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The Mediterranean diet is a diet inspired by the eating habits of Greece, Southern Italy, and Spain in the 1940s and 1950s. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of non-fish meat products.
A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors. A meta-analysis in 2013 compared Mediterranean, vegan, vegetarian, low-glycemic index, low-carbohydrate, high-fiber, and high-protein diets with control diets. The research concluded that Mediterranean, low-carbohydrate, low-glycemic index, and high-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes, while there was limited evidence for an effect of vegetarian diets on glycemic control and lipid levels unrelated to weight loss. However, reviews of early 2016 have been more cautious: Concerns have been raised about the quality of previously performed systematic reviews and meta-analyses examining the impact of a Mediterranean diet on cardiovascular risk factors, further standardized research has been found to be necessary, and the evidence as to the prevention of vascular disease by the Mediterranean diet has been found to be "limited and highly variable". Newer reviews have reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors such as high blood pressure and other cardiovascular diseases.
The Mediterranean diet often is cited as beneficial for being low in saturated fat and high in monounsaturated fat and dietary fiber. One of the main explanations is thought to be the health effects of olive oil included in the Mediterranean diet. Olive oil contains monounsaturated fats, most notably oleic acid, which is under clinical research for its potential health benefits. The European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies approved health claims on olive oil, for protection by its polyphenols against oxidation of blood lipids and for the contribution to the maintenance of normal blood LDL-cholesterol levels by replacing saturated fats in the diet with oleic acid (Commission Regulation (EU) 432/2012 of 16 May 2012). A 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events and stroke, while monounsaturated fatty acids of mixed animal and plant origin showed no significant effects.
In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes. findings similar to those of a 2017 review.
A meta-analysis in 2008 found that strictly following the Mediterranean diet was correlated with a decreased risk of dying from cancer by 6%. A 2017 review found a decreased rate of cancer.
Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer. There is preliminary evidence that regular consumption of olive oil may lower the risk of developing cancer.
A 2016 systematic review found a relation between greater adherence to a Mediterranean diet and better cognitive performance; it is unclear if the relationship is causal.
According to a 2013 systematic review, greater adherence to a Mediterranean diet is correlated with a lower risk of Alzheimer's disease and slower cognitive decline. Another 2013 systematic review reached similar conclusions, and also found a negative association with the risk of progressing from mild cognitive impairment to Alzheimer's, but acknowledged that only a small number of studies had been done on the topic.
Major depressive disorder
There is a correlation between adherence to a healthy diet, like the Mediterranean diet, and a lower risk of depression. Studies on which these correlations are made, are observational and do not prove cause and effect.
As the Mediterranean diet usually includes products containing gluten like pasta and bread, increasing use of the diet may have contributed to the growing rate of gluten-related disorders.
Although there are many different "Mediterranean diets" among different countries and populations of the Mediterranean basin, because of ethnical, cultural, economic and religious diversities, the distinct Mediterranean cuisines generally include the same key components, in addition to regular physical activity:
High intakes of olive oil (as the principal source of fat), vegetables (including leafy green vegetables), fresh fruits (consumed as desserts or snacks), cereals (mostly whole grains), nuts and legumes.
Moderate intakes of fish and other seafood, poultry, dairy products (principally cheese and yogurt) and red wine.
These proportions are sometimes represented in the Mediterranean Diet Pyramid. Total fat in a diet with roughly this composition is 25% to 35% of calories, with saturated fat at 8% or less of calories.
In Northern Italy lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables. In both North Africa and the Middle East, sheep's tail fat and rendered butter (samna) are traditional staple fats.
History and reception
The concept of a Mediterranean diet was developed to reflect "food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s". Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator), the Mediterranean diet failed to gain widespread recognition until the 1990s. Objective data showing that Mediterranean diet is healthful originated from results of epidemiological studies in Naples and Madrid  confirmed later by the Seven Countries Study, with first publication in 1970, and a book-length report in 1980. The most commonly understood version of the Mediterranean diet was presented, among others, by Walter Willett of Harvard University's School of Public Health from the mid-1990s on.
The Mediterranean diet is, from the point of view of mainstream nutrition, based on a paradox: although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries like the United States, where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox.
A diet rich in salads was promoted in England during the early Renaissance period by Giacomo Castelvetro in A Brief Account of the Fruits, Herbs, and Vegetables of Italy.
By 2011 Mediterranean diet had become one of many fad diets promoted as a way of losing weight.
As of 2018 the traditional Mediterranean diet was eroding due to homogenization of dietary choices and food products in the global economy.
When Ancel Keys and his team of researchers studied and characterized the Mediterranean diet and compared it with the eating habits of the US and the most developed countries during that period, some identified it as the "Diet of the Poor". According to the famed Portuguese gastronomist Maria de Lourdes Modesto who met with Keys, Portugal was included in their observations and studies, and according to their conversation, Keys considered Portugal had the most pure "Mediterranean" diet. However, Salazar, the dictator of Portugal, did not want the name of Portugal included in what he understood as the diet of the poor.
Still today the name of the diet is not consensual among Portuguese gastronomists. After the Mediterranean diet became well-known, some studies evaluated the health benefits of the so-called "Atlantic diet", which is similar to Keys' "Mediterranean" diet, but with more fish, seafood, and fresh greens. Virgílio Gomes, a Portuguese professor and researcher on food history and gastronomy says, Portuguese cuisine is really an "Atlantic cuisine".
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