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Mediterranean Diet

Mediterranean diet


The Mediterranean diet is based upon the eating patterns of traditional cultures in the Mediterranean region.

Several noted nutritionists and research projects have concluded that this diet is one of the most healthful in the world in terms of preventing such illnesses as heart disease and cancer , and increasing life expectancy.


The countries that have inspired the Mediterranean diet all surround the Mediterranean Sea. These cultures have eating habits that developed over thousands of years. In Europe, parts of Italy, Greece, Portugal, Spain, and southern France adhere to principles of the Mediterranean diet, as do Morocco and Tunisia in North Africa. Parts of the Balkan region and Turkey follow the diet, as well as Middle Eastern countries like Lebanon and Syria. The Mediterranean region is warm and sunny, and produces large supplies of fresh fruits and vegetables almost year round that people eat many times per day. Wine, bread, olive oil, nuts, and legumes (beans and lentils) are other staples of the region, and the Mediterranean Sea has historically yielded abundant fish. The preparation and sharing of meals is a very important and festive part of Mediterranean culture as well, and Mediterranean cuisine is popular around the world for its flavors.

American interest in the therapeutic qualities of the Mediterranean diet began back in the late 1950s, when medical researchers started to link the occurrence of heart disease with diet. Dr. Ancel Keys performed an epidemiological analysis of diets around the world. Epidemiology is the branch of public health that studies the patterns of diseases and their potential causes among populations as a whole. Keys' study, entitled the Seven Countries Study, is considered one of the greatest epidemiological studies ever performed. In it, Keys gathered data on heart disease and its potential causes from nearly 13,000 men in Greece, Italy, Croatia, Serbia, Japan, Finland, the Netherlands, and the United States. The study was conducted over decades. It concluded that the Mediterranean people in the study enjoyed some significant health advantages. The Mediterranean groups had lower mortality rates in all age brackets and from all causes, particularly from heart disease. For instance, the rates of heart disease for Greek men aged 5054 were 90% lower than for a comparable group of Americans. The study also showed that the Mediterranean diet is as high or higher in fat than other diets, obtaining up to 40% of all its calories from fat. It has, however, different patterns of fat intake. Mediterranean cooking uses smaller amounts of saturated fat and higher amounts of unsaturated fat, mostly in the form of olive oil. Saturated fats are fats that are found principally in meat and dairy products, although avocados, some nuts and some vegetable oils also contain them. Saturated fats are used by the body to make cholesterol , and high levels of cholesterol have since been directly related to heart disease.

Several other studies have validated Keys' findings regarding the good health of people in the Mediterranean countries. The World Health Organization (WHO) showed in a 1990 analysis that four major Mediterranean countries (Spain, Greece, France, and Italy) have longer life expectancies and lower rates of heart disease and cancer than other European countries and America. The data are significant because the same Mediterraneans frequently smoke and don't have regular exercise programs like many Americans, which means that other variables may be responsible. Scientists have also ruled out genetic differences, because Mediterraneans who move to other countries tend to lose their health advantages. These findings suggest that diet and lifestyle are major factors. A 1994 study conducted in France found that the rate of heart attacks and the rate of cardiac deaths were lower for the Mediterranean diet group than for a group of controls.

The Mediterranean diet gained more notice when Dr. Walter Willett, head of the nutrition department at Harvard University, began to recommend it. Although low-fat diets were recommended for heart disease, Mediterranean groups in his studies had very high intakes of fat, mainly from olive oil. Willett and others proposed that the risk of heart disease can be reduced by increasing one type of dietary fatmonounsaturated fat. This is the type of fat in olive oil. Willett's proposal went against conventional nutritional recommendations to reduce all fat in the diet. It has been shown that unsaturated fats raise the level of HDL cholesterol, which is sometimes called "good cholesterol" because of its protective effect against heart disease. Willett has also performed studies correlating the intake of meat with heart disease and cancer.

Willett, other researchers at Harvard, and the WHO collaborated in 1994 and designed the Mediterranean Food Pyramid, which lists food groups and their recommended daily servings in the Mediterranean diet. These nutritionists consider their food groups a more healthful alternative to the food groups designated by the U.S. Department of Agriculture (USDA). The USDA recommends a much higher number of daily servings of meat and dairy products, which Mediterranean diet specialists attribute to political factors rather than sound nutritional analysis.


The Mediterranean diet is a recommended preventive diet for heart disease, strokes, cancer, and the improvement of general health. The diet offers foods that are tasty, economical, and easy to prepare. Another benefit is that many people are more familiar with purchasing, preparing, and eating Mediterranean foods than some foods that are central to other dietary therapies.


