Mediterranean Diet: From Ancient Traditions to Modern Science—A Sustainable Way Towards Better Health, Wellness, Longevity, and Personalized Nutrition

Abstract

The Mediterranean Diet (MD), although not always called by this name, has emerged over centuries as a diet influenced by diverse civilizations in the Mediterranean region, who blended local produce, traditions, and rituals with new ingredients and customs introduced through trade, migrations, or occupations. Historically characterized mainly by plant-based foods, olive oil, fish, moderate meat consumption, and moderate wine consumption, MD was also shaped by the holistic health principles advocated by figures like Hippocrates, Plato and Galen. Modern investigations, including Ancel Keys’ Seven Countries Study, confirmed its protective role against cardiovascular disease and other chronic illnesses, while UNESCO’s designation of the MD as an Intangible Cultural Heritage highlights its broader cultural significance. Today, although MD faces challenges from globalization and shifts in modern lifestyles, the advances in personalized and AI-driven nutrition, as well as specific public health initiatives offer opportunities to preserve its core tenets of balance, sustainability, and communal eating for future generations along with many scientifically proven benefits of this diet and the associated lifestyle.

1. Introduction

The Mediterranean Diet (MD) is widely recognized as one of the world’s healthiest and most enduring dietary patterns, with roots stretching back thousands of years. Ancient civilizations across the Mediterranean Basin, such as the Greeks, Romans, and Phoenicians, shaped this way of eating by emphasizing locally available plant foods, olive oil, seafood, and moderate wine consumption [1,2,3]. Philosophers and physicians of antiquity, notably Hippocrates, promoted balanced eating as key to overall well-being, thus firmly establishing the diet’s focus on health and longevity [4].

Centuries of cultural exchange and trade routes further enriched the MD by introducing new grains, fruits, and spices into Mediterranean kitchens. In the modern era, it gained scientific validation through Ancel Keys’ pivotal Seven Countries Study, which found that populations adhering to this traditional dietary pattern experienced significantly lower rates of heart disease [5]. Subsequent research affirmed its role in mitigating risks for metabolic disorders, certain cancers, and cognitive decline [6].

Today, the MD is celebrated not only for its proven health advantages, but also for its role in promoting environmental sustainability and socio-economical connectedness [7,8,9]. Moreover, it is recognized by United Nations Educational, Scientific and Cultural Organization (UNESCO) as an intangible cultural heritage [10,11], but it faces contemporary challenges, such as urbanization and changing food markets that threaten its continuation. Despite these obstacles, the MD remains a powerful model, reminding us that holistic, culturally rooted eating practices can drive both personal well-being and global health.

1.1. The Ancient Foundations of Mediterranean Diet—Time Period Before Christ (BC)

The Mediterranean Diet has evolved over millennia through geographic, cultural, and historical influences [12]. Originating in ancient civilizations, such as the Minoans (7000–2000 BC), Phoenicians (1200–332 BC), Classical Greeks (479–323 BC), and Romans (31 BC–476 AD), the MD developed as a plant-based diet supplemented with olive oil, fish, and moderate amounts of meat and wine [2]. These civilizations shaped Mediterranean food culture through migrations, trade, and agricultural exchanges, integrating additional ingredients such as citrus fruits, rice, and oriental spices.

More specifically, the word diet comes from the Greek díaita, meaning “way of living; lifestyle”, underscoring its broader lifestyle implications [12,13,14]. Ancient Greek physicians and philosophers viewed diet as a key component of health. Hippocrates (460 BC) emphasized its therapeutic role with his famous quote, “Let thy food be thy medicine and thy medicine be thy food” [4]. His work On Diet influenced later physicians like Galen (130–200 AD), who advocated for balanced nutrition [15]. Plato also stressed dietary moderation, recommending a diet of cereals, legumes, fruits, milk, honey, and fish, while limiting meat and wine. He argued that overconsumption led to illness, and that physicians should regulate diet as a science [16,17].

The Mediterranean Basin, as a historical crossroads region, saw the introduction of various food products through trade. Citrus fruits, for example, were originally brought from Southeast Asia and gradually became key components of Mediterranean agriculture [18]. While today these ingredients are emblematic of Mediterranean cuisine, historical records confirm that they were absent from the ancient Mediterranean diet and only integrated centuries later [2]. Figure 1 depicts how the MD dietary pattern evolved in the region throughout the centuries, from BC to AD. One can notice that the variety of food items in the region has changed and increased as time passed due to the trade and mix of nations in the Mediterranean region.

