Which of the following is not recommended as a component of the Mediterranean diet?

The Mediterranean-style diet has fewer meats and carbohydrates than a typical American diet. It also has more plant-based foods and monounsaturated (good) fat. People who live in Italy, Spain, and other countries in the Mediterranean region have eaten this way for centuries.

Following the Mediterranean diet may lead to more stable blood sugar, lower cholesterol and triglycerides, and a lower risk for heart disease and other health problems.

The Mediterranean diet is based on:

  • Plant-based meals, with just small amounts of lean meat and chicken
  • More servings of whole grains, fresh fruits and vegetables, nuts, and legumes
  • Foods that naturally contain high amounts of fiber
  • Plenty of fish and other seafood
  • Olive oil as the main source of fat for preparing food. Olive oil is a healthy, monounsaturated fat
  • Food that is prepared and seasoned simply, without sauces and gravies

Foods that are eaten in small amounts or not at all in the Mediterranean diet include:

  • Red meats
  • Sweets and other desserts
  • Eggs
  • Butter

There may be health concerns with this eating style for some people, including:

  • You may gain weight from eating fats in olive oil and nuts.
  • You may have lower levels of iron. If you choose to follow the Mediterranean diet, be sure to eat some foods rich in iron or in vitamin C, which helps your body absorb iron.
  • You may have calcium loss from eating fewer dairy products. Ask your health care provider if you should take a calcium supplement.
  • Wine is a common part of a Mediterranean eating style but some people should not drink alcohol. Avoid wine if you are prone to alcohol abuse, pregnant, at risk for breast cancer, or have other conditions that alcohol could make worse.

Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960-2984. PMID: 24239922 pubmed.ncbi.nlm.nih.gov/24239922/.

Prescott E. Lifestyle interventions. In: de Lemos JA, Omland T, eds. Chronic Coronary Artery Disease: A Companion to Braunwald's Heart Disease. Philadelphia, PA: Elsevier; 2018:chap 18.

Thompson M, Noel MB. Nutrition and family medicine. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 37.

Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 47.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee. Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2010;121:e1–e170. [PubMed] [Google Scholar]

2. Schroeder S. Shattuck Lecture. We can do better--improving the health of the American people. N Engl J Med. 2007;357(12):1221–8. [PubMed] [Google Scholar]

3. Keys A, Aravanis C. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press; Cambridge, MA: 1980. [Google Scholar]

4. Kris-Etherton P, Innis S. Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. J Am Diet Assoc. 2007;107:1599–611. [PubMed] [Google Scholar]

5. Lichtenstein A, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J, American Heart Association Nutrition Committee Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82–96. [PubMed] [Google Scholar]

6. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85. [PubMed] [Google Scholar]

7. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos R, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. NEJM. 2013;368(14):1279–90. [PubMed] [Google Scholar]

8. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343(8911):1454–9. [PubMed] [Google Scholar]

9. Llorente-Cortés V, Estruch R, Mena MP, Ros E, González MA, Fitó M, Lamuela-Raventós RM, Badimon L. Effect of Mediterranean diet on the expression of pro-atherogenic genes in a population at high cardiovascular risk. Atherosclerosis. 2010;208:442–50. [PubMed] [Google Scholar]

10. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, Fiol M, Gómez-Gracia E, López-Sabater MC, Vinyoles E, Arós F, Conde M, Lahoz C, Lapetra J, Sáez G, Ros E, PREDIMED Study Investigators Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11. [PubMed] [Google Scholar]

11. Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J, Estruch R, Covas MI, Corella D, Arós F, Ruiz-Gutiérrez V, Ros E, PREDIMED Study Investigators Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14–9. [PMC free article] [PubMed] [Google Scholar]

12. Salas-Salvadó J ea. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168(22):2449–58. [PubMed] [Google Scholar]

13. Fung T, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093–100. [PMC free article] [PubMed] [Google Scholar]

14. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH. The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124:903–15. [PubMed] [Google Scholar]

15. Kastorini C, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299–313. [PubMed] [Google Scholar]

16. Nordmann A, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M. Meta-analysis comparing mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9):841–51. [PubMed] [Google Scholar]

17. Kris-Etherton P, Harris WS, Appel LJ, American Heart Association. Nutrition Committee Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106(21):2747–57. [PubMed] [Google Scholar]

18. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Scholte op Reimer W, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A, European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG) European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) Eur Heart J. 2007;28(19):2375–414. [PubMed] [Google Scholar]

19. Bucher H, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002;112(4):298–304. [PubMed] [Google Scholar]

20. Carroll D, Roth MT. Evidence for the cardioprotective effects of omega-3 Fatty acids. Ann Pharmacother. 2002;36(12):1950–6. [PubMed] [Google Scholar]

21. Chen Q, Cheng LQ, Xiao TH, Zhang YX, Zhu M, Zhang R, Li K, Wang Y, Li Y. Effects of omega-3 fatty acid for sudden cardiac death prevention in patients with cardiovascular disease: a contemporary meta-analysis of randomized, controlled trials. Cardiovasc Drugs Ther. 2011;25(3):259–65. [PubMed] [Google Scholar]

22. Di Minno M, Tremoli E, Tufano A, Russolillo A, Lupoli R, Di Minno G. Exploring newer cardioprotective strategies: ω-3 fatty acids in perspective. Thromb Haemost. 2010;104(4):664–80. [PubMed] [Google Scholar]

23. Filion K, El Khoury F, Bielinski M, Schiller I, Dendukuri N, Brophy JM. Omega-3 fatty acids in high-risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2010;10(24) [PMC free article] [PubMed] [Google Scholar]

24. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, Worthington HV, Durrington PN, Higgins JP, Capps NE, Riemersma RA, Ebrahim SB, Davey Smith G. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 2006;332(7544):752–60. [PMC free article] [PubMed] [Google Scholar]

25. Oomen C, Feskens EJ, Räsänen L, Fidanza F, Nissinen AM, Menotti A, Kok FJ, Kromhout D. Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands. Am J Epidemiol. 2000;151(10):999–1006. [PubMed] [Google Scholar]

26. von Schacky C, Harris WS. Cardiovascular benefits of omega-3 fatty acids. Cardiovasc Res. 2007;73(2):310–5. [PubMed] [Google Scholar]

27. Whelton S, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol. 2004;93(9):1119–23. [PubMed] [Google Scholar]

28. Yzebe D, Lievre M. Fish oils in the care of coronary heart disease patients: a meta-analysis of randomized controlled trials. Fundam Clin Pharmacol. 2004;18(5):581–92. [PubMed] [Google Scholar]

29. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169(7):659–69. [PubMed] [Google Scholar]

30. Burr M, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, Zotos PC, Haboubi NA, Elwood PC. Lack of benefit of dietary advice to men with angina: Results of a controlled trial. Eur J Clin Nutr. 2003;57:193–200. [PubMed] [Google Scholar]

31. Miocardico R, Gruppo Italiano per lo Studio della Sopravvivenza Nell’Infarto Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione Trial. Lancet. 1999;354(9177):447–55. [PubMed] [Google Scholar]

32. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K, Japan EPA lipid intervention study (JELIS) Investigators Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (jelis): A randomised open-label, blinded endpoint analysis. Lancet. 2007;369:1090–8. [PubMed] [Google Scholar]

33. Burr M, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM. Effects of changes in fat, fish and fibre intakes on death and reinfarction: diet and reinfarction trial (DART) Lancet. 1989;2(8666):757–61. [PubMed] [Google Scholar]

34. He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR, Greenland P. Accumulated evidence on fish consumption and coronary heart disease mortality: A meta-analysis of cohort studies. Circulation. 2004;109:2705–11. [PubMed] [Google Scholar]

35. Marckmann P, Gronbaek M. prospective cohort studies. Fish consumption and coronary heart disease mortality: a systematic review of prospective cohort studies. Eur J Clin Nutr. 1999;53(8):585–90. [PubMed] [Google Scholar]

36. Morris MC, Manson JE, Rosner B, et al. Fish Consumption and Cardiovascular Disease in the Physicians’ Health Study: A Prospective Study. American Journal of Epidemiology. 1995;142(2):166–75. [PubMed] [Google Scholar]

37. Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, Willett WC. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med. 1995;332(15):977–82. [PubMed] [Google Scholar]

38. Balk E, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis. 2006;189(1):19–30. [PubMed] [Google Scholar]

39. Appel L, Miller ER, 3rd, Seidler AJ, Whelton PK. Does supplementation of diet with ‘fish oil’ reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med. 1993;153(12):1429–38. [PubMed] [Google Scholar]

