A classic Mediterranean diet trial used canola oil, so the pattern travels well

Key takeaways

• In Spain’s CORDIOPREV trial of 1,002 heart patients, 17.3% of people on a Mediterranean diet had a major heart or artery event over about seven years, compared with 22.2% on a low-fat diet⁵.
• France’s Lyon Diet Heart Study cut repeat heart attacks with a “Mediterranean” diet that used canola oil, a fat that isn’t traditional in the region⁴⁵.
• Among 25,315 U.S. women followed for about 25 years, the highest Mediterranean diet scores went with a 23% lower risk of death, a gap that shrank to about 11% once smoking, exercise and other habits were counted⁷.
• A three-year trial of the MIND diet, a Mediterranean-style plan built for brain health, found no memory advantage over a healthy, mildly calorie-cut comparison diet⁸.
• The U.S. Surgeon General’s January 2025 advisory called alcohol the third leading preventable cause of cancer, so wine is the one Mediterranean habit not to start for your health¹⁰.

In the Lyon Diet Heart Study, French researchers randomly assigned 605 heart attack survivors to one of two diets³. One group ate a standard “prudent” Western diet. The other was coached toward a Mediterranean-style diet³⁴.

The study was planned to run five years. Its scientific and ethics committee stopped it after an average of 27 months because the Mediterranean group was doing so much better¹³.

Final results, published in 1999, counted 14 cardiac deaths or nonfatal heart attacks in the Mediterranean group. The comparison group had 44⁴.

This is a detail that rarely makes the travel posters. The Lyon diet leaned on canola oil, which, as a later Spanish research team noted, isn’t a traditional fat in the Mediterranean region⁵.

That’s good news if you don’t have a Greek grandmother, an olive grove or an Italian grocery budget. The research points to a pattern you can cook from many traditions. This article covers what it shows, where it has been oversold, and a week of meals for five kitchens.

A study of 12,763 men started the story, and its critics raise fair points

The modern Mediterranean diet grew out of the Seven Countries Study, which Ancel Keys began in 1958¹. It followed 12,763 men ages 40 to 59 in 16 groups across the United States, Finland, the Netherlands, Italy, the former Yugoslavia, Greece and Japan¹.

Men in southern Europe, especially on Crete and in southern Italy, had low rates of heart disease, and their eating became the model². As an observational study, which compares groups as they live, it could show links but not prove that diet caused the differences.

In a 2025 review, Alessandro Menotti and Paolo Emilio Puddu, longtime researchers on the study, concluded that it largely backed Keys’s view that saturated fat, acting through blood cholesterol, tracks with heart disease¹. They also named a limit: the study sorted food into just 19 broad groups, so later analyses couldn’t cleanly separate olive oil from other oils, or fiber-rich bread from other bread¹.

A 2015 review by Surinder Phull and colleagues at two British universities gathered critiques from outside the study²:

• Some social scientists see the “Mediterranean diet” as largely an American invention, shaped to mirror U.S. nutrition advice.
• The frugal eating Keys observed may have reflected economic necessity as much as preference.
• North African and eastern Mediterranean countries rarely appear in the model, though they share the same sea.

None of this erases the trials that came later. It does explain why there’s no single correct Mediterranean menu.

Three heart trials tested the pattern, each in a different way

A randomized controlled trial, where people are assigned to diets by chance, is the best test of whether a diet itself changes health. Mediterranean eating has several.

Lyon, France: heart attack survivors. The Mediterranean group had fewer events on every measure the trial tracked, with risk roughly 47% to 72% lower⁴. Its weak points, according to the Spanish team behind a later trial: the comparison diet wasn’t a truly healthy one, and the study ran too short⁵.

PREDIMED, Spain: high risk, no heart disease yet. Its corrected 2018 version found that a Mediterranean diet helped prevent heart and stroke events in high-risk people without heart disease⁵. Its first report, from 2013, was withdrawn: in June 2018 the New England Journal of Medicine retracted it over errors in how some participants were randomized and published a reanalysis the same day. The main conclusion held, Harvard’s Nutrition Source explains¹⁴. Our articles on healthy fats and on heritage diets tell that story in full.

CORDIOPREV, Spain: people with heart disease. This single-hospital trial assigned 1,002 adults with coronary heart disease to a Mediterranean diet rich in extra-virgin olive oil or to a low-fat diet built on complex carbohydrates, with dietitian support for about seven years⁵.

