What-you-NEED-to-know-about-the-Mediterranean-diet

So what exactly is the Mediterranean Diet?

Firstly, I’m going to tell you what it’s NOT:

The mediterranean diet is not a “diet diet” - it’s not a restrictive, deprivation-infused, weight-loss diet. It’s not about counting calories or obsessing over portion sizes, or cutting out entire food groups. It is a delicious, nutritious, abundant way of eating that you will never have to white knuckle your way through with a growling, empty stomach.

It’s also not a fad. The Mediterranean diet in its modern form has been around for decades (and in its traditional form has been around for centuries).

So with that out of the way…

The Mediterranean diet is actually a way of eating (or in nutritionist-speak, a “dietary pattern”) that is modelled on the diet traditionally enjoyed by people in the olive tree-growing areas of the Mediterranean basin like Crete, Greece, and southern Italy, back in the halcyon days before Western fast food infiltrated every corner of the world.

Science first “discovered” the Mediterranean diet back in the mid-20th Century, when it was first observed that people in these Mediterranean countries displayed lower rates of chronic disease and higher than average adult life expectancy than Americans, despite their limited access to healthcare.* Upon closer look, the differences in lifestyle and especially diet between the Mediterranean way of eating and the standard American diet were stark. The American diet was heavy in red meat, saturated fats and refined-flour breads and baked goods. In the Mediterranean diet, people were consuming large amounts of plant foods (vegetables, fruits, grains, legumes, nuts, seeds, herbs and spices), their main animal protein was fish and seafood, not red meat, their bread was grainy and unrefined, they used olive oil in their cooking, salads, and even as a table condiment to dip their rustic grainy bread into, they consumed small amounts of fermented dairy like yoghurt and cheese, and a glass of wine, usually red and always with meals.

Check out this timeline of the history of the Mediterranean diet:

IMAGE REF: Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health: A critical review. Circulation research. 2019 Mar 1;124(5):779-98.

It was a tantalising concept: could this delicious, abundant way of eating also be the secret to the robust good health of the people of the Mediterranean?

These days (after literally HUNDREDS of scientific studies) the answer is obvious - of course it is! The Mediterranean Diet features heavily in all of the foods and nutrients that nutrition science has found to be supportive of good health. The heavy emphasis on plant foods means that the Mediterranean diet is rich in all the different kinds of fibre, not to mention super-healthy phytonutrients. It’s use of olive oil as the main added fat, plus its emphasis on seafood over red meat means that the diet is higher in scarce but super-healthy, anti-inflammatory omega 3 fatty acids, and lower in saturated fats, the emphasis on whole, unprocessed foods means that the diet packs a LOT of micronutrients for your calorie buck and also places a much lower glycemic load on our bodies than the standard western diet.

The Mediterranean diet was even voted by a panel of 25 health and nutrition professionals as the best diet for 2020. And with good reason:

The Mediterranean diet is one of the most extensively studied dietary patterns in the world.

And studies have found many positive health benefits associated with adherence to a Mediterranean diet:

The Mediterranean diet is a very nutrient dense diet. You can read about nutrient density HERE. Because the diet features a vibrant array of fruit, vegetables, unrefined or minimally refined grain products, plus seafood, fermented dairy and phytonutrient-rich olive oil, it delivers a lot of vitamins, minerals and phytonutrients relative to calories - I like to call this a big nutrition bang for your calorie buck! This means that people on a Mediterranean diet are a lot less susceptible to nutrient deficiency, and indeed studies have shown the inadequate intakes of the B group vitamins (B1, B2, niacin, B6, folate, or B12) were rare in the Mediterranean basin, and intakes of antioxidant vitamins (vitamins E and C) and carotenes were also high
It has a lower glycemic impact: because it features whole, unprocessed carbs and eschews refined processed foods, the Mediterranean diet has a much lower glycemic impact than the standard western diet. This means that the meals consumed on a Mediterranean diet are much less likely to spike your blood sugar and insulin levels than the standard western diet that is heavy in refined carbs and ultra processed foods.
It can help you reach and maintain a healthy body weight. Because of its nutrient density, the Mediterranean diet is incredibly satiating - you are not deprived of delicious foods and your body is not deprived of the micronutrients it needs to function at its best. So it is a healthy way of eating that people are very likely to adhere to for the long term. In fact, in one of the most successful weight loss trials to date, those assigned to the Mediterranean diet maintained their weight loss over a period of six years.
The Mediterranean diet has been shown to lower your risk of a number of illnesses, including heart disease, stroke, high blood pressure, elevated “bad” cholesterol levels, Type 2 Diabetes, certain cancers, dementia or cognitive decline.
In an exciting new sphere of nutrition science research, the Mediterranean diet has been shown to improve mood in people suffering mild-to-moderate depression, and also to boost cognitive performance.
It has been shown to be supportive of a healthy microbiome. The tiny bacteria in your large intestine are your secret health weapon. The “good guy” bacteria in our large intestine are involved in vitamin synthesis, immune function, appetite regulation, and they can even protect us against cancer! But you need to feed them right! And that’s where the Mediterranean diet comes in - it’s rich in “prebiotic” fibres that serve as food for our“probiotics” (the healthy microbes that live in our large intestine). The tiny “good guy” microbes that live in our large intestine are very picky eaters. They only like the super healthy, fibre-rich whole foods and plant-food phytonutrients like polyphenols.
People concussing a Mediterranean diet have also been found to have lower levels of inflammatory markers in their blood, reducing their risk of inflammatory conditions. This is due to the high intake of fibre- and phytonutrient-rich plant foods, coupled with a dietary fat intake that is much higher in anti-inflammatory omega 3 fatty acids than the standard western diet.
It has even been associated with increased longevity!