40. Morris M, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993;88(2):523–33. [PubMed] [Google Scholar]

41. Calder P. n-3 Fatty acids and cardiovascular disease: evidence explained and mechanisms explored. Clin Sci (Lond) 2004;107(1):1–11. [PubMed] [Google Scholar]

42. Harris W, Miller M, Tighe AP, Davidson MH, Schaefer EJ. Omega-3 fatty acids and coronary heart disease risk: Clinical and mechanistic perspectives. Atherosclerosis. 2008;197:12–24. [PubMed] [Google Scholar]

43. Howard B, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, Kuller LH, LaCroix AZ, Langer RD, Lasser NL, Lewis CE, Limacher MC, Margolis KL, Mysiw WJ, Ockene JK, Parker LM, Perri MG, Phillips L, Prentice RL, Robbins J, Rossouw JE, Sarto GE, Schatz IJ, Snetselaar LG, Stevens VJ, Tinker LF, Trevisan M, Vitolins MZ, Anderson GL, Assaf AR, Bassford T, Beresford SA, Black HR, Brunner RL, Brzyski RG, Caan B, Chlebowski RT, Gass M, Granek I, Greenland P, Hays J, Heber D, Heiss G, Hendrix SL, Hubbell FA, Johnson KC, Kotchen JM. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–66. [PubMed] [Google Scholar]

44. Hu F, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, Hennekens CH, Willett WC. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;337(21):1491–9. [PubMed] [Google Scholar]

45. Lichtenstein A, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J, American Heart Association Nutrition Committee Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2009;114:82–96. [PubMed] [Google Scholar]

46. Fuhrman B, Aviram M. Flavonoids protect LDL from oxidation and attenuate atherosclerosis. Curr Opin Lipidol. 2001;12(1):41–8. [PubMed] [Google Scholar]

47. Covas MI, Nyyssonen K, Poulsen HE, et al. The effect of polyphenols in olive oil on heart disease risk factors: a randomized trial. Ann Intern Med. 2006;145(5):333–41. [PubMed] [Google Scholar]

48. Visioli F, Caruso D, Grande S, et al. Virgin Olive Oil Study (VOLOS): vasoprotective potential of extra virgin olive oil in mildly dyslipidemic patients. Eur J Nutr. 2005;44(2):121–7. [PubMed] [Google Scholar]

49. Marin C, Ramirez R, Delgado-Lista J, Yubero-Serrano EM, Perez-Martinez P, Carracedo J, Garcia-Rios A, Rodriguez F, Gutierrez-Mariscal FM, Gomez P, Perez-Jimenez F, Lopez-Miranda J. Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium. Am J Clin Nutr. 2011;93(2):267–74. [PubMed] [Google Scholar]

50. Bellido C, López-Miranda J, Blanco-Colio LM, Pérez-Martínez P, Muriana FJ, Martín-Ventura JL, Marín C, Gómez P, Fuentes F, Egido J, Pérez-Jiménez F. Butter and walnuts, but not olive oil, elicit postprandial activation of nuclear transcription factor kappaB in peripheral blood mononuclear cells from healthy men. Am J Clin Nutr. 2004;80(6):1487–91. [PubMed] [Google Scholar]

51. Widmer R, Freund MA, Flammer AJ, Sexton J, Lennon R, Romani A, Mulinacci N, Vinceri FF, Lerman LO, Lerman A. Beneficial effects of polyphenol-rich olive oil in patients with early atherosclerosis. Eur J Nutr. 2012 Epub ahead of print. [PMC free article] [PubMed] [Google Scholar]

52. Mensink R, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb. 1992;12(8):911–9. [PubMed] [Google Scholar]

53. Shah M, Adams-Huet B, Garg A. Effect of high-carbohydrate or high-cis-monounsaturated fat diets on blood pressure: a meta-analysis of intervention trials. Am J Clin Nutr. 2007;85(5):1251–6. [PubMed] [Google Scholar]

54. Howard B, Kritchevsky D. Phytochemicals and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation. 1997;95(11):2591–3. [PubMed] [Google Scholar]

55. Beitz R, Mensink GBM, Fischer B. Blood pressure and vitamin C and fruit and vegetable intake. Annals of Nutr & Metabolism. 2003;47:214–20. [PubMed] [Google Scholar]

