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Dr. Miguel Ángel Martínez-González, Professor of Public Health at the University of Navarra. Salvador Salas Health The 14 pillars of the traditional Mediterranean diet and the myths that undermine itSUR speaks to oneof the world’s top Mediterranean diet experts, who unmasks fake health foods and makes the case for red wine - in moderation
Friday, 6 March 2026, 09:22
Miguel Ángel Martínez-González is one of the world’s most influential epidemiologists and researchers in the field of nutrition and preventive medicine. Born in Malaga in 1957, he holds the chair of public health at the University of Navarra. He is recognised worldwide for leading the most audacious and ambitious studies related to the Mediterranean diet, such as the Sun project or Predimed (Prevention with Mediterranean Diet), considered the largest nutrition trial carried out in Europe, or Predimed Plus. With more than 1,200 articles and prestigious awards, he is one of the most cited scientists in the world. He is undoubtedly the great guru of the Mediterranean diet, which he has helped to define. But what is and what isn’t this diet?
“They are not ultra-processed foods, which are foods where you don’t recognise the natural food, they are packaged, they have a long shelf life and they are loaded with additives, basically. They are very cheap, very tasty to the palate,” he says. Also outside the Mediterranean diet are “desserts such as sugary sweets, cream”. Nor is eating red or processed meat more than three or four times a month, “everything that is burgers, sausages, cheap minced meat”. Serrano ham is part of the Mediterranean diet, however.
What is the Mediterranean diet?
“Its key element is extra virgin olive oil,” he explains to SUR, and continues: three pieces of fruit a day. “It is very important that fresh fruit is the usual dessert,” he reflects, as well as two portions of vegetables a day, “one of them in a salad”.
It is “prioritising poultry meat to red and processed meat; and then three portions a week of pulses, three portions of fish and three portions of nuts, that is what we have defined,” he says.
"The sofrito, as the base of many dishes, is a very important characteristic, because it has a set of antioxidants, polyphenols," says Dr. Martínez-González.
On the basis of these indications, his team drew up the Mediterranean diet index called Medas, made up of 14 points. But there is more: “Butter, margarine and cream, industrial pastries that come ready-made, should be greatly reduced,” he says, adding: “The sofrito, as a base for many dishes, is a very important characteristic, because it has a set of antioxidants, polyphenols, etc.”
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Image of a selection of foods that make up the Mediterranean diet. EFEIt gives even more clues: breakfast cereals do not fall into this classification. Olive oil with wholemeal bread does. “And you can add tomato and you can also have a bit of ham or some eggs.
”What about a glass of red wine? “There is a brutal controversy,” he says, because there are more than 100 epidemiological studies that have found that high alcohol consumption is associated with the highest mortality: three or more drinks a day. “That clearly kills people prematurely.”. However, “those who consume between one and two drinks a day have less mortality than abstainers.”
Recently, Dr Martínez-González and his team published an article in the prestigious European Heart Journal in which they moved “from observation to intervention, which is what we did in Predimed”, he says. “What was done in Predimed?” Each group is told one thing. “Of those 14 points of the Mediterranean diet, one of them was that those who were already drinkers were told, ‘Let your drink be a glass of wine at lunch’.” In total, 7,447 people took part in the study and these were joined by the Sun project, 10,000 participants, some as young as 40 years old.
Mortality rate fell
With the former, if you add red wine to the 13 points, “it turns out that mortality is reduced in the long term; we wanted to see this with a cohort of younger people,” he explains. In the second case, they found in a replicated and independent manner “also a rare reduction in mortality with the same”. The Sun Mediterranean diet “reduces mortality by 23 per cent, and if you add wine, it goes down by 33 per cent”.
Getting the article out thanks to a huge team of international scientists has not been easy. It entered the sixth review, as this is a controversial topic. This is the Unati project. Healthy consumption would be one glass of wine at meals for women and two for men. “We think that the pattern of consumption can be as important or more important than the amount of ethanol consumed: it is not the same to consume 60 degrees of alcohol a week, which you concentrate in four glasses of rum in a row some weekend in two hours, than that same amount of 60 degrees based on one or two glasses of wine at meals throughout the week, it is radically different,” he argues.
More than 500 doctors from all over Spain are taking part in the study, for which it is calling for volunteers from among the people of Malaga. Among others, the endocrinologist Daniel Cabo, the cardiologists Joaquín Cano and Aurelio Rojas, the preventivists Raquel Cueto and Enrique Gómez Gracía, the internist Miguel Pérez Velasco, etc, are involved. “All you have to do is to be between 50 and 70 years old for men and between 55 and 75 for women,” he says. People who will have the added bonus of medical assistance and advice for a year. They are looking for a total of 10,000 volunteers in the country. “This is going to make Spain, as it has been with the Mediterranean diet, the leading country in the world in alcohol research.”
The myths
The doctor also lists the myths of the so-called Mediterranean diet: foods such as fried potatoes, cooked sausages, dairy products in general (yoghurt is said to be Mediterranean, but sometimes a lot of sugar is added, he says), churros and white bread are not part of the diet. “The wheat is stripped of its grain, germ and bran, which is the most nutritious part, and we are left with the endosperm, with the starch, which is pure fuel, and this has to do with the increase in obesity and diabetes, because we are efficient at transforming starch into sugar,” he says.
Pasta, if it is cooked al dente, is not a problem. The problem is that in Spain “it is so cooked that it melts in the mouth: they are fast-absorbing carbohydrates”.
As for carbohydrates, it is not so much the quantity as the quality that matters. “The quality of carbohydrates depends on four factors: whether they are solid or liquid - liquids are much worse, i.e. sugary soft drinks; whether they have a high glycaemic index; whether they are refined rather than wholemeal; and whether they have little or a lot of fibre,” he says.
"The Mediterranean diet is not what is consumed now in Spain, it is the diet of the 50s and 60s of the last century, the diet of our grandparents," he says
Dr Martínez-González points out another of the myths: “Pizza is an ultra-processed food, the Americans changed it from being thin and rather hard, to having a lot of dough, soft, and as a vehicle for the rapid release of cheese” to provide an outlet for the surplus cheese on the US market. “Pizza has been distorted,” he says bluntly, calling orange juice for breakfast “nonsense”: “You’re taking a lot of good things away from the orange. Peel it and eat it whole. And I don’t even want to know if the juice comes in a carton or bottle,” he concludes.
In any case, the doctor argues, the Mediterranean diet “is not what is consumed now in Spain, it is the diet of the 50s and 60s of the last century, the diet of our grandparents”.