What the ‘Mediterranean Diet’ Is, and How to Actually Follow
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The Mediterranean diet has made the bullshit list of “best diets” once again, which got me thinking: has anybody ever gone on the Mediterranean diet? Like on purpose? There’s no straightforward app to track it, and no easy-to-read book that gives simplistic rules to say yes or no to a given meal.
For that matter, do any of us actually know what the Mediterranean diet actually consists of? There’s olive oil, for sure, and fish. But then what? “My understanding is almost entirely based on the stock images for those articles,” said a member of the Lifehacker staff who shall remain nameless, but who was saying what we were all thinking.
So let’s dig in. What do you really need to know to follow the Mediterranean diet?
Most studies are observational
First, a little background on where the definition of the Mediterranean diet comes from. Scientists used the term to describe the typical diets of people in certain Mediterranean communities, and then extended the definition to include similar-ish diets in other places. But it’s important to know that many of the studies on the Mediterranean diet’s effect on diabetes, cancer, heart disease, dementia, and other health conditions are observational studies.
In other words, when you see a headline about the Mediterranean diet, it’s not necessarily from a study that assigned one group of people to a Mediterranean diet and another group to a different diet (although those studies do exist). More typically, the studies survey people—sometimes in the Mediterranean region, sometimes not—on what they typically eat. Their answers are used to come up with a score (2 points if you eat more than 250 grams of vegetables on an average day, for example), and the people with the highest scores are contrasted against the people with the lowest scores.
Where do these scores come from? Here’s a paper describing one of the common systems. The numbers were determined by reviewing several dozen studies, each with their own definitions of the diet, studying people in a variety of areas—some in the Mediterranean, but others in other parts of Europe and occasionally on other continents.
You can read the scoring criteria here. In short, you get two points for each of the following:
- At least 250 grams of vegetables per day (1 point for 100-250)
- At least 300 grams of fruits and nuts per day (1 point for 150-300)
- At least 140 grams of legumes (beans and lentils) per week (1 point for 70-140)
- At least 195 grams of cereals (that is, grains) per day (1 point for 130-195)
- At least 250 grams of fish per week (1 point for 100-250)
- Less than 80 grams of meat per day (1 point if you’re under 120)
- Less than 180 grams of dairy (1 point if you’re under 270)
- Alcohol in the range of 12 to 24 grams per day (1 point if you’re under 12 grams, no points if you’re over 24)
You also get one additional point if you cook with olive oil.
As you can see, it’s not exactly straightforward to use this system as a measure of your diet. Cheese and skim milk are both dairy products, but they’ll weigh different amounts. The same goes for fruit and nuts: are we talking a fresh apple, or a bag of pistachios? You’d also need to convert your units if you’re not used to grams—250 grams of fish is about half a pound, but 250 grams of vegetables could look very different depending on what the vegetable is. For example, that could be 2-1/2 cups of broccoli or one large onion.
Alcohol is a bit simpler: 12 grams is considered a standard drink, so that’s roughly one to two drinks per day, depending on alcohol content. A 12-ounce beer at 5% ABV has 14 grams of alcohol.
I find all this counting to be a hilarious counterpoint to U.S. News’s judgment that “no counting carbs, points, or calories” is a pro of the Mediterranean diet. You have to count a heck of a lot of stuff to figure out if you are even on the Mediterranean diet.
Some more caveats
Before you douse your first fillet of fish in olive oil, you should know that a group of epidemiologists wrote in 2019 that while observational studies seem to make a good case for the Mediterranean diet, the trial evidence—studies of people who went on the diet, having not followed it before—is only “promising (though not conclusive)” when it comes to reducing heart disease risk.
It’s also important to remember that the scientific understanding of the Mediterranean diet has been cobbled together from foods that are considered traditional in Greece, Italy, and neighboring areas. Foods are included, or not, based on how typical they are deemed to be of that traditional eating pattern.
This means that when people say the Mediterranean diet is scientifically backed, they are referring to the studies that have been done on people who sorta-mostly follow it. It does not mean that scientists constructed it from scratch, specifying olive oil because they deemed it healthier than other oils, or determined 250+ grams to be the perfect amount of vegetables for some particular reason.
Okay, but how do you actually follow this diet?
All that said, the Mediterranean diet seems to be a perfectly fine way to eat. If you’d like to try it, go for it. The vagueness of the diet’s description is both a pro and a con. The good news is that no food groups are cut out and nothing is officially off-limits. Unfortunately, without strict rules or definitions, it’s hard to know exactly what to have at your next meal if you want to stay on the diet.
The scorecard above is not the only way to judge the Mediterranean-ness of a diet, but it’s as good a starting place as any. Here’s approximately what it would look like as a day’s eating:
- Vegetables: it’s still hard to measure out 250 grams of different sizes and shapes of veggies, but the more familiar recommendation of 3 cups of vegetables should get you in the right ballpark.
- Fruits and nuts: Two pieces of fresh fruit, like an apple and an orange, will hit the 300 gram target easily. Swap in other fruits as you prefer, and try to get a handful of nuts in your day somewhere—maybe as a topping to a salad or another dish, or maybe just a handful on their own.
- Legumes: 140 grams per week is just 20 grams a day when you average it out. One can of chickpeas or black beans will check off this requirement for the week.
- Cereals (grains): You can meet the 195-gram requirement with a cup of cooked brown rice. If you think of it as two 100-gram servings, you could have one meal with half a cup of rice or farro, and one meal with a 2-ounce side of pasta. More is fine, according to the scorecard, but you’ll want to make sure to leave room for everything else.
- Fish: 250 grams per week means a quarter-pound serving twice per week—but that’s a minimum. You can have more.
- Meat: The 80 gram average per day is a little under three ounces (the famous “palm sized” or “deck of cards” serving). This is the size of a quarter-pounder patty, or half a chicken breast. Unlike fish, this is meant as a maximum, so you may want to do a meatless day each week to bring the daily average down.
- Dairy: 180 grams is about six ounces. So a container of yogurt that weighs in at five to six ounces would be considered plenty for the day. Or go with feta or mozzarella in a meal.
- Alcohol: the recommended amount works out to one to two drinks per day. A glass of wine with dinner would meet the recommendation.
- Olive oil can be used as needed for cooking.
Add that together, and a day’s meals might include a breakfast of yogurt and fruit; a lunch salad with fish and veggies; and a dinner with meat, rice, and more veggies; and some hummus and whole-grain bread for a snack.
For recipe inspiration, Oldways (an organization that promotes traditional eating patterns, including but not limited to the Mediterranean diet) has a database of recipes here that you can filter by diet. OliveTomato has a printable shopping list (identifying typical “Mediterranean” groceries you might want to stock up on) and a sample 5-day meal plan. There is also a Mediterranean diet subreddit where people post meal ideas and recipes.
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