By Kathleen M. Zelman, MPH, RD, LD
WebMD Expert Column
The Mediterranean Diet: What It Is
Some experts consider the "Mediterranean diet" -- rich in plant foods and monounsaturated fats -- to be one of the healthiest in the world. The Mediterranean diet has long been associated with heart health and longevity. Beyond that, it can also be an excellent weight loss plan, as long as you eat in moderation.
The Mediterranean coastal region stretches across Europe from Spain to the Middle East. Fifty years ago, scientists noticed that people living in this region tended to be healthy and live long lives, primarily because of their diet and lifestyle. Mediterranean cuisine varies by region, but is largely based on vegetables, fruits, olives, beans, whole grains, olive oil, and fish, along with a little dairy and wine. Additionally, the Mediterranean lifestyle includes leisurely dining and regular physical activity.
Studies show that calorie-controlled diets rich in plant foods, healthy fats, and lean protein -- like the Mediterranean diet -- are a nutritious formula for weight loss. A study in the New England Journal of Medicine found that a Mediterranean diet was as effective as a low-fat diet for losing weight and also offered some metabolic benefits.
"Research continues to demonstrate that being physically active and eating a nutritious diet of primarily whole foods that are filling and satisfying can enable people to control weight," says cardiologist Arthur Agatston, MD, creator of the South Beach Diet, which is based on the Mediterranean diet model.
Some other perks of living the Mediterranean lifestyle include a reduced risk of chronic diseases such as diabetes, cancer, Alzheimer's and heart disease, says cardiologist Robert Eckel, MD, past president of the American Heart Association.
Mediterranean Diet: What You Can Eat
There is not a single "Mediterranean diet." Instead, it's a dietary pattern of plant foods, monounsaturated fats (mainly olive oil), fish, and limited amounts of animal products.
The basic Mediterranean diet pattern is as follows:
- Legumes: Eat daily.
- Fruit: 2.5 cups daily.
- Vegetables: 2 cups daily.
- Fish: More than twice weekly.
- Nuts: A handful daily.
- Meat/poultry: Less than 4 ounces daily.
- Dairy products: 2 cups of a low-fat variety daily.
- Wine: 1 daily serving for women, two for men.
- Fats: Use primarily monounsaturated fats.
- Eggs: Less than 4 per week.
Some tips for embracing the Mediterranean style of eating:
- Select whole grains for your breads, cereals, and other starches.
- Choose nuts, seeds, legumes, fish, low-fat dairy, and poultry to satisfy your protein needs (you can include lean meat on occasion as well).
- Most importantly, reduce the amount of saturated and trans fats in your diet. Use olive or canola oil instead of butter or margarine.
- If you choose to drink alcohol, enjoy it as a glass of wine with lunch and/or dinner.
"It's almost too good to be true -- a steaming pasta dish with tomato sauce and herbs, or a grilled piece of snapper drizzled with olive oil and fresh cracked pepper, or a great salad of greens, tomatoes, a crumble of Parmesan, and a drizzle of olive oil and lemon," says K. Dun Gifford, Oldways Preservation Trust president. "Scientists report these dishes are as healthy as it gets."
Consult the Mediterranean diet pyramid for more information.
The Mediterranean Diet: How It Works
The Mediterranean diet mainly emphasizes foods that are low-fat, low-cholesterol, and high-fiber. Reducing total fat is one of the easiest ways to trim calories, because fat is more than twice as caloric as carbs or protein. Further, foods rich in lean protein and fiber (like beans and legumes) are filling and make meals more satisfying.
Nuts, fish, and olive oil provide healthy monounsaturated fats (MUFAs), which also contribute to satisfaction and don't raise cholesterol levels the way saturated fat does.
Most foods included in the Mediterranean diet are fresh and seasonal rather than highly processed. Preparation methods tend to be simple; foods are rarely deep-fried.
And the wide variety of delicious foods makes it easier to stick to the Mediterranean diet for the long term. But even on a diet full of healthy foods, it's important to watch portions -- especially for higher-calorie foods like nuts and olive oil.
"Calories and portions still count, even when they are healthy," says Dawn Jackson Blatner, RD, a spokeswoman for the American Dietetic Association. "For example, olive and canola are good for the heart but hard on the waistlines because all oils contain 120 calories per tablespoon."
It's important to remember that the Mediterranean diet is not a quick weight loss diet, but a way of life. Almost as important as the food is regular physical activity and leisurely dining -- taking pleasure and time to savor meals with friends and family. The multiple factors at work in the Mediterranean lifestyle, Agatston says, provide health benefits that "work together and cannot be replaced."
Depending on your calorie level, following a Mediterranean diet plan with controlled portions could result in slow and lasting weight loss of 1-2 pounds a week.
Mediterranean Diet: What the Experts Say
The Mediterranean diet comes highly recommended by nutrition experts.
"We are all advocating for a high-quality diet rich in nutrients," Eckel says. "The only gray area is how much healthy unsaturated fat and my recommendation is to stick with the guideline of 30%-35% of calories and make most of those monounsaturated fats."
The Mediterranean style of eating is also enjoyable, says Columbia University nutrition researcher Wahida Karmally, DrPH, RD. "The Mediterranean diet is a healthful and delicious way of promoting weight loss," she says.
Family practice physician Rod Ono, MD, says he uses the Mediterranean diet as a template to help his patients move away from the typical American diet toward a healthier one. He notes that even a partial switch to a Mediterranean style of eating can be beneficial.
"You can still gain the health benefits if you incorporate more of the foods on the Mediterranean diet into your weekly planning," he says.
Eckel notes that exercise is an important part of the equation. He suggests following federal guidelines that call for exercising at least 30 minutes five times a week (or daily), including resistance training twice a week.
"Physical activity is an essential part of a healthy lifestyle but during weight loss, focus more on reducing the amount of food consumed and once you reach your goal weight, fire up the exercise portion," he says.
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Mediterranean Diet: Food for Thought
There are many health benefits of following a diet rich in fruits, vegetables, and whole grains -- and weight loss is just one of them.
The Mediterranean diet is free of gimmicks. It has clearly been shown to be a healthy, sustainable diet that can help you trim your waistline in addition to a preventing a host of chronic diseases.
Enjoying the bounty of delicious foods on a Mediterranean-style diet should take feelings of deprivation out of the equation, and make losing weight easier and more sustainable.
Robert H. Eckel, MD, professor of medicine, Colorado Denver School of Medicine; director, Lipid Clinic, University of Denver.
Rod Ono, MD, family practitioner, Hawaii.
Wahida Karmally, DrPH, RD, nutrition researcher, Columbia University.
K. Dun Gifford, president, Oldways Preservation.
Dawn Jackson Blatner, RD, spokeswoman, American Dietetic Association. Arthur Agatston, MD, cardiologist; author, The South Beach Diet Supercharged.
New England Journal of Medicine, July 17, 2008, vol. 359:229-241.
American Heart Association web site.
Reviewed on January 07, 2010