What Is the Mediterranean Diet?
The Mediterranean Diet is composed of Mediterranean diet foods which are one of the freshest, colorful and aromatic foods.
Mediterranean diet is based on foods consumed by the people of countries near the Mediterranean sea. The region includes countries like Italy, Greece, Spain, etc.
The term “Mediterranean diet” was coined by Ancel Keys, an American physiologist, who noticed a correlation between low cardiovascular disease occurrence and the plant-based food high in unsaturated fatty acids in the Mediterranean region (1).
There are some variations in food recipes based on the customs and traditions of the local population.
Therefore, no specific definition of the Mediterranean diet exists but the common consensus is that the Mediterranean diet is a plant-based diet rather than a meat-based diet.
What Can You Eat On a Mediterranean Diet?
- High consumption: Cold-pressed extra-virgin olive oil, vegetables, fruits, cereals, nuts, and legumes, etc
- Moderate consumption: fish, poultry, and red wine(only with meals), etc
- Low consumption: Red meat and dairy, eggs, etc
Very little to no consumption: Processed meat and sweets
Being physically active and having a strong family and food sharing is part of the Mediterranean diet lifestyle (4).
The Mediterranean Diet Food Pyramid
Mediterranean diet does not represent a single country. It is a “food pattern” that is spread across the region, so naturally, there is a great variety in foods, eating habits, traditions that depend on the type, quality and availability of ingredients.
Thus combinations of different foods constitute guidelines for the current Mediterranean diet which are represented in the form of food pyramids.
Food pyramids represent foods in order of their importance: foods that should be consumed in the largest quantities are placed at the bottom of the pyramid and foods that should be consumed in small or negligible quantities sit at the top of the pyramid.
Currently, there are 3 Mediterranean food pyramids that can be used as guidelines for the Mediterranean diet (5).
- The Oldway’s Preservation and Exchange Trust pyramid
- The traditional Mediterranean diet of the Greek nutrition guidelines
- The Mediterranean Diet Foundation pyramid
A comparison of Three Food guidelines is given below.
Mediterranean Diet Nutrition Profile
Macronutrients and micronutrients come mostly from plants and moderate to low quantities from animal and dairy products. For daily energy intake, approximately 37% come from Fat, 15% from Proteins, and 43% come from Carbohydrates (6).
Let’s look at the macronutrients of the Mediterranean diet (7).
The majority of fats intake comes from Extra Virgin Olive Oil (EVOO). Olive oil is packed with monounsaturated fatty acids (MUFA) that have an anti-inflammatory and heart-protective function.
The other sources of fats are fish which are an abundant source of Polyunsaturated fatty acids (PUFA) which include long-chain omega-3 fatty acids (eicosapentaenoic acid or EPA and docosahexaenoic acid or DHA).
Nuts, seeds, and green vegetables provide PUFA alpha-linolenic acid.
Saturated fatty acids are consumed in very low quantities that come from meat, olive oil, nuts, and seeds.
Carbohydrates come in the form of whole grains cereal for example bread (including sourdough bread), potatoes, pasta, and rice are the main carbohydrate foods. Fresh fruits are other sources of carbohydrates.
The processed and refined carbohydrates are consumed in very little quantities.
The main protein sources are fish, nuts, legumes, and lentils. Other protein sources used in low quantities are eggs, dairy, red meat, and poultry.
Mediterranean diet is full of minerals and vitamins which have many health benefits. These are provided by cereals, fresh fruits, and vegetables (8).
Moreover, Extra virgin olive oil contains polyphenols that have antioxidant properties. Most important of them are flavonoids. Other sources of flavonoids are red wine, coffee, tea, nuts, fruits, vegetables, herbs, and spices. (9,10,11).
Whole grains are good sources of fiber which is quite beneficial for health and lowering the risk of cardiovascular disease (12).
Mediterranean Diet Choices
Since there is such a great variety of fruits and vegetables available depending on different regions, it is difficult to list everything but the general rule is to eat fresh predominantly plant-based foods.
Seafood is taken in moderation.
The animal products e.g. goat, beef or poultry, cheese, yogurt, milk, etc is taken in limited quantities.
Some of the common health Mediterranean diet foods given below (13).
