Mediterranean diet is a generic term used to describe the dietary pattern of individuals living in the countries along the coast of the Mediterranean Sea, including Greece, Italy, southern France, Crete, Spain, and parts of the middle east. Before large-scale trade became available in the 1950s, people would eat what was available to them based on their geography, creating a seasonal variability for most. The Mediterranian diet is primarily a plant-based diet with the contributions from animal-based products being comprised of fish and poultry with a limited quantity of dairy products. While the modern version of the diet utilizes a higher proportion of red meat and processed foods, the diet's primary focus remains the same - plant-based with healthy fats.

The food choices in the Mediterranian diet are comprised mainly of green leafy vegetables with a variety of legumes, nuts (e.g., walnuts, almonds, pistachios), fresh fruits, and whole grains also included. As the Mediterranean region is a significant producer of olive oil, this is also a staple in the diet. Olive oil is a monounsaturated fat containing alpha-linoleic acid, an omega-3 essential fatty acid, which has been indicated to provide a cardioprotective benefit. The reduction of risk factors is believed to be the major contributor to the reduction in cardiovascular disease seen in those who adhere to the Mediterranian diet. Fish and other animals of the sea provide a great source of other omega fatty acids and are another predominant reason for the cardioprotective nature. Another important element to acknowledge is the consumption of wine in moderation (specifically red), which has been suggested to provide multiple metabolic benefits. The most reproducible benefit appears to be in lipid metabolism, believed to be attributable to ethanol, but its microconstituents also may play important roles in hemostasis and inflammation.

Why is it a good idea to eat based on a Mediterranean diet?

A Mediterranean diet is one that includes lots of fruits, vegetables and whole grains and fewer meats and sweets. There are many reasons why eating a Mediterranean diet is a good idea. From research, we know that it can help prevent many diseases. It can help you to

• Lose weight
• Lower your risk of heart disease, high blood pressure and stroke
• Prevent many cancers
• Avoid diabetes
• Prevent dementia

It can also reduce wheezing and asthma in children and reduce hip fractures in women over the age of 50.

Another important part of being healthy is having healthy bacteria in your intestines. Everyone has bacteria in the intestines, or the gut. Some bacteria are healthier than others. The foods you eat determine which bacteria live in your intestines. Eating a Mediterranean diet helps make sure that you have healthy bacteria. We also know that people who eat a Mediterranean diet live longer and are healthier overall.

We know that eating a diet with plenty of fruits and vegetables and less meat helps the environment, too. It takes more grain, land and fuel to feed and transport animals than it does to feed people. Eating a Mediterranean diet is one way we can protect our forests.

What is a Mediterranean diet?

A Mediterranean diet is a pattern of eating based on what people from Crete, Greece and Southern Italy ate in the 1950s and 1960s. At that time, people from those regions were the healthiest, even if they didn’t have good medical care. They lived longer. They also had fewer diseases.

What if I don't like typical Mediterranean foods? What can I do?

The Mediterranean diet is one example of a traditional diet. Traditional diets are the foods eaten by people from different parts of the world in the 1950s and 1960s. This was before people ate as many processed foods as they do today. All regions have traditional diets: Latin America, Africa, Asia, the Arctic, and Europe. All traditional diets are healthier than more modern diets. They have a few things in common. They all emphasize eating meals together with friends and family and being physically active. Fruits, vegetables and whole grains are eaten at each meal. Dairy products (milk, yogurt, cheese) are eaten a few times per week in some cultures. Meat is eaten less often. Sweets are eaten only on occasion. Fruits are eaten for dessert. An Asian traditional diet may include rice, noodles and soybeans. A Latin American diet may have beans and corn. These diets may include different vegetables and different spices. But research shows that traditional diets are healthier than modern ones that have processed foods and sugar. Processed foods are those that come in bags, boxes or cans. They may have artificial ingredients to make them last longer.

What is an anti-inflammatory diet?

Inflammation is a natural way the body protects itself. It is how the body fights off infections and sends blood to areas that need healing. It is what causes an infected area to be red, warm, swollen, and painful.

However, too much inflammation can cause disease—arthritis, heart disease, rheumatoid arthritis, asthma, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), chronic pain and fibromyalgia, dementia, and cancer.

What we eat can cause inflammation in our bodies. We know some foods that can cause inflammation: red meat, dairy, refined and simple carbohydrates (white flour, sugar, white rice, white pasta), processed foods and alcohol. (Processed foods are those that have a long shelf life such as crackers, cookies and foods that are in boxes, bags or cans).

