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Mediterranean Diet Guide

The best-researched eating pattern in the world, made practical. See what the trials found, score your own diet in 2 minutes, then use the food guide and 20 recipes to eat the Mediterranean way.

Unlike most diets, this isn't about cutting out food groups. It's about eating more vegetables, legumes, whole grains, fish, nuts and olive oil. Take the 2-minute diet score →

What is the Mediterranean diet?

It's the traditional way of eating in countries around the Mediterranean Sea, such as Greece, southern Italy and Spain, as it was in the 1950s and 60s. Researchers noticed these communities had remarkably low rates of heart disease.

It's a pattern, not a strict plan. Plenty of vegetables, fruit, legumes, whole grains and nuts. Extra virgin olive oil as the main fat. Fish and seafood several times a week. Moderate yoghurt, cheese, eggs and poultry. Red meat and sweets only occasionally. Meals are often shared and unhurried.

There's no counting and nothing is banned, which is a big reason people find it easy to stick with.

OccasionallyRed meat, sweets
A few times a weekPoultry, eggs, cheese, yoghurt
2–3+ times a weekFish & seafood, legumes
Every mealVegetables, fruit, whole grains, olive oil, nuts, herbs & spices
Every dayWater, physical activity, shared meals

Based on the Mediterranean diet pyramid (Oldways and the Mediterranean Diet Foundation).

What does the research actually show?

The Mediterranean diet is backed by large randomised trials, not just population studies. That's rare in nutrition science. Tap a topic to open it.

Strong consistent results from randomised trials Moderate good trials, some limits Promising smaller or early trials
Estruch et al., 2018 — New England Journal of Medicine ("PREDIMED")
Randomised controlled trialn = 7,447 adults at high heart riskMedian 4.8 years

People told to follow a Mediterranean diet with extra olive oil (about 1 litre a week per household) or extra nuts (30 g a day) had about 30% fewer heart attacks, strokes and cardiovascular deaths than a group advised to eat low-fat. The hazard ratios were 0.69 for olive oil and 0.72 for nuts. Nobody was asked to cut calories.

An honest note: the original 2013 paper was retracted and republished in 2018 after problems were found with how some participants were randomised, such as households and whole clinics being assigned together. The re-analysis, which accounted for this, reached the same conclusion.

Delgado-Lista et al., 2022 — The Lancet ("CORDIOPREV")
Randomised controlled trialn = 1,002 people with heart disease7 years

In people who already had coronary heart disease, a Mediterranean diet led to fewer repeat cardiovascular events than a low-fat diet: 17.3% vs 22.2%, a risk about 28% lower. The benefit was clearest in men, who made up 82% of participants.

de Lorgeril et al., 1999 — Circulation ("Lyon Diet Heart Study")
Randomised controlled trialAbout 600 heart attack survivors46 months

A Mediterranean-style diet was linked to a 50–70% lower risk of repeat heart problems compared with a usual Western diet, even though cholesterol levels were similar in both groups.

Takeaway: this is the best evidence we have that what you eat, not just how much, can prevent heart attacks and strokes.
Salas-Salvadó et al., 2014 — Annals of Internal Medicine (PREDIMED sub-study)
Subgroup of a randomised trialn = 3,541 without diabetesMedian 4.1 years

Fewer people developed type 2 diabetes on the Mediterranean diets: 6.9% with olive oil and 7.4% with nuts, compared with 8.8% on low-fat. The olive oil group's risk was about 40% lower. This happened without calorie restriction or extra exercise.

Gardner et al., 2022 — American Journal of Clinical Nutrition ("Keto-Med")
Randomised crossover trialn = 33 with prediabetes or type 2 diabetes12 weeks each diet

A Mediterranean-style diet improved HbA1c almost as much as keto (−7% vs −9%, not significantly different). It lowered LDL cholesterol, whereas keto raised it, and people found it easier to keep up afterwards.

Takeaway: a strong, sustainable option for blood sugar. If you take diabetes medication, it's still worth telling your GP when you change your diet.
Jacka et al., 2017 — BMC Medicine ("SMILES" trial, Deakin University)
Randomised controlled trialn = 67 adults with major depression12 weeks

Run in Geelong and Melbourne. Adults with moderate-to-severe depression either had seven sessions with a dietitian on a modified Mediterranean diet, or social-support sessions. 32% of the diet group reached remission, compared with 8% of the social-support group. That's roughly one extra remission for every four people helped.

