There are specific benefits to both the ketogenic and Mediterranean diets, which can make it difficult to decide which one is best for you. Our step-by-step keto vs. Mediterranean diet guide will help you determine which one is better for your personal health goals. To meet in the middle, we also have some tips for those who want to try Mediterranean-style keto.
SEE ALSO: Our guide on how to eat out on keto
The ketogenic diet is a type of low-carb diet in which at least 60-80% of your daily calories come from fat, 20% from protein, and 5% or less from carbs. It was first invented to help treat children with epilepsy. Since its initial use, the ketogenic diet has been studied and found to have several potential health benefits, such as for the treatment and prevention of chronic diseases such as diabetes. One of the most prominent benefits of the keto diet is weight loss, which is one of the main reasons for the fast-growing popularity of this diet.
For centuries, fasting was used to treat people with epilepsy. The search for a better alternative to fasting for children with epilepsy lead to the discovery of the ketogenic diet. In 1921, Dr. Wilder proposed that the keto diet can help mimic some of the active mechanisms of fasting for epilepsy. However, the popularity and use of the keto diet for epilepsy almost faded away by the late 1930’s after the invention of more drugs and treatments for epilepsy.
The popularity of ketogenic diet skyrocketed again in 1993 when it cured a two-year-old boy named Charlie Abraham’s epilepsy. Charlie suffered from uncontrollable drop seizures every day. His father said that Charlie has had numerous failed drugs and all kinds of treatments including a “fruitless brain surgery”.
Charlie’s father discovered the potential of the keto diet for epilepsy from a book (Seizures and Epilepsy: A Guide for Parents). He immediately brought Charlie to John Hopkins where the two-year-old underwent a medically supervised ketogenic diet. Charlie’s seizures disappeared within a few days and never came back again.
Abraham was frustrated about not being told about the ketogenic diet in the first place; thus, he created a foundation to create awareness about the ketogenic diet for the treatment of pediatric epilepsy. This contributed to the rise in popularity of the keto diet again in 1997, followed by studies documenting the effectiveness of the diet for epilepsy published in 2008 and 2009. 
In 1921, Dr. Woodyatt noted that starvation or a low carb diet elevated the levels of acetone and beta-hydroxybutyric acid (ketones) in normal individuals. The scientific term for high levels of ketone bodies in blood is called ketonemia. Dr. Wilder proposed the ketogenic diet when they were searching for another alternative way to mimic fasting metabolism (ketonemia).
Carbohydrates (glucose) are considered as the primary fuel source for your body. A lower carb intake of fewer than 50 grams per day decreases insulin production and this causes your body to enter a catabolic state. At this point, stored carbohydrates (glycogen) will be used up first before the body enters the next metabolic process known as gluconeogenesis. Gluconeogenesis refers to the body’s own production of glucose, which takes place in the liver. This is how your body produces fuel during prolonged fasting .
The prolonged decrease in stored glucose levels causes gluconeogenesis to become insufficient to meet the body’s energy needs, which is when the body enters another process known as ketogenesis. Ketogenesis is the process in which the body converts fatty acids into ketone bodies to be used as fuel in the absence of glucose.
Ketosis is the process of the body using ketone bodies as fuel instead of glucose. Achieving this metabolic state via the ketogenic diet is known as nutritional ketosis. The diet-induced production of ketones is safe and is not the same as ketoacidosis (dangerously high levels of ketones in the blood), which usually occurs in people with type 1 diabetes. Ketones can be utilized by the body’s organs such as the heart, brain, muscles, and kidneys.
As stated earlier, the ketogenic diet was invented to treat pediatric epilepsy and has been more successful than conventional treatments in some cases.
A 2014 study found that the ketogenic diet can be effective to treat epilepsy in the adult and adolescent population. In this study, 29 adult and adolescent patients were put on the ketogenic diet for an average duration of 9 months. Results revealed that over half of the patients had a reduction in seizure frequency; some were reduced by over 50%. The study also stated that the keto diet was well tolerated and had a similar success rate to those seen in children .
Polycystic ovary syndrome is a hormonal disorder that affects millions of women worldwide. It’s usually characterized by hyperandrogenism, ovulatory dysfunction, and ovarian cysts , with many affected being of higher weight.
