Has the “Mediterranean Diet” Ever Existed?

Many of us believe we understand what the Mediterranean diet entails, and perhaps some of us even think we follow it. But does a “Mediterranean Diet” actually exist?

The Mediterranean diet divides opinion. Some present it as the diet that will make you live a long and healthy life. Others call it a myth, or even a load of nonsense. Having grown up and lived in various Mediterranean countries, we decided to get to the bottom of this mystery. Spoiler - its inception was more orchestrated than we might think.

The early days

In the 1950s, while enjoying a work vacation in Cilento, Italy, Ancel Keys, an American physiologist and nutritionist, observed that the communities he was visiting experienced fewer chronic diseases. Intrigued, in 1958, Keys embarked on a comparative study analysing dietary habits and the prevalence of cardiovascular diseases across seven different countries with cultures that contrasted in lifestyle, dietary preferences, risk factor levels, and, presumably, incidence of and mortality from chronic heart diseases: the United States, Finland, the Netherlands, Italy, Yugoslavia (now known as Croatia, Slovenia, Macedonia, Bosnia and Herzegovina, Montenegro and Serbia), Greece, and Japan.

His curiosity stemmed from the escalating incidence of cardiovascular disease in the United States, coinciding with shifts in lifestyle and diet. Most notably, the transition to urban living and reliance on supermarket foods rich in saturated fats, sugars, and animal products. Keys' investigation yielded some compelling evidence: Mediterranean populations, with diets akin to those he observed, exhibited lower rates of cardiovascular diseases than populations in other regions.

However, his findings weren’t without criticism. The scientific community accused Keys of cherry-picking countries and biased data collection to support his theories. In response, a group of biologists and nutritionists worked to carefully examine Mediterranean dietary cultures for commonalities and potential health benefits. Previously, interest in identifying similarities had been scant, with countries each championing their own distinctive culinary traditions.¹

Researchers observed that Mediterranean diets were often characterised by abundant cereals, legumes, fruits, vegetables, olive oil and oily fish, with sporadic consumption of products like cheese, eggs, and meat. Wealthier individuals tended to consume more meat, while fish was more prevalent on islands compared to mainland areas. Poorer and rural populations relied more heavily on cereals due to economic constraints, with meat reserved for special occasions.¹

When people refer to "THE Mediterranean Diet", these characteristics are likely what they're referring to. However, it's important to recognise that dietary practices vary across Mediterranean countries and regions, each with its own unique traditions and culinary landscapes.

A Spanish woman maintains a centuries-old tradition of roasting sweet peppers over an open fire to preserve the fruit. Photo by David Silverman via Getty Images.

The study that brought the evidence home

For years, scientists debated whether the Mediterranean diet really helped prevent heart disease. Then, in 2013, the PrediMed study grabbed headlines for its strong scientific evidence. Lasting five years, this clinical trial assigned 7,447 participants to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control group sticking to a low-fat diet. Importantly, all participants were deemed to be at high risk for heart disease.²

The research initially highlighted the significant health benefits of the Mediterranean diet. However, once again it wouldn’t take long for questions to arise about the study's methods, especially regarding how participants were assigned to different diet groups. Some researchers didn't ensure proper randomisation, instead grouping people from the same clinic or family into the same dietary plan. While these flaws don't completely discredit the study's results, they underscore the challenge of making broad generalisations about dietary advice for overall health.²

Practically, humans can survive and thrive thanks to a myriad of different dietary patterns. The Mediterranean diet is simply one of these.^1,2 But there is one thing that we can certainly conclude: dozens of studies show that, in general, following a diet rich in vegetables and whole grains and low in animal products is undeniably beneficial for our overall health.

Read more about how different diets impact longevity

What about sustainability?

In recent years, the environmental sustainability of the Mediterranean diet has come under the spotlight.³

As it is predominantly plant-based, it has long been celebrated for its relatively low environmental footprint compared to diets richer in animal products. This, in addition to its preference for local products from smaller producers, results in the diet showing a smaller contribution to greenhouse gas emissions and most likely also a minimised strain on water resources, and deforestation.⁴

A recurring concept in our exploration of sustainable and healthy dietary frameworks was the "Planetary Health Diet." Developed collaboratively in 2019 by 37 scientists of the EAT-Lancet commission, this global “reference diet” is symbolically represented by half a plate of fruits and vegetables, and the other half primarily consisting of whole grains, plant proteins (beans, lentils, pulses, nuts), unsaturated plant oils, modest amounts of meat and dairy, and some added sugars and starchy vegetables. The diet was developed combining requirements for optimal human health and sustainability, bridging planetary and human health.^5,6

Intrigued by its similarities, we compared the two diets and discovered a few striking resemblances, particularly in their emphasis on ample servings of fruits and vegetables and minimal consumption of red meat. It's almost as if the planetary health diet represents a nuanced iteration of the Mediterranean diet.⁴

For those of us residing in the Mediterranean, this revelation holds promise. It suggests that aligning with the principles of the planetary health diet could offer substantial benefits, both for our well-being and environmental sustainability. Now we just have to make sure we align with the Mediterranean diet itself.

Does the Mediterranean diet have a future?

In recent years, eating habits in southern Europe have changed a lot due to the influence of modern dietary trends driven largely by advertising and globalisation of our food systems. We've shifted away from the traditional Mediterranean diet, opting for more convenient and readily available food products. While this change has brought some positive effects, such as a decrease in undernutrition among Southern European populations due to better access to food, has also led to negative consequences.⁴ With growing affluence, there's been a rise in the consumption of meat, dairy, eggs and sugary foods, all contributing to health problems like obesity and heart diseases - now major concerns worldwide.⁴

This shift has also taken its toll on the environment and small-medium sized farmers, as they are one of the main benefactors of the economic support that comes with diets that consume and celebrate local produce.⁷

The Mediterranean diet faces new threats, especially in North Africa and the Levant. Factors such as ongoing conflicts, economic disparities, and cultural shifts are making it increasingly challenging for many people to access and afford this diet. Conflicts disrupt food supply chains, leading to food shortages and inflated prices. Economic disparities limit access to fresh, locally sourced ingredients, as processed foods often become more affordable options.⁸ And cultural shifts towards Westernised diets, influenced by globalisation and urbanisation, also play a role, as traditional dietary patterns are replaced by fast food and convenience meals.⁴

Recognising the value of threatened traditions, UNESCO listed the Mediterranean diet as part of humanity's intangible cultural heritage in 2010. Interestingly, UNESCO did not focus solely on the nutritional or sustainability aspects. Instead, it suggests that the Mediterranean diet embodies a particular relationship with food, characterised by a rich tapestry of rituals and traditions. These include communal meals shared with family and friends, seasonal celebrations centred around local produce, and culinary practices passed down through generations. There seems to be more consensus on what Mediterranean diets are when it comes to rituals and the relationship with food than when it comes to what exactly is on the plate.⁹ For UNESCO, the Mediterranean diet is not a series of rigid nutritional prescriptions to be strictly followed for weight loss or health. And its value is not just about the environment, which could also be addressed by other dietary models, such as vegetarianism or veganism. The Mediterranean diet may be more of an ideal than a reality, highlighting a particular relationship with food and, therefore, the world around us.

Today, a modernised version of that ideal could become a powerful tool: a form of resistance to an increasingly broken food system.