What is the Mediterranean Diet?

The Mediterranean Diet is a way of eating inspired by the lifestyle of people who live near the Mediterranean Sea. The diet was traditionally based on foods eaten in the olive growing areas of Greece, Italy, and Spain. In recent years, many have expanded it to reflect more of a philosophy than a strict dietary plan. In fact, practitioners of the Mediterranean Diet often consider it a lifestyle more than a way of eating, stressing the importance of eating whole, real foods, incorporating regular physical activity, and sharing meals with others.

Health care practitioners consistently rank the diet as one of the healthiest in the world, citing research that indicates improvement in cardiometabolic health over standard diets [1]. As a way of eating, the Mediterranean Diet is largely made up of healthy fats (predominantly extra-virgin olive oil and fatty fish), vegetables and fruits, legumes, unprocessed whole grain foods, and poultry. The breakdown of macronutrients is roughly 40% carbohydrates, 40% fat, and 20% protein. Below is a typical Mediterranean Diet Food Pyramid:

Olive oil is an essential part of what makes the Mediterranean Diet so healthy and is commonly a part of every meal. With roughly 40% of calories coming from fat, the diet itself is a moderate fat one. Olive oil is profoundly linked to cardiovascular health [2]. In observational studies, it is also associated with a decreased risk of cancer and even dementia [3,4]. The important role of fatty fish in the diet gives added cardiovascular benefits [5]. Some are surprised to learn that such a healthy diet includes as much fat as it does, but studies repeatedly show that moderate and high fat diets are excellent for cardiometabolic health [6,7]. The Mediterranean Diet is no exception.

While the diet also focuses on plant-based foods, with about 40% of calories coming from carbohydrates, this is not the standard high-carb fare so common in Western diets. The sources of foods eaten on a Mediterranean Diet are significant, with special emphasis on local, fresh, fiber-rich complex carbohydrates over simple ones. This distinction is significant. The longer it takes for carbohydrates to be digested, the better it is for metabolic health. Steel cut oats, beans, and legumes, for example, are all excellent sources of resistant starch, a form of carbohydrates that resists digestion and acts much like fiber in the body. Similarly, the vegetables, fruits, and unrefined whole grains that are such an important part of the diet primarily contain slowly digestible starch that takes longer for the body to break down than the rapidly digested starches found in processed carbs (like sugar, juice, and carbs that typically come from a box or bag, like cold cereal or crackers). These resistant and slow-release carbs have a steadier, more moderate impact on blood sugar and insulin, increase satiety, and reduce cravings over regular high-carb diets [8].

A typical day on a Mediterranean Diet may look like:

Breakfast: Veggie Omelet or Full Fat Greek Yogurt with Nuts and Berries

Mid-Morning Snack: Seasonal fruit with a serving of cashews

Lunch (largest meal of the day): A “lathero” (in oil) dish–commonly seasonal vegetables, lentils, or beans cooked with olive oil, tomato sauce, and herbs, and accompanied with whole grain bread and cheese.

Afternoon Snack (if hungry): Veggies and hummus

Dinner: A small platter with olives, tomatoes, and a few pieces of cheese  AND  a leafy green salad with olive oil dressing, crumbled cheese, and nuts

This is only a sample of the kind of meals eaten on the Mediterranean Diet, but the diet lends itself to a lot of flexibility and individual adaptation. 

There’s no question that the Mediterranean Diet is superior to the standard Western diet, but some advocates are going a step further and combining it with another popular diet that has consistently been shown to improve health outcomes: the keto diet.

Keto Mediterranean Diet

By combining these two powerhouse diets, practitioners of a low carbohydrate or ketogenic Mediterranean Diet have a wealth of evidence supporting the healthiness of their lifestyle. Some small, simple adjustments to the moderate carb Mediterranean Diet are all that are required to make it more low carb or keto-friendly. The keto diet has been shown to offer improvements in everything from epilepsy [9], insulin resistance, and diabetes to Alzheimer’s and Parkinson’s diseases [10,11], cancer, and more. 