Other foods lower inflammation in our bodies. These include fruits, vegetables, nuts, seeds, beans, whole grains, and fish. All traditional diets have foods that lower inflammation. The Mediterranean diet is one example of a traditional diet. It has been studied by many researchers.

How do I eat a Mediterranean diet?

• Every day:
  • Be physically active, eat meals with friends and family
  • Eat fruits, vegetables, whole grains, beans, nuts, seeds, herbs and spices
• At least twice per week:
  • Eat fish or seafood
• A few times per week, eat in small amounts:
  • Low fat dairy (cheese, yogurt)
  • Eggs
  • Poultry
• Eat less often (once per week or less)
  • Red meat
  • Sweets
• Drink:
  • Mostly water
  • Wine in moderation (For women: up to 1 glass daily, with no more than 7 glasses per week. For men: up to 1-2 glasses daily, with no more than 10 glasses per week).

What’s the eating style that’s best for health? Is it a Mediterranean eating plan? Vegetarian? Low carb? With all the eating styles out there, it’s hard to know which one to follow.

Healthy eating is one of the best ways to prevent or delay health problems. Eating well, along with getting enough physical activity, can help you lower your risk of health problems like heart disease, diabetes, obesity, and more. To reach your goals, experts advise making small, gradual changes.

“The best diet to follow is one that is science based, that allows you to meet your nutritional requirements, and that you can stick to in the long run,” says Dr. Holly Nicastro, an NIH nutrition research expert. “It’s not going to do you any good to follow a diet that has you eating things that you don’t like.”

The main source of science-based nutrition advice is the Dietary Guidelines for Americans. These guidelines describe which nutrients you need and how much. They also point out which ones to limit or avoid.

“Every five years an expert panel reviews all available scientific evidence regarding nutrition and health and uses that to develop the dietary guidelines,” Nicastro explains.

The guidelines are regularly updated because our scientific understanding of what’s healthy is continuously evolving. These changes can be confusing, but the key recommendations have been consistent over time. In general, healthy eating means getting a variety of foods, limiting certain kinds of carbs and fats, watching out for salt, and being aware of your portion sizes.

Limit Added Sugars

Added sugar is the extra sugar added to foods and drinks during preparation. Corn syrup, high-fructose corn syrup, brown sugar, and honey are examples of sweeteners added to foods and drinks, especially regular sodas.

“The sugars present normally in milk and fruit are not considered added sugar,” explains Dr. Kimber Stanhope, a nutrition researcher at the University of California, Davis.

Stanhope’s research focuses on the effects of added sugar on the development of disease. Her studies have shown that consuming too much high-fructose corn syrup may increase the risk of weight gain and heart disease.

The Dietary Guidelines for Americans suggest a daily limit on added sugar of no more than 10% of calories. That’s about the amount in 16 ounces of regular soda (190 calories). You can find information about added sugars on most Nutrition Facts labels now.

“Anybody can improve their diet by substituting fruits and vegetables for sugar as their snacks, as part of their dessert, and as part of their meals,” says Stanhope. “There are no advantages of consuming added sugar.”

Consider Your Fats

Fat is high in calories and can increase your chances of developing obesity, heart disease, and other health problems. But there are different kinds of fats.

Fats that are liquid at room temperature, or oils, are considered to be healthier than those that are solid. Solid fats are found in high amounts in beef, chicken, pork, cheese, butter, and whole milk. Solid fats have more saturated fats than liquid oils. Liquid oils—such as canola, corn, olive, or peanut oil—have mostly unsaturated or polyunsaturated fats.

The dietary guidelines encourage consuming liquid oils rather than solid fats. Nicastro advises that you examine the fat content on the Nutrition Facts label. The label shows how much saturated fat a product contains. Experts suggest that you aim for getting less than 10% of your calories from saturated fats.

“For the average person, that’s going to be less than 20 grams of saturated fat per day,” Nicastro says.

For example, a small cheeseburger may have 5 grams of saturated fat, a typical cheeseburger may have 13, and a double cheeseburger with bacon may have 24!

Check Labels for Salt

The Nutrition Facts label also shows salt, or sodium. Experts advise you to limit salt, which tends to be very high in processed foods.

If you eat salty, highly processed food, you can quickly go over the daily limit of one teaspoon of salt (2,300 milligrams of sodium). Two hot dogs might have 900 milligrams of sodium. A can of ravioli might have 1400 milligrams. Other examples of salty, highly processed foods are bacon, frozen pizzas, and salad dressings.

Along with a lot of added salt, processed foods might have preservatives, sweeteners, and other substances added during preparation.

