General Guidelines on the Mediterranean Pyramid⁽²⁾
The Mediterranean diet focuses on plant-based sources such as beans, vegetables, nuts, seeds, and whole grains. It also includes seafood.
In 1993, Oldways, Harvard School of Public Health, and World Health Organization (WHO) identified the
framework of the Mediterranean diet.⁽¹⁾⁽²⁾⁽⁵⁾
- Level 1- The pyramid highlights physical activity and social connection as the foundational element.
- Level 2- This level suggests eating an abundant amount of fruits, vegetables, whole grains, olive oil, beans, nuts, herbs and spices, legumes, and seeds.
- Levels 3 and 4- The next two levels focus on consuming moderate amounts of fish and seafood, poultry, eggs, cheese and yogurt.
- Level 5- The tip of the pyramid shows limited consumption of sweets and meats.
How Does the Mediterranean Diet Work?
The Mediterranean diet was not developed as a weight loss plan — in fact, it evolved naturally by people living in the Mediterranean region over centuries. Healthcare professionals and general population favor this diet because it is a well-rounded approach to eating that is not restrictive.
Two of the five Blue Zones— areas where people live longer and have lower rates of disease — are located in Mediterranean cities; specifically Ikaria, Greece and Sardinia, Italy.⁽⁷⁾ These places have the lowest rates of heart diseases and cancer worldwide.
Basic Steps to the Eating Plan ⁽⁵⁾⁽⁶⁾
Eat vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood, and extra virgin olive oil.
Eat in moderation: Poultry, eggs, cheese, and yogurt.
Limit These Unhealthy Foods and Ingredients
- Added sugar: Soda, candies, ice cream, table sugar, and similar foods
- Refined grains: White bread, pasta made with refined wheat, etc.
- Trans fats: Found in margarine and various processed foods
- Refined oils: Soybean oil, canola oil, cottonseed oil and others
- Processed meat: Processed sausages, lunch meat, hot dogs, etc.
- Highly processed foods: Anything labeled "low-fat" or "diet" or which looks like it was made in a factory.
"Read food labels carefully if you want to avoid unhealthy ingredients."
What Are the Pros and Cons of a Mediterranean Diet?⁽⁴⁾
Pros
It is easy to implement and provides diverse food options. Everyone in your family can follow a Mediterranean diet both at home and at restaurants, family events, etc.
You can eat what you love. With such a variety of whole, fresh foods available as options, it is easy to build meals based on this diet. You do not have to eliminate your favorites but you may need to make some adjustments. For instance, rather than a sausage and pepperoni pizza, you can choose pizza with vegetables, topped with some cheese. Fresh foods like fruits and vegetables allow you to add volume into meals for fewer calories.
The Mediterranean diet is rich in olive oil, seafood, nuts, and seeds, which are abundant in heart-healthy fats. Some of those heart-healthy fats are polyunsaturated such as Omega 3, 6, and monounsaturated. These fats are low in cholesterol. By limiting processed and red meats, you will also reduce the saturated fats in your diet.
The foods comprising the Mediterranean diet have higher satiety, meaning it will take longer for you to feel hungry.
The diet has the potential to reduce the risk of heart disease, diabetes, cancer, and Alzheimer disease, and
improve longevity.⁽³⁾
Cons
There are no known long-term risks to following the Mediterranean diet. Note, however, consumption of milk, a source of calcium is limited. You can drink skim milk and eat low-fat cheese and yogurt in small amounts. Non-dairy calcium sources include fortified almond, rice, and soy milk, sardines, kale, salmon, fortified cereal, greens, beans, and tofu made with calcium sulfate.
Foods to Eat⁽¹⁾
Exactly which foods are included in the Mediterranean diet is controversial, partly because the diet varies between countries. The diet examined in most studies is high in healthy plant foods and relatively low in animal foods.
- Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, sweet potatoes, turnips, cucumbers, etc.
- Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.
- Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, etc.
- Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.
- Tubers: Potatoes, sweet potatoes, turnips, yams, etc.
- Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, and whole-grain bread and pasta
- Fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc. Seafood is recommended at least twice a week
- Poultry: Chicken, duck, turkey, etc. Eggs: Chicken, quail, and duck eggs
- Dairy: Low-fat cheese, yogurt, Greek yogurt, etc.
- Herbs and spices: Basil, bay, black pepper, cloves, coriander, cumin, dill, fennel, garlic, lavender, mint, parsley, rosemary, saffron, tarragon, thyme, turmeric, nutmeg, cinnamon, etc.