56. Alonso A, de la Fuente C, Martín-Arnau AM, de Irala J, Martínez JA, Martínez-González MA. Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Brit J Nutr. 2004;92:311–319. 2004;92:311-9. [PubMed] [Google Scholar]

57. Lin B, Morrison RM. Higher fruit consumption linked with lower body mass index. Food Review. 2002;25:28–32. [Google Scholar]

58. Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H. Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol. 2004;159:572–580. 2004;159:572-80. [PubMed] [Google Scholar]

59. Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006;136(10):2588–93. [PubMed] [Google Scholar]

60. He F, Nowson CA, Lucas M, MacGregor GA. Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens. 2007;21(9):717–28. [PubMed] [Google Scholar]

61. Dauchet L, Amouyel P, Dallongeville J. Fruits, vegetables and coronary heart disease. Nat Rev Cardiol. 2009;6(9):599–608. [PubMed] [Google Scholar]

62. Crowe F, Roddam AW, Key TJ, Appleby PN, Overvad K, Jakobsen MU, Tjønneland A, Hansen L, Boeing H, Weikert C, Linseisen J, Kaaks R, Trichopoulou A, Misirli G, Lagiou P, Sacerdote C, Pala V, Palli D, Tumino R, Panico S, Bueno-de-Mesquita HB, Boer J, van Gils CH, Beulens JW, Barricarte A, Rodríguez L, Larrañaga N, Sánchez MJ, Tormo MJ, Buckland G, Lund E, Hedblad B, Melander O, Jansson JH, Wennberg P, Wareham NJ, Slimani N, Romieu I, Jenab M, Danesh J, Gallo V, Norat T, Riboli E, European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart Study Collaborators Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Eur Heart J. 2011;32(10):1235–43. [PMC free article] [PubMed] [Google Scholar]

63. Broekmans W, Klopping-Ketelaars WAA, Kluft C, van den Berg H, Kok FJ, van Poppel G. Fruit and vegetables and cardiovascular risk profile: a diet controlled intervention study. Eur J Clin Nutr. 2001;55(8):636–42. [PubMed] [Google Scholar]

64. John J, Ziebland S, Yudkin P, Roe LS, Neil HAW, Oxford Fruit and Vegetable Study Group Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomized controlled trial. Lancet. 2002;359(9322):1969–74. [PubMed] [Google Scholar]

65. Knekt P, Ritz J, Pereira MA, O’Reilly EJ, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Rimm EB, Ascherio A. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80(6):1508–20. [PubMed] [Google Scholar]

66. Huxley R, Neil HA. The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2003;57(8):904–8. [PubMed] [Google Scholar]

67. Hollman P, Cassidy A, Comte B, Heinonen M, Richelle M, Richling E, Serafini M, Scalbert A, Sies H, Vidry S. The biological relevance of direct antioxidant effects of polyphenols for cardiovascular health in humans is not established. J Nutr. 2011;141(5):989S–1009S. [PubMed] [Google Scholar]

68. Van Horn L. Fiber, lipids, and coronary heart disease. A statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation. 1997;95(12):2701–4. [PubMed] [Google Scholar]

69. Katcher H, Legro RS, Kunselman AR, Gillies PJ, Demers LM, Bagshaw DM, Kris-Etherton PM. The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr. 2008;87(1):79–90. [PubMed] [Google Scholar]

70. Tighe P, Duthie G, Vaughan N, Brittenden J, Simpson WG, Duthie S, Mutch W, Wahle K, Horgan G, Thies F. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr. 2010;92(4):733–40. [PubMed] [Google Scholar]

71. Brownlee I, Moore C, Chatfield M, Richardson DP, Ashby P, Kuznesof SA, Jebb SA, Seal CJ. Markers of cardiovascular risk are not changed by increased whole-grain intake: the WHOLEheart study, a randomised, controlled dietary intervention. Br J Nutr. 2010;104(1):125–34. [PMC free article] [PubMed] [Google Scholar]

72. Mellen P, Walsh TF, Herrington DM. Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis. 2008;18(4):283–90. [PubMed] [Google Scholar]

73. Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson JE, Hennekens CH, Willett WC. Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr. 1999;70(3):412–9. [PubMed] [Google Scholar]

74. Jacobs DJ, Meyer KA, Kushi LH, Folsom AR. Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women’s Health Study. Am J Clin Nutr. 1998;68(2):248–57. [PubMed] [Google Scholar]

