The Ultimate Guide To The Ketogenic Mediterranean Diet

9 min read

keto mediterranean diet

The Mediterranean diet is widely known as being one of the best diets for weight loss and overall health. When compared to a typical western diet filled with processed foods, this clean diet is a safe, effective, and reliable bet.

Recently, more and more people are moving towards the Mediterranean version of Keto for a more clean approach.

The keto diet is the perfect example of this, with a plethora of research backing the substantial impact this uncommon approach has on several conditions ranging from diabetes and obesity to neurological disorders like Alzheimer’s disease, Parkinson’s disease, and epilepsy. However, there are small subsets of the population that may worsen their health by following a low-carb, high-fat diet like keto.

Long story short, the Mediterranean diet and the keto diet both have significant advantages under different contexts. When we combine them into one diet, however, most of their downsides melt away, leaving us with a way of eating that can significantly improve every aspect of health.

Before we take a closer look at the Mediterranean keto diet, let’s uncover the foundational principles of each diet first. This will equip you with some of the dietary knowledge you need to meet your goals more effectively.

How does the Mediterranean diet work?

The Mediterranean diet has been the subject of intensive research for more than 50 years. Its rise in popularity began after Ancel Keys, PhD, a professor from the University of Minnesota, published the Seven Countries Study.

This study examined the health outcomes of nearly 13,000 middle-aged men in the United States, Japan, Italy, Greece, the Netherlands, Finland, and then-Yugoslavia. His team found that men from Crete — a large island in the Mediterranean sea — experienced lower heart disease rates than their counterparts in other countries. Keys et. al. concluded that this result is linked to the men’s post-World War II “poor” diet, which focused on fruits, vegetables, grains, beans, and fish .

Since Keys’ first observation decades ago, hundreds of studies have documented an array of health benefits linked with the “traditional” Mediterranean diet. These benefits include:

  • increased life span
  • lower risks of certain cancers, heart disease, Alzheimer’s disease, and type 2 diabetes
  • reduced mortality risk from stroke and heart attack
  • reduced incidence of stroke and heart attack
  • improved body composition
  • enhanced brain function
  • lower levels of blood pressure and LDL cholesterol

The traditional Mediterranean diet — i.e., what is typically used in studies examining the Mediterranean diet —  consists of 50%–60% of daily calories from carbohydrates, 25%–35% of calories from fat (with a heavy emphasis on natural unsaturated fats), and the remainder from protein.

Common staples of the Mediterranean diet are as follows:

  • Vegetables
  • Fruits
  • Nuts
  • Seeds
  • Legumes
  • Potatoes
  • Whole grains
  • Bread
  • Herbs & spices
  • Fish & seafood
  • Olive oil

Cheese, poultry, eggs, and yogurt are also a part of the diet in moderation. Typically, red meat is rarely consumed, and sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils, and other highly processed foods are avoided.

Because of its relatively simple concept and the abundance of research supporting its benefits, the Mediterranean diet is typically ranked as one of the best diets for health and weight loss by multiple publications.

This approach to eating, however, is not a magic bullet. It may be a safe bet for general health improvement, but research suggests that other diets can have a much more profound impact on specific aspects of health. The keto diet, for example, has been found to improve several common health conditions in a way that the traditional Mediterranean diet cannot match.

How does the regular Keto diet work?

Ketosis is a metabolic state in which your body is consistently using and burning a highly efficient alternative fuel called ketones. To produce ketones and enter ketosis, we must continually trigger a process in the liver called ketogenesis. The healthiest way to do this is by limiting carb consumption more than other common low carb diets.

This is why this version of the low carb diet is called the “ketogenic diet” — Its primary objective is to limit carbs to the point that you stimulate ketogenesis and enter nutritional ketosis.

To achieve this unique metabolic state, you must avoid these high-carb foods:

  • Grains – wheat, corn, rice, cereal, etc.
  • Sugar – honey, agave, maple syrup, etc.
  • Fruit – apples, bananas, oranges, etc.
  • Tubers – potato, yams, etc.

