Mediterranean Diet: Choosing Heart-Healthy Foods and Snacks

According to Dina Dugan, MS, RD, LDN, a clinical dietitian with Baystate Noble Hospital in Westfield, MA, “The Mediterranean diet is more than just a meal plan. It’s a lifestyle rooted in the traditional eating habits of countries bordering the Mediterranean Sea, such as Italy, Greece, and Spain—all countries with historically low rates of chronic disease and high life expectancy.”

Another clinical dietician with Baystate Health, Brandy Sarrette, RDN, LDN, adds, “The Mediterranean diet is one of the longest and most well-researched diets in the world. Research has repeatedly found it reduces heart disease and certain cancers, lowers bad cholesterol and blood pressure, contributes to weight loss, stabilizes blood sugar levels, and improves quality of life.

What Is the Mediterranean Diet?

Often referred to as the anti-inflammatory diet and often recommended for those with cardiovascular disease, the Mediterranean diet emphasizes the consumption of whole, unprocessed foods, focusing on a wide variety of plant-based ingredients, lean healthy proteins, and healthy fats while encouraging an active lifestyle.

“In combination,” says Dugan, “these foods and lifestyle habits work to address several major health issues afflicting many Americans, including heart disease—the cause of 1 in 5 deaths in 2022, high blood pressure, type 2 diabetes, and high cholesterol. Research also suggests its anti-inflammatory and antioxidant properties work to protect against obesity and certain cancers, stabilize blood sugar levels and may even contribute to better brain health.

“The best part,” Dugan adds, “is that it’s not restrictive in the same way many other diets are. By embracing it as a true lifestyle as opposed to a limited-time diet, you can enjoy a wide variety of flavorful foods while reaping the health benefits it provides.”

Eating for Better Heart Health

As heart disease is the number one cause of death in the U.S., the Mediterranean diet is frequently recommended for people who’ve experienced or are at risk for a cardiac episode.

Sarrette explains, “Each of the featured foods has a component that works to protect the heart or reduce risk factors that can negatively impact heart health.”

The primary heart-health benefits of the diet include:

• Reduced risk of heart attack and stroke: Omega-3 fatty acids found in fatty fish such as salmon, tuna, sardines, and herring reduce blood clots that could lead to stroke or heart attack.
• Reduced inflammation: Rich in antioxidants, vitamins, and minerals that help reduce inflammation, the Mediterranean diet can help with a variety of conditions linked to inflammation, including diabetes, obesity, and several types of cancer.
• Lowered cholesterol: Healthy fats found in olive oil, nuts, and seeds lower levels of low-density lipoprotein (LDL, aka ‘bad’ cholesterol) and overall cholesterol levels
• Better weight management: Consuming fresh vegetables, fruits, whole grains, and healthy fats can help with weight loss and long-term management, which reduces risk of heart disease and other chronic conditions.

What to Eat On the Mediterranean Diet

Like the traditional FDA food pyramid that we’re all accustomed to seeing, the Mediterranean diet is also structured like a pyramid. However, Dugan’s quick to note, “That’s where the similarities end.”

“One of the most interesting aspects of the Mediterranean diet is that the biggest, base layer isn’t comprised of food choices. Instead, it focuses on the elements of a healthy lifestyle. This includes regular physical activity, getting adequate rest, maintaining a positive attitude, and engaging with others through shared meals and other activities.”

She notes that the diet provides a lot of leeway to followers on this level. “The idea is that the lifestyle should be something you enjoy doing so it’s not as prescriptive as other diets. For example, on the physical activity front, do whatever you enjoy doing. That might be walking, biking, yoga, dancing, and so on. The key is to do something every day at whatever level you can do it. Even better, do it with friends or family or even a class so you can benefit from the lift that spending time with others gives our mental health.”

The next layer of the pyramid reflects the importance of staying hydrated to our physical health. “Again, there’s lots of room for personal preference and taste here,” says Dugan. “You want to aim for six to eight 8-ounces glasses of water daily, but you can consume that in the form of herbal teas or fruit- or herb-infused water to keep things interesting and tasty.”

The Mediterranean diet also allows for the consumption of red wine in moderation. “People tend to get a little excited about this aspect of the diet but it’s important to keep the word ‘moderation’ in mind and to also know that if wine doesn’t fit with your lifestyle or health needs, it’s not a must-have,” says Dugan. “If you do choose to include red wine, you should limit consumption to one 5-ounce glass per day if you’re a woman and two glasses per day if you’re a man.”

The balance of the pyramid is broken into things you should consume with every meal, things you should consume daily, and things you should consume on a weekly basis.

On the every-meal front, fruits and vegetables are prominent. “Ideally,” says Dugan, “you want to have 1-2 servings of fruit with each meal. This can be a small piece of fruit or ½ cup of cut fruit. You also want to include 1-2 servings of vegetables. That equates to about 1 cup of raw vegetables or ½ cup cooked. If possible, strive for a colorful assortment for the maximum intake of different vitamins.”

Your every-meal intake should also include whole grains. This could be in the form of rice (brown, red, or wild), barley, quinoa, whole-grain cereal or whole wheat bread. Dugan encourages people to be careful when choosing whole grain breads.

“You want to look for ‘whole wheat flour’ and not just ‘wheat flour on the label,” she says. “The term ‘100% whole grain’ is also an indication that a product is providing what’s desired.”

Olive oil should also be included in every meal. “This could be for cooking or as a dressing,” says Dugan. “Extra virgin is best, but regular olive oil is a better choice than other fattier types of oils”

Sarrette adds, “You really have a world of ingredients to choose from to make healthy, delicious meals and snacks…and you can pull it off in almost every cuisine style,” she says. “It may take a bit of time to adjust to a new approach to cooking and enjoying food, but it’s not difficult or more expensive than other ways of eating.”

Moving up the pyramid to foods to consume on a daily and weekly basis, Dugan says Mediterranean diet followers should enjoy the following:

Daily: 1-2 servings

Daily: 2 servings

Weekly: 1 serving

• Processed meat (hot dogs, sausage, bacon)
• Red meat
• Sweets (small slice of cake, serving of candy per package lable)

Weekly: 2 or more servings

• Fatty fish (salmon, tuna, halibut)
• Eggs (up to 4 servings per week)
• Legumes
• White meat (no more than 2 servings per week
• Potatoes (no more than 3 servings per week)

She adds, “Feel free to add fresh fruit, nuts, or even a drizzle of honey to your yogurt. Whatever makes it more flavorful or enjoyable for you.”

Stocking Your Pantry for the Mediterranean Diet

To make the transition to the Mediterranean diet easier, make sure you consistently have the ingredients on hand to prepare meals and snacks that fall in line with the diet.

She recommends the following:

Eating on the Mediterranean Diet When Away from Home

Dining out doesn’t have to mean abandoning the diet. Instead, use these strategies when ordering.

If you’re traveling, pack your snacks before heading out. “Convenience store options rarely check the boxes for healthy,” says Dugan. “Instead take an extra minute to fill a baggie with nuts, baby carrots or other durable veggies, or even a piece of fruit. They’re easy, healthy and can help quell a snack craving much better than any fried bagged option.”

Your Diet, Your Health, Your Terms

Both Dugan and Sarrette acknowledge that making dietary changes can be tricky—especially when cooking for others. While they don’t discourage people from going all-in for the fastest benefits, they note that it’s perfectly fine to ease your way into the diet. Simply increasing your fruit and vegetable intake to one serving with every meal or snack can be an important first step to enjoying a healthier way of eating and living.

• Vegetables (fresh, frozen, and low-salt or no-salt canned)
• Tubers (sweet, white, yellow and purple potatoes)
• Whole grains (bread, pasta, rice, and cereals)
• Fruit (fresh, frozen, or canned if packed in own juice)
• Legumes (lentils, chickpeas, black beans, kidney beans, etc.)
• Nuts and seeds (unsalted or low salt)
• Seafood (sardines, salmon, trout, shrimp, mackerel, mussels, scallops, and tuna either fresh or canned)
• Dairy (low-fat versions of yogurt, milk, and cheese)
• Poultry
• Eggs
• Healthy fats (extra-virgin olive oil, olives, avocados, avocado oil)
• Choose fish, seafood, or a vegetarian main entrée
• Ask for foods to be grilled instead of fried
• Choose whole grain breads
• Add vegetables to your order including salads or grilled or steamed options without any heavy sauce