Online Health Chat with Julia Zumpano, RD, LD

Friday, April 17, 2015


A diet rich in fruits, vegetables, legumes and whole grains, fish, nuts and low-fat dairy is proven to have positive health effects, such as cholesterol, blood pressure and weight reduction. In addition, emphasizing vegetable oils rich in monounsaturated fats and low in saturated fats has also been proven beneficial for prevention of heart disease. These dietary patterns exemplify the traditional Mediterranean diet.

The traditional Mediterranean diet refers to the dietary patterns typical in the early 1960s 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; with rates of coronary heart disease among the lowest in the world during that time.

The Mediterranean diet emphasizes an abundance of foods from plant-based sources. Julia Zumpano, RD, LD, will be discussing the key components of the Mediterranean diet and ways to incorporate these foods into your diet.

About the Speaker:

Julia Zumpano, RD, LD, is a registered clinical dietitian who works in the Department of Nutrition Therapy at Cleveland Clinic. She focuses on strategies and behavior modification individualized to each patient's lifestyle, needs and readiness to change. She is involved in nutrition program development, research projects and studies, patient and employee education, and community outreach. Julia also “practices what she preaches” as a certified fitness instructor, leading a variety of fitness classes at the Cleveland Clinic Employee Fitness Center and as a vegetarian.

Completing her undergraduate degree at the University of Akron and her dietetic internship here at Cleveland Clinic with Nutrition Therapy, Julia was involved in a variety of clubs and organizations throughout her academic endeavors including the Cleveland and Ohio dietetic associations.

Let’s Chat About the Mediterranean Diet

Moderator: Welcome to our chat about the Mediterranean Diet with Cleveland Clinic nutritionist Julia Zumpano, RD, LD. Thank you, Julia, for taking the time to be with us to share your expertise and answer our questions.

Let’s get started with our questions.

Diet How Tos

Fancy Pants: How should a person “get started” following a Mediterranean diet?

Julia_Zumpano,_RD,_LD: Begin to replace animal fats with plant fats and double the amount of fruits and vegetables you eat. Replace at least one meal of red meat per week with fish and one with legumes (beans).

RIZAPOO: Is there an initial cost to starting the Mediterranean diet? Is it expensive to start, and what are considered the “staple” foods?

Julia_Zumpano,_RD,_LD: There is no cost. The staples are vegetables, whole grains, fruit, legumes, fish, olive oil, nuts and seeds.

Foods to Choose

swhogg: In regard to the Mediterranean diet, is olive oil or grapeseed oil healthier?

Julia_Zumpano,_RD,_LD: Olive oil.

tanya: Please explain how coconut oil, coconut milk etc. are so often recommended when they are high in saturated fats. Thanks.

Julia_Zumpano,_RD,_LD: Coconut is not suggested when it comes to heart health, but it could be beneficial for other disease states.

SD: Is avocado oil a good alternative to olive oil, or is olive oil healthier?

Julia_Zumpano,_RD,_LD: Olive oil is a better choice. We have limited information on the use and benefits of avocado oil. Olive oil has been significantly studied and has proven positive results from a cardiovascular standpoint.

Foodie: What type of fish do you recommend to be the healthiest?

Julia_Zumpano,_RD,_LD: Wild salmon.

swrobel: Is consuming chicken breast part of this lifestyle change?

Julia_Zumpano,_RD,_LD: Yes, white meat is included.

swhogg: My yoga instructor swears upon using organic GHEE (clarified butter) instead of just butter. She claims it is full of nutrients and lots of other good things. Do you agree with using GHEE (like on toast) rather than regular butter?

Julia_Zumpano,_RD,_LD: I would not suggest either when it comes to heart health, although GHEE is a better choice than butter (in moderation).

RIZAPOO: Are there any specific fruits/vegetables that should NOT be consumed in the Mediterranean diet?

Julia_Zumpano,_RD,_LD: No, there are not any that should not be consumed, but tropical oils, such as palm and coconut, should be avoided. Limited amounts of coconut can be consumed although, keep in mind, it’s high in fat.

