A Review of the Mediterranean Diet  

Dr. Christopher McGowan
March 28, 2023

Most people probably start a diet with a specific time frame in mind: I want to lose X number of pounds in Y number of weeks. And so they go about picking a diet plan or weight loss program to help them achieve that goal, with the intention that they’ll abandon the diet once they reach the goal. This is a huge part of the reason that most people also don’t have a lot of long term success and end up “yo-yo dieting” where they lose a little weight and then gain it back and then try to lose weight again.

A lot of fad diets are developed and marketed with this very phenomenon in mind—they promise that you’ll lose weight by adhering to a series of seemingly simple rules. The problem is, however, that the rules are often tedious and unsustainable. There are some diets, though, that people adopt with the intention of losing weight but would more aptly be labeled as lifestyles. One of the most popular and potentially beneficial of these lifestyle diets is known as the Mediterranean diet.   

What is the Mediterranean Diet?        

The Mediterranean diet isn’t really a “diet” in the popular sense of the word; rather, it is a generic term for a way of eating that is based on the traditional dietary habits of people in some areas of the Mediterranean basin like Greece, France, Italy, Spain, and Northern Africa. While there are many different styles of cuisine in this region, the common elements are a relatively high consumption of fruits, vegetables, legumes, and unprocessed whole grains with moderate amounts of fish, lean meats, dairy products, and olive oil. 

Origin of the Mediterranean Diet 

Though the diet is based on traditions from Mediterranean countries, the principles aren’t quite as common as they once were even in those places. Like in many other industrialized nations around the world, the sharp increase in the consumption of processed foods has changed the eating habits of much of the population. For this reason, the Mediterranean diet in its modern form is more like an amalgamation of the principles that were derived from study of life around the Mediterranean Sea prior to the 1950s. 

In 1955, a researcher at the University of Minnesota named Ancel Keys began a project known as the Seven Countries Study that looked at the relationship between diet, lifestyle, and health conditions like cardiovascular disease. The study ran for over two decades and followed participants in the United States, Japan, and several European countries. Keys eventually published the study in 1978, and he found that there was a strong correlation between the effect of dietary sources of saturated fat on cholesterol and the rates of coronary artery disease and stroke.   

Even though research had shown that some fats—like olive oil—had positive associations with human health, much of the medical world and dietary health recommendations were focused on limiting fats of all kinds for much of the 1970s and 80s. Then, in 1993, the Harvard School of Public Health, the World Health Organization, and the Oldways Preservation Trust developed the Mediterranean Diet Pyramid, a guide for how to adopt a Mediterranean-style diet and realize the related health benefits. The release of this guide renewed interest in the Mediterranean diet and led to more research and greater public awareness. 

In more recent years, the Mediterranean diet has gained widespread acceptance in the medical community as a healthy diet that promotes heart health. In fact, the American Heart Association recommends the diet as a way to reduce the risk of cardiovascular disease while the American Diabetes Association recommends it as a way to reduce the risk of type 2 diabetes. In 2013, the Mediterranean diet was even granted a special status by UNESCO as an Intangible Cultural Heritage of Humanity.  

What Are the Main Foods in a Mediterranean Diet?

One of the main reasons the Mediterranean diet is so enduringly popular is that it’s less about restrictions and more about choices. This is also why it’s best understood as a different dietary pattern rather than a “diet” in the way Americans tend to think of the word. Adopting this eating plan revolves around emphasizing certain types of food that are known to be associated with a longer lifespan and a lower risk of chronic disease. Below is a list of the main foods and categories of the diet: 

