Unlock the Secrets of the Modern Mediterranean Diet: Your Ultimate Guide to Healthy Living!

Most people associate the word “diet” with a way of eating that severely restricts many foods or beverage items, or even complete food groups such as meat or dairy. The Mediterranean diet is not like that. It’s exactly what it sounds like! It reflects the eating habits of those living around the Mediterranean Sea such as Italy, Greece, France, Morocco and Monaco. People in this region have access to rich soil for farming and a coastline for fresh seafood, so their diet is primarily plant-based and very low in red meats. Modifying your eating habits to include more of the foods identified above may seem like a small change, but it can have a big impact. Following a Mediterranean diet is not rigid with rules regarding when and how much of these foods you should eat. In contrast, the Western diet is rich in ultra-processed foods loaded with saturated fats and sodium.

What is the Mediterranean Diet?

The Mediterranean diet has received much attention as a healthy way to eat, and with good reason. The traditional Mediterranean diet is based on foods available in countries that border the Mediterranean Sea. The Mediterranean diet focuses on eating plant-based, whole foods and healthy sources of fats and proteins. It's called the Mediterranean diet because it's based on the way people in Mediterranean countries traditionally eat. Experts now also consider the Mediterranean diet to be the best-known and most well-studied diet in the world. There's plenty of evidence that following this diet has a wide range of health benefits. There’s no single or strict Mediterranean diet plan. But, in general, you'd be eating lots of fruits and vegetables, beans and nuts, healthy grains, fish, olive oil, small amounts of meat and dairy, and moderate amounts of red wine. This lifestyle also encourages daily exercise, sharing meals with others, and enjoying it all.

The Mediterranean diet mainly refers to the traditional eating habits of people who live along the Mediterranean Sea, especially in Greece and southern Italy. It refers not just to food but to a more general way of living or lifestyle. The diet includes many plant foods that come from the Mediterranean and other regions. While this diet emerged naturally in a particular part of the world, recognition of the diet and the term "Mediterranean diet" is credited to Ancel Keys, an American scientist. Keys was one of the first to note a link between diet in the Mediterranean and improved heart health. The diet has since been well studied, with proven benefits for heart health, longevity, and a wide range of other health conditions. Of course, everyone is different when it comes to food preferences. You may respond to the Mediterranean diet differently than someone else. People also can have different nutritional needs or concerns based on certain health conditions, sensitivities, or predispositions they have. It's always a good idea to talk to a doctor or dietitian before making big changes to your diet. Any specific claims about the Mediterranean diet are not backed by WebMD. But the Mediterranean diet and its health benefits have been widely studied.

Core Components of the Mediterranean Diet

The foundation of the Mediterranean diet is plant foods. Moderate amounts of dairy, poultry and eggs are part of the Mediterranean diet, as is seafood. Unsaturated fats are a strength of the Mediterranean diet. Olive oil and nuts are the main sources of fat in the Mediterranean diet. They provide unsaturated fat. Fish also are a key part of the Mediterranean diet. These are known as fatty fish. Omega-3s are unsaturated fats that may lower immune system action in the body known as inflammation. They also may help reduce blood fats called triglycerides, and they affect blood clotting. Lean fish and shellfish also are included in the Mediterranean diet. Shellfish include shrimp, crab, clams and scallops. Choose fish that are low in mercury. Too much mercury can harm the brain and nervous system over time. Like people all over the world, some who live in the Mediterranean region drink alcohol and some do not. Red wine tends to be included more often than is white wine.

