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The Mediterranean Diet is more accessible than you might think. Discover how to transform a classic American hamburger into a healthy cardiologist recommended meal!

Updated: Apr 4

A heart healthy diet that has stood the test of decades of research and hundreds of clinical trials is The Mediterranean Diet. This is a diet that researchers have found to decrease risk of CVD from a range of 9% to 52% and mortality from around 7% to 47%.1  Does that mean eating gyros and pizza will save us all from heart disease? Definitely not. In this blog we discuss: What do doctors mean when they refer to the Mediterranean Diet? What are the core components that define the diet? Why is it one of the most recommended diets? And where can you start?

According to the American Heart Association (AHA), the Mediterranean diet has long been recognized as a significant factor influencing cardiovascular health. Rooted in the traditional eating habits of countries bordering the Mediterranean Sea, this diet offers a blueprint for a heart-healthy way of life. In fact, the AHA Life Essentials, which are crucial guidelines for enhancing and sustaining cardiovascular well-being, emphasize the importance of dietary choices as they are linked to other life essentials such as: lowering cholesterol and maintaining a healthy weight.2



Your diet is a bank account. Good food choices are good investments– Bethenny Frankel

What constitutes a Mediterranean Diet? What are some replacements? 

The American Heart Association recommends a Mediterranean Style diet as it aligns with the goals of a heart- healthy diet pattern.3 The Mediterranean Diet consists of: 

Abundance of plant-based foods: Fruits, vegetables, legumes, nuts, and whole grains form the foundation of the Mediterranean diet. These nutrient-based foods provide an array of vitamins, minerals, antioxidants, and fiber that positively contribute to heart health.

Healthy fats: Olive oil, a quintessential component of the Mediterranean diet, replaces unhealthy saturated and trans fats such as butter. Rich in monounsaturated fats, olive oil helps reduce LDL (“bad”) cholesterol levels and maintain cardiovascular health. Additionally, nuts and seeds are also excellent sources of healthy fats.

Choose whole grains compared to refined grains: Choose whole wheat bread, brown rice, quinoa, and whole grain pasta. These options provide more fiber, nutrients, and have a lower glycemic index (value used to measure how much specific foods increase blood sugar levels).

Fish and seafood: The Mediterranean region is known for its consumption of fatty fish, such as salmon, sardines, and mackerel. These fish are high in omega-3 fatty acids, which have been linked to a reduced risk of heart disease.4

Limited red meat and processed foods: Red meat and processed foods are limited in the Mediterranean diet. Instead, small portions of lean meats, such as poultry and lean cuts of beef or pork, are consumed occasionally.

Cut the excess sodium and replace it with herbs and spices: Mediterranean cuisine is renowned for its flavorful use of herbs and spices. Fresh herbs like basil, rosemary, thyme, and oregano, as well as spices such as garlic and cinnamon, are frequently used to add taste to dishes, reducing the need for excessive salt or unhealthy seasonings which are unhealthy to optimal heart health. 



The Mediterranean Diet - Illustrated by Zhiyao Zhang


What's the science and how did the diet come to be?

The benefits of the Mediterranean diet were not found in some brand new groundbreaking study; they originate from lifelong practices that span 5000+ years. The diet is rooted in longevity and was first coined the term “Mediterranean Diet” in the 1960s by Ancel Keys through the Seven Countries Study. 

The Seven Countries Study is a large-scale epidemiological study aimed to investigate the correlation  between diet, lifestyle factors, and cardiovascular disease (CVD) in different populations around the world. The study involved a cohort of all males aged 40 to 59 from Yugoslavia, Italy, Greece, Finland, the Netherlands, the United States, and Japan. The study collected extensive data on the participants' dietary habits, blood cholesterol levels, and medical history and used statistical models to demonstrate health outcomes.

The main findings of the Seven Countries Study, which was published in the 1970s, suggested a strong association between saturated fat intake, blood cholesterol levels, and the risk of developing heart disease. The study found that populations with higher consumption of saturated fats, such as those in the United States and Finland, had higher rates of heart disease compared to populations with lower saturated fat consumption, such as those in Greece and Japan. The study correlated dietary habits of the Mediterranean population specifically Greece and Southern Italy to reduce cardiovascular disease. 

While the Seven Countries studies had its limitations other studies that took different approaches concluded similar results, such as the European Prospective Investigation into Cancer and Nutrition (EPIC)–Elderly Prospective Cohort Study, and the HALE project all concluded similar findings between a Mediterranean diet and a reduced number of cardiovascular-related events. 

Other studies also confirm such results: 

1. A meta-analysis of 16 prospective cohort studies which included over 22,000 women, with a  follow-up period of around 12.5 years, revealed that women who adhered most closely to a Mediterranean diet experienced a 24% reduced risk of cardiovascular disease and a 23% reduced risk of premature mortality in comparison to those with with alternative diets 5

2. In the PREDIMED study, 7,447 individuals in Spain with a high risk of heart disease followed either a Mediterranean diet with added olive oil, a Mediterranean diet with added nuts, or a low fat control group over a span of 4.8 years. The study found that among the people who supplemented extra-virgin olive oil or nuts within a Mediterranean diet significantly reduced the incidence of major cardiovascular events, compared to the control group.6


Turning the Unhealthy American Diet Staples to the Healthiest: 

‍Hamburgers and pizza are two of the most commonly consumed meals in America. However, they often contain high levels of unhealthy fats, excessive sodium, and calories, which can contribute to elevated cholesterol levels and an increased risk of heart disease. Adopting a Mediterranean diet doesn't mean giving up your favorite food choices, most of the time you can create healthier versions that are inspired by your personal favorite meals that are inspired by the mediterranean  Here are some healthier Mediterranean food switches that turn the most unhealthiest meals into the most healthiest meals:  


Mediterranean-style Hamburger 

To create a Mediterranean-inspired hamburger, you can replace the traditional beef patty with a healthier alternative. Prepare a veggie burger using ingredients like chickpeas, lentils, or black beans as the base. 


