There have been concerns regarding the definition of the Mediterranean diet. It has been noted that it is not clearly defined and that it reflects a variety of eating habits traditionally practiced by populations in countries bordering the Mediterranean Sea, with considerable variability by location.
This is concerning. The issue here is that the term “Mediterranean Diet” does not necessarily reflect the variety of eating habits from across the Mediterranean.
The term “Mediterranean Diet” is misleading and often a “loaded” term. Nowadays, when we talk about the Mediterranean diet, we talk about it as noted above, the traditional eating habits practiced by people living around the Mediterranean. As Registered Dietitian Rita Carey mentions in her article in Today’s Dietitian ” the Mediterranean diet… has become, for many, the de facto diet of anyone living in countries bordering the northern Mediterranean Sea.” But is it?
To answer that we need to look closely at what all these countries were eating traditionally, but also the research. Back when the Mediterranean diet was “discovered”, studies have focused on diets of specific countries mainly Italy, Greece and Spain, not all of the Mediterranean. We should not confuse Mediterranean Cuisine, Mediterranean Foods or even Mediterranean lifestyle with THE “Mediterranean Diet”. They are quite different things. Yes the Mediterranean Diet refers to a lifestyle, but also to a specific pattern of eating as a whole, not specific dishes or cuisine.
When the first guidelines were developed back in the 90’s with Oldways, Harvard and the World Health Organization you will see that they clearly state “This Mediterranean diet pyramid is based on food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s”. This is an important point because it helps in developing more specific guidelines. Both countries have areas that are considered “Blue Zones” and when I look at the diet of the Greek Blue Zone on the island of Ikaria, I can say with certainty that their diet today, is the diet that most of rural Greeks had in the 60’s and even the 70’s.
In an email, Walter Willett, an American physician and nutrition researcher and Professor of Epidemiology and Nutrition at the Harvard School of Public Health, who was one of the developers of the original Mediterranean diet pyramid, told me this about the original Mediterranean Diet Pyramid: “we defined a specific Mediterranean Diet for which the documentation of benefit is most complete”, however he does add that there are variations. But that’s where it gets confusing. What are these variations? Sure the evidence exists for diets of specific countries mainly Italy, Greece and Spain, so yes there are are those varieties, but not so much if at all, on any of the other countries around the Mediterranean, (just take a look at the bibliography).
So I’m a bit surprised as to why the findings in specific countries would apply to more than a dozen other countries just because they border the Mediterranean. This is not what I would call evidence-based practice but generalizations. We just don’t know that much about the traditional diets (and their effect on health) of all these countries around the Mediterranean. So, for this reason, it may be more useful to refer to the specific variations we do know about, that way we can all be more specific when using the term Mediterranean diet.
A Dietary Pattern
Of course this does not mean that one cannot enjoy other Mediterranean dishes or recipes from all these countries, but they must adhere to that specific pattern, yes we are talking about patterns not individual dishes. It IS specific and it reflects the poor man’s diet of the time.
If we therefore get away from this idea that the Mediterranean Diet is the diet of all of the Mediterranean (which it is not), then we can move forward to more specific guidelines which can be helpful in providing consistency and reliability in research. And while this diet is not a manmade diet, and many believe it cannot be clearly defined, I believe it can and it is time to do just that.