What Is The Mediterranean Diet?

You’ve probably heard the Mediterranean diet is a healthy way of eating. But did you know it’s been around for decades? Ancel Keys, Ph.D., an American researcher, discovered in the 1950s that foods eaten by people who lived in regions around the Mediterranean, namely southern Italy and Greece, protected them against heart disease.

Over the years, registered dietitians and food writers have formulated this diet into a practical and popular way of eating. The American Heart Association and Dietary Guidelines for Americans (2020-2025) have endorsed the Mediterranean diet as a way of eating that can help reduce risk of heart disease and stroke, as well as a slew of other health ailments.

There is no one strict version of this diet, nor does it require calorie counting or even portion measurements. Instead, it emphasizes the importance of eating fresh vegetables, fruits, nuts, legumes and whole grains, as well as extra-virgin olive oil, lean meats, fish and red wine in moderation. It also encourages the limiting of red meat, processed foods, dairy and sweets. 

The Mediterranean diet remains a popular way of eating because it’s easy to follow and successfully contributes to optimal health and longevity. In fact, the Mediterranean diet “may help prevent weight gain, type 2 diabetes, heart disease, and certain cancers, as well as preserve cognitive function with age and promote gut health, among other benefits,” says Boston-based registered dietitian Elizabeth Ward, coauthor of The Menopause Diet Plan: A Natural Guide to Managing Hormones, Health and Happiness and former spokesperson for the Academy of Nutrition and Dietetics.

The Mediterranean Diet Food List

Luckily, Mediterranean diet foods aren’t unusual or hard to find, but they are fresh. “Because it’s based on fresh and lightly processed plant foods, the Mediterranean diet is rich in fiber, vitamins, minerals and phytonutrients, which are protective plant compounds,” says Ward. Below is a list of Mediterranean diet-approved foods and how they can benefit your health.

Vegetables and Fruit

Eating plenty of vegetables can help prevent cardiovascular disease, according to a 2017 article in the journal Nutrients. And a diet that relies on vegetables and fruit can prevent some cancers, according to a study published in the Journal of the American Dietetic Association.

Legumes and Whole Grains

Legumes (or all kinds of beans, including lentils) help regulate blood sugar and may have anti-cancer effects. They also provide protein, fiber, B vitamins, iron and other nutrients. Meanwhile, whole grains are also rich in fiber and contain minerals and phytochemicals, and lower the risk of heart disease, diabetes and cancer.

Olive Oil and Nuts

The Mediterranean diet relies heavily on extra-virgin olive oil, an unsaturated fat source proven to help lower the chance of stroke and heart attack and reduce blood pressure.

Nuts are nutrient powerhouses, packed with unsaturated fat, protein, fiber and B vitamins. Most nuts contain magnesium, which helps support healthy blood pressure and blood sugar and keeps bones strong, among other benefits. And walnuts specifically contain alpha-linoleic acid, an important omega-3 fatty acid that might reduce risk of coronary heart disease.

Fish

The Mediterranean diet prioritizes fish over other meat sources. “Fish and shellfish provide high-quality protein, omega-3 fatty acids that promote heart and brain health and help fight chronic inflammation, and several vitamins and minerals, including vitamin D and selenium,” Ward says. “Coldwater fish, such as salmon, have more [healthy] fats than warmer-water fish, but all seafood offers some omega-3s.”

Red Wine and Dairy in Moderation

This diet “allows for small amounts of wine with meals, but you don’t have to start drinking if you don’t already,” says Ward. “And the operative word in the recommendation is ‘small.’” The American Heart Association says this means one 5-ounce glass a day for women, and two for men. Some studies suggest that wine, especially red wine which is rich in phytonutrients, has a beneficial effect on the heart, but the results are unclear.

Meanwhile, the Mediterranean diet encourages the consumption of dairy products such as eggs, cheese and yogurt in moderation. These provide calcium, phosphorus, vitamins A and D, protein and saturated fat.

Measuring portions isn’t necessary with this diet, but moderation is key. “It’s important to remember that the eating pattern matters most, and no single food used in the Mediterranean diet, such as olive oil, is a magic bullet for better health,” explains Ward. “For example, you can’t slather as much olive oil as you want on your foods or eat as much feta cheese or nuts as you like.”

Sweets and Meat on Rare Occasions

Eat sweets and meat sparingly on the Mediterranean diet. Avoid junk food, or packaged foods that contain added sugar, saturated fat or salt but few nutrients.

Putting It Together: A Mediterranean Diet Meal Plan

Not sure how this way of eating plays out in real life? Looking at the guidelines for the Mediterranean diet provided by the American Heart Association and those presented in the American Journal of Clinical Nutrition, here is a general meal plan:

Evidence suggests the Mediterranean diet can reduce risk of premature death from all causes in both men and women. Here are some of the specifics:

Reduces Obesity and Type 2 Diabetes

Eating a Mediterranean diet can help reduce obesity and Type 2 diabetes, both of which can lead to heart disease and stroke, among other health problems. A review of five studies found that overweight or obese people who followed the Mediterranean lost similar or more amounts of weight than those on low-carb, low-fat or other diets.

Lowers Risk of Stroke and Coronary Heart Disease in Women

Results of a 20-year follow up of the Nurses Study (a large continuous study of thousands of nurses designed to identify risk factors for chronic illness) revealed that women who adhered to the Mediterranean diet had a lower risk of coronary heart disease and stroke than those who did not.

Improves Gut Health

A European study of older adults found that those who followed the Mediterranean diet for a year improved their gut health, which can lead to healthier aging, improved cognition and reduced frailty.

Lowers Risk of Dementia and Cognitive Decline

The Mediterranean Diet is associated with lower risk of dementia and cognitive impairment.

