Heart disease is the leading cause of death globally. Over 30% of global deaths are related to cardio vascular disease, with almost 90% being down to strokes and heart attacks [1, 2]. The majority of heart diseases can be prevented by addressing the behavioral risks known to increase the risk of disease, including tobacco use, alcohol, and diet.
For anyone with heart disease or at risk of developing heart disease, management and early detection is key. First, let’s define heart disease, which you may also know as cardiovascular disease.
What Is Heart Disease
It’s simply a group of disorders of the blood vessels and heart. Under this umbrella, coronary heart disease, peripheral arterial disease, congenital heart disease, rheumatic heart disease are all included. A stroke or a heart attack is an acute event that is typically caused by a blockage preventing blood flow to the brain or heart.
The reason for this is a fatty deposit build-up within the walls of blood vessels supplying the brain or heart. There are a variety of risk factors that increase the strokes and heart attacks, including an unhealthy diet, tobacco use, obesity, alcohol, diabetes, and physical inactivity.
Causes of Heart Disease
As far as organs go, your heart is one of the most important. It’s a muscle that serves as a pump. It has two halves, is made up of four chambers, and separated by valves. Each half of the heart contains an atrium and a ventricle.
The atria (which is the plural of atrium) is in charge of collecting blood while the ventricles push the blood out. The right side pumps low-oxygen blood to the lungs, it is then sent to the left side of the heart, which pumps oxygen-rich blood to the body’s tissues and organs. This keeps you healthy and energized.
Heart disease interrupts this process. There are dozens of heart diseases and they all impact the heart and cardiovascular system in different ways.
What causes this?
Heart disease comes in a variety of forms, but there are common risk factors that cause all of them. While some are out of your control, plenty of them are within your realm of control.
Women Versus Men
According to Harvard Medical School, men run double the risk of contracting heart disease than women [*]. That doesn’t mean, however, that women aren’t at risk for heart disease. Heart disease is the leading cause of death in both men and women. So, if you’re a woman reading this, you still need to take proactive steps to prevent it.
As with many illnesses and diseases, the older you get the greater the risk. Heart disease is no different. 4 in 5 heart disease patients are over 65 years old [*] and as you get older, the risk of death due to heart attack increases.
If you have a family history of hypertension, diabetes, or heart disease, then your risk of heart disease increases. If you aren’t sure whether this ticks a box for you, the typical belief is that if you have a biological relative who has had a heart
attack before they’re 50, then you have a strong history of heart disease, thus making you a high-risk person.
While your family history is no guarantee that you will suffer from heart disease, it certainly increases the risk greatly.
The risks listed above are not within your control. The risks we’re about to discuss, however, are within your control.
If you are overweight or obese, then you are at higher risk for high blood pressure which pushes your heart to work harder thus leaving it at risk for heart disease [*].
There’s also the risk of higher cholesterol levels, which may lead to blockages. Obesity also increases the risk of diabetes, which is another heart disease risk factor. Regular exercise and a healthy diet are key to controlling weight.
There are plenty of health risks that accompany smoking, and heart disease is a big one. Smoking increases the risk of blood clots, increases blood pressure, and ultimately, puts your heart health at risk. Your best bet when it comes to tobacco use, don’t use it. If you’re already a smoker, it’s never too late to quit and that time is now.
Cholesterol is necessary for the health of your body, but there are two different kinds of cholesterol. There are HDL and LDL cholesterols. High-density lipoprotein is the good cholesterol, while low-density lipoprotein is the bad cholesterol.
You put your heart health at risk when there is too much cholesterol. High cholesterol can also lead to atherosclerosis, which is a disease-causing fatty plaque to accumulate in the walls of blood vessels. This can prevent blood flow to your heart and lead to a heart attack.
Your cholesterol level is influenced by your sex, age, dietary choices, family history, and activity levels. You can get your LDL levels lower if you exercise regularly and eat a healthy diet. Exercise also increases your HDL levels. If you struggle to control your cholesterol levels, you may require a prescription to manage it.
High Blood Pressure
If you have high blood pressure and no controls in place, then you run the risk of heart disease. Uncontrolled high blood pressure makes your heart work harder to pump blood. Why does that matter? When you exercise or overwork a muscle it grows bigger.
