Mediterranean Diet vs. Keto: Which is Better?

Considering a keto or Mediterranean diet?  Both can help manage diabetes and weight.  But which is right for you?

The Mediterranean diet is based on traditional diet patterns of countries including Greece, Italy, and Spain.  The diet is a balanced way of eating that focuses more on whole foods including:

• Dishes high in fruits and vegetables
• Plenty of whole grains, beans, lentils, and nuts
• Emphasizes herbs and spices
• Meals are rich in healthy fats like olive oil (although vegetable oils work just as well)
• Fish and seafood twice weekly
• Moderate amounts of dairy, eggs and poultry
• Minimalization of red meat, saturated fats, and sugar.

The ketogenic or “keto” diet was introduced in the early 1900’s as a treatment for epilepsy and has gained traction for weight loss and managing diabetes within the past few decades.  Keto emphasizes weight loss through fat-burning by putting your body into a state of “ketosis.”  This is where your body breaks down it’s stored fat into substances called ketones that are used for energy during a state of carbohydrate restriction.

So which diet is right for you?

Each diet limits and restricts different foods.  The Mediterranean diet as is generally less restrictive.  Both diets include non-starchy vegetables, limiting added sugars, and limiting refined grains.  The main differences between the two diets involve legumes, fruits, and whole grains, which are avoided in traditional keto diets but included in traditional Mediterranean-style diets.

New insights: keto vs. Mediterranean diets.

Dr. Christopher Gardner’s group at Stanford University recently sought to explore which of these diets was more effective in patients with prediabetes or type-2 diabetes.  Patients were place on these two diets each for 12-weeks in random order.  The study showed no differences in hemoglobin A1c (HbA1c) values, a commonly test used to diagnose prediabetes and diabetes and help manage blood sugar levels.   Both diets showed decreases in HbA1c.  The keto diet showed decreases in triglycerides compared to the Mediterranean diet, which is typical of lower carbohydrate diets.  The Mediterranean showed decreases in LDL-cholesterol compared to the keto diet, which is typical of lower fat (particularly lower saturated-fat containing) diets.  A follow-up analysis showed that participants found it easier to adhere long-term to the Mediterranean diet, likely due to it being less restrictive.  There was no difference in weight loss among the two diets.

What does this new landmark study tell us?

A couple things can be gathered from this important work.  First, a diet high in refined carbohydrates (including added sugars) is likely one of the culprits contributing to the obesity epidemic and diet-related chronic diseases, such as type-2 diabetes.  Second, carbohydrates from legumes, fruit, and whole grains seem to promote health and prevent disease.  We also showed this in our large authoritative review on the health benefits of fruits and vegetables.  Finally, both diets when balanced correctly can be effective, but the Mediterranean diet is much easier to adhere to in the long-term.  The Mediterranean diet may also be better suited for individuals with high LDL-cholesterol, which is a known risk factor for heart disease.

The bottom line.

Its best to reduce intakes of refined carbohydrates, added sugars, sodium, and saturated fat for long-term health.  How you do this depends on what’s easiest for you in the long run.  A diet that is balanced in intake of fruits, vegetables, whole grains, legumes, nuts and seeds, low or non-fat dairy, seafood, and lean meat is the way to go!

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