During the last decade, great strides have been made to delineate the importance of diet in the prevention and treatment of the metabolic syndrome. Dietary recommendations have emphasized a low-fat ("antiatherogenic") diet as the first-line therapeutic approach. However, the complex etiology of the metabolic syndrome would seem to necessitate tailored dietary approaches beyond simple macronutrient modification. Current data have revealed varying biological effects of individual macronutrients within the same category, suggesting that adjusting dietary macronutrient percentages without considering their physiological impact may not be adequate. The concepts of glycemic index and glycemic load support the need for differentiation between various types of carbohydrates. Additionally, significant evidence to date indicates that metabolic syndrome biomarkers improve with dietary patterns rich in phytochemical complexity (e.g., Mediterranean diet). Taking these aspects into account, we designed a specific dietary approach consisting of foods found in the popularized Mediterranean diet, modified to include only those items that are low in glycemic load and grains (gluten) and are antiinflammatory. Initially based on scientific literature, this food plan has since been tested and adapted in our clinic over the past decade. This paper describes the rationale of the dietary program and provides an overview of data on its efficacy in individuals with metabolic syndrome.