Why The Mediterranean Diet Was Ranked 2019's Top Diet

The Mediterranean diet is more a style of eating than an official diet. Unlike ketogenic or Atkins or the American Heart Association diet, the Mediterranean Diet has no formal definition. In the mid-20th century, the diet of the inhabitants of the Greek island of Crete was linked to health benefits. Locally sourced plant foods were the mainstay: nuts, olives, legumes, fruits, greens and vegetables. Dairy foods (from goat milk), fish and lamb were included in small amounts. Sugary desserts were not common, although honey was used as a sweetener.

Why adopt this diet? Research consistently links this style of eating to a lower risk for numerous chronic diseases such as heart disease and cancer, as well as easier weight management. However, it's not promoted as a weight loss diet.

The Mediterranean diet can very loosely be described as a plant-based diet, meaning most of the food one eats is from plants. But what exactly does that mean? Advocates and researchers can't even agree on the fat content. In one multi-year study from Spain, subjects consumed 40% of their calories from fat, primarily from olive oil or nuts. Other definitions suggest 25-35% fat. Some Mediterranean diet publications simply omit reference to calories from fat, carbs or protein. Suffice it to say, this diet allows for a more liberal fat intake than low fat diets, including the American Heart Association diet. The key is that the source of fat is olive oil or nuts, rather than meats, cheese or butter.

Here's a very rough estimate of the calorie breakdown of a Mediterranean diet:

  • 35-40% fat, mostly as plant-sourced fats
  • 15-20% protein
  • 40-50% carbohydrate, primarily from vegetables, fruit, nuts, legumes, grains, not from sugary sweets

Rather than "permitted" or "prohibited" foods, the should list is described as:

Foods to Emphasize

  • Vegetables
  • Fruit
  • Whole grains
  • Foods made from grains (bread, pasta)
  • Olive oil
  • Nuts
  • Legumes

Foods to Eat in Limited Portions

  • Cheese
  • Milk
  • Yogurt
  • Eggs
  • Meat
  • Fish

Foods that should be used only rarely

  • Sweets
  • Animal fats like butter
  • Processed meats

Updated Mediterranean diet pyramids or books also include wine, in moderation. Wine production and consumption is widespread throughout the Mediterranean region, and is a traditional beverage. Water is also typically included as a recommended beverage.

For many people, the term "Mediterranean Diet" implies that the foods and recipes must be from the Mediterranean region. This is a misconception. In fact you could create a plant-based diet using foods from Central America or Asia. There is no rule saying you have to eat Mediterranean regional cuisine.

  • Breakfast: oatmeal with dried fruit and nuts, topped with yogurt

  • Lunch: burrito wrap with refried beans, cheese, salsa, avocado, chopped fresh tomatoes and lettuce

  • Snack foods: peanuts/cashews/almonds/walnuts, fresh fruit or fruit salad, small yogurt, hummus and vegetables

  • Dinner: pasta with meatless marinara sauce and grated cheese, large tossed salad with olive oil dressing.

Another misconception: simply adding olive oil to your existing diet makes it Mediterranean. No. The most important concept is plant-based. In fact, you could use canola oil. However, extra virgin olive oil is preferable, given the potential health benefits of polyphenols in olive oil, as well as the monounsaturated fat content.

Pros

  • Filling - a diet that emphasizes whole plant foods will fill you up, leaving little room for empty calorie foods, or big servings, which helps control calorie intake.

  • Satisfying - there are endless delicious possibilities, considering the wealth of foods available. Plus the higher fat content increases the satiety value, making it easier to stick with.

  • Adaptable to many regional food preferences - there is no mandate to eat only foods from the Mediterranean region. You could put together a plant-based Mediterranean style diet using foods from Southeast Asia.

  • Highly nutritious: the wealth of plant foods means a high intake of fiber, vitamins, minerals and antioxidants. Plus this type of diet is friendly to healthy gut microbes.

  • Health benefits: associated with lower risk for heart disease, diabetes and cancer.

Cons

  • Lack of clear rules. People who need strict food rules might find this diet too open-ended and potentially confusing. There's no official way to measure "plant-based."

  • Not necessarily convenient. You could follow this diet by eating nothing but salads, pasta, nuts and fruit, along with some yogurt or cheese and nuts for snacks. But that could get old. In order to enjoy all the food possibilities, you might need to do some cooking.

  • Missing favorite foods? Large portions of meat are not part of this diet. A meal consisting of a half-pound steak, a baked potato with butter and sour cream and a little serving of broccoli is not a Mediterranean-style meal. If you're used to sweets and desserts everyday, you might not adjust well to the idea that those should be rare treats.

  • You don't like olive oil. This isn't necessarily a deal-killer. You could use canola and perhaps some alternative nut oils like walnut or avocado. The main point is to emphasize plant-sourced oils rather than fats from meats or dairy.

  • Overeating. If you pick less filling plant-based foods - say pasta, bread, rice - and eat big portions of those, skimping on vegetables and legumes, you could end up overeating and getting few of the potential benefits of plant-based eating.

Cost

The Mediterranean diet shouldn't cost more than your average grocery bill. You might think fresh vegetables and produce and good olive oil are expensive, but you'll be buying less meat and fewer processed foods. So, a Mediterranean diet is as expensive or inexpensive as you make it, depending on your food choices.

Social Support

As the food choices are so varied, it's hard to imagine social support is necessary to help you stick to this diet. However you might benefit from culinary support, whether cooking instructions or recipes or a good source of Mediterranean style take out food.

Mediterranean Diet - Summary

Does it work?

Yes, it's linked to better weight management and lower risk for chronic diseases.

Who would most benefit from this diet?

The Mediterranean diet is a good fit for people who want to make long-term diet changes to improve health and weight. You should be comfortable choosing foods without a set of strict rules and guidelines about grams of this or that, or calorie counts or when to eat what. There is no list of prohibited foods to limit your choices.

Is it viable long term?

The Mediterranean diet isn't something you go on for a few weeks, and then abandon. It's a diet for life. It's been the long-term diet for millions of people living around the Mediterranean region. Variations on the plant-based theme are certainly viable long term anywhere in the world.

Do I like this diet?

Yes I do, and in fact it's how I eat and will continue to eat.

Resources

While there is no official Mediterranean Diet website or book, many organizations provide information and guidance, in the form of books, brochures, websites, recipes and meal plans. Here are a few:

  • Oldways Preservation Trust promotes the Mediterranean diet along with other traditional world cuisines, and is a great source of information on foods, recipes and meals.

  • Sharon Palmer RDN is the author of the "Plant Powered" book series, focused on newsletter on her website.

  • The Mediterranean Living website has a list of resources.

  • The Olive Tomato website is run by Greek dietitian Elena Paravantes. She actively promotes the Mediterranean diet and her website is full of recipes and helpful information.

There are too many cookbooks with a Mediterranean diet emphasis to list separately. Your local library would be a good place to browse cookbooks. Most recipe websites, as well as Pinterest, allow you to search for "Mediterranean" style recipes. There is plenty of information out there to get you started.

Originally Published December 12, 2017
Updated August 1, 2019

Donna P Feldman MS RDN is author of Feed Your Vegetarian Teen and Food Wisdom for Women: nutrition for aging with energy, vitality and health. Donna writes about food and nutrition at Radio Nutrition and is co-host of the Walk Talk Nutrition podcast.
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Disclaimer: The information provided here does not constitute medical advice. If you are seeking medical advice, please visit your healthcare provider or medical professional.

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Meal Planning & Diets/Mediterranean Style Weight Loss/Diets

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