The Mediterranean diet, or MDiet, is based on traditional foods eaten in countries like Greece, Italy, and Spain. This diet, which avoids red meat, sugary foods and processed ingredients, has gained attention for improving heart health. Atherosclerosis, which causes arteries to harden and narrow due to plaque buildup, can be prevented or slowed by eating less red meat and saturated fats, both of which increase the risk of plaque formation.1
Research shows the MDiet can improve the health of blood vessels, especially in people with conditions like type 2 diabetes. While it doesn’t help everyone the same way, some studies suggest it reduces artery plaque in people already showing early signs of plaque buildup. Regular exercise with the MDiet may further reduce plaque and slow artery stiffening, making it a powerful approach for heart health when combined with a healthy lifestyle.1
Mediterranean Origins
The Mediterranean diet has deep cultural roots, originating from the traditional eating habits of people in countries along the Mediterranean Sea. For centuries, this diet has centered around whole, minimally processed foods. Shaped by the region’s geography and climate, the focus on fresh, seasonal ingredients created a diet rich in flavor and nutrients, with meals often celebrated in close-knit communities as a social ritual.
In the 1950s, researchers began noticing the potential health benefits of the Mediterranean diet when Dr. Ancel Keys led the famous Seven Countries Study. This study revealed that people in Mediterranean regions experienced lower rates of heart disease than those in Northern Europe and the United States. The findings suggested that dietary factors, not just genetics, might be key to heart health, prompting scientists to further investigate the diet’s effects on cardiovascular health.2
Over the following decades, more evidence confirmed the Mediterranean diet’s unique benefits, showing a reduction in cardiovascular disease rates and improved longevity among its followers. By the 1990s, studies demonstrated that its high levels of antioxidants, fiber, and healthy fats could help prevent atherosclerosis by lowering inflammation and improving cholesterol levels.
Today, the Mediterranean diet is widely regarded as one of the world’s healthiest diets, recommended by health organizations for its protective effects on heart health.
Key Ingredients
The Mediterranean diet consists of nutrient-dense foods known for their potential cardiovascular benefits, particularly in reducing risk factors associated with atherosclerosis and heart disease. The most prominent features of the diet are:
Extra Virgin Olive Oil (EVOO)
Rich in monounsaturated fats and polyphenols, EVOO helps reduce inflammation, supports healthy cholesterol levels by increasing HDL (“good” cholesterol), and shields blood vessels from oxidative damage. The polyphenols in EVOO, such as oleocanthal, have been shown to reduce inflammation similarly to anti-inflammatory drugs.3
Other compounds, like hydroxytyrosol, can help prevent the oxidation of LDL (“bad” cholesterol), a key step in atherosclerosis prevention.4
Fresh Fruits and Vegetables
High in dietary fiber, antioxidants, and essential vitamins, such as vitamin C, vitamin E, and beta-carotene, vegetables and fruits protect vascular health by lowering oxidative stress and inflammation. Their antioxidants neutralize free radicals, reducing the risk of LDL oxidation. Fiber aids in reducing cholesterol absorption and managing blood pressure, while certain phytochemicals in green leafy vegetables (like nitrates) have been shown to improve blood flow and blood vessel function.5
Nuts and Seeds
Nuts and seeds, like almonds, walnuts, and flaxseeds, are excellent sources of unsaturated fats, plant sterols, and fiber, all of which contribute to lower LDL cholesterol levels and better endothelial function. The omega-3 fatty acids in some nuts, like walnuts, reduce inflammation, while plant sterols competitively block cholesterol absorption, aiding in plaque prevention. Nuts also contain arginine, which helps maintain flexible blood vessels and lowers the risk of clot formation.6
Whole Grains
Whole grains like oats, barley, and farro are packed with fiber, B vitamins, and minerals like magnesium. The high fiber content lowers cholesterol by binding to it in the digestive tract, preventing its absorption. B vitamins in whole grains, especially B6 and folate, help reduce levels of homocysteine, an amino acid associated with increased cardiovascular risk. Whole grains also help regulate blood sugar, which prevents damage to blood vessels and the development of insulin resistance.7
Fish and Seafood
Fish such as salmon, sardines, and mackerel are rich in omega-3 fatty acids, including EPA and DHA, which lower triglycerides, reduce blood pressure, and decrease inflammation in the body. Omega-3s help prevent arrhythmias (irregular heartbeats) and support plaque stability, reducing the risk of rupture that can lead to a heart attack. Selenium, an antioxidant mineral found in many types of seafood, further aids in protecting blood vessels from oxidative damage.8
Legumes
Beans, lentils, and chickpeas are excellent sources of fiber, plant-based protein, and minerals like potassium and magnesium. The soluble fiber in legumes helps lower cholesterol by reducing its reabsorption. Their low glycemic index helps stabilize blood sugar, reducing insulin resistance and protecting blood vessels from the adverse effects of high blood sugar. The high magnesium content supports muscle relaxation, including in blood vessel walls, helping lower blood pressure.9
Red Wine (in moderation)
Red wine contains resveratrol and other polyphenols that can improve endothelial function, reduce inflammation, and promote better blood flow. These polyphenols increase nitric oxide production, which helps blood vessels relax, improving circulation and lowering blood pressure. However, it’s important to consume red wine in moderation (up to one glass per day for women and two for men) as higher amounts can increase cardiovascular risks.10
Diet Variations by Country
The exact components of the Mediterranean diet vary by country, reflecting the unique flavors and traditions of each region. However, some core food groups—like vegetables, whole grains, and healthy fats—are staples across all Mediterranean cuisines, providing heart-protective nutrients regardless of the local ingredients used.
