Mediterranean Diet

What is the Mediterranean Diet?

The Mediterranean Diet is a way of eating that emphasizes plant-based foods and healthy fats.

In general, if you follow a Mediterranean Diet, you’ll eat:

• Lots of vegetables, fruit, beans, lentils and nuts.
• Lots of whole grains, like whole-wheat bread and brown rice.
• Plenty of extra virgin olive oil (EVOO) as a source of healthy fat.
• A moderate amount of fish, especially fish rich in omega-3 fatty acids.
• A moderate amount of cheese and yogurt.
• Little or no meat, choosing poultry instead of red meat.
• Little or no sweets, sugary drinks or butter.
• A moderate amount of wine with meals (but if you don’t already drink, don’t start).

A dietitian can help you modify this diet as needed based on your medical history, underlying conditions, allergies and preferences.

What is the definition of the Mediterranean Diet?

There are many definitions of the diet (each with slightly different goals for servings). That’s because the diet focuses on overall eating patterns rather than strict formulas or calculations. It’s also based on eating patterns across many different Mediterranean countries, each with their own nuances. Because there’s no single definition, the Mediterranean Diet is flexible, and you can tailor it to your needs.

What are the benefits of the Mediterranean Diet?

The Mediterranean Diet has many benefits, including:

• Lowering your risk of cardiovascular disease.
• Supporting a body weight that’s healthy for you.
• Supporting healthy blood sugar, blood pressure and cholesterol.
• Lowering your risk of metabolic syndrome.
• Supporting a healthy balance of gut microbiota (bacteria and other microorganisms) in your digestive system.
• Lowering your risk for certain types of cancer.
• Slowing the decline of brain function as you age.
• Helping you live longer.

Cardiologists often recommend the Mediterranean Diet because extensive research supports its heart-healthy benefits. One study (published in 2018) looked at people at high risk of cardiovascular disease over a five-year period. These people were split into two groups. One group followed the Mediterranean Diet, and the other group followed a low-fat diet. The Mediterranean Diet group had a 30% lower relative risk of cardiovascular events compared to the low-fat diet group. Such events included heart attack, stroke or cardiovascular-related death.

Researchers believe these protective benefits are partly due to the healthy fats you eat with the Mediterranean Diet. These come from foods like olive oil, nuts and fish.

Why is the Mediterranean Diet good for me?

The Mediterranean Diet includes many different nutrients that work together to help your body. There’s no single food or ingredient responsible for the Mediterranean Diet’s benefits. Instead, the diet is good for you because of the combination of nutrients it provides.

Think of a choir with many people singing. One voice alone might carry part of the tune, but you need all the voices to come together to achieve the full effect. Similarly, the Mediterranean Diet works by giving you an ideal blend of nutrients that harmonize to support your health.

A Mediterranean Diet is good for you because it:

• Limits saturated fat and trans fat. You need some saturated fat, but only in small amounts. Eating too much saturated fat can raise your LDL (bad) cholesterol. A high LDL raises your risk of plaque buildup in your arteries (atherosclerosis). Trans fat has no health benefits. Both of these “unhealthy fats” can cause inflammation.
• Encourages healthy unsaturated fats, including omega-3 fatty acids. Unsaturated fats promote healthy cholesterol levels, support brain health and combat inflammation. Plus, a diet high in unsaturated fats and low in saturated fat promotes healthy blood sugar levels.
• Limits sodium. A diet high in sodium can raise your blood pressure, putting you at greater risk for a heart attack or stroke.
• Limits refined carbohydrates, including sugar. Foods high in refined carbs can cause your blood sugar to spike. Refined carbs also give you excess calories without much nutritional benefit. For example, such foods often have little or no fiber.
• Favors foods high in fiber and antioxidants. These nutrients help reduce inflammation throughout your body. Fiber also helps keep waste moving through your large intestine. Antioxidants protect you against cancer by warding off free radicals.

What does the Mediterranean Diet look like?

The Mediterranean Diet doesn’t look the same for everyone. In general, it includes lots of whole grains, vegetables, and fruit along with moderate amounts of fish, legumes and nuts.

The chart below shows some serving goals and tips that dietitians often recommend. It’s important to talk to a dietitian about your individual needs and goals so you can develop a plan that’s best for you.

How do I start a Mediterranean Diet?

You may have many questions as you begin a new eating plan. It’s important to consult with a primary care physician or dietitian before making drastic changes to your diet or trying any new eating plan. They’ll make sure your intended plan is best for you based on your individual needs. They’ll also share meal plans and recipes for you to try at home.

