Mediterranean Diet

An evidence-based eating pattern shown to support gut health, inflammation, and quality of life in people with IBD and IBS.

Mediterranean food with salmon, oil and vegetables

Mediterranean Diet for Digestive Health

The Mediterranean Diet (MED) is a well-studied dietary pattern associated with improved cardiovascular, metabolic, and overall health. Increasingly, research supports its role in digestive health, including benefits for people living with Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). 

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Unlike diets that focus primarily on eliminating symptom triggers, the Mediterranean diet emphasizes food quality, diversity, and sustainability, making it a good option across many chronic gastrointestinal (GI) conditions.

What is the Mediterranean Diet?

The Mediterranean Diet is characterized by a high intake of plant-based foods, healthy fats, and lean protein sources.

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This pattern provides dietary fiber, polyphenols, antioxidants, and unsaturated fats that support gut health and help regulate inflammation.¹˒²

Picture showing the various food groups within in Mediterranean Diet

Figure 1. Image from the Mediterranean Diet Handout - Developed by the Department of Family Medicine, East Carolina University.

Typical intake includes:

Vegetables

2 servings per meal

Fruits

1-2 servings per meal

Extra virgin olive oil

3 tablespoons per day

Breads and cereals

1-2 servings per day

Legumes

2 or more servings per week

Seafood

more than 2 servings per week

Eggs

2-4 servings per week

Poultry

2 servings per week

Dairy

1-2 servings per day (typically yogurt or cheese

Red meat

less than two servings per week

Sweets

less than two servings per week

Health Benefits Beyond the Gut

In addition to improving symptoms in IBD and IBS, strong evidence supports the Mediterranean diet’s benefits in:

Cardiovascular disease
Cancer prevention
Type 2 diabetes
Metabolic Health

Much of these benefits are attributed to reduced systemic inflammation and higher consumption of vegetables, fruits, nuts, fish, avocados, and olive oil.³^,⁴

The Mediterranean diet may also serve as a preventive strategy against:

Colon cancer⁵
Later-onset Crohn’s disease⁶

Figure 2. What a Mediterranean diet looks like.¹⁴

The Mediterranean Diet and IBD

How Might the Mediterranean Diet Benefit IBD?

The Mediterranean diet may benefit individuals with IBD through several interconnected mechanisms. One proposed mechanism is through the diet’s anti-inflammatory effects on the gut microbiome. Multiple studies demonstrate that Mediterranean diet patterns favorably alter the microbiome and reduce inflammation.⁷^,⁸^,⁹The benefits include:

Increased microbial diversity

Enhanced production of beneficial metabolites

Improved gut barrier function

Learn more about Diet and the Microbiome

A bowl with healthy Mediterranean style foods including avocado, spinach, chickpeas, mushrooms, olive oil and broccoli

What Does the Evidence Show?

Growing research supports the Mediterranean diet as a beneficial dietary pattern for people with Crohn’s disease and ulcerative colitis.

Symptom Reduction

The MED has been shown to significantly reduce symptoms in patients with either Crohn’s disease or ulcerative colitis²^,¹⁰

Lower inflammatory markers

A significantly larger portion of patients following the MED experienced lower CRP levelslower fecal calprotectin levels (<250 ug/g) and improved quality of life scores.²

Improved outcomes

An important finding from the DINE CD trial¹⁰ was that patients with CD on either the SCD or MED had significant improvements in patient reported outcomes, including fatigue.

Post-surgical benefits

Following pouch surgery for UC, patients with higher adherence to the MED were associated with decreased fecal calprotectin levels.¹¹

The benefits of MED also extend to pediatric patients and study findings support the Mediterranean diet as a safe and effective dietary approach for pediatric IBD. In a prospective, randomized study of 100 patients (aged 12-18) with mild to moderate disease, half were given MED for 12 weeks.¹² After this dietary change, the MED group showed:

Significant decreases in both clinical disease activity scores

PCDAI and PUCAI

Significants decrease in most inflammatory markers

CRP, calprotectin, TNF-α, IL17., IL 12 and IL13

Tips when Implementing the Mediterranean Diet

The Mediterranean Diet and IBS

How Might the Mediterranean Diet Improve IBS Symptoms?