Health benefits of the Mediterranean diet:

I have included a selection of studies at the end of this article. If you are a fellow science nerd, I encourage you to look up these and other studies! Oldways also maintains a register of studies into the Med diet. You can check it out HERE.

Did I mention that, in addition to being nutritious and protective, the Mediterranean diet is a DELICIOUS way to eat?

So what do you eat on the Mediterranean diet?

Check out this Mediterranean diet food pyramid, developed by Oldways in partnership with Harvard university.

And this one from The Mediterranean Diet Foundation:

The emphasis is on real food

The Mediterranean diet is what I call a “low-pro” diet - processed, convenience and fast foods are eschewed in favour of delicious, vibrant whole foods that are unprocessed (like fruit, veggies, nuts and seeds) or minimally/appropriately processed (like crusty wholemeal bread and yoghurt). There are no ultra-processed foods in sight - and that is a VERY good thing for our health. https://www.healthyhappywonderful.com/blog/what-you-need-to-know-about-processed-foods

Remember that the Mediterranean diet is a “traditional” diet, one that was widely consumed before plastic-encased processed and convenience foods, and fast foods chains even existed. So if you transition to a Mediterranean diet, you will more likely be consuming wheat in the form of bulgur or delicious grainy wholemeal bread than as crackers, muffins or bread made from refined white flour.

You are encouraged to eat a LOT more plants!

Whilst it is not a vegetarian diet, the Mediterranean diet could easily be described as a plant-strong diet, due to its strong emphasis on plant foods like veggies, fruit and all other whole, unrefined plant foods like beans, pulses, whole grains, nuts, seeds, herbs and spices.

Mediterranean meals are dominated by vegetables, in all the colours of the rainbow: in salads, soups, stews, grilled, steamed, baked, sautéed - you name it. You will eat at least 5-7 serves of veggies a day.

Fruit is also a staple of the Mediterranean diet: 2-3 servings fruit per day are consumed, usually as dessert in place of cakes, cookies and ice cream.

Legumes like peas, split peas, kidney beans, chickpeas and lentils also feature, either in salads, soups or stews, and are consumed at least 3 times per week.

Whole, unprocessed grains are used in recipes and as side dished, and refined white bread is replaced with crusty rustic wholemeal breads. You can still eat breads and crackers on the med diet, but read labels pay extra attention to their degree of processing. Check out this handy guide to identifying genuinely healthy wholegrain breads, crackers and baked goods.

Nuts and seeds are consumed regularly, up to one 30g handful a day.

Herbs and spices are used liberally to flavour meals, in place of large amounts of salt. These herbs and spices not only provide flavour, they are also rich in an array of phytonutrients - health-giving plant compounds.

So if you are transitioning from a standard western diet to a Med diet, you will find yourself working out delicious ways to add all of these vibrant healthy foods into your diet each day. I love any diet that takes the emphasis away from deprivation!

Because there is so much emphasis on all of these different plant foods, the Mediterranean diet is high in all the different types of fibre.

You are also going to get an amazing dose of super-healthy phytonutrients. In recent years scientists are increasingly uncovering their myriad health benefits including antioxidant, anti-inflammatory, improved circulation among many others. I will be writing about phytonutrients soon, but in the meantime check out this article I wrote about the amazing anthocyanins in purple plant foods.

The Mediterranean diet is not a “low carb” diet, it is a “good carb” diet

The Mediterranean diet is certainly not a “low carb" diet. But I would describe is as a “good carb” diet! Refined white flour breads and pastas are replaced with genuinely wholegrain versions, veggies dominate, and healthy whole grains like oats, barley and bulgur are used in recipes. Plastic-encased, nutrient-bereft ultra-processed food products just don’t have a place at the Mediterranean table. Because of this, the Mediterranean diet has a much lower glycemic impact than the standard western diet, meaning that your blood sugar and insulin levels won’t spike as high.

