I’m a big proponent of the MD for a ton of reasons and one of the main ones is that it’s really not a diet – it’s a pattern of eating and it encompasses a lifestyle. It’s flexible, sustainable, diverse, balanced, has virtually no restrictive rules and is proven to have hugely beneficial impacts on physical and mental health - preventing disease and slowing progression of disease. The diet does amazing things for your short-term health – improved energy, a healthy weight – but what’s more important is the long-term protective benefit against disease. I also love that the MD is extremely versatile, easy to follow, and customizable so it can work for almost everyone. In this article, I outline everything you need to know about the MD, how to eat and live the MD lifestyle, and all of the amazing benefits of the MD lifestyle.
What exactly is the MD? There is actually no strict definition or consensus on what exactly the Mediterranean diet is (this is a good thing!), it is generally defined as the dietary pattern historically followed by the people that live in the Mediterranean in countries such as Greece, France, Italy, and Spain. The people of these countries were found to be significantly healthier when compared to Americans and have a much lower risk of chronic diseases such as obesity, type 2 diabetes, heart disease, and stroke [i]. The key concepts of the MD involve intake of lots of fruits, vegetables, legumes, olive and whole grains combined with a moderately low intake of all animal protein and rare consumption of red meat. The preferred animal protein in the MD is fish, and it is recommended to eat fish or seafood about twice per week. The MD is not low in fat – it is recommended that fat make up 25-40% of total daily dietary intake; however, there is a focus on what KIND of fat you consume. MD is low in saturated fat and high in unsaturated fatty acids with olive oil being the major source of fat in the diet. The diet is also high in polyphenols from olive oil and other fruits and vegetables as well as antioxidants found naturally in fruits, vegetables and wine.
Take a look at the below Mediterranean Diet Food Pyramid – at the foundation of the pyramid is physical activity and enjoying meals with others. These are key components of the MD lifestyle and play a crucial role in the health benefits of the diet. I love how the diet encompasses more than just the input and output of food. It emphasizes other aspects of health and promote these as the foundation of a healthy lifestyle – movement and relationships.
In a nutshell, the MD is high in plant foods and relatively low in animal-based foods. More than anything, the MD has a true emphasis on the quality of food and eating real, unprocessed whole foods. Instead of counting calories or macros, MD focuses on how food is made, where it comes from, and getting a diversity of color and flavor in your diet. As far as beverages, water is the beverage of choice, but the MD also allows for a moderate amount of red wine consumption. The recommendation is roughly 1 glass of red wine per day due to the polyphenols, antioxidants and associated cardiovascular benefits. Red wine is definitely not a requirement of the diet, but if you enjoy red wine, it’s definitely a perk! Ultra-processed foods, refined grains, added sugar, soda, and trans fats are avoided in the MD.
Eat: Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood and extra virgin olive oil.
Eat in moderation: Poultry, eggs, cheese and yogurt.
Eat rarely: Red meat.
Avoid: Sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils and other highly processed foods.
Easy swaps to make at home or when eating out:
Load up on all veggies
Try to have one serving of nuts every day
Pick olive oil instead of butter or margarine
Always choose whole grains
Avoid anything labeled as “low fat” or “diet”
When it comes to health benefits, the MD diet has been studied for years and has proven to be the gold standard of healthy eating. It promotes a healthy weight, prevents chronic disease and even slows progression of certain disease in affected individuals. Chronic disease is a food-, lifestyle, and environment-driven, phenomenon. [ii] The definition of a lifestyle disease is a condition or disorder associated with the way in which a person lives, most notably food habits and diet. 8 of the 10 leading causes of death in the US are due to chronic and/or lifestyle diseases such as heart disease, stroke, type 2 diabetes, cancer, dementia, kidney disease [iii]. 6 in 10 US adults have a chronic disease [iv]. The 2019 NHANES data showed that 40% of US adults and 19% of US children have obesity. While a lot of people with these disorders may be considered elderly, many people are not, and regardless, none of these conditions are a normal or natural part of the aging process. These stats are terrifying but the silver lining is that the majority of disease in this country is lifestyle and/or food-driven aka lifestyle and diet modifications can help prevent and cure some of the major things killing us. There is evidence that following the MD throughout your life (aka start now!) may protect you from heart disease, stroke, type 2 diabetes, dementia, and depression.
