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The Ultimate Guide to the Mediterranean Diet for Optimal Heart Health

Mediterranean Diet

If you have ever been curious about following a heart healthy diet, you likely have heard of the Mediterranean Diet (MED). This diet is one of the most popular and well-studied diets around. Let’s go over what the mediterranean diet for heart health is all about.

What is the Mediterranean Diet?

This diet is essentially a representation of eating habits of people living in areas bordering the Mediterranean Sea. The MED focuses on high intake of vegetables, fruit, grains (whole grains mostly), legumes, and healthy fats. The MED recommends an intake of fish once per week, drinking wine and eating dairy in moderation, limiting red meat consumption, being physically active, and eating meals with others.

Latest Research on the Mediterranean Diet and Heart Health

Research continues to show that this diet can be powerful in preventing chronic disease. This includes a seemingly protective effect against cardiovascular disease (CVD), cognitive impairments, and cancer, among other conditions.

Cardiovascular Benefits:

Many studies have found an association between the MED and improved cardiovascular outcomes, but let’s take a look at three recent studies with high enrollment rates and particularly impactful findings:

  • A 2018 study found that better adherence to a MED pattern was significantly associated with lower average triglyceride levels, body mass index, and waist circumference in 6,874 older adults who were overweight or obese and had metabolic syndrome. It also lowered cardiovascular risk factors in women, which is impactful considering that heart disease is the leading cause of death in women in the United States.
  • A study published in 2019 reflects that 12 months of the MED diet in combination with physical activity and behavioral support helped over 600 older participants lose weight, improve circulation, and lower their risk factors for CVD.
  • Another 2019 study that found a Mediterranean-style diet improved cardiovascular health in 1,142 participants aged 65 to 79. The results also showed reductions in blood pressure and arterial stiffness.

While research on this diet has consistently found an association between following the MED with reduced risk of CVD-related incidences, some scientists are still calling for more research to more directly link the MED with improved cardiovascular outcomes.

20+ Best Heart Healthy Mediterranean Diet Foods

The Mediterranean Diet is a pattern of eating, where the focus is on what food groups we want to increase and use to make up the majority of our meals. Still, it can be helpful for people to have some examples of which foods to include. Keep reading for examples of specific foods to include if you’re looking to follow a Mediterranean Diet for heart health.

Fresh Fruits and Vegetables

Colorful fruits and vegetables are a staple in the Mediterranean Diet. They contain a variety of vitamins, minerals, fiber and antioxidants. These compounds help lower blood pressure, improve blood vessel function, reduce inflammation and protect against heart disease. Some examples of fruits to include are berries, citrus fruits like oranges, lemons and grapefruits, apples, grapes, and pomegranate. Some examples of vegetables to include are dark leafy greens like spinach, kale, arugula and swiss chard, tomatoes, peppers, broccoli, and eggplant.

Whole Grains

Whole grains, like whole wheat breads or pastas, couscous, brown rice, quinoa, bulgur, oats, and barley are key sources of complex carbohydrates to include in the Mediterranean Diet. The fiber, vitamins, minerals and phytochemicals that whole grains provide help to regulate blood sugar and reduce the risk of heart disease and stroke.

Extra Virgin Olive Oil

Olive oil is a mainstay cooking oil in the Mediterranean Diet. The monounsaturated fats and antioxidants in extra virgin olive oil help lower LDL cholesterol, aka the “bad” cholesterol, thereby reducing the risk of heart disease. If you want to follow the Mediterranean Diet for heart health, think of extra virgin olive oil as your go-to cooking oil.

Fatty Fish

mediterranean diet

Fatty fish like salmon, sardines and mackerel are heart-healthy sources of protein and of omega-3 fatty acids that should be included multiple times per week when following the Mediterranean Diet for heart health. These types of fish support improvements in blood lipid levels, decreased triglyceride levels, can help lower blood pressure and overall promote cardiovascular health. Really lean into the Mediterranean Diet by preparing your fish with extra virgin olive oil and a side of leafy greens.

