September 12, 2026

An Introduction to Mediterranean Diet

John Dang M.D.

The Mediterranean diet has gained popularity in recent years for good reason. It has been proven to reduce risk of cardiovascular disease, metabolic syndrome, diabetes, and a slew of other medical issues. As an added benefit, the Mediterranean diet is relatively simple and does not greatly restrict dietary options. 

The following recommendations are based on PREDIMED trial conducted in Spain.

• Abundant use of olive oil for cooking and dressing dishes (Consider up to 60mL (4 tbsp) per day)
• Consumption of ≥ 2 daily servings of vegetables (at least one of them as fresh vegetables in a salad), without counting garnishing 
• ≥ 2-3 daily serving of fresh fruits (including natural juices)
• ≥ 3 weekly servings of legumes
• ≥ 3 weekly servings of fish or seafood (at least one serving of fatty fish)
• ≥ 3 weekly servings of nuts or seeds. Consider walnuts (15g / day), hazelnuts (7.5g / day), almonds (7.5g / day).
• Select white meats (e.g. poultry without skin) instead of red meats or processed meats (burgers, sausages, etc)
• Cook regularly (at least twice a week) with tomato, garlic and onion adding or not other aromatic herbs, and dress vegetables, pasta, rice and other dishes with tomato, garlic and onion adding or not other aromatic herbs. This sauce is made by slowly simmering the minced ingredients with abundant olive oil.

*At the moment we do not recommend excess oil intake simply to make up the volumes studied in the trial. Eat a natural amount of oil, don’t go over 60mL per day. 

**Serving size for fruits and vegetables typically equal 1 cup of the raw ingredient

• Cream, butter, margarine
• Cold meat, paté, duck
• Carbonated and/or sugared beverages
• Pastries, industrial bakery products (such as cakes, donuts, or cookies)
• Out-of-home pre-cooked cakes and sweets
• Industrial desserts (puddings, custard)
• French fries or potato chips

Be it weight loss or cardiovascular health, portion control is an important part of healthy dietary practices. Even when making healthy food choices, eating calories beyond what your body requires can still lead to negative health consequences, including overweight/obesity, and elevated cholesterol and sugar levels.

In general, we recommend eating until fullness. However, reduced food portions CAN still be achieved without feeling hungry. Hunger and satiety are complex sensations; beyond the actual volume of solid food or liquid consumed, there are various factors that can influence how much food people consume. 

• Eat to 80% full; your body will gradually adjust to a lower food portions
• Consider doing a 8:16 intermittent fasting; for weight loss, skipping dinner is particularly useful
• DO NOT eat to avoid wasting food
• Eating out is fine and encouraged; there are between 14-21 meals in a week, plan for eating out no more than 2-3 times
• When eating out with friends, consider eating a small salad or fruit before leaving your house to avoid excess calorie intake
• Keep yourself hydrated; try drink water before snacking if you’re feeling peckish
• Use smaller plates
• Lead all meals with low calorie foods (i.e. soups, salads)
• Eat slowly and drink water
• Don’t keep snacks or sweets in the house

*Portion control is a general recommendation for many patients who have elevated cholesterol levels. This is not a universal recommendation, particularly for patients with low BMI or for elderly patients. If any questions regarding this portion, please consult Dr. Dang.

The general rule for improved cardiovascular health is the use of mono or polyunsaturated fats as the primary fat used in cooking, in condiments, or consumed directly. In the literature, this would mean fatty fish, monosaturated fats (olive oil is used in almost all trials, though avocado oil is also rich in monosaturated fats), white meat, and nuts. From a practical standpoint, avoidance of fats that are solid at room temperature (butter, limited use of cheese, animal fats) would seem a reasonable approach.

With regards to amount of fats, an interesting study done in Spain published in 2022 (CORDIOPREV) challenges the notion that a lower fat diet in and of itself is useful for preventing the worsening of cardiovascular disease. The study found that patients with existing cardiovascular disease had a better outcome adhering to a Mediterranean diet than to a low fat diet. Since these two diets are not mutually exclusive and in fact have more similarities than differences, what seems to be the deciding factor? It seems that the Mediterranean diet liberalized fats intake (only in the context of increased olive oil and nuts intake) at the expense of decreased carbohydrate consumption. That is to say, this study should not be interpreted as a carte blanche to increase oil and fats intake; rather, this should be interpreted as a more balanced diet, with a higher proportion of healthy oils intake so as to decrease carbohydrate (particularly processed carbohydrate) intake.

With regards to method of cooking, we recommend grilling, sauteeing, baking/broiling, and stewing. In the context of the above discussion, it would be reasonable to make the argument that using the appropriate oils and proper amounts, fried food food would still be “allowed”. Nevertheless, no literature has supported this notion and so we do not recommend fried food in any significant portion beyond the occasional treat.