Mediterranean Diet

Purported Benefits, Side Effects & More

Mediterranean Diet

Purported Benefits, Side Effects & More
Mediterranean Diet

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

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

A Mediterranean diet is 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. The Mediterranean lifestyle also promotes social connection by sharing meals with family and friends. Epidemiological studies show that the Mediterranean diet is a model of healthy eating that contributes to better health and overall quality of life, and can reduce the risk of heart disease, stroke, diabetes, certain cancers, and death.

What are the potential uses and benefits?
  • Heart disease

    Several studies support this use.
  • Disease/cancer prevention

    The Mediterranean diet has been shown beneficial in several studies.
  • Weight management

    Several studies support its use for weight loss.
  • Diabetes management

    Mediterranean diet was found helpful in managing diabetes.
  • Cholesterol management

    Several studies support this claim.
What else do I need to know?

Do Not Take if:

  • You have certain food allergies: The Mediterranean diet consists of a variety of grains, fruits, vegetables, and nuts/seeds.

Special Point:

  • It is advisable to avoid/reduce foods such as red/processed meat, high dairy, and artificial preservatives for health maintenance.
  • Cancer patients may have special nutritional needs and should consult a dietician before adopting new diets.
  • Alcohol consumption can increase the risk of certain cancers.

For Healthcare Professionals

Brand Name
Omega diet
Clinical Summary

The Mediterranean diet is consumed in regions that border the Mediterranean Sea. Epidemiological studies show that it contributes to better health and overall quality of life. It is also an established model of eating for primary and secondary prevention of various chronic diseases. The Mediterranean diet 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), comprises 15% to 20% as the major source of dietary fats in this diet (2). Another hallmark is the low consumption of meat and dairy products (3). The Mediterranean lifestyle also emphasizes social connection by sharing meals with family and friends.

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). In addition, large prospective studies have found the Mediterranean diet reduces hip fracture incidence (12), risk of cardiovascular events (10) (13) (39) (40)  and gastrointestinal cancers (6) (14), overall cancer risk (7), and preserves kidney function in coronary heart disease patients (41). When compared to a specific carbohydrate diet, Mediterranean diet may also confer greater benefit in patients with Crohn’s disease with mild to moderate symptoms (38). Other studies suggest it can reduce systolic blood pressure, improve endothelial functioning (31), and protect against macular degeneration (32). As well, leisure-time physical activity along with the Mediterranean diet, both individually and when combined, lowered all-cause mortality in older adults (33). Adherence to Mediterranean diet, physical activity, smoking abstinence, sedentary behavior avoidance also lowered all-cause mortality in adults regardless of age or medication burden (42).

Various meta-analyses have also confirmed that Mediterranean diet reduces the risk of diabetes and cardiovascular diseases (8) (9) (15) (16) (34) (35), overall mortality (36), and cancer (37) (43) as well as incidence of Alzheimer’s and Parkinson’s disease (1). Taken together, data on the Mediterranean diet further underscores the importance of emphasizing fruits vegetables, legumes, healthy fats, and whole grains.

Cancer patients may have special nutritional needs and should consult a dietician before changing diet. Alcohol consumption can increase the risk of certain cancers (5). Interestingly, certain factors that improved adherence to the Mediterranean diet included female sex, older age, and higher levels of physical activity, while poorer adherence was associated with males and obesity (23).

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 and Benefits
  • 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 across nutrients, and not to a single nutrient (1). At the same time, specific activities have been identified to partly explain the cardioprotective and anti-inflammatory effects, including decreases in oxidative stress, inflammation, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, and tumor necrosis factor α (24) (25) . Greater polyphenol intake from lignans, flavonols, and hydroxybenzoic acids found in the Mediterranean diet may be associated with decreased cardiovascular disease risks (26). Extra virgin olive oil, which contains phenolic compounds, vitamin E, and other lipid molecules, also has antiatherogenic effects, improving endothelial function, lipid profiles, insulin sensitivity, glycemic control, and blood pressure levels (17) (27) (28).

  • The Mediterranean diet may not be appropriate for those with multiple food allergies/intolerances.