In addition, during this time period, Alexander the Great played a crucial role in synthesizing various food cultures through his conquests, blending Greek, Persian, and Indian culinary influences. This integration of diverse dietary customs contributed to the adaptability and richness of MD, which continues to evolve [19].

Furthermore, the religious beliefs and rituals shaped the Mediterranean dietary framework as well. Various nations around the Mediterranean practice different religions, such as Christianity, Judaism, and Islam, which all have their roots in this area. These influences affected the MD, which today does not imply a single dietary pattern, but diverse patterns in accordance with the local foods and cultures [11]. Moreover, the “seven species”, i.e., wheat, barley, grapes, figs, pomegranates, olives, and honey, were dietary staples in the ancient Middle East; they later influenced Mediterranean food culture [4]. The Bible makes several references to these foods, highlighting their importance in trade, sustenance, and religious rituals (Deuteronomy 8:8; Exodus 23:14–16) [20]. Olive oil, for example, as a symbol of joy, health, and blessings, was used to anoint kings, prophets, and priests in the Old Testament, while grains and bread are being central to sustenance and religious observance in the Bible and Torah. Fruits, like figs, grapes, and pomegranates were symbols of prosperity, peace, fruitfulness, and abundance in the Bible and the Quran. These foods were cultivated in ancient Israel and the surrounding Fertile Crescent, and they continue to be a central part of the MD dietary patterns today [4,11]. In addition to this, olive oil is the most studied oil proven to have beneficial health effects due to its antioxidant and anti-inflammatory nature [3,21,22], while whole-grain breads and the above mentioned fruits have been proven to be great sources of dietary fibers, minerals, and vitamins (Figure 2).

1.2. Further Evolution of the Diet: Trade, Agriculture, and Cultural Influence in the Mediterranean—Anno Domini (AD)

The Mediterranean region has long been a cultural and trade hub, influenced by civilizations such as the Romans, Byzantines, Ottomans, Arabs, and Greeks. Over millennia, trade, migration, and conquest have shaped the MD, introducing new ingredients, cooking methods, and cultural traditions that persist to this day [1]. The MD is not a single construct, but an evolving dietary pattern rooted in the agricultural practices and food cultures of the Mediterranean Basin. However, the term “Mediterranean Diet” was first described scientifically in the 1960s to reflect the eating habits of olive-growing regions, particularly in Greece and southern Italy [3,13,23,24]. Historical records indicate that early dietary patterns were heavily influenced by agriculture, with staples such as wheat, barley, grapes, olives, and legumes forming the foundation of Mediterranean food systems [4].

During the medieval period, Arab and Islamic influences also played a crucial role in shaping the Mediterranean diet. Islamic scholars, such as Avicenna and Rhazes expanded dietary knowledge, reinforcing the MD’s holistic approach to health [25]. The Islamic expansion introduced new crops and culinary practices, including the widespread use of rice, nuts, and spices. By the 17th century, Italian writer Giacomo Castelvetro promoted vegetable-rich diets, advocating for reduced meat consumption [1].

During this time period, the MD has also been shaped by the cultural fusion of different civilizations. The Roman Empire further reinforced the diet’s core staples—bread, wine, and olive oil—while also spreading Mediterranean agricultural practices across Europe and North Africa [4]. The Columbian Exchange following Christopher Columbus’s voyages (1492) introduced tomatoes, potatoes, capsicum, corn, legumes, peppers, pomegranate, pumpkins, strawberries, corn, and peanuts to the region [26]. While today these ingredients are emblematic of Mediterranean cuisine, historical records confirm that they were absent from the ancient MD and only integrated centuries later [2].

Despite these historical transformations, the MD has maintained core principles that align with both health and sustainability. It is recognized as a lifestyle that promotes communal eating, physical activity, and the consumption of minimally processed, local, and seasonal foods [27]. Modern scientific research supports its numerous health benefits, including reduced risks of cardiovascular disease, diabetes, and certain cancers [3,23,28]. Additionally, the MD is regarded as an environmentally sustainable diet, contributing to the UN’s sustainable development goals [7,8,9].

