salmon as part of mediterranean diet

What is Our Optimal Diet? Let’s Break Down the Mediterranean Diet

Last Updated on September 17, 2023

“Doc, what should I eat?” might be the most common question posed to me by my patients. It’s a source of great confusion, and there’s often conflicting and misleading information. This is also a question I ask myself, as a busy cardiologist and mother, in response to the dreaded question, “Mom, what’s for dinner?”

Recently, the American College of Cardiology published an overview article with recommendations to address these questions.

The Mediterranean diet is viewed as the gold standard for cardiovascular health. This is a diet based on real food. Unfortunately, it’s quite far removed from our Standard American Diet (appropriately referred to as SAD), where processed foods typically infiltrate all meals and snack times. The Mediterranean diet is based on fresh vegetables and fruit, whole grains, fish, and seafood, with healthy fats from nuts and extra virgin olive oil. This diet also acknowledges that modest consumption of dairy (yogurt and cheeses), eggs, alcohol (red wine typically), and meat are all part of a balanced diet.

Appetites of Our Ancestors

Humans are evolutionarily adapted to get energy from both plant and animal sources. While insoluble fiber from diverse plant sources is optimal for our gut health, we also have enzymes (cell machinery) in our GI tracts to digest animal protein. The combination of these systems makes us “opportunistic omnivores,” a combination of herbivores and carnivores.

Anthropological data tells us that our hunter-gatherer ancestors likely derived somewhere from 15 to 50 percent of their calories from animal-based foods, such as wild fish, seafood, wild birds, and game meats. This diet is far removed from present-day, lacking instant cereals, chips, crackers, sweets, and desserts.

Going Green

Plant-rich diets with the elimination of processed foods can have a profound effect on body weight and cholesterol levels. However, strict vegan diets (no animal-based food) can result in some important deficiencies (such as vitamin B12, iron, zinc, marine-omega-3-fatty acids, vitamin D, and calcium), and likely require physician-support and supplementation.

High-Quality Meat Matters

Our typical American diet is also partially high in processed meats. These typically come from animals raised in inhumane conditions, fed unnatural foods, and often treated with hormones and antibiotics. Consumption of these can lead to chronic diseases including cardiovascular disease, diabetes, and some cancers.1,2

Fish and seafood are also important components of the Mediterranean diet. Dietary guidelines recommend adults to consume 8 to 10 ounces of fish each week, and the American Heart Association recommends double for patients with cardiovascular disease. 3,4,5,6,7

Bringing it All Together: The Mediterranean Diet

We have good data to support a traditional Mediterranean diet. The PREDIMED study randomized patients, without known heart disease but who had risk factors, to eat a Mediterranean diet with extra-virgin olive oil, or a Mediterranean diet with extra mixed nuts (walnuts, almonds, and hazelnuts), or a low-fat diet. The patients who ate the Mediterranean diet (either with olive oil or nuts) and significantly less heart attacks, stroke, and death. This is a strong reason to eat well!

For thousands of years, many people have reaped the benefits of the Mediterranean diet based on fresh whole foods. This style of eating translates into many health benefits, including cardiovascular health and longevity.

So, what’s for dinner? I can’t go wrong with some grilled wild-caught salmon, fresh spinach and feta salad drizzled with olive oil, and a glass of red wine—in moderation.


1. O’Keefe J.H., DiNicolantonio J.J., Sigurdsson A.F., Ros E.”Evidence, not evangelism, for dietary recommendations”. Mayo Clin Proc 2018;93:138-144.

2. O’Keefe J.H., Cordain L.”Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer”. Mayo Clin Proc 2004;79:101-108.




6. Bernstein AM, Sun Q, Hu FB, et al.. Major dietary protein sources and risk of coronary heart disease in women.Circulation. 2010; 122:876–83.

7. Estruch R., Ros E., Salas-Salvado J., et al.”Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts”. N Engl J Med 2018;378:e34.


Alyson Kelley-Hedgepeth, M.D. graduated from Boston University Medical School in 2003. She trained in Internal Medicine at Massachusetts General Hospital and completed a Fellowship in Cardiology at Tufts Medical Center. Dr. Kelley-Hedgepeth is Board Certified in Cardiovascular Disease and Nuclear Cardiology. She is also a Diplomate of the American Board of Internal Medicine and Board Eligible in Echocardiography.

Dr. Kelley-Hedgepeth has extensive experience in managing coronary artery disease, heart failure and arrhythmias. Prior to joining the Lown Cardiolgoy Group, Dr. Kelley-Hedgepeth worked for almost a decade as a non-invasive cardiologist at a multispecialty medical center. There she developed cardiac disease management programs, including heart failure treatment pathways and a post-hospitalization specialized clinic.