The Mediterranean diet is a diet inspired by the eating habits of Greece, Southern Italy, and Spain in the 1940s and 1950s. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheeseand yogurt), moderate wine consumption, and low consumption of non-fish meat products.
There is some evidence that the Mediterranean diet lowers the risk of heart disease and early death. Olive oil may be the main health-promoting component of the diet. There is preliminary evidence that regular consumption of olive oil may lower all-cause mortality and the risk of cancer, cardiovascular disease, neurodegeneration, and several chronic diseases.
UNESCO included the Mediterranean diet to the Representative List of the Intangible Cultural Heritage of Humanity of Italy, Spain, Portugal, Morocco, Greece, Cyprus, and Croatia. It was chosen because “The Mediterranean diet involves a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking, and particularly the consumption of food.”
A 2017 review found evidence that practice of a Mediterranean diet could lead to a decreased risk of cardiovascular diseases, overall cancer incidence, neurodegenerative diseases, diabetes, and early death. A 2018 review showed that practice of the Mediterranean diet may improve overall health status, such as reduced risk of non-communicable diseases, reduced total costs of living, and reduced costs for national healthcare. A 2016 review found similar weight loss as other diets.
A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors. A meta-analysis in 2013 compared Mediterranean, vegan, vegetarian, low-glycemic index, low-carbohydrate, high-fiber, and high-protein diets with control diets. The research concluded that Mediterranean, low-carbohydrate, low-glycemic index, and high-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes, while there was limited evidence for an effect of vegetarian diets on glycemic control and lipid levels unrelated to weight loss. However, reviews of early 2016 have been more cautious: Concerns have been raised about the quality of previously performed systematic reviews and meta-analyses examining the impact of a Mediterranean diet on cardiovascular risk factors, further standardized research has been found to be necessary, and the evidence as to the prevention of vascular disease by the Mediterranean diet has been found to be “limited and highly variable”. Newer reviews have reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors such as high blood pressure and other cardiovascular diseases.
The Mediterranean diet often is cited as beneficial for being low in saturated fat and high in monounsaturated fat and dietary fiber. One of the main explanations is thought to be the health effects of olive oil included in the Mediterranean diet. Olive oil contains monounsaturated fats, most notably oleic acid, which is under clinical research for its potential health benefits. The European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies approved health claims on olive oil, for protection by its polyphenols against oxidation of blood lipids and for the contribution to the maintenance of normal blood LDL-cholesterol levels by replacing saturated fats in the diet with oleic acid (Commission Regulation (EU) 432/2012 of 16 May 2012). A 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events and stroke, while monounsaturated fatty acids of mixed animal and plant origin showed no significant effects.
In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes. findings similar to those of a 2017 review.
A meta-analysis in 2008 found that strictly following the Mediterranean diet was correlated with a decreased risk of dying from cancer by 6%. A 2017 review found a decreased rate of cancer.
Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer. There is preliminary evidence that regular consumption of olive oil may lower the risk of developing cancer.
A 2016 systematic review found a relation between greater adherence to a Mediterranean diet and better cognitive performance; it is unclear if the relationship is causal.
According to a 2013 systematic review, greater adherence to a Mediterranean diet is correlated with a lower risk of Alzheimer’s disease and slower cognitive decline.Another 2013 systematic review reached similar conclusions, and also found a negative association with the risk of progressing from mild cognitive impairment to Alzheimer’s, but acknowledged that only a small number of studies had been done on the topic.
There is a correlation between adherence to a healthy diet, like the Mediterranean diet, and a lower risk of depression. Studies on which these correlations are made, are observational and do not prove cause and effect.
As the Mediterranean diet usually includes products containing gluten like pasta and bread, increasing use of the diet may have contributed to the growing rate of gluten-related disorders.
Although there are many different “Mediterranean diets” among different countries and populations of the Mediterranean basin, because of ethnical, cultural, economic and religious diversities, the distinct Mediterranean cuisines generally include the same key components, in addition to regular physical activity:
- High intakes of olive oil (as the principal source of fat), vegetables (including leafy green vegetables), fresh fruits (consumed as desserts or snacks), cereals (mostly whole grains), nuts and legumes.