For these reasons, nutrition experts collaborated with Oldways (Harvard University), and the World Health Organization (WHO) to construct the first graphical representation of the Mediterranean Diet Pyramid (MDP) in 1993 [22,29]. This initial version was designed to highlight the health benefits of the MD, emphasizing a diet rich in plant-based foods, with olive oil as the primary fat source, and moderate consumption of fish, poultry and dairy while limiting red meat and processed foods. The pyramid served as a simple visual guide to promote heart-healthy eating patterns inspired by traditional diets in Mediterranean regions [11].

Over time, the MDP has evolved to incorporate broader concerns beyond personal health, particularly sustainability and environmental impact. Updates in 2010 and later introduced socio-cultural and economic factors, recognizing the diet as an integral part of Mediterranean heritage [13,29]. The most recent revision integrates sustainability as a key component, encouraging lower consumption of resource-intensive foods like red meat and dairy, while promoting locally grown, environmentally friendly, and seasonal plant-based foods. This shift aligns with modern environmental concerns, ensuring that the MD remains a model for human health across the globe [30]. Notably, the MD is often schematically presented in a pyramid structure, where plant-based foods such as fruits, vegetables, whole grains, legumes, and seeds form the base, while animal-derived foods such as dairy, poultry and fish occupy the middle, and processed foods are placed at the top of the pyramid for minimal or rare consumption during special occasions [13,21,29]. A composite presentation of the MD food pyramid and MD lifestyle pyramid is shown in Figure 3 [8,31] not merely as a dietary guide, but as a representation of a holistic lifestyle, emphasizing not only the most consumed foods in the Mediterranean region, but also the communal eating, conviviality, and physical activity that are an integral part of the people living in the Mediterranean basin. The MD food pyramid (the left triangle, Figure 3) presents the most consumed foods in the Mediterranean, while the MD lifestyle pyramid (the inverted right triangle, Figure 3) presents the social gatherings and celebrations with food consumed together with family and friends, physical activities, enjoyable walks, gardening, afternoon naps (siesta), and others, often practiced in the Mediterranean. Adequate hydration via consumption of water, traditional Mediterranean beverages, such as herbal teas, juices, and yogurts, and moderate consumption of red wine, where religious beliefs allowed it, is another crucial component to the MD [8,29].

Recent discussions emphasize the importance of maintaining traditional aspects of MD while adapting it for global application. The “Planeterranean Diet”, coined by Colao et al. (2022) and later introduced as a concept by Godos et al. (2024), highlights the necessity of preserving Mediterranean culinary heritage and use of locally available food items, while also making the diet applicable to different regions worldwide [32,33].

2. MD Global Recognition

2.1. Seven Countries Study: The First Scientific Evidence of MD

The Seven Countries Study (SCS) was a groundbreaking epidemiological study that played a pivotal role in establishing the concept of the MD and its relationship with cardiovascular health. Conducted by Dr. Ancel Keys in the 1950s, this study provided the first large-scale comparative analysis of diet, lifestyle, and heart disease risk across different populations [5]. The research encompassed seven countries: the United States, Finland, the Netherlands, Italy, Greece, the former Yugoslavia, and Japan. Figure 4 illustrates the countries where the study was conducted. These nations were strategically selected to represent varying dietary patterns, particularly in their intake of saturated fats and their relationship with coronary heart disease [12,34].

At the time, cardiovascular disease (CVD) was a growing concern in the Western world, and Dr. Keys was one of the first to hypothesize a strong dietary link. He proposed what later became known as the diet–heart hypothesis, suggesting that saturated fat intake was directly associated with higher cholesterol levels and, consequently, an increased risk of heart disease [35]. This hypothesis faced strong opposition at first, with critics referring to it as a “wildly speculative diet-heart theory” [25,36,37]. However, through rigorous research, including the SCS, Keys was able to demonstrate that populations consuming diets rich in plant-based foods and olive oil, such as those in Greece and Southern Italy, exhibited lower incidences of CVD [6,38]. The findings of the SCS not only influenced public health policies but also laid the foundation for the formal recognition of the MD as a heart-healthy dietary pattern. Among the study’s most striking results were the observation that Cretan men had the lowest rates of heart disease despite a relatively high-fat diet, which contradicts the prevailing belief that all high-fat diets were harmful. The key difference was the predominant use of monounsaturated fats, particularly from olive oil, in contrast to the saturated fat-heavy diets of Northern Europe and the United States [34].

