Heart-Healthy Mediterranean Diet

This is a plant-based diet low in cholesterol and saturated fat and high in fiber, monounsaturated fat, and omega-3 fatty acids. Increased fiber is provided through 7 or more servings of fruit and vegetables daily. Fruits and vegetables, along with whole grains, legumes, and nuts should be the main component of the meal. Meat, if eaten at all, should be in small portions. When possible, fruits and vegetables should be fresh. Dairy products should be those low in saturated fats.

The main fat source for this diet is monounsaturated oils such as canola or olive oil. Avoid polyunsaturated oils such as corn oil, safflower oil, sunflower seed oil, and soybean oil. Avoid trans-fatty acids in the form of margarine, shortening, deep-fried foods, and most prepared snacks. This diet is high in omega-3 fatty acids through the intake of cold-water fatty fish, certain greens, and nuts as well as the use of flax seed and oil. Examples of cold-water fish are salmon, tuna, trout, herring, and mackerel. Fish is low in cholesterol and saturated fat. Fish should be eaten 3 or 4 times a week. If you do not like fish, you may supplement your diet with other sources of omega-3 fatty acids.

Saturated fat (fat from animal products) should be limited to no more than 8 -10% of total calories. This means that if you are on a 1500-calorie diet you should consume no more than 15 grams of saturated fat a day. If you are on a 2000-calorie diet, you should consume no more than 20 grams of saturated fat.

Dairy products as well as meat can be quite high in saturated fat. Dairy products low in saturated fats include 1% milk, low-fat cottage cheese, and soft cheeses such as low-fat mozzarella. Meat on the Mediterranean diet should be eaten in small amounts. The best meat choices are chicken and turkey. Red meat should be eaten no more than 1 or 2 times per month. Depending on your cholesterol level, two to four eggs with yolks may be eaten weekly.

Dessert and snacks should consist mainly of low-fat dairy products, fruits, and vegetables. Sorbet, sherbet, frozen yogurt, and low-fat ice cream are good choices and may be eaten occasionally. If you are trying to lose weight these will need to be limited. Desserts and snacks containing large amounts of fat and sugar such as pastries, chips, and commercial baked goods should be avoided.

Water should be your beverage of choice (avoid sugar-containing soft drinks and sports drinks). Fruit juices should be as fresh as possible with no added sugar. Fruit instead of juice is even better because of the added fiber. Alcohol, if consumed, should be used in moderation and with meals. Red wine is a good choice. If you are a vegetarian, you are most likely already practicing a heart-healthy diet. If you are not a vegetarian strive to adopt a more plant-based diet.
As with any diet or lifestyle change, don’t forget the importance of exercise!

Mediterranean Diet Guidelines

• Fruits and vegetables – at least 7 servings per day
• Fish (cold water) – 3 or 4 times per week
• Dairy – Low saturated fat versions (in limited amounts) and up to 4 eggs per week
• Grains, starches, legumes, and nuts –  Whole grain fiber-rich cereals, bread and pasta. No refined white flour baked goods or bread. Avoid refried beans with lard. Limit the quantity of nuts and nut butters because they are high in calories. No added oils, fats, or sugars.
• Meat – Lean meats such as chicken and turkey in limited amounts. Red meat should be eaten only 1 or 2 times per month.
• Fats – use olive oil and canola oil. Use canola oil margarine and mayonnaise in limited amounts (because they are high in calories).
• Alcohol – Limited amount with meals. The best choices are red wines.
• Fiber – Ideal intake of daily fiber is 20-35 grams a day.

Read food labels carefully. Pay special attention to serving size, amount of sugar, saturated fat and fiber. If you are having difficulty with weight gain or are unable to lose weight, you will need to decrease the amount of monounsaturated fat in your diet as well as the portion size of grains and starches. Don’t skip meals. It is important to eat several times daily to maintain healthy blood sugar levels. Include a small amount of low-fat protein with each meal.

See the final page for menu examples.

Protein – Carbohydrates – Fats

Food sources can be divided into three groups or categories: Proteins, carbohydrates, and fats. 30-35 % of your total calories should come from fat, 20-30 % from protein and the remaining 40- 50% from carbohydrates.

Protein

Protein contains amino acids, which are an important part of every diet. Amino acids are the basic building blocks of all cells in your body. The body is unable to manufacture its own “essential amino acids.” An appropriate mixture of amino acids is important. Vegetarians need to pay special attention in order to obtain a proper amino acid balance. Animal and dairy proteins already contain the appropriate amino acid mixture.

Protein is necessary for the repair of tissue and the maintenance of muscle, hair, skin, nails, and blood and for the manufacture of hormones and enzymes. Every system in your body is dependent on adequate protein intake.

• 20-30% of your total calories should come from protein (each gram of protein provides four calories). There are both animal and vegetable sources of protein.
• Excess protein intake is not advised. Excess protein waste products are excreted through the urine, which puts unnecessary stress on the kidneys.
• Vegetarians should make sure they include protein-rich vegetarian sources at every meal and to make sure their essential amino acid intake is adequate.
• Protein sources should be low in saturated fats.