- Moderate intakes of fish and other seafood, poultry, dairy products (principally cheese and yogurt) and red wine.
- Low intakes of eggs, red meat, processed meat and sweets.
These proportions are sometimes represented in the Mediterranean Diet Pyramid. Total fat in a diet with roughly this composition is 25% to 35% of calories, with saturated fat at 8% or less of calories.
In Northern Italy, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables. In both North Africa and the Middle East, sheep’s tail fat and rendered butter (samna) are traditional staple fats.
and Trust (2009)
|Olive oil||Every meal||Every meal||Main added lipid|
|Vegetables||Every meal||≥2 serv. every meal||6 serv./day|
|Fruits||every meal||1-2 serv. every meal||3 serv./day|
|Bread and cereals||every meal||1-2 serv. every meal||8 serv./day|
|Legumes||every meal||≥2 serv./week||3-4 serv./week|
|Nuts||every meal||1-2 serv./day||3-4 serv./week|
|Fish/seafood||≥2 serv./week||≥2 serv./week||5-6 serv./week|
|Eggs||Moderate portions, daily to weekly||2-4 serv./week||3 serv./week|
|Poultry||Moderate portions, daily to weekly||2 serv./week||4 serv./week|
|Dairy foods||Moderate portions, daily to weekly||2 serv./day||2 serv./day|
|Red meat||Less often||<2 serv./week||4 serv./month|
|Sweets||Less often||<2 serv./week||3 serv./week|
|Red wine||In moderation||In moderation and respecting social beliefs||Daily in moderation|
|Each serving is: bread 25 g., potato 100 g., cooked pasta 50-60 g., vegetables 100 g., apple 80 g., banana 60 g., orange 100 g., melon 200 g., grapes 30 g., milk or yogurt 1 cup, 1 egg, meat 60 g., cooked dry beans 100 g.|
The concept of a Mediterranean diet was developed to reflect “food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s”.Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator), the Mediterranean diet failed to gain widespread recognition until the 1990s. Objective data showing that Mediterranean diet is healthful originated from results of epidemiological studies in Naples and Madrid, confirmed later by the Seven Countries Study first published in 1970, and a book-length report in 1980.
The most commonly understood version of the Mediterranean diet was presented, among others, by Walter Willett and colleagues of Harvard University’s School of Public Health since the mid-1990s. The Mediterranean diet is based on a paradox: although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries like the United States where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox. By 2011, the Mediterranean diet was included by some authors as a fad diet promoted for losing weight. As of 2018, the value of the traditional Mediterranean diet was questioned due to homogenization of dietary choices and food products in the global economy, yet clinical research activity remained high, with favorable outcomes reported for various disease conditions, such as metabolic syndrome.
When Ancel Keys and his team of researchers studied and characterized the Mediterranean diet and compared it with the eating habits of the US and the most developed countries during that period, some identified it as the “Diet of the Poor”. According to the famed Portuguese gastronomist Maria de Lourdes Modesto who met with Keys, Portugal was included in their observations and studies, and according to their conversation, Keys considered Portugal had the most pure “Mediterranean” diet. However, Salazar, the dictator of Portugal, did not want the name of Portugal included in what he understood as the diet of the poor.
Still today the name of the diet is not consensual among Portuguese gastronomists. After the Mediterranean diet became well-known, some studies evaluated the health benefits of the so-called “Atlantic diet”, which is similar to Keys’ “Mediterranean” diet, but with more fish, seafood, and fresh greens. Virgílio Gomes, a Portuguese professor and researcher on food history and gastronomy says, Portuguese cuisine is really an “Atlantic cuisine”.
- “Decision of the Intergovernmental Committee: 5.COM 6.41, Spain, Greece, Italy and Morocco have nominated the Mediterranean diet for inscription on the Representative List of the Intangible Cultural Heritage of Humanity”. United Nations (UNESCO), Section of Intangible Cultural Heritage. 2010.
- Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
- Davis C, Bryan J, Hodgson J, Murphy K (Nov 2015). “Definition of the Mediterranean Diet; a Literature Review”. Nutrients (Review). 7 (11): 9139–53. doi:10.3390/nu7115459. PMC 4663587. PMID 26556369.
- Rees, K; Hartley, L; Flowers, N; Clarke, A; Hooper, L; Thorogood, M; Stranges, S (12 August 2013). “‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease”. The Cochrane Database of Systematic Reviews. 8 (8): CD009825. doi:10.1002/14651858.CD009825.pub2. PMC 4176656. PMID 23939686.
- Dinu, M; Pagliai, G; Casini, A; Sofi, F (10 May 2017). “Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials”. European Journal of Clinical Nutrition. 72 (1): 30–43. doi:10.1038/ejcn.2017.58. PMID 28488692.
- Piroddi M, Albini A, Fabiani R, Giovannelli L, Luceri C, Natella F, et al. (2016). “Nutrigenomics of extra-virgin olive oil: A review”. BioFactors. 43 (1): 17–41. doi:10.1002/biof.1318. PMID 27580701.
- Buckland G, González CA (Apr 2015). “The role of olive oil in disease prevention: a focus on the recent epidemiological evidence from cohort studies and dietary intervention trials”. Br J Nutr (Review). 113 Suppl 2: S94–101. doi:10.1017/S0007114514003936. PMID 26148926.
- Schwingshackl L, Hoffmann G (Oct 1, 2014). “Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies”. Lipids Health Dis (Review). 13: 154. doi:10.1186/1476-511X-13-154. PMC 4198773. PMID 25274026.
- Psaltopoulou T, Kosti RI, Haidopoulos D, Dimopoulos M, Panagiotakos DB (2011). “Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13,800 patients and 23,340 controls in 19 observational studies”. Lipids Health Dis. 10: 127. doi:10.1186/1476-511X-10-127. PMC 3199852. PMID 21801436.
- “UNESCO – Culture – Intangible Heritage – Lists & Register – Inscribed Elements – Mediterranean Diet”. Retrieved April 3, 2014.
- Martinez-Lacoba, R; Pardo-Garcia, I; Amo-Saus, E; Escribano-Sotos, F (2018). “Mediterranean diet and health outcomes: a systematic meta-review”. European Journal of Public Health. Advance articles (5): 955–961. doi:10.1093/eurpub/cky113. PMID 29992229.
- Mancini, JG; Filion, KB; Atallah, R; Eisenberg, MJ (April 2016). “Systematic Review of the Mediterranean Diet for Long-Term Weight Loss”. American J Med. 129 (4): 407–415.e4. doi:10.1016/j.amjmed.2015.11.028. PMID 26721635.
- Ajala O.; English P.; Pinkney J. (2013). “Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes”. The American Journal of Clinical Nutrition. 97 (3): 505–516. doi:10.3945/ajcn.112.042457. PMID 23364002.
- Huedo-Medina, TB; Garcia, M; Bihuniak, JD; Kenny, A; Kerstetter, J (March 2016). “Methodologic quality of meta-analyses and systematic reviews on the Mediterranean diet and cardiovascular disease outcomes: a review”. American Journal of Clinical Nutrition (Review). 103 (3): 841–50. doi:10.3945/ajcn.115.112771. PMID 26864357.
- Nissensohn M, Román-Viñas B, Sánchez-Villegas A, Piscopo S, Serra-Majem L (January 2016). “The Effect of the Mediterranean Diet on Hypertension: A Systematic Review and Meta-Analysis”. Journal of Nutrition Education and Behavior (Review). 48 (1): 42–53.e1. doi:10.1016/j.jneb.2015.08.023. PMID 26483006.
- Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, Jardine M, Hillis GS, Perkovic V (2016). “Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis”. PLOS One (Review). 11 (8): e0159252. doi:10.1371/journal.pone.0159252. PMC 4980102. PMID 27509006.
