Around the world, many cultures have developed healthy cuisines based on the regional foods available to them. Among the most enduring is the Mediterranean diet, which was first studied in the late 1940s when researchers realized that heart disease was less common in parts of the Greek Isles and southern Italy than in the United States.
Recent research has found that the traditional foods of Greece, Italy, southern France, Spain, Turkey, Lebanon, Israel, and North Africa all play a role in supporting health and longevity.
The region’s fare emphasizes vegetables, fruits, nuts, legumes, whole grains, olive oil, and fish and seafood, along with modest amounts of red meat, poultry, dairy, and sweets. A typical Mediterranean lunch or dinner also includes wine.
Yet like so many other traditional foodways around the world, the Mediterranean diet revolves around more than the foods that comprise it: It’s a way of approaching eating — and life.
“The Mediterranean diet sits within a bigger framework of the Mediterranean lifestyle, where factors like walking, being active, being in community, and taking a siesta are important,” says integrative cardiologist Mimi Guarneri, MD. “It’s about social connection, community, and eating together.”
“How many diets do you know where the mandate is ‘Don’t eat this, don’t eat that’?” asks functional-medicine practitioner Gregory Plotnikoff, MD. “With the Mediterranean approach, the focus is on cultural food traditions.”
Indeed, nonculinary aspects of the Mediterranean diet are so central that physical activity and communal dining make up the largest section of the Mediterranean diet food pyramid. (The pyramid was developed in 1993 by the nonprofit Oldways, the World Health Organization, and Harvard Public Health.)
In 2013 the United Nations Educational, Scientific, and Cultural Organization (UNESCO) even declared the foods and rituals of the Mediterranean diet an Intangible Cultural Heritage of Humanity.
The following ingredients are the staples of the Mediterranean diet. Learn more about their abundant nutritional benefits, plus find ideas for how to enjoy more of them in your own kitchen.
The key source of fat in the traditional Mediterranean diet, olive oil contains abundant monounsaturated fatty acids (MUFAs), which clinical trials have shown to reduce risk factors for heart disease by lowering LDL (“bad”) cholesterol and total cholesterol. Its benefits for heart health are so pronounced that both the U.S. Food and Drug Administration and the European Safety Authority endorse consuming up to 23 grams, or about 5 teaspoons, of olive oil a day.
Olive oil also contains beneficial polyphenols, health-supportive plant compounds. Potent antioxidants, these polyphenols contain anti-inflammatory properties on a par with ibuprofen. They also appear to help balance insulin and blood-sugar levels, and may have antimicrobial, antiviral, and anticancer properties.
Combining olive oil with traditional Mediterranean vegetables like garlic and onion, as well as tomatoes (which are not native to the region, but adopted from South America), amplifies their benefits: A 2019 Spanish study showed that cooking with olive oil may help release the nutrients in those vegetables and increase the body’s ability to absorb them.
How to Enjoy: Olive oil is fine for cooking, but to get the benefit of all its compounds (some of which may be lost to high heat), use it in dressings or as a finishing oil — drizzled on fresh tomatoes or over warm grains or pasta. Seek out organic, cold-pressed, extra-virgin olive oil with a good bite to it; that taste indicates the oil is high in health-supportive polyphenols.
An overwhelming amount of research affirms the value of eating a wide range of whole plant foods, especially those saturated in color. The deep oranges, reds, and yellows found in vegetables and fruits like carrots, bell peppers, and tomatoes signal the presence of beneficial phytochemicals called carotenoids.
Carotenoids’ potent antioxidant properties protect against cell oxidation, which may contribute to the development of cancer and other chronic conditions associated with aging. They’ve been shown to help reduce the progression of age-related macular degeneration, and evidence also points to their ability to improve cognitive function.
Vegetables contain plenty of other antioxidants and anti-inflammatory compounds, too, and they’re an excellent source of essential vitamins, minerals, and fiber. High-fiber diets are associated with a lower risk of cardiovascular disease, improved weight maintenance, and a healthier gut microbiome.
