The Mediterranean and ketogenic diets are both popular eating plans that are drawing plenty of interest from people who want to lose weight. The keto diet promises quick weight loss, while the Mediterranean diet results are more gradual.
Keto requires drastic restrictions of certain healthy foods while encouraging you to consume high amounts of fat, running counter to standard nutritional advice. The Mediterranean diet is a more balanced eating plan that you can incorporate into your daily life to reach and maintain your goal weight.
The Mediterranean diet wins praise from dietitians and doctors alike, but when it comes to keto — not so much.
Inspired by the healthful traditional diet of people living in southern Italy and Greece around the Mediterranean Sea, the Mediterranean diet has also caught on across the pond.
Mediterranean Diet Basics
There isn’t a single version of the Mediterranean diet, it’s a balanced way of eating. In general, here’s what Mediterranean-style eating involves:
— Dishes high in fruit and vegetables.
— Emphasizing herbs and spices.
— Fish and seafood twice weekly.
— Moderate amounts of dairy, as well as eggs and poultry.
— Infrequent red meat, saturated fat and sugar.
Many clients looking for a healthy way to lose weight ask about the Mediterranean diet, and rightfully so, says Carrie Dennett, a Pacific Northwest-based registered dietitian nutritionist and owner of Nutrition by Carrie. “The Mediterranean diet is full of foods that we know from various research is good for us: fruits and vegetables, whole grains, beans and lentils. Often, one of the primary proteins is seafood.”
One concern that clients express is about the carbs in pasta, an Italian food staple. Eating pasta is optional on the Mediterranean diet. “Pasta gets a bad rap,” Dennett says. And it doesn’t have to: By not overcooking pasta, taking moderate portions and topping it with a sauce containing protein and healthy fat, you can minimize the carbs in your meal and prevent them from being absorbed too quickly, which reduces sudden blood-sugar spikes, she says.
The Mediterranean diet is proven to be healthy, and it’s easy to stick with because it’s inclusive rather than “punitive,” says Sharon Palmer, a registered dietitian and author of the Plant-Powered Dietitian blog. “The Mediterranean diet has been around for thousands of years — and it’s the most researched diet on the planet,” she says. “And it’s sustainable.”
Another plus: Because it’s much more plant-forward, the Mediterranean diet is a more eco-friendly diet than keto, says Dana Ellis Hunnes, a registered dietitian, an assistant professor at UCLA Fielding School of Public Health and author of “Recipe for Survival: What You Can Do to Live a Healthier and More Environmentally Friendly Life,” published in January 2022.
[SEE: Keto-Friendly Vegetables.]
With keto, you can find many versions of the diet, such as dirty keto. Some people stay on keto indefinitely, whereas others cycle in and out. Keto is classified as a low-carb diet in the U.S. News Best Diets rankings.
Keto emphasizes weight loss through fat-burning. You slash the carbs you consume and fill up on fats instead. By doing so, you safely enter a state of ketosis, according to diet proponents.
In ketosis, your body breaks down both dietary and stored body fat into substances called ketones. Your fat-burning system now relies mainly on fat — instead of sugar — for energy. That can lead to quick weight loss.
Urine or blood test results, fruity breath, reduced hunger, changes in exercise performance and weight loss can all indicate ketosis.
In general, keto plans call for restricting carbs to about 15 to 20 net carbs a day. Fat intake makes up roughly 70% of daily calories. In comparison, the 2015-20 Dietary Guidelines for Americans call for 130 grams of daily carbs and fat intake ranging from 25% to 35% of daily calories.
Oftentimes, people aren’t actually reaching ketosis, Dennett and Hunnes point out. “Many people, if they’re not being followed by a ketogenic dietitian who specializes in it, are not really doing the ketogenic diet in the full-on sense of the word,” Hunnes says. “They’re just doing a low-carb, high-protein diet, which isn’t necessarily healthy.”
Keto Diet Basics
Keto flips traditional thinking on diets. Here’s how a keto diet might look:
— Instead of skinless poultry and lean cuts of meat, protein sources include ribeye steak, skin-on chicken thighs, pork roast and snacks like bacon.
— Whole-dairy foods are encouraged.
— You counter sugar cravings with keto-friendly desserts like dark chocolate and nut butter.
— For a salad, greens such as spinach, kale and lettuce, along with broccoli, cauliflower and cucumbers, are OK, but starchy veggies — such as corn and sweet potatoes — are too high in carbs.
— Salad dressing could consist of oils like avocado, olive, canola, flaxseed and palm, or even mayonnaise.
