The Mediterranean diet is more than a dietary pattern; it’s the heritage of millennia of exchanges of people, cultures, and foods of all countries around the Mediterranean basin.
The health benefits associated with it have been established by the pioneer Seven Countries Study, followed by numerous other ones. More specifically, it’s been proven to reduce the risk of developing metabolic syndrome, type 2 diabetes, cardiovascular disease, some neuro-degenerative diseases, and cancers. In 2010, the Mediterranean diet was also recognized as an Intangible Cultural Heritage of Humanity by UNESCO.
The Mediterranean Diet Pyramid
The Mediterranean diet pyramid provides both a qualitative and quantitative visual representation of the foods, their relative proportions, and the frequency of consumption.
At the base, we can find food items that should sustain the diet and provide the highest energy intake, and at the upper levels, foods to be eaten in moderate amounts or left for special occasions.
The base of the pyramid
- Cereals: 1 or 2 servings per meal in the form of bread, pasta, rice, couscous, and others. Whole grain is to be preferred, as processing normally removes fiber and valuable nutrients like vitamins, magnesium, iron, etc.
- Vegetables: 2 or more servings per meal. One of the two servings should preferably be consumed raw, to ensure vitamin and mineral daily intakes.
- Fruit: 1 or 2 servings per meal. For both vegetables and fruits, it’s important to consume a “variety of colors and textures”, to ensure a variety of antioxidants and other protective nutrients.
- Dairy products should be consumed in moderate amounts (2 servings per day) in the form of milk, kefir, yogurt, and other fermented dairy products. Although they contribute to bone health due to their richness in Ca, they can be a major source of saturated fat.
- At the center of the pyramid, we find extra virgin olive oil, which, due to its high content in monounsaturated oleic acids and its abundance of antioxidants, should be the main source of dietary lipids and is recommended for both dressing and cooking as it’s highly resistant to elevated temperatures. EVOO has been proven to positively affect blood lipids and cardiovascular health, while also being inversely associated with some cancers.
- Olives, nuts, and seeds are a healthy snack choice, being good sources of healthy lipids, proteins, vitamins, minerals, and fiber.
- Onions, garlic, herbs, and spices enhance flavor and palatability while allowing for reduced consumption of salt, known to be one of the main contributing factors to hypertension among predisposed individuals.
- A daily intake of 1.5–2 L. of water (equivalent to 6-8 glasses), although needs may vary among people due to age, gender, physical activity, weather conditions, and other personal circumstances.
- Legumes (more than 2 servings per week).
Traditionally, Mediterranean dishes do not have animal-origin protein foods as a main source of protein.
- Fish and shellfish (2 or more servings per week), as they have anti-inflammatory properties due to their content of long-chain n-3 PUFA, besides healthy protein and lipids. Their consumption has been proven to reduce the risk of coronary heart disease.
- White meat (2 servings per week) is also a good source of lean protein without the high levels of saturated fat found in some red meat cuts.
- Red meat (less than 2 servings per week, preferably lean cuts) and processed meats (less than 1 serving), as their intake has been consistently associated with some chronic diseases, including coronary heart disease and cancer.
Foods rich in sugars and unhealthy fat, such as candies, pastries, and beverages like sweetened fruit juices and soft drinks.
Cultural and lifestyle elements
There are cultural and lifestyle factors associated with this dietary pattern, such as moderation, a preference for seasonal, fresh, and minimally processed foods, the combination with physical activity (at least 30 minutes throughout the day), and socialization, since time devoted to meals, knowledge transmitted from generation to generation and conviviality are important for the social and cultural aspects of eating, positively affecting food behaviors and therefore health status.
This content is educational in purpose and not to be intended as medical advice.
About the Author
Dr. Patrizia Scali is an Italian ECFMG-certified medical doctor.
Dr. Scali graduated medical school from Università degli Studi di Milano-Bicocca in Milan, Italy and has completed all 3 USMLE Step exams. She has also completed an Accelerated Certificate Program in Business Administration at University of California, Irvine (UCI).
Dr. Scali has conducted pediatric hematology research in Italy, as well as hepatology lab research at Yale School of Medicine in the US.
She has worked as a primary care physician in Italy, her home country, where she also had extensive experience as a telemedicine doctor.