Foodie: Do you consider any other seafood to qualify for a Mediterranean diet such as shrimp, crab, calamari and such?

Julia_Zumpano,_RD,_LD: Yes. Shellfish can be included and is encouraged, especially to replace red meat.

Foodie: Is it OK to eat the salmon skin or do you recommend to remove that for a healthier alternative?

Julia_Zumpano,_RD,_LD: It is OK to eat the skin, but be aware that it may have a potential risk of contaminants. If salmon is wild-raised or organic, the contaminants are much less and, therefore, it is safer to eat the skin, for you can gain certain nutrients from the skin.

Foodie: What are your thoughts on raw seafood such as oysters and raw tuna?

Julia_Zumpano,_RD,_LD: Taking in raw seafood may contain certain bacteria or parasites that can cause you to become ill. The only way to be sure to reduce the level of bacteria is to cook the fish.

swhogg: What are the best fruits and vegetables for getting calcium? Since I hardly ever eat red meat, my recent bone density test (DEXA) showed me a little in the high risk range in regard to osteoporosis.

Julia_Zumpano,_RD,_LD: Your best foods for calcium include broccoli, salmon with bones, dried beans such as kidney, dark greens – spinach, kale, collard, mustard, etc. – almonds, fortified foods such as orange juice and cereal, tofu, milk alternatives such as almond, rice, hemp or soy milk.

Piecing Out Portions

swhogg: I eat a lot of carbohydrates, but they are the good carbs, like whole-wheat bread that has organic, unbleached whole-wheat flour, wheat germ, etc. I think I eat too much of them, though. What is the amount of carbohydrates that is suggested to eat with the Mediterranean diet? I also eat a lot of nuts. What do you suggest about the portion size of nuts?

Julia_Zumpano,_RD,_LD: You should have three to six servings of starch per day. One serving of nut/nut butter per day is one ounce. One ounce equals 1/4 cup, which equals two tablespoons of nut butter.

swrobel: What is the appropriate amount of olive oil to consume on a daily basis. My husband loves to enhance boiled zucchini with lemon and olive oil, salad with olive oil and balsamic vinegar.

Julia_Zumpano,_RD,_LD: Two to four tablespoons per day depending on your calorie needs.

Chinook: From sources I have read, five to 10 servings of fruits/vegetables are recommended on a daily basis. Can this be all fruit or all vegetables? I am not a huge fruit lover.

Julia_Zumpano,_RD,_LD: Yes. It is ideal to take in more vegetables than fruit to keep calories and sugar down and to maximize vitamins/minerals.

Coping with Conditions

JoyD: I have had hypertension controlled with medication since the age of 42. I know that I need to reduce my sodium intake, but, frankly, I have not done a very good job of doing so. I have been looking at the DASH and OmniHeart diets and am wondering if the Mediterranean diet might also work. What are the main differences?

Julia_Zumpano,_RD,_LD: The Mediterranean diet would work as well as the DASH and OmniHeart diets. All three diets encourage fresh fruits and vegetables, lean meats, legumes and minimally processed foods. The key to lowering sodium is using fresh foods, not adding salt, reading labels, avoiding processed foods (meats, cheeses, pre-packaged meals) and limiting eating out.

Highpointer42: What oils besides olive oil are safe to use for persons with heart disease and how much at a time? Is this fat not detrimental to preventing clogging arteries? What about sugar in the diet?

Julia_Zumpano,_RD,_LD: Nut oils, canola oil, sunflower oil, safflower are all safe. Saturated fat is to be limited because of "clogging arteries." Yes, sugar should be limited – specifically added sugars.

BKcchealthchat: How can this diet benefit those who suffer from lupus? Are there any good cookbooks you recommend?

Julia_Zumpano,_RD,_LD: The Mediterranean diet can reduce inflammation due to a high content of omega 3 fatty acids, specifically if you are choosing fatty fish, walnuts, flaxseeds and hemp seeds. Consume very minimally processed foods and limit red meats, which are both pro-inflammatory (cause swelling).

