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What Is The Biggest Issue With The Mediterranean Diet?

Introduction to the Mediterranean Diet

Before we discuss the problem with this diet, it is essential to know the basics of the Mediterranean diet. The Mediterranean diet has been modeled on the traditional foods that people consume in countries that border the Mediterranean Sea, including Greece, Italy, France, and Spain. Research has shown that people from these countries are typically exceptionally healthy and also have a lower risk of developing many chronic conditions.(1, 2, 3)

Although there are no stringent rules that one has to follow while on the diet, it generally encourages the intake of more fruits, vegetables, legumes, whole grains, nuts and seeds, and heart-healthy fats like olive oil. It also restricts the intake of added sugar, processed foods, and refined grains.(4, 5) Several studies have found that the Mediterranean diet can promote healthy weight loss and prevent heart attacks, type 2 diabetes, stroke, and premature death.(6) For this reason, the Mediterranean diet is widely recommended to people who want to enhance their health and also protect against chronic diseases.

However, while there is definitely a lot to celebrate about the Mediterranean diet, there is also one glaring problem that is not talked about. Let’s take a look at this.

What Is The Biggest Issue With The Mediterranean Diet?

The Mediterranean diet is ideally based on the traditional food consumption patterns of the European Mediterranean country. However, at the same time, this diet excludes many of the traditional cuisines of the many other countries which fall along the Mediterranean coastlines. Furthermore, the present-day interpretation of the diet is not as accessible or flexible as it is made out to be because it depends heavily on foods that are out of reach for many people owing to the high cost of these food items, especially heart-healthy fats like olive oil which the Mediterranean diet promotes as one of its key inclusions.(7, 8)

There are 21 countries that represent the Mediterranean region since they touch the Mediterranean Sea. These include:

  • Albania
  • Algeria
  • Bosnia & Herzegovina
  • Croatia
  • Cyprus
  • Egypt
  • France
  • Greece
  • Israel
  • Italy
  • Lebanon
  • Libya
  • Malta
  • Monaco
  • Montenegro
  • Morocco
  • Slovenia
  • Spain
  • Syria
  • Tunisia
  • Turkey

However, when it comes to the Mediterranean Diet, it is primarily modeled after the traditional cuisines of Greece, Italy, Spain, and southern France, while excluding the cuisines of the Middle East, Eastern Europe, and African countries of the Mediterranean region.

The reason behind it goes all the way back to the Seven Countries Study that was undertaken from 1952 to 1957 by American researcher Ancel Keys. Keys carried out informal and exploratory studies in seven countries, including Greece, Italy, the Netherlands, Yugoslavia, Finland, Japan, and the United States. The research team studied the eating patterns in these countries and also measured the rates of diabetes, heart disease, and other risk factors like high blood pressure, high cholesterol, and smoking.(9, 10)

At the end of the study, Keys and his research team concluded that the dietary patterns in Greece and Italy were linked with a significantly lower rate of heart disease and mortality in these countries. Following this, Keys started promoting this type of diet for lower disease risk and better health.(11)

However, today experts criticize the research methods used by Keys and his team. A recent article showed that Keys’ study collected data only from men, and the study also included data from a predominantly white population, with the exception of Japan. This article was published in the Journal of Critical Dietetics.(12)

Due to this, the biggest reason why most non-European cuisines are not a part of the Mediterranean diet is not because of their lack of nutritional properties but because these countries were not included in the early research studies that took place.

Focus on Only European Cuisines Means the Diet Lacks in Many Staples

Experts today agree that the Mediterranean diet is definitely nutritious and contains many health benefits. The diet strongly focuses on the consumption of whole, plant-based foods like fruits, vegetables, nuts and seeds, whole grains, and legumes. It also emphasizes on including lean protein and unsaturated fats. While this is similar to what the standard Dietary Guidelines for Americans also recommends, but including only specific cuisines from Italy, Greece, Spain, and France makes the diet lack in many staples from other Mediterranean countries.(13)

It can be stigmatizing as well to emphasize that only three to four countries eat healthy while other countries are not consuming healthy food. The fact is that the real Mediterranean diet goes far beyond the European staples of fish and olive oil. Every country and cultural group in the Mediterranean region has its own unique food culture, and the Mediterranean diet should therefore also include the food culture and preferences of African and Middle Eastern countries.

Applying the Basics of the Mediterranean Diet to Other Cultural Cuisine

If the principles of the Mediterranean diet are widened to include more cultural cuisine, it can make it more sustainable and realistic for more people. For example, if a person does not like the taste of seafood or olives, the Mediterranean diet in its current form would not be sustainable. At the same time, it might be challenging for some to afford to eat these Mediterranean staples all the time, which may make them feel discouraged and also establish the concept that healthy eating is expensive and out of their reach.

