How To Follow a Mediterranean Diet

For decades, the word “diet” has gotten a bad rap, as fashion magazines and the weight-loss industry teach that the goal of dieting is to shed pounds. But it’s time to rebrand the word “diet” to mean what it is: an eating style.

While some eating styles focus on weight loss (many using unproven, unsafe methods), others focus on specific elements of your health. And time and again, research shows that when it comes to heart health and overall well-being, one eating style reigns supreme: The Mediterranean diet.

“Think of this way of eating as a lifestyle, not a short-term diet,” says registered dietitian Julia Zumpano, RD, LD. “It’s really about filling up your diet with single-ingredient foods that have so much nutritional benefit.” And it’s scientifically backed, too: The Mediterranean diet has been shown to be the healthiest diet for your heart, among other major health benefits.

Mediterranean diet rules

Loaded with fruits, vegetables, whole grains, fish, lean meats and olive oil, the Mediterranean diet focuses on plant-based foods and healthy fats while allowing for versatility and creativity. The goals? Long-term health and longevity.

“Studies of people living in the seven countries around the Mediterranean Sea show that they eat very similar foods, and they have lot fewer health problems,” Zumpano says.

We’ll delve deeper into the guidelines in each of the sections that follow, but here’s your easy, no-frills list of what to aim for when you’re following the Mediterranean diet:

• Fish: Three servings per week (one serving = 3 to 4 ounces).
• Extra-virgin olive oil: At least 1 tablespoon per day, but no more than 4 tablespoons per day.
• Fruit: Three servings of fruit per day (one serving = 1/2 to 1 cup).
• Vegetables: Three-plus servings per day (one serving = 1/2 cup cooked or 1 cup raw).
• Legumes: Three servings per week (one serving = 1/2 cup).
• Nuts: At least three servings per week (one serving = 1/4 cup or 2 tablespoons nut butter).                            
• Whole grains and starchy vegetables: Three to six servings per day (one serving = 1/2 cup cooked vegetables, one slice of bread or 1-ounce dry cereal).

Foods to eat

“The best thing about the Mediterranean diet is that people can follow it,” Zumpano says. “The reason people have followed this style of eating for so many centuries is that it focuses on whole foods that are relatively accessible.”

Here are the foods to incorporate into your life, how much of them to eat and some ideas for preparing them.

Fish high in omega-3s

Fish is a foundational source of protein in the Mediterranean diet. “We recommend eating fish at about three meals a week,” Zumpano says. “Any type of fish can play a role and be a good source of protein, but fish high in omega-3s have specifically been shown to suppress inflammation.”

Omega-3 fatty acids are “healthy fats” that are especially abundant in certain types of fish. They include:

• Salmon.
• Tuna.
• Herring.
• Mackerel.
• Sardines.

Of course, it’s easy to access fresh fish near the Mediterranean, where it’s the most abundant source of protein. It can be a little harder when you don’t live around a body of water, but frozen and tinned fish will do the trick, too.

Goal: Three servings per week (one serving = 3 to 4 ounces).

Other forms of protein

Remember: You should be eating fish three times a week on the Mediterranean diet. But what about the rest of the time?

“Skinless poultry, like white-meat chicken and turkey, are the second preferred choice of protein,” Zumpano says, “and then, the rest of your protein should come from plant-based sources.”

That means:

• Legumes: This category includes dried beans and lentils. “Again, variety is key,” Zumpano notes. “Add lentils to a salad instead of meat, make a bean soup or dip your veggies in hummus, which has tons of protein and fiber.” Aim for three servings per week (one serving = 1/2 cup).
• Nuts: Walnuts, almonds and hazelnuts are the nuts most commonly eaten in the Mediterranean region. “If you favor cashews or peanuts, try to mix them with these other nuts,” Zumpano suggests. Just mind your portion sizes, as the calories can add up quickly. Try for three servings per week (one serving = 1/4 cup or 2 tablespoons nut butter).
• Egg whites: There’s no recommended limit on how many egg whites you can eat per week, but eat egg yolks in moderation.
• Greek yogurt: There’s not much dairy involved in the Mediterranean diet, but Greek yogurt gets a pass because it’s so darn healthy.

Extra-virgin olive oil

You’ve got to cook your food in something, right? Head straight for the good stuff: Extra-virgin olive oil, also known as EVOO, has a ton of antioxidant properties. What makes olive oil “extra virgin”? The oil is mechanically pressed from olives without the use of chemicals or heat, which protects the phenols (a class of organic compounds) in it. The concentration of these phenols may provide extra antioxidant effects.

