Pros and Cons of the Mediterranean Diet

If you’re looking for a diet that’s backed by science, the Mediterranean diet is clearly a winner. Not only is it nutritious, but it emphasizes flavorful meals over restriction. This eating pattern, embraced by countries surrounding the Mediterranean Sea, has been linked to a lower risk of heart disease, cancer, diabetes, and other chronic diseases. 

Of course, there are bound to be a few challenges on any eating plan. For example, some worry about the cost of following a meal plan packed with produce and seafood, and others may struggle with the limits on red meat and added sugar.

Pros

Numerous studies have documented the health benefits of the Mediterranean diet.

General Nutrition

The Mediterranean diet does not eliminate any food groups and encourages a variety of nutrient-dense foods, making it easy to meet your nutritional needs and enjoy a wide range of foods and flavors.

The U.S. Department of Agriculture's 2020—2025 Dietary Guidelines for Americans includes healthful food group recommendations for those following the Mediterranean diet and for those following a proposed U.S. Style Dietary Pattern. The guidelines help to ensure that all nutritional requirements are met, especially calcium and vitamin D.

Heart Health

Scientists have conducted robust research on the Mediterranean diet and heart health, both in observational studies and controlled trials. The results show that there is strong evidence to support the Mediterranean diet for better heart health.

For example, a review study in the European Journal of Clinical Nutrition concluded that following a Mediterranean diet is associated with reduced risk of coronary heart disease, heart attack, and overall mortality.

And in a research review published in 2019, study authors wrote that the available evidence is large, strong, and consistent supporting this eating pattern for reduced rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.

The American Heart Association (AHA) recommends the eating style for preventing heart disease and stroke and reducing risk factors such as obesity, diabetes, high cholesterol, and high blood pressure.

Diabetes Prevention and Management

Following the Mediterranean diet may help those with type 2 diabetes achieve better blood sugar control. A systematic review of 56 trials between 1978 to 2016 and including 4,937 patients with type 2 diabetes found that the Mediterranean diet, as compared with control diets, was able to lower hemoglobin A1c levels by up to 0.32% on average. 

Hemoglobin A1c reflects the body's blood sugar control over the previous three months. Though a 0.32% reduction sounds small, any reduction may be helpful for people with diabetes who are trying to manage blood sugar levels.

Furthermore, a research review published in 2014 suggested that adopting a Mediterranean diet may help prevent type 2 diabetes. In addition, a lower-carbohydrate (less than 50% carbs), Mediterranean-style diet seems good for HbA1c reduction in people with established diabetes.

Improved Mental Health

One surprising benefit may be a connection between the Mediterranean diet and better mental health, according to Kelly Toups, MLA, RD, LDN, director of nutrition for Oldways, a non-profit organization that promotes healthy food and nutrition.

A 2018 study in Molecular Psychiatry found that following a Mediterranean diet is associated with reduced risk of depressive symptoms or clinical depression.

In addition, the Mediterranean lifestyle emphasizes social connections. This is paramount for mental health, particularly among older adults. Maintaining friendships and regular social interaction can reduce loneliness, which is known to be positive for overall health.

Weight Management

It seems counterintuitive that a diet which emphasizes calorically dense olive oil and nuts could help with weight management. However, these satiating fats—in combination with the many fiber-rich vegetables and fruits recommended—can help you feel fuller longer.

Indeed, research has found that people do not gain weight when following a Mediterranean diet. Some studies have suggested the Mediterranean diet and low-carbohydrate diets lead to similar rates of weight loss after one year.

Reduced Inflammatory Markers

Researchers have been investigating the connections between certain inflammatory markers and chronic disease. Higher levels of two inflammatory markers (interleukin 6 and C-reactive protein) are thought to be associated with an increased risk of diabetes. Research shows the Mediterranean diet is associated with lower levels of these inflammatory markers.

Cancer Prevention

Most cases of cancer are not caused by a singular factor, but rather a combination of many genetic and environmental factors. Diet can play a role in this complex disease, and certain dietary patterns—including the Mediterranean diet—are associated with a reduced risk of cancer.

A meta-analysis found that those who adhered most closely to the Mediterranean diet had a lower risk of developing colorectal cancer, breast cancer, gastric cancer, liver cancer, head and neck cancer, and prostate cancer.

Better for the Environment

Diets that rely less on beef and more on grains and other plant-based foods have been shown to be healthier for the planet. Oldways recommends the diet as healthy for humans and healthy for the planet.

According to the organization's consensus statement, it recommends food patterns like the Mediterranean diet that are environmentally sustainable and healthy. Oldways states that the Mediterranean diet saves water, conserves land, and cuts fertilizer use.

Cons

For some people, there may be a few drawbacks to the Mediterranean diet. However, many of these are surmountable.

Cost

There are no expensive branded foods or special supplements that you are required to buy on the Mediterranean diet. But some consumers express concern about the cost of some foods, including fish, seeds, nuts, and olive oil.

For example, fresh seafood tends to be more expensive than other proteins. However, there are several ways to shop on a budget—even for seafood.

Additional Guidance May Be Needed

Even though studies suggest that a Mediterranean diet may reduce diabetes risk and support better blood sugar control, some people with diabetes may need additional guidance while on this diet.

Because there is an emphasis on grains, fruits, and vegetables (including starchy vegetables), meals may be high in carbohydrates. It’s important for people with diabetes to eat a consistent, controlled amount of carbohydrates throughout the day to avoid blood sugar spikes or dangerously low sugars (if you're using insulin or certain oral medications).

This does not mean people with diabetes shouldn’t follow this plan. On the contrary, it can be a great choice. If you have diabetes, though, try working with a dietitian to help you plan the right carbohydrate counts for your meals within the greater framework of the Mediterranean diet.

Restrictions May Feel Challenging

This diet recommends reducing red meat and added sugar consumption, which may be difficult for some people. Those who are used to the standard American diet may consume added sugar in processed foods on a regular basis. Those following the Mediterranean diet are advised to save added sugar for special occasions.

Keep in mind any added sugar reduction is beneficial, so don’t let this deter you. Following a Mediterranean style diet that contains a little added sugar is still more beneficial than following a Western-style diet that’s high in added sugar.

Similarly, if you’re struggling with eating red meat less often, try following this diet while incorporating lean and unprocessed red meats like flank, top round, and brisket half flat, but in smaller portions. Research suggests you'll still reap heart-health benefits.

Concerns About Alcohol Intake

Some experts raise concerns about the regular alcohol intake (particularly wine) in the Mediterranean diet and whether this is truly beneficial to recommend. Toups believes it can be. "When alcohol is consumed as part of a balanced meal, and coupled with daily movement and social connections, studies find a net health benefit," she says.

"The Mediterranean diet and other traditional diets present examples of how to safely enjoy alcohol in moderation (up to one 5-ounce glass of wine per day for women, or up to two 5-ounce glasses daily for men), in a way that may support cardiometabolic health and help to foster positive social connections," says Toups.

But what about when alcohol is consumed in other scenarios? "When alcohol intake is accompanied by unhealthy habits, like smoking or poor diet, or unsafe habits, like driving, obvious health risks present themselves," she says.

The current edition of the USDA Dietary Guidelines for Americans does not recommend that people who do not currently drink alcohol start drinking, but for adults who do choose to drink alcoholic beverages, it is noted that drinking less is better for health than drinking more. When adults choose to drink, the USDA recommends one drink or less per day for women and two drinks or less for men.

May Fall Short on Some Nutrients

The USDA notes that most Americans do not get enough calcium and vitamin D in their diets. Those who choose to follow the Mediterranean lifestyle tend to consume less dairy, so they'll want to ensure they get enough of these nutrients from other sources.

One study found that Spanish children who had low adherence to the Mediterranean diet don't get enough calcium to reach recommended intake levels even when dairy foods were used to compensate for the low adherence. Researchers determined this was because other foods containing calcium were not being consumed.

Fortunately, dairy is not the only source of calcium and vitamin D. There are many other sources including fortified milk alternatives, particularly soy milk and other soy products, as well as fortified orange juice, some whole-grain cereals, seafood, spinach, soybeans, or sesame seeds. Foods like these are encouraged on the Mediterranean diet.

Studies have also shown that both adults and children who adhere to this healthy pattern are likely to have a better nutrient profile, with a lower prevalence of individuals showing inadequate intakes of micronutrients.

No Specific Guidelines

Unlike many other eating patterns, the Mediterranean diet does not provide specific calorie counts, food portion sizes, or strict lists of foods to eat and foods to avoid. There is also no singular source for following this diet.

For some who prefer a more structured eating style (especially for weight loss or weight maintenance), this may present a challenge. However, the Healthy Mediterranean-Style Eating Pattern provided by the USDA can be used as a guide for those who prefer a more specific approach.

To use the guide, simply choose the calorie goal that aligns with your dietary needs then choose a variety of foods in each group and consume them over time in recommended amounts. Calorie targets for healthy adults are provided ranging from 1,600 calories per day to 3,200 per day, which vary based on age, sex, weight, and level of physical activity.

May Be Time Consuming

Shopping for Mediterranean diet foods and preparing meals is likely to take more time than heating up prepared foods or grabbing fast-food on the go. On this diet, processed foods are discouraged, while balanced meals made with whole ingredients are encouraged.

Certainly, this shift may take some adjustment for some people. But many people learn to love cooking and preparing meals for themselves or their families. Additionally, you can prepare large quantities of foods in advance to use at meals later.