Research-Based

The Ultimate Guide To The Mediterranean Diet

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By Leslie Waterson

Reviewed by Juliana Tamayo, MS, RDN - Last Updated

The Ultimate Guide To The Mediterranean Diet

INTRODUCTION TO THE MEDITERRANEAN DIET

There are many different cultures and diets in the countries that surround the Mediterranean Sea, but the basic Mediterranean diet (MED) involves eating plenty of fresh vegetables, fruit, seafood, whole grains, and extra virgin olive oil. Legumes, seeds, nuts, herbs and spices are also a important part of this diet. Things to eat in moderation include poultry, eggs, cheese, yogurt, and wine. Red meat is eaten only on rare occasions. Things to avoid include added sugars, processed foods, and refined oils.

The Ultimate Guide To The Mediterranean Diet

HISTORY OF THE MEDITERRANEAN DIET

The Mediterranean Sea is located between Europe and Africa and humans have lived on its shores for millennia. Fish is plentiful, olive trees grow well and fruit, vegetables and herbs are available year-round due to its mild climate. There is a reason the Roman Empire started here and not in a place like Siberia.

Back in the 1950s, the rate of heart disease and stroke was skyrocketing amongst Americans, while people in other countries such as Greece and Italy were enjoying excellent health and had very little cardiovascular disease. American scientists began to study the connection between diet and cardiovascular disease, and a large-scale nutrition research project called the Seven Countries Study was started to compare diets and rates of disease and mortality of different regions of the world. The study lasted 15 years and investigated 7 different countries, (Greece, Italy, Spain, South Africa, Japan and Finland). Researchers determined that people who ate a diet low in saturated fat and dairy products but high in vegetables, fruit and nuts were healthier, tended to live longer, and reduced their chances of dying, particularly due to heart disease. Several similar studies have been repeated around the world and come to the same conclusion: the Mediterranean diet increases your chances of living a long, healthy life.

MEDITERRANEAN DIET MACROS

The macros for the Mediterranean diet are not strict, but approximate values are: 40% complex carbohydrates, 30-40% healthy fats and 20-30% lean proteins

You get to custom-tailor the diet to your personal preferences, but the place to start is with veggies. Green is better than starchy, but eating a rainbow is important too. To keep things simple, plan on filling half your plate with vegetables.

Fruit is also fine, particularly grapes, berries, apples, dates, citrus fruits, and melons. Enjoy your fruit with yogurt for dessert, or perhaps toss some in a salad. (Avocados and tomatoes are a-okay on the Mediterranean diet too, whether or not you consider them to be fruit.)

Whole grains are preferred to processed ones, and fiber is a big plus when it comes to carbs. This is where you can count your starchy vegetables, like sweet potatoes and squash. About a quarter of your plate can be starches.

The final quarter of your plate should be lean protein, giving fish and seafood priority. Poultry and eggs are good too, but beef and pork is more of an occasional treat (meaning about once a month). Plant proteins from legumes like beans and peas are also good sources of lean protein.

Extra virgin olive oil (EVOO) is the preferred source of fat on the Mediterranean diet, and fatty fish like salmon are excellent sources of anti-inflammatory omega-3s. Nuts, avocados and hummus also provide healthy fats, and moderate amounts of cheese and dairy products can also be incorporated into this diet. The Mediterranean diet tends to be higher in fat than a typical American diet, but lower in cholesterol. For those who follow the MED, their blood lipid numbers tend to be better than people who eat a standard American diet.

BENEFITS OF THE MEDITERRANEAN DIET

HIGH IN ANTI-INFLAMMATORY FOODS 

Inflammation is a hot topic in health these days, because it either causes or exacerbates just about every disease out there. A Mediterranean diet is built on plant-based foods and healthy fats, both of which are rich in anti-inflammatory compounds. Besides helping to lower your risk of obesity, type 2 diabetes, heart disease, stroke, cancer and dementia, the Mediterranean diet is flexible and allows you to still enjoy your food, and your life. 

