Keto vs. Mediterranean Diet: What’s the Difference (and Is One Better Than the Other)?

You’ve resolved to overhaul your eating, and lately, it seems everyone’s touting the benefits of a couple trendy diets in particular, but you’re not sure which plan is best for you. Should you cut out carbs almost entirely, or are you more interested in bringing lots of fresh produce and seafood into your life? In the battle of keto vs. Mediterranean diet, we can help you narrow down your choice. If you want the TL;DR, the Mediterranean diet is the anti-diet with proven benefits for overall health, while the keto diet is a weight loss plan with more restrictions (and fewer clear health benefits). If you’re intrigued, keep reading to find out which is for you.

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What Is the Mediterranean Diet?

Photo: Liz Andrew/Styling: Erin McDowell

In a nutshell, the Mediterranean diet is a food philosophy that’s inspired by the eating habits of people who live in that region, like Greece, Spain, Italy and North Africa. It focuses on increased consumption of fruits, vegetables, unrefined grains, olive oil and legumes and fish, moderate consumption of dairy (like cheese and yogurt) and lean meat and minimal consumption of red meat and sweets. It’s more of a guideline than a diet in the modern sense (it doesn’t exclude any food groups—even red wine is encouraged in moderation), and it’s been studied for its ability to decrease the risk of heart disease, high blood pressure, cancer, diabetes and neurodegenerative diseases.

Because the Mediterranean diet is so loose, it can be overwhelming to know what you should eat. Basically, all fresh fruits and vegetables are on the table, along with complex carbs from sources like barley, brown rice, freekeh and bulgur. You can also have small amounts of dairy and olive oil in place of saturated fats like butter. The only real mistake you could make while eating Mediterranean, says Dr. Felicia Stoler, DCN, is “loading up on animal-sourced protein, including fish and seafood.” If you think of the Mediterranean diet as more akin to plant-based eating, you’ll be on the right track.

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What Is a Keto Diet?

Photo: Liz Andrew/Styling: Erin McDowell

The ketogenic diet (keto for short) is a high-fat, moderate-protein, low-carb diet. The idea is that by drastically restricting your carbohydrate intake (usually to 50 grams or less per day, but some people go as low as 20 grams), you’ll put your body into a state of ketosis, which forces your body to burn fat for energy (instead of carbs) and is thought to lead to faster weight loss. The keto diet focuses on the macronutrients you should consume, but it doesn’t get too specific about their sources. For example, even though some fruit is high in natural sugar (not added), it’s still limited because it’s a carb; similarly, bacon and cream cheese are on the diet because they’re rich in fat.

It’s worth noting that the keto diet was originally used to treat hard-to-control epilepsy in children, and it’s also been studied in the potential treatment of other neurological disorders like Alzheimer’s, ALS, Parkinson’s and brain cancer. It became popular as an extreme low-carb diet for weight loss in the late 2010s, largely through celebrity endorsement.

What are the main similarities between Mediterranean and keto?

One of the most obvious similarities between the Mediterranean and keto diets is that they don’t restrict when it comes to fat, though the types of fat aren’t the same (more on that in a minute). And while both eating plans advice moderate consumption of protein and minimal consumption of sugar, their similarities stop there.

What are the main differences between Mediterranean and keto?

TBH, the Mediterranean and keto diets couldn’t be more different—let’s start with the fact that the Mediterranean diet is barely a “diet” at all, instead functioning as a guideline for healthy eating, while the keto diet restricts food groups. Some other differences include:

Which is healthier—the Mediterranean diet or keto diet?

According to nutritionist Keri Glassman, a truly ketogenic diet is too difficult for most people to stick to in the long run, and she “wouldn’t recommend it for the majority of people.” And, as she explains, one major downside is the dreaded keto flu, “the initial period of the diet during which your body is adjusting to its new carb-free existence and symptoms like fatigue, brain fog and nausea are common.” Because it’s so restrictive, Northwestern Medicine dietician Michelle Gomez explains, it can lead to disordered eating and psychological distress in the long run. And according to Zhaoping Li, M.D., Ph.D. in JAMA, “low-carbohydrate diets have been linked to increased mortality,” while long-term evidence of their benefits is lacking. Plus, as University of Chicago Medicine dietician Mary Condon explains, consuming large amounts of saturated fat “can increase your risk of heart disease.”

(One caveat: Some proponents of the keto lifestyle argue that there’s a difference between “clean” keto and “dirty” keto. Clean keto means eating whole foods from quality sources, like grass-fed beef, pasture-raised pork, free-range eggs, wild-caught seafood and plenty of vegetables—while still maintaining that balance of fat-protein-carbs. Dirty keto means eating anything allowed on the keto diet, even if it lacks micronutrients like vitamins and minerals.)

On the other hand, the Mediterranean diet is widely regarded as a sustainable and healthy way to eat. A 2019 study in the American Heart Association’s Circulation Research journal concluded that “better conformity with the traditional [Mediterranean diet] is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke and total cardiovascular disease.” It currently ranks first in the U.S. News and World Report’s Best Diets Rankings for “Best Diets Overall” (as well as best for diabetes and heart health, and easiest to follow).

We usually hate to play favorites, but when it comes to keto vs. Mediterranean, the winner is clear: The Mediterranean diet has proven benefits for heart health and overall longevity, and although the keto diet might jumpstart weight loss, it’s not a great eating plan for long-term health.

Now, about that glass of red wine…

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