Looking Beyond the Name to the Eating Pattern Behind It
It feels like there is always a new diet fad being touted, an often-strict regimen of eating that will magically cure all that ails you. And even when it’s not a full diet, there’s always an ingredient or category of food that you should either cut out entirely or increase dramatically. These fads make many claims and provide very little research to back them up.
But there is one diet that has been recommended consistently for decades. The Mediterranean Diet. Although most people have probably heard about it, there are several misconceptions that might make it feel unapproachable. Many people assume that if they don’t like “Mediterranean foods”, they won’t be able to stick with this recommendation, and, the word diet is a bit misleading.
To sum it up shortly, the focus is not on eating Mediterranean foods, but on adopting an eating pattern that emphasizes plant foods, healthy fats, minimally processed ingredients, and balanced portions, and it’s meant to be a sustainable lifestyle rather than a short-term fix.
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History of the Mediterranean Diet
The Mediterranean Diet was first identified around the 1950s by physiologist Ancel Keys and explored scientifically in the Seven Countries Study soon after. Keys observed that people who lived in Greece and southern Italy experienced unusually low rates of heart disease, and diet was thought to be a large part of that. In the 1990s, the Mediterranean Diet Pyramid, developed by Oldways in partnership with the Harvard School of Public Health and the World Health Organization, formally introduced the Mediterranean diet as a public health nutrition recommendation. Since then, it has continued to be studied, and the benefits have held steady.
Misconception #1: Calling it a “diet”
When most people hear the word “diet,” they think of a temporary and dramatic change in eating patterns to produce a specific endpoint, such as losing weight or building muscle.
A better term to describe it might be “the Mediterranean Eating Pattern.” It is a flexible, sustainable way of eating that supports overall health. It doesn’t involve strict rules, timing, calorie counting, or the elimination of entire food groups.
Misconception #2: It’s Only Mediterranean Foods
When some people hear the word “Mediterranean,” it can bring to mind images of exotic ingredients that may feel difficult to incorporate into their usual meals. The Mediterranean part of the name has more to do with where this eating pattern was first identified than with the specific foods on your plate.
In the Mediterranean Eating Pattern, the focus is on:
- Vegetables and fruits
- Whole grains
- Beans and legumes
- Healthy fats, especially olive oil
- Nuts and seeds
- Fish and seafood
- Moderate dairy
- Limited ultra-processed foods and added sugars
Adapting the Mediterranean Eating Pattern
The list above can be adapted to include favorite foods from a wide range of culinary traditions. Cultures are far too diverse to sum up in a single list, and food traditions vary enormously by region, family, and personal history; so please think of the examples below as a starting point for inspiration, not a definitive guide. Here are a few broad, illustrative examples of how the Mediterranean Eating Pattern might be reflected across some generalized cuisines:
American – Chicken roasted with vegetables alongside whole-grain rolls and a side salad. Meatloaf made with lean turkey and chopped vegetables alongside a small baked potato and other vegetables. Macaroni and cheese made with whole-grain pasta, less cheese, and broccoli added in. A chef salad with lots of vegetables, a hard-boiled egg, and an olive oil-based dressing.
Latin American – Huevos rancheros with eggs, corn tortillas, avocado, salsa, and black beans. Grilled fish tacos with corn tortillas, cabbage slaw, avocado, and black beans on the side. A bean bowl with whole or lightly mashed beans cooked in olive oil (rather than refried beans made with lard), brown rice, tomato, avocado, cilantro, and lime.
Asian – A brown rice bowl with vegetables like bok choy, cabbage, carrots, and mushrooms, tofu or edamame, and sesame seeds. Grilled or baked salmon with brown rice, steamed broccoli, bok choy or snap peas, and edamame. A soba noodle bowl with buckwheat noodles, vegetables, tofu, mushrooms, and light broth. Bibimbap with brown rice, assorted vegetables, egg, tofu or lean protein, and kimchi. Vegetable curry with mixed vegetables, lentils or beans, and a side of whole-grain roti.
According to Lilia Chavez, a Registered Dietitian Nutritionist and Director of Client Care for Project Angel Heart, a nonprofit organization that provides medically tailored meals to people living with severe and chronic illness, “The benefits of the Mediterranean Diet have been highlighted in research and the media. The Mediterranean Diet is more than specific foods from that region; it’s a balanced approach to nutrients. The ‘diet’ is a combination that helps people meet their nutritional needs while enjoying a flexible, sustainable way of eating that supports long-term health.”
Why It’s Recommended
If you’ve asked a doctor about nutrition, they’ve probably told you that the Mediterranean Diet is a good option to consider, but why are so many doctors suggesting it? Aside from the fact that it’s one of the easier eating patterns to stick to long term because of its flexibility and balance, it’s also one of the most heavily studied eating patterns out there.
The 2023 article “Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review,” published in Nutrients, found benefits for both the general population and people already living with cardiovascular disease. Research has also linked Mediterranean-style eating to a lower risk of cardiovascular disease, reduced risk of stroke, better blood pressure control, improved cholesterol levels, reduced risk of type 2 diabetes, better cognitive health and healthy aging, and lower overall mortality risk.
Nutrition research is notoriously difficult to do well. It’s hard to get large groups of people to follow a specific eating pattern consistently over long periods of time, especially when they are already dealing with a chronic health condition, which is one reason the evidence can be limited. That said, researchers have looked at which eating patterns seem to be associated with better outcomes and quality of life for people living with MS.
MS-Specific Research
A study in the Multiple Sclerosis Journal, “Strengthening the Link: Diet Quality and Disability in MS,” looked at the correlation between how closely a patient’s diet followed the Mediterranean eating pattern and their performance on the MS Functional Composite (MSFC), as well as patient-reported outcomes (PROs) related to perceived physical disability, fatigue severity, gait disturbance, cognitive dysfunction, and anxiety/depression. The researchers found that participants whose eating habits more closely matched the Mediterranean pattern tended to perform better on the MSFC and also reported better outcomes overall. The strongest PRO relationship was seen with depression.
How to Get Started
Behavioral science tells us that making dramatic changes to something like diet overnight isn’t usually sustainable. Instead, it often makes more sense to make small changes over time that gradually shift your eating habits in a way that is easier to maintain. A few ideas to consider as small steps that can get you on your way:
- Add one extra serving of vegetables daily
- Replace butter with olive oil when possible
- Eat fish twice a week
- Include beans or lentils regularly
- Choose whole grains more often
- Reduce ultra-processed snacks and sugary drinks
It is important to remember that there is no diet or eating pattern that has been proven to be the best way of eating for all people living with MS. Diet alone will not “cure” your MS, and it will not solve all of your symptoms. Nutrition should be viewed as one tool in your wellness toolbox, alongside disease-modifying therapies and other treatments recommended by your healthcare team.
But we do know that keeping your body as healthy as possible gives your brain, and the rest of you, a better chance to function at its best. And eating within the well-balanced guidelines of the Mediterranean Eating Pattern, with benefits for heart health, metabolic health, brain health, and healthy aging, is a move in the right direction.
