The Mediterranean Diet: A Heart-Healthy Eating Plan – Butter and All?

The Mediterranean diet is a way of eating based on the traditional cuisine of countries bordering the Mediterranean Sea. It's not just a diet; it's a lifestyle. If you're looking for a heart-healthy eating plan, the Mediterranean diet might be right for you. The diet is known to have an effect on long-term diseases, including heart and blood vessel problems, also known as cardiovascular disease. Today, the Mediterranean diet is one of the healthy eating plans that American nutrition experts recommend. And other diets have some of the same recommendations as the Mediterranean diet.

Embracing the Mediterranean Way: An Overview

There's no single definition for the diet. The foundation of the Mediterranean diet is plant foods. Moderate amounts of dairy, poultry, and eggs are part of the Mediterranean diet, as is seafood. Unsaturated fats are a strength of the Mediterranean diet. Olive oil and nuts are the main sources of fat in the Mediterranean diet. They provide unsaturated fat. Fish are also a key part of the Mediterranean diet. These are known as fatty fish. Omega-3s are unsaturated fats that may lower immune system action in the body, known as inflammation. They also may help reduce blood fats called triglycerides, and they affect blood clotting. Lean fish and shellfish are also included in the Mediterranean diet. Shellfish include shrimp, crab, clams, and scallops. Choose fish that are low in mercury, such as the ones listed above. Too much mercury can harm the brain and nervous system over time. Like people all over the world, some who live in the Mediterranean region drink alcohol, and some do not. Red wine tends to be included more often than white wine. Alcohol has been linked with a lower risk of heart disease in some studies. But it's not risk-free. One large study suggested that people who regularly drank any amount of alcohol had a higher risk of high blood pressure and coronary artery disease. Factors that affect your decision might be the extra calories alcohol brings to the diet, or any kidney or liver problems you may have.

The Core Principles: What to Eat and How Much

The Mediterranean diet puts a strong emphasis on fresh vegetables and fruit, whole grains, legumes, olive oil, and fish. It is based on the traditional cuisines found along the Mediterranean Sea. You focus on overall eating patterns rather than following strict formulas or calculations. In general, you’ll eat:

  • Lots of vegetables, fruit, beans, lentils, and nuts.
  • A good amount of whole grains, like whole-wheat bread and brown rice.
  • Plenty of extra virgin olive oil (EVOO) as a source of healthy fat.
  • A good amount of fish, especially fish rich in omega-3 fatty acids.
  • A moderate amount of natural cheese and yogurt.
  • Little or no red meat, choosing poultry, fish, or beans instead of red meat.
  • Little or no sweets, sugary drinks, or butter.
  • A moderate amount of wine with meals (but if you don’t already drink, don’t start).

This is how people ate in certain Mediterranean countries in the mid-20th century. Researchers have linked these eating patterns with a reduced risk of coronary artery disease (CAD). Today, healthcare providers recommend this eating plan if you have risk factors for heart disease or to support other aspects of your health. A dietitian can help you modify your approach as needed based on your medical history, underlying conditions, allergies, and preferences.

Butter in Moderation: Finding the Balance

The question of whether butter is allowed on the Mediterranean diet is not a simple yes or no. The diet emphasizes unsaturated fats from olive oil and nuts over saturated fats like butter. However, the Mediterranean diet is not about strict restrictions but rather about balance and moderation.

Read also: A Review of the Mediterranean Diet in Kidney Disease

The Mediterranean Diet encourages you to eat plenty of some foods (like whole grains and vegetables) while limiting others. This is how people ate in certain Mediterranean countries in the mid-20th century. Researchers have linked these eating patterns with a reduced risk of coronary artery disease (CAD). Today, healthcare providers recommend this eating plan if you have risk factors for heart disease or to support other aspects of your health. A dietitian can help you modify your approach as needed based on your medical history, underlying conditions, allergies, and preferences.

Navigating Dietary Fats

Replacing saturated fats with unsaturated fats may help lower the risk of heart disease. For example, you could replace butter with olive, canola, or safflower or sunflower oil in cooking or at the table. Extra virgin olive oil (EVOO) should be used instead of vegetable oil and animal fats (butter, sour cream, mayo).

Dairy Consumption

Enjoy some dairy. Some good choices are skim or 1% milk, low-fat cottage cheese, and low-fat Greek or plain yogurt. Limit how much cheese you eat. One serving is about the size of four dice. And cut back on higher fat dairy.

Health Benefits: Why Embrace the Mediterranean Diet?

The Mediterranean Diet has many benefits, including:

  • Lowering your risk of cardiovascular disease, including a heart attack or stroke.
  • Supporting a body weight that’s healthy for you.
  • Supporting healthy blood sugar levels, blood pressure, and cholesterol.
  • Lowering your risk of metabolic syndrome.
  • Supporting a healthy balance of gut microbiota (bacteria and other microorganisms) in your digestive system.
  • Lowering your risk for certain types of cancer.
  • Slowing the decline of brain function as you age.
  • Helping you live longer.

The Mediterranean Diet has these benefits because it:

Read also: Delicious Mediterranean Recipes

  • Limits saturated fat and trans fat. You need some saturated fat, but only in small amounts. Eating too much saturated fat can raise your LDL (bad) cholesterol. A high LDL raises your risk of plaque buildup in your arteries (atherosclerosis). Trans fat has no health benefits. Both of these “unhealthy fats” can cause inflammation.
  • Encourages healthy unsaturated fats, including omega-3 fatty acids. Unsaturated fats promote healthy cholesterol levels, support brain health, and combat inflammation. Plus, a diet high in unsaturated fats and low in saturated fat promotes healthy blood sugar levels.
  • Limits sodium. Eating foods high in sodium can raise your blood pressure, putting you at a greater risk for a heart attack or stroke.
  • Limits refined carbohydrates, including sugar. Foods high in refined carbs can cause your blood sugar to spike. Refined carbs also give you excess calories without much nutritional benefit. For example, such foods often have little or no fiber.
  • Favors foods high in fiber and antioxidants. These nutrients help reduce inflammation throughout your body. Fiber also helps keep waste moving through your large intestine and helps maintain healthy blood sugar levels. Antioxidants protect you against cancer by warding off free radicals.