1. Start by cooking your choice of legumes until tender, and then mash them together in a mixing bowl.

2. To add Mediterranean flavors, incorporate ingredients like chopped red onion, minced garlic, fresh herbs such as parsley and oregano, and a dash of ground cumin. These seasonings will infuse the burger with a delicious and aromatic profile. 

3. To bind the mixture, add breadcrumbs or cooked quinoa and a beaten egg. Mix everything thoroughly until well combined. If the mixture feels too wet, you can adjust the consistency by adding a few more breadcrumbs.

4. Shape the mixture into patties of desired size and thickness. You can refrigerate the patties for about 30 minutes to help them firm up before cooking.

5. When ready to cook, heat a drizzle of olive oil in a skillet or grill pan over medium heat. Cook the patties for a few minutes on each side until they develop a golden crust. Alternatively, you can also grill the patties on an outdoor grill for a smoky flavor.

6. For serving, choose a whole wheat bun as a healthier option. Spread a thin layer of hummus on the bottom bun to add creaminess and depth of flavor. Place the cooked veggie patty on top of the hummus.

7. To enhance the Mediterranean essence, add sliced tomatoes, crisp lettuce leaves, cucumber slices, and a drizzle of tzatziki sauce. Tzatziki, a yogurt-based sauce made with cucumbers, garlic, and dill, provides a refreshing and tangy element to the burger.

8. You can also consider adding optional toppings such as crumbled feta cheese, sliced Kalamata olives, or a sprinkle of fresh herbs like mint or basil for extra Mediterranean flair.


Mediterranean-inspired heart-healthy pizza dish  

Transform a classic American pizza into a Mediterranean-inspired, heart-healthy delight.

1. Start with a whole wheat pizza crust for added fiber and nutrients.

2. Instead of using a heavy tomato sauce, spread a thin layer of homemade or low-sodium tomato sauce on the crust

3. Top it with a moderate amount of part-skim mozzarella cheese, and then add an array of Mediterranean ingredients like sliced cherry tomatoes, Kalamata olives, roasted red peppers, artichoke hearts, and fresh basil leaves. 

4.Finish it off with a sprinkle of crumbled feta cheese for an added tangy flavor. Bake the pizza until the crust is crispy and the cheese has melted to perfection. 

While above we only listed a few ideas, the Mediterranean diet serves can serve as a versatile foundation for any of your meals!!


So, if I eat a Mediterranean Diet, is that enough? 

While the Mediterranean diet is one step towards a healthier heart, it isn't the one all be all factor. Moderation within the diet is also important to ensure you achieve a balance. Ensuring moderation within this diet is crucial for achieving a well-rounded balance. Apart from making dietary changes, incorporating regular physical exercise into your weekly routine, ensuring you get sufficient and restful sleep, and effectively managing stress are equally important factors to be mindful of. If you're interested in learning more about a program that can guide you in starting and supporting your heart health journey, click HERE.


Is eating this diet more expensive? 

When it comes to eating healthy, a common misconception that individuals have is that a healthier diet is more expensive and unaffordable. While this may be true for those adversely affected by living in a food desert where access to healthier grocery stores is limited, it's essential to recognize that shopping healthier doesn't have to be excessively costly. For instance, making small changes can lead to significant improvements in your diet without breaking the bank. One simple switch is opting for leaner options like chicken instead of red meat. Another could be instead of frying the chicken in unhealthy oils, consider grilling or broiling it in the oven with spices for a healthier preparation. By making thoughtful choices and being mindful of your budget, you can enjoy a nutritious diet without overspending. 


Where do I go from here? 

Making a switch in your eating habits doesn't need to be postponed until tomorrow. By investing in the meals you consume today, you can ensure a healthier future, free from the development of chronic preventable illnesses like cardiovascular disease. It's crucial to recognize that what you eat directly affects the potential plaque buildup in your heart's walls. This buildup doesn't wait until you are older, it just  worsens until you experience your first heart attack. So, taking charge of your diet now can significantly impact your long-term health and well-being.



References

1. Martinez-Gonzalez, M. A. & Martin-Calvo, N. Mediterranean diet and life expectancy; beyond olive oil, fruits, and vegetables. Curr. Opin. Clin. Nutr. Metab. Care 19, 401–407 (2016).

3. Volpe, S. L. What is the Mediterranean diet? ACSMs Health Fit. J. 26, 45–47 (2022).

4. Omega-3 in fish: How eating fish helps your heart. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/omega-3/art-20045614 (2022).

5. Pant, A. et al. Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis. Heart 109, 1208–1215 (2023).

6. Estruch, R. et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N. Engl. J. Med. 378, e34 (2018).

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