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The Mediterranean diet has stood the test of time for a reason: It works

Jul 07, 2023Jul 07, 2023

Even if you’re not a fan of hummus, tabouli, or olives, it’s worth giving the Mediterranean diet a chance. Why? Because when it comes to the hierarchy of healthy eating patterns, the Mediterranean diet consistently comes out on top.

In 2023, U.S. News and World Report ranked it #1 overall, as well as giving it first place as the best diet for healthy eating and for being the best plant-based diet. It’s delicious and nutritious, and consuming it is associated with a variety of health benefits. It is also easy to follow and sustainable for the long haul. And you don’t need to live in a Mediterranean country or even leave home to adhere to the eponymous diet or reap its benefits.

“It seems to be the universal love donor—it has real foods, predominantly plants, and it offers pleasure,” says David Katz, a preventive medicine specialist, past president of the American College of Lifestyle Medicine, and co-author of How to Eat. “It captures the fundamentals of whole nutrition—it takes us out of the realm of quick fixes and into the realm of lifestyle. The Mediterranean diet has worked for generations and it works for lifetimes.”

It also happens to be associated with greater longevity: In a study in a 2023 issue of JAMA Internal Medicine, researchers compared the effects of adherence to several healthy eating patterns and found that people who closely followed a Mediterranean diet long term had a nearly 20 percent lower risk of dying prematurely from any cause over a 36-year period.

“Chronic diseases such as cardiovascular disease, cancer, type 2 diabetes, neurodegenerative diseases, and respiratory diseases are the leading causes of death,” Katz notes. “If you’re reducing the risk of these chronic diseases, you’re likely to live longer. The Mediterranean diet builds vitality and [helps prevent] chronic diseases that shorten our lives.”

The Mediterranean diet dates back to the 1950s when Ancel Keys, a physiologist from Minnesota, came up with the idea for the Seven Countries Study. The study brought together a team of researchers to investigate the associations between diet, other lifestyle factors, and cardiovascular disease in the U.S., Italy, Greece, Finland, The Netherlands, the former Yugoslavia, and Japan.

Besides finding links between people’s dietary patterns, their blood cholesterol levels, and their risk of coronary heart disease, the researchers also discovered that those who lived in certain countries around the Mediterranean Sea had lower rates of cardiovascular disease and premature mortality from any cause than participants who lived in other areas.

What these regions also had in common: People in Greece, Italy, and other Mediterranean countries consume diets that are rich in predominantly plant-based foods. The core foods include whole grains, fruits, vegetables, beans, legumes, nuts, seeds, herbs, spices, and healthy fats such as extra virgin olive oil. Moderate amounts of lean proteins (such as fish, seafood, and poultry) are encouraged, as are eggs, dairy products such as yogurt, and wine (red wine, in particular, with meals). By contrast, red meats and sweets are meant to be consumed less often. Over time, this healthy eating pattern came to be known as the Mediterranean diet.

“It’s a balanced diet—the principles are simple, and it’s not exclusionary, which is something a lot of people appreciate,” says Keith Ayoob, a dietitian in New York City and an associate professor emeritus of pediatrics at the Albert Einstein College of Medicine.

Indeed, this healthy eating pattern is inherently flexible. “The Mediterranean diet contains healthy elements from all food groups—whole grains, which are complex carbs, healthy fats such as olive oil and omega-3 fatty acids, and lean protein,” notes Nieca Goldberg, a cardiologist, and associate professor of medicine at the NYU Grossman School of Medicine. “There’s something for everyone in the diet.”

One reason the Mediterranean diet is considered the best is that it is among the most studied eating plans when it comes to health benefits. Research has found that adhering to a Mediterranean style diet is associated with a reduced risk of developing cardiovascular disease, type 2 diabetes, respiratory diseases such as chronic obstructive pulmonary disease, and neurodegenerative diseases (such as Alzheimer’s and Parkinson’s).

