What I Learned About the Mediterranean Diet Studying Nutrition in Italy

June 13, 2023

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I arrived in Rome starry-eyed and ready to experience the Mediterranean Diet firsthand during my dietetic internship. Over the course of the summer, I traveled from Rome to Tuscany and Florence, then to the coast to visit Naples and Ischia.

What I experienced was a bit different than my original impression of the classic Mediterranean diet. In fact, many of my meals in Italy that summer contained plenty of refined flour, dairy, red meat, and dessert. So, what gives?

The stats show that Mediterranean regions are moving toward more of a Westernized eating style. Obesity is on the rise in Mediterranean regions. For example, Spain is estimated to have an obesity prevalence of 25% of the population – one of the highest obesity rates in Europe. Further, folks of Mediterranean descent might aspire to eat in a Westernized way because it gets conflated with social status.

As I ate and drank my way through Italy, I found that my preconceived notions about the Mediterranean diet were idealistic and didn’t consider cultural differences within the region. Read on to learn more about the reality of eating patterns in the Mediterranean.

What is the Mediterranean diet?

The textbook definition of the Mediterranean diet has a few pillars inspired by cultures surrounding the Mediterranean Sea, such as Greece, Italy, Spain, and others. Studied by Ancel Keys in 1958, the original research looked at seven countries and the similarities in eating patterns that seemed to play a role in decreased heart disease risk.

Plant-forward diet: The diet is rich in fruits, vegetables, legumes, nuts, seeds, whole grains, and herbs.
Olive oil as a primary fat source: Olive oil is a staple in the Mediterranean diet and is used in cooking and as a dressing.
Moderate animal-based protein: The Mediterranean diet is supposed to be relatively low in meat and fish. Red meat, including beef and pork, is consumed in small amounts and less frequently compared to other protein sources.
Daily wine consumption: In many regions of the Mediterranean, red wine consumption is normalized, typically with meals and in moderation.

Research suggests that following the Mediterranean diet may offer numerous health benefits, including reduced risk of heart disease, lower rates of certain cancers, improved brain health, and weight management.

Textbook vs. reality

The first meal that was served to us at the university was split pea soup and shaved turkey breast. Then, we had a salad, and then, pasta. So much pasta. Not once did I have a picture-esque salad with tomatoes, feta, and cucumber. Instead, we often found ourselves eating pizza, pasta, and drinking wine at our main meals.

Even within the country of Italy, each region influenced our pattern and style of eating. Rome offered a large diversity of cuisines, Tuscany had an emphasis on pasta and pizza, and the coastal region incorporated significantly more seafood.

In reality, meat and fish were more common than I was led to believe, butter was a common oil source in dishes, and we often ate foods with refined flour. We did, however, eat a variety of plant foods and often picked them directly from a local garden. We spent time thoughtfully preparing our meals, visiting together, and eating slowly. In the afternoon, it was common for the town to go home, spend time together eating, napping, or going out to walk.

What’s missing from the conversation?

A Mediterranean lifestyle can have many similarities, but it’s going to drastically vary from region to region. It’s time to expand our definition of the Mediterranean lifestyle: There are 21 Mediterranean countries and many of them are Middle Eastern and African nations.

This diversity is certainly not captured in the classic definition of the Mediterranean diet and largely is not researched despite containing many healthy foods as well. Consider the plant-heavy, fiber-rich diet of the Middle East or the vibrant spices of the African countries that border the Mediterranean Sea — these foods have well-researched nutrition benefits on their own, but collectively, we have not yet studied those cultures as in-depth as Spain, Italy, and Greece.

Is there a “real” Mediterranean diet?

The Mediterranean diet you’ve imagined may not truly exist, but there still are some core principles that remain true. However, it might not be as simple as only cooking with olive oil and sprinkling feta cheese on your salads!

Eat more plants: One consistent staple in the Mediterranean is a large emphasis on plant foods. Fruits, vegetables, whole grains, or nuts were part of each meal. This is true no matter what part of the Mediterranean you find yourself in — however, the foods change based on the geography.
Enjoy your food mindfully: Spend time cooking together, shopping together, or growing your food. In the Mediterranean, food brings people together. It’s a cherished part of the day to slow down and be mindful. Main meals often lasted two or three hours.
Build a low-stress lifestyle: Western culture doesn’t often prioritize downtime, but taking a break in the afternoon is a cornerstone of many Mediterranean cultures. Enjoy longer meals, take an afternoon walk, or pause for a nap to slow down and reap the stress-relieving benefits of this lifestyle.

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