A different approach to proteins

Unlike the Standard Western Diet, red meat is not the main protein consumed on a Mediterranean diet. There is a much greater emphasis on fish and seafood, poultry and plant proteins like legumes, pulses, plus fermented dairy. Processed meats like bacon and salami are generally avoided. So if you are transitioning from a standard western diet to a med diet you will likely find yourself eating a much wider variety of proteins in addition to red meat, including plant proteins like legumes and pulses.

Fresh unprocessed red meat is consumed no more than once or twice per week, in small amounts, approx. 75g/2.5oz - the size of a deck of cards.

Processed meats including deli meats which contain high levels of sodium and preservatives, are consumed rarely or avoided.

Fish and seafood is the main source of animal protein in the Mediterranean diet. Eat two-tree or more servings of fish/seafood a week. Make sure you include small oily fish that are rich in omega 3 fatty acids and low in mercury.

Plant protein sources like pulses, legumes, nuts, seeds and whole grains feature up to three times per week, in soups, salads and stews.

Poultry and eggs also feature, to a lesser extent, with no more than 3-4 eggs consumed per week.

When it comes to milk and dairy, the emphasis is on fermented dairy products like yoghurt and kefir, which are an amazing source of proteins, minerals (calcium, phosphorus, etc.), vitamins and probiotics, as well as cheeses like feta. These are used more as a condiment or side dish, crumbled into salads.

A healthier ratio of fats and liberal use of olive oil

The Mediterranean diet is by no means a “low fat diet”, but it is a “healthy fat” diet, especially when compared with the standard western diet.

Olive oil is the dominant culinary oil. This is hardly surprising when one considers that the Mediterranean diet is based on the traditional eating patterns of people living in the olive-growing countries of the Mediterranean. It is used in cooking, in salad dressings and even as a table condiment to dip crusty, rustic wholemeal bread into. Olive oil is rich in Vitamin E, beta-carotenes and monounsaturated fat, and powerful phytonutrients. Extra virgin olive oil in particular has shown strong antioxidant and anti-inflammatory activity in vitro (ie, in “test tube”) and in vivo (human) studies.

Aside from olive oil, nuts, and fatty fish are the main sources of fat in the Mediterranean diet.

Super-healthy, anti-inflammatory omega 3 fatty acids feature, due to increased seafood consumption, and there is a much healthier ratio of omega 3 to omega 6 fatty acids due to the use of monounsaturated olive oil in preference to seed oils. So it is no surprise that people on the Mediterranean diet show lower levels of inflammatory markers in their blood than those consuming a standard western diet.

The Mediterranean diet is also lower in LDL-spiking saturated fats due to the fact that red meat is not the main form of protein. Due to the absence of processed and fast fried foods, unhealthy trans fats are non-existent in the Mediterranean diet.

Beverages

Water is consumed as the main daily beverage. Coffee and tea are also consumed in moderation, but sugary sodas, soft drinks and fruit juices are avoided.

Alcohol

The traditional Mediterranean Diet does include alcohol, but subject to a few constraints:

Alcohol is consumed only with meals.
It is consumed as wine, usually red wine.
Hard liquor, shots, cocktails and beer have no place in the Mediterranean diet,
It is consumed only in small amounts - one standard drink a day for women and two for men. Note that one standard drink is 100ml - not the glass that you usually pour yourself after a stressful day.
Alcohol consumption is also spread out over the week. There is no binge drinking on the Mediterranean diet!
And most importantly, alcohol consumption is completely optional. If you don’t drink now, then for goodness sake don’t start!

There are minimal sweets, lollies, desserts or added sugars.

Dessert in the mediterranean diet is more often than not a piece or two of fruit. Sweets are consumed occasionally and in small amounts.

There are no obscure, special “diet foods” or expensive powders or supplements

All the foods featured in the Mediterranean diet are foods that you can easily recognise and find in your supermarket, local shops or farmers market. The emphasis is on enjoying a wide variety of whole, unprocessed foods.

What is NOT in the Mediterranean diet

The health benefits of the Mediterranean diet are not only due to the beautiful healthy foods listed above. Its health benefits are due in equal measure to what is NOT consumed whilst following a Mediterranean diet.

Remember, the Mediterranean diet is a way of eating that has been constructed by scientists, based on observations of the traditional diets of people living in the olive-growing countries in the Mediterranean, in the 1950’s and early 1960’s. Back before food production in that part of the world was industrialised and commodified.

I personally love to come from a place of abundance and possibility, and focus on what I CAN eat, but when you are getting your head around a new way of eating it can also be helpful to understand what is NOT in the Mediterranean diet:

Refined grains, and breads, pastas, crackers, cakes and other baked goods made with refined white flour.
Foods with added sugars, such as pastries, sodas, candies and ice cream
Sugary snack foods like cookies, muffins, muesli bars, lollies and chocolate bars.
Sugar sweetened beverages and bottled juices
Hard liquor, shots, cocktails and beers
Animal fats, and refined fats and oils, including butter, lard, margarine, sunflower oil, canola oil, soybean oil, cottonseed oil, trans fats, etc.
Processed sausages, deli meats, hot dogs, etc.
Highly processed and plastic-encased packaged foods. Basically, anything that looks like it was made in a factory.

