The Mediterranean Diet: Should You Adopt it?

By Danny Lennon, for NASM

The Mediterranean Diet includes:

• Plant foods such as fresh vegetables, fruit, grains and nuts
• Liberal use of healthy fats like olive oil and canola oil
• Fish, poultry and dairy like cheese and yogurt in moderate amounts
• Herbs and spices to replace salt
• Low red meat consumption
• Moderate wine consumption (optional)
• Water

The Mediterranean diet was originally conceived based on observations of the good health experienced by populations living by the Mediterranean (predominantly Greece, Italy, Spain).

Nutrient Profile: One of the good things about the Mediterranean diet is that there is no one single nutrient profile, so there is great flexibility for the consumer.  Restrictions or recommendations are not based on macronutrients, but rather through food-based recommendations. This likely makes it easy to implement for a large number of people without the requirement of monitoring proteins, carbs, and fats.

Daily Food Servings: However, in a relatively recent review of literature aimed to define what the approach looks like, Davis et al. (2015) found that the Mediterranean diet typically contained daily servings of:

• 3 – 9 servings of vegetables
• 0.5 – 2 servings of fruit
• 1 – 13 servings of cereals and
• up to 8 servings of olive oil

From the studies examined, on average the Mediterranean Diet has 37% of the daily calories coming from dietary fat. Of the fat intake, on average 18% was mono-unsaturated and 9% was saturated fat.  The diets followed in these studies also provided about 33 g of fiber per day. These figures fit well within typical evidence-based guidelines for a healthy diet, namely: to have a high fiber intake and prioritize monounsaturated fat over saturated fat.

Lifestyle: However, it is important to note that the Mediterranean diet extends beyond simply food choices, as it also accounts for social and cultural aspects, which are well known to influence long-term health.  For example, the approach traditionally emphasized communal mealtimes, resting after eating, and regular physical activity (Renzella et al., 2018). All of these behaviors may have impacts on health independently of the nutritive value of the food.

The Mediterranean diet is one of the most extensively studied dietary approaches in the world. What does the evidence say about its ability to impact health and body composition?

Health Benefits: When it comes to impacts on health reported in scientific research, the Mediterranean Diet looks like a real winner. There is perhaps no other dietary approach with the consistency of strongly positive health outcomes. The Mediterranean Diet has evidence to support its role in:

• Reducing risk of several chronic diseases (such as Parkinson’s and Alzheimer’s diseases) (Filippatos et al., 2016; Sofi et al., 2010)
• Decreased incidence of cancer
• Improving glycemic control and cardiovascular risk factors in type 2 diabetics (Eposito et al., 2015)
• Decreased mortality (Sofi et al., 2014), at least when adherence to the diet is sufficiently high

However, a recent meta-analysis has suggested that there is “inconsistent, minimal, or no evidence” that the Mediterranean Diet holds an advantage over other diets for hypertension, cognitive function, kidney disease, rheumatoid arthritis, and quality of life (Bloomfield et al., 2016).

Weight Loss: A meta-analysis of trials looking at the diet’s impact on weight loss found that the Mediterranean diet did do better than control diets for weight loss (Eposito et al., 2011).  Unsurprisingly, weight loss was greater when the dietary approach was intentionally combined with caloric restriction, increased physical activity, and a follow-up of longer than six months.

Potential Downsides: These may not be true “downsides” to the Mediterranean Diet, but rather some reasons why it may not be a good fit for some individuals’ specific context. First, if an individual’s food preferences are completely at odds with the main groups of food that the diet is built on, then it may be too difficult to adhere to in the long-term. Second, for those with specific goals of losing body fat, there are not caloric restrictions built into the diet.

While many will naturally eat less on the diet and lose weight, for some people to make progress they may need to either combine a Mediterranean diet with quantifying their caloric intake, or use a strategy that is more readily focused on restricting total energy.

Take Home Points:
   1). Current evidence strongly supports the Mediterranean diet as a health-promoting diet.
   2). Because of the food emphasized in the diet, it will likely positively impact cardiovascular disease markers (e.g. triglycerides, cholesterol, and blood glucose).
   3). As with other diets, adherence is the key to its effectiveness, so attention should be paid to the individual’s foods preferences and likelihood of sticking to an eating strategy.
   4). Additionally, ensuring that an appropriate amount of total energy is consumed relative to the individual’s goal is crucial for body composition changes.

Is it Right For You? Should you try the Mediterranean diet? If you can see yourself sustaining an approach like this long-term, then go for it! There are many benefits and it is built on nutrient-dense foods. However, if this type of strategy sounds wholly unappealing to you, there are many other types of healthy patterns that you can adopt that might be a better fit for you.