Subsequent research further validated the health benefits of the MD. Large-scale studies, such as the Lyon Diet Heart Study and PREDIMED (Prevención con Dieta Mediterránea (Prevention with Mediterranean Diet)) trial, confirmed the MD’s effectiveness in reducing cardiovascular events, metabolic syndrome, and type 2 diabetes [6,34]. The MD has also been linked to a reduced risk of neurodegenerative diseases, certain cancers, and overall mortality [34,35]. Moreover, the diet’s emphasis on fresh, local, and minimally processed foods has positioned it as an ecologically sustainable dietary model [6,8,9,31,34].

While the MD is widely promoted as a model for healthy eating, its adoption outside the Mediterranean region has faced challenges. Variations in food availability and cultural preferences make it difficult to implement the diet in a standardized manner [6,34]. However, studies have shown that adaptations of the MD, such as the “Indo-Mediterranean diet” and similar patterns in Northern Europe and the United States, have still conferred significant health benefits [34,36]. The SCS still remains a landmark study that not only provided critical insights into the diet and its protective effects against CVDs, but also helped to shape the modern nutritional science.

Despite its historical and scientific recognition, the MD is at risk of being overshadowed by the Westernized dietary habits. Studies indicate a declining adherence to the traditional MD in Mediterranean regions, particularly among younger populations, due to increased consumption of processed foods and ultra-processed fast food [34,35,36]. The globalization of food systems and shifts in economic structures have contributed to this dietary transition, raising concerns about the long-term health implications [25,34].

2.2. Blue Zones: Longevity Hotspots and the Mediterranean Lifestyle

The Blue Zones—Sardinia (Italy), Ikaria (Greece), Okinawa (Japan), Nicoya (Costa Rica) and Loma Linda (California)—are regions where populations exhibit exceptional longevity and low rates of chronic diseases. Despite cultural differences, their dietary patterns share common features, many of which align with the traditional Mediterranean Diet. The MD, widely recognized for its health benefits, emphasizes plant-based foods, healthy fats (mainly from olive oil), whole grains, legumes, and moderate animal product consumption, elements that are also central to Blue Zone diets [39].

Across all Blue Zones, dietary habits prioritize whole, minimally processed foods. Studies show that legumes are a primary protein source (beans in Nicoya, lentils in Ikaria, chickpeas in Sardinia), while healthy fats come from nuts, seeds, and olive oil [40]. Whole grains vary by region—sourdough bread in Sardinia, maize in Nicoya, and brown rice in Okinawa—but all provide essential fiber and nutrients. Moderate alcohol consumption is common, particularly red wine in Mediterranean Blue Zones, which is rich in polyphenols [41]. Red meat is rarely consumed, while dairy intake (mostly goat and sheep products) is moderate. These factors collectively support cardiovascular health, metabolic stability, and reduced inflammation [42]. In addition to diet, traditional eating habits reinforce health benefits. Practices like mindful eating, portion control, and communal meals are observed in all Blue Zones [43].

Longevity in these regions is further influenced by lifestyle factors that complement diet, including daily physical activity (gardening in Sardinia, walking in Nicoya, farming in Ikaria) and strong social networks. Psychological well-being is also key; community engagement, stress reduction, and a strong sense of purpose (“Ikigai” in Okinawa, “Plan de Vida” in Nicoya, “Filoxenia” in Ikaria) contribute to lower rates of depression and cognitive decline [40].

Despite their resilience, modernization is altering traditional diets, particularly in younger generations. A study on dietary transitions in Sardinia found that while olive oil and legumes remain dietary staples, processed food consumption is increasing, potentially undermining the longevity benefits observed in these regions [43,44].

Ultimately, Blue Zones demonstrate that diet alone is not the sole determinant of longevity; rather, a holistic approach combining traditional dietary patterns, physical activity, and strong social connections is key. The MD provides a scientifically backed model for health, but its benefits are best realized when combined with the lifestyle habits that have sustained long-lived populations across the world. Preserving and adapting these principles for modern societies could provide a sustainable path toward enhancing health and longevity [43]. Figure 5 illustrates the graphical locations of the Blue Zones.

2.3. Further Mediterranean Diet Recognition and Global Challenges

The Mediterranean Diet, recognized by UNESCO as an Intangible Cultural Heritage of Humanity in 2010 [10,11], is globally celebrated for its health benefits and sustainability. According to the UNESCO’s recognition the MD constitutes a set of skills, knowledge, practices, and traditions ranging from the landscape to the table; it represents a succession of social practices and policies that have transformed simple food into an identity symbol and a community tool of aggregation [45]. However, adherence is declining in its native regions, particularly among adolescents and younger generations in Italy, Greece, and the Eastern Mediterranean [3,46,47]. Factors driving this erosion include urbanization, economic shifts, Westernized diets, and the loss of traditional food culture [48].