  • Fresh fruits and veggies: With three servings each per day, fruits and vegetables make up a significant portion of a Mediterranean diet. Almost any fruits and vegetables can be included, but some nutrient-dense examples that are popular in the region include apples, figs, strawberries, avocados, cucumbers, artichokes, kale, spinach, sweet potato, and eggplant.
  • Whole grains: Unprocessed whole grains are another big part of the Mediterranean diet, and you should aim for 3-6 servings per day. Processed white bread and other bakery items tend to be high in refined carbohydrates, but whole grains are high in fiber and valuable nutrients. Examples include whole-grain bread and pasta or cereals like brown rice, quinoa, oats, or barley.   
  • Healthy fats: Even though many food products are advertised as low fat, the fact is that the body needs some dietary fat. But where the typical American diet is high in saturated fat, the Mediterranean diet focuses on healthier fats like extra virgin olive oil. Olive oil is a monounsaturated fat, a type that has a beneficial effect on cholesterol levels. Olive oil is a great substitute for butter or other animal fats when cooking, but it can also be used to drizzle on salads or as a dip for bread. The recommendation is 1-4 servings (1 tablespoon per serving) each day.     
  • Legumes: Legumes like lentils and beans are another significant part of the typical Mediterranean eating pattern. Like other plant-based foods, they have valuable fiber and nutrients and they can increase one’s sense of fullness after eating. Legumes are a versatile food, and they can be prepared in many different ways. One classic preparation in Middle Eastern cuisine is hummus, a dip made primarily of mashed chickpeas.    
  • Fish: Fish have always been a significant source of nutrition for the peoples that live around the Mediterranean Sea. In addition to being nutrient dense and very filling, fish is an important source of omega-3 fatty acids; these essential nutrients are polyunsaturated fats that the body uses in making new cells. Examples of healthy fish to include in the diet are mackerel, sardines, herring, and tuna.  
  • Nuts: Nuts and seeds are great as snacks that fit the Mediterranean diet, as long as they’re eaten in moderation. At a ¼ cup of nuts per serving, the goal should be about 3 servings per week. Raw or dry roasted with no salt added are the healthiest choice; examples include walnuts, almonds, and hazelnuts.  
  • Poultry: Meat in general gets less emphasis on the Mediterranean diet, but poultry is a good source that you can eat up to one serving per day. Poultry is also a great choice as a replacement for red meat; while red meat is fine in moderation, it nevertheless is associated with an increased risk of cardiovascular disease and other health problems. The healthiest way to consume poultry is baked, boiled, or grilled without the skin.   
  • Dairy: Dairy products can be part of a healthy meal plan as long as you don’t consume more than one serving per day on average; a serving of milk or yogurt is 1 cup, and a serving of cheese is 1.5 ounces. Naturally low-fat cheeses like feta, mozzarella, or ricotta are some of the best options.  
Mediterranean Diet Pyramid

What About Red Wine? 

Red wine has long been associated with the cuisines and eating habits of the Mediterranean region. Some research done in past decades even seemed to show a correlation between the consumption of red wine and certain health benefits. While it’s true that red wine does contain antioxidants that are beneficial at staving off damage from free radicals, the fact is that there are many other sources of antioxidants that don’t contain alcohol. It is possible to drink it in moderation and still be healthy, but the bottom line is everyone is better off avoiding alcohol. There is no evidence that there are any real benefits to drinking it, regardless of its connection with the Mediterranean diet.  

Health Benefits of the Mediterranean Diet

The most basic reason the Mediterranean diet is considered a healthy approach to eating is that it calls for whole, nutrient-dense foods that provide what the body needs without excess calories. Emphasizing these foods also means reducing the consumption of processed foods that are high in refined carbs and saturated fat that are linked to a variety of negative health outcomes. Over the last few decades, studies have consistently showed that the Mediterranean diet is associated with numerous health benefits: 

