A Look at the Mediterranean Diet Pyramid 2016 Update

By Ray Baker

The food pyramid you learned at school told you roughly how much to eat. The Mediterranean version proposed in Milan in July 2016 asks a sharper question: how often, and at what cost to the land and water behind your food. The 1st World Conference on Mediterranean Diet, organised by IFMeD, put forward a new Mediterranean Diet Pyramid as a healthy and sustainable model [1]. The most useful change for your dinner table is simple: animal protein moved from a daily habit to a weekly one [2]. That is why the Mediterranean diet pyramid 2016 still matters when you are over 50 and cooking for one or two.

What is the Mediterranean diet pyramid 2016?

It is the updated Mediterranean Diet Pyramid proposed at the 1st World Conference on Mediterranean Diet in Milan in July 2016 [1]. The Mediterranean diet pyramid 2016 keeps the plant-based base of the older pyramid, shifts animal protein from daily to weekly eating, and adds a third dimension covering the environmental impact of the foods included [2].

Key takeaways

• The Mediterranean diet pyramid 2016 was proposed at the 1st World Conference on Mediterranean Diet in Milan [1].
• Animal protein moved from daily to weekly eating [2].
• A third dimension covers environmental impact and sustainable production [2].
• Main meals combine cereals, vegetables and fruit, plus a small amount of legumes [2].
• Olive oil stays the main added fat, replacing butter and margarine [3].

What changed in 2016?

The first Mediterranean Diet Pyramid appeared in 1993, introduced by the Harvard School of Public Health, Oldways Preservation and Exchange Trust, and the European Office of the World Health Organization. It drew on the eating traditions of Crete, Greece and southern Italy in the mid-20th century, regions with low rates of chronic disease and higher than average adult life expectancy at the time [3].

The Mediterranean diet pyramid 2016 keeps that plant-based core and adds something new. A third dimension represents the environmental impact of the foods included, along with aspects of food production sustainability [2]. The conference described the model as having four dimensions, with cultural, environmental and economic aspects sitting alongside nutrition [1]. Legumes also regained a primary role, helped by the United Nations declaring 2016 the International Year of Pulses [1].

The 2016 papers brought in other quiet changes too. They introduced the idea of composing main meals, and emphasised frugality and moderation because of the public health challenge of obesity, alongside cultural and lifestyle elements such as conviviality, cooking, physical activity and adequate rest [4].

I like that the update is honest about being a guide rather than a rulebook. The authors say plainly that the pyramid is not prescriptive, and that each country should adapt it to its own food system and culture-rooted cuisine [2]. That suits a real kitchen, where the shopping list is shaped by what is in season and what is on special.

The levels, base to top

Reading the Mediterranean diet pyramid 2016 from the base up, the foods eaten most sit at the bottom: cereals, vegetables and fruits, with a small quantity of legumes, beans or similar at main meals [2]. Cereals in the form of bread, pasta, rice, couscous or bulgur should be one to two servings per meal, preferably whole or partly refined grains [2]. Vegetables should reach two or more servings a day, with at least one of the two main meals raw [2]. Fruit is the primary form of dessert, one to two servings per meal [2]. Mixing colours of both vegetables and fruit is strongly recommended to help ensure a broad range of micronutrients and phytochemicals [2].

Olive oil remains the main added fat, replacing butter and margarine [3]. Fish is the preferred animal protein at least twice weekly, with poultry, eggs and dairy in smaller portions either daily or a few times a week, and red meat limited to a few times per month [3]. The top of the updated pyramid holds red and processed meat, pastries and sweets, for occasional use only [2]. If you want the numbers spelled out, my Mediterranean diet servings per day chart turns these levels into everyday amounts.

Lifestyle counts too. The 1993 pyramid highlighted daily exercise and the social side of eating meals together [3], and later thinking adds conviviality, cooking, physical activity and adequate rest [4].

5 easy tips for your plate

None of this needs a spreadsheet. These five habits do most of the work, and they suit a beginner. They follow straight from the levels of the Mediterranean diet pyramid 2016. If you want the gentlest possible start, my lazy Mediterranean diet for senior beginners walks through it step by step.

1. Build each main meal from three parts: a cereal, vegetables and fruit, and a small amount of legumes [2].
2. Keep one of your two main meals raw on the vegetable side [2].
3. Let fruit be dessert instead of reaching for cake [2].
4. Cook with olive oil rather than butter or margarine [3].
5. Treat red meat as a few times a month food, not a daily one [3].

What about portions and budget?

