The Mediterranean Diet

© Peter Smith –Holistic Medicine Practitioner- (updated 1/2013)

The Mediterranean diet has been voted as the healthiest diet in the world by several health organisations, including the World Health Organisation. Long-term studies have shown the Mediterranean diet is associated with a 50% reduction in early mortality. Following the Mediterranean diet and lifestyle will lower your risk of heart disease, cancer, and type 2 diabetes, it can also help you control your weight if done properly. 
It should be noted that to obtain the full effects of the Mediterranean diet you must include all the life-style practices. In addition to the food you must:

1. be physically active for 30 mins per day,
2. relax and connect to your food while you are eating, no TV dinners,
3. drink a little wine every day with meals.


The Mediterranean Diet Food

The Mediterranean diet is a low meat very high vegetable and seafood diet, with olive oil being the only oil used. It can also be done as a vegetarian, just increase the quantity of beans and add a good omega–3 oil like Udos’ Choice. If you buy Mediterranean diet cook books make sure you are getting the right thing, for an example an Italian cook book may not be the Mediterranean diet, it might be rich, meaty recipes.   For the Mediterranean diet think rustic, “peasant” food typified by the cuisine on the island of Crete, the Mediterranean diet is sometimes called the Cretan Diet or the Greek Diet.   Newer books are taking the principals and calling it the Miami Mediterranean diet to develop the diet in America. 

In addition to the health-benefits this diet is cheap, very tasty and easy to learn to cook. 

  • Red meat and desserts 2 times per month. Vegetarians should just increase the beans, peas and lentils. 
  • Poultry and eggs up to 3 days per week.
  • Dairy can be often but only in moderate amounts, choosing from organic mozzarella, feta, goats and sheep’s yogurt with little dairy produce from cows. 
  • Seafood 2-3 days per week. If you cannot achieve this substitute beans, peas or lentils for the protein and a good source of omega 3 like flax or hemp oil.
I recommend Udos’ Choice oil.   
  • The bulk of the diet is made up of vegetables, beans, peas and lentils with the addition of whole-grains and fruits for snacks. The vegetable intake is very high in the form of soups, salads steamed and baked dishes. Please see the wide spectrum of colours of fruit and vegetables shown in the food pyramid above. This is the rainbow diet in practice. The total intake of fruit and vegetables far exceeds the paltry 5 portions of fruit and vegetables recommended by the British Department of Health. 
  • Include Garlic. 
Garlic is an important ingredient of the Mediterranean diet. It reduces your risk of heart disease through several modes of action, including: lowering cholesterol, preventing abnormal blood clots, protecting against LDL cholesterol oxidation, protecting the endothelial lining of the arterial system against free radical damage.
To gain the maximum health benefits from garlic it needs to be crushed and exposed to the air for several minutes before being added to wet ingredients. This creates a chemical reaction that increases the active ingredient called allicin. 
Try eating 2-4 cloves of garlic a day, the higher amounts if you have high cholesterol, or take non-deodorised garlic capsules. 
Cooking garlic for more than 10 minutes can denature the healthy properties, so add it towards the end of cooking. 
The smell of garlic on the breath tends to wear off more quickly with regular consumption, it may be that you build up enzymes to metabolise it. A single clove in a salad at lunch is probably not noticeable, 3 cloves at one time may cause breath odour for a few hours, if you eat it with dinner you should be fine by the next day.
  • Include Olives in salads and as snacks/canapés
  •  Olive oil is the only oil in the kitchen.
There is no butter and absolutely no hydrogenated oils, margarine, trans-fats or vegetable shortenings. The olive oil replacesother fats, it is not added to bad fats in the diet.

About the Olive Oil

The abundant use of olive oil combined with the absence of bad fats may be the single most important aspect of the Mediterranean diet. Olive oil contains two valuable components, firstly a monounsaturated fatty acid, called oleic acid that lowers the bad (LDL) cholesterol and increases the good (HDL) cholesterol; secondly olive oil contains antioxidants known as polyphenols, these reduce the risk of cardiovascular disease and certain types of cancer including colon and breast cancer.

