The Mediterranean Diet Is Hailed as the Gold Standard. But Should It Be?

U.S. News and World Report recently ranked the Mediterranean diet as the best diet for the fifth year in a row. People living in countries that border the Mediterranean Sea generally maintain “an active lifestyle, weight control, and a diet low in red meat, sugar, and saturated fat, and high in produce, nuts and, other healthful foods,” according to the report.

Studies have shown that the Mediterranean diet can support heart health and may reduce the risk of type 2 diabetes. This diet is also recommended by the American Heart Association, U.S. Departments of Agriculture and Health and Human Services, and the Academy of Nutrition and Dietetics.

“The Mediterranean diet is a style of eating that places emphasis on vegetables, whole grains, nuts, lean proteins, and is primarily plant-based,” Cara Harbstreet, MS, RD, LD, a registered dietitian and founder of Street Smart Nutrition, told Verywell.

A new study even suggested that following a plant-based, minimally processed diet, similar to the Mediterranean diet, could add years to your life.

Although the Mediterranean diet is called a “diet,” Harbstreet said it’s more of a lifestyle or eating pattern.

“Unlike other diets of the modern era, there are few restrictions or strict guidelines for portion sizes, calorie counting, or other hard and fast rules,” she said. “It’s often seen as more of a ‘lifestyle’ than a true diet, especially because many people who choose to follow this eating pattern don’t necessarily initiate it for the explicit purpose of weight loss.”

However, some experts said that labeling the Mediterranean diet as the gold standard might end up marginalizing people with different food cultures.

“Almost all cultural diets have foods that are also correlated with health. We need to stop comparing or trying to come up with some gold standard,” Kate Gardner Burt, PhD, RDN, an assistant professor at CUNY Lehman College and a culinary nutritionist, told Verywell. “We need to find a way to focus on the health aspects of all diets rather than hold a white diet as the gold standard.”

If people feel excluded from dietary research or recommendations, they aren’t going to follow meal patterns that don’t align with their eating patterns, Burt explained.

In 2021, Burt published a paper arguing that using the Mediterranean diet as the gold standard “marginalizes people from non-white cultures by maintaining white culture as normative.”

Burt wrote that promoting the Mediterranean diet reflects a bias towards white food in the American healthcare industry. The Mediterranean Diet Pyramid, mostly authored by white men, was based on solely Italy and Greece while excluding members from Middle Eastern and African countries that are also in the Mediterranean region.

“In doing so, the International Scientific Committee has literally and figuratively othered most non-European Mediterranean countries,” Burt wrote.

Oldways, the nonprofit that developed the Mediterranean Diet Pyramid, argued that its pyramid illustration did include beans and pulses, the diet staples associated with the Middle East and North Africa.

What Is the Mediterranean Diet?

Physiologist Ancel Keys was the one of the first to suggest associations between diet quality and health outcomes in the 1940s, Harbstreet explained. Keys observed Greece and Italy in his Seven Countries Study and concluded that the dietary and lifestyle practices in these Mediterranean countries contributed to the low rates of heart disease in the population.

Keys promoted this diet to the American audience in a few books he co-authored with his wife, including the 1975 bestseller How to Eat Well and Stay Well the Mediterranean Way.

The modern Mediterranean diet is based on Key’s findings. The recommended eating pattern includes:

• minimally processed, fresh, and local plant foods (including vegetables, fruits, whole grains, nuts, and legumes)
• olive oil
• cheese and yogurt only in moderation
• fish and poultry in moderation
• limited amounts of red meat
• fruit for dessert on occasion
• wine in moderation

Incorporating Other Cultural Traditions Into the Mediterranean Diet

The Mediterranean diet is included in the most recent Dietary Guidelines for Americans.

While the Dietary Guidelines notes that its dietary recommendations can be adjusted to “reflect personal preferences, cultural traditions, and budgetary considerations,” the only “cultural” diets specifically outlined in the guidelines are the Mediterranean-style dietary pattern.

Harbstreet said some of the foods in the Mediterranean diet can be inaccessible, such as fresh produce, seafood, and plant-based proteins. In the Dietary Guidelines, there’s also the “near-complete omission of Latino, Asian, Middle Eastern, and African cuisines that include many of the same foods recommended in the Mediterranean diet,” she added.

“When the construct of the Mediterranean Diet is uplifted as the pinnacle of ‘healthful eating,’ the implied comparison positions any other culture or cuisine as ‘other.’ When that becomes the default, other food cultures and traditions start to slip, and public opinion starts viewing them as inadequate and undesirable,” Harbstreet said.

Many nutrition professionals are working to make dietary recommendations more inclusive and culturally appropriate.

Grace Derocha, MBA, RD, a spokesperson for the Academy of Nutrition and Dietetics, said the Mediterranean diet calls for less red meat, sugar, and processed food, which are translatable to other diets.

“There are ways to play with what is part of your culture and the foods that you eat and the flavor profiles that you like,” Derocha said, adding that individuals can incorporate cooking methods, spices, and herbs from their own culture into the framework of the Mediterranean diet to make a “fusion” that works for them.