Research suggests that the Mediterranean diet may help improve IBS symptoms through several interconnected mechanisms. Proposed mechanisms include¹⁵^,^16,¹⁷^:

Modulation of the gut microbiota through fibers, polyphenols, and healthy fats

Anti-inflammatory effects in the gut and systemically

Strengthening of the intestinal barrier

Improvement in anxiety and depressive symptoms, supporting gut–brain regulation

A display of Mediterranean style foods including salmon, red peppers, chicken breast, beans, zucchini, oats and blueberries

What Does the Evidence Show?

Feasibility and symptom improvement

In adults with IBS and mild-to-moderate anxiety or depressive symptoms, the Mediterranean diet was shown to be feasible and improved both gastrointestinal and psychological symptoms.¹⁵

Comparable to the low FODMAP diet

A small randomized trial found the Mediterranean diet comparable to the low FODMAP diet in achieving a 30% reduction in abdominal pain severity in people with IBS-D or mixed IBS.¹⁶

Potential first-line option

Another randomized clinical trial found the Mediterranean diet more effective than gentle GI nutrition advice for improving IBS symptoms, suggesting it may be considered a first-line dietary option for IBS.¹⁷

Why Consider the Mediterranean Diet for IBS?

Most dietary approaches for IBS focus on restricting known symptom triggers. While effective for some, this strategy does not always address mental health, gut–brain interaction, or long-term dietary adequacy. 

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Poor mental health is common in IBS, and greater psychological burden is associated with more healthcare use, increased medication reliance, and lower quality of life.¹³

Recent research has explored whether the Mediterranean diet — known for its benefits beyond the gut — could provide broader support for people with IBS.

Implementing the Mediterranean Diet in IBD and IBS

Following the Mediterranean diet can be challenging for some individuals, particularly those with active IBD, strictures, or long-standing low-fiber intake. 

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Individual tolerance varies, and personalization is essential.

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Always work with your healthcare professional when implementing dietary changes.

Practical strategies include:

Juicing or pureeing fruits and well-cooked vegetables initially

Gradually introducing whole fruits and vegetables as symptoms improve

Choosing ancient grains such as farro, spelt, or wild rice

Using rice as a well-tolerated carbohydrate option

Consuming nuts and seeds in tolerated forms

such as: nut butters; hummus; homemade almond milk

Combining the Mediterranean Diet and Low FODMAP Diet

While this combined approach has not yet been tested in clinical trials, researchers have proposed that enriching a Low-FODMAP diet with Mediterranean diet components that are naturally low in FODMAPs may:¹⁸

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Preserve gut microbiota diversity
Improve nutritional adequacy
Reduce the downsides of long-term restriction

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This strategy may be particularly useful for individuals with IBS or IBD who benefit from FODMAP reduction but seek a more sustainable long-term dietary pattern.

Food

Beneficial component

Proposed action

Extra virgin olive oil

Polyphenols

Prebiotic effect, anti-inflammation

Walnuts

Omega-3 fats

Anti-inflammation; shown to increase butyric acid–producing species in healthy individuals

Fish

Omega-3 fats

Western-type diets have an elevated omega-6:omega-3 ratio reaching 20–30:1. Omega-3 PUFAs and their bioactive metabolites compete with omega-6 PUFAs to promote the resolution of inflammation

Oats

B-glucan

Soluble fibers found in abundance in oat grain (free of FODMAPs); prebiotic

Orange

Quercetin

Prebiotic, anti-inflammation

Walnuts

Omega-3s

Anti-inflammation, prebiotic

Orange, clementine

Quercetin

Prebiotic, anti-inflammation

Tomatoes

Quercetin

Prebiotic, anti-inflammation

Oregano, rosemary, thyme

Phenolic compounds

Prebiotics

Small amounts chickpeas + lentils (canned)

GOS

Prebiotic effect

Learn more about LowFODMAP diet

The Mediterranean Diet and Celiac

What If You Have Celiac Disease?

Learn more about the Gluten Free Med diet

The Mediterranean diet can be safely followed by people with celiac disease when adapted to be strictly gluten-free. 

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Many Mediterranean diet staples — such as fruits, vegetables, legumes, fish, olive oil, nuts, seeds, rice, and naturally gluten-free whole grains — align well with a gluten-free eating pattern.

However, careful attention is needed to avoid gluten-containing grains and cross-contamination.

Learn more about the Gluten Free Med diet

Not Sure Which Approach is Right for You?

Nutrition needs vary based on diagnosis, symptoms, and individual tolerance. Working with a registered dietitian experienced in GI conditions can help personalize the Mediterranean diet for IBD, IBS, or celiac disease.