LOW IN SUGAR & PROCESSED FOODS

The basis of the Mediterranean diet is whole, fresh foods found in nature, like vegetables, fish, beans and olive oil. By contrast, the typical American diet is loaded with processed foods, high fructose corn syrup, and chemical additives, all of which are known to negatively impact health. In a Mediterranean diet, sugars come from natural sources, like fruit and honey. 

NATURAL WEIGHT LOSS

Following a Mediterranean diet can help you lose weight without feeling hungry. Whole, unprocessed foods contain more nutrients and fiber, which helps you to feel full while eating less. Because the Mediterranean diet allows for variety and personal preference, it is easier to stick to than many other diets, helping you to not feel deprived.

REDUCED RISK OF CANCER

A diet that is rich in fruits and vegetables like the Mediterranean diet has been proven to fight cancer. This type of diet is rich in antioxidants which protect DNA from damage by free radicals and prevent cell mutation. Antioxidants also reduce inflammation and delay the growth of tumors. Research shows that olive oil reduces the risk of cancer of the bowel and colon, and it may even be a natural treatment for cancer. Besides reducing inflammation, the MED also helps people to maintain a healthy weight, which puts less stress on the body’s systems, warding off disease.

HEALTHIER HEART

The Mediterranean diet contains foods with a lot of omega-3s and monounsaturated fats, both of which decrease the chances of developing heart disease. Olive oil contains the omega-3 called ALA and has been shown to significantly reduce the risk of dying by a heart attack. Olive oil also lowers blood pressure, reduces cholesterol levels and repairs damage done by free radicals.

PREVENTS & TREATS DIABETES

Eating a diet that is rich in whole foods and low in sugar rebalances blood sugar. Research suggests that the Mediterranean diet can help combat diseases that are due to inflammation, including type 2 diabetes and its precursor, metabolic syndrome. The Mediterranean diet’s ratio of (roughly) 40% complex carbs, 30-40% healthy fats and 20-30% quality protein helps to rebalance hormones, preventing hunger, improving mood and the likelihood of bingeing on unhealthy foods. Sugar is kept to a minimum on the MED, and comes from a wholesome source, usually fruit or the occasional homemade dessert.

IMPROVED MOOD & MEMORY 

The Mediterranean diet could be a natural treatment for diseases like Parkinson’s, Alzheimer’s and dementia. Problems with cognition sometimes happen when the brain isn’t getting enough of the neurotransmitter dopamine. A diet rich in anti-inflammatory foods such as vegetables and fruit as well as healthy fats like olive oil and nuts can combat the harm inflicted by toxins and free radicals. It is now known that the probiotics found in yogurt, kefir and other fermented foods are also linked to disorders of mood, cognition and memory.

INCREASED LONGEVITY

While it’s no guarantee, the Mediterranean diet which is rich in plant-based foods and healthy fats appears to offer your best chances of being healthy for a long time. Following a Mediterranean diet has been shown in studies to reduce the risk of developing heart disease by a staggering 70%. (That is better than what most cholesterol-lowering drugs can do by a factor of 3.) A Mediterranean diet offers your best odds of beating death from any cause versus a low-fat diet by 45%.

STRESS LESS

It would be great if diet alone was the reason Italians and Greeks live so long, but the truth is, lifestyle matters too. People who live around the Mediterranean tend to be more physically active. They spend time outdoors and eat with family and friends (rather than cramming in a burger snagged at a drive-thru), and just generally make time to have fun, relax, and explore their hobbies and interests.

The Ultimate Guide To The Mediterranean Diet Health Benefits

DOWNSIDES OF THE MEDITERRANEAN DIET

NOT A LOT OF DIRECTION

The Mediterranean diet’s allowances for variety and personal choice can be its biggest flaw. For those who need help determining what and how much to eat, or prefer set guidelines, there’s not a ton of guidance. How much ‘low to moderate’ or ‘often’ means different things to different people. Luckily, there are plenty of Mediterranean cookbooks and online resources to help you figure this out.

CAN BE COSTLY

Eating fresh fruit, vegetables, quality seafood and extra virgin olive oil will certainly cost more than a fast food meal, but when you consider what you are saving on healthcare costs, it probably works out to invest in the good food and skip the trip to the hospital.

