Why is the Mediterranean diet (still) named healthiest in 2022?

What we should eat for optimal wellness is a continual debate in health communities. Unfortunately, conflicting information, new research results, and persuasive marketing can make nutrition advice confusing. Earlier this year, U.S. News & World Report ranked the Mediterranean diet number one in their "Best Diets Overall" for the fifth year in a row, with good reason. And just because it has the word "diet" in the name doesn't mean it's a restrictive regimen for weight loss — though it's possible to lose weight by following its principles. Instead, the Mediterranean diet is more of a nutritious, well-balanced way of eating. 

One of the most accessible things about following the Mediterranean diet is that you won’t be expected to eliminate entire food groups. You can expect is a big emphasis on vegetables, fruit, lean protein, whole grains, nuts, and seeds, all of which aligns with growing evidence that the healthiest ways to eat are mainly plant-based.¹

Also, if you’re mindful of the environmental impact of your food choices, one study found that the Mediterranean diet (MedDiet) had the smallest footprint of all dietary approaches, especially compared to a typical Western diet that’s heavy on animal-based and processed foods.²

What is the Mediterranean diet? 

The MedDiet gets its name from the characteristic eating behaviors of those near the Mediterranean Sea. It’s a dietary pattern associated with the cuisine in parts of Greece, Italy, Spain, and Turkey. 

Historically, Mediterranean countries have tended to have the healthiest populations in the world.³ ⁴ Their residents are known to researchers for having:

  • High life expectancy

  • Low cancer rates

  • Low rates of cardiovascular disease (the leading cause of death globally)

For these reasons, Mediterranean populations are the subject of ongoing scientific interest surrounding the potential health benefits of the MedDiet. Some studies have focused particularly on the traditional diets in the early 1960s in Greece, Crete, and Southern Italy.⁵

A classic MedDiet is abundant in plant-based foods, including vegetables, fruit, beans, nuts, and seeds. Fruit is a go-to dessert over refined sweets. Olive oil is the primary source of fat, and dairy consumption is limited. Traditionally, fish, poultry, and wine are consumed in low to moderate amounts, with very minimal intake of red meat and processed foods. 

Ranking the healthiest diet 

Since 2018, the Mediterranean diet has been voted the Best Overall Diet by U.S. News & World Report for five consecutive years now. Improved longevity and lower incidence of life-shortening diseases are all part of what led to the MedDiet being voted the best across many categories.

In 2022, U.S. News & World Report also ranked the Mediterranean Diet the Best Plant-Based Diet, the Best Heart-Healthy Diet, Best Diabetes Diet, Best Diet for Healthy Eating, and the Easiest Diet to Follow. 

The rankings are determined by a panel of nutrition, heart health, diabetes, and weight loss specialists. The panel analyzes 40 popular diets, then ranks them according to detailed criteria.

Why is the Mediterranean diet so healthy?

Researchers have studied MedDiet for many years and found ample evidence of its varied health benefits. The advantages range from its followers experiencing less chronic disease overall to having a longer lifespan. 

Here are some of the most notable MedDiet impacts researchers have found so far:

Reduced cardiovascular disease

One person dies from coronary heart disease every 36 seconds in the US.⁶ Heart disease is the leading cause of death around the globe. Researchers are immensely interested in investigating and understanding lifestyle factors that influence and reduce the chances of developing heart disease.

Many studies have found links between reduced risk of heart disease and consuming a MedDiet⁷. Research shows that a Mediterranean-style, vegetarian, or plant-based diet is the top eating approach for reducing the risk of cardiovascular disease.⁸

A 2017 umbrella review across meta-analyses found robust evidence between following the MedDiet and a reduced risk of overall mortality, cardiovascular diseases, and coronary heart disease.⁹ A multi-center trial found that participants at high cardiovascular risk who followed a MedDiet with olive oil or nuts had a 30% reduction in the rate of major cardiovascular events, such as stroke. This was in comparison to the control diet group which reduced fat.¹⁰

Olive oil may play a vital role in MedDiet’s effectiveness. A 2014 meta-analysis found that elevated olive oil consumption was associated with a lower risk of all-cause mortality, cardiovascular events, and stroke.¹¹

Whatever approach to eating you take, research indicates that a heart-healthy way to eat will be high in fruits, whole grains, legumes, and non-starchy vegetables. It will also be low in trans-fats, saturated fats, sodium, red meat, refined carbohydrates, and sugar-sweetened beverages.”⁸

Link to lowered risk of diabetes 

According to the World Health Organization (WHO), an estimated 422 million people worldwide have diabetes, and 1.5 million deaths a year are directly attributable to diabetes.¹²