  • Heart health: As noted above, one of the reasons the Mediterranean diet first became a subject of study was because of the phenomenon (sometimes referred to as the French paradox) of people from Mediterranean countries having fewer incidence of coronary artery disease even though their diet is somewhat high in fat. The research continues to show, however, that people who follow a Mediterranean-style diet have lower rates of heart disease and stroke. Switching to this way of eating is also known to bring down high blood pressure and conditions related to hypertension
  • Diabetes management: Another benefit related to heart health is the effect of the Mediterranean diet on blood sugar levels. The high fiber and low sugar content of the typical foods in the diet can reduce the chances of developing type 2 diabetes and even improve blood sugar controls in those who already have diabetes.  
  • Reduced cancer risk: The Mediterranean diet, like other dietary patterns that put a strong emphasis on plant-based foods, is potentially beneficial for preventing cancer and reducing the risk of dying from cancer. One promising explanation for this association is the high antioxidant content of the fruits and vegetables that form the foundation of the diet. Antioxidants are known to prevent the oxidative stress that come from free radicals, and free radicals are thought to be a driver of the cellular mutation that can cause cancer to develop.  
  • Healthy digestion: The fact that the Mediterranean diet is low in meat and high in fruits and vegetables equates to a healthier digestive tract and less chance of inflammation. Much of this can be attributed to the soluble and insoluble fiber content of plant-based foods; fiber helps maintain bowel regularity at the same time as promoting a healthy balance of gut bacteria.  
  • Improved cognitive function: While more research is needed, many studies to date have shown a relationship between a Mediterranean-style diet and improved cognitive function. It also seems related to slower cognitive decline that comes with aging as well as a lower risk of neurodegenerative diseases like Alzheimer’s disease. 
  • Better mental health: The connection between dietary habits and mental health is still not fully understood, but there has been some evidence in recent years that the Mediterranean diet may be helpful for mental health issues like depression. One possible reason for this is the effect of one’s diet on serotonin production.    
Health Benefits of the Mediterranean Diet

Does the Mediterranean Diet Lead to Weight Loss? 

There’s nothing magical about the Mediterranean diet that makes it such a healthy way of eating. It simply represents a diet revolving around foods that are known to be beneficial for health. The main reason the diet “works” is because it creates a framework for how to live in a healthy way. But even though it is perhaps best known for improving health, there is also plenty of evidence that it can also lead to weight loss.

One of the most convincing studies on the topic was done using 30,000 participants from cities around Italy. The study looked at the effect of adherence to a Mediterranean diet on weight and waist circumference over multiple years. The study found a strong correlation between following the diet closely and a lower risk of obesity. A different study, from 2020, found that people who had already lost weight and adhered to a Mediterranean diet were twice as likely to maintain their weight loss compared to those who didn’t follow the diet closely. 

What the research doesn’t show, however, is that the Mediterranean diet works quickly as a means of losing weight. On the contrary, it’s clear from the research that the diet can only lead to weight loss if the participant is in a caloric deficit. That means it’s possible to be following the diet closely and not lose weight or even gain weight. This is largely because the foods of the Mediterranean diet, while nutrient-dense, are not necessarily low calorie.   

What Do the Experts Say? 

As with evaluating any diet or weight loss plan, it’s a good idea to look to experts for the best insight. Lori Gooch, RDN, LDN, is a Registered Dietitian at True You Weight Loss, and she offers answers to some common questions about the Mediterranean diet: 

What are the pros of the Mediterranean diet?

  • Rich in whole, nutrient-dense foods such as fruits, vegetables, whole grains, nuts, and legumes, which provide a variety of vitamins, minerals, and fiber.
  • Emphasizes healthy fats such as olive oil, which has been linked to numerous health benefits such as improved heart health and decreased inflammation.
  • Includes moderate consumption of lean proteins, such as fish and poultry, which are rich in essential nutrients like omega-3 fatty acids.
  • Has been linked to numerous health benefits such as improved heart health, reduced risk of certain cancers, and improved cognitive function.

What are the cons of the Mediterranean diet?

  • May be difficult to follow for individuals who are not used to a primarily plant-based diet or who do not have access to fresh, whole foods.
  • May be more expensive than a diet that relies heavily on processed or packaged foods.
  • May not provide enough protein for individuals who are very physically active or who require higher protein intake for medical reasons.
  • May not be appropriate for individuals with certain health conditions or dietary restrictions.

What have you found people are generally unaware of when considering the Mediterranean diet?

  • One aspect of the Mediterranean diet that people may not be aware of is the importance of social and cultural factors in its success. While it emphasizes healthy foods including fruits, vegetables, whole grains, and lean proteins, the Mediterranean lifestyle also emphasizes social connections, physical activity, and relaxation.
  • Research has shown that these lifestyle factors may be just as important as the diet itself in promoting health and longevity. For example, a study published in the journal BMJ Open found that social isolation was associated with an increased risk of mortality among Mediterranean adults, even after accounting for factors like diet and physical activity. Another study published in the Journal of the American College of Cardiology found that higher levels of leisure-time physical activity were associated with a lower risk of cardiovascular disease among Mediterranean adults.
  • These findings suggest that while the Mediterranean diet is an important component of a healthy lifestyle, it is not the only factor to consider. Social connections, physical activity, and stress reduction are also critical for promoting health and longevity.