“Stuff that comes in a box or a bag that has a whole lot of different ingredients—many of which you can’t read and understand or pronounce—those things are highly processed and generally bad for your health,” explains Dr. David C. Goff, Jr., a public health expert at NIH.

Make a Meal Plan

“Figuring out what to eat is less than half the battle,” Nicastro says. “Sticking to your plan is a bigger challenge. So that’s why it helps to be really prepared and plan ahead.”

You’re much more likely to stick to your meal plan if you have healthy food that is ready to go. Some people find it helpful to prepare meals for the week in advance so that healthy food is within reach.

The DASH eating plan is a good start. DASH was developed by NIH-supported research to help people lower blood pressure without medicine, but it’s for anyone. Studies have shown that it reduces the risk of many diseases.

“The DASH diet is very flexible because you can follow DASH without going to a specialty grocery store. You can follow it with items that are very familiar to most people in this country,” Nicastro says.

The DASH eating plan is rich in fruits, vegetables, whole grains, beans, seeds, nuts, and fish. Compared to the typical American diet, it’s lower in salt, added sugars, fats, and red meat. It’s also higher in fiber, potassium, magnesium, and calcium than the typical American diet.

“Anybody can follow it, despite specific preferences or culture,” Nicastro says. It even works for people who are vegetarian or only eat Kosher foods.

Get Expert Advice

The Dietary Guidelines for Americans are designed to help people avoid developing obesity, diabetes, and heart disease. But everyone is different. You may have needs and risks that aren’t like the average American. Talk to your health care provider about your unique nutritional needs.

“A great resource for someone to help you with your diet is a registered dietitian nutritionist, or RDN,” Nicastro says.

Make Healthy Diet Choices

• Eat a variety of foods—vegetables, fruits, whole grains, beans, nuts, seeds, lean meat, seafood, eggs, milk, yogurt, and cheese.
• Limit foods that are low in vitamins and minerals.
• Avoid foods with added sugar.
• Replace foods containing saturated fats(like butter or lard) with healthier unsaturated fat options.
• Watch out for foods high in salt.

Kale and salmon, anyone? The foods you choose for meals and snacks may help you build a stronger body and help preserve brain function.

Scientists at the National Eye Institute studied how plant-based foods of the Mediterranean diets could affect our eyes as we age. The study tracked 4,000 participants over a 10-year period, checking their brain function every few years. In addition to their eye-related research, the scientists had two key findings around brain function and aging.

People following a Mediterranean-style diet had a lower risk of brain function decline. Additionally, this type of healthy diet is associated with slower brain function decline.

The Mediterranean diet is a heart-healthy approach to eating. It focuses on fruits, vegetables, whole grains, nuts, legumes, fish, and olive oil. In the study, eating a diet rich in fish and vegetables appeared to have the most positive effect. Study participants who ate the most fish had the slowest rate of brain function decline.

Can eating a specific food or following a particular diet help prevent or delay dementia caused by Alzheimer’s disease? Many studies suggest that what we eat affects the aging brain’s ability to think and remember. These findings have led to research on general eating patterns and whether they might make a difference.

The Mediterranean diet, the related MIND diet, and other healthy eating patterns have been associated with cognitive benefits in studies—though the evidence is not as strong as it is for other interventions like physical activity, blood pressure, and cognitive training. Now researchers are more rigorously testing these diets to see if they can prevent or delay Alzheimer’s disease or age-related cognitive decline.

Diet and Dementia Risk

Changes in the brain can occur years before the first symptoms of Alzheimer's appear. These early brain changes suggest a possible window of opportunity to prevent or delay dementia symptoms. Scientists are looking at many possible ways to do this, including drugs, lifestyle changes, and combinations of these interventions. Unlike other risk factors for Alzheimer’s that we can’t change, such as age and genetics, people can control lifestyle choices such as diet, exercise, and cognitive training.

How could what we eat affect our brains? It’s possible that eating a certain diet affects biological mechanisms, such as oxidative stress and inflammation, that underlie Alzheimer’s. Or perhaps diet works indirectly by affecting other Alzheimer’s risk factors, such as diabetes, obesity, and heart disease. A new avenue of research focuses on the relationship between gut microbes—tiny organisms in the digestive system—and aging-related processes that lead to Alzheimer’s.

The Mediterranean and MIND Diets and Alzheimer’s

One diet that shows some promising evidence is the Mediterranean diet, which emphasizes fruits, vegetables, whole grains, legumes, fish and other seafood, unsaturated fats such as olive oils, and low amounts of red meat, eggs, and sweets. A variation called MIND (Mediterranean–DASH Intervention for Neurodegenerative Delay) incorporates the DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower high blood pressure, a risk factor for Alzheimer’s disease.

