by Charles O. Frazier, MD, FAAFP
January 2026

The Mediterranean diet didn't start as a "diet plan." It was first recognized as a pattern of eating linked to better cardiovascular health. In the late 1950s, Ancel Keys, a physiologist at the University of Minnesota, organized the Seven Countries Study, comparing dietary patterns and heart attack risk among men in seven nations: the United States, Finland, the Netherlands, Italy, Yugoslavia, Greece, and Japan. When the work was published in 1970, it supported a relationship between higher blood cholesterol levels and higher risk of heart attack and stroke, and it helped popularize the idea that dietary patterns common in Mediterranean regions may contribute to lower cardiovascular event rates (Keys 1970).

It took time for the "Mediterranean diet" to become widely recognized as a formal, health-promoting approach. But over the last few decades, multiple studies have reinforced the cardiovascular benefits associated with Mediterranean-style eating patterns (Ventriglio 2020; Estruch 2018; Wade 2018; Jimenez-Torres 2021; Li 2020). Importantly, the research also suggests broader health effects beyond the heart.

What the research suggests it may help

A Mediterranean-style eating pattern has been associated with benefits across a range of outcomes, including:

• Diabetes risk and glycemic control (Koloverou 2014; Schwingshackl 2015; Martin-Pelaez 2020; Esposito 2015)
• Cancer risk (Mentella 2019; Laudisio 2021)
• Mental health (Jacka 2017; Parletta 2019)
• Memory and cognition (Martinez-Lapiscina 2013; Petersson 2016; Valls-Pedret 2015; Berti 2018)
• Neurologic health (Esposito 2021; Solch 2022)
• Weight and body mass index (BMI) compared with other dietary approaches in a recent review (Dominguez 2023)
• Longevity: In a large U.S. cohort of women followed for decades, higher Mediterranean diet adherence was linked with lower all-cause mortality (Ahmad 2024)

What "Mediterranean" eating looks like

Although details vary by region, the traditional Mediterranean pattern generally includes:

• Vegetables in abundance, especially green and leafy green varieties
• Olives and extra virgin olive oil as staple fats
• Legumes and nuts as frequent protein/fat sources
• Fruit as a regular part of the diet
• Fish and seafood more often than red meat
• Poultry occasionally
• Beef and other red meats rarely
• Dairy in smaller amounts, usually as yogurt and cheese rather than large servings of milk

What about wine?

In many traditional Mediterranean settings, wine (often red) is consumed with the main meal. If you drink alcohol, I recommend moderation: up to one glass per day for women and no more than two glasses per day for men.

For a practical visual guide to the classic pattern, many food pyramids are available online, with several modeled after the one from the Oldways Preservation Trust (Oldways 2009).

Making it "low-carb Mediterranean" (without losing the benefits)

I have another article about low-carbohydrate diets and weight loss, but if you're looking to lose weight, I would suggest you make your Mediterranean eating plan lower carb.

Here's the approach I recommend:

1. If you eat bread or pasta, make it whole grain.
2. Reduce the portion sizes significantly, particularly during the weight-loss phase.

Why reduce bread and pasta?

There are two main reasons a low-carbohydrate Mediterranean approach can be especially useful:

1) You can combine two benefits into one strategy.
By cutting back on the bread and pasta that often drive carbohydrate intake, many people can capture the appetite, energy, and weight-loss advantages that are commonly seen early in low-carbohydrate plans while still keeping the cardiovascular (and other) benefits associated with Mediterranean eating.

2) Long-term weight maintenance is the real challenge.
The long-term outcomes for low-carbohydrate diets are often underwhelming: people tend to do well initially, but over time many regain a substantial amount of weight. A low-carbohydrate Mediterranean pattern can help you get traction early, and then, after you've achieved meaningful initial weight loss, transitioning toward a more traditional Mediterranean pattern is usually easier than staying strictly low-carb indefinitely. That transition tends to support better long-term adherence and sustainability.

A simple way to start

If you want a clean starting point, focus on these "anchors":

• Build meals around vegetables first
• Use extra virgin olive oil routinely
• Choose fish and seafood often, poultry sometimes, red meat rarely
• Include nuts and legumes regularly
• Keep bread and pasta small, and prefer whole grains
• If you drink alcohol, keep it moderate

This is not about perfection. It is about repeating a pattern that is both evidence-informed and livable.

 

References
Keys A, Blackburn H, Menotti A, et al. Coronary heart disease in seven countries. Circulation. 1970; 41(Suppl. 1): 1-211.

Ventriglio A, Sancassiani F, Contu MP, Latorre M, Di Slavatore M, Fornaro M, Bhugra D. Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clin Pract Epidemiol Ment Health. 2020 Jul 30;16(Suppl-1):156-164.

Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34.