How to Enjoy: Traditionally, people in Mediterranean regions grew their own vegetables, which provided them ready access to fresh produce as well as ample outdoor activity.
Even if you don’t plant a garden, you can emulate the Mediterranean way by including more brightly colored vegetables and leafy greens in your meals and making movement part of your daily routine.
A rich source of plant-based protein and healthy fats, nuts also offer beneficial vitamins and minerals, such as magnesium and vitamin E, fiber, polyphenols, and phytosterols — plant compounds that support heart health. Studies link eating nuts with a lower risk of hypertension and cancer as well as improved weight maintenance and reduced inflammation.
How to Enjoy: Almonds, walnuts, and macadamia nuts are especially rich in nutrients. Walnuts deliver inflammation-fighting omega-3 fatty acids and have been shown to boost immunity, cognitive function, and mood.
Explorer Dan Buettner is known for identifying the world’s Blue Zones, longevity hot spots where a notable portion of the population lives into their 90s and 100s, with fewer chronic conditions like cancer and heart disease. Two of these are in the Mediterranean — Ikaria, Greece, and Sardinia, Italy.
One type of food that is common in all five of the Blue Zones is beans. “There’s something going on with beans and legumes: It likely has to do with the microbiome,” says functional-medicine physician Myrto Ashe, MD. Beans are an excellent source of protein, as well as antioxidant and anti-inflammatory compounds.
Additionally, experts suspect their fiber content may be why they’re central to diets associated with longevity. Fiber is food for the microbiome.
“The only thing the good bugs in the gut eat is fiber,” says Buettner. “And then they make short-chain fatty acids, which lower inflammation, fine-tune the immune system, and help govern mood.”
How to Enjoy: Lentils are quick cooking and make an easy, hearty soup. Chickpeas and white beans are tasty in salads, as the basis for bean dips, or combined with sautéed greens. Beans add substance to soups and stews. Residents of the world’s Blue Zones consume, on average, a cup of beans a day. (Note: If beans give you gas or indigestion, start with small portions and work your way up. You might also add ginger or fennel to aid digestion.)
The traditional Mediterranean diet relied on fish from the nearby sea. “Fish is traditionally eaten two to three times a week [in Sardinia and Ikaria],” says Buettner.
Studies show that eating fish is linked to decreased risk of stroke, depression, cognitive decline, and other long-term conditions. Some research has connected fish consumption with lower colon-cancer risk.
Toxins in the ocean can accumulate in larger fish, but smaller fish like anchovies and sardines — which are rich in omega-3 fatty acids that support cardiac health and reduce inflammation — don’t present these issues.
How to Enjoy: Sardine lovers are known to enjoy the oily little fish straight from the can, though they’re also nice layered on a sandwich, sautéed in olive oil with garlic and tomato, or mashed into a dip with mayo, parsley, capers, and lemon zest. Anchovies feature a potent briny flavor that tastes great in tomato sauce or salad dressing. Wild-caught salmon fillets are nutritious and easy to grill or broil in the oven.
The traditional Mediterranean meal is accompanied by wine — almost always sipped with friends and family. Experts suspect these components together help make wine a healthy part of the Mediterranean diet.
Red wine also contains some health-promoting compounds, such as resveratrol, which studies have associated with lower inflammation and blood pressure, as well as with overall longevity. Plus, it has other powerful polyphenols, like quercetin and procyanidins, which have been linked to reduced inflammation and improved heart health.
Some health experts, like Guarneri, are skeptical that wine’s benefits outweigh its health risks, but with wine, as with most things, moderation is key.
With the whole of the Mediterranean diet, the benefits of what one consumes are best understood in the broader context of the meal, which ideally includes relaxation, sunshine, and conviviality, as much as any specific food or drink.
How to Enjoy: In moderation, with friends, and, ideally, in the sun. (For guidance on what to look for in a high-quality wine, visit “What’s In Your Wine?“.)
The Carb Question
Thanks to the centrality of whole grains and legumes, the Mediterranean diet is somewhat high in carbohydrates. That has raised questions for proponents of low-carb diets, such as the paleo and ketogenic protocols.
