The real Mediterranean diet: What does it look like?

A traditional Mediterranean diet has been shown to have significant health benefits. But can you follow it if you live nowhere near a Greek island?

We're always being told a traditional Mediterranean-style diet is an incredibly healthy way to eat.

Recent studies have shown this eating pattern can reduce your risk of dementia and reverse symptoms of depression and anxiety.

As well as its proven benefits in preventing heart attacks and promoting a longer life generally, it has specifically been shown to help ward off diabetes as well as bowel and prostate cancers.

But adopting a truly Mediterranean approach to eating, especially that which stems from the island of Crete in Greece, is not as simple as many cookbooks would have us believe.

While plenty of recipes are promoted as Mediterranean, they aren't necessarily the ones research has shown to be so good for us, says Catherine Itsiopoulos from La Trobe University in Melbourne. In fact in most cases they're not, she says.

That's because cookbooks tend to focus on festive foods and desserts from the region, says the head of School of Allied Health and Professor of Nutrition at La Trobe University, who is an expert on the Mediterranean diet.

"When people think of the Mediterranean diet, they always think of the souvlaki and the yiros and all the other meat dishes," she says.

But the diet, made famous by the ground-breaking health studies dating back to the 1960s, was a peasant-style diet that was largely vegetarian, she says.

"[There were] lots of casseroles where in a serve you would get 60 to 70 grams of meat but lots of vegetables. So the casserole was filled with beans and carrots and artichokes and zucchini and then there's a salad on the side. There was half a kilo of fresh fruit and half a kilo of vegetables eaten per person per day."

The 10 commandments

Professor Itsiopoulos, also an adjunct Associate Professor at the University of Melbourne, has developed "10 commandments" of the Mediterranean diet which can help you get a handle on what it involves.

The commandments are:

1. Use extra virgin olive oil as the main added fat (aim for around 60 mls /day)
2. Eat vegetables with every meal (include 100g leafy greens and 100g tomatoes, and 200g other vegetables/day)
3. Include at least two legumes meals (250g serve) per week
4. Eat at least two servings of fish (150-200g serves) per week and include oily fish: for example Atlantic and Australian salmon, blue-eye trevalla, blue mackerel, gemfish, canned sardines, and canned salmon. Canned tuna is not as high in the important fish oil omega-3, but still a good choice to include in your fish serves
5. Eat smaller portions of meat (beef, lamb, pork and chicken) and less often (no more than once or twice a week)
6. Eat fresh fruit every day and dried fruit and nuts as snacks or dessert
7. Eat yoghurt every day (about 200g) and cheese in moderation (about 30 to 40 grams per day)
8. Include wholegrain breads and cereals with meals (aim for 3-4 slices of bread per day)
9. Consume wine in moderation (one standard drink a day, which is about 100 mls), always with meals and don't get drunk. Try and have a couple of alcohol-free days a week
10. Have sweets or sweet drinks for special occasions only

She says these commandments can also be used to apply the health-giving principles of the Mediterranean diet to other kinds of cuisine. As well as researching the diet, she has also written a cookbook based on the exact meals she has used in her research. (Check out her Briami: vegetable bake.)

A healthy switch

Professor Itsiopoulos admits it's quite a different eating style to the one most Australians have today. But her experience introducing the diet to novices has been positive.

One study involved feeding traditional dishes, prepared and cooked by her team, to Australians who had type 2 diabetes. (It turned out to help them control the disease). Some enjoyed the experience so much that they wanted the recipes at the end of the study.

"We had middle-aged people of Anglo-Celtic origin who'd never eaten eggplant in their life and they ate this dish and said it was their favourite," she says.

Interestingly, while the people in the study were not restricted in the volume of food they ate — they were told to eat until they were full — they didn't gain weight.

They also reported "a very positive change in wellbeing, in mood and in the levels of energy they had".

A diet for busy lives?

Paleo diet pros and cons

How does the paleo diet stack up nutritionally?

The paleo diet is based on the notion that our bodies have not evolved to cope with our modern diet, so we must eat the way our hunting and gathering paleolithic ancestors ate. But is it nutritionally sound?

But what if you have to prepare all the meals yourself? Is this an eating style the time-poor can adopt? Professor Itsiopoulos insists it is.

It's true some of the casseroles have up to 20 or 30 ingredients if you count all the herbs and spices. However, modern day conveniences like slow cookers make preparing these meals easier than was once the case, she says. Meals like simple bean soups are quick and easy to make.

"You do have to be prepared. It doesn't take a lot of effort to pop leftovers in a container for lunch at work the next day but you've got to plan for it the day before. Something like a stuffed tomato or pepper, or a layered vegetable dish, you make on the weekend because it's a bit fiddly."

Most of the dishes are suitable for preparing ahead and freezing and she suggests enlisting the help of older children to prepare vegetables and even make some of the simpler meals themselves.

But taking time to "be in touch with food" and make at least some recipes from scratch is an important part of any healthy eating style, Professor Itsiopoulos believes. (Research has shown takeaway and restaurant meals, and even ready-made meal bases such as sauces, are almost always higher in unhealthy ingredients like fat and salt.)

"That's a culture you have to build in your family. It doesn't belong to any particular ethnic background."

What about the dairy?

If you think the Mediterranean diet looks a little low on dairy foods, you're right. It's certainly lower in dairy than is currently advised in the National Dietary Guidelines (which recommend 2.5 to four serves of dairy foods every day (preferably low fat), depending on your age and sex. A "serve" is equal to a glass of milk, a tub of yogurt or two slices (40 g) of cheese.)

But traditional Greek Mediterranean populations got calcium from other sources: sardines and other small fish which were eaten with their bones, and from leafy greens (which contain only a little calcium but the large volume of the greens eaten meant the amount added up).

Slow-cooking meat, including chicken, with bones also causes calcium to leach out of the bones, Itsiopoulos says, and this is then eaten as part of the dish.