How to Follow the Mediterranean Diet

June 1, 2009
Bottom Line Natural Healing
Mark A. Stengler , NMD

Make sure you reap this diet’s healthful benefits

If you are interested in heart health, chances are you have heard of the Mediterranean diet. The eating plan, which incorporates traditional foods of the Mediterranean regions of Greece and parts of France and Italy, is generally characterized by an emphasis on vegetables and fruits… lean proteins, such as fish… olive oil… whole grains… and red wine. It is definitely more healthful than the typical American diet, which is high in saturated and trans fats, sugars and processed carbohydrates.

Studies continue to show that following a Mediterranean-style eating plan benefits heart health and overall health, lowering risk for stroke as well as an array of other health problems, including cognitive impairment, type 2 diabetes and cancer. When enriched with nuts, the diet helps reverse metabolic syndrome (a cluster of risk factors for heart disease and diabetes that includes high blood pressure, excess abdominal weight and insulin resistance).

With so much talk about Mediterranean-style eating, I wanted to explore the origins of this type of diet so that we can reap its multiple benefits today.


The problem is that people think they are following a Mediterranean-style diet when they really are not. Americans, in particular, often modify the traditional Mediterranean diet in unhealthful ways. Examples: Olive oil and whole grains are healthful in moderation, but the excessive amounts that I see many people consume these days are not. And in the Mediterranean region, people have been turning away from the diet—and are suffering the health consequences.

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Scientists who study dietary habits and disease risks of people in Mediterranean countries have come to a surprising conclusion. The most healthful Mediterranean diet—the one associated with the lowest death rates and longest life expectancy—was that consumed by people living in southern Greece and on the island of Crete before 1960. We can’t go back to pre-1960s Greece, but we can re-create that healthful approach to eating.


The benefits of a Mediterranean-style diet are the result of regularly consuming a combination of ingredients. The greater the number of these ingredients in your meals, the better off you’ll be.

Vegetables. All vegetables are rich in antioxidants, vitamins, fiber and minerals—and promote a healthful pH balance. Rule number one of healthful diets is that half of every meal should consist of veggies. One particular leaf vegetable stands out in traditional Greek Mediterranean diets. Wild purslane, which tastes a little like spinach or watercress, commonly was added to salads. Purslane is rich in healthful omega-3 fatty acids, vitamins, the antioxidant glutathione, minerals and pectin, a type of soluble fiber. Purslane is not available in the vast majority of US food markets, but you might find it in a local health-food or ethnic market. Better yet, it is easy to grow in a large pot and thrives in both moist and arid conditions. Pinch off a few leaves (which look a little like those of a jade plant), and use them in salads or sandwiches instead of lettuce. Cooking makes purslane mushy, so it is best used raw. Seeds for planting are available from Territorial Seed Company (800-626-0866, www.TerritorialSeed.com).

Fruit. This great source of vitamin C and other antioxidants can help prevent cell damage.
Recommendation: Eat two to three servings of fruit daily, such as raspberries, blueberries or kiwifruit. Unprocessed fresh fruit, grown locally, has more nutrients than fruit that has been shipped in from other locations. When fresh fruit is not available, choose frozen or dried berries with no added sugar.

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Red wine. Red wine contains resveratrol, an antioxidant found in the skin of red grapes that has blood sugar-lowering properties and may help slow the aging process. While Greeks drank moderate amounts of red wine and have benefited from these antioxidants since ancient times, I don’t recommend the consumption of red wine for health promotion or disease prevention due to the increased risks for various cancers and the possibility of adverse drug-alcohol interactions. There are, however, other ways to increase your intake of resveratrol. Foods high in this antioxidant include peanuts (choose unsalted) and unsweetened purple grape juice. For people who want to lower their blood sugar, I recommend 100 milligrams (mg) to 200 mg daily of resveratrol.

Lean protein. Moderate amounts of protein were part of the pre-1960s Mediterranean diet…

Fish. Many of the Mediterranean diet’s health benefits can be traced to consuming ample quantities of omega-3 fats, which are most concentrated in cold-water fish. Greeks who lived close to the sea probably ate more fish than those who did not. Research consistently shows that omega-3 fats reduce inflammation and therefore the risk for heart disease, cancer and Alzheimer’s disease.
Recommendation: Eat at least one or two servings weekly of cold-water fish, such as sardines or salmon. If you don’t like fish, consider taking 1,000 mg daily of combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Free-range meats and chicken. People in southern Greece traditionally did not eat a lot of beef or lamb. And because the animals were grass-fed, the red meats that they did consume were leaner than today’s meats from animals that are fed corn. The grass diet also meant that the meat was higher in omega-3s and a fatty acid known as conjugated linoleic acid, which studies show may help increase lean muscle mass. Chickens were free to peck at seeds and insects, which also are high in omega-3s. As a result, lamb, chicken and eggs all provided additional omega-3s. So did milk, yogurt and cheese. Recommendation: When shopping, opt for eggs enriched with omega-3s, free-range chickens and meats from grass-fed animals. Consume up to three to four ounces of red meat once or twice weekly. Always trim the fat.