That’s what can happen to your heart as well, the walls thicken and it grows in size. Those aren’t positive attributes for your heart, while they may be for other muscles. These changes signify heart disease. The thicker the walls the less blood is pumped when your heart beats.
Diabetics are at risk of heart disease at the same level as someone who has had a heart attack. It is so important for anyone with diabetes to take good care of themselves and manage their diabetes appropriately. It’s also important for diabetics to keep their cholesterol levels and blood pressure in check.
Stress often leads to overeating, drinking too much alcohol, and smoking. There’s also the way it negatively influences sleep patterns, contributing to further stress. All of these contribute to heart disease.
Overconsumption of alcohol
Too much alcohol can lead to obesity and high blood pressure, which influences the health of your heart. Drinking too much alcohol can also contribute to poor dietary decisions which won’t help your heart health.
Anxiety and Depression
When dealing with anxiety and depression, it’s easy to draw comfort from food and substances which increases the risk of heart disease.
The Mediterranean Diet To Battle Heart Disease: What The Science Shows
According to the British Heart Foundation, the Mediterranean Diet might be exactly what you need in the fight again heart disease [*].
A study published in the Journal of American Medical Association shows that there are plenty of benefits to the Mediterranean diet [*]. The study involved around 25,000 women with an average age of 55 and no history of cardiovascular disease. They were given a dietary questionnaire to calculate a score around the Mediterranean diet.
Each of the core components of the diet was scored and this information was used to divide the participants into groups. Researchers found that the women in the high Mediterranean diet group were less likely to develop heart disease. The high Mediterranean diet group was also less likely to have high blood pressure, diabetes, and high cholesterol, as well as having a lower BMI.
Healthline reports a large study, the PREDIMED Study that included 7,447 individuals with a high risk of heart disease and lasted 5 years concluded that, “People who followed the Mediterranean diet experienced reductions in oxidized LDL (bad) cholesterol, along with improvements in several other heart disease risk factors.”
In reference to the PREDIMED study, the American College Of Cardiology commented – “They found that the Mediterranean diet plus olive oil or nuts reduced risk for heart events by roughly 30% compared to a low-fat diet. This number was similar to initial findings that were published in 2013.”
Another study, (Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation; Montserrat F, et al) assessed 372 individuals who had a high risk of heart disease who either ate a Mediterranean Diet or a low fat diet. Researchers found that levels of oxidized LDL cholesterol decreased in those who consumed the Mediterranean diet but did not do so in the low fat control group. Healthline reports their conclusion: “People who followed the Mediterranean diet experienced reductions in oxidized LDL (bad) cholesterol, along with improvements in several other heart disease risk factors.”
Another study (The Mediterranean Diet and Cardiovascular Health A Critical Review; Martínez-González, et al) also supports this diet as the god standard for heart health- “We have shown here that there is a large, strong, plausible, and consistent body of available prospective evidence to support the benefits of the MedDiet on cardiovascular health. Moreover, in the era of assessing overall food patterns, no other dietary pattern has undergone such a comprehensive, repeated, and international assessment of its cardiovascular effects. The MedDiet has successfully passed all the needed tests and it approaches the gold standard for cardiovascular health.”
Interestingly, another trial concluded: “The Mediterranean diet appeared to reduce the risk of developing type 2 diabetes by 52%.” (Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet: Results of the PREDIMED-Reus nutrition intervention randomized trial; Salas-Salvado J, et al)
Another study analyzed cardiovascular risk factors in 772 subjects from the PREDIMED study who ate the Mediterranean diet for 3 months. Researchers found, “Those on a Mediterranean diet saw improvements in various cardiovascular risk factors. These included blood sugar levels, blood pressure, the ratio of total to HDL (good) cholesterol, and levels of C-reactive protein (CRP), a marker of inflammation and various diseases.” (Healthline: Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors; Estruch R, et al)
Are you convinced yet?
What The Mediterranean Diet Looks Like
The Mediterranean Diet is named after the region it comes from. The inhabitants of Spain, Italy, and Greece commonly eat plenty of fresh produce, legumes, oily fish, whole grains, and olive oil. While their diets have evolved over the years with fast food outlets expanding, the traditional way of eating is still present.
