Online Health Chat with Julia Zumpano, RD, LD

Friday, April 15, 2016


This web chat will focus on the foundation of the Mediterranean diet and how to incorporate this style of eating into your current dietary regimen. It will also discuss the health benefits of the diet and how to adjust serving sizes to better meet your weight and health goals. The speaker will discuss sample menu ideas and recipes, and ways to grocery shop and read labels.

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 that are individualized to each patient's lifestyle, needs and readiness to change. Julia is also a vegetarian.

Let’s Chat About the Mediterranean Diet

Foundational Facts

susanemohr: What is the Mediterranean diet specifically?

Julia_Zumpano,_RD,_LD: The Mediterranean diet is a whole foods diet that emphasizes fish, olive oil, nuts, legumes (dried beans, split peas and lentils), whole grains, vegetables, fruits and red wine (for habitual drinkers). Red meats, full-fat dairy products and condiments, processed foods and sweets/dessert are avoided or limited.

dmryniewicz: Is the Mediterranean diet really a “diet”?

Julia_Zumpano,_RD,_LD: The Mediterranean diet is a way of eating that uses healthy concepts when making your food choices. It is not a diet that has a beginning and end. The goal is that you follow the concepts and way of eating indefinitely.

susanemohr: Are there recommended daily portions for each type of food within the diet e.g. fish, olive oil, nuts, legumes, whole grains, vegetables, fruits and red wine?

Julia_Zumpano,_RD,_LD: The recommended servings vary by person due to calories and needs (weight loss, gain or maintain), but generally, the guidelines are below:

  • Fish - 3 servings per week
  • Olive oil – 2 to 4 Tbsp per day - solely used for added fat - replaces butter, margarine, other oils, mayonnaise, cream sauces
  • Vegetables - 3+ servings per day
  • Fruit – 2 to 3 servings per day
  • Nuts - best choices are walnuts, almonds, hazelnuts - at least 3 servings per week - acceptable to have daily at 1 oz (1/4 cup or 2 Tbsp nut butter)
  • Beans & Legumes - 3 times per week or greater - 1/2 cup cooked = 1 serving
  • Red wine - 1 glass per day for women; 2 glasses per day for men (1 glass = 4 oz)
  • Red meat - none or 1 (3 oz) serving per week
  • Cheese - 3 servings per week (1 serving 1-1.5 oz) - no processed cheeses - choose natural cheeses such as feta, part-skim mozzarella, ricotta, Swiss
  • Grains – 3 to 6 servings per day (3 servings for weight loss)
  • Whole Grains – 5 to 6 servings per day, 1 serving = 1/2 cup cooked

krisimmons: Does the Mediterranean diet include any other saturated fats beyond meat?

Julia_Zumpano,_RD,_LD: Saturated fats are strictly limited on the Mediterranean diet. The goal is to limit saturated fat to no more than 5 percent to 7 percent of daily calories, which for most people range between 7 to 12 grams of saturated fat per day. Cheese and dairy sources of saturated fat are allowed in moderation within this restriction.

In Comparison

nanat426: What is the difference between an "anti-inflammatory diet" and the Mediterranean diet? Would the Mediterranean diet help with chronic inflammation?

Julia_Zumpano,_RD,_LD: There is a difference; however, both diets are quite general and, therefore, include similar foods and concepts that help reduce inflammation. Specifically, both diets encourage whole foods, minimally processed foods, and a high intake of fresh fruits and vegetables, fish (high in omega 3 fatty acids), olive oil, nuts and whole grains.

faride: Hi. My cholesterol is high: 240. I'm 62 years old. My LDL is 165, my HDL is 42 and my triglycerides are 160. I do not eat meat and I walk three times a week. I'm thinking maybe my body produces it. Which diet will be better for me, a plant-based diet or the Mediterranean diet?

Julia_Zumpano,_RD,_LD: Mediterranean plant-based is an option to consider, which allows you to eat fish but no other sources of meat or dairy.

Meat in Moderation

bc4494: I know that the Mediterranean diet is recommended for people with heart disease, but I don't know much about it. Does it include meat, such as turkey and chicken?