Wade AT, Davis CR, Dyer KA, Hodgson JM, Woodman RJ, Murphy KJ. A Mediterranean diet supplemented with dairy foods improves markers of cardiovascular risk: results from the MedDairy randomized controlled trial. Am J Clin Nutr. 2018 Dec 1;108(6):1166-1182.

Jimenez-Torres J, Alcalá-Diaz JF, Torres-Peña JD, Gutierrez-Mariscal FM, Leon-Acuña A, Gómez-Luna P, Fernández-Gandara C, Quintana-Navarro GM, Fernandez-Garcia JC, Perez-Martinez P, Ordovas JM, Delgado-Lista J, Yubero-Serrano EM, Lopez-Miranda J. Mediterranean Diet Reduces Atherosclerosis Progression in Coronary Heart Disease: An Analysis of the CORDIOPREV Randomized Controlled Trial. Stroke. 2021 Nov;52(11):3440-3449.

Li J, Guasch-Ferré M, Chung W, Ruiz-Canela M, Toledo E, Corella D, Bhupathiraju SN, Tobias DK, Tabung FK, Hu J, Zhao T, Turman C, Feng YA, Clish CB, Mucci L, Eliassen AH, Costenbader KH, Karlson EW, Wolpin BM, Ascherio A, Rimm EB, Manson JE, Qi L, Martínez-González Má, Salas-Salvadó J, Hu FB, Liang L. The Mediterranean diet, plasma metabolome, and cardiovascular disease risk. Eur Heart J. 2020 Jul 21;41(28):2645-2656.

Koloverou E, Esposito K, Giugliano D, Panagiotakos D. The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metabolism. 2014 Jul;63(7):903-11.

Schwingshackl L, Missbach B, König J, Hoffmann G. Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015 May;18(7):1292-9.

Martín-Peláez S, Fito M, Castaner O. Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients. 2020 Jul 27;12(8):2236.

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Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. Nutrients. 2019 Sep 2;11(9):2059.

Laudisio D, Castellucci B, Barrea L, Pugliese G, Savastano S, Colao A, Muscogiuri G. Mediterranean diet and breast cancer risk: a narrative review. Minerva Endocrinol (Torino). 2021 Dec;46(4):441-452.

Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, Castle D, Dash S, Mihalopoulos C, Chatterton ML, Brazionis L, Dean OM, Hodge AM, Berk M. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017 Jan 30;15(1):23.

Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L, Baune BT, O'Dea K. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019 Jul;22(7):474-487.

Martínez-Lapiscina EH, Clavero P, Toledo E, San Julián B, Sanchez-Tainta A, Corella D, Lamuela-Raventós RM, Martínez JA, Martínez-Gonzalez Má. Virgin olive oil supplementation and long-term cognition: the PREDIMED-NAVARRA randomized, trial. J Nutr Health Aging. 2013;17(6):544-52.

Petersson SD, Philippou E. Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence. Adv Nutr. 2016 Sep 15;7(5):889-904.

Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martínez-González Má, Martínez-Lapiscina EH, Fitó M, Pérez-Heras A, Salas-Salvadó J, Estruch R, Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med. 2015 Jul;175(7):1094-1103.

Berti V, Walters M, Sterling J, Quinn CG, Logue M, Andrews R, Matthews DC, Osorio RS, Pupi A, Vallabhajosula S, Isaacson RS, de Leon MJ, Mosconi L. Mediterranean diet and 3-year Alzheimer brain biomarker changes in middle-aged adults. Neurology. 2018 May 15;90(20):e1789-e1798.

Esposito S, Sparaco M, Maniscalco GT, Signoriello E, Lanzillo R, Russo C, Carmisciano L, Cepparulo S, Lavorgna L, Gallo A, Trojsi F, Brescia Morra V, Lus G, Tedeschi G, Saccà F, Signori A, Bonavita S. Lifestyle and Mediterranean diet adherence in a cohort of Southern Italian patients with Multiple Sclerosis. Mult Scler Relat Disord. 2021 Jan;47:102636.

Solch RJ, Aigbogun JO, Voyiadjis AG, Talkington GM, Darensbourg RM, O'Connell S, Pickett KM, Perez SR, Maraganore DM. Mediterranean diet adherence, gut microbiota, and Alzheimer's or Parkinson's disease risk: A systematic review. J Neurol Sci. 2022 Mar 15;434:120166.

Dominguez LJ, Veronese N, Di Bella G, Cusumano C, Parisi A, Tagliaferri F, Ciriminna S, Barbagallo M. Mediterranean diet in the management and prevention of obesity. Exp Gerontol. 2023 Apr;174:112121.

Ahmad S, Moorthy MV, Lee IM, Ridker PM, Manson JE, Buring JE, Demler OV, Mora S. Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women. JAMA Netw Open. 2024 May 1;7(5):e2414322.

Oldways Preservation Trust. Mediterranean Diet Pyramid. Available online. https://oldwayspt.org/oldways-resources/oldways-mediterranean-diet-pyramid/ Accessed 1/6/2026.