Key Food Groups

Fruits: Anything with a seed is a fruit. Good choices include avocados, apples, apricots, figs, tomatoes, and melons. Aim for three servings of fresh fruit a day. The variety of colors in fruits and vegetables provide special nutrients called phytonutrients.
Vegetables: Choose any whole veggies you like and aim for some variety. Examples include squash, artichokes, arugula, beets, cucumber, kale, or potatoes. Original Mediterranean vegetables include turnips, artichokes, lettuce, and radishes. Interactions with outside regions led to the introduction of new varieties of fruits and vegetables. Add an extra serving of vegetables to both lunch and dinner, aiming for three to four servings a day. Vegetables present in MD are rich in chemical compounds that offer potential benefits against different types of cancer, such as lycopene in tomato; organosulfur compounds in onion and garlic; capsaicin in hot pepper; indol-3-carbinol, isothiocyanates, and sulforophane in cruciferous vegetables; monoterpenes in oranges and lemons; polyacetylenes in pumpkin and carrots; spermidine and ferulic acid in whole grains; and ginkgetin in capers.
Legumes: The most common legumes of MD are beans, lentils, and chickpeas. Legumes are usually mixed with different cereals, fish, meat, and vegetables. Eat at least three servings a week of legumes. The main components of pulses and beans are flavanols, a type of polyphenols with a ketone group in their chemical formula, which reduce endothelial dysfunction, decrease cholesterol and blood pressure, and regulate energy metabolism.
Nuts and Seeds: Nuts and legumes have been routinely consumed all over the Mediterranean region, Asia, and America. Options include almonds, cannellini beans, chia seeds, chickpeas, fava beans, flaxseed, pine nuts, and lentils. Add whole-grain bread or other whole grains to the meal. Select dense, chewy, country-style loaves without added sugar or butter.
Whole Grains: Explore some options that may be new to you, such as brown rice, barley, buckwheat, couscous, farro, quinoa, or millet. Moreover, people living in the Mediterranean countries regularly consume cereals, such as rice and wheat, in the form of pasta, bread, couscous, etc. Switch to whole-grain bread, cereal and pasta. You also can try other whole grains, such as bulgur, barley and farro. If you eat about 2,000 calories a day, aim to have at least 3 ounces of whole grains. You can get 1 ounce from a slice of bread, a cup of ready-made cereal, or half a cup of cooked rice or pasta.
Seafood: Eat more fish, aiming for two to three servings a week. Fresh or water-packed tuna, salmon, trout, mackerel and herring are healthy choices.
Dairy: Traditionally, the consumption of milk and other dairy products has been low in the Mediterranean countries. Some good choices are skim or 1% milk, low-fat cottage cheese, and low-fat Greek or plain yogurt. Limit how much cheese you eat. One serving is about the size of four dice. And cut back on higher fat dairy.
Poultry: Choose lean poultry in moderate, 3- to 4-ounce portions.
Olive Oil: Switch from whatever fats you use now to extra virgin olive oil. Start by using olive oil in cooking, and then try some new salad dressings with olive oil as the base. The consumption of olive oil is considered the main reason for a long life span amongst Mediterranean populations. EVOO is the major source of unsaturated fatty acids and other components, such as fat-soluble vitamins, polyphenols, chlorophylls, and phytosterols. The polyphenols present in olive oil possess anti-inflammatory, antioxidant, neuroprotective, cardioprotective, anticancer, anti-obesity, anti-diabetic, antimicrobial, and antisteatotic effects.
Wine: In the European Mediterranean countries, MD has been significantly associated with moderate wine consumption during meals. Wine is known to have originated during the Neolithic period, while the Greeks and Egyptians popularized the beverage by developing the techniques related to its refinement and preservation. Substitute wine in moderation for other alcoholic beverages.

Foods to Limit or Avoid

Red meat: Save red meat for occasional consumption or use meat as a condiment, accompanied by lots of vegetables, as in stews, stir-fries, and soups. Reduce red and processed meat. Eat more fish, poultry or beans instead. If you eat meat, make sure it's lean and keep portions small.
Processed or ultra-processed packaged foods: Avoid the packaged food aisles to make it easier.
Refined grains and sugars: Cut out sugary beverages. Eat less high-fat, high-sugar desserts. Poached or fresh fruit is best.
Butter and other saturated or trans fats: Replacing saturated fats with unsaturated fats may help lower the risk of heart disease. For example, you could replace butter with olive, canola, or safflower or sunflower oil in cooking or at the table.

Health Benefits of the Mediterranean Diet

The Mediterranean diet works in large part because it aligns with general dietary guidelines, including:

Eat foods of many varieties.
Eat foods that are low in fat, saturated fat, and cholesterol.
Eat plenty of vegetables, fruits, and whole grains.
Limit sugar and salt.
Drink alcohol in moderation, if at all.