This decline is paralleled by a significant loss of agricultural biodiversity, with over 75% of traditional Mediterranean plant species disappearing [49]. The Food and Agriculture Organization (FAO) and the United Nations emphasize the MD as one of the most sustainable food models, yet its survival depends on revitalizing local food systems, reducing food waste, and supporting sustainable agricultural policies [50,51]. Sustainable tourism and heritage-based dietary programs in Mediterranean regions are reintroducing traditional MD elements into modern consumer habits [45,52]. Despite the challenges, policy interventions, educational initiatives, and sustainable food practices offer a pathway for revitalizing and globalizing the MD while preserving its cultural and health-related benefits [3].

3. Health Benefits of the Mediterranean Diet: Scientific Evidence

The Mediterranean Diet is a well-researched dietary pattern associated with numerous health benefits, particularly in reducing the risk of chronic diseases and promoting longevity. This dietary approach has been linked to significant reductions in cardiovascular disease, metabolic disorders, neurodegenerative conditions, and inflammation-related diseases [29,53,54,55,56,57,58].

Table 1. Health benefits of the Mediterranean Diet, effects on chronic diseases, and key nutritional components.

Health Condition/Disease	Effects of MD	Key Components	References
Cardiovascular Disease and Heart Health	Reduces risk of cardiovascular disease by improving blood pressure, lipid profile, reducing arterial plaque, and lowering inflammation.	Olive oil, nuts, fish, whole grains, fruits, vegetables, red wine (moderation).	[53,55,56,59]
Cognitive Decline, Dementia and Neurodegenerative Diseases	Delays cognitive decline and reduces risk of Alzheimer’s, Parkinson’s, and dementia through neuroprotective properties and enhanced brain plasticity.	Olive oil, polyphenols, omega-3 fatty acids from fish, nuts, and antioxidants from fruits and vegetables.	[60,61,62,63]
Gut Health, Microbiome and Digestive Disorders	Maintains gut microbiota diversity, improves digestion, supports cardiometabolic health, and reduces gut inflammation and dysbiosis.	Fiber-rich foods (legumes, whole grains, vegetables), probiotics from fermented foods, olive oil, polyphenols.	[63,64,65,66]
Autoimmune and Inflammatory Diseases	Regulates immune response, reduces inflammation, and delays onset and severity of autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.	Polyphenols, omega-3s from fish, fiber-rich foods, nuts, and olive oil.	[66,67]
Aging, Longevity and Physical Endurance	Delays aging-related diseases, improves longevity, maintains muscle function, and prevents frailty through antioxidant-rich foods and healthy fats.	Antioxidant-rich foods, polyphenols, olive oil, nuts, legumes, and fiber.	[29,51,60,68]
Metabolic Syndrome, Diabetes and Obesity	Reduces risk of diabetes and metabolic syndrome by improving insulin sensitivity, lowering blood sugar, and preventing obesity.	Whole grains, olive oil, legumes, fiber, fish, and nuts.	[34,53,65]
Cancer Risk and Prevention	Lowers cancer risk by reducing inflammation, oxidative stress, and DNA damage through antioxidants, polyphenols, and fiber-rich foods.	Antioxidants (polyphenols, flavonoids), fiber from whole grains, fruits, vegetables, olive oil.	[34,53]
Mental Health and Psychological Well-being	Improves mental health by reducing symptoms of depression and anxiety, enhancing sleep quality, and promoting cognitive resilience.	Omega-3 fatty acids, vitamins B and D, polyphenols from red wine, whole grains.	[53,66]
Bone and Joint Disorders (Osteoporosis, Arthritis)	Maintains bone density and delays osteoporosis and arthritis progression through anti-inflammatory and calcium-rich components.	Calcium from dairy, magnesium from nuts, omega-3s from fish, polyphenols from olive oil.	[53,64]
Immune Function and Systemic Inflammation	Enhances immune function by reducing chronic inflammation, modulating gut microbiota, and supporting a balanced immune response.	Antioxidants, polyphenols, vitamins (A, C, E), probiotics, fiber-rich foods.	[66,67]

summarizes the key health benefits of the MD, its effects on various diseases and conditions, and its primary dietary components, supported by multiple scientific sources.