Antioxidants protect your body from cellular damage that can speed up the aging process and raise your risk of various diseases. And the polyphenols (plant-based antioxidants) in olive oil have been shown to protect against high cholesterol and high blood pressure.

Plus, olive oil is tasty, which is important when you’re trying to make any eating style a way of life. Use EVOO instead of vegetable oil and animal fats (like butter, sour cream and mayo), and drizzle it on salads, cooked veggies and whole-grain pasta.

“People who live in the Mediterranean use olive oil very freely, and it provides a lot of great flavor to their food,” Zumpano says. “Studies show that even though they’re using it quite generously, they don’t typically experience negative health consequences.”

Goal: Aim for at least 1 tablespoon per day, but no more than 4 tablespoons per day.

Fruits and vegetables

If you’re already a big fan of nature’s bounty, you’re going to love the Mediterranean diet! When you’re following this style of eating, you should have at least one fruit or veggie on your plate at every meal.

“Fruits and vegetables provide antioxidants, phytochemicals and phytonutrients,” Zumpano states, “and variety is key to maximize the nutrients you consume and their benefits.”

Mix it up and keep it colorful, experimenting with new-to-you fruits and vegetables and creative ways of preparing them. Zumpano suggests challenging yourself by including a fruit or veggie that you don’t eat on a regular basis to expand your palate.

Goal: Try to get three servings of fruit per day (one serving = 1/2 to 1 cup) and three or more servings of vegetables per day (one serving = 1/2 cup cooked or 1 cup raw).

Whole grains and starches

When you’re making Mediterranean-friendly choices, minimally processed is best — and in the case of grains, that means choosing whole-grain foods like oats, quinoa, barley and brown or wild rice.

“Processing grains strips them of their outside layers, and oftentimes, heat or chemicals are used to process grains into white flour-based products and snack foods, this process strips most of the nutrients,” Zumpano explains.

“That process kills off many of their best properties and nutritional benefits.” Instead, choose oats, barley, quinoa, brown rice, or a baked red skin or sweet potato. Eat whole-grain bread, cereal, couscous and pasta.”

Starchy vegetables that also fall into this category include:

• Red skin potatoes.
• Sweet potatoes.
• Peas.
• Corn.
• Winter squash (acorn, butternut, delicata, etc.)

Goal: You’ve got some wiggle room here, with a target of three to six servings per day. One serving is 1/2 cup of cooked starchy vegetables, 1/3 cup cooked pasta or rice, a slice of whole-grain bread or 1 ounce of dry cereal.

Limited dairy

We hate to be the ones to tell you to rein in your cheese habit, but the good news is that you don’t need to cut it out altogether.

“Cheese is one thing we really encourage limiting,” Zumpano says. “The recommendation on the Mediterranean diet is about 3 ounces of cheese a week, which isn’t a lot. Most people eat about 3 to 4 ounces of cheese daily!”

But there are healthy swaps to be made. She suggests eating natural, light or part-skim milk cheese and choosing milder varieties like cottage cheese, feta, fresh mozzarella, ricotta and goat cheese. As far as other dairy products go, choose skim or 1% milk and Greek yogurt, plain, or low-sugar yogurt. “Again, you still want to limit your portions,” she reiterates.

Goal: Aim for no more than 3 ounces of cheese per week, and make other smart swaps for full-fat dairy.

Healthier home-baked goods

It’s rare to find baked goods out in the wild that follow Mediterranean diet guidelines, but if you make them at home, you can find substitutes pretty easily. Look for nutrient-dense swaps, subs and adjustments.

“Try to find things that you can make at home that give you that same benefit and pleasure without having so many unhealthy ingredients,” Zumpano suggests.

When you’re making goodies like banana bread and cookies, for example, try these swaps:

• Go for whole-grain flour instead of bleached or enriched flour.
• Bake with liquid oil instead of solid fats.
• Use egg whites instead of whole eggs.
• Reduce the amount of sugar in the recipe, and/or use honey or fruit as sweeteners.

Zumpano also recommends dark chocolate as a dessert. Just be sure you choose 70% cocoa or greater for antioxidants and flavanols, which are related to the production of nitric oxide; it relaxes your blood vessels and improves blood flow, which also lowers blood pressure.

Foods to avoid or limit

In talking about what you should eat, we’ve already discussed a bit about the foods you should try to scale back on or cut out entirely when you’re eating a Mediterranean diet.

