The Mediterranean diet has an image problem in New England. The name conjures Greek islands, Sicilian lemon groves and olive trees, none of which you will find along Route 1. But the pattern itself is not about geography. It is about proportions, and many of its core ingredients are already part of how Rhode Islanders eat, or used to.
Why this pattern
Of all the eating patterns studied for heart health, the Mediterranean diet has some of the strongest evidence. The best known trial is PREDIMED, conducted in Spain among more than 7,400 adults at high cardiovascular risk. Participants were randomly assigned to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts, or advice to follow a lower fat diet.
The trial was retracted and republished in the New England Journal of Medicine1 in 2018 after problems were found with randomization at some sites. The corrected analysis still found that both Mediterranean groups had roughly 30 percent fewer major cardiovascular events, meaning heart attacks, strokes and cardiovascular deaths, than the comparison group.
Notably, the diet was not about restriction. Participants were not told to cut calories. They were told to eat more of certain foods.
The pattern is not about geography. It is about proportions.
The pattern, translated
The Mediterranean approach centers on vegetables, fruit, legumes, whole grains, nuts and olive oil, with fish and seafood several times a week, moderate amounts of dairy and poultry, and limited red and processed meat and sweets. Here is how that maps onto what is available in southern New England.
Fish and shellfish come first. Rhode Island's fishing ports land a wide variety of species, and many fish counters carry local options such as scup, black sea bass, fluke, bluefish and squid, along with Atlantic cod and haddock from the wider region. A large analysis in JAMA2 found that eating about one to two servings of fish a week, especially oily fish, was associated with a 36 percent lower risk of dying from coronary heart disease. Bluefish and mackerel are rich in omega-3 fats and often inexpensive.
Quahogs, the hard-shell clams that are Rhode Island's official state shell, are a lean protein source. Mussels and oysters are too. The trick is preparation. A clear-broth Rhode Island chowder or clams steamed in white wine and garlic fit the pattern. Fried clam strips and stuffies loaded with butter and sausage are better as occasional treats.
Beans have deep roots in New England cooking, though baked beans often come heavy with sugar and pork. Swap toward white beans with greens and garlic, a bean and kale soup that echoes the Portuguese cooking common in the area, or lentils in place of some of the meat in a stew. Beans are also the fastest way to raise your fiber intake.
Vegetables follow the seasons. Fall and winter bring butternut and acorn squash, Brussels sprouts, cabbage, kale, carrots, beets and potatoes. Summer brings tomatoes, corn, zucchini and greens from farm stands across the state. Roasting with olive oil is the simplest way to make them the center of the plate.
Fruit means apples and pears in the fall and berries in summer. Local orchards and pick-your-own farms make that easy and seasonal.
Olive oil is the one import. Use extra-virgin olive oil as the default cooking and dressing fat in place of butter.
Nuts and whole grains round it out. A handful of walnuts, almonds or local hazelnuts a day, and grains like oats, barley, farro and whole wheat in place of white bread and white rice.
A few local cautions
Most commercially sold fish is low in mercury, but some larger predatory fish carry more. The FDA's advice on eating fish3 lists best choices and choices to limit, which is especially useful for people who are pregnant or feeding young children.
If you dig your own shellfish, check closures first. The Rhode Island Department of Environmental Management4 manages shellfishing areas and closes them after heavy rain or when water quality is a concern. Never harvest from closed areas.
What a week might look like
A realistic Rhode Island Mediterranean week might include oatmeal with apples and walnuts for breakfast, a big salad with white beans and olive oil at lunch, roasted local fish with squash and greens for dinner twice a week, a lentil or bean soup on a cold night, clams steamed in broth, and poultry or a modest portion of red meat once or twice. Snacks lean toward fruit, nuts and yogurt.
Cost is the usual objection, and it is partly fair. Fresh fish is expensive. But the backbone of this pattern is beans, oats, cabbage, onions, apples and canned fish, which are among the cheapest foods in any Rhode Island grocery store. Frozen fish and frozen vegetables count too. Many local farmers markets also accept SNAP benefits and offer matching programs that stretch them further.