NOT FOR EVERYONE

The recommended daily glass of wine isn’t going to work if you have a medical condition such as pancreatitis or are taking certain medications. If you have specific health concerns, talk to your doctor before changing your diet.

MEDITERRANEAN DIET DETAILS

The Mediterranean diet is pretty easy to follow and it allows for plenty of variation. The basic rules are to eat lots of vegetables, fruit, nuts, seeds, legumes, seafood, extra virgin olive oil, whole grains, herbs and spices. 

Chicken, turkey, eggs, yogurt, cheese and other dairy products can be eaten in moderation, a few times a week.

Beef and pork are for special occasions only, meaning not more than once or twice a month.

Avoid added sugars, processed foods of all kinds, including meats, grains, and oils. Read the label before buying anything pre-packaged, even supposedly healthy convenience foods.

Eat plenty of fresh vegetables every day, and seafood at least twice a week. Water should be drunk throughout the day, and enjoying a glass of wine each day is also part of this diet. Red wine is preferred. Coffee and tea are fine, but sugary drinks should be avoided.

The Mediterranean diet is also a lifestyle, which involves sharing meals with others, being physically active and just generally taking time to slow down, unplug and enjoy life.

Adding to the diet’s simplicity, there is usually no need to track calories, macros or anything else on the MED. Because the diet provides balanced nutrition, you should find that you feel full and satisfied, and because you no longer eat junk food, cravings should be minimal.

The diet is based on eating 3 meals per day, but if you want a snack, a handful of nuts, a piece of fruit, yogurt, or veggies and hummus would fit the bill.

BEST FOODS TO EAT ON THE MEDITERRANEAN DIET

Vegetables — Chock-full of vitamins, minerals and fiber, as well as antioxidants and other beneficial compounds, veggies are the foundation of the Mediterranean diet. Eat plenty of fresh vegetables every day.

Fruit — Fruit is another daily staple of the Mediterranean diet. It is the primary source of sugar but because it also contains fiber and micronutrients, fruit should not cause a spike in blood sugar. Fruit is a common dessert on the Mediterranean diet.

Fish & Seafood — Fish and seafood provide lean protein and anti-inflammatory omega-3s, and do not contain cholesterol. It is recommended that you eat seafood at least twice a week on the MED.

Legumes — Legumes are beans and peas. Red beans, black beans, soybeans, lentils, peas and green beans are all part of this family. Legumes also provide lean protein without adding cholesterol.

Fats — Extra virgin olive oil is the fat of choice on the Mediterranean diet, but nuts, seeds, and avocados are also welcome sources. Avoid processed fats, including vegetable oils like corn, sunflower, canola, and anything containing trans-fats or hydrogenated oils.

Grains — Unlike many other popular diets out there, things like bread and pasta are not off-limits on the Mediterranean diet. But they should be whole, complete and unprocessed, like whole wheat, steel-cut oats, brown rice, and quinoa.

Herbs & spices — Herbs and spices are a big part of what makes Mediterranean food so delicious. Superfoods like garlic have always been a part of the Mediterranean palate. Use herbs and spices, as opposed to just reaching for the salt shaker, to flavor your food and add valuable phytonutrients and antioxidants at the same time.

The Ultimate Guide To The Mediterranean Diet Foods

FOODS TO AVOID ON THE MEDITERRANEAN DIET

Processed foods — Anything that has a long list of ingredients, particularly unpronounceable ones, should be avoided. Likewise for any food item that has added sugars, high fructose corn syrup or other processed or artificial ingredients, such as hydrogenated oils, MSG, and so on.

Sugary drinks — Soft drinks, juices, coffee drinks, anything with lots of added sugar is not part of this diet.

Red meat and butter — While these are not strictly forbidden, they are meant to be eaten only occasionally. Get your protein from lean meats like fish, poultry and beans, and use olive oil rather than butter.

