Mediterranean Diet 101: A Meal Plan and Beginner’s Guide
The Mediterranean diet is based on the traditional foods that people used to eat in countries like Italy and Greece back in 1960.
Researchers noted that these people were exceptionally healthy compared to Americans and had a low risk of many lifestyle diseases.
Numerous studies have now shown that the Mediterranean diet can cause weight loss and help prevent heart attacks, strokes, type 2 diabetes and premature death.
There is no one right way to follow the Mediterranean diet, as there are many countries around the Mediterranean sea and people in different areas may have eaten different foods.
This article describes the dietary pattern typically prescribed in studies that suggest it’s a healthy way of eating.
Consider all of this as a general guideline, not something written in stone. The plan can be adjusted to your individual needs and preferences.
- Eat: Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood and extra virgin olive oil.
- Eat in moderation: Poultry, eggs, cheese and yogurt.
- Eat only rarely: Red meat.
- Don’t eat: Sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils and other highly processed foods.
You should avoid these unhealthy foods and ingredients:
- Added sugar: Soda, candies, ice cream, table sugar and many others.
- Refined grains: White bread, pasta made with refined wheat, etc.
- Trans fats: Found in margarine and various processed foods.
- Refined oils: Soybean oil, canola oil, cottonseed oil and others.
- Processed meat: Processed sausages, hot dogs, etc.
- Highly processed foods: Anything labeled “low-fat” or “diet” or which looks like it was made in a factory.
You must read food labels carefully if you want to avoid these unhealthy ingredients.
Exactly which foods belong to the Mediterranean diet is controversial, partly because there is such variation between different countries.
The diet examined by most studies is high in healthy plant foods and relatively low in animal foods.
However, eating fish and seafood is recommended at least twice a week.
The Mediterranean lifestyle also involves regular physical activity, sharing meals with other people and enjoying life.
You should base your diet on these healthy, unprocessed Mediterranean foods:
- Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc.
- Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.
- Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, etc.
- Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.
- Tubers: Potatoes, sweet potatoes, turnips, yams, etc.
- Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread and pasta.
- Fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.
- Poultry: Chicken, duck, turkey, etc.
- Eggs: Chicken, quail and duck eggs.
- Dairy: Cheese, yogurt, Greek yogurt, etc.
- Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.
- Healthy Fats: Extra virgin olive oil, olives, avocados and avocado oil.
Whole, single-ingredient foods are the key to good health.
What to Drink
Water should be your go-to beverage on a Mediterranean diet.
This diet also includes moderate amounts of red wine — around 1 glass per day.
However, this is completely optional, and wine should be avoided by anyone with alcoholism or problems controlling their consumption.
Coffee and tea are also completely acceptable, but you should avoid sugar-sweetened beverages and fruit juices, which are very high in sugar.
Below is a sample menu for one week on the Mediterranean diet.
Feel free to adjust the portions and food choices based on your own needs and preferences.
Monday
- Breakfast: Greek yogurt with strawberries and oats.
- Lunch: Whole-grain sandwich with vegetables.
- Dinner: A tuna salad, dressed in olive oil. A piece of fruit for dessert.
Tuesday
- Breakfast: Oatmeal with raisins.
- Lunch: Leftover tuna salad from the night before.
- Dinner: Salad with tomatoes, olives and feta cheese.
Wednesday
- Breakfast: Omelet with veggies, tomatoes and onions. A piece of fruit.
- Lunch: Whole-grain sandwich, with cheese and fresh vegetables.
- Dinner: Mediterranean lasagne.
Thursday
- Breakfast: Yogurt with sliced fruits and nuts.
- Lunch: Leftover lasagne from the night before.
- Dinner: Broiled salmon, served with brown rice and vegetables.
Friday
- Breakfast: Eggs and vegetables, fried in olive oil.
- Lunch: Greek yogurt with strawberries, oats and nuts.
- Dinner: Grilled lamb, with salad and baked potato.