As you get started, you might wonder how much you can modify the Mediterranean Diet without losing its benefits. Remember that the Mediterranean Diet is a general approach to eating. It’s not a strict diet with hard and fast rules. As a result, you can adapt it to suit your needs (ideally with a dietitian’s help).

Below are answers to some common questions you might have about modifications.

Can the Mediterranean Diet be vegetarian?

Yes. If you prefer a vegetarian diet, you can easily modify the Mediterranean Diet to exclude meat and fish. In that case, you’d gain your protein solely from plant sources like nuts and beans. Talk to a dietitian to learn more.

Can the Mediterranean Diet be gluten-free?

Yes. You can modify recipes to exclude gluten-based products. Talk to a dietitian for recipe ideas and support in making necessary changes.

Can I use regular olive oil instead of extra virgin olive oil?

Regular olive oil is a good alternative to oil that’s high in saturated fat (like palm oil). However, to get the most benefits, opt for extra virgin olive oil.

A crucial fact to know before starting the Mediterranean Diet is that not all olive oils are the same. The Mediterranean Diet calls for extra virgin olive oil (EVOO), specifically. That’s because it has a healthy fat ratio. This means EVOO contains more healthy fat (unsaturated) than unhealthy fat (saturated). Aside from its fat ratio, EVOO is healthy because it’s high in antioxidants.

Antioxidants help protect your heart and reduce inflammation throughout your body. Because it’s manufactured differently, regular olive oil doesn’t contain these antioxidants.

Can I eat pizza on the Mediterranean Diet?

It depends how you prepare it. Many American-style pizzas are high in sodium, saturated fat and calories. These aspects make it less than ideal for meeting your Mediterranean Diet goals. Instead of ordering out, try making your own heart-healthy pizza to get more nutritional benefits.

Can I eat foods from non-Mediterranean cultures?

The Mediterranean Diet describes eating patterns in one specific area of the world. That doesn’t mean you should exclude foods and recipes from other cultural traditions.

It’s important to develop an eating plan that’s healthy for you physically, emotionally and socially. The Mediterranean Diet offers a way of eating that research links to many health benefits. This diet focuses on general patterns of eating. It doesn’t ask you to scrutinize every single food choice or eliminate specific foods.

So, there’s room to adjust the Mediterranean Diet to your preferences and cultural traditions. This might mean keeping some traditional recipes the same (no ingredient substitutions) and eating them only on special occasions. Some recipes might be just as tasty and special to you with some substitutions (like olive oil instead of butter, or extra herbs instead of salt). Working with a dietitian can help you decide when and how to make substitutions or other changes to your meaningful recipes.

How does lifestyle relate to the Mediterranean Diet?

To get the most from your eating plan, try to:

• Exercise regularly, ideally with others.
• Avoid smoking or using any tobacco products.
• Prepare and enjoy meals with family and friends.
• Cook more often than you eat out.
• Eat locally sourced foods whenever possible.

When was the Mediterranean Diet created?

The concept of the Mediterranean Diet began in the 1950s. That’s when an American researcher named Ancel Keys began the Seven Countries Study. This study spanned decades. It investigated links between diet and cardiovascular disease around the world.

As part of the study, Keys and his team looked at eating patterns in Greece and Italy in the 1950s and 1960s. They found those eating patterns were linked with lower rates of coronary artery disease (compared with eating patterns in the U.S. and Northern Europe). Thus, the heart-healthy Mediterranean Diet was born.

So, if you follow a Mediterranean Diet today, you’re eating like people did in certain Mediterranean countries in the mid-20th century. Research shows those patterns have shifted over the years and no longer hold true in many Mediterranean countries.

There are visual pyramids and other guidelines that show you how to put a Mediterranean Diet into practice. A dietitian can help you review such resources and explain how to use them in your daily life.

A note from Cleveland Clinic

In a world with endless diet options, it can be hard to know which one is right for you. Research has proven the benefits of the Mediterranean Diet for many people, especially those at risk for heart disease. Beyond protecting your heart, the Mediterranean Diet can help you prevent or manage many other conditions.

As with any eating plan, it’s important to talk to a healthcare provider before getting started. They’ll make sure the plan is appropriate for you and help you modify it as needed. Also, tell your loved ones about your goals. Invite them to cook and share meals with you. It’s easier to follow an eating plan over the long term when you have a supportive community with you along the way.