The Mediterranean Diet Is Not a Diet

Every few years a new eating regime breaks through and a new round of headlines declares it optimal. The Mediterranean pattern just keeps showing up at the top of long-horizon outcomes — cardiovascular risk, cognitive decline, metabolic markers — because it is, in the most literal sense, a way of eating, not a set of rules. The original PREDIMED trial in Spain randomised thousands of adults at cardiovascular risk to a Mediterranean diet with either extra olive oil or extra mixed nuts, against a low-fat control. Both Mediterranean arms outperformed the control on major cardiovascular events. What the trial actually changed wasn't macronutrient ratios; it was groceries. More vegetables and legumes than the day before. Fish twice a week. Olive oil as the default fat. Whole grains over refined. Cheese and yogurt in modest amounts. Wine, optional, with food. Meat, occasional. The protocol isn't aspirational. It's almost dull. Which may be why it works.