Oils: Extra virgin olive oil, (cold-pressed is the best option but it is expensive)
Vegetables: Spinach, kale, turnips, cauliflower, broccoli, cabbage, cucumber, onion, leeks, garlic, cucumber, yam, chard, watercress, asparagus, beet, potatoes, eggplant, zucchini, bell peppers, sweet potatoes, squash, okra, artichoke, etc
Legumes: Chickpeas, peas, lentils, lupines, etc
Fruits: Banana, coconut, apples, pear, mango, plum, quince, figs, cherry, raspberry, lemon, Kiwi, capers, olives, grapes, tomatoes, avocado, prickly pears, melons, watermelons, etc
Whole grain: Wheat, rice, soybean, bean, barley, buckwheat, corn, millet, sorghum, etc
Nuts: Almonds, hazelnuts, walnuts, chestnuts, tiger nut, peanuts, sunflower seeds, cashews, etc
Herbs and spices: Borage, marjoram, tarragon, pepper, saffron, turmeric, clove, ginger, parsley, cumin, coriander, fennel, oregano, rosemary, sage, lemon balm, savory, fenugreek, bay leaf, mallow, thistle, cayenne pepper, allspice, etc
Fish and seafood: Herring, albacore, tuna, Sardine, trout, salmon, prawns, shrimps, langoustine, octopus, oysters, mussels, clam, etc
Dairy: Cheese, milk, yogurt, etc
Meat: Goat, beef, chicken, etc
Drinks: Water, red wine and coffee
Miscellaneous: Mushrooms, and chocolate
Mediterranean Diet Plan: 1 Week Example (14)
Breakfast: Porridge (Cooked rolled oats with skim milk) with honey, cinnamon and berries, Herbal tea
Snack: A handful of walnuts
Lunch: Soy and linseed sandwich with spinach tinned tuna in olive oil, tomato and, onion
Dinner: Lentil soup+olive oil drizzled+1 slice of soy and linseed bread and 1 piece of feta, a glass of wine
Snack: 3 dry figs
Breakfast: 2 slices of soy & linseed bread with chopped tomato, onion, herbs in olive oil with lemon juice + coffee
Snack: low-fat Greek yogurt with honey
Lunch: Leftover Lentil soup+olive oil drizzled+2 slices of soy + 1 piece feta & fruit
Snack: a handful of almonds
Dinner: baked snapper(fish)+baked potatoes boiled greens +olive oil & lemon juice, a glass of wine
Snack: 2 slices of rockmelon
Breakfast: low-fat yogurt with chopped fruits, honey cinnamon with almond & walnut + coffee
Snack: a few sultanas sesame snack bar
Lunch: 2 toasted soy & linseed breads+canned sardines in olive oil tomatoes and onions
Dinner: baked risoni with lamb + salad with olive oil, a glass of wine
Snack: a handful of walnuts
Breakfast: 2 slices of soy & linseed bread+boiled egg +avocado with lime juice +cracked pepper, herbal tea
Snack: low-fat yogurt with honey and berries
Lunch: Leftover baked risoni with lamb + salad with olive oil+1 slice of soy and linseed bread
Snack: 3 dried apricots + a handful of almonds
Dinner: Chicken soup+1egg, carrot+coleslaw salad, a glass of wine
Breakfast: Porridge (Cooked rolled oats with skim milk) with honey, cinnamon and berries, Coffee
Snack: 2 slices of watermelon
Lunch: soy and linseed sandwich, feta cheese, roasted vegetable+drizzled olive oil
Snack: a handful walnuts
Dinner: Cannellini bean soup, drizzle olive oil+ 1 slice of soy and linseed bread, a glass of wine
Breakfast: 2 slices of soy and linseed bread + 1 poached egg, tomato stew, Coffee
Snack: Low yogurt + honey
Lunch: Cannellini bean soup, drizzle olive oil, fruits
Snack: A handful of almonds
Dinner: Chicken fillet with caramelized red onions in red wine, oregano sauce, boiled greens with olive oil, 1 soy, and linseed bread, a glass of wine
Snack: 3 dried figs
Breakfast: low-fat greek yogurt + chopped fruits, honey, cinnamon, Coffee
Snack: 2 slices of honeydew
Lunch: salad (pear, walnut, rocket) with tinned salmon in olive oil + 2 slices of soy and linseed bread
Snack: a handful of walnuts
Dinner: Green pea casserole with beef, rice pilaf with greek coleslaw salad, a glass of wine
Snack: a piece of baklava
Health Benefits of the Mediterranean Diet
Mediterranean diet has been studied for its health benefits. In fact, the term was coined by Ancel Keys for the Mediterranean diet’s implication in reducing Cardiovascular disease risk.
