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This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
The Mediterranean diet is an eating pattern traditionally followed in countries around the Mediterranean sea. It is built on vegetables, fruit, whole grains, legumes (beans, lentils, chickpeas), nuts, seeds, herbs and extra-virgin olive oil as the main fat, with fish and seafood a few times a week, moderate amounts of poultry, eggs and dairy such as yoghurt, and little red meat, processed meat and sweets. It is a pattern of eating and not a strict plan, which makes it easy to adapt to local foods. The traditional Saudi plate shares many features: whole wheat dishes (jareesh, harees), legumes (foul, lentil soup, hummus), dates, fish, chicken, laban, vegetables, herbs and spices. The parts that move away from it are usually large portions of white rice with fatty meat, fried pastries, sugary drinks and sweets, and heavily processed foods.
How common is it?
Diets high in refined carbohydrates, sugary drinks, and processed and fried foods have become common in many countries, including Saudi Arabia, alongside high rates of overweight, type 2 diabetes and fatty liver disease. Most people eat fewer vegetables, legumes and fish than they are advised to, so many can benefit from moving towards this pattern.
Why does it happen?
The benefits are thought to come from the whole pattern: high fibre, healthy unsaturated fats, plant compounds (polyphenols) and fewer refined carbohydrates and processed meats. It improves cholesterol, blood sugar, blood pressure and body weight regulation, reduces liver fat, and feeds the gut microbiome. Problems arise when a good traditional meal is eaten in a very large portion, with the rice, bread and oil disproportionate to the vegetables and protein, or when sweets and sugary drinks are added at every meal.
Symptoms
- Heavy, sluggish feeling and reflux after very large rice-and-meat meals
- Gradual weight gain around the waist
- Constipation on a low-vegetable, low-fibre diet
- Raised blood sugar, cholesterol or liver enzymes found on blood tests
- Bloating when legumes and fibre are increased too quickly
Red flags — seek urgent medical care
Chest pain, shortness of breath, or pain spreading to the arm or jaw after meals or exertion
Could be a heart problem rather than indigestion. Call emergency services immediately (997).
Extreme thirst, frequent urination, blurred vision or unexplained weight loss
May suggest uncontrolled diabetes. See a doctor urgently.
Right-sided upper belly pain, yellow eyes or skin, dark urine or pale stools
May indicate a liver or gallbladder problem. See your doctor urgently.
Blood in stool, black stools, vomiting blood, or persistent change in bowel habit
Not related to diet alone; needs urgent assessment. Go to the emergency room if bleeding is heavy.
How is it diagnosed?
There is no test for "diet quality". Your doctor or dietitian will review your usual meals, weight and waist, blood pressure and blood tests (sugar or HbA1c, cholesterol, liver enzymes). If you have fatty liver disease, diabetes, reflux or another condition, your plan is adjusted to it. Short food questionnaires and a seven-day food diary are useful for finding where to start.
What the latest science says
The strongest trial evidence is the PREDIMED study in Spain (published in the New England Journal of Medicine in 2013 and republished with corrections in 2018), in which people at high heart risk who followed a Mediterranean diet with extra-virgin olive oil or nuts had about 30% fewer major cardiovascular events than people advised to eat a low-fat diet. The Lyon Diet Heart Study and later meta-analyses support lower cardiovascular events and better blood sugar control. In liver disease, the 2024 EASL-EASD-EASO clinical practice guidelines on metabolic dysfunction-associated steatotic liver disease (MASLD) recommend the Mediterranean diet and a weight loss of 5 to 10% in people with excess weight. The American Heart Association (2021) and the World Cancer Research Fund both advise plant-rich diets, and the International Agency for Research on Cancer classified processed meat as carcinogenic to humans (Group 1, 2015) and red meat as probably carcinogenic. Most evidence for the diet is from Mediterranean populations, so results may differ in other settings, and long-term adherence is the main challenge. Evidence for Saudi-specific adaptations comes mostly from observational and small studies.