Much of the original research into the Mediterranean Diet began in the 1960s, finding that the people in the Med were far healthier than Americans and were low risk for so many lifestyle diseases. Following the Mediterranean diet can help prevent heart disease, stroke, type 2 diabetes, and is great for weight loss, too.
Perhaps the greatest part of the diet is that there isn’t a single way to follow it. As there are many Mediterranean countries, there are a variety of ways to enjoy the common foods related to it. So, nothing is written in stone here, you can adjust to meet your individual preferences and needs.
- Traditionally, Mediterranean diet consists of a wide variety of fruits, vegetables, and whole grains, as well as healthy fat (olive oil, seeds, and nuts).
- In terms of dairy and fish, moderate amounts are allowed, while it involves very little meat or eggs.
- Red wine is welcome, in moderation.
- The average Mediterranean style diet tends to be high in calories coming from fat. However, the majority of those fats are from healthy sources. It’s still important for you to pay attention to your intake to ensure the balance is right.
- Herbs and spices
- Whole Grains
- Olive Oil
Eat in Moderation
- Red Meat
- Added sugar – candy, soda, sugar in hot beverages, ice cream, etc.
- Processed meat – hot dogs, sausages, salami, and other deli meats.
- Refined oil – canola oil, soybean oil, vegetable oil, etc.
- Refined grain – pasta, white bread, etc.
- Sugary drinks – soda, fruit juice, coffee chain beverages.
- Processed food – anything that comes pre-packaged or features a diet or low-fat label.
- Trans fat – often found in processed foods, as well as margarine.
Due to the variation between countries and cultures, there are foods we can argue about. Some people will say certain things should be excluded, while others would argue the opposite point. The list provided above is simply a rough guide.
Ultimately, the reason the Mediterranean Diet is great for heart health is that it’s low in animal products and high in plant food. There’s another beneficial aspect of the Mediterranean lifestyle.
Meals tend to be a big affair, with families taking over entire sections of restaurants as they share big plates of fish, tomato salad, and red wine, stretching meals out to three hours at a time. Generations of the family all breaking bread together. They are highly social and often get more exercise.
That being said, I would like to highlight some of the best food options when it comes to the categories we discussed above.
- Bananas, pears, apples, oranges, peaches, figs, strawberries, melons, etc.
- Eggplant, tomatoes, onions, garlic, broccoli, cucumbers, cauliflower, kale, carrots, etc.
- Seeds and nuts
- Walnuts, cashews, almonds, pumpkin seeds, sunflower seeds, etc.
- Sweet potatoes, turnips, potatoes, etc.
- Chickpeas (hummus), beans, pulses, peas, lentils, etc.
- Whole grains
- Brown rice, whole-grain bread, whole-grain pasta, buckwheat, whole oats, whole wheat, corn, rye, barley, etc.
- Shrimp, mussels, salmon, tuna, trout, crab, sardines, mackerel, clams, oysters, etc.
- Cheese and plain yogurt
- Healthy Fats
- Olive oil, avocados, nuts etc.
- Herbs and Spices
- Basil, rosemary, oregano, mint, sage, pepper, nutmeg, cinnamon, cilantro, etc.
The best ingredients and foods are single ingredients. If you pick up a pack of food and there are a dozen ingredients, then it’s not a great choice.
In terms of beverages, the go-to Mediterranean diet beverage is water.
While red wine is okay to drink, you should limit yourself to a glass a day and take a couple of days off a week. If you can, avoid it altogether and just focus on water.
You can introduce cucumber and mint to your water if you’re looking for a different flavor. You should also feel free to enjoy tea, coffee, and herbal teas as well. However, you should avoid adding sugar or sweeteners to your beverages.
It might take a bit of getting used to, but why waste calories? That also means you should do your best to avoid fruit juice. It takes around ten oranges to get a single glass. It might be delicious, but it’s incredibly high in sugar. You wouldn’t sit and eat ten oranges in one sitting so, why would you drink it?