Some, but not all, observational studies—those in which individuals are observed or certain outcomes are measured, without treatment—have shown that the Mediterranean diet is associated with a lower risk for dementia. These studies compared cognitively normal people who ate a Mediterranean diet with those who ate a Western-style diet, which contains more red meat, saturated fats, and sugar.

Evidence supporting the MIND diet comes from observational studies of more than 900 dementia-free older adults, which showed that closely following the MIND diet was associated with a reduced risk of Alzheimer’s disease and a slower rate of cognitive decline.

Not all studies have shown a link between eating well and a boost in cognition. Overall, the evidence suggests, but does not prove, that following a Mediterranean or similar diet might help reduce the risk for Alzheimer’s dementia or slow cognitive decline. To find out more, scientists supported by NIA and other organizations are conducting clinical trials—considered the gold standard of medical proof—to shed more light on any cause and effect. (See a list of trials that are recruiting participants at the end of this article.)

Scientists aren’t sure why the Mediterranean diet might help the brain. This primarily plant-based diet has been shown to improve cardiovascular health, which may, in turn, reduce dementia risk. In contrast, the typical Western diet increases cardiovascular disease risk, possibly contributing to faster brain aging.

In addition, this diet might increase specific nutrients that may protect the brain through anti-inflammatory and antioxidant properties. It may also inhibit beta-amyloid deposits, which are found in the brains of people with Alzheimer’s or improve cellular metabolism in ways that protect against the disease.

What Do We Know About Individual Foods?

Many foods—blueberries, leafy greens, and curcumin (found in the spice turmeric), to name a few—have been studied for their potential cognitive benefit. These foods were thought to have anti-inflammatory, antioxidant, or other properties that might help protect the brain. So far, there is no evidence that eating or avoiding a specific food can prevent Alzheimer’s disease or age-related cognitive decline.

But scientists continue to look for clues. One study, based on older adults’ reports of their eating habits, found that eating a daily serving of leafy green vegetables such as spinach and kale was associated with slower age-related cognitive decline, perhaps due to the neuroprotective effects of certain nutrients. Another recent study, in mice, found that consuming a lot of salt increased levels of the protein tau, found in the brains of people with Alzheimer’s, and caused cognitive impairment.

What About Vitamins and Supplements?

Observational studies and clinical trials have looked at many over-the-counter vitamins and dietary supplements, including vitamins B and E and gingko biloba, to prevent Alzheimer’s disease or cognitive decline. The idea is that these dietary add-ons might attack oxidative damage or inflammation, protect nerve cells, or influence other biological processes involved in Alzheimer’s.

Despite early findings of possible benefits for brain health, no vitamin or supplement has been proven to work in people. Overall, evidence is weak as many studies were too small or too short to be conclusive.

Take DHA (docosahexaenoic acid) for example. Studies in mice showed that this omega-3 fatty acid, found in salmon and certain other fish, reduced beta-amyloid plaques, a hallmark of Alzheimer’s. However, clinical trials in humans have had mixed results. In a study of 485 older adults with age-related cognitive decline, those who took DHA daily for 24 weeks showed improved learning and memory, compared to those who took a placebo. Another study of 4,000 older adults—conducted primarily to study eye disease—concluded that taking omega-3 supplements, alone or with other supplements, did not slow cognitive decline.

At this time, no vitamin or supplement is recommended for preventing Alzheimer’s or cognitive decline. Although widely available from drugstores and on the Internet, many of these have not been tested for their effects on thinking. Their safety and effectiveness are largely unknown, and they may interact with other medications. (Note: A deficiency in vitamin B12 or folate may cause memory problems, which are reversible with proper treatment.)

Research Continues to Seek Answers

The idea of Alzheimer’s as a metabolic disease that affects the brain, and Alzheimer’s markers such as glucose metabolism, have led scientists in various directions. Besides the Mediterranean diet and its variations, they are looking at other diets as well as individual foods and nutrients.

For example, the ketogenic diet is a high-fat, low-carbohydrate diet that prompts the production of ketones, chemicals that help brain cells work. Studies show that this diet may affect gut bacteria in distinctive ways in people with and without cognitive impairment, and may help brain cells better use energy, improving their overall function.

Researchers are seeking answers to these questions:

• Which foods are critical to brain health and should be included in diet-based interventions?
• Which groups of people are most likely to benefit from dietary interventions targeting prevention of dementia and cognitive decline?
• Do dietary interventions have a greater effect if begun in midlife?

