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Mediterranean Diet Pocket Guide

Fast Facts

  • Studies of the Mediterranean diet as it is understood today started with the Seven Countries Study conducted in the 1960s.
  • Following the Mediterranean diet has been shown to improve heart health, lower the risk of diabetes and reduce the risk of early death from any cause, as well as helping to prevent age-related changes in memory and thinking. 1

What is the Mediterranean Diet?

The Mediterranean diet is a set of guidelines shaped and inspired by the traditional eating patterns of the regions around the Mediterranean Sea, including southern Italy and Crete. There isn’t an official “Mediterranean diet plan,” like there is for programs like the Atkins or South Beach diet. Instead, you are encouraged to eat:

  • Modest servings of lean protein, including fish
  • Plenty of fruits and vegetables
  • Beans and whole grains
  • Healthy fats, such as olive oil

The most commonly used visual guide is the Oldways Mediterranean Diet Pyramid. 2

How do you follow a Mediterranean eating plan?

Here are some tips for eating the Mediterranean way.

Instead of making meat the centerpiece of each meal, build more menus around grains, beans, fruits and veggies.

  • Eat fish or seafood twice a week. If you’re wondering about the best options, check www.SeafoodWatch.org.
  • Limit red meat (the traditional Mediterranean diet recommends eating it just a couple of times a month).
  • Eat three servings a day of dairy products such as yogurt, cheese, milk or cottage cheese.
  • Use spices and herbs to flavor your meals instead of a lot of salt.
  • Drink a limited amount of wine (see precautions below).
  • Embrace physical activities, such as walking instead of driving when possible, and social activities such as enjoying meals with others.

What foods should I avoid on the Mediterranean diet?

Foods to avoid or eat less of that are common in the traditional US diet include:

  • Highly processed meats, such as hot dogs, salami, bacon or “deli” meats.
  • Packaged foods, such as ready-to-eat or frozen meals and prepackaged and seasoned rice, potatoes and soups.
  • High-sugar, high-salt treats such as chips, packaged cookies and candies.
  • Foods that seem healthy but are highly processed, like many yogurts, granola or energy bars, and fruit-flavored snacks and drinks.

You don’t have to give up all these foods forever – just eat less of them and focus more on eating the Mediterranean way. Small changes are the key to success over time!

What conditions does the Mediterranean diet treat?

The Mediterranean diet lowers your risk of several physical and mental health conditions and can improve symptoms of some long-term (chronic) conditions. These include: 3-8

  • Type 2 diabetes
  • Heart disease
  • Metabolic syndrome
  • Excess weight and slow metabolism
  • Digestive disease/distress
  • Hormonal disorders
  • Obesity and cancers related to obesity
  • Rheumatoid arthritis
  • Depression
  • Nonalcoholic fatty liver disease
  • Heart disease
  • Stroke

Is there evidence that the Mediterranean diet works?

Yes! Research on the Mediterranean diet has grown. Consistently eating a Mediterranean-type diet can also help protect against cancer 9 and even help you sleep better. 10

Management of Type 2 Diabetes

  • A systematic review and meta-analysis comparing the Mediterranean diet to other diets in its ability to manage type 2 diabetes found that the Mediterranean diet was associated with better glycemic (blood sugar) control and a decrease in cardiovascular (heart disease) risk factors. 4
  • A study of people with type 2 diabetes who ate a low carbohydrate Mediterranean-style diet and those who ate a low-fat diet showed better results (less need for medication to control blood sugar and lower risk for heart disease) in the Mediterranean diet group. 5

Weight Loss, Fewer Obesity-Related Cancers

  • A meta-analysis of randomized controlled trials found that adults engaged in the Mediterranean diet who restricted their calorie intake, increased their physical activity and utilized the diet more than 6 months experienced a significant reduction in weight and body mass index. Appropriately engaging in the diet did not result in any weight gain. 6
  • A study of 450,000 people across 10 European countries found that those following a Mediterranean diet had a lower risk of obesity-related cancers than those who did not eat this way. The risk was lower for smokers and lower whether people lost weight (measured by body mass index and waist-to-hip ratio) or not, suggesting that the anti-inflammatory effects of this way of eating play a role. 7

What foods should I avoid on the Mediterranean diet?

