6.8: Mediterranean Diet

The Mediterranean diet, named for the regional cuisine it represents, was introduced in Section 2.6 of this book. Both the American College of Cardiology and the American Heart Association state that the Mediterranean Diet food pattern is supported for heart health. Their primary recommendations are as follows:¹

• Focus on a food pattern that includes vegetables, fruits, legumes, nuts, whole grains, and lean protein.
• Reduce saturated fat to less than 6% of total calories, and replace those fat calories with monounsaturated and polyunsaturated fats, complex carbohydrates, and fiber.
• Avoid trans fat.
• Limit refined carbohydrates (those containing less than 25% whole grain by weight) and sugar-sweetened beverages.
• Keep daily sodium intake to less than 2300 mg, but optimally less than 1500 mg, and limit processed meats.
• Go for a food-first approach to your health. For heart health, don't depend on supplements. Dietary supplements, including omega-3 fatty acids, vitamins C, D, and E, beta-carotene, and calcium, have not been proven to reduce the risk of heart disease.

Figure \(\PageIndex{1}\):Digital rendering of the satellite view of the Mediterranean Sea. This globe rendering is a screenshot from the Globe Master geography game, shared by the game authors. For the globe texture, Whole world - land and oceans composite image was used, created by NASA/Goddard Space Flight Center (public domain). This file is licensed under CC BY 3.0.

Mediterranean Diet Score Quiz

1. Take the Mediterranean Diet Score Quiz. A higher score has been linked to better health outcomes related to heart health, diabetes, cancer, obesity, and mental health.
2. Give yourself one point for every YES answer and zero points for every NO answer.
3. For each NO answer, read the suggestions to see if there are areas of your food intake that could improve to match the recommendations. Research indicates that for every 2-point increase (two small changes) in your score, there is a reduction in risk factors for disease.²

Instructions describe table elements

	Question	YES	NO	Suggestions to Align with a Mediterranean Food Pattern
1	Fruit: do you eat 3 fruit servings daily? One serving = 1 whole fruit or 1/2 cup fruit).			Colorful fruits from a variety of sources provide the fiber and nutrients that support heart health.
2	Vegetables: do you eat 2 servings of vegetables daily? One serving = 1 cup fresh or cooked or 2 cups fresh salad greens			Colorful vegetables from a variety of sources provide the fiber and nutrients that support heart health.
3	Do you eat vegetables, pasta, or rice dishes with a homemade sauce of garlic, onions, olive oil, and tomatoes twice or more weekly?			In the Mediterranean Diet, it is common to include homemade sauces made with garlic, onions, olive oil, and tomatoes.
4	Red meat: do you eat less than 1 serving of red meat, hamburger, sausage, or processed meats daily? One serving=3 1/2 to 5 ounces			Choose lean meats and cooking methods that require less fat (e.g., grilling, baking, and broiling). Try more white meat, fish, and plant sources of protein.
5	Chicken or turkey: do you choose chicken or turkey more often than beef, pork, hamburger, or sausage?			Ideal lean proteins are those without visible fat or skin.
6	Fish or seafood: do you eat fish or seafood at least 3 times per week? One serving=3 1/2 to 5 ounces of fish or 4 to 5 pieces of seafood.			Eat more white or oily fish. Fish rich in Omega-3 fatty acids include salmon, trout, herring, sardines, and anchovies.
7	Legumes (beans, lentils, peas): do you eat 3 servings or more each week?			Legumes provide soluble fiber, protein, and nutrients that support heart health. Legumes are a budget-friendly option.
8	Nuts: do you eat nuts at least 3 times per week? 1 serving=one ounce			Nuts, such as walnuts, almonds, and pistachios, provide healthy fats, fiber, and vitamins that support heart health.
9	Olive oil: is olive oil the main source of fat you use for cooking?			Olive oil is high in monounsaturated fatty acids.
10	Olive oil: do you have 4 tablespoons or more of olive oil each day?			Olive oil is a healthy choice for cooking and preparing foods.
11	Butter, margarine, and cream: do you eat less than 1 Tablespoon of butter, margarine, and cream daily?			Consider plant-based alternatives for the dairy additions.
12	Sugar-sweetened beverages: do you drink less than one can (12 ounces) daily?			Consider drinks that are lower in sugar. High-sugar drinks have a negative impact on diabetes and heart disease.
13	Baked goods: do you eat commercial or packaged baked goods (cookies, cake, doughnuts) less than twice per week?			Try baking snacks with healthier ingredients, or choose packaged snacks that are lower in processed sugars, fat, and sodium.
14	Wine: do you drink 3 or more glasses of wine per week? 1 serving = 5 ounces			If you don't drink alcohol, don't start for the sake of improving your diet score!

Attributions

Zimmerman, "An Introduction to Nutrition (Zimmerman)," CC BY-NC-SA 3.0. Text and references added.

References

1. Virani S, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9):833-955. doi:10.1016/j.jacc.2023.04.003.
2. Martínez-González MA, García-Arellano A, Toledo E, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134. doi:10.1371/journal.pone.0043134.