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The “Mediterranean Diet”, A Misleading Term.

ByElena Paravantes, MS, RD

Mediterranean dietThere have been concerns regarding the definition of the Mediterranean diet. It has been noted that it is not clearly defined and that it reflects a variety of eating habits traditionally practiced by populations in countries bordering the Mediterranean Sea, with considerable variability by location.

This is concerning. The issue here is that the term “Mediterranean Diet” does not necessarily reflect the variety of eating habits from across the Mediterranean.

The term “Mediterranean Diet” is misleading and often a “loaded” term. Nowadays, when we talk about the Mediterranean diet, we talk about it as noted above, the traditional eating habits practiced by people living around the Mediterranean. As Registered Dietitian Rita Carey mentions in her article in Today’s Dietitian ” the Mediterranean diet… has become, for many, the de facto diet of anyone living in countries bordering the northern Mediterranean Sea.” But is it?

To answer that we need to look closely at what all these countries were eating traditionally, but also the research. Back when the Mediterranean diet was “discovered”, studies have focused on diets of specific countries mainly Italy, Greece and Spain, not all of the Mediterranean. We should not confuse Mediterranean Cuisine, Mediterranean Foods or even Mediterranean lifestyle with THE “Mediterranean Diet”. They are quite different things. Yes the Mediterranean Diet refers to a lifestyle, but also to a specific pattern of eating as a whole, not specific dishes or cuisine.

Evidence

When the first guidelines were developed back in the 90’s with  Harvard and the World Health Organization you will see that they clearly state “This Mediterranean diet pyramid is based on food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s”. This is an important point because it helps in developing more specific guidelines. Both countries have areas that are considered “Blue Zones” and when I look at the diet of the Greek Blue Zone on the island of Ikaria, I can say with certainty that their diet today, is the diet that most of rural Greeks had in the 60’s and even the 70’s.

In an email, Walter Willett, an American physician and nutrition researcher and Professor of Epidemiology and Nutrition at the Harvard School of Public Health, who was one of the developers of the original Mediterranean diet pyramid, told me this about the original Mediterranean Diet Pyramid: “we defined a specific Mediterranean Diet for which the documentation of benefit is most complete”, however he does add that there are variations. But that’s where it gets confusing. What are these variations? Sure the evidence exists for diets of specific countries mainly Italy, Greece and Spain, so yes there are are those varieties, but not so much if at all, on any of the other countries around the Mediterranean, (just take a look at the bibliography).

So I’m a bit surprised as to why the findings in specific countries would apply to more than a dozen other countries just because they border the Mediterranean. This is not what I would call evidence-based practice but generalizations. We just don’t know that much about the traditional diets (and their effect on health) of all these countries around the Mediterranean. So, for this reason, it may be more useful to refer to the specific variations we do know about, that way we can all be more specific when using the term Mediterranean diet.

A Dietary Pattern

Of course this does not mean that one cannot enjoy other Mediterranean dishes or recipes from all these countries, but they must adhere to that specific pattern, yes we are talking about patterns not individual dishes. It IS specific and it reflects the poor man’s diet of the time.

If we therefore get away from this idea that the Mediterranean Diet is the diet of all of the Mediterranean (which it is not), then we can move forward to more specific guidelines which can be helpful in providing consistency and reliability in research. And while this diet is not a manmade diet, and many believe it cannot be clearly defined, I believe it can and it is time to do just that.

Elena Paravantes, MS, RDN is a Registered Dietitian Nutritionist by the U.S. Commission on Dietetic Registration (CDR). She is an expert on the Mediterranean Diet. She has been active as a clinician, consultant, author and lecturer for 20 years, both in the U.S. and Greece. An expert on the Greek Mediterranean Diet, her interviews and articles have been published in many publications including CNN, U.S. News and World Report, Prevention, NPR, and Shape. Elena has collaborated with a number of organizations including Loyola University, Yale University, University of Missouri, Louisiana State University, and the American College of Greece. Elena earned her Bachelor of Science in Human Nutrition and Dietetics and her Bachelor of Liberal Arts and Sciences in Psychology from the University of Illinois at Chicago. She holds has a Master’s Degree of Science in Health Management.

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6 Comments

  1. In my experience, many people (wrongly) think of Italy when referring to the ‘Mediterranean Diet’- my father-in-law comes from Northern Italy where the climate and food is anything but typically Mediterranean (he wasn’t brought up on tomatoes, garlic, herbs or olive oil; all considered typically Italian)- and don’t get me started on olive oil, that really is a ‘loaded’ topic haha. Coming from a Greek Cypriot background, I may be biased but I prefer olive oil from either Cyprus or Crete as it tends to have that rich, dark colour and peppery flavour. I think Spanish and North African olive oil often gets overlooked which is a shame 🙂

    Reply

    1. Thanks Eva, Yes Northern Italy has a quite different diet than Southern Italy. That’s why the researchers mention specifically southern Italy when discussing the Mediterranean diet.

  2. Thank you for continuing to help get the Information right about the true Mediterranean style of eating. I recently took a book out of the library with an eating plan supposedly based on the Mediterranean diet. It placed meat or fish in almost every meal. Yes, there were vegetables, but not in the proportions that I would have expected. It went back to the library the next day.
    I continue to be intrigued by the amount of green leafy vegetables and herbs in this type of eating and I have incorporated much of that into my own diet.
    You are so right that many plans that call themselves the Mediterranean diet have nothing to do with the actual style of eating that has afforded longevity, good health, and other benefits to many of the people living in this area. One could eat many of the foods indigenous to countries around the Mediterranean in the wrong proportions and reap none of the benefits of the original diet.
    Meat once a week? Mostly vegetables? Good grains? Just a little fish? Lots of green herbs? A style of eating typical of very few places in the world and certainly not here in America. Keep up the good work.
    M B Corso

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  3. When we refer to the people of the island of Ikaria I think dietary habits count but it is more important their absolute lack of stress. Anyone who has visited the island knows what I mean.

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