4. Lessons Learned from Territorial Diets Across Cultures: A Comparative Perspective

Throughout history, different civilizations have developed dietary patterns that reflect their geographic, cultural, and socioeconomic realities. These traditional/territorial diets, shaped over centuries, are deeply connected to local food systems, agricultural practices, climate conditions, and social customs. Unlike modern industrialized diets, which are often high in ultra-processed foods, refined sugars, and transfats, traditional diets emphasize whole, locally sourced, and minimally processed foods that support human health and environmental sustainability [69,70].

The MD, deeply rooted in the ancient civilizations of Greece, Rome, and the Near East, has evolved over millennia into one of the most studied and widely recognized dietary patterns for health and longevity. MD was historically based on the principles of balance, moderation, and seasonality, emphasizing foods that were readily available and naturally grown. Over time, it has been influenced by trade, migration, and cultural exchanges, integrating diverse food elements while maintaining its core structure of olive oil, whole grains, legumes, fresh vegetables, seafood, nuts, and moderate wine consumption [2,26,71]. Similar to MD, other traditional diets across the world, such as the Okinawan Diet (Japan), Nordic Diet (Scandinavia), Latin American Diets, and African Plant-Based Diets, also evolved based on local geography, climate, and agricultural practices, offering distinct health benefits yet sharing fundamental principles [69,72].

The Okinawan Diet, renowned for its association with exceptional longevity, prioritizes sweet potatoes, tofu, seaweed, and fish, with minimal animal fats and processed foods, aligning with MD’s emphasis on plant-based nutrition, anti-inflammatory compounds, and lifestyle factors such as communal eating and physical activity. The most profound fact about Okinawan diet is calorie control or restriction—called ‘hara hachi- bu’ in Okinawa—that means people stop eating when they are 80% satiated. Calorie control is among the main Chinese Taoist teachings, which advocate a restriction of dietary energy to achieve maximal longevity. However, unlike MD, Okinawan cuisine is naturally low in fat, lacking the monounsaturated-rich olive oil that is central to MD’s cardio-protective properties [73,74,75].

The Nordic Diet, developed in the colder climates of Denmark, Sweden, Norway, Finland and Island mirrors MD in its emphasis on whole grains (rye, barley, oats), fatty fish (herring, salmon), and seasonal vegetables, yet it substitutes olive oil with rapeseed oil (canola oil) and includes a higher intake of dairy products [76,77,78].

On the other side, traditional diets in Latin America tend to be rooted in whole grains (primarily maize) and beans, along with ample fruits and vegetables (like peppers, tomatoes, avocado, potatoes, pineapple, passion fruit, carrots, and zucchini), and sometimes seafood [79]. Many ingredients popularized as “superfoods” today, such as quinoa, amaranth, chia seeds, and acai berries, are native to Central or South America.

Likewise, traditional African diets emphasize the plant-based food, comprising various small grain cereals, mainly millet and sorghum, dark green leafy, vegetables, tropical fruits, legumes, starchy stems, and root tubers. Animal products that are dominant in African diets include fish, fermented milk, and to a small extent, game meat, poultry, beef, and mutton, promoting gut health and metabolic balance, akin to MD’s focus on probiotic-rich foods such as yogurt and olives [80,81].

Table 2. Comparative analysis of Territorial Diets across the cultures.

Aspect	Mediterranean Diet	Okinawan Diet	Nordic Diet	Latin American Diet	African Plant-Based Diet	References
Carbohydrate sources	Whole grains (wheat, barley, oats)	Low grain, high sweet potato consumption	Whole grains (rye, oats, barley)	Corn-based grains (tortillas, arepas)	Whole grains (millet, sorghum), starchy tubers	[2,26,71]
Fat sources	Olive oil	Minimal oil use, low fat diet	Rapeseed (canola) oil	Minimal oil use, some plant-based fats	Palm oil, groundnut oil	[73,74,75]
Protein sources	Seafood, legumes, dairy, poultry, moderate red meat	Fish, tofu, legumes	Fish, legumes, dairy, free range meats	Legumes, seafood, poultry	Legumes, fish, minimal red meat	[76,77,78]
Dairy Products	Moderate intake (cheese, yogurt)	Minimal intake	High dairy intake	Minimal dairy	Minimal dairy	[79]
Vegetable Consumption	High variety	High variety	High variety	High variety	High variety	[80,81]
Fruit Consumption	Moderate	Low	Moderate	High	High	[70]
Fermented Foods	Yogurt, olives	Fermented soy (miso, tofu)	Fermented dairy	Fermented maize (chicha)	Fermented dairy, sorghum beer	[72]

depicts information about the key similarities and differences in these Territorial Diets.