In 2014, two meta-analyses discovered a clinically relevant link between the eating patterns in the Mediterranean and a reduced risk of developing diabetes¹³ ¹⁴. Reviews in 2017 and 2018 had similar findings.⁹ ¹⁶

The American Diabetes Association has also highlighted the importance of dietary interventions for diabetes,  including the importance of following a Mediterranean style of eating to reduce blood pressure, improve stability of glucose levels, and avoid ultra-processed foods.¹⁷

Connection with lower cancer mortality

Data supporting the MedDiet as a preventative measure finds it somewhat beneficial when it comes to cancer risk. For example, a 2017 review found that the diet was associated with a decreased cancer rate. However, the authors note that the evidence was suggestive (weak) and warranted further study.⁹

However, a meta-analysis found that following a MedDiet reduced the incidence of (or mortality from) cancer by 6%.¹⁷

More recently, a systematic review in 2020 found that following the MedDiet was related to lower risk of cancer mortality in the general population and all-cause mortality among cancer survivors.”¹⁸

Reduced rates of depression 

Globally, at least 5% of adults are impacted by depression. It is one of the leading causes of disability worldwide.¹⁹

The MedDiet’s emphasis on plant-based foods may be related to reduced rates of depression within the Mediterranean population. 

An analysis of 41 different studies found that diets rich in plant-based foods (including the Mediterranean diet) were associated with a 33% reduction in rates of depression.²⁰

Improved cognitive ability 

A 2016 systematic review associated the Mediterranean way of eating with increased cognitive performance, including learning, decision-making, reasoning, and problem-solving abilities.²¹

A 2016 systematic review also found brain benefits linking the MedDiet to slower cognitive decline and a lower risk of Alzheimer’s disease. However, a limited number of studies have been completed. 

Dementia is an area where further research is required to study the links between cognition and diet impact.²²

Why the Mediterranean diet is great for weight loss 

High rates of obesity are a growing global concern. Data shows that obesity has tripled since 1975 with roughly 30% of the global population affected. It is also one of the leading causes of preventable death.²³ Many studies have found a link between those who eat a MedDiet and a lower risk for obesity.

A meta-analysis found that following a MedDiet was associated with a lower risk of obesity, metabolic syndrome, and type 2 diabetes.²⁴

One study in 2018 analyzed 32,000 participants over 12 years. The researchers concluded that following the MedDiet was associated with reduced weight gain and reduced increase in waist circumference.²⁵

In a five-year clinical trial with adults experiencing either Type 2 diabetes or an increased risk for cardiovascular disease participants ate either a:

  • Mediterranean diet with olive oil

  • Mediterranean diet with nuts

or

  • Control diet

The olive oil group didn’t experience a significant outcome, but individuals assigned the diet with nuts saw a reduction in waist size.²⁶

Starting the Mediterranean diet 

With such a wide variety of foods to choose from, many people find following a MedDiet turn out to be quite enjoyable.

Food and nutrition non-profit Oldways created the Mediterranean Diet Pyramid as a visual guide. 

The pyramid illustrates which foods to enjoy with every meal (whole grains, fruits, vegetables, beans, nuts, herbs, spices, and olive oil), in moderation (fish, dairy, eggs, poultry), and less often (meats and sweets). 

What to keep in mind

Focus on whole, plant-based foods 

A key feature of MedDiet is the emphasis on whole (unprocessed) plant-based foods, with fruits and vegetables making up the majority of what you eat. 

Many studies have shown that increases in fresh fruits and vegetables alone lead to better health outcomes. For example, a study of 200,000 patients found that the relative risk of cardiovascular disease was reduced by 4% with each serving of vegetables and 7% with each serving of fruit.²⁷

Another study in 2004 found that fruit and vegetable consumption is associated with lower blood pressure.²⁸ An additional study found that increased fruit and vegetable intake was linked with a lower body mass index (BMI).²⁹

Centering your diet around whole plant foods is a key component of the Mediterranean diet. 

Base meals on plenty of fruits, vegetables, whole grains (including brown rice, quinoa, wholegrain pasta, and wholegrain bread) legumes, nuts, seeds, herbs, spices, and olive oil.

Choose your protein wisely 

It’s important to keep in mind that protein isn’t just found in animal foods. It is also found in plant-based foods, particularly legumes like beans, peas, lentils, and nuts.

The MedDiet is characterized by limited animal proteins. Meat, particularly red meat, is avoided or only eaten in small portions, while seafood and fish are more central.

