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The Mediterranean Diet Has Ranked #1 For Seven Years In a Row—What Makes It So Effective?

Tanja Ivanova

In its annual Best Diets ranking, U.S. News and World Report has awarded the top spot to the Mediterranean diet for the seventh year in a row. According to the publication, this style of eating—inspired by the eating habits of people living in the Mediterranean region—has such serious staying power because it’s easy to follow long-term and has been shown to support heart health, bone, and joint health, and help prevent certain diseases, such as diabetes.

But “diet” is really a misnomer, says Maya Feller, MS, RD, CDN, author of Eating From Our Roots and a member of U.S. News and World Report’s Best Diets expert panel. “It's less of a diet, more of a lifestyle, an eating pattern,” she says. “[It] can be customized based on the individual's likes, dislikes, personal preference, religious needs, and access.”

“The Mediterranean diet is really a long-term dietary lifestyle…versus another kind of restrictive time-period diet,” agrees Maggie Berghoff, a functional medicine nurse practitioner and author of Eat to Treat. Rather than cutting out certain food groups or counting calories, “it focuses on [eating] a lot of healthy fats, healthy oils, and plant-based foods,” she says.

What Is the Mediterranean Diet?

The Mediterranean diet started to gain attention as a healthy way of eating in the 1950s, when scientist Ancel Keys, PhD, of the the University of Minnesota School of Power discovered a correlation between eating habits, lifestyles, and cardiovascular health.

“What the research found was that people who followed Mediterranean patterns of eating actually tended to have better cardiovascular profiles, so lower cholesterol, better lipid markers, good cholesterol,” says Feller.

Dr. Keys didn’t invent the Mediterranean diet, of course; he simply began to popularize a way of eating and enjoying food that people in the Mediterranean had been following for centuries. “The biggest tenets of that are seafood; lean proteins in the form of beans, nuts, and seeds; whole grains; ancient grains; fermented dairy; fruits,” says Feller. “And then alcohol is consumed in moderation.”

When looking for inspiration for your Mediterranean menu, Feller says it’s important to consider all 22 countries that surround the Mediterranean Sea—not just Greece, Italy, and France.

“The countries of North Africa and the Middle East are not often highlighted [when talking about the Mediterranean diet], when in fact, their patterns of eating are credible and really centered on legumes, grains, seeds, fermented dairy, and really interesting types of fruits,” she says. “We often are told: cucumber, feta, olives, tomato, and red onion—that's the Mediterranean diet. Yes, that's wonderful, but it could also be couscous and chickpeas in a curry with berbere. There's so many different ways that it can show up.”

Mediterranean Diet Foods

Great news, folks: With the Mediterranean diet, it’s a very “you do you” approach to healthy eating. That being said, the Mediterranean lifestyle does encourage you to load your plate with particular foods and food groups.

  • Fresh fruits and vegetables: According to Cleveland Clinic, you should have at least one serving of veg per meal.

  • Seafood: The Mediterranean diet emphasizes seafood and poultry protein sources; fish in particular, is a great source of heart-healthy omega-3s.

  • Healthy fats and oils: Extra-virgin olive oil is touted as the Med diet’s hero, but Berghoff says that other oils, such as walnut and pecan oil, are also rich in healthy polyphenols.

  • Legumes: Pulses and legumes like lentils, beans, chickpeas, and peas are great sources of protein, fiber, and healthy fatty acids—and the Med diet encourages you to eat them multiple times a week.

  • Nuts, seeds, and grains: Whether you’re eating ‘em as a snack, sprinkling them on your salads, or making a bowl of whole-grain cereal, add in nuts.

  • Fermented dairy: While the Med diet recommends reducing your overall dairy intake to once a day, Feller says that folks in the Mediterranean reap the gut-healthy benefits of fermented dairy like yogurt and goat cheese.

Foods to Avoid When Following the Mediterranean Diet

Alcohol should be consumed in moderation, if at all, on the Mediterranean diet, says Feller.

Wine is not a health food, let’s be clear. But there is research to support that a “Mediterranean way of drinking”—or drinking no more than one glass of wine per day with food—may have certain health benefits for adults over 35, including reduced risk of cardiovascular disease.

In addition to alcohol, the Mediterranean diet asks you to limit ultra-processed foods, refined carbohydrates, and foods that are super high in sugar (excluding fruits), says Berghoff.

