Mediterranean Diet

What is the Mediterranean diet?

The Mediterranean diet is the traditional way of eating in the countries around the Mediterranean Sea, the Mediterranean cuisine as it was cooked in villages and small towns for generations. It is not a diet in the sense of a programme but a pattern. Plant foods form its base: vegetables, fruit, cereals, preferably whole grain, pulses, nuts, seeds, olives, herbs and spices. Olive oil, above all extra virgin olive oil, is the main fat. Fish and shellfish, white meat, eggs and dairy are eaten in moderate amounts, red meat and processed meat rarely, sweets on special occasions.

The current description by the Mediterranean Diet Foundation from 2011 places these foods in a pyramid and adds what cannot be eaten: frugality and moderation, seasonal, local and traditional products, biodiversity, cooking, shared meals, physical activity and rest. UNESCO sees it the same way. In 2010 it inscribed the Mediterranean diet on the Representative List of the Intangible Cultural Heritage of Humanity for Spain, Greece, Italy and Morocco; in 2013 the inscription was extended to Croatia, Cyprus and Portugal. UNESCO describes it as a body of skills, knowledge, rituals and traditions, from the field to the table, and names eating together as the foundation of the cultural identity of the communities. In Italy the Cilento is one of the communities named in the file.

Ancel Keys and the Seven Countries Study

The scientific career of the Mediterranean diet began with the American physiologist Ancel Keys. After pilot surveys in southern Italy and on Crete in 1957, his Seven Countries Study examined 12,763 middle-aged men in sixteen groups in seven countries between 1958 and 1964. The men on Crete had remarkably little heart disease, and their diet became the model for what is now called the Mediterranean diet. In 1975 Ancel Keys and his wife Margaret published How to Eat Well and Stay Well the Mediterranean Way, the book that brought the term to a wider public.

What the studies show

The Mediterranean diet is among the most studied eating patterns in the world. The strongest evidence concerns the heart and blood vessels.

PREDIMED. The best known trial was run in Spain with 7,447 people who had a high cardiovascular risk but no cardiovascular disease. They were assigned to a Mediterranean diet with extra virgin olive oil, a Mediterranean diet with nuts, or advice on a reduced-fat diet. After a median of 4.8 years, 3.8 percent had a heart attack, stroke or cardiovascular death in the olive oil group, 3.4 percent in the nut group and 4.4 percent in the control group. That corresponds to about 30 percent fewer events. The benefit came mainly from fewer strokes; for heart attacks and deaths alone the trial showed no clear effect. The first publication of 2013 was withdrawn in 2018 because at several sites participants had not been randomised individually, for instance whole households or a whole clinic together. The researchers reanalysed the data, also without the 1,588 affected participants, and the result held. Critics point out that such flaws cannot be fully corrected by statistics.

CORDIOPREV. A second Spanish trial compared a Mediterranean diet with a low-fat diet in 1,002 people who already had coronary heart disease, over about seven years. The Mediterranean diet prevented more major cardiovascular events. Over four fifths of the participants were men; in women the trial found no difference between the two diets.

The overall picture. A Cochrane review from 2019 brought together 30 randomised trials. It rates the evidence that a Mediterranean diet reduces strokes in people without prior disease as moderate, and the evidence on deaths in people who already have heart disease as low. Its authors conclude that some uncertainty about the effects remains. Many further findings, on diabetes, on the brain or on life expectancy, come from observational studies, which show associations but cannot prove causes.

Wine. Traditionally, wine in moderation with meals belongs to the pattern, and the 2011 pyramid still includes it. The World Health Organization stated in 2023 that no level of alcohol consumption is safe for health. Whatever the Mediterranean diet achieves does not depend on wine.

The plants that carry it

The Mediterranean diet is the cuisine of a landscape, and a few plants carry it.

The olive is its centre. It supplies the main fat of this kitchen, and the fruit itself. The old olive groves of the Mediterranean are the oldest part of this food system.

Pulses supply protein where meat was scarce: fava beans, chickpeas, lentils, beans and peas. As legumes they also bind nitrogen from the air and enrich the soil they grow in.

Vegetables and wild plants fill the plate. Alongside cultivated vegetables, gathered wild greens have long been part of the meal. On Monte Ortobene near Nuoro in central Sardinia, an ethnobotanical study recorded 44 plant species used as food. Wild asparagus was named most often; wild beet, chicory, wild fennel and sow thistle were also named frequently. The same study notes that this knowledge now lives mostly among the elderly and is in danger of being lost.

Fruit and nuts complete it: the fig, fresh or dried, citrus, grapes, almonds and walnuts.

Why a garden feeds this kitchen

The foods that form the base of the Mediterranean diet are almost all plants of a Mediterranean garden. A food forest on the Mediterranean model can bring them together in layers, for example olive and almond in the upper storey, fig and citrus below, and herbs, vegetables and pulses on the ground. The fava bean feeds people and soil at once.

The rhythm fits as well. In the Mediterranean garden year the wet half from autumn to spring is the season for sowing pulses such as the fava bean and many vegetables; summer brings figs and grapes, and the olives ripen towards winter. Eating from such a garden means eating by the season, which is exactly what the description of the Mediterranean diet asks for. A garden near the house also brings the other elements of the pattern within reach: work outdoors, fresh food, and meals made from what was picked the same day.

The traditional Sardinian diet

The traditional diet of the Sardinian mountains shows that the Mediterranean diet was never a single menu. In the villages of the Blue Zone, the economy rested on herding. Until the 1960s food there was based on cereals and on dairy from sheep and goats, with pulses and vegetables. Animals were a source of income and were rarely slaughtered; meat was eaten seldom and mostly preserved with salt at home. Lard was used more than in the textbook pattern, and milk and cheese played a larger role. The change to a richer diet reached the mountains later than the lowlands.

When it came, pulses, vegetables and lard became less common, while meat, fresh fruit, fish, pasta, sweets and milk became more common. A study of long-lived elders in Ogliastra found that some traditional foods are still eaten regularly: the bread pistoccu every day, minestrone, culurgiones and Cannonau wine. The milk they drink comes from sheep and goats rather than from cows.

Researchers suggest that the old cohorts may have benefited from both the frugal traditional diet and the greater variety that came later. Whether diet explains their long lives is open. The Sardinian kitchen is therefore not proof of a health promise but an example of what the Mediterranean diet was at its origin: frugal, local and bound to the land.

How Terra Humana understands the Mediterranean diet

For Terra Humana the Mediterranean diet is first of all a relationship with a landscape. Olive, fava bean, fig and wild greens are not ingredients from a shop but plants with a place, a season and a history. Where they grow together, the land is fed and the people living from it are fed too. We do not promise anyone a longer life through food. We take the evidence as it is, good for the heart and the vessels and less certain elsewhere, and we hold on to what the old kitchens of the Mediterranean knew: that eating well begins with the soil and is completed at a shared table.