Replacing red meat-based meals with fish—especially cold-water fish like salmon, sardines, or herring—provides a source of Omega-3 fatty acids. Omega-3s are convey a wide range of health benefits, particularly for the heart.³⁰

Limit dairy 

While the Mediterranean diet does allow for small amounts of dairy, dairy is not promoted in the diet. It is worth considering limiting the amount you include in your diet. 

Instead of adding dairy to every meal, try smaller amounts for flavor, choose lower-fat options, or switch to plant-based alternatives. 

Cut back on processed foods

It’s no secret: highly processed foods aren’t conducive to general health—the MedDiet limits processed foods like refined sugars and flour. 

Cookies, donuts, and ice cream are for celebrations and not part of the regular diet. Instead, focus on fruits for dessert and use natural sweeteners like Medjool dates in sweet recipes. 

Choose unsaturated fats 

Olive oil is the main source of dietary fat in the studied Mediterranean regions. This has led to an interest in olive oil and its benefits. Olive oil is associated with a range of improved health outcomes.

Extra virgin olive oil, in particular, contains (poly)phenolic compounds, which have been heavily researched. Some studies have found links between the consumption of olive oil and a reduced risk of heart disease, some cancers, Alzheimer's, and diabetes.³¹ So, replacing other fats in your diet with olive oil can be beneficial. 

Less restriction, more abundance 

While many eating regimens are focused on restricting food groups or calorie intake, the MedDiet is an attractive option because it allows ample variety and nutrients.

In addition, the emphasis on whole, plant-based foods without banning anything outright can also make it relatively easy and realistic to stick with long-term. 

The MedDiet promotes consuming a large variety of plant-based foods daily in place of meats and processed foods. Healthy fats in the form of olive oil are also encouraged, and small amounts of animal protein in the form of fish and seafood are recommended. 

A Mediterranean way of eating is also effective for satisfying hunger because it is full of fiber-rich foods like vegetables and whole grains.

The lowdown 

With the longevity and overall decrease in disease associated with this eating pattern, it’s clear why the Mediterranean Diet has been voted the best diet for healthy living in 2022. It’s a relatively straightforward approach to eating. You won’t have to follow restrictive guidelines or count calories.

If you take up this diet vegetables, fruits, legumes, whole grains, nuts, and seeds will make up most of what you eat. Fish will be the preferred source of protein over poultry and red meat. Olive oil will be the primary source of fat in your diet, and sweets or processed foods are reserved for special occasions. 

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s).

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Sources:
  1. Nutritional update for physicians: Plant-based diets (2013)

  2. Environmental footprints of the Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet (2013)

  3. Healthiest Countries 2022 | World Population Review

  4. Cardiovascular diseases | World Health Organization

  5. Mediterranean diet pyramid: a cultural model for healthy eating (1995)

  6. Heart disease facts | Centers for Disease Control and Prevention

  7. Mediterranean diet and cardiodiabesity: A review (2014)

  8. A clinician's guide to healthy eating for cardiovascular disease prevention (2019 - NCBI)

  9. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials (2018)

  10. Primary prevention of cardiovascular disease with a mediterranean diet (2013)

  11. Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies (2014)

  12. Diabetes | World Health Organization

  13. Adherence to a Mediterranean diet and risk of diabetes: A systematic review and meta-analysis (2014)

  14. The effect of Mediterranean diet on the development of type 2 diabetes mellitus: A meta-analysis of 10 prospective studies and 136,846 participants (2014)

  15. A clinician's guide to healthy eating for cardiovascular disease prevention (2019 - Mayo Clinic)

  16. Lifestyle management: Standards of medical care in diabetes (2019)

  17. Adherence to Mediterranean diet and health status: meta-analysis (2008)

  18. An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer (2021)

  19. Depression | World Health Organization

  20. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies (2019)

  21. Mediterranean diet, cognitive function, and dementia: A systematic review of the evidence (2016 - Oxford Academic)

  22. Mediterranean diet, cognitive function, and dementia: A systematic review of the evidence - PMC (2016-NCBI)

  23. Most obese countries 2022 | World Population Review

  24. Mediterranean diet and cardiodiabesity: A systematic review through evidence-based answers to key clinical questions - PMC (2019)

  25. Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort (2018)

  26. Retraction and republication—Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial (2019)

  27. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies (2006)

  28. Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study (2004)

  29. Higher fruit consumption linked with lower body mass index | Google Scholar

  30. Omega-3 fatty acids | NIH: National Institute of Health

  31. Olive oil and prevention of chronic diseases: Summary of an International conference (2018)

Chloe Garnham is a writer exploring a broad range of topics, including healthcare, education, and technology.

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