The Ultimate Guide To The Mediterranean Diet Foods To Avoid

KEYS TO SUCCESS ON THE MEDITERRANEAN DIET

EMPHASIZE PLANTS

Vegetables, fruit, nuts, whole grains and seeds are the base of this food pyramid. Eat the full range of colors to get maximum nutrients and fiber.

POUR ON THE EXTRA VIRGIN OLIVE OIL

Extra virgin olive oil is another important component of the Mediterranean diet. Extra virgin is preferred because of the process used to make it. EVOO is unrefined and contains more antioxidants, vitamins and minerals, and less oleic acid. (Olive oil is rated by its acidity, lower acidity being better. The amount of oleic acid in olive oil tells you how much of the fat has broken down into fatty acids, which is undesirable.) EVOO is not treated with chemicals or heated. Steer clear of other oils like soybean, corn, and sunflower as they have been chemically altered.

DISH UP THE FISH

Fish and seafood are meant to be eaten a minimum of twice a week on the MED. Fish and seafood contain beneficial omega-3 fatty acids but no cholesterol and are a lean source of protein. Chicken, turkey and eggs can also be eaten on a moderate basis, meaning a few times a week.

SAY YES TO YOGURT

Yogurt and other fermented dairy products like kefir contain gut-friendly probiotics and can be included daily in your Mediterranean diet. Cheese is also fine and can be consumed every day or a few times a week.

RED LINE THE RED MEAT

Red meat is one thing you want to cut back on. It can still be enjoyed occasionally, however, as a special treat.

SAVOR SMALL SWEETS

Things like fruit and yogurt make up a typical Mediterranean dessert. Sweets should be enjoyed about as frequently as red meat, meaning rarely. Ideally, they will be homemade, and small portions are best.

CONQUER COOKING

This diet is all about freshly-prepared dishes. Make it a family affair and learn to cook Mediterranean dishes together.

DRINK UP

Water is the beverage of choice on this diet, but a glass of red wine is also a Mediterranean staple.

BE CONVIVIAL

The Mediterranean diet is not only about olive oil, wine and fresh veggies. A relaxed meal with friends and family can do wonders for your stress level and your mental health. 

MOVEMENT MATTERS

The Mediterranean lifestyle is not a sedentary one. Why not organize an après-dinner stroll with your family and friends?

COMMON MYTHS ABOUT THE MEDITERRANEAN DIET

THE LOCALS ARE ALL HEALTHY 

The Mediterranean is a huge area, and not everyone eats a healthy diet. The Mediterranean diet is based primarily on Greece and southern Italy where olive oil and fish are consumed in large quantities.

YOU GET TO EAT ALL THE CHEESE, PASTA, AND BREAD YOU WANT

This is only true if you want to eat a moderate amount. Bingeing is not healthy, be it on food, drink, or Seinfeld reruns. Cheese has a lot of calories, as well as saturated fat. While there are people who live along the Mediterranean who eat cheese every day, they don’t down a whole log of mozzarella in one go. 

Ditto for pasta and bread. Italians do tend to eat pasta regularly, but their portion size is much smaller than what the typical American would serve. Pasta isn’t considered a main dish, but rather a side. As for bread, Italians might have one slice to soak up the extra sauce (and olive oil).

Overeating anything will likely lead to weight gain and other health problems. 

YOU GET TO EAT DESSERT EVERY DAY

Mediterranean desserts are delicious but just because they are for sale at the bakery doesn’t mean the locals eat them all the time. Too much sugar isn’t good for a body, no matter if it comes from honey or any other natural source. Stick to fruit as offering more complete nutrition along with the sweet taste.

THE DIET IS ALL THAT MATTERS

A balanced diet will do much for your health, but locals of the Mediterranean also live an active lifestyle. That doesn’t mean they hit the gym, but they’re active throughout the day, walking, biking or performing other manual labor. We all need to get some form of physical exercise every day. 

People who live around the Mediterranean also tend to live a slower, less stressful life. Take a cue from them: slow down, unplug, relax and enjoy.