Here are two helpful rules-of-thumb:

If you are ever unsure about whether a particular food, meal or product belongs in the Mediterranean diet, ask yourself, would a person living “la dolce vita” in a village in Crete or Calabria recognise it? Would it be a part of their diet?

If not, doing put it in your shopping trolley and don’t put it in your mouth!

Just because a food or meal is included within Italian, Greek or Spanish cuisine does not mean it falls within the Mediterranean diet

Pizza and lasagna laden with sausage and cheese and made with refined white flour dough/pasta? Deep fried cannoli or panettone made with refined white flour? Yep, they all fall within Italian cuisine, but they don’t fall within the Mediterranean diet.

Want to check how close your diet is to a Mediterranean diet?

Try one of these questionnaires, used by researchers to assess the degree to which study subjects’ adhere to the Mediterranean diet:

Mediterranean Diet Score
Oldways Med Diet Score
The PREDIMED brief 14-item screener

REF: Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediter- ranean diet. N Engl J Med 2013

Here are my top tips for transitioning to a Mediterranean diet and making it work for you!

Find creative, delicious ways to add an array of veggies to each meal. Yes, that includes breakfast!

I make sure I am getting at least (at least!!) five serves of veg and two serves of fruit a day. Check out THIS post for my top tips to help you eat more vegetables.

The old adage from the corporate world “what gets measured gets managed” is also very true in nutrition and health! So track your intake of fruit, veg and other whole, unrefined plant foods to make sure you are eating a genuine plant-strong Mediterranean diet. If you want to have a bit of fun with the process, play the rainbow game. And if you’re feeling adventurous, try new and different plant foods that you have never tried before!

Use olive oil in your cooking and in your salad dressings.

If it helps, become an olive oil connoisseur. There are LOTS of different types of olive oils (I’ll write about this at some point). Try a few until you find one you like best.

When it comes to olive oil, go for the good stuff! Extra virgin olive oil is obtained from the first pressing of the ripe fruit and has a high content of antioxidants (tocopherols, polyphenols, and phytosterols).

Swap refined breads and crackers for genuinely wholemeal versions.

We've been urged to choose wholegrain options for decades now. We know refined carbohydrate foods like white bread are less-than-ideal choices for every day. The body treats them much like sugar, so they spike blood glucose and cause insulin to surge, which over time can contribute to insulin resistance.

But ‘healthwashing” is ubiquitous in the food industry, and researchers have noted that so many supposedly “wholegrain” breads, crackers and baked goods are not genuinely wholegrain at all.

Sometimes, highly processed foods are incorrectly labelled as "whole grain" or "wholemeal". Those sneaky food companies have managed to be pretty, ummm, flexible (or to put it less politely, downright misleading), with many products labelled as "wholegrain" that are not much better than their refined counterparts.

This makes it tough for people who just want to make the best choice for themselves and their families when they're at the supermarket. They purchase these products in good faith believing they have chosen the "healthy" option, but they are still so refined that they will spike blood-sugar and insulin.

So here is a fantastic rule of thumb for you to follow when choosing breads, crackers and other baked goods:

Step 1: Check the label, and focus on the "per 100g" column.

Step 2: Look at the amount of Carbohydrate (total carbohydrate). It will be listed there in grams.

Step 3: Look for the amount of fibre. Again, it will be listed in grams. And here's a pro tip: if fibre isn't listed you can be pretty sure it's basically non-existent in that product!

The ratio of carbohydrate to fibre should not be higher than 10:1. If it is, the product is actually too refined to legitimately be classified as "wholegrain".

Basically, if you are buying a grain-based product like bread, check the carb-to-fibre ratio, and give it a miss if it is more than 10:1. If the product has a carb:fibre raio of 7:1 or lower, it gets the green light.

Rethink your attitude to protein.

Choose smaller serves of red meat: view red meat more as an accompaniment, rather than the centre of you meal, accompanied by lots of vegetables, as in stews, stir-fries, and soups.
Cut right back on processed meats: don’t you give me “but bacon!”. I’ve heard it all before. You can eat bacon, but very occasionally and in small, sensible serves, not as a food group, m’kay?
Boost your fish and seafood consumption: Aim to eat fish/seafood at least 2-3 times per week. All seafood is recommended, but a super-healthy tweak that I recommend to my clients on the Mediterranean diet is to make an effort to include fish that are rich in anti-inflammatory omega 3 fatty acids and also low on the food chain (and therefore very low in mercury); fish like sardines and anchovies. Check out this recipe, and this and this and this one! If handling raw fish fresh from the fishmonger is a little daunting at this stage, don’t worry - tinned fish is perfectly fine!
Choose lean poultry in moderate, deck-of-card-size portions.
Work on including plant sources of protein like beans and legumes.