Only buy extra virgin or at least virgin olive oil. This is produced without the high heat (cold pressed) and chemicals that would damage the oil and polyphenols. Extra virgin generally tastes better. Unfiltered looks cloudy or has more of sediment and may produce an undesirable taste if used for frying, use it for dressings where it can have a superior flavour.  

The cloudy sediment on the bottom is rich in the antioxidants, so gently mix them in, trying not to aerate and mix in air bubbles when you do this. 
Use up olive oil within a maximum of 6 months of purchase and within 4 weeks of opening. The antioxidants in olive oil are stable for 3 months but decline after that and by 6 months have fallen by 40%.
The antioxidants are damaged by heat and light so keep your oil in a cool dark place (though not in the fridge). In a dark cupboard is ideal, never by the window. Dark bottles help, tins are ideal because they are light tight. I hate to knock farmers/food markets but I have often seen olive oil in glass bottles in direct sunlight at these markets, it’s damaged! Wrapping the bottle in brown paper and an elastic band keeps the light out.

Use a minimum of least 2 dessertspoons per day to obtain the heart protective benefits. You can use a lot more than this, use enough oil to make you feel full and satisfied so that you don’t need to over eat/snack between meals. Olive oil contains about 90 calories per dessertspoon, this may seem like a lot, but 3-4 spoon in a large salad with some protein (meat, fish, egg or beans) would be quite filling for only 270-360 calories from the oil. The key, from a weight-control point of view, is to hold back or eliminate the carbohydrates. Add pasta and this meal becomes fattening, which is fine if you labour with your body but not if you sit in an office.

The style of frying done in the Mediterranean diet does not involve very high temperatures. In the pan there would typically be wet tomatoes, onions and garlic, it is more sautéing than frying. The presence of the water reduces the temperature and the steam generated drives off damaging oxygen. The polyphenols are probably destroyed but the oleic acid will largely survive. Adding extra water to the pan significantly reduces the heat damage. Moderate sautéing to keep the diet interesting is acceptable. 
Use the olive oil on salads and steamed vegetables as a dressing. A dressing must be used up straightaway before the oil starts to oxidise, do not make up a bottle-full of dressing and keep it, do not buy readymade dressing. 
Eating plenty olive and omega 3 oils is essential for good health so learning how to make quick and tasty dressings is important. 
I’ve seen ridiculously complex instructions for making vinaigrette dressings online, it’s actually quick and easy, watch how Jamie Oliver does it 
The basic dressing formula is 3 parts oil to 1 part acid liquid like vinegar or lemon juice, remember this formula. You can use all vinegar, a mixture of different types like balsamic or apple cider, or a mixture of vinegar and lemon juice. 

Add seasoning: fresh ground pepper and a pinch of salt (use potassium salt if you have hypertension) and you are 90% there. Put these ingredients into a narrow glass and whisk with a fork. Taste it, and if its too acidic add a couple of pinches of xylitol or honey to counter balance the acid. Some olive oils have a grassy taste and will need this sweetness to make good dressings. Reduce the amount of vinegar if it is very strong. Apple cider vinegar is probably not the best from a cuisine point of view, but is the healthiest vinegar option. 
For speed use a cheep (less than £10) battery powered coffee frother which can whisk the dressing in seconds, and a small glass graduated beaker (like a science lab beaker). With the beaker you can see the quantities of the liquids as you go and don’t even need a spoon. With this beaker and whisk set-up it takes less than 2½ minutes to prepare a tasty dressing. 
Try a pinch of cayenne to wake up the flavours. 
Add ¼-1 teaspoon smooth Dijon mustard. This adds flavour and thickens the dressing so it coats the salad/veg. 
Add a splash of shoyu sauce for tangy salt.
Add a little garlic, or use store garlic in your oil. 
Use orange juice (double the amount) instead of vinegar for a fruity flavour. 
Add fish sauce and more cayenne or chilly for Asian flavours. 
etc. etc. etc.
Try thinning a teaspoon honey with lemon juice and whisking in olive oil; pore this over slices of peeled blood oranges as a desert or appetiser. See for recipe ideas with olive oil, but reject recipes that involve storing the oil after you have mixed air into it. 
  •   Include Wine
       1-3 units per day for men and ½-1½ for women (see later). 