NO WAY IS EATING ALL THAT FAT HEALTHY

We’ve been suffering from a terrible myth for years now: that all fat is bad. It is true that the Mediterranean diet contains more fat than the average American diet, but fat from olives, avocados and nuts have been shown to offer health benefits for your heart and your overall health. 

YOU CAN EAT A TON & NEVER GAIN WEIGHT

It may seem like people who live in the Mediterranean eat a lot. And maybe they do, but it involves lots of vegetables which are low in calories. The portion size of the high-calorie foods like meat, cheese and dessert also tends to be much smaller than what we eat in the US. Also, snacking isn’t a thing in these regions, whereas Americans seem to eat all day long.

DRINKING A LOT OF WINE IS GOOD FOR YOU

A glass or two of wine probably won’t do you any harm and may provide benefits for your heart and overall health, but just like bingeing on cheese or carbs, overdoing the alcohol will not do you any favors in the long run.

The Ultimate Guide To The Mediterranean Diet Myth

COMMON MISTAKES ON THE MEDITERRANEAN DIET

EATING TOO LITTLE FAT

We’re so conditioned to think fat is bad, we all naturally avoid it, and you’ll find a lot of low-fat ‘Mediterranean’ recipes out there. But the Mediterranean diet is not a low-fat diet. Olive oil is what makes all those veggies go down easy. Don’t skimp on it.

CUTTING TOO MANY CARBS

While it’s true that simple carbs and added sugars are not good for you, complex carbs in the form of vegetables, legumes and whole grains are the basis of this diet. Give old-style grains like buckwheat and farro a try.

PIZZA IS NOT A FOOD GROUP

Most kinds of American pizza you’ll come across are basically fast food, full of empty calories, sodium and unhealthy fat, and therefore not part of this diet. But you can certainly make a Mediterranean-style pizza yourself, using a whole-grain crust, plenty of fresh vegetables and a sprinkling of cheese.

THERE’S NO MAGIC FORMULA

Olive oil and a glass of wine are not magic bullets. The power of this diet comes from the pattern of healthy eating that is sustainable and enjoyable.

IT’S NOT A FREE PASS TO DRINK

A glass or two of wine with dinner is fine; a whole bottle is not. This diet is about eating and drinking fresh, tasty things in moderation, not bingeing.

COMMON QUESTIONS ABOUT THE MEDITERRANEAN DIET

WHAT IS THE EASIEST WAY TO START?

It’s best to start the Mediterranean diet by learning the basic principles and understanding what makes it so healthy. (Hopefully this article was helpful.) Check out the list of foods, recipes, and other resources below. Next, take a look at what you’re currently eating and see what overlaps. Because the diet is so flexible, you may find that you don’t need to make drastic changes, and that just a few tweaks make all the difference.

IS IT POSSIBLE TO EAT ALL THAT FAT AND STILL LOSE WEIGHT?

The Mediterranean diet is higher in fat than some other diets, but it is the healthy kind that your body needs. By eating a healthy balance of fats, complex carbs and lean proteins, you should feel full and satisfied on fewer calories. Because the Mediterranean diet doesn’t demand that you follow unusual habits (such as avoiding all carbs or eating enormous quantities of protein) it can help you lose weight and keep it off.

IS THERE A VEGETARIAN OR VEGAN VERSION OF THE MEDITERRANEAN DIET?

It is possible to follow the Mediterranean if you are a vegetarian or vegan. Olive oil, avocados and nuts are acceptable healthy fat sources for all three diets, and beans and peas provide complete plant proteins. Fruits and veggies are of course a-okay for all these diets, and more complex carbs from whole-grain breads and pasta round out your macronutrients. Vegans and vegetarians sometimes struggle to get enough vitamin B-12, D, iron, calcium, zinc and a few other nutrients no matter what diet they follow, so be sure to supplement if needed.

DO YOU HAVE TO EXERCISE WITH THE MEDITERRANEAN DIET?

Short answer: yes. Longer answer: It doesn’t have to be in a gym. Probably very few of the people who lived in Greece and Italy in the 1950s were hitting the Stairmaster. Their lifestyle contained physical activity, naturally. As a rule of thumb, aim for an hour of physical activity each day.