Greece: Greek cuisine includes ample extra-virgin olive oil, rich in monounsaturated fats, olives, and abundant greens like wild herbs and leafy vegetables. Traditional dishes often include seafood like sardines and mackerel, known for heart-healthy omega-3s, and legumes like chickpeas and lentils, offering fiber and plant-based protein.
Italy: Italian diets emphasize olive oil, tomatoes, garlic, and a variety of colorful vegetables. Whole grains, particularly durum wheat in pasta, as well as legumes, provide fiber and nutrients that promote heart health. Seafood and small portions of lean meats are common, and red wine is occasionally enjoyed with meals for its antioxidant-rich polyphenols.
Spain: Spanish meals frequently feature olives, olive oil, and fresh produce like tomatoes, peppers, and onions. Spain is famous for seafood, particularly sardines and anchovies, high in omega-3s, and nuts like almonds, which supply healthy fats and fiber. Traditional dishes also include beans, adding fiber and protein.
Turkey: In Turkey, olive oil and nuts are staples, as well as fresh vegetables like eggplant, tomatoes, and bell peppers. Seafood and yogurt-based dishes are popular, the latter providing probiotics that can support heart health. Bulgur wheat and other whole grains are used in many meals, providing fiber and B vitamins.
Lebanon: Lebanese cuisine is rich in vegetables like cucumber, tomatoes, and herbs such as mint and parsley. Olive oil is a key ingredient, and dishes often incorporate garlic and lemon juice. Lentils, chickpeas, and nuts are also widely used, offering fiber and antioxidants that support cardiovascular health.
Morocco: Moroccan diets focus on fresh produce, olive oil, and spices like turmeric and cumin, which add flavor and have anti-inflammatory properties. Whole grains, such as couscous and barley, are common, along with legumes like chickpeas. Fish is consumed regularly, providing heart-healthy fats.
Israel: Israeli meals often include olives, olive oil, and fresh, colorful salads with tomatoes, cucumbers, and herbs. Fish, especially from the Mediterranean, is popular, as are grains like barley and farro. Legumes such as chickpeas and lentils are staples, adding fiber and plant protein.
Egypt: In Egypt, the diet includes a wide variety of vegetables and legumes, with fava beans being a dietary staple. Olive oil is used frequently, and dishes are flavored with heart-protective herbs and spices like garlic, cumin, and coriander. Fish is commonly consumed, especially in coastal areas.
Tunisia: In Tunisia, olive oil and olives are central to the diet, along with vegetables like tomatoes, peppers, and carrots. Whole grains and legumes such as chickpeas are common, as well as fish. Harissa, a chili pepper paste, is used frequently, adding flavor and anti-inflammatory benefits.
France (Southern Mediterranean): Southern French diets focus on olive oil, fresh vegetables, and fish, especially sardines. Red wine, in moderation, is often enjoyed with meals for its antioxidant properties. Fresh herbs, including rosemary and thyme, add flavor and are thought to have anti-inflammatory effects.