Historically, all these diets were sustainable and locally adapted, yet the MD stands out for its extensive scientific validation. Landmark studies, such as the Seven Countries Study [82] and the PREDIMED trial [83] confirmed MD’s protective effects against cardiovascular disease, cognitive decline, and metabolic disorders, findings that are only emerging for other traditional diets. Beyond its nutritional composition, MD embodies a cultural and lifestyle element, promoting slow eating, communal meals, and a connection to nature, traditions that have contributed to its recognition by UNESCO as an Intangible Cultural Heritage of Humanity. However, despite its ancient origins and documented health benefits, MD is now at risk because modernization, globalization, and Western dietary influences lead to declining adherence in Mediterranean regions, paralleling shifts seen in Okinawa and Latin America, where industrialized food consumption is replacing territorial diets. While all these traditional diets offer substantial health benefits, the MD remains one of the most balanced, adaptable, and scientifically validated dietary patterns, integrating ancient wisdom, modern nutritional science, and environmental sustainability, making it a gold standard for global health recommendations and chronic disease prevention in the modern era [84,85].

5. Mediterranean Diet and Novel Trends in Food Science and Nutrition

The Mediterranean Diet, shaped over thousands of years through the agricultural and culinary traditions of ancient civilizations, has long been associated with health, longevity, and disease prevention. However, as societies move further into the digital age, artificial intelligence (AI), data-driven nutrition, and personalized health technologies are playing an increasingly important role in shaping the future of dietary patterns, including the Mediterranean Diet [86]. While MD has traditionally been passed down through generations via cultural practices, local traditions, and family meals, modern lifestyles have reduced its adherence, particularly in younger populations, as processed foods, fast-paced work environments, and convenience-based eating habits dominate daily life [87]. To counteract this trend, AI and machine learning technologies are emerging as powerful tools that could enhance MD adoption, personalization, and accessibility, ensuring that its health benefits remain relevant for future generations [88,89,90].

AI is revolutionizing personalized nutrition by analyzing individual dietary habits, genetic predispositions, microbiome profiles, and health conditions to recommend customized meal plans based on MD principles [91]. This approach ensures that individuals receive the full benefits of MD, such as reduced cardiovascular disease risk, improved cognitive function, and better metabolic health, by fine-tuning macronutrient balance and meal timing according to personal health markers. For example, in one innovative application, researchers developed an AI-powered smartphone application that identifies meal components from a single image, estimates serving sizes, and automatically generates a Mediterranean Diet Adherence score. This end-to-end system provides weekly feedback with meal specific recommendations and has been shown to closely match expert dietitian evaluations, with only a 3.5% mean error margin. Furthermore, this study demonstrated that 83% of participants expressed willingness to continue using the AI-based app in daily life, indicating strong user acceptance and potential for sustained engagement. The system also included a traffic light style feedback mechanism, enabling users to understand which food categories (e.g., legumes, red meat, fruits) needed improvement, enhancing motivation and awareness [92].

Despite this, many different kinds of AI-powered chatbots and virtual dietary assistants are used in order to interact with users in real time, providing nutrient-dense Mediterranean meal suggestions, portion control guidance, and grocery shopping recommendations [93].

Figure 6 shows how AI contributes to generating personalized food recommendations.

In addition, as societies face rising rates of obesity, cardiovascular diseases, and neurodegenerative disorders, integrating AI-driven insights with the time-tested benefits of MD offers a promising future in preventive medicine and digital health innovation. The MD is no longer just a product of ancient civilizations; it is evolving into a technology-enhanced, potentially AI-driven nutritional model that can be tailored to the needs of individuals and global populations in the 21st century and beyond.

Simultaneously, advancements in food science, engineering, and nanotechnology are enhancing the bioavailability of MD’s food categories and their bioactive compounds [94,95,96]. More particularly, nano-encapsulation techniques improve the stability and controlled release of polyphenols, omega-3 fatty acids, and probiotics, ensuring that these beneficial compounds remain bioavailable for longer periods [97]. Furthermore, nano-structured food packaging materials or active forms of packaging are being developed to enhance food safety and quality, minimize spoilage, food waste and loss, and maintain the nutrient integrity of Mediterranean staples such as olive oil, nuts, dairy products and many more [98,99,100,101,102,103,104]. These technological advancements complement AI-driven nutrition strategies by ensuring that food retains its nutritional quality while being tailored to individual health needs [105].

