Read the Latest from Our Experts About cctopics » Heart & Vascular Health
Alcohol May Cause You to Develop Irregular Heartbeat
10/30/14 1:45 p.m.
Even in moderation, alcohol may be hard on your heart. A new study finds that having as little as one to three alcoholic drinks each day may increase your risk for atrial f...
by Heart & Vascular Team
You’ve Been Diagnosed with Esophageal Cancer: Now What? (Video)
10/29/14 8:14 a.m.
If you or a loved one has been diagnosed with cancer of the esophagus, the muscular tube that connects our thro...
10 Tips for Lowering Your Cholesterol
10/27/14 10:10 a.m.
We all want to be heart-healthy, and ensuring healthy levels of cholesterol — a fat, or lipid, carried through ...
Recipe: Low-Cal Chocolate-Walnut Biscotti
10/24/14 4:00 p.m.
Getting back into baking now that the weather has turned crisp once again? Try our chocolate-walnut biscotti. T...
Why Your Low-T Medications May Not Be Safe
10/23/14 8:31 a.m.
If you’re taking a medication for low testosterone to ward off the effects of aging – such as decreased l...