In 2008, researchers studied the effectiveness of what they called the “Spanish Ketogenic Mediterranean Diet”. They placed no restrictions on participants’ calories but incorporated olive oil as the main source of fat, above-ground green vegetables and salads as the main source of carbohydrates, and fish as the primary source of protein, with meat, eggs, shellfish, fowl, and cheese as secondary sources. It also included moderate red wine intake. The study found that this Mediterranean-inspired keto diet was overwhelmingly beneficial in improving cardiovascular health and metabolic syndrome, as well as for weight loss [12].

Although the Mediterranean Diet doesn’t involve much red meat, adding 18 oz a week of lean, unprocessed red meat or pork to a Mediterranean Diet has been shown to be just as effective for heart health as the traditional diet [13]. Considering all the benefits of eating red meat, such an addition can make this way of eating even better.

So whether you’re interested in trying the Mediterranean Diet or incorporating elements of it into a carbohydrate restricted lifestyle, rest assured that you’re making a great choice for your health.

References

1.  Esposito K, Maiorino MI, Bellastella G, Panagiotakos DB, Giugliano D. Mediterranean diet for type 2 diabetes: cardiometabolic benefits. Endocrine. 2017 Apr;56(1):27-32. doi: 10.1007/s12020-016-1018-2. Epub 2016 Jul 9. PMID: 27395419.
2.  Guasch-Ferré M, Hu FB, Martínez-González MA, Fitó M, Bulló M, Estruch R, Ros E, Corella D, Recondo J, Gómez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Muñoz MA, Pintó X, Lamuela-Raventós RM, Basora J, Buil-Cosiales P, Sorlí JV, Ruiz-Gutiérrez V, Martínez JA, Salas-Salvadó J. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014 May 13;12:78. doi: 10.1186/1741-7015-12-78. PMID: 24886626; PMCID: PMC4030221.
3.  Markellos C, Ourailidou ME, Gavriatopoulou M, Halvatsiotis P, Sergentanis TN, Psaltopoulou T. Olive oil intake and cancer risk: A systematic review and meta-analysis. PLoS One. 2022 Jan 11;17(1):e0261649. doi: 10.1371/journal.pone.0261649. PMID: 35015763; PMCID: PMC8751986.
4.  Klimova B, Novotný M, Kuca K, Valis M. Effect Of An Extra-Virgin Olive Oil Intake On The Delay Of Cognitive Decline: Role Of Secoiridoid Oleuropein? Neuropsychiatr Dis Treat. 2019 Oct 29;15:3033-3040. doi: 10.2147/NDT.S218238. PMID: 31754302; PMCID: PMC6825477.
5.  Rimm EB, Appel LJ, Chiuve SE, Djoussé L, Engler MB, Kris-Etherton PM, Mozaffarian D, Siscovick DS, Lichtenstein AH; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Seafood Long-Chain n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation. 2018 Jul 3;138(1):e35-e47. doi: 10.1161/CIR.0000000000000574. Epub 2018 May 17. PMID: 29773586; PMCID: PMC6903778.
6. https://www.sciencedaily.com/releases/2004/02/040202070609.htm
7. https://medschool.vanderbilt.edu/vanderbilt-medicine/study-balanced-high-fat-diet-improves-body-composition-inflammation/
8.  Vinoy S, Laville M, Feskens EJ. Slow-release carbohydrates: growing evidence on metabolic responses and public health interest. Summary of the symposium held at the 12th European Nutrition Conference (FENS 2015). Food Nutr Res. 2016 Jul 4;60:31662. doi: 10.3402/fnr.v60.31662. PMID: 27388153; PMCID: PMC4933791.
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836058/
10. https://pubmed.ncbi.nlm.nih.gov/31405021/
11. https://charliefoundation.org/am-i-a-candidate/keto-for-parkinsons/
12.  Pérez-Guisado, J., Muñoz-Serrano, A. & Alonso-Moraga, Á. Spanish Ketogenic Mediterranean diet: a healthy cardiovascular diet for weight loss. Nutr J 7, 30 (2008). https://doi.org/10.1186/1475-2891-7-30
13.  Lauren E O’Connor, Douglas Paddon-Jones, Amy J Wright, Wayne W Campbell, A Mediterranean-style eating pattern with lean, unprocessed red meat has cardiometabolic benefits for adults who are overweight or obese in a randomized, crossover, controlled feeding trial, The American Journal of Clinical Nutrition, Volume 108, Issue 1, July 2018, Pages 33–40, https://doi.org/10.1093/ajcn/nqy075