- Healthy Fats: Extra virgin olive oil, olives, avocados, and avocado oil
A Mediterranean Sample Menu for 1 Week
Feel free to adjust the portions and food choices based on your own needs and lifestyle. Before starting dietary changes, share these recommendations with your nutritionist/dietitian, or physician in case of a health condition or allergies. There is usually no need to count calories or track macronutrients (protein, fat and carbs) on the Mediterranean diet. Note: Greek salad and Pita bread are normally eaten with most meals.
| BREAKFAST | LUNCH | DINNER | |
|---|---|---|---|
| Monday | Breakfast berry fruit salad bowl, with Greek yogurt, and rolled oats | Chickpea, chicken and kale soup with a side Greek salad, pita bread | Leftover chickpea, chicken, and kale soup with a Greek salad, with pita bread, cup of grapes |
| Tuesday | Oatmeal with raisins, flaxseed, blueberries, apples, and grape | Lentil veggie salad, with side Greek salad, and fruit salad | Mediterranean lasagna with low-fat cheeses and ground chicken (can be made meatless using spinach, eggplant, or zucchini) and beet salad, sliced apples |
| Wednesday | Spinach and tomato omelet, a cup of fruit | Hummus Greek salad with falafel and tahini sauce, and pita bread, side Greek salad, dried apricots | Mediterranean quinoa salad, with tuna pepperoncini, yogurt and honey olive cake |
| Thursday | Yogurt, chia seeds with sliced fruits and nuts. | Quinoa bowl with avocado, cucumbers, tomatoes, red peppers, and lemon wedges, side Greek salad, cup of grapes | Broiled salmon, served with brown rice and vegetable with carrot and cabbage salad, olive oil, and lemon |
| Friday | Caprese avocado toast(avocados, tomato, mozzarella cheese) sliced pears | Mediterranean pizza with plum tomatoes, olives, goat cheese, basil, and artichokes, side Greek salad, cup of sliced pears | Leftover Mediterranean pizza from lunch, with a Greek salad and hummus, olives, and tomatoes, pita bread |
| Saturday | Breakfast pita with hummus, tabbouleh, olives, grapes, and figs | Beans and kale soup with carrots, zucchini , onion, and parmesan cheese, pita bread, side salad | Lamb stew with onion, potatoes, carrots, tomatoes, chickpeas, Greek salad with flat bread |
| Sunday | Egg and spinach toast, oatmeal with fruit and nuts | Sundried tomato pasta with olives, artichokes, garlic, and side Greek salad, figs | Baked chicken and roasted vegetables, brown rice, Greek salad |
What to Drink
Water should be your go-to beverage.
The Mediterranean diet allows moderate amounts of red wine — around one glass per day (optional). Coffee and tea are also acceptable, but you should avoid sugar-sweetened beverages and fruit juices, which are very high in sugar.
How to Follow the Diet at Restaurants
It is very simple to make most restaurant meals suitable for the Mediterranean diet.
- Choose fish or seafood as your main dish
- Ask the kitchen to use olive oil to prepare your dish
- Select whole-grain bread
Healthy Mediterranean Snacks
You do not need to eat more than three meals per day. If you become hungry between meals, there are plenty of healthy snack options:
- A handful of nuts
- A piece of fruit
- Dried kale or apple chips
- Carrots or baby carrots Berries, grapes, or figs
- Leftovers from the night before Greek yogurt
- Apple slices with nut butter
Practical Tips on implementing the Mediterranean Diet
- If you have health conditions, talk to a dietitian/ nutritionist/physician before starting a diet.
- Clear your pantry of processed and unhealthy food items such as sodas, ice cream, candy, pastries, white bread, crackers, and processed foods.
- Find recipes for all meals which align with the food groups suggested in the Mediterranean pyramid.
- Create a meal calendar with those recipes Make a grocery list based on your meal calendar.
- Shop at the perimeter of your grocery store where you will usually find whole foods. Always try to choose the least-processed options.
Sources:
McManus, K. (2019). A practical guide to the Mediterranean diet. Retrieved from: https://www.health.harvard.edu/blog/a-practical-guide-to-the-mediterranean-diet-2019032116194
N.d. (2009), Mediterranean Diet Pyramid. Retrieved from: https://memory.ucsf.edu/sites/memory.ucsf.edu/files/MediterraneanDietHandout.pdf
Romagnolo, D., Selmin, O. (2017). Mediterranean Diet and Prevention of Chronic Diseases. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625964/
N.d. (2018). Diet Review: Mediterranean Diet. Retrieved from: https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet
/Migala, J. (2019). What Is the Mediterranean Diet? Your Ultimate Guide to the Heart-Healthy Eating Philosophy. Retrieved from: https://www.everydayhealth.com/mediterranean-diet/guide/
Gunnars, K. (2018). Mediterranean Diet 101: A Meal Plan and Beginner's Guide. Retrieved from: https://www.healthline.com/nutrition/mediterranean-diet-meal-plan
N.D. (n.d.), Blue Zone History. Retrieved from: https://www.bluezones.com/
about/history/
