Mediterranean Diet

Mediterranean Diet

For Patients & Caregivers

How It Works

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. 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.

Purported Uses
  • Heart disease
    Several studies support this use.
  • Disease/cancer prevention
    The Mediterranean diet has been shown to be beneficial in several studies.
  • Weight management
    Several studies support its use for weight loss.
  • Diabetes management
    Mediterranean diet was found to be helpful in managing diabetes.
  • Cholesterol management
    Several studies support this claim.
Do Not Take If
  • You have food allergies: The Mediterranean diet consists of a variety of grains, fruits, vegetables, and nuts/seeds.
  • You have gastrointestinal difficulties: The Mediterranean diet may compound digestive 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.
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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).

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).

Although there were no significant associations with reduced bladder cancer risk (11), other large prospective studies found that adherence to the Mediterranean diet resulted in significant reductions for hip fracture incidence (12), risk of sudden cardiac death (13), gastric adenocarcinoma incidence (6) , modest reductions in colorectal cancer risk (14), and overall reduction in cancer risk (7). A randomized controlled trial demonstrated that a Mediterranean diet can reduce the risk of cardiovascular  events (10). Conclusions of various meta-analyses also indicate associations between greater adherence to the Mediterranean diet and significant reductions in weight gain (15) (16) as well as risk factors for diabetes and cardiovascular diseases (8) (9) (15), overall mortality, cancer incidence and mortality, and incidence of Alzheimer’s and Parkinson’s disease (1). Results from PREDIMED, the largest long-term randomized trial in Spain examining disease and mortality outcomes with the Mediterranean diet, also confirm these findings (17) (18) (19) (20) (21) (22). Moreover, secondary analyses of PREDIMED suggests that a Mediterranean diet supplemented with extra-virgin olive oil confers benefits in the prevention of breast cancer (29), and improves atheroprotective functioning of high-density lipoproteins for individuals at high risk for cardiovascular disease (30). Other studies suggest it can reduce systolic blood pressure, improve endothelial functioning (31), and protect against macular degeneration (32).

Interestingly, a large cross-sectional study identified certain factors that improved adherence to the Mediterranean diet, including female sex, older age, higher levels of physical activity, and moderate alcohol consumption, while poorer adherence was associated with males and obesity (23). However, these results may not be translatable to the general public and may be unique to the culture of the Spanish populations studied.

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).

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 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 or those with gastrointestinal difficulties which prevent them from consuming a normal diet.
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. 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.

  7. 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.

  8. 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.

  9. 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 13. doi: 10.1056/NEJMoa1800389.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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.

  22. 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.

  23. 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; Published online September 14, 2015:doi:10.1001/jamainternmed.2015.4838.

  24. 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.

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