Mediterranean Diet

Health Care Professional Information

Brand Name

Omega diet

Clinical Summary

Mediterranean diet represents the diet consumed in regions that border the Mediterranean Sea. Epidemiological studies show that it contributes to better health and overall quality of life. The Mediterranean diet is also an established model of eating for primary and secondary prevention of various chronic diseases. It consists of a variety of fruits, vegetables, cereals, legumes, poultry, fish, nuts, seeds, olive oil, and moderate intake of red wine with meals (1). Olive oil, a monounsaturated fatty acid (MUFA), is the major source of dietary fat and MUFAs comprise 15% to 20% (2). A hallmark of the Mediterranean diet is the low consumption of meat and dairy products (3).

Recent epidemiological analyses suggest that over 90% of type 2 diabetes, 80% of coronary heart disease, and 70% of stroke can be avoided by adopting healthful food choices that model the traditional Mediterranean diet (4). Large prospective studies found that adherence to Mediterranean diet resulted in significant reduction in the incidence of gastric adenocarcinoma (6) and overall reduction in cancer risk (7). A randomized-controlled trial demonstrated a Mediterranean diet can reduce risk of cardiovascular events (10). Conclusions of meta analyses also indicate an association between greater adherence to the Mediterranean diet and a significant reduction in risk of metabolic syndrome (8), cardiovascular factors (9), overall mortality, cancer incidence and mortality, and incidence of Alzheimer's and Parkinson's disease (1).

Food Sources

A variety of fruits, vegetables, cereals, legumes, combined with poultry, fish, nuts, seeds, olive oil and moderate red wine intake with meals (1).

Purported Uses
  • Heart disease
  • Cancer prevention
  • Weight management
  • Diabetes management
  • Cholesterol management
Mechanism of Action

The health benefits of the diet are attributed to the synergistic interactions between the nutrients, and not to a single nutrient (1).

Contraindications
  • The Mediterranean diet may not be appropriate for those with multiple food allergies/intolerances or those with gastrointestinal difficulties which prevent them from consuming a normal diet.
  • Alcohol consumption can increase the risk of certain cancers (5).
Herb Lab Interactions

Several studies have demonstrated that adherence to a Mediterranean diet positively affects blood lipid levels (4).

Literature Summary and Critique

Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013. Feb 25.
In a multicenter trial in Spain, 7447 participants at high cardiovascular risk were randomly assigned to Mediterranean diet (fruits, vegetables, legume, white meat, and wine) with extra-virgin olive oil, Mediterranean diet with nuts, or a control group with reduced fat diet. The trial was stopped after a median follow-up of less than 5 years as interim analysis showed nearly 30% reduction in cardiovascular risk in the treatment groups. The primary end point was the rate of major cardiovascular events such as myocardial infarction, stroke or death which occurred in only 288 participants: Those assigned to Mediterranean diet with extra-virgin olive oil (96 events), those on Mediterranean diet with nuts (83 events) versus the control group (109 events) with no reported adverse events. This trial demonstrated the benefits of Mediterranean diet in preventing cardiovascular diseases.

Sofi F, Cesari F, Abbate R, et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344.
In this meta-analysis, 12 cohort studies were examined that comprised more than 1.5 million healthy individuals and 40,000 non-fatal and fatal events. Greater adherence to the Mediterranean diet was associated with a significant reduction in risk of overall mortality, cancer incidence and mortality, cardiovascular mortality and incidence of Alzheimer's and Parkinson's disease. The cumulative analysis of the 12 studies demonstrated that a two-point score increase in adherence to the diet yielded a 9% reduction of overall mortality, a 6% reduction of incidence or mortality from cancer, a 9% reduction in cardiovascular mortality, and a 13% reduction in incidence of Alzheimer's or Parkinson's disease.

References
  1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.
  2. Zazpe I, Sanchez-Tainta A, Estruch R, et al. A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study. J Am Diet Assoc. Jul 2008;108(7):1134-1144; discussion 1145.
  3. Benetou V, Trichopoulou A, Orfanos P, et al. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer. Jul 8 2008;99(1):191-195.
  4. Willett WC. The Mediterranean diet: science and practice. Public Health Nutr. Feb 2006;9(1A):105-110.
  5. Allen NE, Beral V, Casabonne D, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009 Mar 4;101(5):296-305.
  6. Buckland G, Agudo A, Lujan L, et al. Adhrerence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr. 2009 [Epub ahead of print].
  7. Couto E, Boffetta P, Lagiou P, et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer. 2011 Apr 26;104(9):1493-9.
  8. Kastorini CM, Milionis HJ, Esposito K, et al. The effect of mediterranean diet on metabolic syndrome and its components a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011 Mar 15;57(11):1299-313.
  9. Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011 Sep;124(9):841-851.e2.
  10. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013. Feb 25. [Epub ahead of print]

Consumer Information

How It Works

Bottom Line: Mediterranean diet is associated with a reduction in the incidence of many diseases, but may not be suitable for everyone.

The Mediterranean diet represents the diet commonly consumed in regions that border the Mediterranean Sea. It consists of a variety of fruits, vegetables, cereals, legumes, poultry, fish, nuts, seeds, olive oil, and moderate intake of red wine with meals. Epidemiological studies have shown it to be a model of healthy eating that contributes to better health and overall quality of life. Mediterranean diet can reduce the risk of heart diseases.

Purported Uses
  • Heart disease
    Several studies support this use.
  • Disease/Cancer prevention
    Mediterranean diet has been shown beneficial in several studies.
  • Weight management
    One recent study supports its use for weight loss.
  • Diabetes management
    Mediterranean diet was found helful in managing diabetes.
  • Cholesterol management
    Several studies support this claim.
Research Evidence

In a study conducted in Spain, 7447 people were randomly placed in three groups. The first two consumed Mediterranean diet with extra-virgin olive oil or with nuts. They were compared to subjects in the control group who ate a reduced fat diet. People who ate the Mediterranean diet were 30% less likely to develop heart disease after five years compared to those in the control group.

A meta-analysis examined 12 studies which included more than 1.5 million healthy individuals and 40,000 non-fatal and fatal events. There is evidence that people who consume Mediterranean diet are less likely to develop cancer, heart disease, Alzheimer's and Parkinson's disease. They also tend to live longer.

Do Not Take If
  • You have food allergies (Mediterranean diet consists of a variety of grains, fruits, vegetables, and nuts/seeds).
  • You have gastrointestinal difficulties (Mediterranean diet may compound the problems.)
Special Point

Cancer patients may have special nutritional needs and should consult a dietician before changing diet.

Alcohol consumption can increase the risk of certain cancers.

E-mail your questions and comments to aboutherbs@mskcc.org.