Torwen:
Hello and welcome back to the Ideal Nutrition podcast. My name is Torwen Eerkens, and I’m here today with my co-host, Aidan Muir. Today, we’re talking about the Mediterranean diet and whether we think it’s the gold standard for health.
Aidan:
So, the Mediterranean diet is a nutritional pattern modelled after the traditional eating habits of people in Mediterranean countries. Specifically Greece, Italy and Spain during the mid 20th century. Obviously, that timing is pretty key. It was before a large increase in certain food availability. It is also characterised by high consumption of plant-based foods and healthy fats.
Protein intake is moderate, with an above-average emphasis on fish and plant-based sources. It also includes lower intakes of red meat. Processed food intake is very low in general. It can also include lifestyle factors, such as social interaction during meals.
Torwen:
Now, there’s an array of benefits associated with the Mediterranean diet pattern. This includes a high intake of fibre, healthy fats and plant-based foods. It also includes a lot of minimally processed foods, which promotes a bit of an anti-inflammatory style diet. It does have proposed benefits for some specific conditions, which we’ll run through today as well. So, should we start with cardiovascular disease?
Aidan:
Absolutely. That’s the most well-documented one. So, it’s just a clear benefit of the Mediterranean diet. All the research kind of supports this. Even the first review I found, once again prepping for this podcast, was designed to critically analyse the research. It was a critical review. It was kind of positioned as, have we all been misled? Has the data been wrong?
A few people have found flaws in some of the more well-known studies on it. And even that review, which tried to address controversies, concluded the available evidence is large, strong and consistent. Better conformity with the traditional Mediterranean diet is associated with better cardiovascular health outcomes. This includes clinically meaningful reductions in a long list of things.
Torwen:
Yeah, so I don’t know if it’s the same review, but it looked at over 40 studies. Potentially a different one. It consistently showed 10 to 30% lower cardiovascular disease risk, especially with high adherence. That’s something that does come back, and we will talk about adherence. It seems the closer you adhere to this diet, the better the outcomes are.
Aidan:
Now, a nuanced one here is cholesterol. I have read a lot of studies where the Mediterranean diet didn’t really change people’s cholesterol. That was assuming they were weight neutral during the study. That happened even though there was a massive improvement in dietary quality.
I’ve sat through a lot of professional development seminars from people who exclusively study the Mediterranean diet. It seems like a common theme that the Mediterranean diet doesn’t necessarily improve this. I’ve had a fresh look at the research again. And my current sense is that, on average, people get a small improvement in cholesterol levels.
But not all studies show this. One thing that is super clear is that it does not seem to matter. It improves cardiovascular disease outcomes regardless. The main reason we care about cholesterol is for this outcome.
Torwen:
Anything else you wanted to add in terms of cholesterol, or should we chat about weight in general?
Aidan:
Yeah, let’s talk about weight.
Torwen:
Yeah. So this diet is interesting. It’s not necessarily used to support weight loss. Research does show it’s not necessarily better than other diets, such as lower-carb diets. But generally, it has high-fibre foods, high volume and less processed foods. It likely does promote a healthy weight, which we do find in many populations. But it’s important to note there is also a very high fat intake. That can lead to a high intake of energy-dense foods.
Aidan:
Yeah. Although it’s not specifically a weight loss diet, it may reduce the risk of significant weight gain. I’ve looked at a lot of studies on ad libitum Mediterranean diet intakes. That is just people eating until they feel comfortably full. A lot of those result in weight maintenance, even if dietary quality is massively improved. I want to take a step back and go more into big-picture nutrition stuff. Weight loss requires a calorie deficit.
If you do almost anything ad libitum, there are cases where it will result in weight loss. But there are reasons why it won’t in all cases. If you go into a deficit, other things often change. Typically, your appetite will increase. Typically, energy expenditure will decrease over time. Those things can lead people to naturally maintain over time, even with big dietary improvements. There are many cases where people stop drinking alcohol and expect weight to just fall off. Then it doesn’t happen. Did their calorie intake increase elsewhere because of these same variables?
Ways around that would often be some form of structure, whether around portion sizes or whatever. So, doing a lot of things ad libitum might not lead to the results you expect. That’s my two cents on why we sometimes see this. The high fat content of the Mediterranean diet also matters.
Torwen:
In terms of proposed mechanisms, the cardioprotective nature and anti-inflammatory effects are likely due to high bioactive compound intake. That includes polyphenols in plant foods and extra virgin olive oil. Those are believed to have an anti-inflammatory effect.
Aidan:
Yeah, and it’s super high in monounsaturated fats as well, which could play a role. This diet is also high in omega-3s because of the emphasis on fish intake. So, the combo of that can lead to a bunch of benefits. Including reducing the risk of atherosclerosis building up, which is playing a big role.
We also see such a low intake of processed foods. That is potentially playing a role as well. If we go back to that concept of staying leaner on average, it’s harder to overconsume foods. You have less access to really tasty, easily accessible food designed to encourage overeating. There are a few downsides as well.
Torwen:
Should we go through those too?
Aidan:
Sure thing. Where do you want to start?
Torwen:
Let’s talk about athletes, and specifically lower protein. In terms of energy requirements, it can also be harder to meet them through diets like the Mediterranean diet. It’s important to consider it can be lower in protein, especially when reducing red meat portions. Yes, it contains some fish and poultry in moderation as well.
But generally, the diet pattern doesn’t support super high protein intakes. So people like athletes, who have high protein requirements, may not find it optimal. In the same way, athletes or anyone with high energy requirements may struggle too.