Ditch sugary sodas and soft drinks

Just stop buying them, no excuses. Need extra motivation? Read THIS post.

Drink water, or sparkling water with a squeeze of lime, or iced tea or herbal tea. Anything but that health-sabotaging sugary rubbish!

Change your attitude to alcohol

In the med diet, alcohol is consumed in small amounts and with meals, and is more often than not consumed in the form of red wine. Replace beer or liquors with wine — no more than one 100ml/5oz glass per day for women, and two for men. And note that I said 100ml! Now go measure your standard pour of a glass of wine. Yup….

While a glass of red wine with dinner was a feature of the traditional mediterranean diet observed by scientists way back when, the fact is that the wine itself is not any kind of magic bullet. And as science has progressed, we now know that people enjoying vibrant health on the med diet were doing so despite their alcohol consumption, not because of it.

So go (REEEAAAAALLLY) easy on the wine, or don’t have any at all.

Change your attitude to snacks and treats

People living la dolce vita in 1950’s/60’s Italy/Greece/Spain didn’t snack on chocolate bars, cookies, muffins, muesli bars or heavily sweetened fruit yoghurts. They ate three abundant, delicious whole food meals a day, and if they did ever feel hungry between meals they would grab a piece of fruit, a handful of nuts or olives or a slice of rustic wholemeal crusty bread, perhaps with a sliver of feta.

Eat fruit for dessert

Cakes, ice cream, candy and all things dessert just don’t feature in the traditional med diet. So if you feel like something sweet after dessert, enjoy a delicious blood orange, or any fruit that takes your fancy really. If you’re transitioning from the Mediterranean diet from Paleo or Keto and are fearful of fruit, READ THIS POST and fear not!

Season your meals with herbs and spices

In place of high levels of salt, use delicious, healthy herbs and spices like garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper. You will be lowering your artery-stiffening sodium intake and giving your body a beautiful supply of super-healthy phytonutrients!

Shop and eat with the seasons

With its strong emphasis on fresh produce, the Mediterranean diet encourages eating with the seasons.

So when you go shopping, look for fruit and veg that is in season. Fruit and veg in season are much cheaper than imported out-of-season foods, and the produce always tastes better.

And here are some additional tweaks I recommend if you choose the Mediterranean diet, to take the health-benefits to the “next level”:

One way I tweak the Mediterranean diet, is to make sure I am following my carb-smart guidelines

The Mediterranean diet is already a relatively low glycemic index diet, but I believe every little bit helps, so I follow my own carb-smart guidelines (you can check them out here), and I always make sure I cook and cool overnight any “carby” foods like potatoes, pasta and rice. I recommend you do this too! You can read about this here and here.

Be flexible when it comes to healthy foods

What I mean is, don’t be a geographical purist! The Mediterranean diet is a way of eating that has been constructed by scientists, based on observations of the traditional diets of people living in the olive-growing countries in the Mediterranean, in the 1950’s and early 1960’s. But there are a LOT of delicious, super-healthy foods that we have access to that would not technically be included in the diet, simply because they weren’t grown in that part of the world at that time. Please don’t short-change your health or your tastebuds by dogmatically excluding these foods from your diet. I want you to:

Add in avo: Purists argue that avocado is not part of the Mediterranean diet because it originates in South America. Insert eye roll here. Avocado is delicious. It is also nutritious - a fantastic source of micronutrients, fibre and healthy fats. So if you love avocado as much as I do, ignore the purists and spread it on your bread, make dips with it, use it in salads and salad dressings.
Include soy: Again the purists quite rightly point out that soy had no place in the traditional mediterranean diet. But it is a great source of plant based protein, so why not include it. Some boffins have even proposed a sub-classification called the “Japo-Mediterranean” diet, which includes olive oil, wine, fish, beans, nuts and seeds, soy, vegetables, fruits, bread, rice, seaweed, dairy products, and mushrooms. Whatever. If you enjoy tofu, tempeh, edamame, soy milk etc, go ahead and include them in your diet.
Season with asian herbs and spices: Lemongrass, ginger, turmeric and a whole lot of other delicious, healthy herbs and spices weren’t grown or consumed in the Med. But they are delicious and healthy. So don’t short change yourself for the sake of Med diet purity!

Remember, substance over form dahlinks! The essence of the Mediterranean diet is that it is a “low-pro” diet rich in whole, unprocessed foods with a heavy emphasis on plant foods, a balance in protein rather than red meat dominance, with olive oil as the main “added fat”.

Be inflexible when it comes to less-than-healthy foods

OK so I have encouraged you to go a bit freestyle with your interpretation of the med diet to add in avocado, soy and other vibrant, healthy foods that weren’t geographically a part of the med diet.