However, there is an easy solution to this. By focusing on the overall patterns of the Mediterranean diet, which includes increasing your intake of plant-based foods and opting for unsaturated fats instead of saturated ones, you can make the diet more customizable and flexible and also affordable.

For instance, every culture eats vegetables, fruits, and grains. So you can think about adding more of these items to your diet. Just because the concept of the Mediterranean diet in the mainstream media does not promote your specific heritage, it does not mean that these food products are incorrect and unhealthy for you.

In fact, many non-European cultures also incorporate such types of foods. Indian cuisine focuses a lot on vegetable curries, while stir-fry vegetables are a staple of Southeast Asia. Guatemalan stews are also prepared with lots of vegetables and some amount of meat, while Ethiopian cuisine is heavy on legumes. So while these dishes are not necessarily the ones highlighted in the Mediterranean diet, but they contain many of the same nutrients and foods. So just because you don’t eat fish and olive oil each day, it does not mean that you cannot develop healthy eating habits to reap the benefits of the Mediterranean diet.


The Mediterranean diet is typically based on the traditional cuisine of Greece, Italy, Spain, and France. There is no doubt that the Mediterranean diet is very nutritious and provides many health benefits. However, its excessive focus on only European cuisines excludes a lot of other cultural foods that can be equally nutritious and health-promoting. Eating the traditional Italian and Greek foods that are usually highlighted in the Mediterranean diet, like olive oil, salmon with feta, and tomatoes, can be a delicious meal and also healthy, but maybe this may not be the type of food you love. This is why it is essential to have flexibility in your diet and eating pattern, especially if you feel like your favorite foods and dishes are not included in the traditional Mediterranean diet. The better way is to adopt healthy eating patterns from the Mediterranean diet while including the foods you like to eat. So rather than strictly following the Mediterranean diet, you can incorporate healthy plant-based foods and unsaturated fats in your diet instead of processed foods and saturated fats.


  1. Lăcătușu, C.M., Grigorescu, E.D., Floria, M., Onofriescu, A. and Mihai, B.M., 2019. The mediterranean diet: From an environment-driven food culture to an emerging medical prescription. International journal of environmental research and public health, 16(6), p.942.
  2. Belahsen, R. and Rguibi, M., 2006. Population health and Mediterranean diet in southern Mediterranean countries. Public health nutrition, 9(8A), pp.1130-1135.
  3. Keys, A., 1995. Mediterranean diet and public health: personal reflections. The American journal of clinical nutrition, 61(6), pp.1321S-1323S.
  4. Davis, C., Bryan, J., Hodgson, J. and Murphy, K., 2015. Definition of the Mediterranean diet; a literature review. Nutrients, 7(11), pp.9139-9153.
  5. Simopoulos, A.P., 2001. The Mediterranean diets: what is so special about the diet of Greece? The scientific evidence. The Journal of nutrition, 131(11), pp.3065S-3073S. Tosti, V., Bertozzi, B. and Fontana, L., 2018. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. The Journals of Gerontology: Series A, 73(3), pp.318-326.
  6. Wahrburg, U., Kratz, M. and Cullen, P., 2002. Mediterranean diet, olive oil and health. European Journal of Lipid Science and Technology, 104(9‐10), pp.698-705.
  7. Hu, F.B., 2003. The Mediterranean diet and mortality-olive oil and beyond. New England Journal of Medicine, 348(26), pp.2595-2596.
  8. Menotti, A. and Puddu, P.E., 2015. How the Seven Countries Study contributed to the definition and development of the Mediterranean diet concept: a 50-year journey. Nutrition, metabolism and cardiovascular diseases, 25(3), pp.245-252.
  9. Blackburn, H., 2017. Invited commentary: 30-year perspective on the Seven Countries Study. American journal of epidemiology, 185(11), pp.1143-1147.
  10. Fidanza, F., Alberti, A., Lanti, M. and Menotti, A., 2004. Mediterranean Adequacy Index: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study. Nutrition, Metabolism and Cardiovascular Diseases, 14(5), pp.254-258.
  11. Burt, K., 2021. The whiteness of the Mediterranean diet: A historical, sociopolitical, and dietary analysis using Critical Race Theory. Critical Dietetics, 5(2), pp.41-52.
  12. Dietaryguidelines.gov. 2022. Home | Dietary Guidelines for Americans. [online] Available at: <https://www.dietaryguidelines.gov/> [Accessed 10 April 2022].

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 15, 2022

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