Takeaway: exciting, but it was a small trial. Diet can be a helpful addition to treatment, but not a replacement for it. If you're struggling, talk to your GP.
Shai et al., 2008 — New England Journal of Medicine ("DIRECT")
Randomised controlled trialn = 3222 years (85% completed)

A calorie-reduced Mediterranean diet led to 4.4 kg of weight loss over two years. That's nearly identical to low-carb (4.7 kg) and better than low-fat (2.9 kg), and it gave better blood sugar results in people with diabetes.

In PREDIMED, people didn't gain weight despite eating lots of olive oil and nuts, which are high in calories. Olive oil still counts, though: 4 tablespoons is about 480 kcal. If weight loss is your goal, use it instead of other fats, not on top of them.

Takeaway: for weight loss you still need to eat a bit less overall. But the Mediterranean pattern makes that easier to sustain than most diets.

The bottom line

  • The Mediterranean diet has the strongest trial evidence of any eating pattern for preventing heart attacks and strokes.
  • It helps prevent and manage type 2 diabetes, and early trials, including an Australian one, suggest benefits for mood.
  • Nothing is banned and there's nothing to count, so it's one of the easiest diets to stick with for life.
  • The key habits: olive oil as your main fat, vegetables and legumes daily, fish 2–3 times a week, nuts most days, and red meat and sweets as occasional extras.

References

  1. Estruch R et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 2018;378:e34 (retraction and republication of 2013 paper).
  2. Delgado-Lista J et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet 2022;399:1876–85.
  3. de Lorgeril M et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779–85.
  4. Salas-Salvadó J et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med 2014;160:1–10.
  5. Gardner CD et al. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin (Keto-Med). Am J Clin Nutr 2022;116:640–52.
  6. Jacka FN et al. A randomised controlled trial of dietary improvement for adults with major depression (the "SMILES" trial). BMC Med 2017;15:23.
  7. Shai I et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229–41.
  8. Schröder H et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 2011;141:1140–5.
  9. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol, 2020.

Frequently Asked Questions

It can be. In the two-year DIRECT trial, a calorie-reduced Mediterranean diet produced about the same weight loss as low-carb (4.4 vs 4.7 kg) and more than low-fat. Its bigger strengths are heart health and how easy it is to stick with. For weight loss, keep portions sensible and use olive oil and nuts instead of other fats, not in addition.

In PREDIMED, the olive oil group was given about a litre a week per household, and the diet score awards a point for 4 tablespoons a day or more. That's a lot of calories (about 480), so for most people the practical advice is: make extra virgin olive oil your only added fat, and use it generously on vegetables, salads and in cooking.

No. The benefits of the diet don't depend on alcohol, and no health authority recommends starting to drink. If you do drink, Australian guidelines are no more than 10 standard drinks a week and no more than 4 on any day. Our diet score lets you skip the wine question.

Yes. It's built on some of the cheapest foods in the supermarket: tinned legumes and tomatoes, oats, seasonal vegetables, frozen berries, eggs and tinned fish. Meat plays a smaller role, which usually lowers the shopping bill. Buy olive oil in large tins, and nuts in bulk.

It's one of the most recommended patterns for it. It replaces saturated fat (butter, fatty meats, pastries) with unsaturated fats from olive oil, nuts and fish, and adds plenty of fibre from legumes and oats. In the Keto-Med trial, LDL fell on the Mediterranean diet but rose on keto. Keep taking any prescribed medication.

Keto and Atkins cut carbohydrates hard, especially at the start. The Mediterranean diet keeps whole-grain carbs, fruit and legumes, and focuses on the quality of fats and carbs rather than the amount. For heart attack and stroke prevention it has much stronger long-term evidence. For fast early weight loss or blood sugar control, low-carb diets can work faster. See our Keto and Atkins guides to compare.

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Keto Diet Guide Atkins Diet Guide Carnivore Diet Guide Fat Loss Evidence Guide Energy & Macro Planner
Disclaimer: This guide is general information based on published research. It is not medical advice and doesn't replace advice from your GP, specialist or an Accredited Practising Dietitian. If you have a medical condition, take medication, or are pregnant, talk to your health professional before making big changes to your diet. Nutrition values are estimates.