The Mediterranean Diet vs The Keto Diet—All You Need To Know (Complete Guide 2021)

This complete, comprehensive guide will explain the similarities & differences of the Mediterranean diet vs the Keto diet so you can decide which is best for you!

Are you trying to lose weight, navigate a health condition, avoid or reverse chronic disease, or simply feel more energetic? You likely already know that the food you put in your body may be the single most important factor in reaching these goals. Research shows that diet likely accounts for 75% of weight loss. It’s estimated that up to 35% of cancer deaths are attributable to diet. The foods you eat and the beverages you drink can directly impact how you feel every day. The Ketogenic Diet (also called Keto for short) and the Mediterranean Diet are two of the most popular diets. This guide will introduce you to both diets and help you decide which one is the right one for you.

This guide will cover:

  • Introduction to the Mediterranean Diet
  • The Principles of the Mediterranean Diet
  • Tips to Getting Started with the Mediterranean Diet
  • Introduction to the Keto (Ketogenic) Diet
  • The Principles of the Standard Keto Diet
  • Tips to Getting Started with the Keto Diet
  • Similarities between the Mediterranean diet vs the Keto diet
  • Weight Loss Effects of the Mediterranean diet vs the Keto diet
  • Significant Differences between the Mediterranean Diet vs the Keto diet
  • Conclusion

An Introduction to the Mediterranean Diet

Just as the name suggests, The Mediterranean Diet is a way of eating similar to the way of eating among people who lived in the Mediterranean region back in the 1960s. Researchers noticed that the people living in the areas of Italy, Greece, and the areas surrounding the Mediterranean Sea had remarkably better overall health conditions than other parts of the world. (Ancel Keys is often credited with the Seven Countries Study.) Researchers noted that people living in Mediterranean countries in the 1960s were less susceptible to heart diseases, cancer, diabetes, and obesity. They lived longer, healthier lives.


What was the secret to this healthy lifestyle filled with long-term results?
Researchers concluded that people in these areas eat and live according to a set of healthy eating principles. These principles became known as the Mediterranean Diet. People all over the world who adopt these healthy principles can reap many health benefits. Thousands of peer-reviewed studies suggest that following the Mediterranean Diet principles can reduce a person’s risk of many health ailments including cancer, dementia, cardiovascular disease, obesity, and more.

Principles of the Mediterranean Diet

So, what does the world-famous Mediterranean Diet involve? In a nutshell, here are the principles to follow and the foods to eat. 


These core principles will give you a great understanding of the Diet:

Real, whole foods:

The Mediterranean Diet is composed primarily of real, whole foods. Avoid processed foods, processed cheeses, and processed oils. Choose real food over all other food products.

Fruits and vegetables:

The Mediterranean Diet is primarily a plant-based diet. That means, most or all of your meals will include some vegetables and fruits. No fruits or vegetables are off-limits. Try them raw, steamed, grilled, roasted, pureed into smoothies, mixed into soups, you get the idea! Aim to fill half your plate with produce at every meal. Many experts recommend that you strive for 7 to 9 servings per day for optimal health. This is substantially more than many people eat every day.

Whole grains, nuts, beans, and legumes:

These foods are part of the base of the Mediterranean Diet pyramid. You should strive to eat whole grains and beans at every meal. Whole grains include whole wheat, brown rice, barley, and couscous. Beans and legumes include black beans, lentils, chickpeas, and others.


Seafood, including fish like salmon, sardines, and haddock and shellfish like shrimp, is highly recommended. The Mediterranean Diet recommends that you eat seafood at least twice per week.


Extra virgin olive oil:

Olive oil is a huge part of the Mediterranean Diet. Studies indicate that the monounsaturated fats in olive oil can help to reduce blood pressure and inflammation, and may help reduce bad cholesterol (thereby positively impacting your total cholesterol). Use olive oil in place of butters, margarine, and other oils including soybean, canola, and vegetable.


Poultry and dairy products:

Dairy and poultry are recommended in moderation; the diet is a moderate protein diet, after all. Dairy products like cheese and plain yogurt are most traditional on this diet. Poultry includes chicken, turkey, duck, and other meats from birds.