References

Bach-Faig A, Berry EM, Lairon D, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274-2284. doi:10.1017/S1368980011002515
Chicco, F., Magrì, S., Cingolani, A., Paduano, D., Pesenti, M., Zara, F., Tumbarello, F., Urru, E., Melis, A., Casula, L., Fantini, M. C., & Usai, P. (2021). Multidimensional Impact of Mediterranean Diet on IBD Patients. Inflammatory Bowel Diseases, 27(1), 1–9. https://doi.org/10.1093/ibd/izaa097
Martini D. Health Benefits of Mediterranean Diet. Nutrients. 2019;11(8):1802. Published 2019 Aug 5. doi:10.3390/nu11081802
Tosti V, Bertozzi B, Fontana L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. J Gerontol A Biol Sci Med Sci. 2018;73(3):318-326. doi:10.1093/gerona/glx227
Illescas O, Rodríguez-Sosa M, Gariboldi M. Mediterranean Diet to Prevent the Development of Colon Diseases: A Meta-Analysis of Gut Microbiota Studies. Nutrients. 2021;13(7):2234. Published 2021 Jun 29. doi:10.3390/nu13072234
Khalili H, Håkansson N, Chan SS, et al. Adherence to a Mediterranean diet is associated with a lower risk of later-onset Crohn's disease: results from two large prospective cohort studies. Gut. 2020;69(9):1637-1644. doi:10.1136/gutjnl-2019-319505
Reddavide R, Rotolo O, Caruso MG, et al. The role of diet in the prevention and treatment of Inflammatory Bowel Diseases. Acta Biomed. 2018;89(9-S):60-75. Published 2018 Dec 17. doi:10.23750/abm.v89i9-S.7952
Tomasello G, Mazzola M, Leone A, et al. Nutrition, oxidative stress and intestinal dysbiosis: Influence of diet on gut microbiota in inflammatory bowel diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(4):461-466. doi:10.5507/bp.2016.052
Ghosh TS, Rampelli S, Jeffery IB, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut. 2020;69(7):1218-1228. doi:10.1136/gutjnl-2019-319654
Lewis JD, Sandler RS, Brotherton C, et al. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease [published correction appears in Gastroenterology. 2022 Nov;163(5):1473]. Gastroenterology. 2021;161(3):837-852.e9. doi:10.1053/j.gastro.2021.05.047
Godny L, Reshef L, Pfeffer-Gik T, et al. Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. Eur J Nutr. 2020;59(7):3183-3190. doi:10.1007/s00394-019-02158-3
El Amrousy D, Elashry H, Salamah A, Maher S, Abd-Elsalam SM, Hasan S. Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial. J Inflamm Res. 2022;15:2075-2086. Published 2022 Mar 29. doi:10.2147/JIR.S349502
Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol. 2020; 17(8):473-486. doi: 10.1038/s41575-020-0286-8.
Serra-Majem L, Tomaino L, Dernini S, et al. Updating the Mediterranean diet pyramid towards sustainability: focus on environmental concerns. Int J Environ Res Public Health. 2020; 17(23):8758. doi: 10.3390/ijerph17238758.
Staudacher HM, Mahoney S, Canale K, et al. Clinical trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2024; 59(4):492-503. doi: 10.1111/apt.17791.
Singh P, Dean G, Iram S, et al. Efficacy of Mediterranean diet vs. low-FODMAP diet in patients with nonconstipated irritable bowel syndrome: a pilot randomized controlled trial. Neurogastroenterol Motil. 2025; 37(10):e70060. doi: 10.1111/nmo.70060.
Bamidele JO, Brownlow GM, Flack RM, et al. The Mediterranean diet for irritable bowel syndrome: a randomized clinical trial. Ann Intern Med. 2025; 178(12):1709-1717. doi: 10.7326/ANNALS-25-01519.
Kasti A, Petsis K, Lambrinou S, et al. A combination of Mediterranean and low-FODMAP diets for managing IBS symptoms? Ask your gut! Microorganisms. 2022; 10(4):751. doi: 10.3390/microorganisms10040751.

MED Research Articles

See all MED Research Articles

April 18, 2025

Efficacy of Dietary Interventions in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis

March 23, 2024

Healthy Lifestyle Is a Protective Factor from Moderate and Severe Relapses and Steroid Use in Inflammatory Bowel Disease: A Prospective Cohort Study

December 1, 2023

Adherence to the Mediterranean diet is associated with decreased Fecal Calprotectin Levels in Children with Crohn's Disease in Clinical Remission under biological Therapy

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