Similarities Between Mediterranean and Keto
The keto and Mediterranean diets have at least one thing in common: Because there’s no single, established plan for either, you can incorporate features from different versions to suit your taste, food preferences, lifestyle and budget.
In addition, the two allow more fat than many other diets. Although specific food sources may differ, there can be some overlap. With keto, “You can use healthy fats like avocado, avocado oil, nuts and seeds,” Hunnes says. “With the Mediterranean diet, you can also use a lot of avocado, nuts and seeds and olive oil.”
Depending on how you tweak them, both diets could put a dent in your budget. With keto, “you’re removing certain staple foods like beans, lentils and whole grains, which are relatively inexpensive,” Dennett notes.
You can make food choices, such as purchasing more affordable cuts of meat, to fulfill keto fat requirements more economically.
“You don’t see a lot of criticism of the Mediterranean diet, but one criticism I sometimes do see is that it can be more expensive,” Dennett says. You can adapt — for instance, if fresh seafood is unavailable or too pricey.
“People can do tuna or sardines, (which) are very healthy and full of omega-3s,” she suggests. Similarly, you could introduce frozen fruits and vegetables in place of some fresh produce.
Early research suggests that the keto diet may help lower blood sugar (blood glucose) levels and avoid blood sugar spikes, which may help prevent or manage Type 2 diabetes. Small studies in 2017 and 2018 found reductions in hemoglobin A1C levels, a measure of long-term glucose control, among people with prediabetes or diabetes who followed a ketogenic diet.
The Mediterranean diet has consistently demonstrated health benefits. In a long-term study of nearly 26,000 healthy U.S. women published in December 2018, heart disease risk was reduced by about 25% for those who followed a Mediterranean diet.
Previous large European and U.S. studies of adults who adhered to the diet found reductions in the risk of heart attack, stroke or death. The Mediterranean diet may help reverse metabolic syndrome — a constellation of risk factors that makes people more likely to develop heart disease or diabetes.
You can lose weight on either diet.
Differences Between Mediterranean and Keto
Meal delivery services are available for both diets. The top Mediterranean diet meal services offer ready-made or quick-prep meals ranging from roughly $7 to $13 per meal. Top keto diet meal services may cost slightly more, ranging from roughly $11 to $15 per meal.
The diets really diverge when it comes to health ratings. With its established health benefits and safety, the Mediterranean diet consistently ranks No. 1, alone or tied with DASH (another balanced diet), in Best Diets for Healthy Eating.
Keto, which eliminates certain foods with essential nutrients and is heavily loaded with fat, earns low marks from the panel of health and nutrition experts. Keto is ranked last among all diets for health in 2022, while Modified Keto Diet, which allows a bit less dietary fat and more protein and carbs, places slightly higher than the original.
Following a keto diet is more likely to lead to quick, dramatic weight loss, which is why it lands near the top for Best Fast Weight-Loss Diets. However, keeping the weight off is another matter. With the Mediterranean diet, weight loss is more of a marathon than a sprint, and you’ll drop pounds more gradually. Mediterranean ranks around the middle of Best Weight-Loss Diets overall.
The Mediterranean diet is considered safe for everyone from children to seniors. However, anyone with health conditions should talk to their doctor before making major dietary changes.
Diets with higher fat content, like keto, can pose risks for heart health. The keto diet may not be indicated for people with certain medical disorders and is not considered safe for those with liver or kidney conditions. Hormonal changes may include dramatic effects on insulin and reproductive hormones.
The use of keto for people with diabetes, especially among those taking insulin, remains controversial. It’s important to talk to your doctor before starting a keto regimen.
Which One Is Better?
The keto diet may work better for people looking primarily for quick weight loss, whereas the Mediterranean diet may be a better choice for those interested in a balanced eating plan to maintain a healthy weight over time. Here’s what to consider:
|Weight Loss||Gradual weight loss could approach 20 pounds over a year.||Up to 10 pounds in first week (includes water weight).|
|Food||Balanced plan high in produce, nuts, whole grains, olive oil. Moderate in seafood, poultry, dairy. Infrequent red meat or sweets.||Extremely low-carb, high-fat plan with many versions.|
|Health Benefits||Reduces risk factors for heart disease and diabetes.||May reduce blood sugar levels and spikes.|
|Health Risks||No risks reported.||Not advised for people with liver or kidney conditions.|
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Update 05/10/22: This story was previously published at an earlier date and has been updated with new information.