Red wine:

For people who already drink alcohol, red wine is recommended in moderate amounts. If you do not currently drink alcohol, it is not advised to add it into your diet.


Foods to limit or avoid:

Red meat (people in the Mediterranean eat red meat on occasion, on average about one ounce of red meat per week or less). Refined sugar (like white sugar and corn syrup) should only be eaten in small amounts.

Processed foods, meats, and cheese with artificial ingredients and chemicals should be avoided as much as possible. One study showed that people who eat four or more processed foods per day have an increased risk of all-mortality of 18%!


Tips to Get Started with The Mediterranean Diet

You may have gotten a decent understanding of the Mediterranean Diet from the principles above. We wanted to give you a few tips for embarking on this healthy diet if you choose to do so. Here are a few tips to help in your journey through the Mediterranean Diet:

Increase Vegetable Intake

Research continues to show that most Americans do not take in enough vegetables. The dietary guidelines for Americans call for adults to eat two to three cups of vegetables every day. Up to 90% of Americans do not eat that amount!

Enjoy Beans, Legumes, and Vegetarian Meals More Often

The Mediterranean Diet focuses on eating beans, legumes, and whole grains many times throughout the week—as often as every single day. One study found that people who ate beans four times per week had a 22% lower risk of heart disease.

Eat Seafood Twice a Week

Instead of eating red meat, opt for seafood. Seafood is a healthy, lean protein choice. Additionally, fish and shellfish are full of healthy fats including Omega 3s.

Switch to Whole Grains Instead of Refined Grains

Use whole wheat flour instead of white flour. You can make or buy whole wheat bread, pita, pizza crusts, and much more. Additionally, try enjoying some naturally unrefined grains like brown rice, barley, couscous, and more.

Use Healthy Good Fats

Gone are the days of low fat and low-fat diets. We now know that fat is important for our health. But the right kind of fat is critical. Saturated and trans fats found in butter and margarine are bad for heart health. Olive oil has been shown to be beneficial for heart health, according to the American Heart Association. Olive oil is the healthy fat most used on the Mediterranean Diet.

Introduction to the Keto Diet

The Ketogenic Diet was developed in the 1930s as a treatment for epileptic seizures. Keto has since gained popularity in the past few years, in part because of celebrities and social media influencers promoting it for fast weight loss. Some people who have opted for this diet have reported that they can see a significant change in weight in minimum time.
In recent years, “keto” friendly food products and supplements have hit the shelves in grocery stores and pharmacies. These include shakes, bars, keto cookies, and “fat bombs”. You can also find different products like urine and breath tests to help you tell if you have entered a state of ketosis. (Ketosis is a metabolic state in which you have a lot of ketones in your blood as a result of burning fat instead of carbohydrates for energy. Learn more about ketone bodies here.) With news of people losing weight on keto and the vast array of ketogenic products available everywhere, you may have wondered whether it would be the right diet for you. To follow this diet, you will need to adapt to a new eating plan that is likely pretty different from your existing one. You will not be able to deviate from the strict parameters at all. And rapid weight loss may be one thing, but what about your health? Read on for more!

Requirements of the Ketogenic Diet

Let’s explore what you eat on a keto diet. This is, after all, the most asked question regarding this diet. As per its name, following the keto diet means that you will consume foods that encourage the production of ketone bodies. In this mode, the body uses the ketones as an additional energy source and facilitates fat burning in excessive amounts. The body will switch from burning sugar or carbs to burning fat, both the fat that you eat and the fat found in your body. The Keto diet is a high-fat, low-carb, and moderate-protein diet. For most people following this diet, fat will compose 70 to 80% of their daily calories, while net carbs are as low as 5 - 10%. This is no more than about 35 grams of carbohydrates per day for many people, or just over the carbs found in one banana (which is why bananas are not allowed on the diet!) Dieters following this diet will be eating large quantities of fat (saturated as well as unsaturated) and low-carb foods such as meats, fish, nuts, seeds, eggs, cheese, butter, and oils. In addition to helping your body learn to burn fat instead of carbs, so much fat will likely help you stay full and satiated.