May Reduce the Risk of Common Cancers

Colorectal cancer is the third most common cancer worldwide among men and the second most common cancer among women. Studies show that adhering to the Mediterranean way of eating may reduce the risk of colorectal , breast and prostate cancer.

Reduces High Blood Pressure

High blood pressure is a condition associated with heart disease and stroke. Following the Mediterranean diet can reduce high blood pressure, thus reducing those serious health risks.

Research doesn’t suggest any risks associated with the Mediterranean diet, but consult with your doctor to make sure it’s safe for you before giving it a try.

“Everyone needs to consider their individual nutrient needs as part of their eating style,” says Ward. “I’m a little concerned about women getting enough iron, calcium and vitamin D because of the limitations on red meat and dairy foods,” Ward says.

Women over the age of 50 should also be aware of their protein intake on this diet, and include some type of protein (like eggs, yogurt, chicken, legume, nuts or fish) with every meal. Due to its focus on fish and dairy, the Mediterranean diet might not be the best choice for vegans or vegetarians, either.

Pro tip: Not all fish are safe for eating. “The Food and Drug Administration (FDA) says to avoid king mackerel, orange roughy, marlin, shark, swordfish, tilefish and big eye tuna because they contain the most mercury,” says Ward. “The safest fish include salmon, haddock, canned light tuna and shrimp. And, of course, don’t eat fish if you are allergic to it.”

Sources

Aboul-Enein BH, Puddy WC, Bernstein J. Ancel Benjamin Keys (1904–2004): His early works and the legacy of the modern Mediterranean diet. Journal of Medical Biography. 2017;28(3):139-147.

Ancel Keys. 7 Countries Study. Accessed 03/03/2021.

What is the Mediterranean Diet? American Heart Association. Accessed 03/03/2021.

Dietary Guidelines for Americans 2020-2025. USDA. Accessed 03/03/2021.

Babio N, Bulló M, Salas-Salvadó J. Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutrition. 2009;12(9A):1607-17.

Martinez-Gonzalez MA, Gea A, Ruiz-Canela M. The Mediterranean Diet and Cardiovascular Health; A Critical Review. Circulation Research. 2019;124:779–798.

Kastorini CM, Milionis HJ, Esposito, K, et al. The Effect of Mediterranean Diet on Metabolic Syndrome and its Components. Journal of the American College of Cardiology. 2011;57(11):1299-313.

Trichopoulou A, Costacou T, et al. Adherence to a Mediterranean Diet and Survival. The New England Journal of Medicine. 2003;348:2599-2608.

Mitrou PN, Kipnis V, et al. Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population. Archives of Internal Medicine. 2007;167(22):2461-2468.

Tang GY, Meng X, Li Y, et al. Effects of Vegetables on Cardiovascular Diseases and Related Mechanisms. Nutrients. 2017;9(8):857.

Steinmetz KA, Potter JD. Vegetables, fruit, and cancer prevention: a review. Journal of American Dietetic Association. 1996;(10):1027-39.

Mudryj AN, Yu N, Aukema HM. Nutritional and health benefits of pulses. Applied Physiology, Nutrition, and Metabolism. 2014;39(11):1197-1204.

Jonnalagadda SS, Harnack L, Liu RH, et al. Putting the Whole Grain Puzzle Together: Health Benefits Associated with Whole Grains—Summary of American Society for Nutrition 2010 Satellite Symposium. Journal of Nutrition. 2011;141(5):1011S–1022S.

O’Keefe JH, Torres-Acosta N, et al. A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week.Journal of the American College of Cardiology. 2020;76(12):1484–1493.

Phytonutrients. USDA Nutrition. Accessed 03/03/2021.

Gaforio JJ, Visioli F, et al. Virgin Olive Oil and Health. Nutrients. 2019;11(9):2039.

Nocella C, Cammisotto V, et al. Extra Virgin Olive Oil and Cardiovascular Diseases: Benefits for Human Health. Endocrine, Metabolic & Immune Disorders- Drug Targets. 2018;18(1):4-13.

Massaro M, Scoditti E, Carluccio MA, et al. Effects of Olive Oil on Blood Pressure: Epidemiological, Clinical, and Mechanistic Evidence. Nutrients. 2020;12(6):1548.

Ros E. Health Benefits of Nut Consumption. Nutrients. 2010;2(7):652–682.

Mozaffarian D. Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Alternative Therapies in Health and Medicine. 2005;11(3):24-30.

Haseeb S, Alexander B, Baranchuk A. Wine and Cardiovascular Health A Comprehensive Review. Circulation. 2017;136:1434–1448.

Dairy, Nutrients and Health Benefits. USDA My Plate. Accessed 03/05/2021.

Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. American Journal of Clinical Nutrition. 1995;61(6):1402S-1406S.

Babio N, Bullo M, Salas-Salvado J. Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutrition. 2009;12(9A):1607-17.

Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women. Circulation. 2009;119(8):1093–1100.

Ghosh TS, Rampelli S, Jeffrey IB, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status. Gut. 2020;69(7):1218-1228.

Anastasiou CA, Yannakoulia M, Kosmidas MH, et al. Mediterranean diet and cognitive health: Initial results from the Hellenic Longitudinal Investigation of Ageing and Diet. PLoS One. 2017;12(8).

Donavan MG, Selman OI, Doetschman TC, et al. Mediterranean Diet: Prevention of Colorectal Cancer. Frontiers in Nutrition. 2017;4:59.

Jennings A, Berendsen AM, de Groot L, et al. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Stiffness in Older Adults. Hypertension. 2019;73:578–586.

DeFilippis AP, Sperling LS. Understanding Omega-3’s. American Heart Journal. 2006;151(3):564-70.