In short, Zumpano explains, “The Mediterranean style of eating doesn’t rule out a ton of foods except for things that are really processed — the stuff that, deep down, we know is probably not great for our health.”

Here’s a breakdown of what to stay away from or to significantly limit:

Red meat

When you’re following a Mediterranean diet, fish, poultry and plant-based protein should replace beef, pork, veal and lamb.

“If you have progressive heart disease, scale way back on red meat,” Zumpano advises, “but if you’re following the Mediterranean diet for overall heart health, red meat can be included in moderation.”

Aim for no more than a single, 3-ounce serving per week, and stick to lean cuts like tenderloin, sirloin and flank steak.

Refined flour products

Remember what we said earlier about processed grains? Bringing it back around, replace processed options like white bread, white rice, crackers, pretzels and pastries with healthier whole-grain options.

Full-fat dairy

Dairy isn’t a big part of a Mediterranean diet, but it can be difficult for dairy-loving North American eaters to make the switch.

Replace whole-milk dairy, cream and cream-based sauces and dressings with non-dairy options, when possible, and with fat-free or 1% dairy. Skip sugary, full-fat yogurt in favor of plain, lower-fat yogurts.

And nix the processed cheeses, too. We’re looking at you, American cheese — but many other cheeses fall into this category, too, including Swiss, gruyere, Colby, cheddar and any kind that you spread, squeeze or buy in a bag. Turn instead to light, mild cheeses.

Egg yolks

Egg yolks have saturated fats that can raise your cholesterol. Most healthy people can eat up to four to six egg yolks per week while following a Mediterranean diet, but to get some of the benefits of eggs without the negatives, stick to egg whites whenever you can.

Commercial baked goods

Packaged cakes, cookies, donuts and other desserts are loaded with sugar and refined carbohydrates, with little to no nutritional value.

“There’s not much room in this eating style for commercial baked goods,” Zumpano says. “For special occasions, sure, but not on a regular daily or even weekly basis.”

Fried foods

Chicken nuggets and mozzarella sticks aren’t big in the Mediterranean! Stick to baking, broiling, roasting and grilling your foods, and avoid the urge to fry — though the exceptions are air-frying and pan-frying, which can be both delicious and healthy.

“There’s definitely something to be said for pan-fried fish,” Zumpano adds. “It adds a nice, crispy flavor on the outside.”

Just be sure to keep the heat low, use a little EVOO and then pop the lid onto your pan for a few minutes to achieve the crispiness you crave. You can even use whole-grain bread crumbs, ground flaxseeds or almond flour to incorporate a bit more fried flavor without all the fat and calories of traditional frying methods.

Benefits of following the Mediterranean diet

We almost never say this, but for once, it’s true: This is one style of eating with no discernible downsides. “It has so many positive benefits that any small step toward the Mediterranean time is a step in the right direction,” Zumpano says.

Here are some of those proven benefits:

• Protects your heart: This cardiologist-recommended diet has been proven time and again to be the healthiest for your heart. A 2018 study found that people who followed the Mediterranean diet for five years had a 30% lower risk of heart attack, stroke and cardiovascular-related death than those who ate a low-fat diet during the same time.
• Reduces inflammation: The Mediterranean diet is a type of anti-inflammatory diet. “Inflammation degrades our body’s ability to work at peak capacity, which eventually leads to disease,” Zumpano explains. “But this eating style creates anti-inflammatory chemicals and enzymes that work to suppress inflammation and protect your body.”
• Lowers your risk for certain diseases: Inflammation raises your risk of dementia, cancer, gut-related health concerns and more. But reducing inflammation, like by eating a Mediterranean diet, reduces that risk.

The Mediterranean diet is also associated with better brain function, stable blood sugar, a healthy gut and a lower risk of certain cancers — all good things, and all associated with longevity.

How to start the Mediterranean diet

It’s worth reiterating: This isn’t some short-term fad diet with strict rules and restrictions. The Mediterranean diet is a lifestyle, a way of eating that’s meant to stick with you for the long term — so you don’t have to feel beholden to stressful, stringent guidelines that seem impossible to follow.

Start by incorporating a fruit or vegetable into every meal and exchanging processed snacks for healthier ones. It’s OK to stay within your comfort zone at first, but as you get comfortable, begin experimenting with new ingredients and recipes to expand your options.

“There’s so much variety that you can find something you enjoy in each food category and start there,” Zumpano encourages. “Then, start to get a little bit more adventurous by adding new food choices and variety.”