As research and nutrition advice evolves, the idea of the “perfect” diet is changing, too. Low-fat used to be all-the-rage until we started realizing it wasn’t sustainable (or palatable) for long-term weight loss or health. Now that we know fat is “in,” good and necessary, we’re faced with different recommendations within that realm.
We’ve already compared two of the most popular diets these days: the ketogenic diet and the Paleo diet. In this article, we’ll be comparing the keto diet vs the Mediterranean diet, summarizing each and then seeing where they are similar as well as different.
What is the Keto Diet?
The ketogenic diet is a strictly modified form of the original Atkins diet, a low-carb and high-protein diet. Atkins first came on the scene in the 1980’s, and it was revolutionary in its advice to eat more fat and reduce carbs.
The ketogenic diet, which focuses on very high fat (at least 70-80%), moderate protein (20-25%), and very low carb intake (5-10%), was originally designed to reduce seizures in children with epilepsy. Since then, it’s been discovered to be helpful for everything from weight loss to possible alternative cancer therapies.
The idea behind the keto diet is to put the body into ketosis, a metabolic state where the body uses up all its carb stores and begins burning fat for energy instead. Ketosis has many health benefits and is also used as a preventative diet for chronic disease.
Keto foods include:
- Fats including healthy oils, avocados, fatty nuts or nut butters, eggs, and full-fat dairy like butter or ghee
- Animal proteins including beef, poultry, organ meats, fatty fish, and eggs
- Non-starchy and low-carb vegetables (see our guide to the best vegetables on the keto diet)
- None or VERY limited amounts of fruits and only those that are low in sugar like berries
- NO sugars, flours, or processed foods as any extra carbs can kick you out of ketosis
What is the Mediterranean Diet?
The Mediterranean Diet’s popularity extends many years and is based on the dietary choices of people in France, Italy, and Spain during the 1940-50s. The actual diet of those around the Mediterranean Sea varies quite a bit. In studies, the diet typically has fats making up about 30% (about 8% or less from saturated), protein making up about 20%, and carbohydrates making up about 50%.
Mediterranean diet foods include:
- High-quality oils, mostly olive oil
- Beans and legumes, such as beans, peas, and lentils
- An abundance of fruits and vegetables
- Dairy products, especially yogurt and cheese
- Fish as the main source of non-vegetarian protein — at least twice a week
- Unrefined whole grains, including brown rice, quinoa, and whole grain breads
- Moderate wine drinking
- Low amount of meat products, besides fish
- Little to no refined sugars, flours, and processed foods
This diet became highly recommended after it was found to lower the risk of several chronic diseases, including heart disease .
The high levels of oleic acid from olive oil and polyphenols from wine is thought to provide many benefits of the Mediterranean diet.
Keto Vs Mediterranean: Similarities
Both diets share a few notable similarities:
There are health positives for both diets. For example, the ketogenic diet has been shown to help increase HDL cholesterol, lower LDL and total cholesterol, and lower triglycerides. It’s been used by those with type 2 diabetes. In preliminary research, it has even shown promise for use in treating and preventing serious conditions like cancer.
The Mediterranean diet has been in mainstream practice much longer than the keto diet and brings a few similar results. A meta-analysis in 2014 found a relationship between more olive oil consumption and reduced risk of death, stroke, and heart disease.
These benefits have shown especially successful for long-term weight loss when compared to low-fat diets. During a large study  that spanned two years comparing low-fat, low-carb, and Mediterranean diets, the results showed both the Mediterranean and low-carb diet brought more weight loss over time than the low-fat group.
Both keto and Mediterranean may be higher in salt than other “clean” diets. The Mediterranean diet is high in sodium due to oily dressings with high salt and foods like olives, anchovies, and cured cheeses. Foods on the keto diet are actually naturally very low in salt, so adding salt is encouraged to avoid electrolyte deficiencies.
Both diets also emphasize eating whole, fresh vegetables and proteins and avoiding added sugars, additives, chemicals, and processed foods.
Keto Vs Mediterranean: How They Differ
Although they share a few common benefits, the ketogenic diet and Mediterranean diet do have many differences:
The Mediterranean diet emphasizes healthy fats and eliminates refined sugars, but it also includes a very high amount of carbohydrates — including fruits and whole grain breads and pastas. The standard version of the diet is really in no way a low-carb diet. In contrast, the ketogenic diet is strictly very low in all carbohydrates, even the unrefined versions.
The Mediterranean diet is higher in fat compared with standard low-fat diets, but it’s much lower in fat percentage than keto.
The type of fat is also different: Mediterranean diet emphasizes unsaturated fats from oils and fish, while keto foods include both saturated and unsaturated fats (following the more recent science, as we know the evil of saturated fats has been debunked.)
Both ways of eating can help improve health, especially if someone was eating junk before, the purpose of the ketogenic diet goes much deeper. It’s more than just a weight loss or health diet; it’s designed to “hack” the body’s metabolic state through ketosis.
For someone simply interested in eating better and losing weight, the Mediterranean diet can be a good place to start, but the high carbohydrate intake, especially from grains and pastas, is problematic over the long-term. It could be used as a springboard for gradually moving into a more low-carb diet like keto.
The Keto-Mediterranean Diet: Best of Both Words
Some people follow something called the “Ketogenic Mediterranean Diet” that incorporates the best of each diet. The diet features about 7-10% carbs, 55-65% fat, 22-30% protein, and 5-10% alcohol.
- high amounts of healthy oils (especially coconut and olive) and other plant fats like avocados
- fatty fish as the main protein source along with eggs, cheese, and lean meats
- lots of salad and non-starchy vegetables
- a moderate intake of red wine
Just like with the keto diet, starches, sugars, and grain-based flours are completely eliminated. The difference is that the diet emphasizes slightly different fat sources than the standard keto diet and also allows red wine.
When it comes down to it, the fact is that most people need some type of nutritional intervention — whether that comes from the Mediterranean or the ketogenic diet. The difference is that the ketogenic diet is more updated with recent research and brings about specific results from being in ketosis, which we personally favor above all.
Sources: “Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.” New England Journal of Medicine, vol. 359, no. 20, 2008, pp. 2169–2172., doi:10.1056/nejmc081747.  Rees, Karen, et al. “’Mediterranean’ Dietary Pattern for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, Dec. 2013, doi:10.1002/14651858.cd009825.pub2.
Dr. Anthony Gustin is a board-certified sports chiropractor, functional medicine practitioner, entrepreneur, podcast host, and founder of Perfect Keto.
After growing his sports rehab and functional medicine clinics to six locations in San Francisco, he shifted his mission to help as many people as possible achieve optimal health and well-being.