How To Follow The Mediterranean Diet
If you want to go Mediterranean, then you have plenty of options. I’m going to provide you with a sample menu, but before we do that, let’s look at a general overview. It’s going to seem daunting because it might sound like a lot of change to come at one time. The reality of the matter is the Mediterranean diet is delicious and easy!
So, think about working in four to five cups of fruit and vegetables daily, you can do that in eight separate servings. What does that look like realistically?
You can work in a full cup of berries at breakfast.
When lunch rolls around you can chop up tomatoes and cucumbers (a half-cup each), enjoy two cups of shredded lettuce in a salad tossed with a homemade olive oil dressing. Then you can finish it off with an orange.
That’s eight servings right there. You can take it further because you haven’t even had dinner yet or considered snacks! Boost it with a cup of broccoli for dinner and add in extra vegetables in your recipe.
See, it isn’t as difficult as it might initially sound, is it?
How do you make it stick, though? That’s the thing.
A Mediterranean diet isn’t a traditional diet in terms of weight loss. The Mediterranean diet is successful because it’s a way of life. So, if you want to do this you have to stop calling it a diet and start looking at it for what it is – a lifestyle. So, check out these tips I’ve put together to help you make this lifestyle last.
- Start every mealtime with a healthy serving of vegetables or fruit. Start with one, and increase it to two, then to three as time goes on.
- Always have fruit or vegetables at snack-time.
- Don’t feel guilty about using frozen vegetables or fruit. There are plenty of high-quality frozen fruit options from tropical fruit to berries. You’ll also pay less for mixed forzen vegetables. Is fresh better? Yes, but if you struggle to eat all of it or to afford all of it, then stock your freezer!
- Breakfast is a great opportunity to introduce more fruit and vegetables. For example, plain yogurt is a great source of protein, and eating it with a couple of servings of fruit is a great way to start the day.
- You can use meal tracking apps, to make sure you’re getting plenty of the right stuff.
With a greater focus on plant-foods, you aren’t just doing your heart health a favor, you’re doing the environment a solid, too. Vegetables, legumes, and whole grains might just make up the entirety of your meal with meats featuring just a couple of times a week.
Generally, when cooking while eating a Mediterranean diet, you would do so using a healthy fat like olive oil and loads of herbs and spices to season. You should say goodbye to white pasta, white bread, and pizza dough if it contains white flour. These are things you can reintroduce using whole-grain or whole-wheat options. Take a look at this meal plan and how you can make it work for your needs.
|Breakfast||Plain yogurt with a serving of walnuts and blueberries.|
|Lunch||2 cups of salad greens, top with olives, cherry tomatoes, and an olive oil and vinegar dressing. Enjoy with a serving of hummus and whole-grain pita bread.|
|Dinner||Homemade pizza using wholegrain dough. Use tomato sauce, grilled vegetables. You can gain calories and protein with shredded chicken or tuna.|
|Breakfast||A pan-fried egg served on a slice of whole-wheat toast with a grilled tomato. Consider adding avocado.|
|Lunch||Grilled vegetable sandwich on whole-grain bread. Consider caponata! You can add avocado or hummus instead mozzarella.|
|Dinner||A small portion of baked salmon or cod with garlic, lemon, and black pepper. You can enjoy with a baked or roasted potato dressed with olive oil and topped with chives.|
|Breakfast||Wholegrain oats (1 cup) with honey, cinnamon, and dates. Add in a low-sugar fruit, perhaps raspberries. If you need more, toss in shredded almonds.|
|Lunch||Boil white beans with spices like cumin and garlic and enjoy with a cup of salad dressing with olive oil and topped with feta, tomato, and cucumber.|
|Dinner||Wholegrain pasta ( a half-cup) with a homemade tomato sauce. Add grilled vegetables and treat yourself to a tablespoon of freshly grated parmesan.|
|Breakfast||Scrambled eggs mixed with tomatoes, onions, and peppers. Enjoy with quarter of an avocado.|