LucyintheSkies: I have hyperlipidemia (high blood cholesterol) most likely related to genetics and to dietary habits. Can following a Mediterranean diet be beneficial, and how long does it take before seeing results?

Julia_Zumpano,_RD,_LD: Yes, it could be beneficial and you should see results in about three months. I would suggest meeting with a dietitian to provide you with specific recommendations to maximize your results.

RIZAPOO: I've had bariatric surgery. Would this diet be appropriate as a lifestyle change? It seems that fish is the main protein source meat-wise and I'm not a big fish eater. I'd rather deal with poultry and occasional red meats. Would this diet work without a lot of fish consumption?

Julia_Zumpano,_RD,_LD: I would consult your physician or dietitian as to whether or not this diet would be best. It depends on what your nutrient requirements are after surgery and how long ago you had the surgery.

mabel155: Is the Mediterranean diet good for people diagnosed with chronic kidney disease?

Julia_Zumpano,_RD,_LD: If you have chronic kidney disease (CKD), you would be best advised to meet with a dietitian, for there may be a need to further reduce your intake of protein, potassium, sodium, phosphorus and fluid, depending on the stage of CKD.

RIZAPOO: Would this diet work for someone with Crohn's disease?

Julia_Zumpano,_RD,_LD: Crohn's disease presents differently from person to person. Be mindful that the Mediterranean diet is high in fiber in the form of fresh fruits, vegetables, beans, whole grains and nuts/seeds. These foods can present issues (diarrhea, gas, bloating, etc.) to a person with Crohn's. It would be best to meet with a dietitian to discuss your specific symptoms of Crohn’s so that a meal plan tailored toward reduction of these symptoms can be established.

Facts About Fats

Melethils: How do I minimize the adverse effects of oils/fats on arterial endothelial health? I understand nuts like walnuts help?

Julia_Zumpano,_RD,_LD: Replace all sources of saturated fat with mono- and polyunsaturated fats. Use these in moderation with the goal of no more than 35 percent of your total calories from fat.

Melethils: How much and what types of fats are best for congestive heart disease patients? Please provide the best dietary approach to minimize the effect of fat intake on plaque formation in coronary arteries. Thanks.

Julia_Zumpano,_RD,_LD: Mono- and polyunsaturated fats – olive oils, nuts, seeds and fatty fish – are best. Use these in moderation, no more than 35 percent of your total calories from fat.

General Information

hipandleg: My wife thinks it would be a lot of work (having to grocery shop more often for fresh items) to follow the Mediterranean diet. Where can I get Mediterranean diet recipes?

Julia_Zumpano,_RD,_LD: You are welcome to check out our heart healthy recipes at: or

Sally: Can you suggest a book that would contain information about the Mediterranean diet?

Julia_Zumpano,_RD,_LD: A good one would be Heart 411 by our own Dr. Nissen and Dr. Gillinov.

Makin: When is it a good idea to meet with a dietician? For certain diseases or conditions or just general healthy eating?

Julia_Zumpano,_RD,_LD: All of the above. A dietitian can tailor a diet toward your specific medical and personal needs.


Moderator: That is all of the time we have for questions. Thank you everyone for participating today; and thank you, Julia, for your insightful answers to our questions about the Mediterranean Diet.

For Appointments

To make an appointment with Julia Zumpano, RD, LD, or any of the other specialists in our Digestive Disease and Surgery Institute, Department of Nutrition at Cleveland Clinic, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at

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The Center for Human Nutrition provides evaluation, education and treatment to people who have disease-related nutrition problems. Additionally, the Center is involved with a multitude of programs to promote health and wellness. Both of these efforts are driven by a dedicated team of registered dietitians, dietetic technicians, nurses, pharmacists, physicians and surgeons who work together to provide comprehensive support for patients with specialized nutrition needs.

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