Mediterranean-diet advocates note that not all carbohydrates are the same. Those found in vegetables, fruits, legumes, and nuts are rich in fiber and phytonutrients, and the body processes them differently than the carbs found in sugary foods, white flour, and pasta — which is not, contrary to popular belief, a mainstay of the Mediterranean meal.
“Some folks hear the phrase ‘Mediterranean diet’ and think it is fine to include lots of pasta,” says functional-medicine practitioner Myrto Ashe, MD. But even in Italy, pasta is typically served as a small first course before the main dish, not in heaping portions as a meal’s centerpiece.
It’s also worth reiterating that the traditional Mediterranean way of life included routine physical activity: People walked most everywhere and often worked tending gardens or farming. This physical activity may have helped regulate the effects of more carbs.
“A diet that includes 65 percent of calories from carbs may be better suited to places where people walk a lot,” says Ashe. It may work less well for a more sedentary person, she notes, which is why she encourages her patients to be sensitive to how these foods affect them personally and adjust accordingly.
She recommends moving away from a reliance on simple carbohydrates like bread and pasta and including more leafy greens, cruciferous vegetables, nuts, legumes, and spices. “I would like people . . . to try to bring a diverse array of foods into their homes if they can,” Ashe says.
Regardless of your individual carbohydrate needs, the Mediterranean protocol can be embraced for its core principles: Enjoy fresh, whole foods as often as possible, prioritize plants, choose healthy fats, and eat at a leisurely pace, together with family and friends.
“When thinking about the Mediterranean approach to eating, I’m not guided by counting carbs [or other macronutrients],” says functional-medicine physician Gregory Plotnikoff, MD. Instead, he says, he’s guided by the image of an abundant, plant-based meal shared at a gathering of loved ones.
What the Science Says
Researchers have been observing the salutary effects of many traditional diets around the world, including the Mediterranean diet, for decades. “There is level-A scientific evidence to support the Mediterranean diet for the prevention of cardiovascular disease, cancer, and cognitive decline,” says integrative cardiologist Mimi Guarneri, MD.
In 1948, American epidemiologist Leland Allbaugh visited the Greek island of Crete, where the people were impoverished yet enjoyed substantially lower rates of heart disease and cancer than people in the United States and northern Europe. He noted that their plant-heavy diet, while spartan, seemed to play a key role in their overall health.
This research was followed by epidemiologist Ancel Keys’s Seven Countries Study, a large-scale observational study beginning in the 1950s that looked at some 13,000 middle-aged men across seven countries, examining connections between what they ate with their risk of heart attack. It surmised that Mediterranean staple foods like phytonutrient-rich vegetables and polyphenol-dense olive oil were associated with decreased risk of heart disease and related death.
While subsequent research has highlighted study limitations of Keys’s work, the project gave rise to broader concepts about personal health: It was the first large-scale analysis to show that a healthy lifestyle may promote overall good health, and suggested that the risk for cardiovascular disease may be modifiable.
Other, more recent research supports many of these findings. The 2001 Lyon Heart Diet Study found that participants who ate a Mediterranean-style diet had a 50 to 70 percent lower chance of recurrent heart disease, despite having the same risk factors as the control group.
The 2018 Primary Prevention of Cardiovascular Disease with a Mediterranean Diet study looked at a large group at high risk of cardiovascular disease. Participants who followed a Mediterranean diet rich in olive oil and nuts were less likely to experience a major cardiovascular event compared with the control group, who ate a reduced-fat diet.
A 2020 study published in the journal Gut found positive changes in the gut microbiome of older adults who ate a Mediterranean diet. The 612 participants experienced lower inflammation, improved cognitive function, and reduced risk of frailty. A 2015 study found that older adults who ate a modified Mediterranean diet lowered their risk of Alzheimer’s disease by as much as 53 percent. Even participants who only followed the diet moderately reduced their risk by 35 percent.
This was excerpted from “Lessons From the Mediterranean Diet” which was published in Experience Life magazine.