The Mediterranean diet pyramid 2016 suggests proportion, not portion sizes. It does not specify amounts, and how much you eat at each meal is up to you, because it varies with your physical activity and body size [3]. The updated recommendations target healthy adults aged 18 to 65 and should be modified for older people and anyone with health problems such as cardiovascular disease [2]. That line matters if you are over 50 and managing a condition, so treat the pyramid as a starting point and talk to your doctor or dietitian about your own plate.

On cost, the base of the pyramid is the cheap end. Dried legumes, whole grains and seasonal vegetables carry most of the meals, and the expensive items sit near the top where you eat them least. A plain Tuesday dinner might be a bowl of wholemeal pasta, a large handful of rocket and tomatoes, and a spoonful of chickpeas. If you tend to overserve at dinner, my Mediterranean recipes for portion control show plates that help you stop before you feel overfull.

Does the science back it?

The evidence behind the Mediterranean diet pyramid 2016 is careful rather than triumphant. A systematic review and meta-analysis of six studies covering 10,950 participants reported protection against major vascular events, coronary events, stroke and heart failure, but not for all-cause mortality or cardiovascular mortality [5]. Once the study the authors had serious concerns about was excluded, the benefit for vascular events and stroke persisted, while the apparently positive findings for coronary events and heart failure disappeared [5]. The review’s own conclusion is careful: the Mediterranean diet may protect against vascular disease, but the quantity and quality of the evidence is limited and highly variable, so results must be interpreted with caution [5].

A separate literature review reports that studies over several decades suggest following the Mediterranean diet can reduce the risk of cardiovascular disease and cancer and improve cognitive health, while noting that methods for evaluating and defining the diet are inconsistent [6]. If you are eating this way after a cardiac event, my summary of the new evidence on Mediterranean diet after a heart attack is a sensible next read.

Frequently asked questions

Is the 2016 pyramid still used?

Yes. The Mediterranean diet pyramid 2016 was designed as a simplified framework that countries adapt to their own geography, economy, culture, dietary needs and meal patterns, so the shape has stayed useful [2].

How much red meat is allowed?

Red meat is limited to a few times per month in the Harvard Nutrition Source description of the pyramid [3], and the updated pyramid places red and processed meat at the top, to be consumed only occasionally [2].

Do I have to count calories?

No. The pyramid suggests proportion rather than portion sizes and does not specify amounts, leaving the quantity at each meal to you, based on your activity and body size [3].

Is olive oil the only fat?

Olive oil is recommended as the primary added fat, replacing other oils and fats such as butter and margarine [3]. Foods that naturally contain healthful fats, including nuts, avocados and oily fish, are also highlighted [3].

Can I follow it after 65?

The updated recommendations target healthy adults aged 18 to 65 and should be modified for older people and those with health problems such as cardiovascular disease [2]. Ask your doctor or dietitian to adjust it for you.

What goes into a main meal?

Main meals should combine cereals, vegetables and fruits, and a small quantity of legumes, beans or similar, though not in every meal [2]. Cereals are one to two servings, vegetables two or more servings a day, and fruit one to two servings [2].

Honest take

The Mediterranean diet pyramid 2016 did not reinvent Mediterranean eating. It tidied it up, moved meat down the frequency list, and admitted that what we eat has a footprint beyond our own waistline [2][1]. That is a fair summary of how I cook now: beans more often, fish twice a week, meat as a treat, and olive oil doing the heavy lifting. This article is general information, not medical advice, so use it as a guide and check anything specific with your doctor or dietitian.

References

1. IFMeD. 1st World Summit on the Mediterranean Diet: The New Sustainable Pyramid Will Guide Our Eating Habits. 2016. https://www.ifmed.org/wp-content/uploads/2016/07/CS_WORLD_CONFERENCE_IFMED_def.pdf
2. Updating the Mediterranean Diet Pyramid towards Sustainability. PMC (Nutrients). https://pmc.ncbi.nlm.nih.gov/articles/PMC7728084/
3. Harvard T.H. Chan School of Public Health, The Nutrition Source. Diet Review: Mediterranean Diet. https://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/mediterranean-diet/
4. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition, Cambridge Core. https://www.cambridge.org/core/journals/public-health-nutrition/article/mediterranean-diet-pyramid-today-science-and-cultural-updates/70359644D12A038AC003B935AA04E120
5. Effects of the Mediterranean Diet on Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4980102/
6. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean Diet: A Literature Review. Nutrients. 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4663587/

Get well and stay well,
Ray Baker