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Dieting the Mediterranean Way

Eating Well when Eating Less

Terry Maratos-Flier, MD

You're embarking on a diet, a decision that surely must lead to better health. Think again. Not all diets are created equal. The Mediterranean diet is most commonly recognized as the healthiest diet in terms of heart and overall health. If weight loss is your goal, some popular weight loss diets can be modified to fit within the tenets of the Mediterranean diet, while others, sadly, are lost causes.

Dr. Terry Maratos-Flier, an endocrinology investigator who specializes in obesity, diabetes and energy metabolism at Beth Israel Deaconess Medical Center, weighed in on which diets impede and which improve your heart health, and why heart patients often go wrong when it comes to selecting the proper heart-healthy diet.

"Very rarely is there a 'one-size-fits-all' type of diet," says Dr. Maratos-Flier. "The Mediterranean diet isn't so much a diet but a consistent way of eating. It's a lifestyle choice that incorporates plenty of fruits and vegetables and complex carbohydrates such as whole grains, legumes, chickpeas and lentils. It also stresses consumption of 'good' unsaturated fats, like those found in avocados and olive and canola oils, among other oil types, as well as omega-3 fatty acids from lean protein like fish. This makes the Mediterranean diet the overall winner when it comes to improving heart health."

Dining Out for a Healthy Heart (Download PDF) Because the Mediterranean diet is not touted as a weight loss solution, but rather an everyday diet to live by, it may be tempting to instead strictly follow diets that claim to help you slim down quickly, like Atkins or South Beach. Flier explains how the following popular diets can be modified to incorporate a Mediterranean-friendly regimen, and how they stack up to the Mediterranean diet.

Weight Watchers

Weight Watchers is a diet that uses a point system, but declares no food off limits. Foods are given point values that add up throughout the day as you eat. Staying within your total daily and weekly point limits is the key to losing weight with this diet. It also lets dieters to have an occasional indulgence within the framework of the point system, allowing you to plan for the points rather than sabotaging the diet. The "eat whatever you want" mentality also lends itself well to dieting the Mediterranean way, as healthier food choices, such as legumes and fish, all tend to be lower on the point scale and get the Mediterranean seal of approval. You can eat most fruits and veggies for no points at all. Note for wine lovers: a small glass of white wine is three points while red is four points.

South Beach

The South Beach diet is also adaptable to the Mediterranean way of eating. It stresses consumption of good carbs and fats (as does the Mediterranean) but is lower in carbohydrates than the typical American diet. You can stay true to the lifestyle of both diets if you consume (but limit amounts of) complex carbs like whole grains and chick peas and seek out the unsaturated fats. While the South Beach diet has been proven to have a positive short-term effect on weight loss, the long-term hasn't been quite as successful. And, when introducing acceptable desserts into the South Beach way of life, the changes and additions to the diet could interfere with the health benefits.


The Ornish diet gets recognition for being very low in fat, but it's restricted to 10 percent of daily calories, which is difficult to maintain. Taking its name from its creator, Dr. Dean Ornish, the diet fits easily into the Mediterranean diet lifestyle as it emphasizes heart-healthy staples like whole grains and lean, fish protein over carbs and meat.


The Atkins diet focuses on ketogenic eating, which increases the amount of fat consumed while greatly reducing the amount of carbohydrates. The body converts carbohydrates like pasta or bread effectively into sugar, making it more difficult to burn off, so that the body generates fat instead of fuel. On the other hand, protein and fats like those found in meat and dairy could help burn the fat that was converted from carbs.

"Following a low-carb, high-protein diet can result in weight loss," says Maratos-Flier. "But it is probably the unhealthiest diet in terms of heart health."

A study recently published in the British Medical Journal echoes this viewpoint. Researchers from the University of Athens in Greece followed more than 40,000 Swedish women, ages 30 to 49, for 15 years. The study's results showed that women with a low-carb, high-protein diet were 28 percent more likely to have a heart attack or stroke.

For those who would like to try this type of weight-loss diet, Maratos-Flier recommends adapting it to the Mediterranean lifestyle by consuming modest amounts of lean protein, as opposed to protein from red meat, and including lots of low-carb veggies.

And the Winner Is?

The key to a heart-healthy diet lies in minimizing consumption of foods that have been known to increase cholesterol and/or blood pressure, in turn boosting the risk of developing heart disease. Almost any diet can be adapted to include more of the heart-healthy foods and less of the foods that interfere with heart health.

But if weight loss winners are what you're after, rest assured that you can follow the tenets of the Mediterranean diet and still lose weight. A study featured in the July 2008 edition of the New England Journal of Medicine found that those who embarked upon a calorie-restrictive version of the Mediterranean diet lost more weight than those on the low-fat diet. The study focused on 322 people, all categorized as "moderately obese," who were divided into groups and administered one of three diets: a low-fat, calorie-restricted diet; a calorie-restricted Mediterranean diet; or a low-carbohydrate diet without calorie limitations.

For a full year, 95.4 percent of study participants stuck with their diet while 84.6 percent kept with it for two years. At the end of the study, in addition to learning that the Mediterranean dieters lost more weight, researchers found that participants with diabetes acquired better control of blood glucose levels. Diabetes is a risk factor for heart disease and cardiovascular troubles. Those on the Mediterranean diet also consumed a higher percentage of monounsaturated fat to saturated fat, lowering the propensity for clogged arteries from over-consumption of "bad" fat.

The solution to the dieter's dilemma, says Dr. Maratos-Flier, is to choose and adapt the diet that best fits with what your body wants and needs.

"Diets are not a one-size-fits-all exploration," says Maratos-Flier. "What may work well for one person may not be the solution to a healthier life for you."

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2012