75. He M, van Dam RM, Rimm E, Hu FB, Qi L. Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus. Circulation. 2010;121(20):2162. [PMC free article] [PubMed] [Google Scholar]

76. Anderson J, Baird P, Davis RH, Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutr Rev. 2009;67(4):188–205. [PubMed] [Google Scholar]

77. Anderson J, Hanna TJ, Peng X, Kryscio RJ. Whole grain foods and heart disease risk. J Am Coll Nutr. 2000;19(3 Suppl):291S–9S. [PubMed] [Google Scholar]

78. Jenkins D, Wesson V, Wolever TM, Jenkins AL, Kalmusky J, Guidici S, Csima A, Josse RG, Wong GS. Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response. BMJ. 1988;297(6654):958–60. [PMC free article] [PubMed] [Google Scholar]

79. Tarini J, Wolever TM. The fermentable fibre inulin increases postprandial serum short-chain fatty acids and reduces free-fatty acids and ghrelin in healthy subjects. Appl Physiol Nutr Metab. 2010;35(1):9–16. [PubMed] [Google Scholar]

80. Good C, Holschuh N, Albertson AM, Eldridge AL. Whole grain consumption and body mass index in adult women: an analysis of NHANES 1999-2000 and the USDA pyramid servings database. J Am Coll Nutr. 2008;27(1):80–7. [PubMed] [Google Scholar]

81. Adom K, Liu RH. Antioxidant activity of grains. J Agric Food Chem. 2002;50(21):6182–7. [PubMed] [Google Scholar]

82. Hu F, Manson JE, Willett WC. Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr. 2001;20(1):5–19. [PubMed] [Google Scholar]

83. Hu F, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep. 1999;1(3):204–9. [PubMed] [Google Scholar]

84. Banel D, Hu FB. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr. 2009;90(1):56–63. [PMC free article] [PubMed] [Google Scholar]

85. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. N Engl J Med. 2011;364:2392–2404. [PMC free article] [PubMed] [Google Scholar]

86. Kelly R. Diet and exercise in the management of hyperlipidemia. Am Fam Physician. 2010;81(9):1097–102. [PubMed] [Google Scholar]

87. Bazzano L, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. 2001;161(21):2573–8. [PubMed] [Google Scholar]

88. Sasazuki SFHSG. Case-control study of nonfatal myocardial infarction in relation to selected foods in Japanese men and women. Jpn Circ J. 2001;65(3):200–6. [PubMed] [Google Scholar]

89. Zhang X, Shu XO, Gao YT, Yang G, Li Q, Li H, Jin F, Zheng W. Soy food consumption is associated with lower risk of coronary heart disease in Chinese women. J Nutr. 2003;133(9):2874–8. [PubMed] [Google Scholar]

90. Wangen K, Duncan AM, Xu X, Kurzer MS. Soy isoflavones improve plasma lipids in normocholesterolemic and mildly hypercholesterolemic postmenopausal women. Am J Clin Nutr. 2001;73(2):225–31. [PubMed] [Google Scholar]

91. Sanders T, Dean TS, Grainger D, Miller GJ, Wiseman H. Moderate intakes of intact soy protein rich in isoflavones compared with ethanol-extracted soy protein increase HDL but do not influence transforming growth factor beta(1) concentrations and hemostatic risk factors for coronary heart disease in healthy subjects. Am J Clin Nutr. 2002;76(2):373–7. [PubMed] [Google Scholar]

92. Jenkins D, Kendall CW, Jackson CJ, Connelly PW, Parker T, Faulkner D, Vidgen E, Cunnane SC, Leiter LA, Josse RG. Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women. Am J Clin Nutr. 2002;76(2):365–72. [PubMed] [Google Scholar]

93. Zhan S, Ho SC. Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile. Am J Clin Nutr. 2005;81(2):397–408. [PubMed] [Google Scholar]

94. He J, Gu D, Wu X, Chen J, Duan X, Chen J, Whelton PK. Effect of soybean protein on blood pressure: a randomized, controlled trial. Ann Intern Med. 2005;143(1):1–9. [PubMed] [Google Scholar]

95. Wong W, Taylor AA, Smith EO, Barnes S, Hachey DL. Effect of soy isoflavone supplementation on nitric oxide metabolism and blood pressure in menopausal women. Am J Clin Nutr. 2012;95(6):1487–94. [PMC free article] [PubMed] [Google Scholar]