The Oldways Preservation Trust is a nonprofit that has developed eating plans based on the traditional diets of several global regions. Called “heritage diets,” these ways of eating share a common emphasis on fruits, vegetables, whole grains, herbs and spices. Emphasis is on shopping for fresh foods, preparing meals at home and eating with others to enjoy the social and relationship aspects of food.

Learn more at www.oldwayspt.org under “Explore Heritage Diets.” Besides Mediterranean, the diets include African, Asian, Latin American, vegetarian and vegan. 11

If your heritage is Northern European, you may also want to explore the Nordic diet. This way of eating has quite a bit in common with the Mediterranean diet, with an emphasis on fish, plant-based foods and whole grains. 12 Although canola oil is recommended instead of olive oil, you can use olive, avocado or coconut oil if you are avoiding seed oils.

Cognitive Function and Dementia

  • A systematic review of 12 studies found that participants who strictly followed the Mediterranean diet had better cognitive function, lower rates of declining cognitive functioning, and a reduced rate of Alzheimer’s disease. There was a relationship between the level that the participants followed the diet and the impacts it had on cognitive function.8 Other reviews have concluded that there may be some association and the Mediterranean diet does not make cognitive function worse, but more studies are needed. 13/sup>

Depression and Type 2 Diabetes

  • Patients with diabetes and depression who participated in a Mediterranean diet with an increased intake of nuts experienced a significant decrease in depressive symptoms in comparison to those who were assigned to participate in a low-fat diet. 14 Other studies suggest a Mediterranean diet may help relieve depression, but large studies with control groups (people who do not eat the Mediterranean diet) are needed. 15

Osteoarthritis and Quality of Life

  • A study looking at the diets of 4,470 adults found that higher adherence to a Mediterranean diet was associated with increased quality of life and decreased pain levels, disability, and depressive symptoms 16

If you or your health care provider are seeking more in-depth research on the effectiveness or impact of the Mediterranean diet for particular health concern, visit www.ncbi.nlm.nih.gov/pubmed/?term=Mediterranean+diet.

Interested in exploring the origins of the Mediterranean eating plan? It was first widely publicized in the 1975 book How to Eat Well and Stay Well the Mediterranean Way by Ancel and Margaret Keys.

Are there precautions, side effects or safety concerns I should be aware of before I begin the Mediterranean diet?

The Mediterranean diet provides significantly more fiber and probiotics than a standard Western diet high in processed food. This is because you will be eating more fruits and vegetables as well as more whole grains and beans.

You may experience some discomfort – stomach upset, gas, bloating and light-headedness – when you start to eat this way. Your body needs time to process the changes. If the Mediterranean diet is a big change from your usual way of eating, you may want to start slowly. (See the information below on working with a nutrition expert, who can help you adapt your regular diet to eat the Mediterranean way.) Any discomfort should pass in a few days or weeks and of course, you should feel free to talk with your health care provider about any concerns.

Additionally, the Mediterranean diet does allow for the consumption of a moderate amount of wine. That amount is one drink for women and two for men per day. However, you should not drink if you have a condition where alcohol would cause harm, including liver disease, a history of alcohol misuse or pregnancy. If you don’t drink, there is no need to start drinking to follow the Mediterranean diet.

Who can help me start the Mediterranean diet?

If you’re healthy, you can start a Mediterranean diet on your own. Several good guides are available for doing this. Websites with menu and food plan options can be found at:

You can also work with a registered dietitian or a certified nutritionist or talk with your doctor or other primary health care provider about starting this eating plan.

How do I find a nutrition expert?

Ask your doctor or other health care provider to recommend a nutrition expert. Check to see if the nutritionist is licensed or certified to practice. The primary organization of qualified nutrition professionals is the Academy of Nutrition and Dietetics.

Their website can help you find an expert with a search by ZIP code.

Look for a registered dietitian or registered dietitian nutritionist (RDN). People in these occupations must usually have a four-year college degree plus 900 to 1,200 hours in a dietetic internship through an accredited program. They must also pass a dietetics registration exam and meet continuing professional education requirements. Some RDNs are certified in a specialized area, including pediatric nutrition, sports dietetics, nutrition support or diabetes education.