The Mediterranean diet has several general characteristics:

  • The bulk of the diet comes from plant sources, including whole grains, breads, pasta, polenta (from corn), bulgur and couscous (from wheat), rice, potatoes, fruits, vegetables, legumes (beans and lentils), seeds, and nuts.
  • Olive oil is used generously, and is the main source of fat in the diet as well as the principal cooking oil. The total fat intake accounts for up to 35% of calories. Saturated fats, however, make up only 8% of calories or less, which restricts meat and dairy intake.
  • Fruits and vegetables are eaten in large quantities. They are usually fresh, unprocessed, grown locally, and consumed in season.
  • Dairy products are consumed in small amounts daily, mainly as cheese and yogurt (1 oz of cheese and 1 cup of yogurt daily).
  • Eggs are used sparingly, up to four eggs per week.
  • Fish and poultry are consumed only one to three times per week (less than 1 lb per week combined), with fish preferred over poultry.
  • Red meat is consumed only a few times per month (less than 1 lb per month total).
  • Honey is the principle sweetener, and sweets are eaten only a few times per week.
  • Wine is consumed in moderate amounts with meals (12 glasses daily).


Many Mediterranean cookbooks are available that can help with planning and preparing meals. A good first step is eliminating all oils, butter, and margarine and replacing them with olive oil. Meals should always be accompanied with bread and salads. Mediterranean fruits and vegetables are generally fresh and high in quality; American consumers may find equivalents by shopping in farmers' markets and health food stores that sell organic produce. Meat intake should be reduced and replaced by whole grains, legumes, and other foods at meals. The dairy products that are used should be yogurt and cheese instead of milk, which is not often used as a beverage by Mediterraneans.

Researchers have been quick to point out that there may be other factors that influence the effectiveness of the Mediterranean diet. Getting plenty of physical exercise is important, as is reducing stress . Researchers have noted that Mediterraneans' attitude toward eating and mealtimes may be a factor in their good health as well. Meals are regarded as important and joyful occasions, are prepared carefully and tastefully, and are shared with family and friends. In many Mediterranean countries, people generally relax or take a short nap (siesta) after lunch, the largest meal of the day.


Although wine is recommended with meals in the Mediterranean diet, those with health conditions and restrictions should use caution. The diet allows generous quantities of olive oil, but only when the olive oil substitutes for other fats and is not used in addition to them. In other words, consumers may have to significantly reduce fat intake from meat and dairy products, margarine, cooking oils, and other sources.



Jenkins, Nancy Harmon. The Mediterranean Diet Cookbook. New York: Bantam, 1994.

Vegetarian Times Cooks Mediterranean. New York: William Morrow, 2000.

Willett, Walter, M.D. Nutritional Epidemiology. London: Oxford University Press, 1998.


Oldways Preservation and Exchange Trust (provides information on the diet). 45 Milk Street. Boston, MA 02109. (617) 695-0600.

Douglas Dupler

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Mediterranean Diet


MEDITERRANEAN DIET. The Mediterranean diet is defined variously. It sometimes refers simply to the dietary patterns and social mores surrounding eating in the countries bordering the Mediterranean Sea. In nutritional parlance the meaning is somewhat more confined. It applies to the traditional diet of European countries on the Mediterranean as characterized by foods and by patterns of nutrient intake.

Italy, Greece, France, and Spain are particularly associated with the diet because they were involved in the several ecological studies of dietary patterns, lifestyles, and coronary artery heart disease in the 1950s and 1960s led by Ancel Keys of the University of Minnesota (Keys, 1970, 1995; Keys et al., 1954). These landmark studies associated the relatively high dietary fat intake in those countries with a much lower prevalence of coronary artery disease than in the United States or northern Europe. Since dietary fat was thought to be the major culprit in coronary artery disease, this seemed remarkable at the time. Later discoveries linked saturated fat and cholesterol rather than total fat to heart disease risk. Olive oil, high in monounsaturated fat, and fish, high in polyunsaturated fat, which constituted the majority of the fat in the Mediterranean diet, were associated with lower risk. Other aspects of the food and nutrient profiles and lifestyles (for example, more physical activity, less smoking, etc.) may have contributed to low disease risk as well.

Reasons for Interest

Originally, interest in the Mediterranean diet was based on that association with decreased risk of coronary artery disease. The traditional Mediterranean diet included liberal amounts of fruits, vegetables, legumes, grains, and wine; high amounts of monounsaturated fats; moderate consumption of alcohol; liberal amounts of fish; and low amounts of meat and milk products. The diet was accompanied by a lifestyle that involved a good deal of obligatory physical activity, no smoking, and a relaxed attitude toward life. The actual diets were usually moderate in energy for physical activities. They were also relatively low in saturated fats and sugars and relatively high in most of the fat-and water-soluble nutrients and phytochemicals.

In the late twentieth century nutritional scientists attempted to examine whether or not the Mediterranean diet is associated with decreased risks of other diseases. Where traditional diets conforming to the Mediterranean pattern are eaten, health benefits seem to be present. In addition, the increased American interest in fine dining, ethnic cuisine, and food habits contributed to the popularity of the Mediterranean diet.

