How Cooking Methods Shape the Mediterranean Diet’s Health Impact

The health benefits long associated with the Mediterranean diet may not come solely from food. A new scientific review argues that how meals are prepared, combined and shared at the table could be just as important as what ends up on the plate.

“I realized that in intervention studies that I was participating in as a researcher, we were focusing a lot on what the Mediterranean diet is when we were trying to have these changes in the participants, but we were not providing them how to do it,” said Miguel Ruiz-Canela, a longtime Mediterranean diet researcher and professor and chair of the Department of Preventive Medicine and Public Health at the University of Navarra in Spain.

Decades of research have linked the dietary pattern to a lower risk of cardiovascular disease and a broad range of chronic conditions. Most of that work, however, has focused on individual foods and nutrients.

Far less attention has been paid to cooking techniques, food combinations and the cultural rituals that surround Mediterranean meals.

In the new review, led by Ruiz-Canela and published in the journal Gastronomy, researchers propose a concept called Mediterranean Culinary Medicine. The approach combines nutrition science with the traditional cooking practices and food culture of Mediterranean countries.

The review builds on decades of Mediterranean diet research, including landmark intervention studies such as PREDIMED, which demonstrated significant health benefits associated with adherence to the dietary pattern.

“Usually, when one talks about the Mediterranean diet, we are referring to the Mediterranean pyramid,” Ruiz-Canela said. “What you are basically seeing in this pyramid is a group of foods and how much can be consumed according to the frequency during the week, month or day. But I think it’s more profound than this.”

“You need to consider olive oil as the culinary fat, but also techniques and the way that you have meals with family and friends,” he added. “That is the sociability part of the Mediterranean food culture. And there are other traditions that are part of the way that this food is consumed.”

One example is sofrito, a traditional Mediterranean preparation that typically combines tomato, garlic and onion cooked slowly in extra virgin olive oil. Ruiz-Canela noted that the technique was considered important enough to be included among the dietary habits assessed in the PREDIMED studies, which asked participants whether they used sofrito two or three days a week.

“This is very important in the culinary tradition in Mediterranean countries. Many dishes begin with this sofrito, maybe with some variation from one country to another. But mostly it is a cooking method where you use olive oil and combine it with vegetables,” he said. “This is like a middle-temperature, slow process, and there are many biochemical reactions that are very beneficial.”

The review argues that cooking methods can alter the nutritional characteristics of food in ways that are often overlooked in nutrition research. Some nutrients may be lost through excessive heat or discarded cooking water, while others become more available to the body through cooking and interaction with fats such as olive oil.

“When you are cooking, you are producing some change in the raw food,” Ruiz-Canela said. “This has an influence on the nutritional properties because some nutrients are influenced by temperature.” He noted that boiling vegetables, for example, can lead to nutrient losses if the cooking water is discarded, while gentler techniques such as steaming may better preserve certain compounds.

At the same time, cooking can also enhance nutritional value. “There are other nutrients or vitamins that are more easily integrated when you are cooking with some fat, especially with olive oil,” he said. “And the use of a moderate temperature helps to modify the food and liberate some nutrients from the cells of vegetables. This makes it easier for them to be available for our metabolism.”

The authors write that such culinary effects deserve greater attention, particularly because most epidemiological studies focus on food consumption and nutrient intake rather than on how meals are prepared.

Beyond cooking techniques, the review also explores broader cultural dimensions of the Mediterranean diet. The concept of Mediterranean Culinary Medicine builds on the existing field of culinary medicine, which integrates nutrition science with culinary skills and food preparation.

According to Ruiz-Canela, applying culinary medicine within Mediterranean countries requires acknowledging the unique traditions and social practices that characterize the region’s food culture.

“The idea of adding Mediterranean Culinary Medicine was to focus on this idea that we are joining the Mediterranean diet with the culinary medicine field,” he said. The researchers believe this means considering not only ingredients and recipes but also culture, family traditions, local food availability and the ways meals are shared.

“When you are talking about incorporating the cooking part, the culinary tradition, this is related to culture, tradition, the influence from generation to generation and the availability of local foods,” he said.

While the dietary pattern has been successfully adopted in many countries outside the Mediterranean Basin, Ruiz-Canela believes certain cultural elements are harder to export. “You can extrapolate the Mediterranean diet, but mostly focus on the foods that you are consuming,” he said. “But I think it cannot be fully extrapolated because there are many aspects related to culture that are more difficult to extrapolate.”

Those aspects include shared meals, family gatherings and the broader food culture that surrounds eating — all emphasized in modern representations of the Mediterranean diet but studied far less often than nutrients or food groups. For Ruiz-Canela, these elements help explain why the diet cannot be reduced to a simple list of foods.

Ruiz-Canela acknowledged that research on culinary practices remains far less developed than research on the Mediterranean diet itself. “This area is opening a new window,” he said. “There are some studies pointing in this direction, but they are not as frequent, and they are less profound in terms of scientific robustness than other research following the Mediterranean diet.”

Even so, researchers believe the field holds significant potential, particularly in healthcare settings. One section of the review examines how culinary approaches may help address conditions such as dysphagia, malnutrition and sensory impairments that affect patients’ ability to eat. In these cases, the way food is prepared may be just as important as its nutritional composition.

Ruiz-Canela also argued that discussions about health should not ignore the role of enjoyment. “We have to focus more on the idea of pleasure,” he said. “In gastronomy, pleasure is very important, but maybe we don’t talk about it at all when we are talking about health. Health and pleasure can exist together.”

As researchers continue to investigate the relationship between cooking, culture and health, Ruiz-Canela envisions closer collaboration between physicians, dietitians and culinary professionals.

“We need to bring to the team not only dietitians, physicians and other health professionals, but also chefs and cooks,” he said.