PATIENT EDUCATION
The Mediterranean Diet
BARBARA WOODWARD LIPS
PATIENT EDUCATION CENTER
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Heart disease is less common in the countries that border the Mediterranean Sea than
it is in the United States. Researchers believe that the diet people follow in Greece and
southern Italy is a key to their health.
The Mediterranean diet is more than a “diet.” It is a heart-healthy eating plan. For most
people, what is good for your heart is good for your brain — and the rest of your body, too.
When you follow this eating plan on a regular basis, you lower your risk for:
Death from cardiovascular disease and stroke.
Cancer and death from cancer.
Alzheimer’s, a disease that affects the brain, and Parkinson’s, a disease that affects
the nervous system.
Type 2 diabetes.
The Mediterranean diet is shown to improve the effects of inflammatory diseases such
as arthritis. In addition, it also may improve the well-being of those with depression.
Studies have shown a reduction in:
Dementia.
Frailty.
Macular degeneration in people 60 years of age and older.
Childhood asthma.
Erectile dysfunction and female sexual dysfunction.
Metabolic syndrome.
Arthritis.
Atrial fibrillation.
If you have questions after you read this or want more information about this eating
plan, talk with your health care provider or a registered dietitian.
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The Keys to a Heart-Healthy Diet
The key components of the Mediterranean diet include:
Eating whole grains, fruits, vegetables and plant-based fats every day.
Eating fish, poultry, eggs, beans and legumes weekly.
Eating only moderate portions of dairy.
Eating a limited amount of red meat.
Drinking a sensible amount of red wine.
Taking part in regular physical activity.
Drinking water or unsweetened tea every day.
Using fresh herbs and spices for flavoring.
Making mealtime a social gathering with family and friends.
Know what to eat
Fruit and vegetables
Incorporating fruits and vegetables into your diet on a regular basis helps you to meet
your daily requirements for vitamins, minerals and fiber. Additionally, these foods
are excellent sources of antioxidants and phytochemicals (plant-based nutrients) that
support our health in numerous ways.
It is important to choose a variety of produce based on the type, color and
preparation method.
Various preparation methods can affect content and bioavailability of nutrients. While
some nutrients will dissipate quickly with heat, others become more readily absorbed
after being cooked.
A good goal is to aim for 2 to 3 servings of fruits and 4 or more servings of vegetables per
day. If this sounds like a lot for you, always remember that some is better than none!
One serving of fruit equals:
1 medium piece of fruit
1 cup of cut fruit
One serving of vegetables equals:
2 cups leafy vegetables
1 cup raw vegetables
½ cup cooked vegetables
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More tips:
Eat seasonal produce.
Wash your produce to remove dirt and surface pesticides before you eat it.
Buy canned fruit in water or its own juice.
If you buy frozen fruit and vegetables, be sure to read the labels and avoid added
sodium and sugar. Flash frozen vegetables and fruit keep their nutrients better in
the freezing process.
Seafood
Fish and shellfish are excellent sources of protein. Additionally, cold-water fish contain
high amounts of heart healthy, anti-inflammatory omega-3 fats. Examples of cold-water
fish include albacore tuna, salmon, lake trout, sardines, mackerel and herring.
Try to eat three or more servings of fish per week. One serving equals 3 to 5 ounces,
which is about the size of a standard deck of cards.
Poultry
Choose white meat or poultry, such as chicken and turkey, without the skin. One
serving is 3 ounces, which is about the size of a deck of cards.
Fast facts
People in Greece eat an average of nine servings a day of antioxidant-rich fruits
and vegetables. Some antioxidant-rich fruits are prunes, raisins, blueberries,
blackberries, strawberries, raspberries, plums, oranges, red grapes and cherries.
Antioxidant-rich vegetables include kale, spinach, Brussels sprouts, alfalfa
sprouts, broccoli, beets, red bell peppers, onions, corn and eggplant.
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Legumes and beans
Eat three or more servings per week of legumes or beans. One serving is a half-cup.
Some examples of legumes are split peas, lentils and peanuts. Limit your intake of
peanuts; they are high in fat. Some examples of beans are red, green, black, lima,
kidney, soy and navy. Most legumes and beans are high in fiber and protein and low in
fat. Legumes and beans can be a healthy and inexpensive substitute for meat.
Grains
Whole grains are part of a balanced diet as they provide your body with fiber, vitamins
and minerals. Choosing 100% whole grains, instead of white refined products, ensures
maximum nutrient content within your foods and helps to regulate blood sugar levels.
Serving sizes for various grain products vary. Always check the nutrition facts label
and talk to your dietitian to determine the number of servings that is best for you.
Nuts and seeds
Nuts and seeds are excellent sources of a variety of nutrients such as dietary fat, fiber,
vitamins and minerals. For example, almonds are rich in protein, while Brazil nuts
contain high amounts of selenium. Nuts are perfect for snacks and pair well with
salads, yogurt and many other dishes.
Try to eat four servings of nuts per week. One serving equals 1/4 cup. Be sure to look
for raw, unsalted nuts and seeds.
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Healthy fat
The Mediterranean diet focuses on regularly choosing foods high in unsaturated
fat. Unsaturated fat can help reduce your LDL cholesterol level. A good choice of
unsaturated fat is olive oil. It is a staple in the Mediterranean diet. Extra-virgin olive
oil and virgin olive oil are the least-processed forms and provide antioxidant benefits.
Olive oil can be used instead of butter or margarine.
Unsaturated fats are plant-based and liquid at room temperature. While coconut oil can be
liquid in warmer climates, it is high in saturated fat and is not the best choice for regular
cooking. Additional sources of unsaturated fat include grapeseed oil and avocado oil.
Limit saturated fats and avoid hydrogenated and partially hydrogenated oils. These
are called trans fats. They can contribute to heart disease. Look for these words on
nutrition labels to help you determine which products are healthiest for you.
Dairy
Dairy can be a good source of protein and calcium. Choose low-fat or non-fat products,
such as skim milk or 1% milk, low-fat cottage cheese or sliced cheese, and low-fat or
non-fat yogurt.
Avoid yogurt with added sugar. Add your own fruit or flavoring to plain yogurt, if
you prefer.
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Balance your plate
A healthy meal includes about half a plate of non-starchy vegetables and fruit, a quarter
plate 100% whole grains and a quarter plate of a lean protein. Starchy vegetables include
potatoes, corn, peas and winter squash. Limit the amount of starchy vegetables you eat.
Dairy could be skim milk or reduced-fat yogurt. Limited amounts of healthy fats are
included too.
Mediterranean cooking
Tomato sauce
Homemade tomato sauce is commonly used in Mediterranean dishes. Cook with sauce
made from tomato, garlic and onion, plus herbs to taste. Use it over vegetables, pasta,
rice and other dishes. You can make this sauce with olive oil and chopped ingredients.
Simmer slowly over low heat.
Extra-virgin olive oil
Use extra-virgin olive oil most often for low-heat cooking, such as sautéing. Do not use
it for frying or other high-heat cooking methods. Use it for salad dressing as well.
Herbs and spices
Choose herbs and spices instead of salt to flavor your food. They taste great and are
better for most people than salt (sodium). Consider adding oregano, thyme, garlic, basil,
mint, parsley, rosemary and sage.
Consider meatless meals
Many people find going meatless for some or all of their meals works well within the
Mediterranean diet. Meatless meals could include lentils, beans and soy as the main
protein source.
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Know what to eat less of
Limit foods high in saturated fat and sugar when following a Mediterranean diet.
Red meat and processed meats
Limit red and processed meat, including beef, pork, goat, lamb, hot dogs, sausages,
brats, cured ham, cold cuts and packaged lunch meat. Be sure to remove all the fat you
can see before you cook the meat.
High-sugar, high-fat and highly processed foods
Limit high-sugar desserts, including pastries, cakes, cookies, candy and pudding. Also
limit fried foods, such as French fries and potato chips.
High-fat dairy products
Limit whole and 2% milk, butter, margarine and ice cream. Limit the amount of cheese
you eat. One serving of cheese is the size of four small dice.
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High sugar drinks
Avoid sweetened and sugary beverages. Carbonated water is fine. Limit fruit juice.
Eating a whole fruit provides more nutrients and health benefits.
Consider these topics too
Wine and alcohol
The Mediterranean diet typically includes wine. However, it is an optional part of this
eating plan. In moderate amounts, alcohol can reduce the risk of heart disease.
Drinking more than the suggested amounts may increase your risk of health problems,
including certain types of cancer.
If you drink alcohol, choose wine as your primary drink. Red wine is a more Mediterranean
choice than white wine. But white wine is fine too. Limit your intake to one glass per day.
Drink it with a meal. In general, 5 ounces is considered one glass of wine. Studies have
shown benefit for men when they drink 5 ounces of wine per day and for women when they
drink 3 ounces of wine per day.
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Water
The best fluid for the body is water. Your body depends on water to regulate body
temperature, remove wastes and carry nutrients and oxygen to your cells, among
other tasks.
Relax and enjoy eating
A big part of the Mediterranean way of life is to slow down and enjoy yourself! Sit at a
table for your meals as frequently as possible and limit distractions while you eat. Take
at least 20 minutes to enjoy those meals, and try to eat as many meals as possible with
family and friends.
Exercise
Daily physical activity and regular exercise are important to support and maintain
a healthy lifestyle. This includes leisure activities but also getting a set amount of
vigorous activity. General recommendations are to get at least 150 minutes of moderate
intensity exercise per week.
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Traditional Mediterranean diet foods
Use the following food list to plan your meals.
Vegetables Seafood
Artichokes
Arugula
Beets
Broccoli
Brussels sprouts
Cabbage
Carrots
Celery
Celeriac
Chicory
Collard greens
Cucumbers
Eggplant
Fennel
Kale
Leeks
Lemons
Lettuce
Mushrooms
Onions
Peas
Peppers
Potatoes
Pumpkin
Radishes
Scallions
Shallots
Spinach
Sweet potatoes
Zucchini
Clams
Crab
Eel
Flounder
Lobster
Mackerel
Mussels
Octopus
Oysters
Salmon
Sardines
Sea bass
Shrimp
Squid
Tilapia
Tuna
Yellowtail
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Fruits Herbs and spices
Apples
Apricots
Avocados
Cherries
Clementines
Dates
Figs
Grapefruit
Grapes
Melons
Nectarines
Olives
Oranges
Peaches
Pears
Pomegranates
Strawberries
Tangerines
Tomatoes
Anise
Basil
Bay leaf
Chiles
Cloves
Cumin
Fennel
Garlic
Lavender
Marjoram
Mint
Oregano
Parsley
Pepper
Rosemary
Sage
Sumac
Tarragon
Thyme
Za’atar
Dairy Nuts, beans, legumes and seeds
Brie
Chevre
Feta
Manchego
Parmigiano-Reggiano
Pecorino
Ricotta
Yogurt (including Greek yogurt)
Almonds
Cannellini beans
Chickpeas
Cashews
Fava beans
Green beans
Hazelnuts
Kidney beans
Lentils
Pine nuts
Pistachios
Sesame seeds
Split peas
Walnuts
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Inventory: How Do You Eat Now?
If you answer yes to a question, put a 1 next to that question. Then add up
your total points.
What does it all mean?
There are 14 points possible on this inventory. To eat a heart-healthy diet, your goal
should be 11 or more points.
Do you use olive oil as your main cooking fat?
Do you use an olive-oil-based sauce 2 or more times per week?
Do you eat 4 Tablespoons or more per day of olive oil?
Do you eat 2 or more servings per day of vegetables? One serving is 1
cup of raw veggies or 1/2 cup of cooked veggies. These measurements
are about the size of tennis ball.
Do you eat 3 or more servings per day of fruit? One serving is
1 whole medium-size fruit or about 1 cup of fresh fruit. These
measurements are about the size of tennis ball.
Do you eat 3 or more servings per week of beans, such as kidney or
black beans, or legumes, such as split peas and lentils? One serving is
1/2 cup of cooked beans.
Do you eat 4 or more servings per week of nuts? One serving is 1/4 cup.
Do you eat 3 or more servings per week of fish or shellfish?
One serving is 3 to 5 ounces of fish or 6 to 7 ounces of shellfish.
Do you consume skinless white meat poultry (chicken, turkey) more
often than red meat (beef, pork, lamb)?
Do you eat 1 serving or less per day of meat: hamburger, veal, lamb,
venison, pork, ham or sausage? One serving is 3 ounces (oz.), the size
of a deck of cards.
Do you eat 1 serving or less per day of butter, margarine or cream?
One serving is 1 teaspoon.
Do you drink 1 can or less per day of sweetened carbonated
beverages? One can is 12 oz.
Do you eat 3 servings or less per week of sweets or pastries, such as
cake, cookies, biscuits and custard?
Do you drink 1 glass of wine per day? 1 glass = 5 ounces for men and
3 ounces for women. Do not add more points if you drink more wine than
this. Do not add points for any other kind of alcohol you may drink.
Your total points:
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Food Pyramid
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Notes
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Notes
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Notes
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BARBARA WOODWARD LIPS PATIENT EDUCATION CENTER
Mrs. Lips, a resident of San Antonio, Texas, was a loyal Mayo Clinic patient of more than 40 years and a self-made business leader who significantly expanded
her family’s activities in oil, gas and ranching. Upon her death in 1995, Mrs. Lips paid the ultimate compliment by leaving her entire estate to Mayo Clinic. By
naming the Barbara Woodward Lips Patient Education Center, Mayo honors her generosity, her love of learning, her belief in patient empowerment and her
dedication to high-quality care.
This material is for your education and information only. This content does not replace medical advice, diagnosis or treatment. New medical
research may change this information. If you have questions about a medical condition, always talk with your health care provider.
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