Will my insurance company cover the cost of seeing a nutrition expert?

Most commercial and government insurances, including Medicare and Medicaid, cover medical nutrition therapy (MNT) for certain conditions, including diabetes and obesity. Obesity screening and counseling is covered if it is received in a primary care setting. Medicare recipients in rural areas may receive MNT through telehealth.

Should I tell my primary care physician that I am starting the Mediterranean diet?

Yes, always inform your primary care provider of any major dietary changes or weight loss or gain. They may need to adjust your medications or other treatments, and it’s important for them to know you are making lifestyle changes. This helps them work with you to develop whole person health.

References

  1. Guasch-Ferré M, Willett WC. The Mediterranean diet and health: a comprehensive overview. J Intern Med. 2021 Sep;290(3):549-566. doi:10.1111/joim.13333. Epub 2021 Aug 23.
  2. Oldways Preservation Trust. Happy 25 years to the Mediterranean diet pyramid. Available at oldwayspt.org/blog/happy-25-years-mediterranean-dietpyramid. Accessed February 20, 2025.
  3. Kiani AK, Medori MC, Bonetti G, et al. Modern vision of the Mediterranean diet. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl3):E36-E43.
  4. Esposito, K., Maiorino, M.I., Bellastella, G., Chiodini, P., Panagiotakos, D., & Giugliano, D. (2012). A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open, 5(8).
  5. Wilson, C. A Mediterranean diet is best for type 2 diabetes mellitus. Nat Rev Endocrinol 6, 2 (2010).
  6. Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. (2011). Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metabolic Syndrome and Related Disorders, 9(1): pp. 1-12.
  7. Aguilera-Buenosvinos I, Morales Berstein F, González-Gil EM, et al. Adherence to the Mediterranean diet and obesity-linked cancer risk in EPIC. JAMA Netw Open. 2025;8(2):e2461031.
  8. Lourida, I., Soni, M., Thompson-Coon, J., Purandare, N., Lang, I.A., Ukoumunne, O.C., & Llewellyn, D.J. (2013). Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology, 24(4): pp.479-89.
  9. Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean diet: A review. Nutrients. 2019 Sep 2;11(9):2059. doi: 10.3390/nu11092059. PMID: 31480794; PMCID: PMC6770822.
  10. Scoditti E, Tumolo MR, Garbarino S. Mediterranean diet on sleep: A Health Alliance. Nutrients. 2022 Jul 21;14(14):2998. doi: 10.3390/nu14142998. PMID: 35889954; PMCID: PMC9318336.
  11. Oldways Preservation Trust. Explore heritage diets. Available at oldwayspt.org/explore-heritage-diets. Accessed February 26, 2025.
  12. Cleveland Clinic Health Essentials. Nordic diet: What is it and what can you eat? November 19, 2021. Available at health.clevelandclinic.org/nordic-diet. Accessed February 26, 2025.
  13. Samieri C, Grodstein F, Rosner BA, et al. Mediterranean diet and cognitive function in older age. Epidemiology. 2013 Jul;24(4):490-9.
  14. Sánchez-Villegas, A., Martínez-González, M.A., Estruch, R., Salas-Salvadó, J., Corella, D, Covas, M.I., Arós, F., Romaguera, D., Gómez-Gracia, E., Lapetra, J., Pintó, X., Martínez, J.A., Lamuela-Raventós, R.M., Ros, E., Gea, A., Wärnberg, J., & Serra-Majem, L. (2013). Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Medicine, 11(208).
  15. Bizzozero-Peroni B, Martínez-Vizcaíno V, Fernández-Rodríguez R, et al. The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2025 Jan 1;83(1):29-39. doi: 10.1093/nutrit/nuad176. PMID: 38219230.
  16. Veronese, N., Stubbs, B., Noale, M., Solmi, M., Luchini, C., & Maggi, S. (2016). Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative. American Journal of Clinical Nutrition, 104(5): pp. 1403-1409.

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Topics: Behavior & Lifestyle | Blood Pressure | Chronic Disease | Cognitive Function | Dementia | Depression Osteoarthritis | Diet | Inflammation | Integrative Health | Mediterranean Diet | Nutrition | Self-Care | Type 2 Diabetes | Weight Loss

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