What is the Mediterranean Keto Diet?

Heard of the Keto Mediterranean diet? It’s become super popular in low-carb circles.

Mediterranean Keto is just a whole foods Keto diet with a focus on fish, olive oil, and red wine. Yes, you read that correctly: moderate red wine consumption is encouraged.

In today’s article, you’ll learn the rules of Keto and the Mediterranean diet, how they compare, how they differ, health benefits, and how to combine them. Let’s get started. 

What Is the Keto Diet?

You’ve heard of the ketogenic diet. It’s a high-fat, moderate-protein, low-carb diet best known for stimulating weight loss. 

On Keto, you eat about 60% of your calories from fat, 30% from protein, and 10% (or less) from carbohydrates. Restricting carbohydrates and increasing healthy fat consumption is the key to entering ketosis, the fat-burning state after which the Keto diet is named. 

Here’s how ketosis works. When you don’t eat carbs, your blood sugar stays low, which helps keep the hormone insulin low. And when insulin stays low, that signals your liver to burn fat (from body fat and dietary fat) and produce ketones. 

Ketones? Think of these molecules as backup brain fuel. They help your brain (and other cells) stay sharp in the absence of carbs.[*]

There’s no shortage of Keto research. It shows promise with weight loss, cognitive health, diabetes reversal, inflammation, and much more.[*][*][*]

On a whole foods Keto diet, you eat healthy fats (olive oil, coconut oil, butter), meat, dairy, nuts, fish, and piles of non-starchy veggies. Your other main job is to avoid refined sugar, grains, tubers, and other high carbohydrate foods. 

Keto may sound restrictive, but once your body adapts to using fat for energy, the carb cravings tend to dissipate. Plus, you can always eat some carbs, take a break from ketosis, and restart later. 

What Is the Mediterranean Diet?

Back in the 1960s, researchers noticed that people living in France, Italy, Greece, and Spain had unusually low rates of heart disease.[*] Why?

Maybe it was their diet. These folks consumed fish, olive oil, vegetables, whole grains and the occasional glass of red wine. This general eating pattern became known as the Mediterranean diet. 

There are many theories why the Mediterranean diet is healthy. It could be the antioxidants from olive oil, polyphenols from red wine, the omega-3 fats from fish, some combination, or something else entirely.[*]

Maybe it's the abundant sun and social ties (not nutrition) that makes people living in coastal Europe so healthy. After all, most of the data on the Mediterranean diet is observational. 

In other words, it’s not clear that the Mediterranean diet causes good health. But at least at the population scale, it doesn’t prevent it.

Unlike the Keto diet, the Mediterranean diet doesn’t have strict macronutrient rules. But in general, it’s high in carbohydrates, low to moderate in protein, and fairly low in fat. 

Here are the basic principles of the Mediterranean diet:

• Allowed carbs include whole grains, legumes, lentils, and all types of fruits and vegetables. These comprise the bulk of calories. 
• Protein predominantly comes from fish (at least twice per week) and legumes. Processed meat consumption is discouraged, but poultry is often included.
• Most fat comes from olive oil, along with certain dairy products.
• Moderate red wine consumption is encouraged.

The Mediterranean diet, like Keto, also avoids packaged foods and refined sugar. 

The Keto Diet Vs. The Mediterranean Diet: Similarities

Mediterranean and Keto diets have a couple of key features in common. 

#1: No refined foods

Refined sugar is a key contributor to the American obesity epidemic.[*] High sugar intakes (mostly from sugary beverages) create metabolic problems that promote runaway fat storage, especially in sedentary people. 

Both Keto and Mediterranean diets avoid refined sugar, packaged foods, and most other foods in aisles 1-10 of the grocery store. Because of this, both diets are a significant improvement over the Standard American Diet.  

#2: Health benefits

The Keto diet has shown the potential to promote weight loss and improve heart disease risk factors. Multiple controlled trials (especially in people with diabetes and obesity) support this point.[*][*]  

The Mediterranean diet appears to have similar potential benefits: weight loss, lower triglycerides, decreased insulin resistance, lower blood sugar, and lower blood pressure. The supporting evidence, however, is mostly observational.[*]

The Keto Diet Vs. The Mediterranean Diet: Differences

Now for the main differences between a Keto and Mediterranean diet. 

