Frequently Asked Questions

Below pyramid, representing a healthy, traditional Mediterranean diet, is based on the dietary traditions of Crete, much of the rest of Greece and southern Italy circa 1960, structured in light of current nutrition research. The selection of these regions and this time period as a basis for the design follows from three considerations:
Recognition that the rates of chronic diseases were among the lowest in the world and adult life expectancy was among the highest for these populations at that time, even though medical services were limited;

Availability of data describing the character of food consumption patterns of the areas at that time; and

The convergence of the dietary patterns revealed by these data and our current understanding of optimal nutrition based on epidemiological studies and clinical trials worldwide.
Variations of this diet have traditionally existed in other parts of Italy, parts of Spain and Portugal, southern France, parts of North Africa (especially Morocco and Tunisia), parts of Turkey, other parts of the Balkan region, as well as parts of the Middle East (especially Lebanon and Syria). The diet is closely tied traditionally to areas of olive oil cultivation in the Mediterranean region.

Given these carefully-defined parameters of geography and time, the phrase traditional Mediterranean diet is used here as shorthand for the healthy traditional diets of these regions at that time.

The design of the pyramid is not based solely on either the weight or the percentage of energy (calories) that foods account for in the diet, but on a blend of these that is meant to give relative proportions and a general sense of frequency of servings, as well as an indication of which foods to favor in a healthy Mediterranean-style diet. The pyramid describes a diet for most healthy adults. Whether changes would need to be made for children, women in the reproductive years, and other special population groups is an issue that needs further consideration.

A principal objective of this graphic illustration is to foster a dialogue within the international scientific, public health, food and agricultural, governmental and other communities as to what specific elements and configuration of the traditional diets of the Mediterranean should be regarded as healthful.

For Americans, northern and eastern Europeans and others who want to improve their diets, this model provides a highly palatable, healthful framework for change. Equally positive results can be obtained either by entirely adopting a Mediterranean-style diet, or by alternating meals based on this Mediterranean model with meals inspired by healthful dietary traditions of other cultures in other parts of the world. For those living in the Mediterranean region, this pyramid provides a basis for preserving and revitalizing, within a modern lifestyle, centuries-old traditions that contribute to excellent health and a sense of pleasure and well-being that are a vital part of our collective cultural heritage.

This pyramid was the first in a series in development to illustrate geographically the healthy traditional food and dietary patterns of various cultures and regions of the world. This initiative is an outgrowth of a multiyear conference series, "Public Health Implications of Traditional Diets," jointly organized by Harvard School of Public Health, a United Nations World Health Organization/Food and Agriculture Organization (WHO/FAO) Collaborating Center, and Oldways Preservation & Exchange Trust. These pyramids, taken as a collection, offer substantive refinements of the United States Department of Agriculture's Food Guide Pyramid, refinements that reflect the current state of clinical and epidemiological research worldwide and our understanding of what constitutes optimal human nutrition status.

Diet Characteristics
Dietary data from those parts of the Mediterranean region that in the recent past enjoyed the lowest recorded rates of chronic diseases and the highest adult life expectancy show a pattern like the one illustrated in the list below. The healthfulness of this pattern is corroborated by epidemiological and experimental nutrition research. The average amounts given are in most cases intentionally nonspecific, since variation is known to have been considerable within this pattern. The historical pattern includes the following (with several parenthetical notes adding contemporary public health perspective):

1. An abundance of food from plant sources, including fruits and vegetables, potatoes, breads and grains, beans, nuts, and seeds;

2. Emphasis on a variety of minimally processed and, wherever possible, seasonally fresh and locally grown foods (which often maximizes the health-promoting micronutrient and antioxidant content of these foods);

3. Olive oil as the principal fat, replacing other fats and oils (including butter and margarine);

4. Total fat ranging from less than 25 percent to over 35 percent of energy, with saturated fat no more than 7 to 8 percent of energy (calories);

5. Daily consumption of low to moderate amounts of cheese and yogurt (low-fat and non fat versions may be preferable);

6. Weekly consumption of low to moderate amounts of fish and poultry (recent research suggests that fish be somewhat favored over poultry); from zero to four eggs per week (including those used in cooking and baking);

7. Fresh fruit as the typical daily dessert; sweets with a significant amount of sugar (often as honey) and saturated fat consumed not more than a few times per week;

8. Red meat a few times per month (recent research suggests that if red meat is eaten, its consumption should be limited to a maximum of 12 to 16 ounces {340 to 450 grams} per month; where the flavor is acceptable, lean versions may be preferable);

9. Regular physical activity at a level which promotes a healthy weight, fitness and well-being; and

10. Moderate consumption of wine, normally with meals; about one to two glasses per day for men and one glass per day for women (from a contemporary public health perspective, wine should be considered optional and avoided when consumption would put the individual or others at risk.)

K. Dun Gifford
Oldways Preservation & Exchange Trust

Supporting Documents
• Questions and Answers About the Mediterranean Diet Pyramid and its Relationship to the USDA Food Guide Pyramid

Contemporary Perspectives on the Traditional Diets of the Mediterranean Region

• Foods from Plant Sources at the Center of the Plate
• Olive Oil and Total Fat
• Low to Moderate Consumption of Dairy Products
• Sparing Use of Fish, Poultry, Eggs and Red Meat
• Wine in Moderation and with Meals Physical Activity and Other Lifestyle Factors