The Diet encourages you to eat:

Fatty cuts of meat:
The diet encourages a moderate amount of protein intake (around 10 - 20% of your total caloric intake) so you won’t be eating animal products and animal meat in huge quantities. But instead of lean cuts like chicken breast, you will more often be eating fatty meat like skin-on chicken thighs, pork chop, and bacon. We caution that too much saturated fat from animal products can raise your bad LDL cholesterol, which can put you at higher risk for stroke. A better option or way to follow keto would be to eat leaner cuts of meat and then add on healthier fats like olive oil and avocados (might we call this a “Mediterranean Keto Diet”?). This is rather than eating too many high-saturated fat foods.
Whole-milk dairy:
Since getting enough fat is a high priority, you will be consuming whole milk, full fat dairy products like cheese, whole milk yogurt, and even heavy whipping cream. As a reminder, full-fat dairy products come with saturated fat. (Many high-fat foods do.)
Most interpretations of keto permit you to have low-carb sweeteners, including pure stevia, monk fruit sweeteners, sucralose, and more. As these low-calorie sweeteners don’t raise your body sugar, they likely won’t kick you out of ketosis. Make sure to note, though, that some of these no-calorie sweeteners may have a laxative effect if you consume too much of them. Additionally, long term side effects are still unknown for many new no-calorie sweeteners on the market. Since fruit is not permitted (except small portions of berries), desserts normally include treats made with nut butters, coconut butter, traditional butter, and other high-fat treats. There are commercially produced foods on the market that fit these stipulations as well. Be advised that processed “keto” treats may have artificial ingredients or chemicals. We mentioned above that artificial ingredients and chemicals in processed foods can be detrimental for your health. We recommend that you always try to choose real whole foods first.
Low-carb veggies:
Low-carb vegetables are permitted when following the keto diet. You will be able to eat celery, lettuce, kale, spinach, broccoli, and cucumbers. High carb veggies like sweet potatoes and corn are not allowed.
Oils and Fatty Spreads:
Oils like olive oil, avocado, canola, are permitted. So are spreads like butter, mayonnaise, and cream cheese.

Foods to Avoid:

The Keto Diet requires that you avoid the following categories of food.
Virtually all fruit is moderate or high in carbohydrates. As such, fruit is not permitted on the keto diet (except for small portions of berries). Please note, that by restricting this entire food group, you will be missing out on some great nutrients, antioxidants, and vitamins.
Grains and Starches:
This includes breads, pasta, rice, cereal, etc. These are all way too high in carbohydrates and will throw you out of ketosis. A common complaint of keto dieters is non-regular bowel movements. This is likely due to limiting the amount of fiber-rich grains and starches.
Beans and legumes:
While an excellent source of lean protein, beans and legumes are high in carbs and low in fat. Thus, they are generally not permitted while doing a keto diet.
Starchy vegetables:
Including potatoes, carrots, peas and corn are too high in carbs to be permissible.
Sugary beverages:
Such as soda, fruit juice, and energy drinks. Sugar is a no.
Sugary Foods:
Such as pastries, cakes, cookies, cereals, candy, jam, and jellies. These foods are mainly sugar plus flour and are too high in carbohydrates.
No-fat and low-fat:
The diet emphasizes high fat, so you won’t be eating the low-fat versions of anything.
All alcohol is to be avoided, as it contains carbs.

Tips to Get Started with the Keto Diet

We have covered the main principles. Now, let’s explore the basic things that you will need to know before starting a Keto diet.

Know What Food Is Allowed

Since this diet is fairly strict, you will need to get very familiar with the diet and everything that you can and cannot eat. Printing out a checklist may be helpful. Refer to the section above for more specifics.

Pick Healthier Options

Some people who follow a keto diet eat nothing but bacon and butter. These foods are compliant with the keto diet. But, processed meat and high quantities of saturated fat are not ideal for health. Too much saturated fat and animal products can put stress on your heart and contribute to heart disease and inflammation. Additionally, if you choose to eat only the less healthy keto options, you will miss out on vitamins, nutrients, antioxidants, healthy fats, and fiber from vegetables, avocado, seafood, and more. If you are picking primarily commercially produced “keto” cakes, bars, and shakes, you are likely to be consuming a lot of artificial ingredients too. One study found that people who ate 4 or more ultra-processed foods per day had an 18% increase in the risk of mortality. Yikes! If you go these routes, you may be sacrificing your health in an effort to lose weight. Instead, you could follow the keto diet but focus on health. This might look like choosing quality protein sources. You might add heart-healthy olive oil and avocados. Eating primarily unprocessed foods would be great. Finally, you could focus on getting in enough non-starchy vegetables. These examples would be ways to follow a keto diet that would promote fewer health complications.

Know About The Keto Flu

The keto flu is faced by many people who start on the keto diet. Symptoms include: fatigue, dizziness, and headache. These unpleasant side-effects generally last one to two weeks as your body transitions from your current style of eating to the ketogenic diet due to the effects of your body transitioning to ketosis. Hey keto mama has some tips for avoiding the keto flu, such as decreasing carbs slowly and increasing your electrolytes.

Have an After Plan

Having an 'after plan' is essential before going onto a keto diet. Why? Well, this diet is not a permanent diet and should only be followed for a limited amount of time. Following a strict diet like keto will cause you to miss out on healthy food groups, like grains, beans, and fruit. Avoiding these healthy foods for the long-term is not a viable solution. So, think about what your plan is going to be to reintroduce some of these forbidden foods once you have reached your goals.

Similarities Between Mediterranean Diet And Keto Diet

Although the Mediterranean Diet and the Ketogenic Diet seem pretty different on the surface, there are still a few prevailing similarities when examining the Mediterranean Diet vs the Keto diet. Read on for a few commonalities between the ways of eating:

Not Low-Fat Diets

Low-fat used to be the darling of the health world. Recently, studies have indicated that fat is not to be feared. Rather, fat can help us feel satisfied and the right kind of fat seems to be good for our health. The traditional Mediterranean Diet is a moderate fat diet, deriving most of its fat from heart-healthy olive oil and fatty fish (high in Omega 3s). The Keto diet is a high fat diet.

Decrease in Sugar Intake

Instead of focusing on lowering your intake of fat, both diets recommend that you reduce your consumption of sugar. Many studies have demonstrated the problematic nature of too much sugar. According to Harvard Health, too much sugar can increase inflammation in your body and raise your overall blood pressure. There’s also concern that too much sugar can contribute to metabolic syndrome and metabolic disease. Both of these can contribute to heart disease. Sugar is also incredibly easy to overeat—and it doesn’t make you feel full like calories from real foods—so it can directly contribute to weight gain.

Some Health Benefits

Both diets seem to have some health benefits. The typical Standard American Diet (also known as a typical western diet) involves eating lots of processed foods, not enough vegetables, and too much sugar. Virtually any deviation away from this way of eating is likely an improvement. Both the Mediterranean Diet and the Ketogenic Diet encourage a decrease in sugar consumption, which is good for health. Additionally, the Mediterranean Diet promotes lots of vegetables and fewer processed foods, both important for maintaining health. Both Keto and the Mediterranean Diet are successful at helping people lose body fat (more on that below). If you suffer from obesity, losing weight is an excellent way to improve a number of different health risks. These include risks of high blood pressure and heart attacks. Aside from long-term weight loss, the Mediterranean Diet has been studied more than any other diet in the world. Over 6,000 studies & reviews show that this diet plan is effective against many different kinds of chronic diseases and conditions, including diabetes, heart disease, cancer, dementia, and many others. Keto, on the other hand, is primarily used to help control seizures in patients with epilepsy and may help improve neurologic conditions such as Alzheimer’s and Parkinson’s disease. However, some recent research indicates that a Ketogenic diet may increase risk factors for heart disease. More on that below.