There's evidence the Mediterranean diet may come with health benefits such as:

Reducing the risk for cardiovascular diseases, such as heart attack and stroke
Supporting a healthy weight
Supporting healthy blood sugar, blood pressure, and cholesterol levels
Lowering the risk for metabolic syndrome and diabetes
Supporting a healthy gut microbiome
Reducing cancer risk
Supporting healthy brain function and thinking with age
Increasing lifespan and longevity

These benefits come from the Mediterranean diet, as it:

Limits saturated and trans fats in favor of unsaturated fats that are rich in omega-3 fatty acids
Limits salt
Limits refined grains and sugars
Encourages foods naturally high in fiber, antioxidants, and other nutrients

The Mediterranean diet (MD), defined by Ancel Keys in the 1960s, is one of the most well-known and well-researched dietary patterns worldwide. The MD is the traditional dietary pattern followed by the inhabitants of the Mediterranean region. Furthermore, MD is considered an environmentally sustainable dietary pattern. Specifically, an epidemiological study revealed the association of MD with the decreased incidence of cardiovascular diseases. Similarly, other observational and epidemiological studies reported an inverse relationship of MD with disease risk and mortality in various types of cancers. A recent meta-analysis based on observational studies and clinical trials highlighted the beneficial effects of MD on various chronic diseases, such as cardiovascular diseases, diabetes, myocardial infarction, coronary heart disease, neurodegenerative diseases, cancer incidence, and overall mortality. Furthermore, studies have analyzed the effects of MD on cognitive function, aging parameters, and improvement in quality of life.

Data from several studies have strongly established that nutrition is a key factor in promoting a healthy lifestyle and preventing many chronic diseases. In particular, a large number of studies have established the protective effects of the Mediterranean diet against several chronic diseases, among which are diabetes, cardiovascular diseases, cancer, aging disorders, and against overall mortality. Animal and human translational studies have revealed the biological mechanisms regulating the beneficial effects of the traditional Mediterranean diet. Indeed, several studies demonstrated that this nutritional pattern has lipid-lowering, anticancer, antimicrobial, and anti-oxidative effects. Moreover, the Mediterranean diet is considered environmentally sustainable.

Specific Health Benefits in Detail

Cardiovascular Health: One of the main characteristics of MD is the regular consumption of EVOO, which contains a mixture of essential dietary fatty acids. The PREDIMED study has examined alterations in canonical pathways of the cardiovascular system. Nine of these pathways were altered by MD + virgin olive oil, whereas four pathways were modified by MD + nuts. Overall, the results showed that MD modulates crucial pathways associated with cardiovascular risk, such as renin-angiotensin, atherosclerosis, hypoxia, angiopoietin and nitric oxide signaling, and endothelial nitric oxide synthase signaling pathways. This finding supports the idea that MD could exert beneficial effects by altering the expression of genes associated with cardiovascular diseases. Interestingly, the study noted that the atherosclerosis signaling pathway was significantly downregulated after the MD + EVOO intervention. The initial mechanistic studies explaining the inverse relationship of MD with cardiovascular risk focused on high monounsaturated fatty acid and low saturated fatty acid contents of MD. These studies also examined other conventional risk factors, such as plasma lipid concentration, glucose metabolism, and blood pressure.
Anti-inflammatory Effects: The PREDIMED study showed that MD exerts anti-inflammatory effects on the cardiovascular system and is able to reduce both systolic and diastolic blood pressure. Specifically, PREDIMED reported that serum levels of several genes decreased after 3-5 years of MD intervention. Recently, the participants of a randomized clinical trial who adhered to an MD + EVOO dietary pattern demonstrated a significant decrease in inflammatory markers and oxidized circulating LDL.
Neuroprotective Effects: Oxidative, inflammatory, and nitrosative stresses are the most common causes for neurodegeneration, whereas antioxidant molecules, such as polyphenols from olive oil, restore neuronal function by improving the redox status. In transgenic mouse models of Alzheimer’s disease, hydroxytyrosol was found to alleviate oxidative stress in the brain and mitochondria as well as neuroinflammation by inducing the expression of the Nrf2-dependent gene. Similarly, the administration of oleuropein for 8 weeks at a dose of 60 mg/kg/day was able to decrease oxidative stress and increase mitochondrial function via activation of the Nrf2 pathway in spontaneously hypertensive rats.
Anticancer Effects: Since the last decade, several in vivo and in vitro studies have revealed anticancer effects of hydroxytyrosol from olive oil against numerous malignant cell types, which could be attributed to different mechanisms of action. Most of the studies have been focused on colon cancer, which is the third most prevalent cancer worldwide and is associated with a high death rate in developing countries. Because of its autooxidation properties, the accumulation of H2O2 is considered one of the most significant anticancer mechanisms of hydroxytyrosol. However, several studies have highlighted the proapoptotic and antiproliferative mechanisms of hydroxytyrosol based on the type of cancer cells studied. Furthermore, in hepatocellular carcinoma cells, hydroxytyrosol exerts anticancer effects by inhibiting proliferation and inducing apoptosis and G2/M cell cycle arrest. Moreover, hydroxytyrosol could lead to angiogenesis and tumor growth inhibition in vivo via the inhibition of NF-κB and PKB/Akt pathways.
Diabetes Management: Several in vivo animal studies on diabetes have established the beneficial effect of oleuropein or olive leaf extracts rich in oleuropein against type 2 diabetes. Clinical trials that enrolled people with type 2 diabetes mellitus have reported significant reductions in fasting plasma glucose levels and glycated hemoglobin levels after treatment with 500 mg/day of olive leaf extracts for 14 weeks. In animal model of diabetes, significant reductions in serum glucose, oxidative stress, and cholesterol levels were observed after oleuropein treatment.