Even within the positive results of the feasibility study by Papathanail et al. (2022) [92] and other studies, some participants and dietitians highlighted that despite the system’s utility, personalization of suggestions and contextual understanding of meals were limited, reminding us that technology must be seen as a complement to human centered dietary education and support rather than a replacement for it; the cultural, social, and communal aspects of the Mediterranean Diet remain irreplaceable. While AI can enhance adherence, personalization, and scientific validation of MD, it cannot fully replicate the traditional experience of Mediterranean dining, which includes mindful eating, family meals, and the Mediterranean lifestyle’s emphasis on relaxation and social connections.

Thus, the future of the Mediterranean Diet lies in a hybrid model: one that embraces AI-driven tools and scientific advances to improve dietary adherence and sustainability while protecting the rich traditions, biodiversity, and social rituals that define this ancient way of eating. Such an integrative approach ensures that the MD remains not only nutritionally relevant but also culturally and environmentally sustainable in a fast-changing world.

6. Sustainability of the Mediterranean Diet: Environmental and Socio-Economic Perspectives

MD is a sustainable dietary pattern that promotes environmental preservation, economic resilience, and cultural heritage. Its emphasis on plant-based foods, local and seasonal produce, and traditional agricultural practices contributes to lower greenhouse gas emissions, reduced land and water use, and biodiversity conservation [7,8,9,69,106]. The diet supports local economies by encouraging small-scale farming and reducing dependence on industrialized food systems while fostering social cohesion through communal eating traditions [107]. It is more than composition/distribution of food items consumed by individuals/societies; it has been incorporated into their lifestyle by influence of local, social, cultural, and socioeconomic factors [7,11]. Moreover, the importance of social meals, such as Christmas, Thanksgiving, Eid al-Fitr, and many other gatherings, is common to different cultures and nations, but they clearly demonstrate the common sense that “the family who eats together, stays together” [108].

However, adherence to the MD is declining due to globalization, changing lifestyles, and the preference for convenience foods, which undermine its sustainability potential [105,109,110]. Addressing these challenges through education, policy incentives, and the promotion of sustainable food production can help maintain the MD’s role in supporting resilient food systems and environmental sustainability [9] (Figure 7). Namely, “…more efficient, sustainable, resilient and equitable food systems are needed if we are to eliminate hunger and achieve the Sustainable Development Goals…” [50,106].

In general, science plays a central role in achieving Sustainable Development Goals (SDG), and all SDGs are involved in every aspect of food security through its four dimensions: access, availability, utilization, and stability. However, globally, people and communities suffering from food insecurity are often affected by the climate change, which threatens ~1/3 of the world’s food production. On the other hand, some 30% of all food produced for human consumption is lost or wasted; if this could be prevented, then there would be enough food to feed the planet. However, this is not yet achievable due to geopolitical or economic considerations overriding those of equity. The transformation of food systems is crucial to address many of these issues. The global and sustainable food systems will contribute towards the global planetary wellbeing which reflects three core elements—public health, planetary health and economic health—and when they are in coalition, there will be an overall prosperity for all, leaving no one behind [110].

7. Conclusions

The Mediterranean Diet (MD) is a perfect example of how deeply embedded food traditions, shaped over centuries, can also form the basis of modern, science-backed approaches to healthy and sustainable dietary patterns and lifestyles. By prioritizing plant-based ingredients, olive oil, and moderate animal-based products, MD supports not only human well-being, but also responsible agricultural practices that respect local ecosystems. Even as younger generations gravitate toward more globalized or convenience-oriented diets, the ongoing initiatives aim to safeguard the MD-style methods and community centric principles as the ones that have survived the tests of the time, through periods of famine and prosperity among different nations and cultures, while still practicing their own religions and traditions. The Mediterranean Diet’s resilience demonstrates that a strong connection to the ancestral food ways remains invaluable for improving dietary habits, protecting biodiversity, and fostering a more harmonious relationship between nations with respect to their heritage and environment. Looking forward, combining these cultural roots with innovations in food technology and nutrition science can help preserve this unique holistic way of eating.