Major events, a combined count of heart attacks, strokes, artery-opening procedures, peripheral artery disease and cardiovascular deaths, struck 87 people on the Mediterranean diet (17.3%) and 111 on the low-fat diet (22.2%)⁵. That works out to about 25% lower risk⁵. The two groups didn’t start to pull apart until about three years in, an American College of Cardiology summary noted⁶.

The benefit showed clearly in the 827 men: 16.2% versus 22.8% had events⁵. Among the 175 women, the difference wasn’t significant, and the authors say there may have been too few women to tell⁵.

Read the fine print, too. Two olive oil foundations helped pay for the trial and supplied its olive oil, alongside Spanish governments and the European Union. The authors report that the funders had no role in the design, analysis or writing⁵. No single type of event, such as heart attacks alone, differed significantly on its own⁵.

One quieter finding may matter most. More people abandoned the low-fat diet (17.2%) than the Mediterranean one (9.2%)⁵.

The long-life findings are real but smaller than the headlines

In the Women’s Health Study, researchers at Brigham and Women’s Hospital followed 25,315 U.S. women, mostly health professionals, who enrolled from 1993 to 1996⁷¹⁵. Over an average of nearly 25 years, 3,879 died⁷.

Women who scored highest on a nine-point Mediterranean diet scale had a 23% lower risk of death from any cause than those who scored lowest. Their risk of cancer death was 20% lower and of cardiovascular death 17% lower⁷.

This is the part that’s easy to miss. After the researchers also accounted for smoking, physical activity, alcohol and menopause status, the advantage shrank to about 11%⁷. People who eat well tend to do other healthy things, and studies like this can’t fully untangle them.

Inflammation markers, metabolism-related molecules, certain blood fats, body mass index and insulin resistance each explained about 7% to 15% of the lower risk⁷. LDL cholesterol, the so-called bad cholesterol, explained very little⁷, a hint that the diet works through more than the cholesterol pathway Keys emphasized.

The women were 94.9% white and well educated, and they reported their own diets years before many of the deaths⁷¹⁵. So the results may not apply to everyone.

The brain and mood results are humbler

The MIND diet blends Mediterranean eating with DASH, a diet designed to lower blood pressure, into a plan aimed at the aging brain⁸. A 2023 randomized trial in the New England Journal of Medicine put it to the test⁸.

Researchers assigned 604 adults ages 65 to 84 to the MIND diet or to a control diet for three years⁸. All were overweight, had a family history of dementia and had no memory problems at the start. Both groups got counseling and a mild calorie cut⁸.

Both groups’ thinking scores rose slightly: 0.205 units on the MIND diet and 0.170 on the control diet, a gap too small to rule out chance⁸. Brain scans changed about the same in both groups⁸.

Maybe the MIND label added nothing, or maybe the control diet was healthy enough that three years couldn’t separate them. Either way, the trial doesn’t support buying a branded plan to protect your memory.

In Australia’s SMILES trial, published in 2017, researchers assigned 67 adults with moderate to severe depression to seven sessions with a clinical dietitian or to a social support program⁹. After 12 weeks, 32.3% of the diet group reached remission, compared with 8.0% of the comparison group⁹.

That’s encouraging, and it’s one small, short trial. People can’t be kept from knowing they’re changing their diet, and only 56 of the 67 had complete data at the end⁹. Better food can be part of caring for your mood. It isn’t a replacement for treatment.

If you’re struggling, talk with a clinician you trust. In a crisis, call or text 988, the Suicide and Crisis Lifeline.

Wine is the part of the tradition to leave behind

Older pictures of the Mediterranean diet often showed wine with meals. The evidence has moved.

On January 3, 2025, then-Surgeon General Vivek Murthy issued an advisory on alcohol and cancer¹⁰. It called alcohol the third leading preventable cause of cancer in the United States, after tobacco and obesity, and tied it to at least seven cancers, including breast, colorectal and liver cancer¹⁰.

The advisory linked alcohol to about 100,000 cancer cases and 20,000 cancer deaths a year in the U.S., and it noted that fewer than half of Americans recognize the risk¹⁰. It recommended adding cancer risk to the health warning label on alcoholic drinks and rethinking drinking limits¹⁰.

The 2025–2030 Dietary Guidelines, released in January 2026, removed numeric alcohol limits. They advise drinking less for better overall health and say some people, including pregnant women, should avoid alcohol completely¹¹.