These clinical trials are recruiting participants to test dietary interventions:

• Enhanced Mediterranean Diet for Alzheimer's Disease Prevention—Cognitively normal adults age 65 and older in Kansas City, KS, are randomly assigned to either a Mediterranean diet or a low-fat diet to gauge the impact on cognitive function, brain volume, and other measures.
• Mediterranean Diet, Weight Loss and Cognition in Obese Older Adults—This Chicago study will test the effects of a Mediterranean diet, with and without caloric restriction, to promote weight loss and improve cognitive function in obese older adults.
• Multicultural Healthy Diet to Reduce Cognitive Decline—This 18-month trial will investigate whether an anti-inflammatory diet tailored to a multicultural population in Bronx, NY, can improve cognitive functioning.
• Brain Energy for Amyloid Transformation in Alzheimer’s Disease—Older adults with MCI in Winston-Salem, NC, are randomly assigned to follow either a modified Mediterranean ketogenic (low-carbohydrate/high-fat) diet or an American Heart Association high-carb/low-fat diet for 16 weeks, with follow-up to assess effects on cognition and Alzheimer’s biomarkers.

If you have diabetes, you probably know more than most about the foods you eat and how they affect your diabetes management. While there’s no such thing as a “diabetes diet,” some people have found certain eating plans to be helpful in managing diabetes.

Healthy eating is key to managing your blood sugar. But what does it mean to eat healthy? The truth is, healthy eating looks no different for you than it does for anyone else. It includes eating foods that are lower in added sugars and saturated fat. While there’s no one-size-fits-all approach to eating healthy, several eating plans can help manage your diabetes.

The American Diabetes Association released a report reviewing several eating plans that have been shown to help people with diabetes. One of the most researched has been Mediterranean-style eating. Studies report benefits such as improved A1C levels, cholesterol, and heart health.

What Is Mediterranean-Style Eating?

Mediterranean-style eating is the traditional eating habits and lifestyle in countries along the Mediterranean Sea. More than 20 countries border the Mediterranean. Because each country differs in culture, religion, economy, and agricultural production, there’s not one specific Mediterranean way to eat. But Mediterranean eating has many common factors. These include:

• Eating plenty of fruits, vegetables, whole grains, beans, and nuts.
• Using extra virgin olive oil instead of butter or other oils.
• Limiting dairy products and red meat.
• Limiting sweets, added sugars, sodium (salt), and highly processed foods.

How Can This Way of Eating Help You Manage Diabetes?

When you have diabetes, your body doesn’t make or use insulin well and can’t keep your blood sugar at normal levels (known as insulin resistance). This causes spikes in your blood sugar and over time can lead to serious complications. Because Mediterranean-style eating is rich in plant-based foods and limits processed ones, it can help reduce insulin resistance. This leads to better blood sugar management and lower A1C levels. Mediterranean-style eating can also help:

• Improve heart health. Saturated fats and sodium are bad for your heart. They can increase cholesterol levels and blood pressure. Since heart disease is one of the most common complications of diabetes, you’ll want to limit these food with high amounts of saturated fat or sodium in your diet. Following Mediterranean-style eating can reduce your risk of heart disease and stroke.
• With weight loss, if you’re overweight. Mediterranean-style eating emphasizes foods that are full of fiber. Fiber helps with blood sugar and weight management. The Mediterranean lifestyle also encourages being physically active. Being active helps control blood sugar levels and lowers your risk of heart disease and nerve damage.
• Reduce inflammation. High blood sugar from diabetes can cause inflammation. Foods such as leafy green vegetables, fruits, olive oil, and fatty fish can help reduce inflammation and strengthen your immune system.

Choosing What’s Right for You

When choosing or creating a diabetes meal plan, it’s important to consider how different foods will affect your blood sugar and weight loss goals (if needed). Because Mediterranean-style eating limits processed foods and those high in sugar, it can help. But whether you follow this style or not, people with diabetes are advised to limit or avoid processed food.

There are things you should look out for when choosing a diabetes meal plan. For example, some eating plans can be high in carbohydrates (carbs). Mediterranean-style eating includes foods like pasta, rice, and bread, all of which can cause weight gain and spikes in your blood sugar. Fortunately, there are healthier alternatives. Instead of regular pasta you can choose whole-grain or vegetable noodles. You can also eat brown rice instead of white rice. Making these simple substitutions and paying attention to portion size can help you limit the amount of carbs you eat.

There’s no one way of eating to manage diabetes, so experiment and find what works for you. Whether it’s Mediterranean-style foods or any other, the right food plan for you will depend on your health needs, lifestyle, beliefs, taste, and culture. Work with a diabetes care and education specialist to help create yours. Working together, you can find a diabetes food plan that suits you best.