#1: Carb intake

The Keto diet is very low in carbohydrates, generally allowing just 20-50 grams per day. Not true of the Mediterranean diet, which permits high-carb foods like legumes, lentils, whole grains, and root vegetables. 

Optimal carb intake is highly individual. But for reversing type 2 diabetes or obesity, the latest science points to low-carb interventions like Keto showing the most promise.[*]

Carb restriction is also essential for the production of ketones, tiny molecules that may help improve cognition, boost energy levels, and reduce inflammation.[*][*] If you want the benefits of ketosis, you can’t eat many carbs. 

#2: Fat sources

Keto fat calories can come from butter, animal fat, coconut oil, dairy, avocados, olive oil, MCT oil, nuts, egg yolks, fatty fish, and several other sources. Certain fats (like MCT oil) are more ketogenic than others, but there’s plenty of flexibility on fat choice. 

On the Mediterranean diet, however, olive oil is king. Dairy and omega-3's also add a few fat calories. 

Some claim that the Mediterranean diet is healthy because it limits saturated fat. Saturated fat is supposed to be bad for your heart, right? 

But here’s the thing: Two massive meta-analyses (studies of studies) found no link between saturated fat consumption and cardiovascular disease risk.[*][*] Good to know. 

How To Do The Keto Mediterranean Diet

Combining Keto with a Mediterranean diet plan is simple. Just take the Mediterranean diet and remove the carbs. 

This means that whole grains, beans, and root vegetables are out—and olive oil and fish are in. You can also eat leafy greens, cruciferous vegetables, eggs, poultry and (if tolerated) dairy.  

With Keto staples like red meat, butter, and coconut oil either significantly reduced or off-limits, the Keto Mediterranean diet can be fairly restrictive, but here are a few delicious meal ideas:

• Keto Mediterranean Fish Soup
• Keto Sardine and Broccoli Tray Bake
• Low Carb Spanish Basque Calamari Stew

Benefits of the Keto Mediterranean Diet

The same potential benefits of the Keto diet—weight loss, better energy, reduced cravings, improved focus, reduced risk of chronic diseases, etc.—should also apply to a properly-formulated Keto Mediterranean diet. 

Several studies have looked at the Mediterranean Keto diet. Here’s what they found: 

• Thirty one obese people lost an average of 31 pounds on a 12-week “Spanish Ketogenic Mediterranean diet” of fish, olive oil, vegetables and red wine. They also saw improvements in blood pressure, blood glucose, triglycerides, LDL cholesterol, and HDL cholesterol. The main weakness of this study? There was no control group.[*]
• In another study, 89 obese people lost weight (and maintained it) by cycling the Keto Mediterranean diet with a standard Mediterranean diet for an entire year.[*] Again, no control group. 
• A high-protein Keto Mediterranean diet significantly reduced heart disease risk markers in 106 Italian council employees.[*] Also, no control group. 

The takeaway? More controlled studies would be nice, but it’s a good bet that Keto Mediterranean works similarly to a standard Keto diet. 

One last point. By banning saturated fat, Keto Mediterranean may solve a concern experienced by a subset of Keto dieters: elevated LDL cholesterol. 

Yes, saturated fat is well-documented to elevate LDL cholesterol—and this represents a possible increase in heart disease risk.[*] While saturated fat doesn’t appear to increase heart disease risk on a population scale, this large-scale finding might not apply to everyone.[*][*] For these folks, Mediterranean Keto could be a great option.   

Should You Try The Keto Mediterranean Diet?

Before you dive in, understand that Mediterranean Keto is significantly more restrictive than a standard whole foods Keto diet. If Keto already seems restrictive to you, just wait until you eliminate certain meats, butter, and other sources of saturated fat. 

But if you’re concerned about cholesterol levels on Keto—or if you simply want to experiment—go for it. Just be sure to monitor your bloodwork, body weight, energy levels, mood, sleep, exercise performance, and anything else that matters to you. That’s how you’ll know if it’s working for you. And if needed, find a registered nutritionist to support you on your journey.