And get most of your calories from these healthy high-fat foods:

  • Meats – fish, beef, lamb, poultry, eggs, etc.
  • Low-carb vegetables – spinach, kale, broccoli, and other low carb veggies >
  • High-fat dairy – hard cheeses, high fat cream, butter, etc.
  • Nuts and seeds – macadamias, walnuts, sunflower seeds, etc.
  • Avocado and berries – raspberries, blackberries, and other low glycemic impact berries
  • Sweeteners – stevia, erythritol, monk fruit, and other low-carb sweeteners >
  • Other fats – coconut oil, high-fat salad dressing, saturated fats, etc.

It is also essential to make sure you are eating around 70% fats, 25% protein, and 5% carbohydrate. When carb and/or protein consumption are too high, ketone production will be impaired.

Although there hasn’t been as much research on the keto diet as there has been on the Mediterranean diet, The current data suggests that the diet can have a profound impact on our health including:

  • Remarkable decreases in insulin, blood sugar, and hbA1c levels
  • Significant reductions in triglyceride levels
  • Optimization of blood cholesterol levels via increasing HDL and improving LDL particle stability
  • Significant reductions in blood pressure
  • Reducing the severity of type 2 diabetes, fatty liver disease, PCOS, certain types of cancer and neurological disorders including epilepsy, Alzheimer’s disease, and Parkinson’s disease
  • Substantial increases in fat loss

Despite the proven upsides of the keto diet, there are some potential downsides, commonly emphasized in the public media. The main keto criticism is that the increased saturated fat content of the keto diet will significantly increase cholesterol levels and heart disease risk.

Although this may occur for a small subset of the population that has familial hypercholesterolemia and/or hypothyroid related issues, the majority of the research literature has found that keto optimizes cholesterol levels and many other risk factors for heart disease. (For a closer look at the research behind these statements, check out our in-depth article on the keto diet and heart disease.)

That being said, research indicates that combining keto with the Mediterranean diet can actually reduce LDL cholesterol levels, which may provide us with even more protection from heart disease. We will take a look at this promising data after we compare and contrast the two diets.

How are both diets similar?

When we compare the keto diet and Mediterranean diet to westernized diets, many similarities arise that help us understand why these two vastly different approaches can both improve health substantially.


  • They benefit from similar aspects of health. Both diets, when compared to westernized low-fat diets, help us improve several important biomarkers for overall health, such as cholesterol, triglycerides, blood sugar, and blood pressure levels.
  • They provide us with similar long-term weight loss results. Although the keto diet typically yields more weight loss in the short-term, studies indicate that both diets achieve similar weight loss after 1-2 years.
  • They both have similar adherence levels. Although the keto diet looks more restrictive than the Mediterranean diet on paper, research indicates that it has roughly the same drop-out rates as other diets in dietary intervention trials (at around 24%). This may suggest that diet adherence depends more heavily on individual differences than on how much a diet restricts specific foods or macronutrients.
  • They both are biased toward “clean eating.” Both keto and Mediterranean diets tend to avoid all heavily processed foods and derive most of their calories from minimally processed, high-quality whole foods. This simple shift in food quality is one of the critical factors responsible for the many health benefits these diets have in common.

Although they share several common benefits, the ketogenic diet and the Mediterranean diet do have many noteworthy differences:

  • Carb intake. The Mediterranean diet emphasizes healthy fats and eliminates refined sugars, but it also includes a moderately high amount of carbohydrates — including fruits and whole grain breads and pastas. In contrast, the ketogenic diet is always going to be very low in all carbohydrates, even from unrefined higher carb plant foods.
  • Fat intake. The Mediterranean diet is higher in fat compared with standard low-fat diets, but it’s much lower in fat than keto. The primary source of calories on the keto diet is fat, while the primary source of calories on the Mediterranean diet is usually carbs.
  • Type of fat consumed. The type of fat typically consumed on both diets is also different. The Mediterranean diet emphasizes natural unsaturated fats from plant-based oils and fish, while keto foods include copious amounts of saturated and unsaturated fats.

