How to Follow the Mediterranean Diet

Adopting a Mediterranean diet can be easy and cheap. This leaflet is about the types and amounts of ingredients to eat in order to get maximum health benefit from the diet.

The typical Western diet is high in animal fats and preservatives, but low in fruit and vegetables. Scientific research has shown that this food combination is partially responsible for triggering many chronic diseases and cancers.

Research has also shown that following a Mediterranean diet can reduce the chance of developing conditions such as heart disease, type 2 diabetes, high blood pressure, obesity and even Alzheimer's disease. See separate leaflet called Health Benefits of the Mediterranean Diet.

Switching from a Western to a Mediterranean diet represents a healthy lifestyle choice. It can reduce the risk of a premature death and increase the chance of a healthy retirement, free from long-term medication. 

The term 'Mediterranean Diet' describes a specific mix of dietary food ingredients, shown, to promote health and long life in people from many countries, including the UK and USA.

The word 'Mediterranean' refers to the origins of the diet, rather than needing to eat Greek or Italian foods (see Note 2) - although, experimenting can be enjoyable and rewarding.

When planning ingredients for Mediterranean-style meals, it is good to include lots of variety. For example, using a range of fruit and vegetables gives the body maximum access to sources of vitamins, minerals and other trace nutrients. This is quite logical, because it's only recently that supermarkets have been able to make foods available throughout the year. This counteracts natural seasonal variety in the human diet.

The overuse of salt in flavouring Western-style meals and fast foods has been linked with increased blood pressure. The healthy alternative is to replace the excess salt with herbs, as Mediterranean folk have done for many years. This can also add new flavours to quite simple pasta, rice dishes and stews.

The Mediterranean Diet is not about quick fix 'superfoods'. Nor is it a strict list of what you should not eat. Rather, the Mediterranean Diet is a formula for healthy day-to-day eating over the long term. Here's a quick guide for those who would like to try it:

  • Maximise your intake of vegetables, peas and beans (legumes), fruits and wholegrain cereals.
  • Limit your red meat intake - fish and poultry are healthy substitutes.
  • Where possible, use mono-unsaturated olive oil or rapeseed oil in place of animal fat such as butter or lard.
  • Limit your intake of highly processed 'fast foods' and 'ready meals', where you cannot tell saturated fat and salt intake.
  • Eat no more than moderate amounts of dairy products, and preferably low-fat ones.
  • Do not add salt to your food at the table - there is already plenty there.
  • Snack on fruit, dried fruit and unsalted nuts rather than cakes, crisps and biscuits.
  • Drink (red) wine during meals, but no more than three small glasses per day if you are a man and no more than two small glasses per day if you are a woman.
  • Water is the best 'non-alcoholic beverage' (as opposed to sugary drinks), although health benefits have also been claimed for various teas and coffee (see Note 3).

The World Health Organization (WHO) - and the UK Government's Change4Life campaign - recommend we eat five portions of fruit and vegetables a day. This guidance is partly based on research into the Mediterranean Diet (see Note 4). 

Health-promoting food types to be encouraged

The following contain essential nutrients and have health-promoting properties.

Vegetables and Fruits
Examples Vegetables: onions, cabbage, courgettes, cucumbers, carrots, spinach, leeks, broccoli, asparagus, lettuce, cauliflower, aubergine, garlic and peppers.
Fruit: oranges, grapes, apples, bananas, pears, melons, plums, cherries, pineapples, olives, figs - and, perhaps surprisingly, tomatoes.
Also Tinned vegetables and fruit, vegetable soups and juices, dried fruit, fruit juice. Potatoes, often thought of as vegetables, are discussed separately below.
Analysis High in fibre, antioxidants and vitamin C.
Benefits Help reduce risk of heart and vascular disease, cancers and bowel problems.
Risk in Excess None known.
Cereals - wholemeal where possible
Examples Wheat, barley, oats, millet, corn and brown rice.
Also Found in cereal flakes, muesli, porridge, wholemeal pasta, wholemeal bread, spaghetti, couscous, polenta, crispbread, biscuits.
Analysis Proteins, carbohydrate, fibre, vitamins, minerals, anti-inflammatory agents.
Benefits Associated with decreased bowel problems, including cancers, lowered 'bad' blood fat and decreased heart disease.
Risk in Excess None known (some people are intolerant to gluten).
Legumes (grow in pods)
Examples Peas, beans, lentils, chickpeas, peanuts (they're not really nuts).
Also Representatives from this versatile group can be spotted piled on plates (humble baked beans or peas), as bases for tasty soups and stews (for example, lentils) or in Mediterranean-style dips (for example, houmous).
Analysis Protein, carbohydrate, fibre, vitamin B, vitamin C.
Benefits Associated with reduced risk of heart and vascular disease.
Risk in Excess None known.
White and Oily Fish (and Seafood)
Examples White fish and shellfish: sole, cod, plaice, haddock, hake, halibut, sea bass, turbot, whiting, mullet, tinned tuna, squid, mussels, prawns, crab, lobster.
Whole fish: whitebait, sardines, pilchards, anchovy.
Oily fish: salmon, mackerel, herring, trout, fresh tuna.
Also Fish liver oil.
Analysis Protein, essential vitamins, minerals. Oily fish (and some shellfish) contain cardio-protective omega 3 fatty acids, vitamins A and D. Whole fish are a source of calcium and phosphorus. Shellfish are also good sources of trace minerals.
Benefits A mix of oily and white fish in the diet is an alternative source of protein that reduces the risk of heart disease and heartbeat irregularities.
Risk in Excess Some oily fish contains low levels of pollutants. Pregnant women and those trying for a baby should limit intake of certain types of fish.

Beneficial food types, to be carefully measured

The Mediterranean Diet components contain essential nutrients and have health-promoting properties. However, there are known health risks if consumed in excess.

When cooking Mediterranean-style meals, unsaturated oils are used to replace saturated animal fats, such as butter and lard (see Note 5). If you cover your healthy vegetables with a cream- or cheese-based sauce, then you'll be adding saturated fat. Instead you could cut back on the saturated fat by using a smaller amount of a stronger cheese. Vegetables roasted with small amounts of olive oil are delicious. You could clean the plate with unbuttered, tasty, wholemeal bread.

Many 'fast foods' are designed to tempt the palate, but contain high levels of unhealthy saturated fat, trans-fat (heat-degraded fat) and salt.

Overall, although typical Western and Mediterranean diets can have a similar total fat content, the Mediterranean Diet is high in health-protective mono-unsaturated fat. In contrast the Western diet is high in artery-clogging saturated and trans-fat (See Note 6).

Mono-unsaturated Oils (Fats)
Examples Olive oil (the traditional Mediterranean oil) and rapeseed oil (made in the UK).
Also Found in olives, nuts and seeds, avocados.
Analysis High in mono-unsaturated fat, low in saturated fat, high in calories (kcal). Also contain essential fatty acids and assist with vitamin absorption. Types of fat found in oils are normally listed on the back of the bottle. These oils are quite stable and don't degrade into toxic components when heated.
Benefits Help protect against heart disease, some cancers (for example, breast) and assist in lowering blood pressure.
Risk in Excess Mainly through risk of obesity due to high energy content.
Lean White Meat
Examples Chicken, turkey and other poultry.
Also Chicken fast food, turkey burgers, processed pies - generally high in animal fat and therefore not counting as lean white meat.
Analysis Lean white meat without skin is high in protein, vitamins (including vitamin B12) and minerals, but with much less saturated animal fat than red meat.
Benefits Contains essential nutrients.
Risk in Excess Mainly from ingesting too much saturated fat.
Nuts and Seeds
Examples Nuts: almonds, chestnuts, walnuts, cashew nuts, Brazil nuts.
Seeds: pumpkin, sunflower, sesame, poppy.
Also Found in muesli, seeds on breads, on cakes, etc.
Analysis Protein, fibre, vitamins and minerals. Nuts are high in 'good' unsaturated fats.
Benefits Help protect against heart disease, type 2 diabetes and reducing 'bad' blood cholesterol. Nuts possibly help body mechanisms control weight.
Risk in Excess Are high in energy and therefore traditionally thought to be associated with weight gain in excess. Avoid salted nuts - high salt intake is associated with high blood pressure. People with nut allergy should avoid nuts.
A tip Try having dried fruit, unsalted nuts or seeds as a snack in place of cream cakes, doughnuts or chocolate biscuits.
Wine - particularly Red Wine
Examples A huge range of red wines is available. Each prepared by fermentation of juice extracted from one or more varieties of grape.
Also Used in cooking.
Analysis Alcohol, antioxidants and anti-inflammatory chemicals. High in calories.
Benefits In small, regular amounts it can help protect against heart disease. Appears to have added effect if drunk with Mediterranean-style meals.
Risk in Excess Regularly exceeding recommended limits (three units per day for men and two units per day for women) increases the risk of addiction, cirrhosis, heart disease and cancer - for example, breast. Pregnant women should not drink any alcohol.

Restricted foods

The following foods contain essential nutrients, but also carry significant health risks if consumed in excess.

Milk and Dairy Produce
Examples Milk, yoghurt, cheese, butter, cream, fromage frais.
Also Sauces, desserts, creamy curries, etc.
Analysis High in protein, vitamin A, vitamin B12 and calcium. Dairy products can also be high in 'bad' animal fats. Cream and butter are particularly high in fat. Cottage cheese, mozzarella and feta are some of the lower saturated fat cheeses. Ricotta is a high-fat cheese. Semi-skimmed milk is lower in fat than full-cream milk. Some products have added salt.
Benefits Calcium is needed for strong bones.
Risk in Excess Increased risk of heart and vascular disease, and raised 'bad' blood cholesterol due to the saturated fat content.
A tip Full-cream milk is rich in calcium, but also in saturated fat. Selecting semi-skimmed milk, low-fat yoghurts and lower-fat cheeses can help reduce bad unhealthy fat intake. Cottage cheese, mozzarella and feta are some of the lower saturated fat cheeses. Ricotta is a high-fat cheese (see Note 3).
Red Meat
Examples Beef, pork, lamb.
Also Found as mince and processed in pies, sausages and fast food.
Analysis High in protein, vitamins (including vitamin B12) and minerals (for example, iron). Generally high in saturated animal fat. Lean cuts contain less fat.
Benefits Contains essential nutrients. But these can also be obtained from white meat, fish and vegetables.
Risk in excess Increased risk of cardiovascular disease and raised 'bad' blood cholesterol.
A tip One way of reducing red meat intake is to save it for special treats - for example, Sunday roast. Alternatively, portions of red meat can be divided up and used throughout the week by mixing with vegetables in rice and pasta dishes.
Potatoes
Examples There are many varieties associated with different cooking processes.
Also Found as chips and crisps. Used in pies and processed food.
Analysis A good source of energy, fibre, B vitamins and potassium. They also contain vitamin C. They are high in starch, which is rapidly converted to glucose. Potatoes are often thought of as a vegetable, but have different properties, so are counted separately from vegetable intake.
Benefits From nutrients and fibre.
Risk in Excess High available starch content associated with increased risk of type 2 diabetes.
Sweets and Sweet Desserts
Examples Chocolates, sweets, creamy desserts, biscuits, rich cakes.
Also Processed, 'ready-made' desserts.
Analysis Many products are high in sugar and saturated fats and high in calories. Often low in vitamins and minerals.
Benefits Calcium content, if milk-based. Dark chocolate and cocoa contain flavonoids (antioxidants). Research is continuing into whether small amounts of dark chocolate can help protect against heart disease.
Risk in Excess Sweet foods damage teeth. Increased risk of heart and vascular disease, type 2 diabetes, obesity.
A tip You already knew eating too many sweet desserts and chocolates might be an unwise choice. But, perhaps these foods will be even more delicious when served as occasional treats? How about substituting fresh fruit and yoghurt?

Research shows that people who adopt a strict Mediterranean diet and take regular exercise, often find this helps keep their weight under control. Mediterranean-style meals, packed with fruit, vegetables and grains can be quite filling. This reduces any desire to top up with extra calories.

If this doesn't do the trick, then you may need to reduce your energy intake and/or increase your physical activity. The recommended way to find out whether you need to lose weight is to measure your body mass index (BMI). See separate leaflet called Obesity and Overweight in Adults

Reducing energy intake

The notes above are an indication of the high-energy foods. If you use too much oil, eat too many nuts, or take too much alcohol or sugary drinks, your body may take in more energy than it needs. It will then store it as fat. If excess weight remains a problem, then it is worth seeing if you can reduce calorie intake levels.

Increasing exercise

It is recommended that, where possible, adults undertake at least 30 minutes of daily exercise. This could be taking long walks, jogging, cycling or swimming, so as to sustain a minimal level of fitness. This also helps the body to regulate weight. Body regulatory mechanisms tend to get a bit sluggish if left sitting around for too long. Any extra exercise will help to burn excess calories and fat. See separate leaflet called Weight Reduction - How to Lose Weight.

Sticking to a Mediterranean diet and keeping active goes a long way to keeping you healthy. It also reduces your risk of various serious diseases. But remember, it is part of a 'package' of things that you can do to keep healthy. The other main things that you can do are to not smoke, and to have your blood pressure checked every 3-5 years - unless advised it should be more often, by a doctor or nurse. 

Scientific research has shown that the closer we can get to the 'ideal' Mediterranean Diet, outlined in the pyramid chart below, the greater the health advantage. The benefit of adopting the whole dietary pattern is greater than the health-giving properties of each type of food.

Mediterranean diet pyramid

A guide to portions or servings described in the pyramid is as follows:

  • Vegetables: a cup of raw leafy vegetables or half a cup of other vegetables.
  • Potatoes: 100 g.
  • Legumes: one cup (100 g) of cooked dry beans.
  • Nuts: 30 g. Eat as a snack or sprinkle on food for added taste.
  • Fruit: one apple, banana, one orange, 200 g of melon or watermelon, 30 g of grapes.
  • Meat: 60 g of cooked lean meat or fish.
  • Grains: half a cup (50-60 g) of cooked pasta or rice; one slice of bread (25 g).
  • Dairy:one cup of milk or yoghurt; 30 g of cheese.
  • Eggs: one egg.
  • Wine: 125 ml glass of average-strength red wine.

The strict Mediterranean Diet has been assessed and found to contain all the essential nutrients required for normal health. But, more than this, it also prevents excesses of ingredients linked to ill health.

Mediterranean Diet - Overall
ExamplesThe Mediterranean Diet is based on a traditional mix of foodstuffs eaten by peoples of the Eastern Mediterranean - particularly Crete and southern Italy.
AlsoThe diet has been tested in Western industrialised countries such as the UK and USA.
AnalysisHigh in fruit, vegetables, legumes and cereals. Fish and white meat mainly eaten in place of red meat. Mono-unsaturated oils used in place of saturated animal fats. Moderate red wine intake with meals.
BenefitsExceptional reductions in risk of early death, heart disease, cancer and chronic conditions such as hypertension, high cholesterol and type 2 diabetes. Also, reductions in Parkinson's disease and Alzheimer's disease risk. Adoption of the diet has proved a successful strategy for healthy weight reduction.
Risk in ExcessThe Mediterranean Diet maximises the intake of health-promoting ingredients, whilst minimising quantities of ingredients associated with health risks. Those adopting the Mediterranean Diet are likely to have a lower risk of disease than those who don't.

1: In the mid-1900s, it was discovered that certain peoples of the Eastern Mediterranean (particularly Greece and southern Italy) lived longer, disease-free lives than peoples in industrialised Western countries, including the UK, even though those in the West had easy access to sophisticated health services. A key reason turned out to be differences in diet. This led researchers to analyse and successfully test an ideal diet - 'the Mediterranean Diet' - on Westerners.

2. Many aspects of the traditional Mediterranean Diet, were first introduced into Britain back in Roman times, when locals also ate a lot of 'Celtic beans'. Of course, this was before Western civilisation entered its Dark Ages. So, the Mediterranean Diet could be listed as one of the things 'the Romans did for us'.

3. It is recommended that we drink at least 6-8 glasses of non-alcoholic fluid through the day, to prevent dehydration in the temperate UK climate. More would be required in hotter weather.

4. Legumes - for example, beans - feature in the Mediterranean Diet and count as one of the WHO daily fruit and vegetable portions.

5. Traditional Mediterranean people do not like butter. Toast drizzled with a little olive olive oil, herbs and garlic is still a popular Mediterranean snack.

6. Sunflower oil is often used for cooking in the UK. It is a 'polyunsaturated fat' that is healthier than saturated animal fats.

7. For many years people were advised to restrict the number of eggs they ate, as the yolk contains high levels of cholesterol. However it is now known that this has little effect on the levels of cholesterol in your blood.

If you'd like to try the full Mediterranean Diet at home, the pyramid above has been copied into this handy tick chart of food to be consumed through the week.

Portions

Using the tick chart for several weeks helps to educate the eyes and palate in what to buy and cook, as well as what to avoid. Over time, the healthy Mediterranean Diet can become a natural part of your way of life and, indeed, part of you. It's probably the closest science can currently get to a 'user guide' for fuelling the human body.

Original Author:
Dr Gordon Brooks
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Last Checked:
13/06/2013
Document ID:
9222 (v4)
© EMIS
The Information Standard - certified member