Saturday
- Breakfast: Oatmeal with raisins, nuts and an apple.
- Lunch: Whole-grain sandwich with vegetables.
- Dinner: Mediterranean pizza made with whole wheat, topped with cheese, vegetables and olives.
Sunday
- Breakfast: Omelet with veggies and olives.
- Lunch: Leftover pizza from the night before.
- Dinner: Grilled chicken, with vegetables and a potato. Fruit for dessert.
There is usually no need to count calories or track macronutrients (protein, fat and carbs) on the Mediterranean diet.
You don’t need to eat more than 3 meals per day.
But if you become hungry between meals, there are plenty of healthy snack options:
- A handful of nuts.
- A piece of fruit.
- Carrots or baby carrots.
- Some berries or grapes.
- Leftovers from the night before.
- Greek yogurt.
- Apple slices with almond butter.
It’s very simple to make most restaurant meals suitable for the Mediterranean diet.
- Choose fish or seafood as your main dish.
- Ask them to fry your food in extra virgin olive oil.
- Only eat whole-grain bread, with olive oil instead of butter.
It is always a good idea to shop at the perimeter of the store. That’s usually where the whole foods are.
Always try to choose the least-processed option. Organic is best, but only if you can easily afford it.
- Vegetables: Carrots, onions, broccoli, spinach, kale, garlic, etc.
- Fruits: Apples, bananas, oranges, grapes, etc.
- Berries: Strawberries, blueberries, etc.
- Frozen veggies: Choose mixes with healthy vegetables.
- Grains: Whole-grain bread, whole-grain pasta, etc.
- Legumes: Lentils, pulses, beans, etc.
- Nuts: Almonds, walnuts, cashews, etc.
- Seeds: Sunflower seeds, pumpkin seeds, etc.
- Condiments: Sea salt, pepper, turmeric, cinnamon, etc.
- Fish: Salmon, sardines, mackerel, trout.
- Shrimp and shellfish.
- Potatoes and sweet potatoes.
- Cheese.
- Greek yogurt.
- Chicken.
- Pastured or omega-3 enriched eggs.
- Olives.
- Extra virgin olive oil.
It’s best to clear all unhealthy temptations from your home, including sodas, ice cream, candy, pastries, white bread, crackers and processed foods.
If you only have healthy food in your home, you will eat healthy food.
Though there is not one defined Mediterranean diet, this way of eating is generally rich in healthy plant foods and relatively lower in animal foods, with a focus on fish and seafood.
You can find a whole world of information about the Mediterranean diet on the internet, and many great books have been written about it.
Try googling “Mediterranean recipes” and you will find a ton of great tips for delicious meals.
At the end of the day, the Mediterranean diet is incredibly healthy and satisfying. You won’t be disappointed.
5 Studies on the Mediterranean Diet — Does it Work?
Heart disease is a major problem around the world.
However, research shows that the incidence of heart disease seems to be lower among people living in Italy, Greece, and other countries around the Mediterranean, compared with those living in the United States. Studies suggest that diet may play a role.
People around the Mediterranean have traditionally followed a diet that’s rich in plant-based foods, including fruits, vegetables, whole grains, breads, legumes, potatoes, nuts, and seeds.
The main dietary fat is extra virgin olive oil, and people also consume moderate amounts of red wine, fish, poultry, dairy, and eggs. Meanwhile, red meat plays only a small part.
This eating pattern has started to become popular around the world as a means to improve health and prevent disease.
Several randomized controlled trials, which are reliable and effective methods of research, have looked at the possible benefits of this diet.
This article looks at 5 long-term controlled trials on the Mediterranean diet. All of them appear in respected, peer-reviewed journals.
Most people who joined these studies had health problems, including diabetes, metabolic syndrome, or a high risk of heart disease.
Most of the studies looked at common health markers, such as weight, heart disease risk factors, and markers of diabetes. Some larger studies also looked at rates of heart attacks and death.
1. The PREDIMED Study
This large study involved 7,447 individuals with a high risk of heart disease.
For almost 5 years, the participants followed one of three different diets:
- a Mediterranean diet with added extra virgin olive oil
(Med + Olive Oil) - a Mediterranean diet with added nuts (Med + Nuts)
- a low fat diet control group
None of the diets involved reducing calories or increasing physical activity.
Many researchers have used data collected during PREDIMED to investigate its effect. The studies looked at the diet’s effect on different risk factors and end points.
Here are 6 papers (1.1 to 1.6) from the PREDIMED study.
1.1 Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra Virgin Olive Oil or Nuts. The New England Journal of Medicine, 2018.
Details. In this study, 7,447 individuals with a high risk of heart disease followed either a Mediterranean diet with added olive oil, a Mediterranean diet with added nuts, or a low fat control group. The study lasted for 4.8 years.
The main focus was the diet’s potential effect on heart attack, stroke, and death from cardiovascular causes.
Results. The risk of combined heart attack, stroke, and death from heart disease was lower by 31% in the Med + Olive Oil group and 28% in the Med + Nuts group.
Additional details:
- There were no statistically significant differences in
heart attacks or stroke between the diets. - Dropout rates were twice as high in the control group
(11.3%), compared with the Mediterranean diet groups (4.9%). - People with high blood pressure, lipid problems, or
obesity responded better to the Mediterranean diet than the control diet. - There was no statistically significant difference in
total mortality, which is the overall risk of death from all causes.
Conclusion. A Mediterranean diet with either olive oil or nuts may reduce the combined risk of stroke, heart attack, and death from heart disease.
1.2 Salas-Salvado J, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status. JAMA Internal Medicine, 2008.
Details. Researchers analyzed data from 1,224 individuals in the PREDIMED study after following the diet for 1 year. They looked at whether the diet helped reverse metabolic syndrome.
Results. The prevalence of metabolic syndrome decreased by 6.7% in the Med + Olive Oil group and 13.7% in the Med + Nuts group. The results were statistically significant only for the Med + Nuts group.
Conclusion. A Mediterranean diet supplemented with nuts may help reverse metabolic syndrome.
1.3 Montserrat F, et al.
Details. Scientists assessed 372 individuals with a high risk of heart disease after following a diet in the PREDIMED study for 3 months. They looked at changes in oxidative stress markers, such as oxidized LDL (bad) cholesterol.
Results. Levels of oxidized LDL (bad) cholesterol decreased in both Mediterranean diet groups but did not reach statistical significance in the low fat control group.
Conclusion. People who followed the Mediterranean diet experienced reductions in oxidized LDL (bad) cholesterol, along with improvements in several other heart disease risk factors.
1.4 Salas-Salvado J, et al.
Details. Researchers assessed 418 people without diabetes who participated in the PREDIMED study for 4 years. They looked at their risk of developing type 2 diabetes.
Results. In the two Mediterranean diet groups, 10% and 11% of people developed diabetes, compared with 17.9% in the low fat control group. The Mediterranean diet appeared to reduce the risk of developing type 2 diabetes by 52%.
Conclusion. A Mediterranean diet without calorie restriction appears to prevent the development of type 2 diabetes.
1.5 Estruch R, et al.
Details. Scientists analyzed data for 772 participants in the PREDIMED study with regards to cardiovascular risk factors. They had been following the diet for 3 months.
Results. Those on a Mediterranean diet saw improvements in various cardiovascular risk factors. These included blood sugar levels, blood pressure, the ratio of total to HDL (good) cholesterol, and levels of C-reactive protein (CRP), a marker of inflammation and various diseases.
