One Region Is Abandoning The Mediterranean Diet — Another Is Adopting It
The Mediterranean diet is one of the most studied eating patterns in the world, consistently linked to lower rates of heart disease, diabetes, and cognitive decline.
But adherence has been declining steadily in the countries where it originated and rising in places like Sweden. A recent review1 examines the forces behind this shift and what it means for how we think about healthy eating.
What makes the Mediterranean diet worth talking about
The Mediterranean diet isn't a rigid meal plan. Built around vegetables, fruits, legumes, whole grains, nuts, and olive oil, it also includes regular fish and seafood, moderate dairy and eggs, and limited red meat and processed foods.
What makes it distinctive is not just what's on the plate but how it's eaten: minimally processed, seasonal food, prepared at home and shared with others.
Scientific interest dates to 1953, when epidemiologist Leland Allbaugh surveyed Crete and found the local population had remarkably low rates of chronic disease.
Ancel Keys followed with the Seven Countries Study in 1958, comparing dietary habits and cardiovascular disease rates across seven nations; populations in Mediterranean regions showed markedly lower rates of coronary heart disease than their Northern European and American counterparts.
What the science actually shows
Since then, the evidence has only grown stronger.
- Heart health: People following the Mediterranean diet have shown significant reductions in major cardiovascular events. It also improves cholesterol balance and supports healthy blood vessel function in people at elevated cardiovascular risk.
- Metabolic health and diabetes: The Mediterranean diet is associated with a 19 to 23% lower risk of developing type 2 diabetes. Among people already living with diabetes, it's been linked to better blood sugar control through anti-inflammatory actions, improved insulin signaling, and beneficial effects on gut bacteria.
- Cancer: An inverse association exists between Mediterranean diet adherence and overall cancer risk, with lower rates of colorectal, head and neck, lung, liver, and bladder cancers. Researchers attribute this to the diet's high content of fiber, polyphenols, antioxidants, and anti-inflammatory compounds.
- Brain health: Greater adherence to the Mediterranean diet is associated with lower risk of Alzheimer's disease and related dementias. This holds true even among people carrying the APOE ε4 gene variant (the major genetic risk factor for Alzheimer's) and appears consistent across sexes.
The paradox in numbers
Despite all of this, adherence has been declining steadily in Mediterranean countries, particularly among younger generations.
The review draws on several studies to map the decline in Italy. A 2024 study of university students aged 18 to 24 found only about one-third showed high adherence.
A large survey of 3,732 respondents found just 5% with high adherence and 12% with low adherence. A study tracking more than 10,000 Italian adults between 2019 and 2022 documented a significant decline over that period.
Overweight and obesity now affect roughly 30% of children and 43% of adults in Italy.
Sweden tells a different story.
The review points to a European study finding that Swedish children had the highest Mediterranean-like dietary adherence scores among all countries evaluated, while children from Cyprus (historically one of the regions most associated with the diet) had the lowest. Greater adherence was also linked to about 15% lower prevalence of childhood obesity.
Several factors appear to be driving Sweden's shift:
- Sustainability awareness: Younger Swedish generations have shown growing preference for plant-based and environmentally sustainable food choices.
- Preventive health focus: Growing public awareness around food quality and long-term health is reshaping dietary norms.
- Policy alignment: Sweden's 2025 national dietary guidelines now emphasize vegetables, fruits, legumes, whole grains, and fish, principles that closely mirror the Mediterranean diet.
Why it's disappearing where it started
The decline reflects a mix of economic, cultural, and structural forces.
- Cost: Fresh produce, legumes, fish, nuts, and extra-virgin olive oil have become increasingly expensive due to inflation and supply chain instability. Ultra-processed foods are often cheaper, more accessible, and heavily marketed, particularly to lower-income households.
- Time: Traditional Mediterranean meals require time-intensive preparation. Faster schedules and longer working hours make convenience foods a more practical option for many families.
- Globalization: The expansion of fast-food chains and processed food products throughout Mediterranean urban centers has reshaped eating behaviors, especially among younger generations.
- Cultural drift: Among younger populations, traditional dietary practices are sometimes seen as outdated. Sophisticated marketing through digital media associates Western-style food with modernity and social identity, further eroding the appeal of traditional habits.
How to eat more like the Mediterranean diet actually intended
Even moderate improvements in adherence are associated with meaningful health benefits. A few practical places to start:
- Anchor meals around plants: Make vegetables, legumes, and whole grains the foundation of most meals rather than a side dish.
- Switch your fat source: Replace butter and refined vegetable oils with extra-virgin olive oil as your primary cooking fat.
- Eat fish at least twice a week: Fatty fish like salmon, sardines, and mackerel provide omega-3 fatty acids that support both cardiovascular and brain health.
- Reduce ultra-processed foods deliberately: Identify the two or three ultra-processed items you consume most frequently and find whole-food alternatives.
- Cook more, even imperfectly: Batch cooking on weekends, keeping simple pantry staples on hand (canned legumes, olive oil, whole grains, canned fish), and learning a handful of quick Mediterranean recipes can lower the barrier considerably.
- Treat red meat as an occasional ingredient: Shift it from a daily staple to a weekly or less frequent choice rather than cutting it out entirely.
- Make meals a social experience when possible: The cultural dimensions of the Mediterranean diet (eating slowly, sharing food, being present at the table) are part of what makes it sustainable long-term.
The takeaway
The science is consistent: the closer you eat to Mediterranean principles, the more your long-term health stands to benefit. What's less certain is whether the populations who built this diet will continue to practice it.
The real paradox isn't that Sweden is catching up; it's that the countries with the most to lose are the ones moving furthest away.