Weight Loss Effects of Keto and Mediterranean Diet

Many people are interested in losing weight. So, let’s explore the weight loss effects of both diets. Keto is known to be a weight-loss diet. What about the Mediterranean Diet?
Both Promote Weight Loss!
Happily, both diets are effective for weight loss! One recent review of 5 studies found that the Mediterranean Diet seems to be equally as effective as other diets for weight loss. The review found that over the long term (or longer term) length of time of 1 year, participants in the study lost an average of 9 to 22 pounds while following the Mediterranean Diet. That was equal to other diets, like the low-fat diet. Keto tends to produce quick weight loss upfront, in the short term. This is what many people are drawn to. It is primarily water weight loss at first. If you are able to stay very strict with the low carbohydrate, high fat diets and get your body into ketosis, you are likely to continue to lose weight fairly quickly. Many people, however, are not able to stay in ketosis and the weight that they lose is just the water weight. Afterward, the weight loss stalls. Sadly, it is often regained. The Mediterranean Diet is effective in helping people lose weight and, equally importantly, effective in helping people keep the weight off. Studies have shown how eating a Mediterranean Diet can help you lose weight now and maintain a healthy weight long-term.

Significant Differences Between the Traditional Mediterranean Diet and Standard Ketogenic Approach

Okay, enough of the discussions of the similarities and the things that make them related. Let’s move on to the critical part that will help you decide which diet will suit you better according to your preferences and your fixed goals. These two ways of eating are quite different. It’s not possible to follow both diets at the same time. So let’s dive in.

Keto Is a Diet & The Mediterranean Diet Is a Lifestyle

One of the major differences between the two “ways of eating” is that one is a diet while the other is a set of principles. You can see that the keto diet is very strict. The diet requires elimination of entire food groups that can make it difficult for many people to follow. A person following the ketogenic diet cannot “cheat” and eat too many carbs, even on a special occasion. Why? Because in order to see the fast weight loss that the diet promotes, a person needs to remain in a state of ketosis. A person’s body will only stay in ketosis if the amount of carbs eaten remains extremely low. (Keto is a low carb diet.) The keto diet is recommended to only be followed for a shorter period and will likely be unsustainable for more extended periods due to the risk of vitamin and mineral deficiencies. On the other hand, the Mediterranean Diet is a lifestyle. It is not just a diet; it is a pattern of eating that could be adopted permanently. No foods are completely off-limits and the vast array of foods that are available to a person following this diet are huge. The flexibility and moderate nature of the Mediterranean Diet make it much easier to maintain for the long run. In fact, people in the Mediterranean have eaten this way for thousands of years.

Keto Is Restrictive

Keto is a strict diet in that it completely eliminates an entire food group (fruits) and reduces one of the macronutrients (carbohydrates) to a minimal amount. People on this diet need to completely cut down their carbohydrate intake in order to make sure that their bodies develop into the ketosis stage. Even a small “slip” could undo some of your hard work. On the other hand, the Mediterranean Diet is a flexible eating pattern that lets the dieter choose between many, many kinds and types of food. You are not restricted to foods with Mediterranean flavors—you can use the Mediterranean Diet principles of whole grains and lots of veggies and explore many different spices, foods, and cuisines.

What you Eat is Vastly Different

The Keto Diet is a low-carb diet with moderate-protein intake. It’s also a high-fat diet. On this diet, you will be consuming 70-80% of your calories from fat, 5%-10% from carbs, and 15%-20% from protein.
A Day with Keto
A typical day on Keto will include lots of foods with high fat contents, including bacon, whole milk dairy, butter, ribeye and skin-on chicken thighs. Keto eaters enjoy limited amounts of non-starchy vegetables like salad and broccoli. As we mentioned, a person following this diet will completely eliminate or severely reduce several categories of food. These include bread, fruit, beans, starchy veggies (like sweet potatoes) and other carbohydrate-rich foods. In order to get into a state of ketosis, in which the body burns fat for energy instead of carbohydrates, eaters must be quite strict about not deviating from the diet.
A Mediterranean Day
The Mediterranean Diet, on the other hand, is a more balanced, flexible approach. People following the Mediterranean way are not required to eat according to specific marcos, and in fact, most people do not track calories or macros at all. Instead, eaters focus on building their plate around fruits, vegetables, beans, nuts, and legumes; eating seafood twice per week, increasing their leafy greens intake, bean & whole grain intake, moderating their poultry and dairy, and reducing red meat, sugar, and processed food intake. It’s important to note that the Mediterranean Diet is not a high carbohydrate diet, as it is sometimes presumed. Rather, it is a balanced, moderate carbohydrate one. A typical day on the Mediterranean Diet will likely include lots of meals built around fruits, veggies, beans, legumes, and whole grains. Eaters will enjoy seafood, olive oil, and non-processed cheeses. A meal might end with a square of dark chocolate or an occasional glass of red wine (up to one glass per day for women and up to two glasses per day for men). No foods are completely eliminated. It’s a style of eating that has been around for thousands of years and can be enjoyed by the whole family.