A diet rich phytoestrogens, fiber and polyunsaturated fatty acid with a reduction in refined carbohydrates were beneficial in reducing body weight and waist circumference and risk of breast cancer in a group of postmenopausal women (15).
Another long term study observed that adherence to the Mediterranean diet was associated with a lowered risk of obesity (16).
Cardiovascular diseases are manifested by conditions such as coronary heart disease (CHD) (coronary artery disease, ischemic heart disease), stroke, high blood pressure (hypertension), and rheumatic heart disease.
Ancel Keys Seven Countries Study article on the Mediterranean diet focuses on cardiovascular diseases. The fat intake of the Crete and East Finland population is similar but the occurrence rate of coronary heart disease was 30 times less in the Crete sample population. The saturated fatty acids constituted 24% of the East Finland diet compared to 8% in Crete (17).
Consumption of polyunsaturated fatty acids (especially n-3 PUFA) compared to saturated fatty acids (SFA) have been linked to cardiovascular disease protection (18).
Mediterranean diet is packed full of healthy Polyunsaturated fatty acids with low amounts of saturated fatty acids.
A large meta-analysis showed that the Mediterranean Diet can reduce the risk of Cardiovascular disease (19).
Others have shown a reduction in LDL levels with the Mediterranean diet with virgin olive oil (20).
Mediterranean diet can also be beneficial in decreasing the risk of developing Diabetes Type 2. A randomized trial in Spain on a large number of patients observed that taking Mediterranean diet enriched in olive oil could reduce the risk of diabetes in patients with cardiovascular risk (21).
An analysis of several studies done on the impact of the Mediterranean diet showed a positive correlation between the Mediterranean diet and Diabetes reduction (22).
Mediterranean diet could prevent the risk of developing nonalcoholic fatty liver disease NAFLD by unsaturated fatty acids, fibrous, polyphenolic food (23).
A meta-analysis of studies noted that adherence to the Mediterranean diet positively correlates with reduced risk of Metabolic syndrome (24).
Mediterranean diet can also reduce the risk of cancer mortality, The highest adherence score to an MD was significantly associated with a lower risk of all-cause cancer mortality, colorectal cancer, breast cancer, gastric cancer, prostate cancer, liver, cancer, head and neck, pancreatic and respiratory cancer (25).
Adherence to the Mediterranean diet was also associated with improved cognitive health and lowered risk of Alzheimer’s and Parkinson’s disease (26).
Another study concluded that the Mediterranean diet rich in olive oil, fruits and vegetables can also protect against late age depression (27).
Mediterranean diet is associated with several health benefits. It can reduce the risk of several diseases as noted by several observational and a few randomized trials. However, robust studies are needed to fully understand the mechanisms by which the Mediterranean diet can provide health benefits.
The Mediterranean diet was studied by Ancel Keys who posited that consumption of fresh fruits and vegetable and olive oil-based food is correlated with a low occurrence of lower cardiovascular disease risk.
Therefore, the Mediterranean diet is a plant-based diet with moderate dairy and low red meat consumption.
Mediterranean diet could have health benefits that include heart, brain and liver protection.
Frequently Asked Questions (FAQs)
What is Mediterranean Eating Pattern?
The Mediterranean eating pattern is another way to describe Mediterranean diet. It was observed by Dr. Ancel Keys in the 1950s in Mediterranean countries. Dr. Keys described his findings in his research paper noting a reduction in lower reported cases of coronary heart disease in people living in Mediterranean region (28).
How is the Mediterranean diet helpful in CVD and weight loss?
The observational studies have shown that food rich in olive oil, fiber and low in refined carbohydrates is beneficial in weight loss and decreasing the risk of CVD.
What foods are not allowed on the Mediterranean diet?
The general rule of the Mediterranean diet is to avoid any processed food. This includes:
Oils such as soybean,vegetable, corn, sunflower oil, etc.
Processed meat e.g. packaged sausage, packaged meat, etc
Confectionary products e.g. sweets, candies, cakes, etc
Red meat and poultry is allowed but in low quantities.
What do you eat for breakfast on the Mediterranean diet?
The Mediterranean diet breakfast is composed of unprocessed cereals, grains, fruits, and vegetables. Examples are given in the 1 week example meal plan above.