A lifestyle choice, not a panacea
The Mediterranean diet is meant to act as a positive shift in eating
In the 1950s, researchers across the globe embarked on a sweeping and ambitious study. For decades, they scrutinized the diets and lifestyles of thousands of middle-aged men living in the United States, Europe and Japan and then examined how those characteristics affected their risk of developing cardiovascular disease.
The Seven Countries Study, as it later became known, famously found associations between saturated fats, cholesterol levels and coronary heart disease. But the researchers also reported another notable result: Those who lived in and around the Mediterranean — in countries like Italy, Greece and Croatia — had lower rates of cardiovascular disease than participants who lived elsewhere. Their diets, rich in fruits, vegetables, legumes, whole grains, nuts, seeds, lean proteins and healthy fats, seemed to have a protective effect.
Since then, the Mediterranean diet has become the bedrock of heart-healthy eating, with well-studied health benefits including lower blood pressure and cholesterol, and a reduced risk of Type 2 diabetes.
“It’s one of a small number of diets that has research to back it up,” said Dr. Sean Heffron, a preventive cardiologist at NYU Langone Health. “It isn’t a diet that was cooked up in the mind of some person to generate money. It’s something that was developed over time, by millions of people, because it actually tastes good. And it just happens to be healthy.”
Experts explain the science behind the Mediterranean diet.
What is the Mediterranean diet?
The Mediterranean diet isn’t as much a strict meal plan as it is a lifestyle, said Julia Zumpano, a registered dietitian who specializes in preventive cardiology at the Cleveland Clinic in Ohio. People who follow the Mediterranean diet tend to “eat foods their grandparents would recognize,” Heffron added — whole, unprocessed foods with few or no additives.
The diet prioritizes whole grains, fruits, vegetables, legumes, nuts, herbs, spices and olive oil. Fish rich in omega-3 fatty acids, like salmon, sardines and tuna, are the preferred animal protein source. Other lean animal proteins, like chicken or turkey, are eaten to a lesser extent. And foods high in saturated fats, like red meat and butter, are eaten rarely. Eggs and dairy products like yogurt and cheese can also be part of the Mediterranean diet, but in moderation. And moderate alcohol consumption, like a glass of wine at dinner, is allowed.
Breakfast might be smashed avocado on whole-grain toast with a side of fresh fruit and a low-fat Greek yogurt, Heffron said. For lunch or dinner, a vegetable and grain dish cooked with olive oil and seasoned with herbs — roasted root vegetables, leafy greens, a side of hummus and small portions of pasta or whole grain bread, with a lean protein like grilled fish.
“It’s very easy to follow, very sustainable, very realistic,” Zumpano said.
What are the benefits?
A number of studies have found that the Mediterranean diet contributes to better health, and in particular better heart health, in a variety of ways. In one study, published in 2018, researchers assessed nearly 26,000 women and found that those who followed the Mediterranean diet most closely for up to 12 years had about a 25% reduced risk of developing cardiovascular disease. This was mainly because of changes in blood sugar, inflammation and body mass index, the researchers reported.
Research has also found that the diet can protect against oxidative stress, which can cause DNA damage that contributes to chronic conditions like neurological disease and cancer. And some studies suggest it can help reduce the risk of Type 2 diabetes.
The diet may also have profound health benefits during pregnancy, said
Dr. Anum Sohail Minhas, an assistant professor of medicine at Johns Hopkins Medicine. In a study of nearly 7,800 women published in December, researchers found that those who followed the Mediterranean diet most closely around the time they conceived and during early pregnancy had about a 21% reduced risk of any pregnancy complications, such as preeclampsia, gestational diabetes or preterm birth.
On its own, though, the Mediterranean diet isn’t a panacea, Heffron said — it won’t eliminate your chances of developing cardiovascular disease, and it won’t cure a disease, either. Other tenets of good heart health, like getting regular exercise and adequate sleep and not smoking, must be followed.
Will it help with weight loss?
The diet can be conducive to weight loss, Zumpano said, but you’ll still need to watch calories.
“Nutrient-rich foods aren’t necessarily low in calories,” said Heffron, who noted that the diet includes foods like olive oil and nuts, which are heart-healthy yet high in calories and can lead to weight gain if consumed in large portions. But if you’re changing your diet from one that is rich in calories, saturated fats and added sugars, for instance, with one that prioritizes vegetables, fruits and leaner proteins, that can result in some weight loss, he said.
How long do you need to follow the Mediterranean diet to gain benefits?
If you’re just starting to follow the Mediterranean diet, limited evidence suggests that you may notice some cognitive improvements — including in attention, alertness and contentment, according to a 2021 review of studies — within the first 10 days or so. But for there to be sustained, long-term payoffs in terms of heart health, people need to stick with it, Zumpano said, ideally for their whole lives.
The diet allows for some flexibility, she added; the occasional cake or steak won’t undo its overall benefits.
Are there downsides?
The diet usually provides a balanced blend of nutrients and adequate protein, so typically there are no significant risks associated with it, Heffron said.
But because the diet recommends minimizing or avoiding red meat, you may want to make sure that you are getting enough iron. Good sources of iron include nuts, tofu, legumes and dark leafy green vegetables like spinach and broccoli. Foods rich in vitamin C, like citrus, bell peppers, strawberries and tomatoes, can also help your body absorb iron. And because the diet minimizes dairy, you may want to speak with your doctor about whether you need to take a calcium supplement.
However for the average person, the benefits of the Mediterranean diet likely far outweigh any potential negatives, Minhas said.