But don’t go taking this too far.

Remember, the Mediterranean diet is healthy not just because of what it includes, but also because of what it excludes - deep fried fast foods, ultra processed package foods, hard liquor, refined flour products, sugary or salty snack foods.

So if a person living the good life in a village in Crete or Calabria wouldn’t recognise it, don’t buy it and don’t eat it! Especially if you are adopting the diet to address a health issue like obesity, insulin resistance, high cholesterol or hypertension!

Stay out of over-nutrition

If I was forced to give only one piece of nutrition advice. For the rest of my life, “stay out of over-nutrition” would be it! When we consume more energy than our bodies need to function, this causes stress at the cellular level as our bodies strain to process more food than it can deal with in one sitting. So no mater what foods you consume, don’t consume them in amounts that place strain on your body!

In my view, one of the best things about the Mediterranean diet is the fact that there is no obsessive calorie counting or portion measurement. But that can have a downside if (like me) you are prone to over-eating, especially when the food is as vibrant and delicious as the food on the Mediterranean diet!

So remember that moderation is key to enjoying the health benefits of the Mediterranean diet. Pay attention to your portion sizes, slow down when you are eating, and pay attention to your satiety signals.

My favourite way to adapt the Mediterranean diet is to adopt other healthy aspects of the Mediterranean lifestyle

You see, the Mediterranean diet is not just a diet. It’s a whole wonderful way of life. According to the United Nations Educational, Scientific and Cultural Organisation (UNESCO), it “involves a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking and particularly the sharing and consumption of food”. In fact, in 2013, UNESCO added the Mediterranean diet to its list of the intangible cultural heritage of humanity.

So here are some lifestyle “add ins” you might want to try:

Avoiding too much sedentary time.
Engaging in regular physical exercise, preferably incidental or functional exercise like cleaning, gardening, and walking where you need to go instead of driving.
Growing your own food, even if it’s just a pot of basil on your kitchen windowsill.
Cooking simple, delicious meals using lots of veggies and whole food ingredients, rather than ordering home delivery.
Slowing down and savouring your meals.
Making an effort to connect with immediate and extended family, and your wider community.

Simple swaps when transitioning to the Mediterranean diet

The Mediterranean Shopping List

Have I convinced you to try the Mediterranean diet? Are you ready to get started? To set you up for success, here is a shopping list:

Vegetables (fresh or frozen): artichokes, asparagus, avocados, beets, bell peppers, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, celery, corn (sweet yellow), cucumbers, eggplant, fennel, green beans, green leafy vegetables, kale, lettuce, mushrooms, olives, onions, peas, potatoes, radishes, spinach, squash, sweet potatoes, tomatoes, turnips, etc.

Fruits (fresh or frozen): apples, bananas, berries (strawberries, blueberries, blackberries, raspberries, mulberries, etc), cherries, citrus, dates, figs, grapes, melons, nectarines, peaches, pears, pomegranates, strawberries, etc.

Fish and shellfish: Salmon, sardines, trout, tuna, mackerel, prawns/shrimp, oysters, clams, crab, lobster, scallops, mussels, etc.

Whole Grains and (genuinely) wholegrain products: barley, brown rice, buckwheat, bulgur, couscous, faro, kamut, steel cut oats, rolled oats, polenta, quinoa, wheat berries, whole grain, genuinely wholemeal breads, rolls, tortillas, and pasta. Remember to use this rule of thumb when shopping for wholegrain breads, crackers and baked goods!

Legumes: chickpeas, kidney beans, navy beans, borlotti beans, lentils, lima beans, split peas, etc.

Poultry: Chicken, duck, turkey, etc.

Eggs: Chicken, quail and duck eggs.

Nuts, and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, pecans, pine nuts, pistachios, sesame seeds, sunflower seeds, pumpkin seeds, etc.

Herbs and spices (fresh or dried): basil, chili powder, chilies, cinnamon, cloves, cumin, dill, garlic, ginger, fennel seed, marjoram, mint, nutmeg, oregano, parsley, pepper (black or red), rosemary, saffron, sage, tarragon, thyme

Dairy products: yogurt, kefir and cheeses like feta and cottage cheese.

Oils: extra-virgin olive oil

Remember:

1. shop the perimeter of the supermarket. That's where the fruits, veggies and most of the whole, unprocessed foods are.