Implementing the Mediterranean Diet

To get started on a Mediterranean diet, you'll need to first understand the basic principles. It isn't a strict diet, but it focuses on:

Lots of whole vegetables, fruits, whole grains, nuts, and beans
Olive oil as a primary source of fat
Cheese and yogurt, in moderate amounts
Fish and poultry, in low or moderate amounts
Limited red meat
Limited desserts or heavily sweetened foods
Wine, often with meals

In general, making changes to your diet is best if you do it slowly. Start with elements that seem most natural to you or easiest. For example, you could:

Switch from other oils or butter to olive oil for cooking and salad dressings
Snack on nuts or olives
Replace refined carbohydrate breads with whole-grain breads
Swap white rice for bulgur, barley, farro, couscous, or whole-grain pasta
Add more veggies and salads to your meals
Replace meats with lentils, chickpeas, or beans a few times a week
Drink wine in place of other forms of alcohol
Stick to water instead of soda or juice
Skip dessert or stick with fresh fruit
Choose fresh, whole foods you can buy locally, if possible

Practical Tips for Incorporating the Mediterranean Diet

How can you incorporate these healthy foods into your everyday life? Here are some small changes you can make. Pick one change every week and incorporate it gradually.

Begin or end each meal with a salad.
Seek out the best quality food available.
Finally, try to have dinner as a family as often as possible.
Eat more fruits and vegetables. Each day, aim for 2 to 3 servings of fruit and four or more servings of vegetables. One serving of fruit equals a medium piece of whole fruit or one cup of chopped.
Use unsaturated fats from plants.
Eat more seafood. Eat fish or shellfish 2 to 3 times a week. Children and people who are pregnant or breastfeeding may want to limit certain types of fish due to mercury levels. One serving of fish is around 3 to 5 ounces for adults. That's about the size of a deck of cards.
Get nuts. Each week, aim to eat four servings of raw, unsalted nuts.
Enjoy some dairy.
Spice it up. The Mediterranean diet has a lot of flexibility, so you can make it a delicious and nutritious way to eat.

Sample Meal Ideas

There are many ways to incorporate the delicious foods of the Mediterranean diet into your daily menu. Here are some recipe ideas for breakfast, lunch, dinner, and snacks:

Breakfast: A slice of whole grain toast with avocado and sunflower seeds, vegetable scramble with a side of fruit, plain yogurt with nuts and fruit.
Lunch: Greek salad with olives, feta, and olive oil dressing, chickpea and whole grain salad with olive oil and fresh herbs, whole grain pasta salad with plenty of veggies.
Dinner: Salmon with a side of broccoli and farro, chicken kabob with quinoa and a green salad, lentil curry with brown rice.
Snacks: Orange, nuts, apple and cheese. Instead of grabbing a packaged snack, the best snacks for a Mediterranean diet may include a handful of nuts, whole fruit, or raw vegetables with hummus. Greek salad made with chopped mixed greens, kalamata olives, tomatoes, fresh parsley, feta cheese.

