Eating Mediterranean

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Here are some fun and tasty strategies that make it easy to adopt a Mediterranean eating pattern...

Reduce Cost:

  1. Buy seasonal fruits & veggies -- they're less expensive and more nutritious.
  2. Canned beans, canned tuna, and lentils are cheap protein sources.
  3. Choose stores that offer low prices without compromising food quality.

Prioritize Nutrients:

  1. Choose whole grains instead of refined grains for a nutrient and fiber boost.
  2. Limit your purchases of foods with empty calories.
  3. Stock up on frozen spinach, broccoli, and peppers for extra vitamin C.

Boost Flavor:

  1. Flavor your food with dried and fresh herbs like basil, oregano, and thyme.
  2. Add depth and spice to your meal with garlic.

A Mediterranean style diet has been found to lower the risk for heart disease, but a new study out of Italy finds it may only benefit those with higher incomes or higher education.  The plant-based Mediterranean diet focuses on fruits, vegetables, whole grains, legumes and low-fat dairy.  Fish, olive oil and lean poultry are also emphasized and red meat, sugar and alcohol are advised in moderation. 1

Marialaura Bonaccio and her colleagues evaluated over 18,000 participants’ diets, lifestyle, smoking status, health history, education, marital status and income in their 5-year study from 2005 to 2010.  The variety of fruit, vegetables, meat and fish were also examined as well as cooking methods.  Bread was categorized as whole grain or refined and vegetables were determined organic or non-organic. 2

Over a 4-year follow up, researchers found that subjects experienced over 5250 cardiac events such as heart failure, strokes and diagnosis of coronary heart disease.  After evaluating the data, researchers noted that a Mediterranean diet was helpful in reducing cardiovascular risk factors, but only in those with higher education and higher income.  Benefits were not seen in those with lower socioeconomic status and education despite compliance with the same diet.

When the data was evaluated more closely, investigators found some differences in the diet quality of participants.  Fish consumption, whole grains and organic produce was more frequently consumed in the higher income groups compared to lower.  Items such as olive oil, which varies in quality, may have altered the diet quality in participants.  Differences in cooking methods may also have contributed to different results in the study. 2

One caveat of the study, as pointed out by Mercedes Sotos-Prieto, an assistant professor at Harvard Chan School of Public Health who did not participate in the study, is that the new study relied on self-reported diet histories.  The study does not prove cause and effect, just a link between socioeconomic status, education and health outcomes.

Other researchers agree that the diet may vary quite a bit based on quality, variety and freshness of foods.  Food deserts in lower income communities may not offer the same food and organic produce may be unavailable or too expensive for many to obtain.  Maria Korre (also from Harvard) suggests that lack of time and costs associated with shopping are barriers to some individuals eating healthier.


  1. Ramón Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., Jordi Salas-Salvadó, M.D., Ph.D., Maria-Isabel Covas, D.Pharm., Ph.D., Dolores Corella, D.Pharm., Ph.D., Fernando Arós, M.D., Ph.D., Enrique Gómez-Gracia, M.D., Ph.D., Valentina Ruiz-Gutiérrez, Ph.D., Miquel Fiol, M.D., Ph.D., José Lapetra, M.D., Ph.D., Rosa Maria Lamuela-Raventos, D.Pharm., Ph.D., Lluís Serra-Majem, M.D., Ph.D., Xavier Pintó, M.D., Ph.D., Josep Basora, M.D., Ph.D., Miguel Angel Muñoz, M.D., Ph.D., José V. Sorlí, M.D., Ph.D., José Alfredo Martínez, D.Pharm, M.D., Ph.D., and Miguel Angel Martínez-González, M.D., Ph.D., for the PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013; 368:1279-1290.
  2. Marialaura Bonaccio, Augusto Di Castelnuovo, George Pounis, Simona Costanzo, Mariarosaria Persichillo, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello on behalf of the Moli-sani Study Investigators. High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Moli-sani studyInternational Journal of Epidemiology, 2017.

By Lisa Andrews, MEd, RD, LD

PDF Handout: Mediterranean Handout

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