What is a Mediterranean Diet?
The Mediterranean diet is a dietary pattern characterized by high consumption of olive oil, vegetables, fruits, whole grains, legumes, nuts, and fish, with moderate wine intake and limited red meat and processed foods. 1
Core Food Components
The Mediterranean diet emphasizes the following key elements:
High-Consumption Foods (Daily to Multiple Times Weekly)
- Olive oil as the primary source of fat, particularly extra virgin olive oil, which provides monounsaturated fatty acids and polyphenols 2, 1
- Abundant plant foods including vegetables, fruits, whole grains, legumes, nuts, and seeds consumed daily 1, 3
- Fish and seafood at least twice weekly 3
- Whole grains as a staple carbohydrate source 2, 1
Moderate-Consumption Foods
- Dairy products primarily in the form of cheese and yogurt, consumed in low to moderate amounts 1, 4
- Poultry and eggs in moderate portions 3, 4
- Wine consumed in low to moderate amounts, typically with meals 2, 1
Limited-Consumption Foods
- Red meat consumed only a few times per month in small portions 3, 4
- Sweets and sugar-sweetened beverages minimally consumed 3
- Processed foods kept to a minimum 1
Nutritional Characteristics
The Mediterranean diet has distinct macronutrient and micronutrient profiles:
- Total fat intake ranges from 32% to ≥35% of total energy, with only 9-10% from saturated fats 2
- High monounsaturated and polyunsaturated fatty acids, with emphasis on omega-3 fatty acids from fish and plant sources 2, 3
- Dietary fiber intake of 27-37 grams per day, which is double the current US average intake 2, 3
- Rich in polyphenols from olive oil, fruits, vegetables, and wine 1
- Low in saturated fats (≤7-8% of energy) and animal protein 5, 4
Cardiovascular and Health Benefits
The Mediterranean diet demonstrates substantial evidence for reducing morbidity and mortality:
- Reduces coronary heart disease risk by 29-69% and stroke risk by 13-53% 2, 3
- Provides a 10% reduction in cardiovascular disease events for every 2-point increase in adherence to the dietary pattern 2, 3
- Lowers systolic blood pressure by 6-7 mm Hg and diastolic blood pressure by 2-3 mm Hg 2, 3
- Reduces all-cause mortality rates among adherents 1
- Decreases inflammation through its bioactive compounds 1
The landmark PREDIMED trial demonstrated a 30% reduced risk for myocardial infarction, stroke, and cardiovascular mortality after 4.8 years when comparing Mediterranean diet supplemented with olive oil or nuts versus a control low-fat diet 2
Comparison with Other Dietary Patterns
The Mediterranean diet shares similarities with the DASH (Dietary Approaches to Stop Hypertension) diet, as both emphasize fruits, vegetables, whole grains, and limited saturated fats 3. However, key differences exist:
- The Mediterranean diet is lower in dairy products compared to DASH 2, 3
- Higher in olive oil and seafood than DASH 2, 3
- Includes moderate wine consumption, which is not emphasized in DASH 3
- DASH focuses more on low-fat dairy and sodium restriction (1500-2300 mg/day), while Mediterranean diet emphasizes fat quality over quantity 2
Historical Context and Cultural Elements
The term "Mediterranean diet" originated from the Seven Countries Study led by Ancel Keys around 1960, based on food patterns typical of Crete, Greece, and southern Italy in the early 1960s, where adult life expectancy was among the highest in the world 5, 4. Beyond just food composition, the traditional Mediterranean diet includes cultural and lifestyle elements such as home-cooked meals, eating main meals in company, and regular physical activity 6
Important Caveats
There is no single standardized Mediterranean diet, as considerable variability exists by geographic location among Mediterranean countries 2. This cross-cultural variability limits the development of precise associations and has led to criticism that current research does not fully comply with contemporary methodological quality standards 2. Various scoring systems have been developed to quantify adherence, but these differ across studies 2, 1.