The importance of the Wine

Regular intake of genuinely moderate amounts of wine are good for you. Several studies have shown a decline in mortality from all causes of between 10-26% in people who consume a little alcohol compared to those who consume no alcohol. This makes alcohol and wine in particular potentially one of the most impressive health promoting and life extending supplements you can add to your diet! You can think of small doses of wine as a supper food. The benefits vary according to the type of beverage and gender. Regular consumption of green tea, by comparison significantly reduces the incidence of bowel cancer, and some types of vitamin E (gamma tocopherol) reduce the risk of cardiovascular disease. But these benefits only pertain to specific conditions and not mortality from all causes. Of course we must be cautious about accepting such impressive findings without being sure that the research was not funded by the commercial interests of the drinks industry. Having said that moderate wine consumption is part of the Mediterranean diet and we know that the latter promotes good health. 
To obtain these great benefits it is important to:-
  • Consume the right amount.
  • Consume it frequently, basically daily. It will not improve your health to go for a week without a drink and than have 7 glasses in one session.
  • Consume it with meals and not on an empty stomach.
Understand that to use wine as a disease preventing supplement the quantity must be kept within a narrow therapeutic range. If you go over the beneficial level you will produce the opposite effect and significantlyincrease your risk of mortality compared to none-drinkers.
The problem of course, is that most people who drink do not drink moderately, indeed it’s quite difficult to do so. Could you meet someone for a drink and consume one ½ pint (280 mL) of beer, or one small catering glass of wine and then stick with non-alcoholic drinks? Could you drink this little every day even in your own home without the amount is creeping up? If not, your health would be better off not drinking alcohol at all. Unfortunately alcohol is one of those drugs that makes you feel a little bit more would make you feel a little bit better, whilst simultaneously diminishing your resolve and capacity for rational decision-making. Another problem is that almost no one seems to be able to be honest about how much they actually drink, even with themselves. 
One study (M Gronbaek et al. Type of alcohol consumed and mortality from all causes, coronary heart disease and cancer. Annals of Internal Medicine 2000 133:411-419) found significant difference in the health effects of beer and spirits compared to wine. 
In summary beer and spirits increased mortality rates from cancer, but in very moderate doses decreased mortality rates from coronary heart disease, such that very moderate consumption resulted in an overall reduction in all causes of mortality of 10% compared to non-drinkers. Slightly higher consumption -but still within the recommended units- of beer and spirits per week resulted in little or no benefit to overall mortality, basically the benefits gained against coronary heart disease were cancelled out by increased mortality from cancer. Consumption of over 21 drinks of beer and spirits significantly increased overall mortality compared to that of non-drinkers.
Wine drinkers however did much better, this is because wine consumption not only reduced mortality from coronary heart disease, but also reduced mortality from cancer. Compared to non-drinkers consuming moderate amounts of wine every day reduces mortality from all causes from 20 to 26%.  
Comparison of the different studies is difficult because some studies are not specific about the exact amount of alcohol, expressed in either units or grams, but rather talk in terms of standard drinks. Over time wine has become stronger and wineglasses bigger, a standard glass of wine today contains 2.3 units of alcohol, compared with only 1 unit a couple of decades ago. Despite these difficulties most studies have produced more or less comparable results. 
Overall from meta studies (where the results of several studies are combined):
  • Men can gain a reduction in mortality from all causes of about 20-26% by consuming 1-3 units of alcohol per day derived from wine. Actually some studies showed men could still benefit, although less so, with higher levels of wine intake, but given the risk that this can do more harm than good I could not recommend it. 
  • Women can gain a reduction in mortality from all causes of about 20 to 24% by consuming 0.2-2 units of alcohol per day derived from wine. The maximum benefit of 24% reduction in mortality for women was actually obtained with approximately ½ a unit of alcohol or 1/3 glass of wine per day. This is more like a ‘shot’ than a glassful which I think you will agree is a very small amount. 
In this paper I’m trying to recommend how you would obtain optimal health benefits from your diet, expressed in terms of wineglasses the ideal amount would be:
  • 1 to 1 ½ small glasses of wine per day for a man.  
  • 1/3 to 1 small glass for a woman.
A small wineglass would hold 125 mls.
The difference for a woman between drinking a quarter of a glass and a full glass probably only reduces the benefits from 24 to 22% better off compared to a non-wine drinker. 
The differences in the amounts of alcohol that benefit men and women are due to several factors:
Firstly women tend to weigh less than men. 
Secondly women have on average of 12% more body fat than men and alcohol does not diffuse into adipose tissue (fat storage tissue) as readily as non-fatty tissue like muscle. This means that if you take a man and a woman of equal weight and an equal level of fitness drinking same amount, the alcohol would have a smaller volume of tissue and blood to occupy in the woman’s body, resulting in a higher blood alcohol level than in the man. 
Thirdly excess alcohol consumption significantly increases the risk of breast cancer. This increase hardly changes overall mortality rate for men because breast cancer rates are already so low in men, but may increase the overall mortality rate for women. 