|Lunch||Anchovies or sardines (in olive oil) on whole-grain toast with a squeeze of fresh lemon. Enjoy with a warmed salad of tomatoes and steamed kale (2 cups).|
|Dinner||Boil an artichoke with salt, garlic, and olive oil and eat it along with two cups of steamed spinach you can dress with herbs and lemon juice.|
|Breakfast||A cup of plain yogurt with honey, cinnamon, almonds, and apple.|
|Lunch||A cup of quinoa with olives, peppers, and tomatoes. You can also include chickpeas with thyme and oregano, topped with feta.|
|Dinner||Grilled sardines with two cups of warmed kale salad including cucumber, tomato, olives with a squeeze of fresh lemon juice, and freshly grated parmesan.|
|Breakfast||Two slices of toast (whole grain) with ricotta and figs.|
|Lunch||A small portion of chicken with two cups of salad, tomatoes, cucumber, and a dressing of olive oil and lemon juice.|
|Dinner||A cup of whole-grain couscous with oven-roasted vegetables on the side. Choose from zucchini, artichoke, yams, carrots, eggplant, or a combination. Toss your veg in olive oil and herbs and roast.|
|Breakfast||Wholegrain oats (1 cup) with dates, honey, cinnamon, blackberries, and/or raspberries.|
|Lunch||Stewed root vegetables with onion for a homemade ratatouille. Make enough to have with dinner as a side dish.|
|Dinner||A small portion of (white) fish, two cups of leafy green vegetables, olives, tomato, and leftover ratatouille.|
Don’t forget you’re allowed snacks, too! Avocado on toast is a great, filling option, but nuts, whole fruits, plain yogurt, and hummus with vegetables are also great.
|Breakfast||Plain yogurt with a serving of walnuts and blueberries.|
|Lunch||A whole-grain sandwich with plenty of vegetables.|
|Dinner||Tuna salad, and a dessert of fruits (think orange).|
|Breakfast||A pan-fried egg served on a slice of whole-wheat toast with a grilled tomato. Consider adding avocado.|
|Lunch||Leftover tuna salad from dinner.|
|Dinner||Make a big salad with cucumber, tomato, olives, feta, and treat yourself to a wholegrain pita bread.|
|Breakfast||Plain yogurt with oats and berries.|
|Lunch||Whole-grain sandwich with fresh vegetables and soft cheese.|
|Dinner||Homemade vegetable lasagna. Keep some for tomorrow’s lunch.|
|Breakfast||Oatmeal with berries.|
|Lunch||Leftover homemade lasagna.|
|Dinner||Baked salmon served with roasted vegetables and brown rice.|
|Breakfast||A veggie omelet and a side of fruit.|
|Lunch||Plain yogurt with oats, nuts, strawberries, and a portion of fruit on the side.|
|Dinner||Grilled meat (of your choice, choose a lean cut) with a baked potato, and salad.|
|Breakfast||Stir-fried vegetables with a boiled egg.|
|Lunch||Wholegrain vegetable sandwich.|
|Dinner||Homemade whole-grain pizza. Choose healthy toppings and treat yourself to cheese.|
|Breakfast||Oatmeal with nuts, raisins, and a piece of fruit.|
|Dinner||A small piece of grilled chicken, served with Greek potatoes, and roasted vegetables.|
When you’re following the Mediterranean diet, you don’t need to count calories. That’s not what this is about. However, if you are actively trying to lose weight, then you are free to do so.
Ultimately, the Mediterranean diet is about living a healthy, balanced lifestyle where you eat plenty of fresh fruit and vegetables and look after your overall health and wellness.
If you love eating out, you can do so while still following a Mediterranean Diet.
Choose seafood or fish dishes, ask them to use extra virgin olive oil in the preparation of your food, and choose vegetable sides.
Avoid creamy sauces (or any sauces for that matter). Always opt for wholegrain bread with olive oil rather than white bread with butter.
If you want to reduce your weight, protect your heart health, and lead a happier, healthier life, then it makes perfect sense to transform your habits and adopt a Mediterranean diet.
There’s a reason that so many Mediterranean countries brag long lifespans. In addition to eating healthier, I encourage you to socialize often with the friends and family you enjoy, exercise regularly, drink plenty of water, and work on improving your sleep patterns.
You only get to live life once and if you want to enjoy it fully, you have to be healthy and happy to do so. Don’t shortchange yourself with bad habits and terrible decisions when eating healthily can be every bit as delicious and enjoyable as indulging.