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Does the Mediterranean Diet Lower Cholesterol?

Madison Gouza, MS, RDN, CPT

Published in Nutrition

8 min read

November 29, 2022
Mediterranean dinner
Mediterranean dinner

The Mediterranean Diet, or MeD, has continually ranked as the “#1 Best Diet Overall” by the U.S. News & World Report. But what is it about this diet that makes it so healthy?

Research shows that the Mediterranean diet may have a host of important health benefits. It’s shown to lower your chances of stroke and heart attack, reduce the risk of depression, and improve cognitive function

High cholesterol is one of the major risk factors for coronary heart disease, stroke, and heart attack. With all its heart-healthy benefits, can the Mediterranean diet help reduce high cholesterol levels? 

By the end of this article, you’ll know all about the benefits of the Mediterranean Diet, how it can affect your cholesterol levels, and how you can get started on this healthy diet.

What is the Mediterranean Diet?

Plate of salmon and tomatoes

The traditional Mediterranean diet is a historical blending between cultures, traditions and dietary patterns of several countries of the Mediterranean sea. Currently, the MeD is one of the most heavily researched dietary patterns.

This diet stems from areas such as Greece and southern Italy, and is based on the rural and agricultural habits of these areas. Typically, the diets around the Mediterranean sea consist of a high intake of vegetables, fruits, olive oil, and fish.

Research has shown that the MeD may reduce the risk of heart disease, metabolic syndrome, diabetes, certain cancers, depression, Alzheimer’s and Parkinson’s diseases, as well as other chronic and inflammatory diseases.

It is also shown in other studies to promote blood sugar control, weight loss, and a favorable lipid profile in people with type 2 diabetes. 

So, what kinds of foods are included in this diet? Let’s take a closer look.

The Mediterranean Diet at a Glance

There is no single well-defined MeD, but rather a collection of variations on a common theme that reflects the cuisine of different Mediterranean regions. In general, the MeD is a plant-centered diet with fresh fruits and vegetables. This diet is known for:

A high intake of plant-based foods such as:

  • Beans and legumes
  • Fruits and vegetables
  • Whole grains
  • Olive oil

Moderate amounts of:

  • Fish and seafood
  • Dairy products
  • Red wine (generally with meals)

A low intake of:

  • Saturated fats
  • Red meat
  • Poultry
  • Sweets
  • Processed foods

Is the Mediterranean Diet Good For Heart Health?

Doctor talking to patient in her office

The effect of the MeD on heart health has been widely studied with promising results. In the 1999 Lyon Diet Heart Study, 605 French men who had experienced one myocardial infarction, or heart attack, were randomized to the Mediterranean diet.

After 27 months, the MeD group had a 70 percent reduction in all-cause mortality and a 73 percent reduction in coronary heart disease mortality and related complications. These results are thought to be due to the antioxidant, anti-inflammatory, antiarrhythmic, and antithrombotic benefits of an increased intake of omega-3 fatty acids, monounsaturated fats, vitamins, and fiber that the MeD provides.  

Another important study was the Diet and Reinfarction trial, or DART study. In this study, 2033 men who had experienced myocardial infarctions were randomly assigned to three different dietary patterns: either a reduction in fat intake and an increase in the ratio of polyunsaturated to saturated fat, an increase in fatty fish intake, or an increase in cereal fiber intake.

Those subjects advised to eat fatty fish had a 29 percent reduction of all-cause mortality in a 2-year period compared with those who participated in the other dietary patterns. These results demonstrated that a modest intake of fatty fish may reduce medium and long-term mortality in men after they experienced a heart attack. 

Research has also shown that people with high cardiovascular risk who switched to a MeD-type diet showed significant reductions in cholesterol levels, providing further evidence that the MeD may be a useful tool against risk factors for coronary heart disease. 

Cholesterol and Heart Health

Doctor auscultating patient's heart

Cholesterol is a waxy substance that your body needs to build cells and make bile acids, vitamin D, and hormones. It is found in every cell in your body, and while not all cholesterol is bad, too much can pose serious health problems.