2. Read labels on all grain products including pasta to make sure they are genuinely wholegrain. Use this guide!

3. Always try to choose the least-processed option.

A Sample Weekly Mediterranean Meal Plan

Breakfast ideas

Breakfast parfait made with unsweetened greek yogurt, berries, oats and nuts, sweetened with a little honey or maple syrup.
Porridge made with rolled or steel-cut oats, served with berries and walnuts
Omelet with veggies, tomatoes and onions.
(Genuine) wholemeal toast with avocado, capers and sardines
Baked beans with avocado (wholemeal toast optional)
Strawberry Ripple Chia Porridge
Muesli with added wheat/oat bran and berries and a generous dollop of greek yoghurt
Mexican tofu scramble with black beans and veg (yes, it’s not Mediterranean cuisine, but it fits beautifully within the Mediterranean dietary pattern!)
Mango Berry Bircher Muesli
(Genuinely) wholemeal toast with ricotta and Strawberry Chia Jam

Snacks

You don't need to eat more than three meals per day. But if you become (genuinely) hungry between meals, here are some snack options:

Hummus with Grainy crackers and/or veggie sticks (try my Pumpkin Hummus, Beetroot Hummus, Roast Carrot Hummus, Sun-Dried Tomato Hummus or Pea & Mint Hummus)
Yoghurt with berries and nuts
Wholemeal or pumpernickel bread with avocado
A piece of fruit (apple, pear, etc) and a 30g handful of nuts
Lemony Labneh and Herb Dip
Super Seedy Chickpea Crackers
White Bean Dip with veggie sticks or crackers
A slice of Steve's Healthy Banana Bread
Red Capsicum (Bell Pepper) & Walnut Pesto (Dip) with veggie sticks of (genuinely) grainy crackers
Herbed Labneh Balls
Blanched Green Beans with Lemon, Garlic and Tahini Dip

Lunch ideas

Dinner Ideas

Side Dish Ideas

Serve one or more of these sides with your choice of protein:

Dessert Ideas

RESOURCES

There are so many amazing sources of information and delicious nutritious recipes. Here are a few to get you started:

Websites

Oldways is a food and nutrition non-profit organisation. Their website is a treasure trove of information about a number of traditional diets, including the mediterranean diet: https://oldwayspt.org

The Mediterranean Diet Foundation is also a great resource. If you’re not fluent in Spanish, make sure you view the English version of their website! https://dietamediterranea.com/en/

Brochures

https://oldwayspt.org/system/files/atoms/files/MedDietBrochure.pdf

https://oldwayspt.org/system/files/atoms/files/MED-CommonFoods_0619.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0032/946049/cardiac-meddiet.pdf

Food and Recipes

Oldways list of traditional mediterranean foods
Oldways Med Diet food glossary
Oldways guide to stocking the Mediterranean pantry

Scientific papers

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* Sadly, these days people in these countries have eschewed their delicious nutritious traditional fare in favour of convenient but nutrient-bereft fast and ultra processed foods, and this has been reflected in their rates of chronic diseases like hypertension, type 2 diabetes, obesity and heart disease.

REFERENCES

Trichopoulou, A., & Lagiou, P. (1997). Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutrition reviews, 55(11), 383-389.

Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D. Mediterranean diet pyramid: a cultural model for healthy eating. AJCN. 1995 Jun 1;61(6):1402S-6S.

Sánchez-Sánchez ML, García-Vigara A, Hidalgo-Mora JJ, García-Pérez MÁ, Tarín J, Cano A. Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials. Maturitas. 2020 Apr 11.

Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health: A critical review. Circulation research. 2019 Mar 1;124(5):779-98.

Castro-Quezada I, Román-Viñas B, Serra-Majem L. The Mediterranean diet and nutritional adequacy: a review. Nutrients. 2014 Jan;6(1):231-48.

Martínez-González MÁ, Hershey MS, Zazpe I, Trichopoulou A. Transferability of the Mediterranean diet to non-Mediterranean countries. What is and what is not the Mediterranean diet. Nutrients. 2017 Nov;9(11):1226.

Trichopoulou, A.; Martínez-González, M.A.; Tong, T.Y.; Forouhi, N.G.; Khandelwal, S.; Prabhakaran, D.; Mozaffarian, D.; de Lorgeril, M. Definitions and potential health benefits of the Mediterranean diet: Views from experts around the world. BMC Med. 2014, 12, 112.

Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009 Mar 3;119(8):1093-100.

Estruch, R.; Ros, E.; Salas-Salvado, J.; Covas, M.-I.; Corella, D.; Arós, F.; Gómez-Gracia, E.; Ruiz-Gutiérrez, V.; Fiol, M.; Lapetra, J.; et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 2013, 368, 1279–1290.

Tosti V, Bertozzi B, Fontana L. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. The Journals of Gerontology: Series A. 2018 Mar 2;73(3):318-26.

Ahmad S, Moorthy MV, Demler OV, Hu FB, Ridker PM, Chasman DI, Mora S. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Network Open. 2018 Dec 7;1(8):e185708-.

Lopez-Garcia E, Rodriguez-Artalejo F, Li TY, Fung TT, Li S, Willett WC, Rimm EB, Hu FB. The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. AJCN. 2013 Oct 30;99(1):172-80.

Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018 Jun 13.