The ketogenic diet has been found to be effective in treating PCOS symptoms. For instance, in a 2005 study, eleven obese women with PCOS were instructed to lower their carb intake to 20 grams or less per day for 24 weeks. Researchers found that a low-carb, ketogenic diet significantly improved participants’ weight, percent free testosterone, LH/FSH ratio, and fasting insulin .
The keto diet has been found to be beneficial for brain health and cognitive performance. For example, in a 2016 study, 19 elderly adults were administered a ketogenic meal containing 20 grams of MCTs, and an isocaloric meal without MCT on separate days. Their results showed that the ketogenic meal increased plasma ketones and had a positive effect on participants’ working memory, visual attention, and task switching .
In a 2010 study, 344 rats were fed a standard or a ketogenic diet for 3 weeks. Their results showed that the ketogenic diet significantly improved cognitive performance in the aged rats under normoxic and hypoxic conditions .
A recent 2018 study has found that the ketogenic diet can help increase mitochondria volume in the liver and skeletal muscles, and also increased the median lifespan of rats .
Another small study reported the potential of the keto diet to improve liver damage. In this study, two obese patients with end-stage liver disease were administered a very low-calorie ketogenic diet to reduce weight for liver transplantation. Their results revealed a significant weight reduction in both patients, as well as improved liver function scores. The study also noted both patients didn’t have any adverse effects .
Improved physical performance is one of the most popular benefits of the ketogenic diet. The ketogenic diet has debunked the popular myth that you must consume a high carb diet to perform better in sports and exercise.
For example, in a 2018 study, twenty male endurance athletes were assigned to either a high- or low-carb ketogenic diet group. Both groups completed the same training sessions over a 12 week duration. Results revealed that the keto diet group athletes had improved body composition, fat oxidation during exercise, and specific performance measures compared to the high carb group .
The Mediterranean diet emphasizes eating more plant-based foods and unsaturated fat, such as olive oil, while maintaining a moderate level of protein and fat. This diet practice has been inspired by the eating habits of those living in Greece, Italy, and Spain.
The Mediterranean diet is often referred to as the heart-healthy diet because researchers have found to improve cardiovascular health. Some examples of traditional Mediterranean foods include:
Three main benefits of the Mediterranean diet are:
The Mediterranean diet has debunked the popular myth that you need to consume a low-fat diet for heart health. Instead, it’s brought more attention to the types of fat we eat because that’s what really matters when it comes to heart health.
This diet allows for generous fat intake without any calorie restrictions. The Mediterranean diet is proved to be a heart-healthy diet despite the high fat intake because it emphasizes healthy sources of fats such as oily fish, olive oil, and nuts.
Fish is a great source of protein, which can help contribute to weight loss and weight maintenance because of its ability to induce satiety, or fullness, when eaten. The Mediterranean diet emphasizes a focus on fish as the primary protein because the fat in fish tends to be unsaturated, which is more heart-healthy.
Many studies have shown that the Mediterranean diet reduces the risk of heart disease. In fact, a large study of 7447 people who were at high risk of cardiovascular disease were randomized into three groups; Mediterranean diet with olive oil group, a Mediterranean diet with nuts group, and a low-fat group. The participants were not put on a calorie restricted diet or told to increase physical activity. The total duration of the study was 4.8 years. Their results revealed a significant reduction in the risk of heart attack, stroke, and death from cardiovascular disease in both the Mediterranean diet groups .
Metabolic syndrome has been known to increase the risk of heart disease, stroke, and type 2 diabetes. The dietary patterns of the Mediterranean diet can help decrease the risk of metabolic syndrome by improving blood pressure, cholesterol, and by reducing the inflammation associated with metabolic syndrome .
Many studies have found that the Mediterranean diet can help reduce the risk of dementia, Alzheimer's, and improve cognitive function. A 2015 research paper states that among various types of dietary patterns tested, the traditional Mediterranean diet has shown promising results for dementia and overall cognitive health .
Some people who have reduced insulin sensitivity might find it harder to lose weight despite making lifestyle changes. The Mediterranean diet may help improve insulin sensitivity and reduce inflammation. For example, a 2017 research study found that the Mediterranean diet can help reduce insulin resistance and inflammation by reducing abdominal obesity .