You might be wondering what is it about the MD that makes it so powerful in promoting health. There appear to be three main components of the MD that account for the critical interaction between dietary patterns and disease risk: improved cardiovascular health (increased blood flow), improved mitochondrial function, and its anti-inflammatory effect and protection against oxidative stress. The exact mechanism behind the benefit of the diet is an area of research – is it the specific nutrients and foods within the diet that make it so beneficial or is it the overall balance, combination and interaction of the dietary pattern that make it so healthy?
Research studies have found specific positive correlations between nut, olive oil, fish and vegetable intake and reduced risk of cognitive decline and dementia. For example, they highlight how specific nutrients and food categories within the MD diet such as fish, nuts, olive oil, meat, vegetables, whole grains can play a role in the diet’s relationship to brain function. One of these studies hypothesized that the abundance of phenolic compounds found in both extra-virgin olive oil and nuts may work to counteract oxidative processes that lead to cognitive decline such as improving blood flow to the brain. Researchers in Greece found that a MD diet rich in vegetables and lower in poultry and alcohol were associated with a decreased likelihood of developing depression. Other studies have credited the anti-inflammatory benefits of the MD diet to the decreased risk of developing symptoms of depression.
There is also evidence that the low consumption of meat and meat products is linked to better cognitive performance, increased blood flow and reduced disease risk. The results of this study bring up an interesting relationship between the single dietary component of meat, and association with cognitive function and suggests the possibility that decreased meat intake, rather than the MD diet in its entirety, could account for the MD diet’s linkage to brain health and brings up the need for further research in this area.
What I find so fascinating and exciting about the research in this area is that it’s not only the people who have been following this way of eating for their entire lives that see the benefit of the diet. There are studies that look at groups of middle-aged people who have not been following any type of diet throughout their life. The study puts them on the MD diet for anywhere from 1-5 years, and tracks specific biomarkers of inflammation, blood flow and cognitive function. Even after just a few years on the diet, the researchers saw significant improvements in the specific biomarkers – slowing progression of disease and/or decreasing their risk of developing certain diseases. One research team estimated that there may be as much as a 3.5 year delay in progression of certain diseases in people who have eaten a MD diet for several years as compared to those who have eaten a standard American diet [v]. There’s no question that the earlier you adopt this way of eating, the better, but regardless of your age or health status, you can see benefit.
The Bottom Line
The MD is more of a lifestyle than a diet and it emphasizes all aspects of health – diet, physical activity, relationships and social engagement. There appears to be benefit due to many specific nutrients/foods/patterns of the MD – such as the type of fat and type of protein (fish vs. poultry vs. red meat) consumed, and a consistently high intake of fruits, vegetables and nuts. What I love about this way of eating is it truly is the most diverse, flexible and easy to follow “diet” that is backed by years of research. Some days may look completely different than others and the MD diet doesn’t have strict rules – it focuses more on quality and the lifestyle choices you choose most of the time rather than a specific number of colors or percentage of macro/micronutrients. It’s all about whole, real, natural food, getting back to our roots, and there’s no doubt it has significant short and long-term health benefits. Interested in trying it out and making it a part or of your life long-term? I work with clients on long-term behavioral change, specific Mediterranean diet meal plans and have tons of Mediterranean diet resources and recipes. Get in touch! And if you have any questions, comments or found this helpful, I'd love to hear from you!
[i] Lourida, Ilianna, “Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review.” Epidemilogy: July 2013, Volume 24, 479-489.