Julia_Zumpano,_RD,_LD: Yes, it does include white meat poultry and fish, and small amounts of red meat (beef, pork, veal and lamb). The Mediterranean diet also encourages the use of olive oil, nuts, vegetables, whole grains and fresh fruits.

bc4494: I've read that a plant-based diet is the best for people with coronary artery disease (CAD), which I can understand, but does eating meat such a turkey and chicken create blockages?

Julia_Zumpano,_RD,_LD: Not necessarily. Animal products have been associated with increased “bad” LDL cholesterol due to their saturated fat content. The foods highest in saturated fat include red meat (beef, pork, veal and lamb), whole milk and full-fat dairy products, butter, lard, bacon fat or animal fat, gravies, and skin of poultry. A plant-based diet has shown positive reductions in "bad" LDL cholesterol.

susanemohr: Is pork a red meat?

Julia_Zumpano,_RD,_LD: Yes. Pork, beef, veal and lamb are all red meats.

szczotur: I don't eat fish. What is the serving portion for chicken to replace fish?

Julia_Zumpano,_RD,_LD: Three to four ounces of chicken is acceptable. Consider the use of a plant source of omega 3 fatty acids, such as chia seeds, ground flaxseeds or hemp seeds to supplement in your diet daily.

crystalclear: I do not care for fish. I tolerate tuna as long as it's tuna salad (small amounts of Miracle Whip, pickles, onions). Do you have any suggestions for a fish substitute? I am taking an omega-3 supplement.

Julia_Zumpano,_RD,_LD: If you are taking fish oil that should suffice. Chia and ground flaxseeds are also great sources of plant-based omega 3 fatty acids. Try to make tuna salad with an oil-based dressing or olive oil plus lemon in place of Miracle Whip.

Health Benefits

wdm9999: Hello. I would like to know if following the Mediterranean diet will help someone with overweight and obesity issues and prevention of said issues.

Julia_Zumpano,_RD,_LD: Yes, it can help as long as overall calories are restricted to produce weight loss.

jimblough: What health benefits are associated with the Mediterranean diet?

Julia_Zumpano,_RD,_LD: The Mediterranean diet has been clinically proven to reduce the risk of primary or secondary (first or multiple) heart- and vascular-related diseases and issues. Also, it has been shown to be helpful in controlling cholesterol, blood pressure and blood sugar.

Distinctively for Diabetes

mariaseikh: Are apples good for Type 2 diabetics?

Julia_Zumpano,_RD,_LD: Apples are a carbohydrate. Choose a small (4 oz) apple for one carbohydrate serving (15g carbohydrates). Apples are a good choice because they are high in fiber.

dmryniewicz: As you noted earlier, grains are important in the Mediterranean diet. Grains are carbohydrates as are fruits, etc. For diabetics, what are the best low-glycemic choices in the Mediterranean diet?

Julia_Zumpano,_RD,_LD: It's best to keep the carbohydrates controlled when following any type of diet. Grains that have fiber and protein are best for blood sugar management. These include quinoa, barley, oats, brown or wild rice, farro, whole-grain pasta or bean-based pasta and legumes. As for fruits: berries, kiwi, green apples tend to be lower in sugar, although all fruit can be included as long as it is limited to a 4 oz serving at a time.

mfrietas: Would the Mediterranean diet be helpful to diabetics?

Julia_Zumpano,_RD,_LD: Yes. This diet is naturally low in carbohydrates and high in fiber, and also includes healthy lean protein and fats. It would be best to follow the concepts of the Mediterranean diet while keeping a carbohydrate-controlled plan (keeping the carbohydrates consistent at meals and snacks). Do not exceed 30 to 45g of carbohydrates per meal for women or 45 to 60g per meal for men.

Diet for Disorders

nutzy: I heard a lot about the Mediterranean diet. I can imagine a variety of salads with many grocery products. Could you make some recommendations for people with bowel sensitivity? Thank you.

Julia_Zumpano,_RD,_LD: Recommendations vary depending on what kind of bowel sensitivity you have. Cooked/steamed or pureed vegetables (as opposed to fresh/raw) are typically easier to digest. Also, adding vegetables to soups, smoothies or casseroles can help with tolerability as opposed to eating them alone. Lastly, consider smaller portions spread throughout the day as opposed to one or two large portions.

July: My question is: Which foods are helpful in stroke patients?

