What Is the “Mediterranean Diet” Anyway?

The Mediterranean diet is a diet plan that has been getting a lot of positive press due to its reputation as a heart healthy diet. The diet is based upon the traditional diets of people living in Spain, Italy, and Greece. Typically, the diet is based upon unrefined grains, legumes, fruits, vegetables, olive oil, and fish, with only moderate consumption of dairy or meat. A recent study in the New England Journal of Medicine highlighted the benefits of a Mediterranean diet for primary prevention of cardiovascular disease. But what do we really know about this diet?

In the aforementioned study, the Mediterranean diet was found to be superior to a low fat diet. However, one of the major criticisms of this new study is that the ‘low fat diet’ in comparison was hardly that. This diet was actually more of a typical American diet with 39% fat than a true low fat diet. Truthfully, there are loads of diets that are healthier than the typical American one.

Another problem in interpreting these results is the unclear definition of the Mediterranean diet. To date, there have been over 1500 scientific publications on this diet and almost the same number of definitions. Even inside clinical studies, the term “Mediterranean diet” has been used very loosely.

As a physician, this leads to an even bigger problem of recommending a “Mediterranean diet” to someone. What exactly is it? Is it essentially a vegan diet with splashes of cheese or fish? Is it a diet based on olive oil, bread, pasta, and tomatoes? I’ve found that patients need more concrete help in their quest to eat better. Telling them to ‘eat a Mediterranean diet’ is about as effective as telling them to ‘just quit smoking’. People typically need more direction.

The current study did give us some direction. In the study’s detailed diet inventory, the only differences between the Mediterranean and quasi-low fat diet that were associated with better heart health were:

Use more extra-virgin olive oil (‘good fat’).
Eat more nuts (more ‘good fat’)
Eat more legumes (beans).
Eat more fish.

Instead of giving vague advice (i.e. eat a ‘Mediterranean diet’ or conversely eat a ‘low fat diet’) we should give concrete, actionable recommendations. For example, ‘eat more nuts’ is a pretty achievable health goal. For people looking to live healthier; it is easier to live up to specific goals than a vague standard.

In terms of the Mediterranean diet, I’ve found two common trends. The first is the focus on plant foods. Although the diet allows meat and dairy in low to moderate amounts, the overwhelming focus is on plant foods. The diet encourages increased consumption of fruits, vegetables, unrefined (whole) grains, and legumes (beans, peas, and lentils). Anyone could benefit from this recommendation, no matter what diet they may be following.

The other thing we can learn from the Mediterranean diet is to focus on “good” fats. Unsaturated fats, which are found in plant foods such as nuts, seeds, olive oil, vegetable oils, and avocados are considered to be good or healthy fats. Although moderation needs to be exercised, unsaturated fat is not something to fear. In fact, it much better for you than the saturated fats found in meats and dairy.

So next time you hear talk about the Mediterranean diet, remember these two trends. It will not only benefit your heart, but the rest of your health as well.



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Harvey Hahn, MD, FACC

Dr. Hahn graduated from Loma Linda University in 1994. He is currently the director of the Cardiovascular Fellowship Training Program at the Kettering Medical Center in Kettering Ohio.

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