- Gay, HC; Rao, SG; Vaccarino, V; Ali, MK (April 2016). “Effects of Different Dietary Interventions on Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials”. Hypertension. 67 (4): 733–9. doi:10.1161/HYPERTENSIONAHA.115.06853. PMID 26902492.
- European Food Safety Authority (2011). “Scientific Opinion on the substantiation of health claims related to polyphenols in olive”. EFSA Journal. 9 (4): 2033. doi:10.2903/j.efsa.2011.2033.
- European Food Safety Authority (2011). “Scientific Opinion on the substantiation of health claims related to oleic acid intended to replace saturated fatty acids (SFAs) in foods or diets”. EFSA Journal. 9 (4): 2043. doi:10.2903/j.efsa.2011.2043.
- “COMMISSION REGULATION (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health. Text with EEA relevance”. Official Journal of the European Union. Retrieved August 31, 2016.
- Schwingshackl, L; Missbach, B; König, J; Hoffmann, G (22 August 2014). “Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis”. Public Health Nutrition. 18 (7): 1292–9. doi:10.1017/S1368980014001542. PMID 25145972.
- Koloverou, E; Esposito, K; Giugliano, D; Panagiotakos, D (July 2014). “The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants”. Metabolism: Clinical and Experimental. 63 (7): 903–11. doi:10.1016/j.metabol.2014.04.010. PMID 24931280.
- Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008). “Adherence to Mediterranean diet and health status: meta-analysis”. BMJ (Clinical Research Ed.). 337 (sep11 2): a1344. doi:10.1136/bmj.a1344. PMC 2533524. PMID 18786971.
- Schwingshackl, L; Hoffmann, G (15 October 2014). “Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies”. International Journal of Cancer. 135 (8): 1884–97. doi:10.1002/ijc.28824. PMID 24599882.
- Petersson, SD; Philippou, E (September 2016). “Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence”. Advances in Nutrition (Bethesda, Md.). 7 (5): 889–904. doi:10.3945/an.116.012138. PMC 5015034. PMID 27633105.
- Lourida, Ilianna; Soni, Maya; Thompson-Coon, Joanna; Purandare, Nitin; Lang, Iain A.; Ukoumunne, Obioha C.; Llewellyn, David J. (July 2013). “Mediterranean Diet, Cognitive Function, and Dementia”. Epidemiology. 24 (4): 479–489. doi:10.1097/EDE.0b013e3182944410. PMID 23680940.
- Singh, B; Parsaik, AK; Mielke, MM; Erwin, PJ; Knopman, DS; Petersen, RC; Roberts, RO (2014). “Association of mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis”. Journal of Alzheimer’s Disease. 39 (2): 271–82. doi:10.3233/JAD-130830. PMC 3946820. PMID 24164735.
- Psaltopoulou, T; Sergentanis, TN; Panagiotakos, DB; Sergentanis, IN; Kosti, R; Scarmeas, N (October 2013). “Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis”. Annals of Neurology. 74 (4): 580–91. doi:10.1002/ana.23944. PMID 23720230.
- Volta U, Caio G, Tovoli F, De Giorgio R (2013). “Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness”. Cellular and Molecular Immunology (Review). 10 (5): 383–392. doi:10.1038/cmi.2013.28. ISSN 1672-7681. PMC 4003198. PMID 23934026.
Many factors have contributed to the development of gluten-related pathology, starting with the worldwide spread of the Mediterranean diet, which is based on a high intake of gluten-containing foods.
- Lin PH, Aronson W, Freedland SJ (Jan 8, 2015). “Nutrition, dietary interventions and prostate cancer: the latest evidence”. BMC Med (Review). 13: 3. doi:10.1186/s12916-014-0234-y. PMC 4823849. PMID 25573005.
- Willett WC; Sacks, F; Trichopoulou, A; Drescher, G; Ferro-Luzzi, A; Helsing, E; Trichopoulos, D (June 1, 1995). “Mediterranean diet pyramid: a cultural model for healthy eating”. American Journal of Clinical Nutrition. 61 (6): 1402S–6S. doi:10.1093/ajcn/61.6.1402s. PMID 7754995.