Julia_Zumpano,_RD,_LD: There are not specific foods that are helpful for stroke patients. The most helpful would be controlling your risk factors associated with having another stroke. These include keeping your blood pressure controlled, maintaining a healthy weight, controlling your stress (meditation/exercise/deep breathing), keeping your cholesterol and blood sugars controlled, getting moderate and regular physical activity (as recommended by your physician) and eating healthy, minimally processed foods (the Mediterranean diet is advised).

Eating Tips

lpsaxton: I do well following the diet all day, but come nighttime when I'm tired and my husband and daughter are snacking on chips, candy etc..., I struggle. Do you have any suggestions?

Julia_Zumpano,_RD,_LD: Have healthy snacks available for you, such as cut-up veggies with hummus, fresh fruit, low-fat plain yogurt or cottage cheese, plain popcorn or nuts. Snacks that contain fiber and protein tend to keep you the most satisfied.

lpsaxton: Healthy snacks are available but they just don't taste as good.

Julia_Zumpano,_RD,_LD: Choose a portion-controlled serving of the "unhealthy" snack and supplement that with a healthy snack to avoid eating seconds.

susanemohr: When learning a new food plan, I am accustomed to tracking daily calories and intake (in grams) of protein, fat and carbohydrates. If you're trying to lose weight and are quite active, what should your daily intake be following the Mediterranean food plan?

Julia_Zumpano,_RD,_LD: These values are different for each person. I would highly suggest meeting with a dietitian for a specific plan tailored to your needs and activity.

Specific Foods

ellie7: Are pasta and pizza OK?

Julia_Zumpano,_RD,_LD: Pasta and pizza can be included in moderation. Making adjustments to these foods to reduce fat and carbohydrates would be preferred. For example, choosing a thin crust vegetable pizza with half the amount of cheese, using whole grain pasta noodles and a tomato- or oil-based sauce with vegetables, or avoiding fatty meats and heavy sauces such as pepperoni, sausage, meatballs, cream or alfredo sauce.

jmbt: Does the use of salt have any consequence on this diet?

Julia_Zumpano,_RD,_LD: Salt, which is made up of sodium, can cause blood pressure to rise when used in excess. Elevated blood pressure is a risk factor for developing heart disease. Limit the use of added salt to 1/4 to 1/2 tsp (500 to 1000 mg sodium) per day, for the remainder of your needs will likely be obtained through the foods you eat. Total intake of sodium should not exceed 2400 mg per day.

Hibiscus13: Is parmesan cheese or brie considered processed or natural cheese?

Julia_Zumpano,_RD,_LD: They both are natural cheeses, although brie tends to be high in fat. Choose a light or part skim version if possible or limit the portion.

mfrietas: Won’t pasta cause a spike in blood sugar? Is that dangerous?

Julia_Zumpano,_RD,_LD: Yes. Carbohydrates in general cause blood sugar to rise. The quantity and type of the food significantly impacts how much the blood sugar will rise after eating that carbohydrate. Simple sugars - which include white pasta - do cause the blood sugar to rise the greatest. If you include a healthy protein, fat and fiber with the carbohydrate choice, the blood sugar will rise to a lesser degree. An example is a whole-grain noodle (measured at 1/2 cup cooked) tossed with your choice of vegetables, lean protein (chicken or fish) in a marinara or olive oil. If you prefer traditional white pasta, adding beans to the sauce and having the vegetable on the side will suffice. Most importantly, keep your portion limited to 1 cup cooked or less.

Helpful Hints

Hibiscus13: What is a good source to find guidelines/recipes to follow the diet?

Julia_Zumpano,_RD,_LD: Cleveland Clinic's website on Heart Healthy Nutrition Strategies has lots of great tips and recipes, as well as information on grocery shopping, meal preparation and more:

susanemohr: Is there a resource you recommend for more information on these guidelines?

Julia_Zumpano,_RD,_LD: Our website reviews the basics, including a "Pyramid Overview" and "Pyramid Food Listing":

dmryniewicz: Thanks Julia. Can you recommend any good recipe/cookbooks?

Julia_Zumpano,_RD,_LD: Check out the "Heart Healthy Recipe Corner".


That is all the time we have for questions today. Thank you, Julia, for taking time to educate us about the Mediterranean Diet.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at

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