Do you have firsthand experience with the Mediterranean diet, whether it's something that you've personally tried, or have seen others be successful or unsuccessful with?

  • Although I have not personally tried the Mediterranean diet, there are many who have been successful. For example, a study published in the Journal of Nutrition Education and Behavior interviewed individuals who had successfully adopted the Mediterranean diet and found that their success was largely due to the diet's flexibility and variety. Participants reported that they enjoyed the abundance of fruits and vegetables, as well as the occasional glass of wine or sweet treat.

How much weight do people typically lose with the Mediterranean diet?

  • The Mediterranean diet's main focus is aimed at improving overall health and well-being, which often results in weight loss. According to several studies, those that followed a Mediterranean diet lost an average of 3-5 lbs. Weight loss is highly individualized and will depend on different factors such as starting weight, age, gender, and physical activity level.

For someone that might be considering the Mediterranean Diet, what alternative options should they consider and why?

The Mediterranean diet is a popular and well-researched dietary pattern that focuses on whole, nutrient-dense foods. However, some alternative options that are associated with health benefits may include:

  • The DASH (Dietary Approaches to Stop Hypertension) diet: This diet is similar to the Mediterranean diet in that it emphasizes whole, nutrient-dense foods, but places a stronger emphasis on reducing sodium intake to help lower blood pressure.
  • Plant-based diets: A plant-based diet is a broad term that encompasses a variety of dietary patterns, but generally incorporates fruits, vegetables, whole grains, legumes, nuts, and seeds. Plant-based diets have been associated with a reduced risk of chronic diseases such as heart disease, type 2 diabetes, and certain types of cancer.
  • The Paleo diet: This incorporates whole, unprocessed foods such as lean meats, seafood, fruits, vegetables, nuts, and seeds, while excluding grains, legumes, and dairy products. It may have health benefits such as weight loss and improved blood sugar control.

The Bottom Line

Does the Mediterranean diet work? It depends on your definition of “work.” There can be no doubt that a Mediterranean-style diet that is rich in fruits and vegetables and low in saturated fats and refined sugars is good for health. The research is clear that adopting such a diet will only be a boon for virtually every aspect of health and even potentially lead to a longer life. In that sense, the diet is less of a diet and more of a lifestyle. 

Does the Mediterranean diet work for weight loss? This is where the answer is a little less clear. Because of the nature of the foods you consume (and the ones you avoid), following the diet can provide nutritionally dense foods that are filling in a way that curbs the kinds of food cravings that lead to obesity. The bottom line is, though, that it can only work for weight loss if you are also ensuring that you’re in a calorie deficit—either because you have reduced your intake of calories or increased your physical activity level.  

Sustainable Weight Loss Solutions

When people see the word “diet,” they generally think of a restrictive eating plan that is aimed at achieving weight loss as quickly as possible. The Mediterranean diet isn’t really meant for such an aim, though, so it’s likely that most people trying to lose weight on the diet may have difficulty finding success. Rather than temporarily withholding food to promote weight loss like most fad diets, the Mediterranean diet represents a shift in thinking about food that can potentially lead to overall health and wellness. 

The difficult truth that many people aren’t fully aware of is that dieting for weight loss rarely leads to long term success. This is in part because there are so many different biological and psychological factors involved in weight gain in the first place. Weight gain tends to be seen as a character flaw that needs to be conquered rather than a health condition that requires focused treatment that helps people make the necessary changes. 

At True You Weight Loss, we know how challenging the weight loss journey can be. Most Americans at one point or another have attempted to lose weight, and most have also either failed to lose weight or lost some and then gained it back not long after. That is why we are passionate about providing alternative weight loss solutions that can help you find the freedom you’ve been looking for. If you’d like to learn more about our non-surgical weight loss procedures, please contact us to request a consultation.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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