Breast Cancer risk from alcohol

Women who consume 40 grams of alcohol (4 British units) per day have a higher risk of breast cancer than women who abstain from alcohol. However, in women who take 200 micrograms of folate or folic acid (Vitamin B9) every day, the risk of breast cancer drops below that of alcohol abstainers.
That was the finding of a study of over 17,000 Australian women aged 40-69 over a period of about ten years. These results are consistent with earlier studies.
An exhaustive review of the research evidence has found that women who drink alcohol and have a high folate intake are not at increased risk of breast cancer compared to those who abstain from alcohol. The study was published in the British Medical Journal. 
Other studies have shown that even moderate alcohol intake can increase the risk of developing breast cancer and considered altogether the implication of the research is that women that drink any alcohol at all must consume a folate rich diet to negate the tendency of alcohol to increased breast cancer risk and gain the full potential health benefits of moderate alcohol consumption.
Foods rich in folate include: all dark green leafy vegetables, leeks, citrus fruits, citrus juices, dried beans, and peas. You can also increase folate/folic acid levels with supplements although this should be done as an addition to and not in place of a high vegetable diet. 
In summary a diet containing copious amounts of folate and very moderate amounts of alcohol is likely to reduce mortality from all causes and extend life in women compared to the same diet without any alcohol. There is insufficient research to be sure that this applies equally to women that have female blood relatives (mother, grandmother or sisters) that have had breast cancer. In such circumstances is probably prudent to abstain from alcohol consumption completely, but definitely consume huge amounts of the cruciferous vegetables (broccoli, brussels sprouts, cabbage) on a daily basis for the antioxidant indole-3-carbinol which possesses anti-breast cancer properties equivalent or perhaps superior to tamoxifen. Indol-3-carbinol can also be taken as a supplement.
Finally there are probably significant differences in the ability to tolerate alcohol between one individual and another, and between different gene-pools. For example some but not all people from South East Asia are especially intolerant to alcohol, and there is some evidence that North Europeans and South Europeans possess different abilities to tolerate alcohol. You should also adjust the above figures according to your individual body weight, i.e. are you above or below average body weight. 
Note that research has shown that just one binge drink per month (i.e. 6 units for women and 8 units for men) will reverse the health benefits you gain by moderately drinking the rest of the time. 
If you want to take drinking wine for medicinal purposes seriously I would recommend investing in nice but very small wineglasses (port glasses are perfect) and one of those vacuum pump bottle stoppers to preserve the wine. Some people tell me they dilute their wine with grape juice or sparkling water like Perrier to make it go further which may help you limit the amount. 
The very beneficial anti-oxidant resveratrol is found in much higher amounts in organic wine making it superior from a health point of view. 
(To calculate a British unit multiply the strength in % volume by the amount you are drinking in mls then divide by 1000, e.g. wine at 13.5% X 125 mls (small glass) /1000 = 1.68 units).