Evolution of the Mediterranean Diet Concept

Keys popularized the Mediterranean diet in the early 1970s, and other nutritionists, culinary experts, and commodity groups subsequently advocated it. In the early 1990s, Oldways, a group dedicated to preserving traditional eating patterns, joined members of the Harvard School of Public Health in conducting a series of conferences and other activities to popularize the Mediterranean pattern. This group published a healthy-eating Mediterranean pyramid based on the dietary traditions of the region.

Mediterranean Diet Pyramid

The Mediterranean diet pyramid is available at the website. W. C. Willett, and colleagues described it at length in "Mediterranean Diet Pyramid," published in the American Journal of Clinical Nutrition in 1995. The pyramid puts bread, other grain products, and potatoes at the base. The second tier is vegetables, including beans, other legumes, and nuts, and fruits. Third is a shallow tier for olive oil, and next is a cheese and yogurt tier. All of these foods should be consumed daily.

Near the top of the pyramid are small blocks for foods consumed a few times a week, including fish, poultry, eggs, and sweets. At the peak of the pyramid are foods consumed only a few times a month, including red meats, fats, oils, and sweets. The pyramid is accompanied by a wineglass to indicate "wine in moderation" and a running stick figure with the headline "regular physical activity" (Wilson, 1998).

Acceptable Alternative or Dietary Imperative?

Is consumption of a Mediterranean diet mandatory for good health? The notion of a single Mediterranean cuisine has been criticized on the grounds that no single such diet exists and that to contend one does promotes stereotypes and fails to account for the dynamic nature of dietary changes. Also, diets in the Mediterranean region and elsewhere in Europe change rapidly and no longer reflect those of yesteryear. Many healthful dietary patterns are associated with diets designed to reduce chronic disease risks. It is not necessary to consume diets similar to those traditionally eaten in the Mediterranean to stay healthy, but the Mediterranean diet is one alternative that provides an appropriate and healthful nutrient pattern.

Does the inclusion of Mediterranean-type foods make contemporary American diets healthier? This depends on a number of factors, chiefly how they are used. While decreased risk is associated with traditional Mediterranean diets, the patterns in these countries have changed a great deal since the early 1950s. They may not always provide all of the health advantages their traditional counterparts did, especially if food is eaten in excess. The specific health benefits of individual foods rather than the entire Mediterranean pattern are also unclear. Although most of the traditional foods are delicious and nutritious, other foods with similar nutrient compositions would seem to be equally effective. Therefore simply adding one or more "Mediterranean" foods to American diets does not necessarily provide positive health effects. The overall pattern in moderation has been linked to positive health outcomes.

During the late twentieth century, awareness of the considerable culinary and aesthetic advantages of the Mediterranean diet grew. Many staples of traditional Mediterranean diets have become popular and are widely available in the United States and other Western countries.

The plant-based Mediterranean diets of the early and mid-twentieth century were environmentally sound and responsible in the locales in which they flourished. Whether they are exportable and feasible on a large scale in other climates in non-Mediterranean countries is a matter of debate.

Traditional food habits typical of countries bordering the Mediterranean Sea in the mid-1950s have health and nutritional advantages. Guides for eating in the Mediterranean manner are readily available, but following their advice is not mandatory for good health.

See also Africa: North Africa; Ancient Mediterranean Religions; Greece, Ancient; Greece and Crete; Italy; Rome and the Roman Empire .


Crotty, P. A. "Response to K. Dun Gifford." Nutrition Today 33 (1998): 244245.

Ferro-Luzzi, A., and S. Sette. "The Mediterranean Diet: An Attempt to Define Its Present and Past Composition." European Journal of Clinical Nutrition 43, supp. 2 (1989): 1229.

Gifford, K. Dun. "The Mediterranean Diet as a Food Guide: The Problem of Culture and History." Nutrition Today 33 (1998): 233243.

Keys, Ancel. "Coronary Disease in Seven Countries." Circulation 41, supp. (1970): 121.

Keys, Ancel. "Mediterranean Diet and Public Health: Personal Reflection." American Journal of Clinical Nutrition 61, supp. (1995): 1321S1323S.

Keys, Ancel, and Margaret Keys. How to Eat Well and Stay Well the Mediterranean Way. Garden City, N.Y.: Doubleday, 1975.

Keys, Ancel, et al. "Studies on Serum Cholesterol and Other Characteristics of Clinically Healthy Men in Naples." Archives of Internal Medicine 93 (1954): 328335.

Nestle, M. "Mediterranean Diets: Historical and Research Overview." American Journal of Nutrition 61, supp. 13 (1995): 135205.

Oldways website. "Mediterranean Diet Pyramid." Available at http://www.oldwayspt.orghtml/meet.htm.

Willett, W. C., F. Sacks, A. Trichopoulou, G. Dresher, A. Ferro-Luzzi, E. Helsing, and D. Trichopoulos. "Mediterranean Diet Pyramid: A Cultural Model for Healthy Eating." American Journal of Clinical Nutrition 61, supp. (1995): 1402S1406S.

Wilson, C. S. "Mediterranean Diets: Once and Future?" Nutrition Today 33 (1998): 246249.

Johanna Dwyer

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