Even the trials didn’t push drinking. In CORDIOPREV, wine was optional and only for people who already drank, up to one glass a day for women and two for men⁵. Nothing in this research suggests a nondrinker should start.

An occasional glass is your call to make with the full facts. If you don’t drink, you aren’t missing an ingredient.

What the evidence shows

Claim	Evidence rating	What it rests on
Mediterranean-style eating lowers heart attacks and strokes in high-risk adults and heart patients	Strong evidence	Three randomized trials, Lyon, PREDIMED’s corrected version and CORDIOPREV, each favorable and each with limits4514
It helps people live longer	Promising but early	Observational studies such as a 25-year study of U.S. women; the advantage shrinks when other habits are counted7
The MIND version protects memory better than another healthy diet	Evidence says no	No difference after three years in a 604-person trial8
Better eating can ease depression	Promising but early	One small 12-week trial with a large effect9
Red wine is part of the health benefit	Evidence says no, or unsafe	Alcohol causes cancer; trials made wine optional for existing drinkers510
The benefits require traditional foods such as olive oil	Not enough evidence	Lyon worked with canola oil; versions adapted to other cuisines have less trial data512

The pattern in amounts you can count

“Mediterranean” can sound vague. The CORDIOPREV trial gave participants concrete targets, and they make a useful yardstick⁵:

• Vegetables: at least 2 servings a day, one of them raw or in a salad.
• Fruit: at least 3 servings a day.
• Grains: about 6 servings a day, preferably whole.
• Legumes such as beans, lentils and chickpeas: at least 3 servings a week.
• Fish: at least 3 servings a week, especially fatty fish.
• Tree nuts: at least 3 servings a week.
• Olive oil: at least 4 tablespoons a day. The trial gave each household a liter of extra-virgin olive oil a week.
• Meat: poultry in place of red meat, and red or processed meat less than once a week.
• Sweets and pastries: once a week or less.

For readers who prize tradition, this list should look familiar. It isn’t a product line. It’s beans, greens, grains, fish and oil, cooked at home, much as many grandparents ate wherever they lived. Our guides to healthy fats and to nuts and seeds cover olive oil and nuts in depth.

A seven-day template for five kitchens

Critics argue that “Mediterranean” is too narrow a label. A 2024 review in the journal Foods described one scholar’s argument that the diet has been “white-washed,” dropping foods less familiar to white eaters, such as teff and cassava, even though people around the Mediterranean eat them too¹².

Cost and access are common barriers, too. In one Australian survey, a quarter of people named the cost of fruit, vegetables and fresh seafood, and only 2.6% called the diet affordable¹². In rural Breathitt County, Kentucky, which the review describes as a food desert, cost and access ranked among the top three obstacles¹².

Researchers have built versions for other cuisines, including an Indo-Mediterranean diet that uses millets, brown rice, turmeric and cumin¹². These versions have less trial evidence than the original. Still, the Lyon result suggests the building blocks matter more than the passport⁵.

The template below keeps the weekly targets above and borrows dishes from four other traditions. Cook with olive oil or another plant oil your cuisine already uses, as Lyon did with canola⁵.

Day	Mediterranean base	Latin American	South Asian	East Asian	Southern U.S.
1: Beans	Lentil soup, greens, whole-grain bread	Black bean soup, corn tortillas, salsa	Masoor dal with spinach, brown rice	Tofu and greens in miso broth, brown rice	Black-eyed peas, collards, cornbread
2: Fish	Baked fish, roasted vegetables, potatoes	Fish tacos with cabbage and lime	Fish curry with tomatoes, millet roti	Steamed fish, bok choy, brown rice	Baked catfish, okra and tomatoes
3: Fish salad	Tuna, chickpeas, tomato, cucumber, olive oil	Shrimp, black bean and avocado salad	Grilled fish, chana chaat, cucumber salad	Salmon, edamame and cabbage slaw with sesame	Grilled shrimp over field pea salad
4: Grains	Whole-wheat pasta, white beans, vegetables	Brown rice, pinto beans, peppers	Vegetable pulao with peas, raita	Vegetable and tofu stir-fry, brown rice	Red beans and brown rice, greens
5: Poultry	Chicken with chickpeas and greens	Chicken tinga, black beans	Tandoori-style chicken, dal, salad	Chicken and vegetable soup, rice	Grilled chicken, sweet potato, green beans
6: Fish	Sardines on whole-grain toast, salad	Grilled fish, black beans, plantain	Salmon tikka, cucumber raita	Grilled mackerel, rice, pickled vegetables	Salmon patties, slaw, field peas
7: Feast	Bean and vegetable stew, fruit for dessert	Chicken pozole with cabbage and radish	Rajma with roti, fruit	Hot pot with vegetables, tofu and fish	Okra and shrimp gumbo, brown rice

Every day: fruit at breakfast or as dessert, a handful of nuts or seeds on most days, and water as the main drink.