The Mediterranean Diet includes many different nutrients that work together to help your body. There’s no single food or ingredient responsible for the Mediterranean Diet’s benefits. Instead, the diet is healthy for you because of the combination of nutrients it provides.

Crafting Your Mediterranean Meal Plan

It’s important to consult with a primary care physician (PCP) or dietitian before making drastic changes to your diet or trying any new eating plan. They’ll make sure your intended plan is best for you based on your individual needs. They may also share meal plans and recipes for you to try at home.

In general, when thinking about meals, you’ll want to collect some go-to options and recipes for breakfasts, lunches, dinners, and snacks. The more variety, the better. You don’t want to get stuck in a rut or feel like you’re restricted in which foods you can or should eat. Luckily, there’s plenty of room for changing things up with the Mediterranean Diet. Below are some examples of meals you might enjoy.

Breakfast

Get your day going strong with breakfasts like:

  • Steel-cut oats with fresh berries and ground flaxseed.
  • Whole-grain toast with nut butter and a nutritious smoothie.
  • Greek yogurt topped with fruit and walnuts.
  • Egg white omelet with fresh, seasonal veggies.

Lunch

For midday nutrition and a powerful energy boost, consider:

Read also: Mediterranean Diet, Instant Pot Style

You may want to prepare some lunches the day before so they’re ready to pack or grab from the fridge as needed.

Dinner

Wrap up the day with a hearty, nutrient-packed entree like:

For some added nutrients and color, throw together a side salad - like a sesame cucumber salad or a fennel, orange, and mint salad. To keep things simple, try drizzling mixed greens with a nutritious Mediterranean dressing.

Snacks

Portion and prepare snacks ahead of time so they’re ready when you need them. Here are some ideas of what to keep at the ready:

  • A handful of nuts and seeds (low salt or no salt added).
  • Fresh fruit, ideally local and in-season.
  • Nonfat Greek yogurt and a small piece of dark chocolate (at least 70% cacao).
  • Whole-grain crackers with hummus.
  • Raw veggies with a nonfat Greek yogurt dip.

Mediterranean Diet: Serving Goals and Sizes

A fridge and pantry full of nutritious foods are great for starters. But where do you go from there? How much of each food do you need? It’s always best to talk to a dietitian to get advice tailored to your needs as you get started. The chart below offers some general guidance on serving goals and serving sizes, according to the type of food.

FoodServing GoalServing SizeTips
Fresh fruits and vegetables.Fruit: 3 servings per day; Veggies: At least 3 servings per day.Fruit: ½ cup to 1 cup; Veggies: ½ cup cooked or 1 cup raw.Have at least 1 serving of veggies at each meal; Choose fruit as a snack.
Whole grains and starchy vegetables (potatoes, peas and corn).3 to 6 servings per day.½ cup cooked grains, pasta or cereal; 1 slice of bread; 1 cup dry cereal.Choose oats, barley, quinoa or brown rice; Bake or roast red skin potatoes or sweet potatoes; Choose whole grain bread, cereal, couscous and pasta; Limit or avoid refined carbohydrates.
Extra virgin olive oil (EVOO).1 to 4 servings per day.1 tablespoon.Use instead of vegetable oil and animal fats (butter, sour cream, mayo); Drizzle on salads, cooked veggies or pasta; Use as dip for bread.
Legumes (beans and lentils).3 servings per week.½ cup.Add to salads, soups and pasta dishes; Try hummus or bean dip with raw veggies; Opt for a veggie or bean burger.
Fish.3 servings per week.3 to 4 ounces.Choose fish rich in omega-3s, like salmon, sardines, herring, tuna and mackerel.
Nuts.At least 3 servings per week.¼ cup nuts or 2 tablespoons nut butter.Ideally, choose walnuts, almonds and hazelnuts; Add to cereal, salad and yogurt; Choose raw, unsalted and dry roasted varieties; Eat alone or with dried fruit as a snack.
Poultry.No more than once daily (fewer may be better).3 ounces.Choose white meat instead of dark meat; Eat in place of red meat; Choose skinless poultry or remove the skin before cooking; Bake, broil or grill it.
Dairy.No more than once daily (fewer may be better).1 cup milk or yogurt; 1 ½ ounces natural cheese.Choose naturally low-fat cheese; Choose fat-free or 1% milk, yogurt and cottage cheese; Avoid whole-fat milk, cream, and cream-based sauces and dressings.
Eggs.Up to 1 yolk per day.1 egg (yolk + white).Limit egg yolks; No limit on egg whites; If you have high cholesterol, have no more than 4 yolks per week.
Red meat (beef, pork, veal and lamb).None, or no more than 1 serving per week.3 ounces.Limit to lean cuts, such as tenderloin, sirloin and flank steak.
Wine (optional).1 serving per day (females); 2 servings per day (males).1 glass (3 ½ ounces).If you don’t drink, the American Heart Association cautions you not to start drinking; Talk to your healthcare provider about the benefits and risks of consuming alcohol in moderation.
Baked goods and desserts.Avoid commercially prepared baked goods and desserts; Limit homemade goods to no more than 3 servings per week.Varies by type.Instead, choose fruit and nonfat yogurt; Bake using liquid oil instead of solid fats; whole grain flour instead of bleached or enriched flour; egg whites instead of whole eggs.

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