You’re probably familiar with the Mediterranean Diet. It’s consistently ranked as the healthiest diet out there, and numerous studies have linked it to a lower risk of chronic conditions such as heart disease and type 2 diabetes, as well as a lower risk of premature death (1).

But while there’s plenty to celebrate about the Mediterranean Diet, there’s also a big problem that we’re not talking about enough.

The diet is based on traditional eating patterns of European Mediterranean countries, but it excludes the traditional cuisines of many other nations with Mediterranean coastlines.

Plus, the current interpretation of the diet isn’t as flexible or accessible as it’s made out to be, since it relies heavily on foods that are out of reach for many.

This article explores more about how we can make the Mediterranean Diet more inclusive, regardless of cultural heritage and preferred foods, and some of the problems with the initial research.

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The Mediterranean Diet isn’t representative of the entire Mediterranean region

There are 21 countries that touch the Mediterranean Sea: Albania, Algeria, Bosnia and Herzegovina, Croatia, Cyprus, Egypt, France, Greece, Israel, Italy, Lebanon, Libya, Malta, Monaco, Montenegro, Morocco, Slovenia, Spain, Syria, Tunisia, and Turkey.

However, the Mediterranean Diet is based primarily on the traditional cuisines of Italy, Greece, Spain, and southern France, excluding those of the Eastern European, Middle Eastern, and African countries in the region.

The reason for this can be traced back to the Seven Countries Study. From 1952–1957, American researcher Ancel Keys conducted informal, exploratory studies in seven countries: Italy, Greece, Yugoslavia, the Netherlands, Finland, Japan, and the United States.

The researchers studied eating patterns in each of these countries and measured the rates of heart disease, diabetes, and risk factors such as high cholesterol, high blood pressure, and smoking (2).

Ultimately, Keys and his team concluded that dietary patterns in Italy and Greece were associated with the lower rates of heart disease and all-cause mortality in these countries. So, Keys began to promote this way of eating for better health and lower disease risk (2).

Today, experts are quick to criticize Keys’ research methods. One recent article published in the Journal of Critical Dietetics points out that the study collected data only from men and that, with the exception of Japan, it included only predominantly white populations (3).

The reason non-European cuisines aren’t part of the Mediterranean Diet isn’t that they’re less nutritious but that these countries weren’t included in early research (3).

Focusing only on European cuisines may be stigmatizing

Overall, experts agree that the Mediterranean Diet is nutritious. It emphasizes whole, plant-based foods (fruits, vegetables, nuts, seeds, legumes, and whole grains), lean protein, and unsaturated fats. This is similar to what the Dietary Guidelines for Americans recommend (4).

But specifically calling out the cuisines of Italy, Greece, Spain, and France isn’t necessarily helpful, and many Mediterranean Diet food lists are lacking in cultural diversity.

“Saying that one region (and really, three or four countries) eats healthy implies that other countries and their cultural foods are not healthy, which can be stigmatizing,” says Shana Spence, MS, RDN, a registered dietitian based in New York City.

The true Mediterranean diet expands far beyond European staples like fish and olive oil.

“Each country and/or cultural group in the Mediterranean region has their own unique food culture and preferences,” says registered dietitian Alice Figueroa, MPH, RDN. “We should not only highlight European countries but also African and Middle Eastern countries.”

The basic principles of the Mediterranean Diet can be applied to any cultural cuisine

Widening our idea of what the Mediterranean Diet looks like can also make it more sustainable and realistic for people, Spence says. “If someone does not have a taste for seafood or olives, this way of eating would not be sustainable.”

Likewise, if someone can’t afford to eat these Mediterranean staples all the time, they may get discouraged and feel like healthy eating is out of reach.

On the other hand, focusing on overall patterns in the Mediterranean Diet, such as eating lots of plant-based foods and choosing unsaturated fats over saturated ones, makes it more flexible and customizable.

“Every culture eats veggies, fruits, and grains,” Spence says. “Adding more of these foods [to your diet] is great, and there are ways to do this without thinking that your particular heritage is incorrect because it’s not celebrated in mainstream media.”

Figueroa also notes that many non-European cultures incorporate similar foods: vegetable curries are a pillar of Indian cuisine, stir-fries are a staple in Southeast Asia, Guatemalan stews are made with lots of veggies and a bit of meat, and Ethiopian food relies heavily on legumes.

While these dishes aren’t necessarily the ones you’ll find highlighted in Mediterranean Diet cookbooks, they contain many of the same foods and nutrients.

Ultimately, ingredients that are staples in Greece, Italy, and Spain may not be accessible or enjoyable for everyone.

But just because you don’t eat fish and olive oil every night doesn’t mean that your eating habits aren’t nutritious or that you can’t reap the benefits of the Mediterranean Diet.

Bottom line

The Mediterranean Diet is indeed nutritious and health-promoting, but its focus on European cuisines excludes many other cultural foods that are equally nutritious.

Eating some of those traditional Greek and Italian foods that we often see in the Mediterranean Diet, like salmon with feta and tomatoes, can be a delicious and healthy way to eat and maybe the type of food you love.

Having flexibility with any diet or eating pattern is important and if you’ve felt like your favorite foods and dishes were excluded from the discussion, try adopting patterns from the diet with the foods you love.

Instead of trying to follow the Mediterranean Diet to a T, try eating lots of plant-based foods and choosing unsaturated fats over saturated ones.

Just One Thing

Try this today: Explore the cuisines of non-European Mediterranean countries. Here’s a great recipe for Haraimi, a Libyan fish stew made by cooking fish and potatoes in a rich tomato broth.