Keto Diet Has More Health Risk

As we mentioned at the beginning of this article, the Mediterranean Diet is one of the healthiest ways to live. A panel of health and nutrition experts (including nutritionists, and specialists in diabetes, heart health, and weight loss) have named it the best overall diet for 4 years in a row, including last year and in 2021. People have been enjoying the health benefits of the Mediterranean Diet for thousands of years—starting with the people living along the Mediterranean Basin who ate this way. The Mediterranean approach to eating and living can help you achieve long term health including decreased risk of heart disease and diabetes, losing weight and maintaining it, reducing the risk of cognitive decline, and increasing longevity. (Although even with all the great health benefits, we always recommend that anyone with health conditions should talk to their health care provider before undertaking any big dietary change.) By contrast, the Keto diet calls for a decrease in (or removal of) healthy fruits and legumes, as well as an increase in animal product intake. Low fiber intake combined with high intake of saturated fats can increase your risk of developing heart disease. It can also put you at risk for elevated LDL (bad) cholesterol levels. The ketogenic diet is also NOT a good alternative for people with certain medical conditions, particularly liver or kidney conditions (again, discuss with your healthcare provider before making any dietary changes).

Heart Health

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 conditions and is not considered safe for those with liver or kidney dysfunction. Hormonal changes may include dramatic effects on insulin (and thus blood sugar), insulin resistance, 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.

Vitamin and Mineral Deficiencies

Due to the restrictive nature of the keto diet there is an increased risk of vitamin and mineral deficiencies, which can lead to a wide variety of diseases. Close monitoring of labs and supplementation of vitamins and minerals lacking while following the diet is recommended.

Conclusion: Which is it?

In this article, we have explored the Ketogenic Diet and the Mediterranean Diet. We discussed the principles of each and what a typical day would look like. We noted the similarities and the differences. Both the Keto Diet and the Mediterranean Diet are popular, well-known diets. Both of them can help you lose weight and move away from the Standard American Diet.
Earning Top Marks
Only the Mediterranean Diet, however, has thousands of studies and reviews showing its impressive health benefits. And the Mediterranean Diet has the honor of having been named the “Best Overall Diet” for the 4th year in a row by a panel of nutritionists and experts from the U.S. News and World Report. To earn this title, the Mediterranean Diet beat out 40 other diets, including the paleo diet, the flexitarian diet, the dukan diet, other high fats diets, and yes-- the ketogenic diet. While the ketogenic diet may help you lose weight in the short-term, it’s not a long-term solution. Cutting out healthy food groups like beans and fruit, while eating high amounts of saturated fat and animal protein can negatively impact heart and liver health. Because of the health concerns, keto ranks near the very bottom of all the potential diets, and it should be reserved for treatment of epileptic seizures with close following by a healthcare provider and dietitian.

Help Achieving Your Goals

If weight loss is your top goal, know that you don’t have to sacrifice your health for your waistline! You don’t have to cut out a bunch of food groups, either. A Mediterranean Diet has been shown to be able to improve your health while you lose weight in a sustainable way. If you want guidance, support, and motivation through your weight loss journey, our Registered Dietitian Nutritionists are standing by to assist you with healthy lifestyle changes. If you are ready to jump into one of the best diets, grab our FREE 

Starter Guide & Recipe Book to get your journey started!


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