Besides helping to prevent neurodegenerative diseases, the Mediterranean diet has been found to lower the risk of age-related cognitive decline. In a study in a 2022 issue of JAMA Network Open, researchers investigated the effects over time of high or low adherence to the Mediterranean diet among more than 6,300 middle-aged or older Hispanic adults: Those who stuck closely to the diet had better overall cognition and a decreased level of learning and memory decline over seven years, compared to those with a low level of adherence.

“Certain nutrients found in these foods, such as antioxidants and omega-3 fatty acids, have protective effects on brain cells,” explains Lisa Mosconi, a neuroscientist and director of the Weill Cornell Medicine Alzheimer’s Prevention Program. “Research suggests that adherence to the Mediterranean diet is associated with greater brain volume and a reduced rate of brain atrophy, which are markers of healthier brain aging.” And recent studies show that by simultaneously targeting multiple mechanisms, the Mediterranean diet can prevent cell death and restore function to damaged neurons.

“The Mediterranean diet has been associated with several mental health benefits, such as improved mental well-being, including lower rates of anxiety, depression, and better overall mood,” Mosconi notes.

In another study earlier this year , researchers compared the effects of various plant-based dietary patterns on mood, among 333 healthy participants, and found that those who stuck with a Mediterranean diet had a consistently more positive mood.

Meanwhile, following a Mediterranean diet has been linked with a decreased incidence of various forms of cancer, particularly, colorectal cancer, breast cancer, gastric cancer, liver cancer, head and neck cancer, and prostate cancer.

“It has also been associated with decreased recurrence among cancer survivors,” says Nathan Berger, a professor of medicine, biochemistry, oncology, and genetics, at the Case Western Reserve University School of Medicine in Cleveland. “While it’s never too late to implement a healthy lifestyle, the benefits of the Mediterranean diet have classically been associated with its lifelong practice.”

These are among the many reasons the Mediterranean diet has withstood the test of time. “It’s not a fad diet—it doesn’t make promises about weight loss in fifteen seconds,” Goldberg says.

But while weight loss isn’t an intended goal behind the Mediterranean diet, a study in a 2022 issue of the journal Nutrition Research found that adults who lost a substantial amount had an easier time maintaining their weight loss a year later than those who followed other dietary patterns.

Even among people who don’t lose weight, the Mediterranean diet can mitigate some of the risks that are linked with being overweight including non-alcoholic fatty liver disease.

There’s a lot of sound science that explains the benefits of the Mediterranean diet; it’s rich in antioxidant and anti-inflammatory agents such as unsaturated fats, vitamins C and E, folic acid, as well as phytochemicals (health-promoting compounds in plants) such as carotenoids, polyphenols, lycopene, and flavonoids. This is significant because “many of the processes involved in aging and in disease incidence and progression, especially in Western societies, are mediated by inflammation and oxidative stress,” notes Berger.

In general, “diet is a major determinant of our inflammatory states, and inflammation is widely viewed as the common denominator in every major disease,” Katz adds. This is true, he says, both directly and indirectly because the Mediterranean diet enhances the growth of beneficial bacteria in the gut, which reduces inflammation, according to research in the May 2023 issue of the journal Nutrients.

In addition, various food components within the Mediterranean diet—such as mono- and polyunsaturated fats, fiber, and phytochemicals in produce—can have a positive effect on insulin sensitivity. And mounting evidence suggests that the Mediterranean diet has a lipid-lowering effect; it protects against platelet aggregation (which can lead to blood clots); and it modifies hormones and growth factors that are involved in the development of cancer.

Many experts believe the Mediterranean diet is the optimal diet for most people because it is rich in micro and macro-nutrients, and it has anti-inflammatory and antioxidant properties.

It also happens to be good for the planet. “It’s clear that moving in the direction of eating more plants, not animals, has a lower environmental footprint and results in less total waste,” Katz says.

Besides using less water, land, and fertilizers than animal-based diets do, the Mediterranean diet reduces greenhouse gas emissions like carbon dioxide and nitrous oxide that contribute to climate change. In fact, a study in a 2023 issue of the journal Nutrients found that among mainstream modern diets, the Mediterranean diet, and the vegan diet have the lowest environmental impact.

Ultimately, the Mediterranean diet “is not only healthy for you,” Goldberg says, “but also for the planet.”