The Mediterranean diet encourages the consumption of healthy fats such as olive oil which can help prevent overeating by suppressing appetite. A 2017 cross-sectional study investigated the effect of Mediterranean diet on 1643 adolescents during two school years. Their results showed that those who adhered to the Mediterranean diet had a 30% decreased the risk of being overweight or obese .
In a 2011 meta-analysis review, 16 trials with a total of 3,436 participants were reviewed to assess the effectiveness of the Mediterranean diet on weight loss, finding:
As far as research is concerned, the ketogenic diet has more evidence that it’s effective for weight loss. A 2001 study of 83 obese patients put on the ketogenic diet for 24 weeks resulted in significantly reducing the body weight and BMI of the patients. It also improved their cholesterol profile and didn’t cause any significant adverse effects .
Several studies have also noted that the ketogenic diet can help reduce body mass without having a significant impact on lean body mass. For instance, in a 2014 study, 26 resistance-trained men were divided into two groups:
All participants participated in the same resistance training program. The results revealed that lean body mass increased to a greater extent in the keto diet group compared to the high-carb group .
This depends entirely on your goals. While the keto diet is typically used for weight loss and has the research to back up its effectiveness in that area, the Mediterranean diet has a proven track record of its ability to help improve heart-health, with long-term studies to support it. There aren’t any long-term studies on the effects of a ketogenic diet on heart health at this point in time, nor are there studies on the long-term effects of a keto diet beyond 24 weeks in duration.
Another option would be to adopt some aspects of the Mediterranean diet on a keto diet, which we’ll discuss next.
Ketogenic diets and Mediterranean diets differ when it comes to the carbs; Mediterranean diets include whole grains and no limits on fruit and starchy vegetables, whereas keto doesn’t. Because of this, a Mediterranean diet can’t also be a ketogenic diet. However, you can have a Mediterranean-style keto diet by making some modifications in order to keep your carb intake at 50 grams of less per day.
Here’s what you will NOT change about your keto diet:
The considerations you’ll need to make for a Mediterranean-style keto diet are discussed below, organized by food group.
1. Rice & Pasta
The closest you can get to eating pasta on the keto diet is by making some homemade low-carb pasta with non-starchy vegetables, such as zucchini. You can also buy low-carb noodle substitutes such as shirataki, or make pasta from non-grain flours.
A popular keto sub for rice is cauliflower rice.
2. Bread & Naan
Make yourself some homemade keto bread to replace the whole grain bread on the Mediterranean diet. Keto bread is easy to make, and many recipes don’t require an oven or any fancy tools. You can make super delicious and low carb bread using ingredients such as coconut flour, psyllium husk powder, and xanthan gum.
As stated earlier, fish is the preferred protein source on the Mediterranean diet, which is definitely keto-friendly To make your keto diet even more Mediterranean, include more oily fish such as salmon and mackerel into your diet.
Eggs and poultry are to be eaten less often than fish on the Mediterranean diet, which may not align with the traditional keto diet. Red meat is to be eaten the most sparingly, which also isn’t standard for a traditional keto diet. The Mediterranean diet emphasizes eating beans and lentils for protein, which won’t align with keto either.
Here are some (but not all) keto-friendly Mediterranean-style vegetables to enjoy:
Avoid starchy vegetables such as potatoes and higher-sugar veggies like carrots when doing a Mediterranean-style keto diet.
Fruit on the keto diet are mostly limited to berries, avocados, coconut, lemon juice, and olives.
6. Legumes & Grains
Although nutritionally dense, legumes and grains are high in carbohydrates and thus not allowed on keto.
7. Fat sources
The Mediterranean diet encourages the consumption of healthy fats (unsaturated fats) from foods such as olive oil, nuts, fatty fish, and avocados, and a more modest intake of saturated fats from foods like full-fat dairy (such as butter) and red meat. By focusing on unsaturated fats, your keto diet will be more similar to a Mediterranean diet. Many keto dieters eat butter and red meat often, which wouldn’t be considered Mediterranean-style.
Both ketogenic and Mediterranean diets have their own unique health benefits, but are very different. When choosing which style of eating to adopt, an individual should consider their own personal health goals. Alternatively, aspects of the Mediterranean diet can be applied to the standard keto diet.