Aidan:
Yeah, because even in the ad libitum studies, they often talk about it in ratios or frequency per week. They might have something like a handful of nuts per day. Even if you’re going ad libitum, maybe you have 45 grams instead of 30. But ideally the overall ratio of your food across days and weeks comes out the same. With the lower emphasis on red meat and stuff like that, that still applies.
So yeah, if I was working with an athlete and more muscle mass helped, I’d go higher protein. One practicality I personally find interesting is cost. In 2017, a study called the SMILES trial came out. I’ve spoken about it heaps on the podcast. It related to nutrition for depression, but it specifically used a modified Mediterranean diet. There was a bit of a combination of the Australian Dietary Guidelines and a Mediterranean diet. They did a separate study looking at what it would cost to do this diet. They also looked at what participants were already spending on foods.
That study was in 2017, so there’s inflation. But I’ve done the inflation adjustment as well. Before inflation, participants were spending $138 per week on food and beverages for personal consumption at baseline. The recommended modified Mediterranean diet came out at $112 per person per week. Both estimates were based on mid-range product costs. They basically used a food diary before.
I fact-checked this, and they included costs like alcohol and eating out in the original spending. Obviously, on the diet, they’re not encouraged to do as much of those things. The inflation-adjusted figures were $142 for the Mediterranean diet and $175 for what they were doing. I find this interesting because I used to work with a lot of people who had depression. So I was talking about this study a bit. I remember mentioning these numbers and saying the Mediterranean diet came out a tiny bit lower.
It didn’t resonate with anyone. Everyone was like, $112 per week for food for one person is insane. I think the average person spends more than they think once eating out is factored in. But the other angle is that a Mediterranean diet is not cheap. And we’re probably still going to eat out anyway. It’s probably not going to change that.
Torwen:
And I wanted to add something there, because that’s a very practical recommendation. Another one is the time it takes to cook from scratch. A lot of Mediterranean diet ingredients are whole foods. So you need to cook them to make a complete meal. That can take a lot of time and planning. And, like you say, cost as well.
Aidan:
I’ve been to a lot of PDs from people who have done the research. One little cheat code in some of these studies, and in the SMILES trial, is giving people a hamper. A lot of stuff is already a bit pre-done for them. That gives people time to adjust and practise cooking, because some of the work is done. But the people I’ve heard talk about this said they underestimated how hard the change would be. Most people need to completely change their cooking and learn different ways of cooking.
I know you can get around that in many ways, but it’s food for thought. We’ve just gone through a bunch of Mediterranean diet benefits. The next question is, why don’t you just recommend that for everybody? This is one of my explanations behind that, in addition to the protein issue.
Torwen:
So then the question is, do we need to stick to it 100%? Or can adaptations be made to the diet? I generally think sticking to it 100% is not completely feasible for most people. Taking aspects of the Mediterranean diet and copying that food pattern is probably where my thoughts lie. But I’m keen to hear what you have to say, Aidan.
Aidan:
So, in many cases, I don’t like things that are just arbitrary. This is kind of an example of that. I mentioned earlier it was the mid 20th century, directly post-World War II. Access to food in those countries was different to what we have now. So some of the things are a bit arbitrary based on that. In many cases it lines up pretty well, but it is food for thought. For example, one reason it is low in certain meat and dairy is lower access. It’s low in ultra-processed foods because they didn’t have access. The olive oil thing is interesting because they didn’t have access to mass-produced other forms of oil.
They did have access to a lot of olive oil. That’s probably not that big of a deal. But I will come back to the olive oil one specifically. The traditional Mediterranean diet includes 40 to 60 mL of olive oil per day. We know that because people are getting really good outcomes. Instead of dismissing that, I’d say there is something to it. I think there are some benefits associated with that. But if we’re asking what we recommend for people in Australia or similar countries, I’m probably never recommending that. I think two things can be true.
I think extra virgin olive oil is great from a health perspective. I recommend it to a lot of people. I don’t think we should be having around 500 calories from it. We also have access to other foods they were not consuming in the traditional Mediterranean diet. If most people went that route, they’d probably overconsume calories and create other health complications.
Torwen:
That is especially true with already higher discretionary food intake. That makes a lot of sense. I think the factors I support are high fibre and high plant food intake. Making sure most meals, or at least some, are unprocessed foods makes a lot of sense. Fatty fish is a really interesting one. If you’re unable to consume fish, supplementing with something like an omega-3 or fish oil is my suggestion.
Aidan:
I only had one other downside. I don’t know if you’ve got any more, but alcohol is the only other one I’ve got. I don’t want to go on this one too long. I put this down in writing before the podcast. I was like, geez, that sounds way more savage than how I speak. But it is what it is. The standard Mediterranean diet contains up to one standard drink per day for women. It also contains two for men, often consumed alongside meals.
There was once a time when some people interpreted research as showing a little alcohol was better. That was compared with not drinking at all. I also think the Mediterranean diet perpetuated that a little bit. But that’s absolutely not what the research supports in 2026. From a health perspective, the less alcohol, the better.
So if optimising for health, that’s something I would drop. The more savage bit is that I’m never really out there saying you need to stop completely. But if I’m looking at it objectively, less alcohol is better. That’s kind of the stance I’ve got.
Torwen:
Amazing. We’ll wrap up there then. This has been episode 250 of the Ideal Nutrition Podcast. Thank you for listening along. As always, if you enjoyed this episode, please give us a positive review. Thank you.