There are two main types of cholesterol: HDL cholesterol and LDL cholesterol. When your LDL cholesterol levels are higher, your chances of heart attack or stroke may increase.

Cholesterol circles in your blood, and too much can build up on the inside of your arteries and cause artery plaques. This can lead to a condition called atherosclerosis, also known as coronary heart disease, which is the underlying cause of heart attack and stroke. 

Factors such as your diet can have an impact on your cholesterol levels. Most of the cholesterol your body needs is made by your liver. Dietary sources of cholesterol may have a small impact on cholesterol levels, though not as much as once believed. Dietary cholesterol is only one of several dietary factors influencing overall cholesterol levels. Others include saturated fat, trans fat, soluble fiber, and total caloric intake. 

When it comes to heart health, however, cholesterol isn’t the whole story. Inflammation and oxidative stress can both contribute to the accumulation of cholesterol in your arteries.  Artery plaques that form as a result can greatly increase your risk of heart attack and stroke. 


More Research Around the Mediterranean Diet

A recent extensive Cochrane Systematic Review showed that increasing polyunsaturated fatty acids (PUFA) intake may slightly reduce the risk of coronary heart disease and cardiovascular disease events. Furthermore, this may reduce total cholesterol and triglycerides, while having little or no effect on high‐density lipoprotein. 

More recent studies have suggested that consuming large amounts of processed cooking oils that are high in omega-6 fatty acids (one type of PUFA) may contribute to inflammation and increase the risk of obesity. These factors are both associated with coronary heart disease. 

Researchers generally recommend a ratio of 4:1 when it comes to omega-6 and omega-3 consumption to reduce the risk of health conditions like type 2 diabetes. 

Other randomized studies have tested the efficacy of various antioxidants, vitamins, and supplements in the Mediterranean diet. Their findings seem to indicate insignificant evidence on the role of individual Mediterranean nutrients in preventing heart disease and mortality. 

According to this research, the beneficial effects of the MeD may be related to the synergy between its various cardio-protective foods, and not to individual nutrients or isolated dietary supplements and additives. 

How to Start on the Mediterranean Diet 

So, what does a day in the life of the MeD look like? 

In this section, we’ll talk about applying all of this research with a practical Mediterranean-style meal plan. These recommendations are derived from the latest science on the MeD and eating for coronary artery disease and coronary heart disease prevention. 

Here are some tips to help you start out on this healthier eating plan.

Tips for Making Your Diet More Mediterranean

5 tips for starting the MeD: Reduce your sugar intake, swap out refined carbs for whole grains, aim for lower glycemic index foods, add more fish and seafood to your plate, eat the rainbow

Mediterranean Diet Grocery List

Mediterranean diet grocery list

A Day of Eating on the Mediterranean Diet

Build Your Mediterranean Plate

Here is a dietitian-approved sample of a day in the life of the Mediterranean diet:


  • Veggie scramble with eggs, onions, peppers, and spinach
  • Steel-cut oatmeal topped with some berries and walnuts 


  • Burrito bowl with black beans, avocado, romaine lettuce, salsa, and sour cream 
  • Baked chicken or lean ground turkey 


  • Baked salmon or tofu with steamed green beans and roasted butternut squash, topped with olive oil and herbs

On The Go Snacks

  • Plain greek yogurt topped with berries and seeds/nuts
  • Chopped veggies or fruit dippers in seed or nut butter
  • Hard-boiled eggs with seeds, nuts, and/or fresh fruit
  • Uncured turkey or salmon jerky 
  • Sardine paté on a brown rice cake
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Heather Davis, MS, RDN, LDN

Reviewed by: Heather Davis, MS, RDN, LDN

Heather is a Registered and Licensed Dietitian Nutritionist (RDN, LDN), subject matter expert, and technical writer, with a master's degree in nutrition science from Bastyr University. She has a specialty in neuroendocrinology and has been working in the field of nutrition—including nutrition research, education, medical writing, and clinical integrative and functional nutrition—for over 15 years.

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