How to improve the basic Mediterranean Diet

We now know that certain foods, so-called super foods possess powerful disease fighting properties and you could add these to the basic Mediterranean diet. 
To increase your intake of antioxidants add the following super foods: turmeric, green tea, blueberries, blackberries, pomegranates, dark chocolate (over 70% cocoa), cocoa nibs, cooked tomatoes and broccoli eaten together at the same time (this is especially for men), and apples.   See my Supper Food Recipes -available on request- for lots of healthy chocolate dishes! 
On a side note following the Mediterranean diet is one of the known ways to reduce the rate of prostate cancer in men. The rate of prostate cancer has risen significantly and is now among the leading causes of death due to cancer. It appears that the abundance of the antioxidant lycopene found in cooked tomatoes, olives, olive oil, grapes and wine is protective against this type of cancer. Combining the antioxidants from cooked tomatoes and broccoli in the same meal increases the different antioxidants ability to protect the prostate from cancer. Eat this combination several times per week. Regular exercise is also proven to be preventative. 
You can add more potassium to alkalise the body and lower blood pressure by investing in a good juicer and consuming vegetable juice such as carrot and ginger at least several times a week. Buy a masticating slow speed juicer, not the centrifugal type. These masticating juicers are very expensive but are a great investment; I bought a Champion juicer 25 years ago and it still works as well as the day I bought it! Despite the Champion’s impressive reliability, it can get too hot on long runs and does not handle very soft or stringy things like ginger or wheat-grass. Because of these limitations today I would buy a Green Power Juicer. 
With juicing one liberates and separates all the vitamins, minerals and antioxidants from the fiber. What juicing enables you to do is to consume large additional amounts of the vitamins, minerals and antioxidants without having to eat so much fiber that it would give you diarrhoea. You should still of course be consuming sufficient fibre to induce regular and soft stools. In addition to just regularly supplementing juice to your diet you can perform awesome detoxification programs and fasts with your own fresh-made juices. Or grow your own wheat-grass and inject shots of this antioxidant packed, detoxifying “elixir”. To grow your own wheat-grass and keep a constant supply I would recommend the Easygreen automatic sprouter, although I admit I have not used it. You must consider where a juicer will be situated in the kitchen so it is always ready to use and then rinse clean. 
A liquidiser/blender can be used to make raw vegetable soups. These liquidised soups contain the maximum amount of heat sensitive vitamins such as vitamins C, that can be diminished during cooking. All the fibre remains un-softened by heat and yet all the potassium is liberated by the grinding process. The problem with liquidised food is that it can be difficult to digest for some and tend to sit in the stomach for hours.    
On that point, when cooking vegetables ones goal is to just barely breakdown the cellulose surrounding each cell thereby liberating the nutrition contained within. The optimal point is between the vegetable remaining crunchy, and therefore still containing intact cellulose, and going soggy/soft, where the cellulose has been too extensively broken down to serve as roughage and move the bowels. The only real downside to liquidised vegetable soups is that they can occasionally be difficult to digest compared to cooked soups, I would only recommend small portions so start with. 
Lastly you should eat at least 25-30 g per day of soluble fibre. This type of fibre is different to the insoluble fibre (roughage) found in vegetables and has the effect of absorbing cholesterol in the intestines and removes it from the body. Studies have shown a significant correlation between increased consumption of soluble fibre and a reduction in mortality coronary heart disease.  
Use books and the internet for information and recipe ideas to work on your diet until you achieve 25 g a day. You can expect an 18% reduction in your cholesterol from soluble fibre alone.
Breakfast is a great opportunity to ingest soluble fibre by eating a cereal-based meal, such as porridge or muesli. Add fresh ground brown flaxseeds to some yogurt and you already made a great start. If you can eat beans for lunch in the form of baked beans on wholemeal bread, or a bean salad you’re well on track. Include some beans, carrots, broccoli and brown rice/quinoa in your dinner, add apples and psyllium husks between meals for snacks you’ve probably met your target. 
Best sources of soluble fibre are: apples, oat bran, almonds, flaxseeds, black beans, navy beans, kidney beans, pinto beans, lima beans, brussels sprouts, dried apricots and barley. By far the richest source of soluble fibre is psyllium husks. Caution do not get dehydrated when taking psyllium, it may constipate you. 
See my information document: How to Lower Cholesterol Without Drugs and Prevent Heart Disease for more information and recipes. 
(Version: 1/12)

For more information and recipes on the true Mediterranean diet see The Mediterranean Diet Center

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