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United States Department of Agriculture

Agricultural Research Service

Have the winter blues? Think Mediterranean
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Gerald Combs

It’s been cold enough, recently, to think about warmer climes. Consider the Mediterranean. At least, consider the “Mediterranean diet.” If you don’t know about the Mediterranean diet, you should. It’s a matter of heart health.

Interest in the Mediterranean diet started more than 40 years ago with the findings of Dr. Ancel Keys of the University of Minnesota. Keys was the first to study various factors that determine health status across several different national populations. His pioneering studies revealed that the prevalence of heart disease is much lower in some Mediterranean countries — particularly Italy and Crete — than in the U.S. and in other European countries. He attributed the difference to diet.

Since then, research has confirmed that following the Mediterranean diet pattern can be good for heart health. Independent studies in France, India, Italy and Greece each have shown that adherence to that dietary pattern reduced the numbers of deaths among patients at risk for cardiovascular disease by 31 percent to 56 percent over periods of two to 6½ years.

Two studies compared the Mediterranean diet pattern (35 percent calories from fat) with the American Heart Association-recommended low-fat, heart-healthy diet pattern (25 percent to 35 percent calories from fat). The volunteers who participated in each of these two studies had moderate risk factors for cardiovascular disease.

In one study, conducted in France, both diets were found to produce small decreases in body fat. But interestingly, the changes in serum cholesterol components, which are predictive of decreases in cardiovascular disease risk, were greater among those on the Mediterranean diet (15 percent) than among those on the low-fat diet (9 percent). A study that presently is under way in Spain has found that after only 3 months, diets based on the Mediterranean pattern produced larger drops in blood pressure and blood glucose and larger increases in high-density lipoprotein (“good”) cholesterol than did the low-fat AHA diet.

Actually, there is no single Mediterranean diet. The term refers, instead, to a general pattern of foods traditionally consumed in Italy and Crete, where the prevalence of heart disease was low. The key features of the pattern are generous amounts of fruits and vegetables; emphasis on healthy fats; breads and other whole-grain cereals, potatoes and beans; moderate amounts of dairy products, fish and poultry; small portions of tree nuts; limited consumption of read meat and eggs; and low to moderate consumption of red wine or dark grape juice.

Traditionally, the Mediterranean diet included fruits, vegetables, pasta and rice. But by following these guidelines, it can be implemented today in many ways. For that reason, the Mediterranean diet pattern appears to be easier for many people to follow than other prudent diet patterns. In fact, the French study mentioned above found that during the study, only half as many volunteers withdrew from the Mediterranean diet group than from the low-fat diet group.

The Mediterranean diet pattern emphasizes antioxidant-rich fruits and vegetables and heart-healthy fats. While it provides similar amounts of total fat to the typical Western diet pattern —about 38 percent — it does so through olive and canola oils, sources of monounsaturated fatty acids, as well as tree nuts and fish, sources of omega-3 polyunsaturated fatty acids. These types of fat do not raise blood cholesterol as much as do the saturated fats in animal foods. The Mediterranean diet pattern also emphasizes whole grains, which means it provides more complex carbohydrates than does the typical Western diet pattern.

The Mediterranean diet pattern is consistent with the Dietary Guidelines for Americans as depicted in MyPyramid. Resources useful for evaluating and planning your own diet can be found at More information about the Mediterranean diet pattern, including a useful Mediterranean diet pyramid, can be found at

Last Modified: 2/11/2009