- Massimo Alberini, Giorgio Mistretta, Guida all’Italia gastronomica, Touring Club Italiano, 1984
- Tapper, Richard; Zubaida, Sami (2001). A Taste of Thyme: Culinary Cultures of the Middle East. Tauris Parke Paperbacks. p. 43. ISBN 978-1-86064-603-4.
- This article incorporates text by Courtney Davis, Janet Bryan, Jonathan Hodgson, and Karen Murphy available under the CC BY 4.0 license.Davis, Courtney; Bryan, Janet; Hodgson, Jonathan; Murphy, Karen (2015). “Definition of the Mediterranean Diet; A Literature Review”. Nutrients. 7 (11): 9139–9153. doi:10.3390/nu7115459. PMC 4663587. PMID 26556369.
- “Mediterranean Diet Pyramid”. Retrieved 2013-02-27.
- Bach-Faig, A.; Berry, E. M.; Lairon, D.; Reguant, J.; Trichopoulou, A.; Dernini, S.; Medina, F. X.; Battino, M.; Belahsen, R.; Miranda, G.; Serra-Majem, L.; Mediterranean Diet Foundation Expert Group (2011). “Mediterranean diet pyramid today. Science and cultural updates”. Public Health Nutrition. 14 (12A): 2274–84. doi:10.1017/S1368980011002515. PMID 22166184.
- Martínez-González, M. A.; Sánchez-Villegas, A. (2004). “The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern?”. European Journal of Epidemiology. 19 (1): 9–13. PMID 15012018.
- Ancel Keys, Margaret Keys, How to eat well and stay well the Mediterranean way, Doubleday, 1975
- António José Marques da Silva (2015). The Mediterranean Diet: Discussions and Eating Practices in the Mediterranean (translated) (vol. 2) pp. 52-54. L’Harmattan, Paris. ISBN 978-2-343-06151-1.
- Ancel Keys, ed. (April 1970). “Coronary heart disease in seven countries”. Circulation. 41 (4 Suppl): I1–211. doi:10.1161/01.CIR.41.4S1.I-1. PMID 5442782.
- Ancel Keys (ed), Seven Countries: A multivariate analysis of death and coronary heart disease, 1980. ISBN 0-674-80237-3
- Burros, Marian (29 March 1995). “Eating Well”. The New York Times. Archived from the original on 7 April 2008.
- Kushi LH, Lenart EB, Willett WC (1995). “Health implications of Mediterranean diets in light of contemporary knowledge. 1. Plant foods and dairy products”. Am. J. Clin. Nutr. 61 (6 Suppl): 1407S–1415S. doi:10.1093/ajcn/61.6.1407S. PMID 7754996.
- Kushi LH, Lenart EB, Willett WC (1995). “Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils”. Am. J. Clin. Nutr. 61 (6 Suppl): 1416S–1427S. doi:10.1093/ajcn/61.6.1407S. PMID 7754997.
- Willett WC (2006). “The Mediterranean diet: science and practice”. Public Health Nutr. 9 (1A): 105–10. PMID 16512956.
- Bruno Simini (1 January 2000) “Serge Renaud: from French paradox to Cretan miracle” The Lancet 355:9197:48 doi:10.1016/S0140-6736(05)71990-5
- Brown JE, Isaacs J, Krinke B, Lechtenberg E, Murtaugh M (2011). Nutrition Through the Life Cycle (4th ed.). Cengage Learning. p. 410. ISBN 978-1-133-00816-3.
- Villani A, Sultana J, Doecke J, Mantzioris E (2018). “Differences in the interpretation of a modernized Mediterranean diet prescribed in intervention studies for the management of type 2 diabetes: how closely does this align with a traditional Mediterranean diet?”. European Journal of Nutrition. doi:10.1007/s00394-018-1757-3. PMID 29943276.
- Moreira, José Augusto (October 10, 2012). “Mediterrânica ou atlântica, eis a questão”. Público (in Portuguese).