What is a Mediterranean diet and how to start?

If you know anything about healthy eating, you’ve probably heard about the benefits of eating Mediterranean-style.

For someone testing the waters of heart-healthy eating, that diet can vary. Mediterranean-style eating isn’t necessarily about eating so many servings of a particular food at each meal, said Catherine M. Champagne, a professor of nutritional epidemiology and dietary assessment and nutritional counseling at Louisiana State University in Baton Rouge. “It’s more of a pattern.”

It includes:

  • Fresh fruits and vegetables.
  • Nuts, beans and whole grains.
  • Olive oil as the main source of fat, not butter or margarine.
  • Fish and other seafood.
  • Limit your intake of red and processed meats, sugary sweets, processed foods, and some dairy.

It has its roots in the traditional habits of people in countries bordering the Mediterranean Sea, where rates of heart disease tend to be lower and life expectancy after age 45 is among the highest in the world.

Studies have linked Mediterranean diets with lower cardiovascular risk. One, published in 2018 in JAMA Network Open, found that among nearly 26,000 American women followed for up to 12 years, adherence to such a diet was associated with a quarter lower risk of any of four cardiovascular events, including heart attack and stroke.

Mediterranean-style eating was incorporated into the recent update to an American Heart Association tool for assessing heart health, called Life’s Essential 8. The experts behind Life’s Essential 8 supported both Mediterranean-style eating patterns and DASH, o Dietary Approaches to Stop Hypertension, which have many similar components. Life’s Essential 8 rates diet based on an assessment tool for what is called the Mediterranean eating pattern for Americans.

Christy Tangney, a professor of clinical nutrition and preventive medicine at Rush University Medical Center in Chicago, helped create the 16-question assessment tool.

One of the hallmarks of Mediterranean-style eating is its flexibility, Tangney said. Research in Spain on Mediterranean food, for example, includes soffrito, a sauce made from olive oil and vegetables that is commonly eaten there. Tangney’s Americanized filter leaves out the stir-fry because it’s rarely seen in American diets, and adds berries instead.

The Mediterranean diet lowers “bad” LDL cholesterol, and research suggests it doesn’t affect “good” HDL or slightly increases it, Champagne said.

“We’ve seen a lot of heart health benefits with a Mediterranean diet,” he said.

That doesn’t mean it’s perfect. People trying to lose weight will still need to cut calories. And Tangney said it can be challenging for Americans to embrace whole grains, move away from processed foods and cut back on dairy products like cheese.

In addition, access to fresh fruits, vegetables and other foods in a Mediterranean eating pattern can be challenging for people with low incomes, said Dr. Annabelle Santos Volgman, a professor of medicine at Rush University Medical Center and director Rush Heart medical. Women’s Center.

Understanding the role of wine can also be tricky. The moderate consumption of wine, one or two drinks a day, has been considered part of the diet. But Volgman, who worked with Tangney to develop the screening tool, said the wine’s potential benefits outweigh any potential harm. Federal guidelines recommend that people who don’t drink alcohol shouldn’t start, and for those who do drink, less is better for health.

These caveats aside, adopting aspects of the Mediterranean diet can be easy.

Adopting extra virgin olive oil for cooking or in salad dressings is a place to start, Tangney said. Eat green leafy vegetables every day. “When you look at your plate, most of your plate should be vegetables,” she said.

For protein, a Mediterranean eating plan would see you cut back on red meat, so try fatty fish like anchovies, salmon, mackerel, tuna, or sardines once or twice a week. Beans are a good source of protein; Tangney suggests having them three times a week. Eat nuts or fresh fruit instead of sweets for dessert.

Champagne said breakfast could include olive oil spread on whole-grain toast and possibly an egg. A dinner of salmon with pilaf and a large serving of sautéed vegetables might do the trick, she said. Pasta must be whole grain. And people who don’t really enjoy olive oil can find healthy fats in nuts or avocados.

Diet is not the only part of Mediterranean life that is important for heart health. The eating pattern is historically associated with lifestyles that include exercise and social activity.

But the flexibility that makes Mediterranean-style eating hard to define may make it easy to adopt.

“People love choice,” Tangney said.

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