Preferred Protein Sources: (low in saturated fats)

• Skinless chicken and turkey (white meat)
• Fish (cold water varieties) salmon, tuna, and trout are recommended 3 or 4 per week.
• Whole eggs (2 to 4 per week) and egg whites
• Soybeans* Tofu* Soybean imitation meat products*
• Low-fat dairy products such as low-fat cottage cheese and low-fat cheese
• Protein powders

Acceptable Protein Sources:

• Chicken and turkey (dark meat)
• Lean cuts of beef may be eaten 1-2 times per month
• Ham, pork, Canadian bacon (lean)

Limit or Avoid:

• Fatty cuts of meat
• Hot dogs, bacon, and sausages
• Liver
• Hard cheeses.

*(According to the FDA – diets low in saturated fat and cholesterol that include 25 grams of soy protein may reduce the risk of heart disease).

Carbohydrates

There are three types of carbohydrates: sugar, starches, and fiber. Most carbohydrates are plant-based, such as fruits, vegetables, grain, and legumes. Dairy products also contain carbohydrates. Sugar and starch provide 4 calories per gram of carbohydrates. 40-50% of total calories should come from carbohydrates. Fiber is not absorbed by the body, so it has no caloric value.

Carbohydrates are foods that turn into sugar after they are eaten. Carbohydrates are a dietary essential and are used by the body for energy. Some carbohydrates turn into sugar very quickly, these are sometimes called “high glycemic index carbohydrates.” These carbohydrates may cause a rapid increase in blood sugar levels. These are also called refined carbohydrates. Favorable carbohydrates turn into sugar more slowly and are called “low glycemic index carbohydrates.”

The best choices are carbohydrates high in fiber, low in refined starch, and low in sugar. Remember to eat 5 to 7 servings of fruits and vegetables daily. Eat foods in their least refined form to ensure optimal fiber intake. Water should be your beverage of choice. Alcohol in moderation with meals is ok. Red wines are the best choice. Maximum alcohol intake for women is 6 oz wine, 1 beer or 1 shot of hard liquor. A large man may have twice that amount.

• Preferred Fruits – Apples, apricots, cherries, grapefruit, oranges, peaches, plums, blackberries, cantaloupe, kiwi, nectarines, blueberries, pears, and raspberries.
  • Limit – Bananas, cranberries, dates, figs, mango, raisins, pineapple, and fruit juices.
• Preferred Vegetables – Artichokes, asparagus, broccoli, cauliflower, green beans, cucumber, lettuce, onions, spinach, tomato, radishes, zucchini, mushrooms (boiled), dried beans, pinto beans, black beans, chickpeas, kidney beans, and soybeans.
  • Limit – Corn, carrots, beets, and potatoes.
• Preferred Grains  (low sugar, least refined, and high fiber) – Stone-ground whole grain pasta, brown rice, old-fashioned oatmeal, rye, whole grain bread, high fiber whole grain cereals, barley, whole wheat crackers.
  • Limit – White bread, white rice, low-fiber – high sugar cereals, corn flakes, puffed rice, corn chips, rice cakes, graham crackers, puffed wheat, white bagels, white pretzels, spaghetti, white croissants, white flour, and popcorn.
• Miscellaneous Limit or avoid – refined sugar, honey, jam, sugary beverages, and beer.

Fats

Fats are dense in calories providing 9 calories per gram. 30-35% of your total calories should come from fat. Fat comes from both animal and plant sources. Some fat is essential to the body for maintaining skin and hair, keeping our bodies warm, protecting cell walls, storing and transporting (fat-soluble) vitamins, and are necessary for hormone production. There are three types of fat:

1. Saturated fat
2. Monounsaturated fat
3. Polyunsaturated fat

Saturated fat is usually solid at room temperature. It is found in foods from animal products such as meat, poultry, butter and whole milk. Tropical oils such as coconut and palm oil are also high in saturated fat. Saturated fat raises your blood cholesterol and increases your risk for coronary artery disease. You should limit saturated fat to no more than 8-10% of total calories.

Monounsaturated fat is liquid at room temperature and is found in olive oil, canola oil, and peanut oil. Monounsaturated fat is considered a “good fat”. It has been proven to lower LDL (bad) cholesterol while maintaining or raising HDL (good) cholesterol levels. The bulk of your fat calories should come from monounsaturated fat. Use olive oil for cooking and salad dressings.

Polyunsaturated fat is liquid at room temperature. It is found in nuts and vegetable oils such as safflower, sunflower, soybean, corn, peanut, walnut, flax seed, and in fatty fish. Fats from this group are called essential fatty acids. They are necessary for the body to function. The body is unable to manufacture essential fatty acids so they must come from your diet. These essential fatty acids are subdivided into two families: “omega-3” and “omega-6” fatty acids. A balance is necessary between these 2 fatty acids. Most diets include an excessive amount of omega-6 fatty acids.