Weekly check: fish at least three times, beans at least three times, nuts at least three times, red or processed meat less than once⁵.

Budget moves: dried or canned beans and lentils, frozen produce, canned sardines or salmon, and canola oil when olive oil strains the budget. Our guide to the government’s healthy grocery plan goes further.

Questions readers ask

The bottom line

Mediterranean eating has strong trial evidence for preventing heart attacks and strokes, especially in people at high risk or living with heart disease. The bigger promises (a much longer life, a sharper memory, relief from depression) rest on thinner or mixed evidence.

The good news is that the pattern doesn’t belong to one country. Beans, vegetables, whole grains, fish, nuts and plant oils, cooked at home, can carry your own family’s flavors. Leave the wine out of the health plan, and talk with your clinician before big changes if you take medicines or are pregnant.

Related reading

• Butter made the new food pyramid, but the evidence still leans toward plant oils
• A daily handful of nuts holds up in research, but go easy on Brazil nuts
• Heritage diets hold up in research, and you can keep yours alive
• Some healthy habits clash with your medicines, so check these goals first
• A healthy month of groceries, priced by the government

Sources

1. Menotti A, Puddu PE. “Ancel Keys, the Mediterranean Diet, and the Seven Countries Study: A Review.” Journal of Cardiovascular Development and Disease, 2025;12(4):141. pubmed.ncbi.nlm.nih.gov
2. Phull S, Wills W, Dickinson A. “The Mediterranean Diet: Socio-cultural Relevance for Contemporary Health Promotion.” The Open Public Health Journal, 2015;8:35–40. openpublichealthjournal.com
3. American College of Cardiology. “Lyon Heart Study” (trial summary of de Lorgeril M, et al., Circulation, 1999). ACC, 2010. acc.org
4. de Lorgeril M, Salen P, Martin JL, et al. “Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction: Final Report of the Lyon Diet Heart Study.” Circulation, 1999;99(6):779–785 (MEDLINE record). pubmed.ncbi.nlm.nih.gov
5. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, et al. “Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial.” The Lancet, published online May 4, 2022. cibum.gr
6. American College of Cardiology. “CORonary Diet Intervention with Olive oil and cardiovascular PREVention study – CORDIOPREV” (trial summary). ACC, May 23, 2022. acc.org
7. TCTMD. “How Mediterranean Diets Might Cut Mortality in Women: New Insights” (on Ahmad S, Moorthy MV, Lee IM, et al., JAMA Network Open, 2024). Cardiovascular Research Foundation, 2024. tctmd.com
8. Practical Neurology. “Surprising Results from a Study of the MIND Diet and Its Effects on Cognition” (on Barnes LL, et al., “Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons,” New England Journal of Medicine, 2023). September 6, 2023. practicalneurology.com
9. Jacka FN, et al. “A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial).” BMC Medicine, 2017;15:23 (Deakin University repository). dro.deakin.edu.au
10. U.S. Department of Health and Human Services. “U.S. Surgeon General Issues New Advisory on Link Between Alcohol and Cancer Risk.” Press release, January 3, 2025 (reprinted by POZ). newprod1.poz.com
11. U.S. Department of Agriculture and U.S. Department of Health and Human Services. “Dietary Guidelines for Americans, 2025–2030.” January 2026. cdn.realfood.gov
12. Sam-Yellowe TY. “Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations.” Foods, 2024;13(11):1750. pubmed.ncbi.nlm.nih.gov
13. Aprifel (French Agency for Research and Information on Fruit and Vegetables). “Dietary prevention of coronary heart disease: the Lyon Diet Heart Study” (scientific summary). aprifel.com
14. Harvard T.H. Chan School of Public Health, The Nutrition Source. “PREDIMED Study Retraction and Republication.” June 22, 2018. nutritionsource.hsph.harvard.edu
15. ReachMD. “Mediterranean Diet Tied to One-Fifth Lower Risk of Death in Women” (news report on Ahmad S, et al., JAMA Network Open, 2024, by Brigham and Women’s Hospital researchers). June 4, 2024. reachmd.com