Outlook — what to expect
Moving towards this pattern, even partly, lowers the risk of heart disease and type 2 diabetes and can reduce liver fat, and the benefits grow the longer it is kept up. It does not replace medication when you need it. Changes are best made one meal at a time, and the aim is a pattern you can enjoy for life rather than a short diet.
Treatment
Habits & Lifestyle
Think of the plate and the pace, not only the foods.
- Fill half of your plate with vegetables or salad, a quarter with protein (fish, chicken, legumes, eggs) and a quarter with rice, bread or other starch, in smaller portions.
- Share one large dish at family gatherings rather than refilling the plate several times.
- Walk for at least 30 minutes on most days; the World Health Organization advises at least 150 minutes of moderate activity a week.
- Cook at home more often, and bake, grill or steam rather than deep-fry.
Diet
Keep the dishes you love, and adjust the proportions and the cooking method.
- Use extra-virgin olive oil, and use less ghee and cooking oil in rice dishes. All fats are high in calories, so measure with a spoon.
- Eat fish or seafood at least twice a week (grilled sayadiyah-style fish, baked hamour or shrimp) and keep red meat to small portions; avoid processed meats such as sausages and luncheon meat.
- Make legumes a regular meal: foul, lentil soup, chickpeas, hummus (with limited oil and tahini) and mutabbal-style vegetable dips.
- Choose jareesh, harees, whole-wheat bread and brown rice more often than white rice and white bread, and serve kabsa with a large salad and a smaller rice portion.
- Enjoy dates in modest amounts, about two or three, with water, nuts or laban; keep sweets such as kunafa and luqaimat for special occasions.
- Bake the samboosa instead of frying it, and choose plain laban or yoghurt, fruit and a handful of nuts as snacks. Drink water instead of sugary drinks.
Medications
Diet does not replace the medicines your doctor has prescribed. It works alongside them.
- Keep taking medicines for diabetes, blood pressure, cholesterol or liver disease as prescribed; improved food choices may mean your doctor changes the dose, not you.
- Omega-3 or other supplements are not needed if you eat fish regularly; ask your doctor before starting any.
- Weight-loss medicines are used for specific medical reasons and under supervision, in addition to diet and activity.
Procedures & Surgery
For some people with obesity or complications, procedures are options after lifestyle changes.
- Metabolic and bariatric surgery or endoscopic weight-loss procedures can be considered for selected people with obesity; they need long-term dietary follow-up.
- Liver ultrasound or elastography can check for fatty liver and scarring if you have risk factors.
- Blood tests every few months track sugar, cholesterol and liver enzymes as your diet changes.
Living with the condition
- Change one meal or one habit at a time and keep it for a month before the next.
- Keep fruit, nuts and cut vegetables visible at home and at work.
- Eat with family and friends and enjoy meals; social eating is part of the Mediterranean and Saudi traditions.
In the Saudi context
Hospitality is central to Saudi culture, and serving generous food is a sign of respect, so the aim is not to refuse food but to balance the plate. Ramadan is an opportunity: break the fast with water and two or three dates, then a bowl of soup, a salad and a moderate main meal, and avoid fried items and sweets at every sitting; have a suhoor with protein and fibre such as foul, eggs, yoghurt or laban, and oats. Pre-existing conditions such as diabetes, kidney disease, advanced liver disease and pregnancy need medical advice about fasting before Ramadan. The Saudi Ministry of Health has published national dietary guidelines for Saudis that you can ask your dietitian about. Use kabsa spices, cardamom, saffron, cinnamon and fresh herbs for flavour instead of too much salt.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Is the Mediterranean diet suitable for my condition, and do I need to change how I take my medicines?
- How many portions of rice, bread and dates are right for me each day?
- Should I be checked for fatty liver, diabetes or high cholesterol?
- How should I eat during Ramadan with my health conditions?
- Can you refer me to a dietitian who can adapt my family meals?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide