Pros and Cons of the Mediterranean Diet

Mediterranean Diet-compliant salmon meal

Claudia Totir / Getty Images 

If you’re looking for a diet that’s backed by science, the Mediterranean diet is clearly a winner. 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. Not only is it nutritious, but it emphasizes flavorful meals over restriction.

Of course, there are bound to be a few challenges on any new 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
  • Balanced, flavorful diet

  • Promotes heart health

  • Better diabetes prevention and management

  • Mental health benefits

  • Weight management

  • Reduced inflammatory markers

  • Cancer prevention

  • Environmentally friendly

Cons
  • Some foods are costly

  • Additional guidance may be necessary for certain conditions

  • Some dietary restrictions may be challenging

  • Concerns with alcohol intake

  • May fall short on some nutrients

  • No specific guidelines to follow

  • Can be time consuming

Pros

There have been numerous studies documenting 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.

With the 2015–2020 Dietary Guidelines, the USDA included helpful food group recommendations for those following the Mediterranean diet. They provide an adapted version of the Healthy U.S. Style Pattern to ensure that all nutritional guidelines are met.

The organization states that the two eating patterns are similar in nutrient content, with the exception of calcium and vitamin D which are lower on the Meditteranean plan.

Heart Health

Scientists have conducted a robust amount of research on the Mediterranean diet and heart health, both in observational studies as well as 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.

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

Better Diabetes Prevention and Management

Following the Mediterranean diet may help those with type 2 diabetes achieve better blood sugar control. A systematic review found that the Mediterranean diet, as compared with control diets, was able to lower hemoglobin A1c levels by up to 0.47%. 

Hemoglobin A1c reflects your body's blood sugar control over the last three months. Though it 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. They added that a lower-carbohydrate, 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 those most closely following a Mediterranean diet were 33% less likely to develop incident depression than those not following a Mediterranean diet," she says.

In addition, consider the emphasis on social connections in the Mediterranean lifestyle. 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 conjunction with the many fiber-rich vegetables and fruits recommended—can help you feel full longer.

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

Reduces Inflammatory Markers

Researchers have been conducting trials establishing connections between certain inflammatory markers and chronic disease. 

For example, 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.

In fact, Oldways recommends the diet as both healthy for humans and healthy for the planet. According to the organization's consensus statement, they recommend food patterns like the Mediterranean diet that are environmentally sustainable and healthy. They say 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 cons 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 worry 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.

Cost-Saving Tips

To keep costs down, Toups recommends shopping sales at the grocery store. For example, many recipes that call for a specific variety of fish like cod or seabass can often be made with a local catch that may be a bit cheaper or on sale. Don’t discount frozen seafood either. It is often less expensive than fresh, and when thawed, cooks up beautifully. Lastly, canned fish is another cost-effective option.

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.

This does not mean people with diabetes shouldn’t eat this diet. 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 specifically for special occasions.

Keep in mind any added sugar reduction is beneficial, so don’t let this scare you off. 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 red meat, 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.

The experts at Oldways give insight into this question:

"When alcohol is consumed as part of a balanced meal, and coupled with daily movement and social connections, studies find a net health benefit," says Toups.

"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."

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 bottom line: If you and your doctor conclude it's safe to drink alcohol—in combination with your healthy diet and regular physical activity—this may support heart health. However, you don't have to start drinking to see benefits from this diet, and importantly, don't start drinking if you have a family history of alcohol addiction or are currently pregnant.

May Fall Short on Some Nutrients

While the Mediterranean diet can provide adequate nutrition to meet USDA guidelines for vitamins and minerals, the USDA notes that this eating pattern is lower in calcium and vitamin D. This is due to the fact that less dairy is consumed when following this eating pattern.

The possibility of reduced calcium and vitamin D intake has raised concerns among some people. In fact, some studies have found that some children who follow the Mediterranean diet don't get enough calcium to reach recommended intake levels.

However, dairy is not the only source of calcium and vitamin D. There are many other sources including fortified milk alternatives (soy, almond, or rice milk), fortified orange juice, 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.

In addition, several studies have indicated that women following a Mediterranean diet are likely to have better bone mass and a reduced risk for bone fracture.

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 provide 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 are provided ranging from 1,000 calories per day to 3,200 per day.

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.

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