Follow these simple steps to adopt a proven nutrition strategy and begin to reap its heart-healthy benefits.
The traditional Mediterranean “diet” is not a specific meal plan or a method for losing weight. It is a health-promoting dietary pattern that emphasizes extra-virgin olive oil, whole grains, fruits, nuts, vegetables, and fish. If you are not eating Mediterranean now, how do you get started and reap its benefits?
“Start by incorporating more fruits and vegetables in your diet,” says Dr. Helen Delichatsios, an assistant professor of medicine at Harvard Medical School. Also, take your time easing into the Mediterranean diet’s reliance on healthy plant oils, which may come as a bit of a shock to some American intestines. Using more olive oil in cooking and using liberal amounts in salad dressings are simple starter moves.
What does the science say?
PREDIMED, a study conducted in Spain, tested the ability of a Mediterranean-style eating program to prevent heart attacks, strokes, and diabetes in people with risk factors like smoking, high blood pressure, and elevated cholesterol. (PREDIMED is short for the Spanish name of the trial, Prevención con Dieta Mediterránea, which means “prevention with Mediterranean diet.”)
The trial involved nearly 7,500 people 55 to 80 years old. Researchers randomly assigned them to follow one of three diets. The participants in one group were just advised to reduce fat in their diets. Those in the other two groups were told to eat a Mediterranean diet supplemented with either nuts or minimally processed (extra virgin) olive oil.
After about five years, people on the Mediterranean diets were up to 30% less likely to have heart attacks and strokes or die from heart-related causes, compared with those in the reduced-fat diet group. In absolute numbers, that means 4% of people in the Mediterranean diet group had heart attacks, or strokes, or died from heart-related causes, compared with 5.6% in the reduced-fat diet group.
“It confirmed that a Mediterranean diet pattern that is high in healthy plant oils and minimally processed foods is protective,” says Dr. Dariush Mozaffarian, an associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital. It means Mediterranean eating could prevent scores of heart attacks and strokes.
The trial also suggests that choosing foods based on the specific vitamins, minerals, carbohydrates, protein, and fats they contain (or lack) isn’t a successful strategy. “Instead of increasing percent of calories from this or that, you should increase consumption of healthy foods,” Dr. Mozaffarian says.
How to get started
The Mediterranean diet is an effective way to incorporate healthier foods. Here are the basics:
Fruits and vegetables: Your meal plates should be covered primarily with a variety of fruits and vegetables. Legumes are also common on the Mediterranean plate, either in salads or in soups. This includes kidney beans, garbanzo beans (chick peas), peas, split peas, and lentils.
Healthy plant oils: Mediterranean style diets include significantly more calories from healthy plant oils, especially extra-virgin olive oil. In Mediterranean cooking, Dr. Delichatsios says, “you literally pour it on.” To avoid upset stomachs and bowels, ramp up the amount of oil in your diet gradually.
Use olive oil for salad dressings and for dipping with whole-grain bread. Coat vegetables liberally with olive oil and roast them in the oven. Root vegetables work well, but also eggplant and potatoes.
Eat seeds and nuts, too, as snacks or in salads and grain or pasta dishes, and as substitutes for red and processed meat.
Whole grains: Eat moderate portions of unrefined and whole-grain cereals and breads. (Read the nutrition labels, because packaged bread products may contain excessive amounts of sodium.) Other options are whole-grain rice or pasta.
Dairy: Eat moderate amounts of yogurt and cheese, mostly as a topping or side dish. Add grated cheese or crumbled feta to leafy salads and cold grain dishes, like bulgur wheat salad (tabbouleh).
Fish: Use fish as a main protein source. Also enjoy poultry and a moderate number of eggs—up to three or four per week.
Red meat: A small amount of fresh unprocessed red meat—one or two portions per week—can fit into a healthy Mediterranean diet. Avoid processed meats containing high levels of sodium or other preservatives, including “low fat” deli meats.
Alcohol: Traditional Mediterranean diets consumed in non-Muslim cultures often include alcohol in moderate amounts, usually with meals. For men, no more than two drinks per day; for women, no more than one per day.
Sweeteners: Avoid sugar-sweetened beverages, baked goods, and rich desserts in large portions that may contain lots of refined carbohydrates and trans fats, which are both unhealthy.
Minimize consumption of white bread, white rice, potatoes, and refined carbohydrates such as those found in most breakfast cereals and energy bars. These types of carbohydrates are quickly digested, producing large rises in blood sugar and insulin that are often indistinguishable from eating simple sugar.