Benefits of the Mediterranean Diet

According to Berghoff, many of the Mediterranean diet’s health benefits stem from the ways this eating style reduces inflammation within the body. On the one hand, you’re cutting back on foods that are known to cause inflammation, such as high-sugar foods, highly processed foods, red meats, and alcohol, she says. On the other, you’re increasing the amount of inflammation-reducing foods you’re eating, including plants, omega-3 fatty acids, and monounsaturated fats (largely from olive oil).

What can this do for the body, more specifically?

1. Promotes Heart Health

As mentioned, the original draw to the Mediterranean diet for many people was the research that supported its positive impact on heart health. And since Dr. Keys’s work in the 1950s, new studies have continued to support the Med diet’s ability to improve cardiovascular fitness.

In one study published in 2013, approximately 7,500 people with a high risk of cardiovascular disease in Spain were asked to either follow a Mediterranean style of eating or a controlled diet. After following the participants for nearly 5 years, the diet’s impact was clear (so clear, in fact, that the study was ended early): for those following the Mediterranean diet, the risk of cardiovascular disease was reduced by 30 percent.

The American Heart Association also supports the Mediterranean diet, saying: “This style of eating can play a big role in preventing heart disease and stroke and reducing risk factors such as obesity, diabetes, high cholesterol and high blood pressure.”

2. Supports Healthy Blood Sugar Levels and Reduces Risk of Diabetes

“What the current research says is that a plant-forward type of eating is also supportive when it comes to blood sugar management,” says Feller.

A 2017 meta-analysis of studies that included a total of 1.5 million people found that the heart-friendly Mediterranean diet has a “strong potential for preventing diabetes.” In 2020, research published in the journal Nutrients concluded that following a Mediterranean-style diet was effective for reducing HbA1c (or blood glucose) levels and could also play a role in managing the progression of type 2 diabetes.

3. Supports Bone and Joint Health

Recent research also shows that adhering to a Mediterranean diet that’s rich in anti-inflammatory and antioxidant nutrients can improve bone mineral density, muscle mass, and movement ability—and could, therefore, slow the onset of osteoporosis and sarcopenia (loss of muscle strength).

4. Protects Against Certain Cancers

According to the National Foundation for Cancer Research, the Mediterranean diet has been shown to reduce cancer-related deaths and also play a role in preventing certain cancers, including colorectal, breast, stomach, pancreas, prostate, and lung.

“There is some compelling research around high intakes of plants as well as seafood-rich patterns of eating [having an impact on] some cancers. So this is thought to be an anticarcinogenic pattern of eating,” says Feller.

Feller also makes clear, however, that while the Mediterranean diet may be protective against some cancers, it is not a cure for cancer.

5. Supports Longevity

Put all these benefits together, and you’re looking at the potential to live a longer, healthier life. In fact, two of the original five Blue Zones—or regions that are home to the longest-living people in the world—are within the Mediterranean: Ikaria, Greece and Sardinia, Italy.

What Lifestyle Habits Are Part of the Mediterranean Diet?

We’ve said it before, but we’ll say it again: The Mediterranean diet is more of a way of life than an actual diet.

According to Feller, a Mediterranean approach to food focuses on seasonal ingredients and slow food—and she means slow literally. “A lot of these dishes take a long time to make!” she says. “Think about fermented dairy…[fermentation] is a process.”

Taking time to create and enjoy your meals comes with another benefit: connection. “When we eat in community, we generally tend to be happier and do better,” says Feller.

Beyond eating habits, Berghoff says that a Mediterranean lifestyle encourages physical activity. “[It doesn’t require] a specific workout, just generally moving your body and being a more active person,” she says.

How to Follow the Mediterranean Diet Mindfully

One of the best things about the Mediterranean diet is its “choose your own adventure” approach to eating. But because of this, Berghoff cautions, it’s important to get in touch with what makes your body feel and work in tip-top shape.

Take grains, for instance. Grains, including bread and pasta, are on the menu for the Mediterranean diet, Berghoff says, but not everyone can stomach them. “You want to be sure that you are paying attention to how you feel,” she says. If you’re experiencing bloating or irritated bowels, you’ll want to adapt your choices to avoid the foods that cause this discomfort.

With that in mind, if you’re interested in trying the Mediterranean diet, Feller recommends starting with foods you already know and love. “Think about what you’re eating: What are the vegetables that you like? What are the grains you like? What is the seafood that you like?” she says. “Go back to foods that [you] already eat and think about the ones that fit with [the Mediterranean diet’s criteria].”

Originally Appeared on GQ