Vegetable salad

Healthy Hearts Thrive on the Mediterranean Diet

Americans have heard it many times before – the Italians, Spaniards, and Greeks apparently have healthful living figured out, especially when it comes to healthy eating. And what’s not to love? Nutritious, natural foods are high in fiber, vitamins, and antioxidants. Fresh produce, fish, and olive oil are not only delicious but heart-healthy alternatives to the fatty, sugary, over-processed foods that have become staples of the Western diet.

As countless studies and nutritional experts have repeatedly told us – we would be on the right track if we just exercised more and learned to eat as Mediterranean folks have for centuries. Yet we’re stuck in our bad habits, and cases of diabetes, heart disease, stroke, and obesity continue to rise at an alarming rate. Now, there’s yet another reason to listen.

In February 2013, The New England Journal of Medicine published a study out of Spain, “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.” The study looked at the ”traditional Mediterranean diet,” which researchers characterized as “a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals” (Estruch, R. et al, 2013).

What is different with this study is its scope. Considered the lengthiest, most scientific study on the Mediterranean diet, researchers enrolled close to 7,500 people and followed them for nearly five years. The participants were 43% male (55-80 years) and 57% female (60-80 years). Subjects had “high cardiovascular risk” (but did not have heart disease at the time of selection), and were randomly assigned to one of three diets: A Mediterranean diet including extra-virgin olive oil; a Mediterranean diet including mixed nuts, and a third “control group” was advised only to reduce their dietary fat. All three groups participated in “quarterly individual and group educational sessions” (Estruch, R. et al, 2013).

The researchers found that the high intake of produce, fish, legumes, nuts, and olive oil, coupled with low overall consumption of meat and meat products appeared to be associated with better survival rates in their subjects. “In this trial, an energy-unrestricted Mediterranean diet supplemented with either extra-virgin olive oil or nuts resulted in an absolute risk reduction of approximately 3 major cardiovascular events per 1,000 person-years, for a relative risk reduction of approximately 30%, among high-risk persons who were initially free of cardiovascular disease,” they stated. “Perhaps there is a synergy among the nutrient-rich foods included in the Mediterranean diet that fosters favorable changes in intermediate pathways of cardiometabolic risk, such as blood lipids, insulin sensitivity, resistance to oxidation, inflammation, and vasoreactivity” (Estruch, R. et al, 2013).

Since the Mediterranean region encompasses several cultural and geographical areas, the broad term “Mediterranean Diet” can be confusing. According to Oldways Preservation Trust (a nonprofit food and nutrition education organization), traditional Mediterranean meals typically feature foods grown and harvested in areas surrounding the Mediterranean Sea. In 1993, Oldways teamed up with the European Office of the World Health Organization (WHO) and the Harvard School of Public Health to present the classic Mediterranean Diet and the accompanying Mediterranean Diet Food Pyramid to illustrate their point (Oldways, 2013).

The Mediterranean Diet Pyramid was initially based on the traditional eating patterns found in 1960s Greece, Crete, and Southern Italy. Today it is widely considered the “gold standard” representation of the traditional Mediterranean diet among healthcare professionals, consumers, and educators (Oldways, 2013).

The Mediterranean Diet Pyramid recommends the daily consumption of 10 servings of plant-based foods that are locally grown and minimally processed. The pyramid limits total fat consumption to less than 35% and recommend olive oil instead of butter, low amounts of cheese, yogurt; fish or poultry ( twice per week); and up to seven eggs per week. Fresh fruit is suggested as a daily dessert and red meat is limited to a few times per month. In addition, regular physical activity, one glass of red wine per day, the use of herbs/spices in place of salt, and plenty of drinking water are strongly recommended (Oldways, 2013).

Along with lifestyle changes including exercise and avoiding tobacco smoke (including secondhand smoke), the American Heart Association (AHA) has long encouraged a “heart-healthy diet,” chiefly comprised of fruits and vegetables, high-fiber foods, and whole grains. They also endorse fish (at least two times/week), lean meats and poultry, and fat-free dairy products (AHA, 2013).

For more on the Mediterranean Diet Pyramid and heart-healthy menu ideas, click here.


American Heart Association [AHA]. (2013). Coronary Artery Disease - Coronary Heart Disease.  Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.I., Corella, D., et al. (2013).

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. The New England Journal of Medicine [NEJM].  Oldways Preservation Trust. (2013). Mediterranean Diet Pyramid.