Some more details:
- Blood sugar: fell by 0.30–0.39
mmol/L in the Mediterranean diet groups - Systolic blood pressure: fell by 5.9 mmHG and
7.1 mmHG in the two Mediterranean diet groups - Total to HDL (good)
cholesterol ratio: fell by 0.38 and 0.26 in the two Mediterranean diet
groups, compared with the low fat group - C-reactive protein: fell by 0.54 mg/L in
the Med + Olive Oil group, but did not change in the other groups
Conclusion. Compared with a low fat diet, a Mediterranean diet appears to improve various risk factors for heart disease.
1.6 Ferre GM, et al.
Details. Scientists evaluated 7,216 participants in the PREDIMED study after 5 years.
Results. After 5 years, a total of 323 people had died, with 81 deaths from heart disease and 130 deaths from cancer. Those who consumed nuts appeared to have a 16–63% lower risk of death during the study period.
Conclusion. Consuming nuts as part of a Mediterranean diet may significantly reduce the risk of death.
2. De Lorgeril M, et al.
Details. This study enrolled 605 middle-aged males and females who had had a heart attack.
For 4 years, they consumed either a Mediterranean-type diet (supplemented with an omega-3-rich margarine) or Western-type diet.
Results. After 4 years, those who followed the Mediterranean diet were 72% less likely to have experienced a heart attack or died from heart disease.
Conclusion. A Mediterranean diet with omega-3 supplements may help prevent a repeat heart attack in people who have had a heart attack.
3. Esposito K, et al. Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome. The Journal of the American Medical Association, 2004.
Details. In this study, 180 people with metabolic syndrome followed either a Mediterranean diet or low fat diet for 2.5 years.
Results. At the end of the study, 44% of patients in the Mediterranean diet group still had metabolic syndrome, compared with 86% in the control group. The Mediterranean diet group also showed improvements in other risk factors.
Some more details:
- Weight loss. Body weight decreased
by 8.8 pounds (4 kg) in the Mediterranean diet group, compared with 2.6
pounds (1.2 kg) in the low fat control group. - Endothelial function
score.
This improved in the Mediterranean diet group but remained stable in the
low fat control group. - Other markers. Inflammatory markers
(hs-CRP, IL-6, IL-7, and IL-18) and insulin resistance decreased significantly
in the Mediterranean diet group.
Conclusion. A Mediterranean diet appears to help reduce metabolic syndrome and other cardiovascular risk factors.
4. Shai I, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. The New England Journal of Medicine, 2008.
Details. In this study, 322 people with obesity followed either a calorie-restricted low fat diet, calorie-restricted Mediterranean diet, or an unrestricted low carb diet.
Results. The low fat group lost 6.4 pounds (2.9 kg), the low carb group lost 10.3 pounds (4.7 kg), and the Mediterranean diet group lost 9.7 pounds (4.4 kg).
In those with diabetes, blood glucose and insulin levels improved on the Mediterranean diet, compared with the low fat diet.
Conclusion. A Mediterranean diet may be more effective than a low fat diet for weight loss and managing diabetes.
5. Esposito K, et al.
Details. In this study, 215 people with overweight who had recently received a diagnosis of type 2 diabetes followed either a low carb Mediterranean diet or a low fat diet for 4 years.
Results. After 4 years, 44% of the Mediterranean diet group and 70% of the low fat diet group needed treatment with medication.
The Mediterranean diet group had more favorable changes in glycemic control and heart disease risk factors.
Conclusion. A low carb Mediterranean diet may delay or prevent the need for drug therapy in people who are newly diagnosed with type 2 diabetes.
Two of the studies — the PREDIMED study and the Lyon Diet Heart study — involved enough people and lasted long enough to obtain results about mortality, or the risk of death during the study period (1.1,
To compare them more easily, this article combines the two types of Mediterranean diets in the PREDIMED study into one.
In the Lyon Diet Heart Study, the Mediterranean diet group was 45% less likely to die over the 4-year period than those in the low fat group. Some experts have called this study the most successful diet intervention study in history.
The Mediterranean diet group in the PREDIMED study was 9.4% less likely to die, compared with the control group, but the difference was not statistically significant.
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