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Harvard Commentaries
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Food for Thought Food for Thought

The Mediterranean Menu -- A Diet You Can Enjoy

January 16, 2013

By Kathy McManus, M.S., R.D., L.D.
Brigham and Women's Hospital

Diets consumed by people living in Mediterranean countries have been a subject of interest since antiquity, with more recent investigations focused on their health benefits. Greece and southern Italy are just two examples of regions where eating patterns tend to follow a "traditional Mediterranean diet." People residing in the countries along the Mediterranean Sea have lower rates of coronary heart disease and certain types of cancer even though their diets contain a relatively high percentage of fat.

The Traditional Mediterranean Diet

Although there are many countries that border the Mediterranean Sea, offering different cultures, food availability and lifestyles, there are broad characteristics that make up the foundation of this healthy diet:

  • An abundance of plant foods (fruits, vegetables, whole grains, nuts and legumes) which are minimally processed, seasonally fresh and grown locally
  • Olive oil as the principal source of fat
  • Cheese and yogurt consumed daily in low to moderate amounts
  • Fish and poultry consumed in low to moderate amounts
  • Red meat consumed in small amounts and used more as a sauce and to season food than as the main ingredient in meals
  • Fresh fruit as a typical daily dessert, with sweets containing sugars and honey eaten only a few times each week
  • Wine consumed in low to moderate amounts, usually with meals

The traditional Mediterranean diet is low in saturated fat (less than 8% of total calories), with total fat ranging from 28% to more than 40% of total calories. In addition, the diet includes modest amounts of foods from animal sources. In fact, as in many traditional diets, plant foods make up the core of the daily intake. This balance increases the amount of vitamin B12 and iron available in the diet, and at the same time, keeps the amount of saturated fat low.

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Health Benefits

In 1994, the Lyon Heart Study evaluated the effect of a Mediterranean diet on heart disease. More than 600 patients who had a heart attack were randomly selected to eat either a traditional American Heart Association diet or a Mediterranean-style diet. The Mediterranean-style diet used fish and poultry as the major sources of protein and was high in plant foods including fruits, vegetables, beans, bread, olive oil and nuts. The diet guidelines called for less meat, butter and cream. The study used a specially prepared spread that contained alpha linolenic acid (an omega-3 fatty acid).

After only four years, the results of the Lyon Heart Study showed a significant difference in coronary events (heart attacks and stroke) in the groups who ate the Mediterranean diet versus the American Heart Association diet. The rate of coronary events was reduced by 73%, and total deaths were reduced by 70% in the Mediterranean-style group.

More recently, a study was published examining more than 22,000 adults in Greece and their adherence to the traditional Mediterranean diet. The data showed that the Greeks who had a higher degree of adherence to the diet had a significantly lower total death rate, and fewer deaths from heart disease and cancer.

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Tips for Eating Mediterranean-Style

  • Use olive oil as your main fat source.
  • Choose grains that are whole, unrefined or minimally processed.
  • Limit use of unhealthy fats (saturated and trans).
  • Fill your plate with vegetables, using small amounts of olive oil in preparation or as a salad dressing.
  • Try fresh fruit for dessert.
  • Use fish and poultry as the main protein sources, while limiting red meat.
  • Use small amounts of yogurt and cheese, mostly as a topping or side dish.

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Sample Mediterranean-Style Meals

  • Breakfast
    • 1/3 cantaloupe
    • 1 slice whole-grain toast
    • 2 tsp peanut butter
    • 1 apple
  • Lunch
    • 2 cups fresh spinach salad
    • 2 ounces grilled chicken breast
    • 1 tbs. olive oil
    • 1 tbs. vinaigrette
    • 1 small whole-wheat pita
    • 1 apple
  • Dinner
    • 5 ounces fish (cod, halibut etc.)
    • 1 small sweet potato
    • 2-3 cups broccoli, carrots, peppers, onions sautéed in garlic and olive oil
    • 1 cup fresh fruit
  • Snacks (mid-morning or mid-afternoon) — 1 small handful of nuts (almonds, peanuts, pecans, walnuts etc.)

Mix daily exercise with weight control and a traditional Mediterranean diet and you have a terrific recipe for healthier living. There are other healthy diets that can do just as well, but the most convincing argument for going Mediterranean is the taste!

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Kathy McManus, M.S., R.D., L.D., is the director of the department of nutrition at Brigham and Women's Hospital and director of nutrition and behavioral modification program for the Program for Weight Management at Brigham and Women's Hospital. She graduated with a Bachelor of Science from Simmons College and received a Master of Science degree in nutrition from Framingham State College.

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