WHAT’S THE BIGGEST DIFFERENCE BETWEEN THE MEDITERRANEAN DIET AND AN AMERICAN DIET?

Americans eat a lot more processed foods and sugar whereas the Mediterranean diet is all about freshly-prepared, wholesome foods. A typical American diet also contains much more red meat, dairy, poultry and eggs than is consumed on the Mediterranean diet.

HOW IS A LOW-CARB DIET DIFFERENT FROM THE MEDITERRANEAN DIET?

Low Carb is, by definition, low in carbs. So while vegetables are important to both diets, grains are allowed on the Mediterranean diet and mostly avoided for Low Carb. The amount and source of protein is different as well. The Mediterranean diet is fairly low in protein, and that protein will come from lean, cholesterol-free sources like fish and legumes whereas for Low Carb, red meat is fine and encouraged.

The Ultimate Guide To The Mediterranean Diet Foods Questions

MEDITERRANEAN VS KETO

While fibrous vegetables are important to both these diets, keto is based on the principle of staying in ketosis, or burning fat (rather than glucose). To maintain ketosis, you must eat a lot of fat and very few carbs. Standard macros for keto are 60-90% fat, 10-20% protein and 5-10% carbs. This is very different from the Mediterranean diet which is more like 30-40% fat, 20-30% protein and 30-40% carbs. Fat sources are not restricted with keto, so while olive oil is one fat on the menu, it is not by any means the only one and foods that contain saturated fat like red meat, pork, heavy cream and butter are all perfectly acceptable.

MEDITERRANEAN VS VEGETARIAN

While it is possible to do a vegetarian version of the Mediterranean diet, the authentic Mediterranean diet contains foods from animal sources. Eating fish and seafood is strongly encouraged, and are dairy products, eggs and other animal foods. A pescatarian (a vegetarian who eats seafood) most closely resembles a Mediterranean diet.

MEDITERRANEAN VS PALEO

While there is the shared focus of eating lots of fresh vegetables for both these diets, they have a lot of differences. Paleo dieters avoid grains and legumes, which figure prominently in the Mediterranean diet. While both allow for fish and seafood, Paleo eaters also eat a fair amount of meat. Fruit is an important component of the Mediterranean diet, but Paleo dieters will only eat fruit rarely, and it is supposed to be in season, local, and organic. Both Paleo and Mediterranean eschew processed foods and sugars, but eating natural sugars such as from fruit or honey is common to both, although Paleo dieters will probably eat even less than Mediterranean followers.

BEST MEDITERRANEAN DIET SUPPLEMENTS

The Mediterranean diet is meant to offer complete nutrition through diet alone, but because your dairy consumption may go down, you may wish to supplement a few nutrients such as:

Calcium — This mineral is needed for strong bones and teeth, as well as a healthy heart, muscles, and nerves. The USRDA is 2-3 servings, but the Mediterranean diet recommends no more than 2 servings per day.

Vitamin D — Although we can make vitamin D through our skin, most people still don’t get enough. Vitamin D also promotes strong bones as well as cancer protection, and a lowered risk of other diseases. A vitamin D deficiency can trigger deficiencies in other nutrients, so unless you eat a lot of yogurt and green leafy vegetables, you may wish to supplement.

The Ultimate Guide To The Mediterranean Diet Vitamin D

MEDITERRANEAN DIET RECIPES & RESOURCES

Oldways

Authentic Mediterranean Recipes

More Mediterranean Recipes

Mediterranean Living

MEDITERRANEAN DIET STUDIES

The Seven Countries Study

Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications

Effect of a Mediterranean-style diet on endothelial dysfunction

Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy

PROPONENTS OF THE MEDITERRANEAN DIET

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Leslie Waterson

Leslie has been passionately involved in the health and fitness industries for over a decade. She is constantly reviewing the latest scientific research and studies in order to take a research-backed approach to lifestyle optimization. Her main areas of interest include nutrition and supplementation. Leslie shares her findings on Fitness Clone to help other health enthusiasts choose the products and routines that will help them achieve their goals.