• Omega-3 fatty acids: the best food sources for omega-3 fatty acids are fatty cold-water fish such as salmon, steel head, trout, tuna, sardines, and mackerel. Lean fish such as cod contain less omega-3 fatty acids than fatty fish. Omega-3 fatty acids are also found in plant-based forms such as walnuts, almonds, flaxseeds, flaxseed oil, canola oil, and some dark green leafy vegetables. You should eat a diet rich in omega-3 fatty acids. Try canola oil mayonnaise and spreads. Make your own salad dressings with canola oil or olive oil. Add flax seeds to your favorite recipes or cereal. Use canola oil for baking.
• Omega-6 fatty acids: Corn, safflower, sunflower, soybean, and cottonseed oil are high in omega-6 fatty acids. Omega-6 fatty acids lower LDL but also lower HDL. Limit or avoid oils high in omega-6 fatty acids.

Trans fats are a type of fat created when liquid oil such as corn oil undergoes hydrogenation. This process makes the oil thicker and less likely to spoil. The resulting fat may cause an increased risk for cardiovascular disease by raising your LDL (bad cholesterol) and lowering your HDL (good cholesterol). Trans fats are not listed as such on food labels. Look for clues such as the more solid an oil, the greater the amount of trans fat, and for the terms hydrogenated or partially hydrogenated. Avoid all products that contain trans fats (partially hydrogenated oil): Shortening, stick margarine, pastries, commercially prepared snacks, and mixes, potato and corn chips, flavored popcorn, and some commercially prepared salad dressings.

Review of the Mediterranean Diet

• Strive for a more plant-based diet.
• Go meatless several times a week.
• Try vegetable protein sources such as legumes and soy.
• Increase fiber.
• Eat foods in their least refined version such as whole grains.
• Eat at least 7 servings of fruits and vegetables daily.
• Use olive oil and canola oil as your main fat source.
• Decrease saturated fat to no more than 8-10% of total calories.
• Use low-fat dairy products.
• Use cheese as a flavoring or seasoning.
• Up to four eggs with yolks are allowed weekly (depending on your cholesterol).
• Use lean meat sources such as chicken and turkey, venison, and elk.
• Limit red beef, lamb, and pork to 1-2 times per month.
• Limit trans-fatty acids by avoiding margarine, shortening, deep-fried foods, and commercially prepared baked goods and snacks.
• Avoid corn, safflower, sunflower, and soybean oils.
• Increase omega-3 fatty acids in your diet.
• Eat cold-water fatty fish several times per week. Walnuts, canola oil, flaxseeds, and some vegetable greens are also good sources of omega-3 fatty acids.
• Avoid high-glycemic index carbohydrates such as soft drinks, white rice, sugar, potatoes, sugary breakfast cereals, white flour, corn, white bread, and beer.

Mediterranean Diet Menu Ideas

• Breakfast #1: High-fiber cereal, nonfat milk, 1 cup of fresh fruit
• Breakfast #2: Vegetable omelet (1 egg plus 2 egg whites), vegetables sautéed in canola oil, 1 slice whole-grain toast, 1 tsp canola spread
• Breakfast #3: Low-fat cottage cheese, cantaloupe, 1 slice whole grain toast
• Breakfast #4: Old-fashioned oatmeal, nonfat milk, poached egg

• Lunch #1: Turkey sandwich (whole-grain bread, canola mayonnaise, lettuce tomato), low-fat milk
• Lunch #2: Tuna salad sandwich (whole-grain bread, canola mayonnaise, lettuce)
• Lunch #3: Bean soup, green salad with olive oil vinaigrette
• Lunch #4: Green salad with tuna, whole grain, high fiber wheat crackers, apple
• Lunch #5: Chicken sala, whole-wheat roll, fruit

• Dinner #1: Broiled salmon, green salad, steamed broccoli, 1 small whole grain dinner roll
• Dinner #2: Grilled tuna, squash, steamed spinach
• Dinner #3: Chicken stir-fry, brown rice, green salad with vinaigrette
• Dinner #4: Chicken breast, brown rice, brussels sprouts, whole grain roll
• Dinner #5: Bean soup, whole grain bread, green salad with vinaigrette
• Dinner #6: Whole grain pasta with tomato vegetable sauce, steamed vegetables, green salad with vinaigrette
• Dinner #7: Lean roast beef, small baked potato, green salad

Mediterranean Diet Resources

If you would like further information, you may find the following books and articles helpful:

1. The Omega Diet by Artemis Simopoulos, M.D. and Jo Robinson (Best book overall)
2. Sugar Busters by H. L. Steward, Morrison C. Bethea, M.D., Sam S. Andrews, M.D., Luis A. Balart, M.D.
3. Mastering the Zone by Barry Sears, Ph.D.
4. Good Fat Bad Fat by William P. Castelli, M.D. and Glen C. Griffin, M.D.