Hot Topics: The Mediterranean diet is here to stay

by Professor Catherine Itsiopoulos, APD PhD & Dr Hannah Mayr, AUSMED Heart Trial Research Group

The traditional Mediterranean diet dates back to ancient times (5000-2000 BC) when the key defining ingredients were the trio of wheat, wine and olive oil, as well as wild edible leafy greens and legumes. In more recent times, this dietary pattern has come to include a broad range of colourful fruits and vegetables including citrus fruits, tomatoes, chillies, eggplants, and potatoes which were introduced from South America to Europe in the 1500s by explorers such as Christopher Columbus.

The Mediterranean diet is a plant-based diet, incorporating a wide range of colourful fruits and vegetables, whole grains, legumes and olive oil

The traditional Archetypal Cretan Mediterranean diet was first described in the scientific literature by Ancel Keys and co-workers who investigated the link between diet and lifestyle behaviours and death from heart disease and all causes in the 7 countries study– the researchers found that the group from Crete had almost no deaths from heart disease after 15 years of follow-up which this was linked to their plant-based olive oil rich diet.

The traditional Mediterranean diet is described as a plant-based diet, with a plant to animal food ratio (by weight) of 4:1 – a typical Western diet has a plant to animal food ratio of 1:1. This dietary pattern is abundant in…

  • Fresh fruits and vegetables, especially leafy greens and tomatoes
  • Rich in legumes which are a key source of protein
  • Moderate in dairy with fermented dairy foods such as yoghurt and feta cheese enjoyed most days
  • Fish, specifically small fin fish, is eaten often, especially in areas surrounding the sea
  • Red meat , which is eaten moderately with game meats such as wild hare and free roaming goats preferred
  • Extra virgin olive oil is the main added fat and enjoyed in all cooked and fried meals and salads
  • Nuts, seeds, and dried fruit are often eaten as snacks in between meals
  • Wine is enjoyed in moderation and always with meals
  • Sweets which are eaten on special occasions only

Legumes are a key source of protein in the Mediterranean diet

The traditional Mediterranean diet is now the most researched dietary pattern worldwide and a recent ‘umbrella’ review of 13 meta-analyses of observational studies and 16 meta-analyses of randomised controlled trials investigating the link between adherence to a Mediterranean diet and 37 different health outcomes (covering more than 12.8 million people), has shown that adherence to a Mediterranean diet is protective against deaths from all causes, and from heart disease and stroke, diabetes, some cancers, neurodegenerative diseases and Alzheimer’s and other dementias2. The Mediterranean dietary pattern was recently awarded the best diet of 2019 by the US News and World Report3.

The review analysed 41 different diets and found the Mediterranean diet was the best diet for healthy eating, also emerging as the best plant-based diet, best diet for diabetes and easiest diet to follow.

The Mediterranean dietary pattern has recently been awarded the accolade of best diet of 2019 

Can we all benefit from the Mediterranean diet?

One major critique of the many Mediterranean diet studies to date, is that the majority of evidence in support of the Mediterranean diet in the prevention and management of chronic diseases comes from studies in the Mediterranean where people are already consuming a mostly Mediterranean-type diet. There is a perception that this diet won’t be easy for other populations outside the Mediterranean region to follow.

However in Australia, research teams have investigated the impact of a traditional Mediterranean diet in patients with fatty liver, diabetes, heart disease, asthma, depression and anxiety (refs) and have shown good adherence to this highly palatable dietary pattern and positive health outcomes.

In a recent pilot study of the Australian Mediterranean Diet Intervention in Secondary Prevention of Myocardial Infarction (AUSMED) Trial led by Dr Hannah Mayr (APD PhD),the impact of a Mediterranean diet was compared with a low-fat diet on classic and novel CVD risk factors following 6 months of dietary intervention5. The outcome was positive, showing that participants on the Mediterranean diet achieved high adherence to the Mediterranean diet at 6 months as highlighted below.

Participants improved their intake of whole grain cereals, fresh fruit, dairy (especially yoghurt), extra virgin olive oil, legumes, and fish. However, those following a low-fat diet didn’t significantly change their diets, which  indicates that a low-fat diet is more difficult to follow than a Mediterranean diet.

Study participants were easily able to follow a Mediterranean diet  for 6 months and improved their intake of whole grain cereals, fresh fruit and legumes

So how can we all enjoy a more Mediterranean diet?

The following 10 steps include the key foods and ingredients of a Mediterranean diet that can easily be incorporated into any eating style.

  1. Extra virgin olive oil as the main added fat
  2. Vegetables and salads with every meal >400g per day
  3. Legumes two-three times per week 100g each serve
  4. Fish/seafood twice a week >150g each serve
  5. Meat and chicken less often
  6. Whole grain breads
  7. Fresh fruit everyday
  8. Fermented dairy every day: yoghurt, kefir
  9. Nuts everyday – 30g per day
  10. Wine in moderation and always with meals

Studies have shown that a low-fat diet is more difficult to follow than a Mediterranean diet

So why not give the Mediterranean diet a go! It’s easier than you think – these deliciously easy Stuffed Capsicums need minimal prep or try this filling Chickpea & Spinach Soup from Professor Catherine Itsiopoulos. Take a look at our recipe section here for more inspiration.


  1. Keys et al. The Diet and 15-year death rate in the Seven Countries Study. Am. J. Epidemiol. 1986. 124 (6):903-15
  2. Mayr et al. Australian patients with coronary heart disease achieve high adherence to 6-month Mediterranean diet intervention: preliminary results of the AUDMED Heart Trial. Nutrition. 2019. 61, 21-31
  3. US News & World Report. 2018. U.S. News Reveals Best Diets Rankings for 2018. https://www.usnews.com/info/blogs/press-room/articles/2018-01-03/us-news-reveals-best-diets-rankings-for-2018

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