Nuts and Seeds

Nuts and seeds, such as almonds, walnuts, flaxseeds, chia seeds and pistachios are packed with unsaturated fats, fiber and plant sterols. These powerhouses can help lower LDL cholesterol, reduce inflammation and improve heart health. For a snack, try swapping out a bag of potato chips for a handful of pistachio nuts. Instead of processed peanut butters, see how you like fresh, natural almond butter! Chances are, nuts will help you stay full for longer.


Legumes are a family of foods that include beans, peas and lentils. Think chickpeas, black beans, white beans, green or red lentils and peas. Legumes are a wonderful source of plant-based protein, fiber and lots of vitamins and minerals. Regular consumption of legumes has been linked to lower blood pressure, improved cholesterol, and a decreased risk of heart disease. 

Herbs and Spices

The Mediterranean Diet uses herbs and spices to add not only nutritional value, but depth and complexity of flavor. Herbs and spices like garlic, oregano, basil, black pepper, turmeric, thyme, mint and many more, have antioxidant and anti-inflammatory properties that make them excellent additions to your Mediterranean Diet meals for heart health.

Unique Aspects of the Mediterranean Diet

1. Enjoy Eating with Others

One lesser-known feature of the Mediterranean Diet is its emphasis on enjoying meals with others. As a fairly individualistic society here in the U.S., it is relatively common for people to eat alone, during meetings, in their cars, etc. While this may be unavoidable, it means people miss out on the benefits of slowing down and sharing mealtimes with others.

Studies have shown that eating with others not only increases the quality of the meal consumed, but that it improves digestion by decreasing stress response. This might be, at least in part, because we are more likely to have a better balance between the sympathetic nervous system (“fight or flight”) and the parasympathetic nervous system (“rest and digest”) when we eat with others. Constant over-firing of the sympathetic nervous system takes a toll.

Eating with other people can increase food enjoyment and help us connect with others. Mindfulness can be instrumental in helping us enjoy our meals, reduce stress and aid the digestive process. The MED and its recommended meal composition is scientifically sound yet, the fact that it emphasizes eating meals with others speaks to the importance of not only what we eat, but how we eat.

2. Herbs and Spices — The Antioxidant Secret

Another element of the MEDis its emphasis on herbs and spices, meaning moving away from the salt shaker and leaning into more varied and complex flavors. The MED was inspired by specific geographical locations where herbs and spices are key in developing distinct and bright flavors. Common herbs and spices included in the MED are: bay leaves, oregano, mint, allspice, rosemary, turmeric, nutmeg, and thyme. 

Interestingly, these spices are some of the richest antioxidant sources we can eat. Research has shown that antioxidants can protect our bodies from some types of cell damage. The MED is high in antioxidants and has shown to provide this very benefit, reduced risk of chronic disease and reduction in oxidative stress. 

3. Healthy Fats

With a focus on olive oil, olives, nuts, seeds, and fish, the MED is rich in healthy unsaturated fats. The Dietary Guidelines for Americans 2020–2025 recommends limiting saturated fats and instead focus on increasing unsaturated fats. The importance of the type of fat in this diet can likely explain why the MED has been famously linked to improved cardiovascular outcomes. It is well known that unsaturated fats play a role in lowering LDL (bad) cholesterol and lowering triglyceride levels within the blood.

There is also evidence that a diet rich in monounsaturated and polyunsaturated fats lowers risk of cardiovascular disease. The MED does not eliminate fats from the diet but rather includes the types of fat that can aid in cardiovascular health.

4. Enjoy Movement Daily

Lastly, but certainly not least, this diet recommends daily physical activity. Daily physical activity plays an important role in our overall health, with research indicating an association between more exercise and lower rates of cardiovascular disease, cancer, Alzheimer’s disease, and more.


The MED is a scientifically supported nutritional powerhouse of a diet. This diet does not contain any hidden secrets or magical ingredients. The combination of eating meals with others, antioxidants, healthy fats, and physical activity may prevent, slow down, or even help manage chronic diseases, especially those that threaten heart health. 

Written by Catalina Ruz Gatica, RD, MS and Kelly Wagner, RD, MS from Nutriving LLC, a virtual private practice for nutrition counseling.

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