Sofi, F.; Macchi, C.; Abbate, R.; Gensini, G.F.; Casini, A. Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014, 17, 2769–2782.

Martinez-Gonzalez, M.A.; Bes-Rastrollo, M. Dietary patterns, Mediterranean diet, and cardiovascular disease. Curr. Opin. Lipidol. 2014, 25, 20–26.

Sotos-Prieto, M.; Bhupathiraju, S.N.; Mattei, J.; Fung, T.T.; Li, Y.; Pan, A.; Willett, W.C.; Rimm, E.B.; Hu, F.B. Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and Women. Circulation 2015, 132, 2212–2219.

Grosso, G.; Marventano, S.; Yang, J.; Micek, A.; Pajak, A.; Scalfi, L.; Galvano, F.; Kales, S.N. A Comprehensive Meta-analysis on Evidence of Mediterranean Diet and Cardiovascular Disease: Are Individual Components Equal? Crit. Rev. Food Sci. Nutr. 2015, 57, 3218–3232.

Martinez-Gonzalez, M.A.; Martin-Calvo, N. Mediterranean diet and life expectancy: Beyond olive oil, fruits, and vegetables. Curr. Opin. Clin. Nutr. Metab. Care 2016, 19, 401–407.

Shai, I.; Schwarzfuchs, D.; Henkin, Y.; Shahar, D.R.; Witkow, S.; Greenberg, I.; Golan, R.; Fraser, D.; Bolotin, A.; Vardi, H.; et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N. Engl. J. Med. 2008, 359, 229–241.

Estruch, R.; Martínez-González, M.A.; Corella, D.; Salas-Salvadó, J.; Fitó, M.; Chiva-Blanch, G.; Fiol, M.; Gómez-Gracia, E.; Arós, F.; Lapetra, J.; et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: A prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016, 4, 666–676.

Mancini, J.G.; Filion, K.B.; Atallah, R.; Eisenberg, M.J. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss. Am. J. Med. 2016, 129, 407–415.

Trichopoulou, A.; Bamia, C.; Trichopoulos, D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009, 338, b2337.

Schwingshackl, L.; Missbach, B.; König, J.; Hoffmann, G. Adherence to a Mediterranean diet and risk of diabetes: A systematic review and meta-analysis. Public Health Nutr. 2015, 18, 1292–1299.

Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J, Estruch R, Covas MI, Corella D, Arós F, Ruiz-Gutiérrez V. Reduction in the incidence of type 2 diabetes with the Mediterranean diet. Diabetes care. 2011 Jan 1;34(1):14-9.

Garcia, M.; Bihuniak, J.D.; Shook, J.; Kenny, A.; Kerstetter, J.; Huedo-Medina, T.B. The Effect of the Traditional Mediterranean-Style Diet on Metabolic Risk Factors: A Meta-Analysis. Nutrients 2016, 8, 168.

Schwingshackl, L.; Hoffmann, G. Adherence to Mediterranean diet and risk of cancer: An updated systematic review and meta-analysis of observational studies. Cancer Med. 2015, 4, 1933–1947.

Toledo, E.; Salas-Salvadó, J.; Donat-Vargas, C.; Buil-Cosiales, P.; Estruch, R.; Ros, E.; Corella, D.; Fitó, M.; Hu, F.B.; Arós, F.; et al. Mediterranean Diet and Invasive Breast Cancer Risk among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA Intern. Med. 2015, 175, 1752–1760.

Valls-Pedret, C.; Sala-Vila, A.; Serra-Mir, M.; Corella, D.; de la Torre, R.; Martínez-González, M.Á.; Martínez-Lapiscina, E.H.; Fitó, M.; Pérez-Heras, A.; Salas-Salvadó, J.; et al. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern. Med. 2015, 175, 1094–1103.

Cao, L.; Tan, L.; Wang, H.F.; Jiang, T.; Zhu, X.C.; Lu, H.; Tan, M.S.; Yu, J.T. Dietary Patterns and Risk of Dementia: A Systematic Review and Meta-Analysis of Cohort Studies. Mol. Neurobiol. 2016, 53, 6144–6154.

Loughrey DG, Lavecchia S, Brennan S, Lawlor BA, Kelly ME. The impact of the Mediterranean diet on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Advances in Nutrition. 2017 Jul 6;8(4):571-86.

Aridi YS, Walker JL, Wright OR. The association between the Mediterranean dietary pattern and cognitive health: a systematic review. Nutrients. 2017 Jun 28;9(7):674.

Bhushan A, Fondell E, Ascherio A, Yuan C, Grodstein F, Willett W. Adherence to Mediterranean diet and subjective cognitive function in men. European journal of epidemiology. 2017 Nov 17:1-2.

Crous-Bou M, Fung TT, Prescott J, Julin B, Du M, Sun Q, Rexrode KM, Hu FB, De Vivo I. Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study. BMJ. 2014 Dec 2;349:g6674.

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