Herb Lab Interactions

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

  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. 2010 Feb;91(2):381-90.
  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 Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34.
  11. Buckland G, Ros MM, Roswall N, et al. Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study. Int J Cancer. May 15 2014;134(10):2504-2511.
  12. Benetou V, Orfanos P, Pettersson-Kymmer U, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int. May 2013;24(5):1587-1598.
  13. Bertoia ML, Triche EW, Michaud DS, et al. Mediterranean and Dietary Approaches to Stop Hypertension dietary patterns and risk of sudden cardiac death in postmenopausal women. Am J Clin Nutr. Feb 2014;99(2):344-351.
  14. Bamia C, Lagiou P, Buckland G, et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol. Apr 2013;28(4):317-328.
  15. Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015 Nov;69(11):1200-8.
  16. Esposito K, Kastorini CM, Panagiotakos DB, et al. Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord. Feb 2011;9(1):1-12.
  17. Guasch-Ferre M, Hu FB, Martinez-Gonzalez MA, et al. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014;12:78.
  18. Martinez-Gonzalez MA, Toledo E, Aros F, et al. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevencion con Dieta Mediterranea) trial. Circulation. Jul 1 2014;130(1):18-26.
  19. Buil-Cosiales P, Zazpe I, Toledo E, et al. Fiber intake and all-cause mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study. Am J Clin Nutr. Dec 2014;100(6):1498-1507.
  20. Mitjavila MT, Fandos M, Salas-Salvado J, et al. The Mediterranean diet improves the systemic lipid and DNA oxidative damage in metabolic syndrome individuals. A randomized, controlled, trial. Clin Nutr. Apr 2013;32(2):172-178.
  21. Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. Cmaj. Nov 18 2014;186(17):E649-657.
  22. Martinez-Gonzalez MA, Sanchez-Tainta A, Corella D, et al. A provegetarian food pattern and reduction in total mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study. Am J Clin Nutr. Jul 2014;100 Suppl 1:320s-328s.
  23. Patino-Alonso MC, Recio-Rodriguez JI, Belio JF, et al. Factors associated with adherence to the Mediterranean diet in the adult population. J Acad Nutr Diet. Apr 2014;114(4):583-589.
  24. Fito M, Estruch R, Salas-Salvado J, et al. Effect of the Mediterranean diet on heart failure biomarkers: a randomized sample from the PREDIMED trial. Eur J Heart Fail. May 2014;16(5):543-550.
  25. Urpi-Sarda M, Casas R, Chiva-Blanch G, et al. The Mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease. J Nutr. Jun 2012;142(6):1019-1025.
  26. Tresserra-Rimbau A, Rimm EB, Medina-Remon A, et al. Inverse association between habitual polyphenol intake and incidence of cardiovascular events in the PREDIMED study. Nutr Metab Cardiovasc Dis. Jun 2014;24(6):639-647.
  27. Carnevale R, Pignatelli P, Nocella C, et al. Extra virgin olive oil blunt post-prandial oxidative stress via NOX2 down-regulation. Atherosclerosis. Aug 2014;235(2):649-658.
  28. Domenech M, Roman P, Lapetra J, et al. Mediterranean diet reduces 24-hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial. Hypertension. Jul 2014;64(1):69-76.
  29. Toledo E, Salas-Salvadó J, Donat-Vargas C, et al.Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial: A randomized clinical trial. JAMA Intern Med. 2015 Nov;175(11):1752-1760.
  30. Hernaez A, Castaner O, Elosua R, et al. Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial. Circulation. Feb 14 2017;135(7):633-643.
  31. Davis CR, Hodgson JM, Woodman R, et al. A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial. Am J Clin Nutr. Jun 2017;105(6):1305-1313.
  32. Hogg RE, Woodside JV, McGrath A, et al. Mediterranean Diet Score and Its Association with Age-Related Macular Degeneration: The European Eye Study. Ophthalmology. Jan 2017;124(1):82-89.
  33. Cárdenas-Fuentes G, Subirana I, Martinez-Gonzalez MA, et al. Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study. Eur J Nutr. Jun 2019;58(4):1569-1578.
  34. Rosato V, Temple NJ, La Vecchia C, et al. Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr. Feb 2019;58(1):173-191.
  35. Chen GC, Neelakantan N, Martín-Calvo N, et al. Adherence to the Mediterranean diet and risk of stroke and stroke subtypes. Eur J Epidemiol. Apr 2019;34(4):337-349.
  36. Eleftheriou D, Benetou V, Trichopoulou A, et al. Mediterranean diet and its components in relation to all-cause mortality: meta-analysis. Br J Nutr. Nov 2018;120(10):1081-1097.
  37. Schwingshackl L, Schwedhelm C, Galbete C, et al. Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients. Sep 26 2017;9(10).
  38. Lewis JD, Sandler RS, Brotherton C, et al; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn’s Disease. Gastroenterology. 2021 Sep;161(3):837-852.e9.
  39. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial.   Lancet. 2022 May 14;399(10338):1876-1885.
  40. Jimenez-Torres J, Alcalá-Diaz JF, Torres-Peña JD, et al. Mediterranean Diet Reduces Atherosclerosis Progression in Coronary Heart Disease: An Analysis of the CORDIOPREV Randomized Controlled Trial. Stroke. 2021 Nov;52(11):3440-3449.
  41. Podadera-Herreros A, Alcala-Diaz JF, Gutierrez-Mariscal FM, et al. Long-term consumption of a mediterranean diet or a low-fat diet on kidney function in coronary heart disease patients: The CORDIOPREV randomized controlled trial. Clin Nutr. 2022 Feb;41(2):552-559.
  42. Kelly NA, Soroka O, Onyebeke C, et al. Association of healthy lifestyle and all-cause mortality according to medication burden. J Am Geriatr Soc. 2022 Feb;70(2):415-428.
  43. Wiggs AG, Chandler JK, Aktas A, Sumner SJ, Stewart DA. The Effects of Diet and Exercise on Endogenous Estrogens and Subsequent Breast Cancer Risk in Postmenopausal Women. Front Endocrinol (Lausanne). 2021 Sep 20;12:732255.
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