Considerations and Potential Drawbacks

Any diet comes with pros and cons. Your list of pros and cons of the Mediterranean diet will depend on your own preferences, health concerns, and other factors. Some factors to consider when thinking through the pros and cons include:

You may need to shop more often to have lots of fresh fruits and vegetables on hand.
Your shopping changes may affect your grocery bill.
You'll need to cook or prepare meals at home more often.
The Mediterranean diet allows for lots of flexibility depending on which foods you enjoy, but you'll need to make choices and find new recipes.
Snacks can be simple fruits, nuts, or hummus.
The Mediterranean diet and lifestyle include regular exercise.
It also encourages enjoying healthy meals with friends and family.

One benefit of the Mediterranean diet is that it’s easy to adjust for different diets, needs, or restrictions. For example, a Mediterranean diet can be:

Read also: Reconnecting with Ancestral Eating

Vegetarian
Vegan
Gluten-free
Low-sodium

If you plan to follow another type of diet and aren't sure whether a Mediterranean diet will work for you, consult your doctor or dietitian first to be sure. For example, the Mediterranean Renal diet is an adaptation for people with chronic kidney disease. Compared to a standard Mediterranean diet, it includes:

Less protein
Lower salt
Lower phosphate

Depending on your current diet, habits, and nutritional needs, a Mediterranean diet could have some drawbacks, such as:

Weight gain
Low iron from eating less meat
Low calcium from consuming less milk or other dairy products
Higher food costs
More foods that are perishable

Who Should Be Cautious?

Zelman says that people with certain health conditions, including genetic conditions, that affect their ability to process certain foods or ingredients need to take special precautions with any diet. People with kidney disease also may need to consider other nutrient restrictions. Even then, the Mediterranean diet may offer benefits with some adjustments. Zelman advises working with a registered dietitian nutritionist to help you navigate it.

The Future of Mediterranean Diet Research

Computational and bioinformatic methods play a vital role in investigating the effects of MD. The latest bioinformatic tools and highly efficient data-generation methods have enabled the collection of huge amounts of information and rapid analyses of data. Currently, various bioinformatic tools and techniques, such as networking and pathway analyses, are being applied to understand the complexity of MD effects at the systems biology level.

Epigenomics: The term epigenomics refers to a wide range of genomic modifications without involving changes in the DNA sequence, which lead to alterations in gene expression. The epigenomic profile may be linked to increased cardiovascular risk and aging. Three types of epigenetic biomarkers are often observed based on epigenetic regulators: DNA methylation, noncoding RNA synthesis, and histone modification.
Genomics: The first omics approach was focused on the study of single nucleotide polymorphisms that influence diseases associated with the metabolic status. With technological advancements, genome-wide association studies and, subsequently, next-generation sequencing technologies were applied to explore multiple polymorphisms in a single experiment Currently, studies focusing on gene-diet interactions are involved in examining the heterogenic responses of identical dietary patterns, which means that different individuals exhibit different responses to the same MD components.
Metagenomics: The gut microbiota plays an important role in the relationship between dietary habits and health. Several studies analyzed the effect of MD components on microbiota, both at the species level and at the metagenomic level. Some of the studies reported beneficial effects of MD on the microbiota, and other studies examined the favorable effects of MD on health by simulating the profiles of beneficial microbiota. Moreover, the presence of metabolomic markers in urine or plasma indirectly reflect the microbiota activity.
Transcriptomics: The use of transcriptomics makes it possible to analyze the specific effect of a diet or food on gene expression, thereby leading to a better understanding of specific mechanisms. It is possible to unravel which gene expression is upregulated or downregulated by the influence of certain foods. In humans, several researchers have analyzed the effects of MD and its components on the transcriptome using selected candidate genes as well as the whole transcriptome.

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