Olive oil. Olive oil is rich in antioxidants and oleic acid, an omega-9 fat, which also is known as a monounsaturated fat, a more healthful type of fat that comes from plant sources. The most healthful grade is extra-virgin olive oil, which is made from the antioxidant-rich first pressing of the olives. Extra-virgin olive oil is richer in antioxidants than other oils, such as canola oil or sunflower oil.
Recommendation: One to two tablespoons of olive oil daily. For variety, try macadamia nut oil or avocado oil, both of which also are high in oleic acid and have their own interesting flavors.

Vinegar. Vinegar had its place in the classic Mediterranean diet. Studies have found that a few teaspoons of vinegar can help lower blood sugar and insulin levels and even may help people lose weight. There are a variety of vinegars—from balsamic to apple cider to red wine—that can be mixed with olive oil to make salad dressings. There is no known difference in the health properties of vinegars. For variation, add oregano, garlic, mustard or other spices.

Spices. Spices play a role in Mediterranean cooking. In addition to adding flavor, they are rich in antioxidants and have anti-inflammatory properties. Oregano and rosemary are among the most popular Greek spices. To flavor lamb, Greeks often use these spices and cinnamon, which can lower blood sugar and cholesterol levels.

Whole grains. Whole-grain foods, such as breads and pastas, are a big part of traditional Mediterranean diets. But whole grains, though more healthful than refined, still are primarily starch calories. With three out of four American adults (and one out of three children) overweight, it’s hard to justify eating large quantities of such empty calories. I recommend three to four ounces daily, on average, of whole-wheat grains. (One ounce is equal to one slice of bread, one cup of ready-to-eat cereal or one-half cup of cooked rice, pasta or cooked cereal.)


It wasn’t just the diet that was healthful in Greece prior to 1960. Just as important was the way the Greeks lived. There were several healthful, relaxing aspects of the lifestyle that we can learn from today…

Physical activity. Southern Greece and Crete consisted mostly of small towns and agricultural communities. Physical activity was a routine part of people’s lives. We may not do the heavy lifting that is typical of life on a farm, but we can incorporate regular exercise into our daily routine. Tip: At the very least, go for a 30-minute walk daily.

The sunshine vitamin. People spent a lot of time outdoors in the sun, enabling their bodies to make a lot of vitamin D, which, in turn, boosted immunity and protected against cancer and heart disease. Even today, people living along the Mediterranean have blood levels of vitamin D far higher than those of other Europeans or Americans. A recent study has shown that most Americans are deficient in vitamin D (and a sedentary, indoor lifestyle encourages the deficiency). Supplement with 1,000 international units (IU) to 2,000 IU of vitamin D daily.

Slower pace. Life in small towns and rural areas moved at a slower pace. There were no long daily commutes, no constant barrage of e-mail messages and cell-phone calls. People in the Mediterranean region tended to be part of large families living near one another. They ate long, unhurried meals together. These close, social connections are associated with better health and longevity. We can’t completely escape modern technology, but we can disconnect ourselves from time to time to enjoy the conversation and activities of family and friends.


Greek Salad And Dressing (Serves 3–4)

7–10 ounces Bibb or romaine lettuce, torn or sliced

½ to 1 cup purslane or watercress, torn or chopped

15 slices of English cucumber, each about the thickness of 2 quarters

10–15 cherry tomatoes

10–15 pitted Kalamata olives

4 very thin slices of red onion

6 very thin slices of red bell pepper

Optional: ½ cup crumbled feta or goat cheese

2 teaspoons dried oregano

1 teaspoon dried basil

For the dressing:

4 tablespoons (approximately) extra-virgin olive oil

3 tablespoons (approximately) balsamic or red-wine vinegar

1 tablespoon fresh-squeezed lemon juice

1. Combine all of the salad ingredients except for the oregano and basil in a large salad bowl, and toss.

2. Sprinkle on the oregano and basil, and toss once more.

3. Pour the olive oil over the salad, followed by the vinegar and lemon juice.

4. Toss and serve.

Lamb Meatballs (Serves 2–3)

(Even though meat should be eaten sparingly, I couldn’t resist including this very unique Greek-style lamb dish.)

1 pound ground lamb (or substitute 1 pound ground turkey)

1 tablespoon dried oregano

1 teaspoon dried basil

1 tablespoon ground cinnamon (1 teaspoon ground cinnamon if substituting with turkey)

3–4 cloves garlic, diced

3 tablespoons fresh flat parsley, diced

1. Preheat oven to 375°F.

2. Mix all of the ingredients in a large bowl.

3. Form the meat into small meatballs, and arrange in a baking dish.

4. Bake the meatballs for 15 to 20 minutes.

5. When cooked, drain off as much fat as possible.

6. Serve with vegetables and brown rice.

Source: Mark A. Stengler, NMD, is a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. Dr. Stengler is author of the Health Revelations newsletter, author of The Natural Physician’s Healing Therapies (Bottom Line Books), founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. http://MarkStengler.com