Findings from MDiet Studies
The following studies, conducted over decades and across diverse populations, solidify the Mediterranean diet’s reputation as one that supports heart health by reducing inflammation, improving cholesterol levels, and lowering cardiovascular disease risk factors:
Seven Countries Study (1950s): Led by Dr. Ancel Keys, this landmark study found that populations following a Mediterranean diet had significantly lower rates of heart disease compared to those in Northern Europe and the U.S., linking dietary habits, especially Mediterranean diet patterns, to cardiovascular health for the first time.11
Lyon Diet Heart Study (1990s): A French study that showed participants at high risk of cardiovascular events who followed a Mediterranean-style diet had a 50-70% lower risk of recurrent heart disease. This study helped establish the Mediterranean diet as a heart-health strategy.12
PREDIMED Study (2013): This large, randomized study in Spain evaluated over 7,000 participants and found that a Mediterranean diet supplemented with extra-virgin olive oil or nuts significantly reduced the incidence of major cardiovascular events by up to 30% compared to a low-fat diet.13
EPIC (European Prospective Investigation into Cancer and Nutrition) Study (2005): Involving multiple European countries, EPIC linked higher adherence to the Mediterranean diet with a reduced risk of heart disease and all-cause mortality. This study highlighted the broad benefits of the diet across various populations.14
ATTICA Study (2002-2012): Conducted in Greece, this longitudinal study found that those following a Mediterranean diet had lower levels of inflammation, oxidative stress, and markers of atherosclerosis, underscoring the diet’s role in reducing risk factors for cardiovascular disease.15
Nurses’ Health Study and Health Professionals Follow-Up Study (2013): These U.S.-based studies revealed that high adherence to a Mediterranean diet was associated with a 25% reduced risk of cardiovascular disease over 20 years, adding evidence for the diet’s long-term heart health benefits.16
CORDIOPREV Study (2020): This ongoing trial has shown that a Mediterranean diet improves endothelial function—a key factor in preventing atherosclerosis—in coronary heart disease patients, compared to a low-fat diet. Key improvements included increased flow-mediated dilation, enhanced endothelial cell repair, and reduced oxidative stress.17
Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study (2023): Findings in South Asian populations linked Mediterranean diet adherence to improved heart health, reduced arterial plaque buildup, and lower LDL cholesterol, specifically addressing risks associated with atherosclerosis.18
Advanced Glycation End Products (AGE) Study (2023): Recent research observed that Mediterranean diet adherence reduced AGEs, compounds known to exacerbate atherosclerosis progression by promoting arterial stiffness and plaque formation.19
The Mediterranean Diet in Practice
Starting a Mediterranean diet involves choosing whole, minimally processed foods and using fresh ingredients to make balanced, flavorful meals. Here’s how to get started:
Building Your Shopping List
Focus on foods rich in nutrients and healthy fats:
Fruits & vegetables: Tomatoes, spinach, peppers, berries, and citrus fruits.
Healthy fats: Olive oil, avocados, olives, nuts, and seeds.
Whole grains: Quinoa, bulgur, barley, and whole wheat bread.
Proteins: Fish (e.g., salmon, sardines), shellfish, chicken, and eggs.
Legumes & beans: Chickpeas, lentils, and black beans.
Dairy: Yogurt and cheese (moderation is key).
Herbs & spices: Basil, rosemary, garlic, and oregano.
Traditional Staples vs. Seasonal Local Foods
While traditional Mediterranean foods bring authentic flavors, it’s perfectly fine to choose seasonal, local produce where you live. This keeps your meals fresh, sustainable, and affordable while preserving the diet’s key principle of using whole, unprocessed ingredients. Think of it as a framework you adapt to local and seasonal options, which can often be healthier and fresher than imported ingredients.
Use seasonal guides: Resources like the Seasonal Food Guide website can help you identify local produce in peak season.
Shop farmers’ markets: Smaller community markets have fresh, ripe foods that are locally grown and often less processed.
Join a CSA: Community-Supported Agriculture boxes offer a regular supply of local, seasonal produce and help you explore a variety of foods.
Browse local food sections: Many larger grocery stores have local food sections to highlight seasonal and locally sourced foods.
Check out ethnic markets: Mediterranean and other specialty markets can help you find traditional Mediterranean staples to complement seasonal items.
Tips for Success
Weight-loss diets are notorious for having low-adherence rates. Many people find them difficult to stick to long-term, especially when they involve strict rules or have poor flexibility.20
Viewing the Mediterranean diet as a lifestyle rather than a strict diet will make your new eating plan enjoyable. Go into this diet with a spirit of curiosity. Embrace the opportunity to learn about the foods you are eating and the nutrients they offer.
This is also a great opportunity to learn more about seasonal foods where you live, and form connections with people in your community who grow and enjoy them. Forming a support network of people who embrace a healthy lifestyle and eating patterns will change your life for the better in more ways than one.
Summary
The Mediterranean diet (MD) is a heart-healthy eating pattern rooted in the traditional dietary habits of countries along the Mediterranean Sea. It emphasizes whole, minimally processed foods, including a variety of seasonal fruits and vegetables, healthy fats like olive oil, lean proteins, and whole grains. Cardiologists recommend the Mediterranean diet for its ability to lower inflammation, improve cholesterol levels, and reduce the risk of atherosclerosis and heart disease.
This diet not only promotes better heart health but also fosters a connection to food and community through shared meals. Its focus on fresh, local produce encourages sustainable eating habits while enhancing flavor and nutrition. By adopting the Mediterranean diet, individuals can enjoy a balanced, flavorful approach to eating that supports long-term cardiovascular wellness.