96. Li S, Liu XX, Bai YY, Wang XJ, Sun K, Chen JZ, Hui RT. Effect of oral isoflavone supplementation on vascular endothelial function in postmenopausal women: a meta-analysis of randomized placebo-controlled trials. Am J Clin Nutr. 2010;91(2):480–6. [PubMed] [Google Scholar]

97. Liu X, Li SH, Chen JZ, Sun K, Wang XJ, Wang XG, Hui RT. Effect of soy isoflavones on blood pressure: a meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2012;22(6):463–70. [PubMed] [Google Scholar]

98. Taku K, Lin N, Cai D, Hu J, Zhao X, Zhang Y, Wang P, Melby MK, Hooper L, Kurzer MS, Mizuno S, Ishimi Y, Watanabe S. Effects of soy isoflavone extract supplements on blood pressure in adult humans: systematic review and meta-analysis of randomized placebo-controlled trials. J Hypertens. 2010;28(10):1971–82. [PubMed] [Google Scholar]

99. Jacobs DJ, Gross MD, Tapsell LC. Food synergy: an operational concept for understanding nutrition. Am J Clin Nutr. 2009;89(5):1543S–8S. [PMC free article] [PubMed] [Google Scholar]

100. Kostis W, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol 2012. 2012;59(6):572–82. [PubMed] [Google Scholar]

101. Taylor F, Ward K, Moore HMT, Burke M, Davey Smith George, Casas JP, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Heart Group Cochrane Database of Systematic Reviews. 2011 [PMC free article] [PubMed] [Google Scholar]

102. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013;347:f5577. [PMC free article] [PubMed] [Google Scholar]

103. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev. 2004;1:CD003041. [PubMed] [Google Scholar]

104. McAlister F, Marzona I, Dagenais GR, Teo KK, Yusuf S, Jung H, Turnbull F, Neal B, Chalmers J, MacMahon S, Lowering BP, Gerstein H, Marre M, Fox K, Simoons M, Nissen S, Heerspink HL, Brenner B, De Zeeuw D, Pfeffer M, Kober L, Diener HC, Sacco R, Renin Angiotension System Modulator Meta-Analysis Investigators Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are beneficial in normotensive atherosclerotic patients: a collaborative meta-analysis of randomized trials. Eur Heart J. 2012;33(4):505–14. [PubMed] [Google Scholar]

105. Ronksley P, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671. [PMC free article] [PubMed] [Google Scholar]

106. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96. [PubMed] [Google Scholar]

107. Jun MFC, Lv J, Neal B, Patel A, Nicholls SJ, Grobbee DE, Cass A, Chalmers J, Perkovic V. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet. 2010;375(9729):1875–84. [PubMed] [Google Scholar]

108. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A, Antithrombotic Trialists’ (ATT) Collaboration Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–60. [PMC free article] [PubMed] [Google Scholar]

109. Kuyper L, Khan NA. Atenolol vs nonatenolol β-blockers for the treatment of hypertension: a meta-analysis. Can J Cardiol. 2014;30(5 Supple):S47–S53. [PubMed] [Google Scholar]

110. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Moore H, Worthington HV, Durrington PN, Ness AR, Capps NE, Davey Smith G, Riemersma RA, Ebrahim SB. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database Syst Rev. 2004;18(4):CD003177. [PMC free article] [PubMed] [Google Scholar]

Which of the following is not part of the Mediterranean diet?

The Mediterranean diet is high in plant-based foods such as vegetables, fruits, whole grains, beans, nuts, seeds, and olive oil. Foods not allowed include processed red meats, heavily processed foods, refined grains, alcohol, butter, and refined/processed/hydrogenated oils.

Which of the following is a component of the Mediterranean diet?

One of the best studied diets for cardiovascular health is the Mediterranean diet. This consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption.

What are the three main components of a Mediterranean diet?

The Mediterranean Diet doesn't look the same for everyone. In general, it includes lots of whole grains, vegetables, and fruit along with moderate amounts of fish, legumes and nuts.

Which of the following are recommendations of the Mediterranean diet pyramid?

Mediterranean Diet Recommendations.
Try to base meals around veggies, fruits, legumes, whole grains, nuts & seeds, and beans..
Aim for fish and seafood two times a week..
Poultry, dairy, cheese and eggs in moderate portions throughout the week..
Try to cut back on red meat, saturated fats, and sweets by enjoying less often..