The Mediterranean and ketogenic diets are both popular eating plans drawing plenty of interest from people who want to lose weight. The keto diet promises quick weight loss, while Mediterranean diet results are more gradual.

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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.

Mediterranean Overview

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

While there isn’t a single version, the Mediterranean diet is a balanced way of eating. In general, here's what Mediterranean-style eating involves:

High in fruit and vegetables.

Plenty of whole grains, beans, lentils and nuts.

Herbs and spices for seasoning.

Rich in healthy fats like olive oil.

Fish and seafood twice weekly.

Moderate amounts of dairy, as well as eggs and poultry.

Infrequent red meat, saturated fat and sugar (if any).

Many clients looking for a healthy way to lose weight ask about the Mediterranean diet, and rightfully so, says Carrie Dennett, a Seattle-based registered dietitian nutritionist. “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. By not overcooking pasta, taking moderate portions and topping it with a sauce containing protein and healthy fat, you can minimize its carbs and prevent them from being absorbed too quickly, 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.”

Keto Overview

With keto, you can find many versions of the diet. Some people stay on keto indefinitely, whereas others cycle in and out.

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, sharper mental focus, 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.

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 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.

Pricing/Cost

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.

Health benefits

Losing weight, however you do it, can reduce health risks – such as high blood pressure, heart attacks and cancer – that are associated with being overweight or obese.

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.

Weight-loss effects

You can lose weight on either diet.

Differences Between Mediterranean and Keto

Pricing/Cost

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 $9 to $22 per meal.

Health benefits

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 tying 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 took last place among all diets for health in 2019, the first year it was included in the U.S. News rankings.

Weight-loss effects

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.

Risks

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:

