speakers and officials standing side by side in a row under a huge World Olive Day 2024 sign

The 30th anniversary of the official publication of the Mediterranean Diet Pyramid was commemorated as part of World Olive Day on November 21, 2024. Honoring the pioneers and organizations that promoted this initiative three decades ago, this event brought leading public health experts to Madrid, Spain to share their insights about the Mediterranean diet.

"The publication of this pyramid 30 years ago significantly impacted the global recognition of the Mediterranean Diet as a healthy dietary model. It demonstrated how traditional natural foods can play a crucial role in public health strategies worldwide. Today, the Mediterranean Diet, with olive oil and table olives at its core, remains the model that best combines human health and planetary well-being,” noted Jaime Lillo, Executive Director of the International Olive Council (IOC). The IOC co-organized the celebration with the Spanish National Research Council (CSIC) and the International Center for Advanced Mediterranean Agronomic Studies (CIHEAM) at the CSIC headquarters.

Jaime Lillo, Executive Director of the IOC, with Spanish and EU flags at his side

Greg Drescher, co-creator of the Mediterranean Diet Pyramid and Senior Advisor for Strategic Initiatives at the Culinary Institute of America, said the increasing visibility of the pyramid over the last three decades has also made it clear that good taste and health are compatible, partly thanks to the appeal of extra virgin olive oil. Given extensive evidence for the flavorful Med diet’s health benefits and its impressive sustainability profile, he argued that “the unapologetic elevation of deliciousness from farm to table needs to be a broad public health imperative.” Wider adoption of a Mediterranean-style diet, he said, can contribute to a lower carbon footprint and the preservation of biodiversity, as well as a healthier population worldwide.

Dr. Antonia Trichopoulou, co-creator of the Mediterranean Diet Pyramid and member of the Academy of Athens, reviewed the ancient roots of the Mediterranean diet and clarified its definition in terms of the traditional diet in the olive-growing regions of the Mediterranean in the 1960s, “because the Mediterranean diet cannot exist without olive oil.” She provided an overview of the increasing understanding of the Med diet starting in the middle of the 20th century with the Rockefeller Report and the Seven Countries Study led by Ancel Keys, continuing with the development of the Mediterranean diet pyramid and a 1995 nutrition journal issue focused on that, and then growing exponentially with far more research. While many continued to believe fat was bad for our health for some time, Trichopoulou explained, the focus eventually changed to calories and then to different types of fat, with a fairly wide acknowledgment now that unsaturated fat is far healthier than saturated and trans fat.

Dr. Antonia Trichopoulou

Another important turning point, according to Trichopoulou, was UNESCO’s inclusion of the Mediterranean diet in the Intangible Cultural Heritage of Humanity, along with a growing recognition that the Med diet is an environmentally sustainable diet. The latest development is an effort to share lessons from the Mediterranean diet with people around the world in several variations of a Planeterranean (or Planetary) diet that have been summarized in food pyramids adapted to the culture and local products of various regions. Trichopoulou urges everyone to “act to save not only our health, but our planet.”

Dr. Miguel Ángel Martínez-Gonzalez of the University of Navarra described what he considers the four landmark studies on olive oil and the Mediterranean diet in the 30 years after the development of the Mediterranean diet pyramid—all large randomized trials. As he and others have said, “the Spanish PREDIMED trial has provided the best scientific evidence on the benefits of the MedDiet.” It was so successful that the trial was stopped early to enable more to benefit from the discovery of a 31% reduction in risk of hard clinical cardiovascular disease events in the group following the Mediterranean diet with at least 4 tablespoons of extra virgin olive oil daily, a 40% reduction in new diabetes cases, and a 62% reduction in breast cancer risk, as well as benefits for cognitive function, in comparison to a control group. These results were independently replicated with survivors of cardiac infarction for secondary prevention in the CORDIOPREV randomized trial.

Because there is also a growing obesity epidemic in many parts of the world, the PREDIMED+ trial was developed using an energy-reduced version of the Med diet with physical activity and behavioral and motivational support. Results are expected to be published next year, but so far it appears that participants tend to lose weight and keep that weight off for the six years under consideration. The latest study Martínez-Gonzalez introduced is UNATI, a new trial testing the impact of a moderate drinking pattern vs. abstention on major disease and mortality. There has been considerable debate on whether moderate drinking should be considered a valuable part of the MedDiet, or an unhealthy habit that should be avoided. Answers are expected in 2029.

Dr. Frank Hu of Harvard University considers it remarkable that the Mediterranean diet has been ranked the Best Diet Overall for seven years in a row by experts writing for US News & World Reports, although few Americans had heard of the diet or consumed olive oil 30 years ago. Now, Hu said, “we all know the Mediterranean diet is good for you, but why? Modern science can help us understand.” Hu provided some examples: he pointed out that the diet’s fiber, polyphenols, and healthy fat are beneficial in reducing inflammation, insulin sensitivity, and oxidative stress, while improving gut microbiome diversity. He explained how it was possible to determine that half of the association between consumption of red and processed meat and diabetes comes from heme iron.

On the other hand, the higher consumption of olive oil is associated with a wide range of health benefits, such as reduced risk of cardiovascular disease, type 2 diabetes, total and cause-specific mortality, and dementia-related death. Hu concluded that there is strong evidence that many healthy eating patterns can contribute to healthy aging, increasing the lifespan and the healthspan, but the evidence is strongest and most robust for the Mediterranean diet.

Dr. Walter Willett of Harvard University, another Mediterranean Diet Pyramid co-creator, spoke briefly via video, since he is busy working on an update of an important Lancet report about adapting the Planetary Health Diet for different cultures around the world. As he said, “we know we can translate the Mediterranean diet to other eating cultures, but the Mediterranean diet remains our guiding light,” because “now we have so much evidence from many different places and many different kinds of research that the Mediterranean diet is very healthy” as well as environmentally sustainable.


Thanks to the International Olive Council for the photos that appear with this article.

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