There are many types of keto diets. A keto diet full of vegetable oils and preservatives, for instance, is called a dirty keto diet.
A clean keto diet, on the other hand, is rich in healthy fats, vegetables, meats — you know, all that stuff that doesn’t come in a package.
One iteration of clean keto — a rather popular one lately — is the keto Mediterranean diet.
The keto Mediterranean diet, also called the ketogenic Mediterranean diet or the Mediterranean keto diet, is a very low-carbohydrate diet that has you consuming fish, olive oil, salad, and moderate amounts of red wine.
This article will compare and contrast the keto and Mediterranean diets, then explore what happens when you combine them. Keep reading.
You’ve heard of the ketogenic diet. It’s a high-fat, moderate-protein, low-carb diet best known for stimulating weight loss.
On keto, you eat about 60% of your calories from fat, 30% from protein, and 10% (or less) from carbohydrates. Restricting carbohydrates is the key to entering ketosis, the fat-burning state for which the keto diet is named.
Here’s how that works. When you don’t eat carbs, your blood sugar stays low, which in turn keeps the hormone insulin low. (Insulin regulates blood sugar and promotes fat-storage). And when insulin stays low, it signals your liver to burn fat (from body fat and dietary fat) and produce ketones.
Think of ketones like backup brain fuel. They help your brain (and other cells) stay sharp in the absence of carbs[*].
On a whole foods keto diet, you eat healthy fats (olive oil, coconut oil, butter), meat, dairy, nuts, fish, and piles of non-starchy veggies. Your other main job is to avoid refined sugar, grains, tubers, and other high carbohydrate foods.
Keto may sound restrictive, but once your body adapts to using fat for energy, the carb cravings tend to dissipate. Plus you can always eat some carbs, take a break from ketosis, and restart later.
Back in the 1960s, researchers noticed that people living in France, Italy, Greece, and Spain had unusually low rates of heart disease[*]. Why?
Maybe it was their diet. These folks ate lots of fish, olive oil, and vegetables — and enjoyed the occasional glass of red wine. This general eating pattern became known as the Mediterranean diet.
There are many theories why the Mediterranean diet is healthy. It could be the antioxidants from olive oil, polyphenols from red wine, the omega 3 fats from fish, some combination, or something else entirely[*].
Maybe it’s the abundant sun and social ties (not nutrition) that makes people living in coastal Europe so healthy. After all, most of the data on the Mediterranean diet is observational.
In other words, it’s not clear that the Mediterranean diet causes good health. But at the very least, it doesn’t prevent it. (On a population-wide scale, at least).
Unlike the keto diet, the Mediterranean diet doesn’t have strict macronutrient rules. But in general, it’s high in carbohydrates, low to moderate in protein, and fairly low-fat.
Here are the basic principles of the Mediterranean diet:
- Allowed carbs include whole grains, legumes, lentils, and all types of fruits and vegetables. These comprise the bulk of calories.
- Most protein comes from fish, at least twice per week. Beans also provide some protein, and meat consumption is discouraged.
- Most fat comes from olive oil, along with certain dairy products.
- Moderate red wine consumption is encouraged.
The Mediterranean diet also forbids packaged foods and refined sugar — a prerequisite for any healthy diet.
Mediterranean and keto have a couple of key features in common.
#1: No Refined Foods
Refined sugar (mostly from sugary beverages) drives the American obesity epidemic[*]. High sugar intakes create metabolic problems that promote persistent weight gain.
Both keto and Mediterranean forbid refined sugar, packaged foods, and most other foods in aisles 1-10 of the grocery store. Because of this, both diets are a major improvement over the Standard American Diet.
#2: Health Benefits
The Mediterranean diet appears to have similar benefits — weight loss, lower triglycerides, decreased insulin resistance, lower blood sugar, and lower blood pressure. The supporting evidence, however, is mostly observational[*].
Now for the differences. There are two main ones.
#1: Carb Intake
The keto diet is very low in carbohydrates, allowing only around 20 grams per day. Not true of the Mediterranean diet, which endorses high-carb foods like legumes, lentils, whole grains, and root vegetables.
Optimal carb intake is highly individual. But for reversing type 2 diabetes or obesity, the latest scientific consensus points to low-carb interventions like keto[*].
#2: Fat Sources
Keto diet fat calories may come from butter, animal fat, coconut oil, dairy, avocados, olive oil, red palm oil, MCT oil, nuts, egg yolks, fatty fish, and several other sources. Certain fats (like MCT oil) are more ketogenic than others, but there’s plenty of flexibility on fat choice.
On the Mediterranean diet, however, olive oil is king. Some fat calories also come from dairy and omega 3s.
Some claim that the Mediterranean diet is healthy because it limits saturated fat. Saturated fat is supposed to be bad for your heart, right?
Combining keto with a Mediterranean-style diet plan is fairly simple. Just take the Mediterranean diet and remove the carbs.
This means that whole grains, beans, and root vegetables are out — and olive oil and fish are in. You can also eat plenty of leafy greens, cruciferous vegetables like cauliflower, and eggs. (And dairy, if tolerated).
With keto staples like meat, butter, and coconut oil off limits, the keto Mediterranean diet is pretty restrictive. Here are a few meal ideas:
- Kale and spinach salad topped with sardines and olive oil
- Spicy low-carb salmon patties
- A whey protein, cacao powder, green vegetable, and olive oil smoothie
Benefits of the Keto Mediterranean Diet
All the benefits of the keto diet — weight loss, better energy, reduced cravings, improved focus, reduced risk of chronic diseases, etc. — should apply to the keto Mediterranean diet.
Several studies have looked at this version of keto. Here’s what they found.
- Thirty one obese people lost an average of 31 pounds on a 12-week “Spanish Ketogenic Mediterranean” diet of fish, olive oil, vegetables, red wine. They also saw improvements in blood pressure, blood glucose, triglycerides, LDL cholesterol, and HDL cholesterol. The main weakness of this study? No control group[*].
- In another study, 89 obese people lost weight (and maintained it) by cycling the keto Mediterranean diet with a standard Mediterranean diet for a full year[*]. Again no control group.
- A high-protein keto Mediterranean diet significantly reduced heart disease risk markers in 106 Italian council employees[*]. Also no control group.
The keto Mediterranean diet may be healthy, but it shouldn’t be your first keto diet. Keto is restrictive enough without the extra limitations on meat and saturated fat.
Plus, there’s zero evidence that keto Mediterranean is any healthier than a standard, whole foods ketogenic diet. To gather this evidence, you would need to pit standard keto vs. keto Mediterranean in a randomized controlled trial.
But if you’re already keto and want to experiment: Go for it. Just be sure to monitor your biomarkers, especially the markers related to heart health.
Most importantly, remember why you make these changes. It’s to look, feel, and perform better, not to join the latest fad. Stay healthy, and thanks for reading.