Diabetes Forecast

A Mediterranean Food Plan Can Protect Health

By Tracey Neithercott , ,

Claudio Ventrella/iStockphoto

If you’ve been paying attention to the news over the past couple of years, you may have noticed a common report: The Mediterranean diet is a health rock star. It seems that every week researchers release news about another of the diet’s benefits, and as a result, Americans are adopting the overseas eating plan en masse.

But unlike other diet crazes that appear as blips in America’s nutritional history, this one has staying power. That’s because the Mediterranean diet is less of a diet than a lifestyle—one that’s been shown to be beneficial time and again.

Science Approved

The link between a Mediterranean eating pattern and health went mostly unstudied before the late 1950s, when physiologist Ancel Keys, PhD, began his landmark study of nearly 12,000 middle-aged men from seven countries. The study spanned decades and, among other findings, reported that Mediterranean people, especially those living on the Greek island of Crete, had lower rates of heart disease. The scientific world took note.

Since then, researchers have endeavored to determine all the ways in which a Mediterranean-style eating pattern affects a person’s health. It’s been found to lower the risk for heart disease, high blood pressure, high LDL (“bad”) cholesterol, heart attack, stroke, and type 2 diabetes. The eating pattern protects against chronic diseases, memory problems, and certain types of cancer.

The eating pattern does more than protect; it improves health for people who already have a disease. In a 2014 Diabetes Care study of people with type 2 diabetes, researchers learned that compared with participants on a low-fat diet, those randomly assigned to follow a low-carbohydrate Mediterranean diet saw a greater drop in their A1C level and delayed their need for diabetes medication. Plus, more of the Mediterranean eaters had their diabetes go into remission.

Following a Mediterranean way of eating may be linked to a cheery outlook on life. A 2013 Journal of Psychosomatic Research study found that people who ate foods found in a traditional Mediterranean diet reported being happier than those who didn’t.

Regional Foods

Greece and Italy often come to mind when thinking about the Mediterranean diet. And it’s true that those countries boast the healthful eating patterns lauded in the research. But there are plenty of countries that ring the Mediterranean Sea, including France, Spain, Croatia, Algeria, and Turkey. The eating plan isn’t based on any one country’s cuisine, but instead promotes eating foods from the entire region.

Eating à la Mediterranean means stocking up on:

  • Vegetables
  • Fruits
  • Whole grains
  • Beans and legumes
  • Nuts and seeds
  • Herbs and spices
  • Olive oil

Those staples are the basis of most Mediterranean meals and allow for plenty of variety. Seafood is an important part of the diet but isn’t a necessary part of each meal; a twice-a-week fish dinner is plenty. Eggs and lower-fat cheese and yogurt are eaten moderately. And meats and sweets are eaten only in small amounts and not every day.

Part of the reason the Mediterranean diet is so effective is its substitution of heart-healthy fats for the saturated fat many Americans get from red meat, butter, and fried foods. People in Mediterranean countries rely on monounsaturated fats (mostly from olive oil) and polyunsaturated fats (from nuts and fish), both of which can reduce the risk of heart disease. Red wine, common at many a Mediterranean meal though not mandatory for the diet, may also play a role. It’s been linked to better heart health when enjoyed in moderation—a healthy guideline is no more than two drinks per day for men and one drink daily for women.

What’s more, a traditional Mediterranean diet avoids processed foods and packaged goods, with their added unhealthy fats, salt, and sugar. But there’s plenty of variety in the eating plan. Whole grains, for instance, don’t necessarily have to be whole wheat products and oats. Bulgur, farro, polenta, and quinoa (actually a seed) are nutritious and can add excitement to meals.

The Mediterranean diet may challenge your view on traditional meals. For example, while pasta belongs in the eating plan, it shouldn’t be the focal point of a meal. Aside from being high in carbohydrate, it’s less nutritious than other foods, such as vegetables. So go ahead and have pasta, but halve the amount you’d normally make, then load it with veggies and beans.

The same goes for red meat. “Instead of meat being the whole of the plate, it’s integrated in with the vegetables and whole grains,” says Connie Diekman, MEd, RD, LD, CSSD, director of university nutrition at Washington University in St. Louis and author of The Everything Mediterranean Diet Book: All You Need to Lose Weight and Stay Healthy. Instead of a steak dinner with a side salad, create a big salad topped with a few slices of steak.

Not sure what to make? Seek out health-focused cookbooks featuring recipes from a given Mediterranean country. “You may find one [country’s cuisine] that appeals to you much more,” Diekman says.

Mediterranean Living

The typical adult eating pattern—and typical Greek or Italian restaurant menu—in the U.S. falls short of the healthier Mediterranean style of eating, and researchers suspect there may be more behind Mediterranean people’s health than better nutrition. People living in many countries on the Mediterranean Sea exercise more and generally eat smaller portions than Americans.

And portion control is paramount when following an eating plan rich in fat because even good fats are high in calories. While olive oil is a mainstay of the Mediterranean diet, a serving is only a teaspoon. “You don’t want more than 6 or 7 teaspoons of oil a day,” says Ximena Jimenez, MS, RDN, LD, a dietitian with the Academy of Nutrition and Dietetics. “That’s not including nuts. If you have nuts, you need to lower the amount of oil.” Go overboard on the healthy fats and you may gain weight.

Another possible health factor: In many Mediterranean countries, meals are events. Food is consumed in the company of others, with a focus on conversation and camaraderie. Dishes are savored, and meals last much longer than in the United States. “A lot of times when we eat with others, we eat less,” says Jackie Boucher, MS, RD, LD, CDE, senior vice president and chief operating officer of the Minneapolis Heart Institute Foundation. “You just eat slower, which I think helps.”

Whether Americans following a Mediterranean diet reap the same rewards as Mediterranean people remains to be seen. Research has shown that the diet alone promotes health, but in U.S. studies, participants may not exercise enough or savor meals the way those in Mediterranean countries do. “Still, eating the diet is healthy even if you don’t have the lifestyle,” Diekman says.

Made to Stick

One advantage of the Mediterranean diet is that it’s relatively easy to follow—and stick with. Instead of a list of off-limits foods, the eating pattern focuses on foods you can enjoy. “It’s promoting variety,” Jimenez says. “It’s saying these are all foods you can have.”

People following a Mediterranean style of eating generally feel satisfied. Jimenez says the water in fruits and vegetables is filling. She also praises whole grains and beans for keeping people sated. “Most of them have a lot of fiber, and fiber has been shown to give a lot of satisfaction,” says Jimenez.

The ease with which people can transition from a typical American diet to a Mediterranean-based one depends in part on the state of a person’s diet at the outset. But there’s no need to make over your diet all at once. “Sometimes making small changes helps in terms of sticking with a program,” Boucher says. She suggests talking to a registered dietitian or certified diabetes educator about how to integrate a Mediterranean style of eating into your diabetes management plan.

Keep in mind: It takes about 90 days for behavior changes to turn into habit, Diekman says. So stick with it, and soon Mediterranean eating will feel like second nature.

Mediterranean for a Day

This sample menu from Recipes for Healthy Living (find the recipes at diabetes.org/med) features some Mediterranean-style foods and about 1,600 calories.

Cereal With Fruit and Soy Nuts

Salmon Stuffed With Spinach and Feta

Afternoon Snack
Hummus and Fresh Vegetables

Mozzarella, Tomato, and Chickpea Salad

Evening Snack
Greek Yogurt

Shopping List

Include these items on your grocery list so you have the makings of a Mediterranean eating plan

  • Fruits
  • Vegetables
  • Beans and legumes
  • Nuts and seeds
  • Olive oil
  • Herbs and spices
  • Fish
  • Lower-fat milk, cheese, yogurt


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