As you can see, both diets have the potential to vastly improve health, but each approach can be a better choice depending on the individual. Keto, for example, may help treat specific neurological conditions and can have a more substantial impact on many risk factors for type 2 diabetes and heart disease. In contrast, the Mediterranean diet may be maybe a safer and healthier option for those who do not respond well to low carb diets or diets that are higher in saturated fat.

Best of both worlds?

In 2008, researchers from Spain sought to explore the potential impact of combining the ketogenic diet with the Mediterranean diet. Their diet plan featured these primary characteristics:

  • Unlimited calories (no calorie counting).
  • Olive oil as the major source of added fat, with over 2 tablespoons consumed per day.
  • Green vegetables and salads as the primary carbohydrate source.
  • Fish was the major source of protein.
  • Participants also drank a moderate amount of daily wine (200-400 ml/day).

The researchers called this a “Spanish Ketogenic Mediterranean diet,” and it resulted in changes you’d expected from a standard keto diet, including significant decreases in body fat, blood pressure, glucose, and triglycerides.

The most noteworthy finding, however, was what happened to each subject’s cholesterol numbers. On average, there was a reduction in LDL cholesterol (114.52 mg/dl→105.95 mg/dl) and an increase in HDL cholesterol (50.10 mg/dl→54.57 mg/dl).

In other words, the Spanish Ketogenic Mediterranean diet mitigated the increase in LDL cholesterol commonly experienced as a result of standard keto dieting while keeping its HDL boosting benefits. This indicates that consuming more unsaturated fat-rich foods like fish and olive oil and less saturated fat from other animal foods while restricting carbs may be a suitable strategy for those who struggle with unhealthy cholesterol levels.

A few years later, researchers conducted a similar study, exploring the effects of a six-week Mediterranean ketogenic diet with the addition of herbal extracts. Once again, the change in cholesterol levels was remarkable:

  • Significant reductions in total cholesterol (204 mg/dl to 181 mg/dl)
  • Significant decreases in LDL cholesterol (150 mg/dl to 136 mg/dl)
  • Increases in HDL cholesterol (46 mg/dl to 52 mg/dl)

A more recent study, published in 2015, yielded similar results along with greater decreases in triglycerides, insulin, and inflammation levels when subjects followed the diet and supplemented with omega-3s from krill sources.

In summary, the current literature on the Mediterranean keto diet yielded similar results to what common sense would predict. This unique combination provides us with the benefits of both diets in one.

The current literature suggests that the combination of the Mediterranean and keto diet may provide more significant health benefits than either diet on its own. These science-backed benefits include:

  • Decreased inflammation, total cholesterol, LDL cholesterol, triglyceride, blood sugar, insulin, blood pressure, and hbA1c levels
  • Increased HDL cholesterol levels
  • Significant fat loss

It is also reasonable to speculate that combining the key characteristics of each diet can also help us:

  • Reduce cardiovascular disease incidence and mortality (as discovered through research on Mediterranean diets).
  • Provide us with the unique benefits of ketosis and carb restriction (which you can learn more about in this article about the benefits of keto).

However, there is one crucial limitation to the current data on this diet: No studies have been conducted comparing the Mediterranean keto diet to the standard keto diet, Mediterranean diet, and/or a low-fat diet control group. This makes it difficult to determine how significant the differences are between each diet.

Despite this limitation, the current data does show us that the Mediterranean keto diet has the potential to optimize at least ten key biomarkers associated with heart disease, type 2 diabetes, and overall health all at once. This extends beyond what either the standard keto diet or the Mediterranean diet can help us achieve on their own.

To maximize these benefits, however, we must identify the primary principles responsible for the remarkable results. This will allow us to formulate a safe, simple, and highly effective Mediterranean keto diet.

There is enough data on each diet and their individual macronutrient components to identify the health-promoting aspects that every keto Mediterranean diet should have. These key characteristics include:

  • Restrict carbs low enough to promote ketosis. Typically, total carbs should be below 35g and net carbs below 25g to stimulate ketone production and enter deeper levels of ketosis overtime. This level of carb restriction can help reduce your appetite, boost weight loss, and significantly decrease your insulin, blood sugar, hbA1c, and triglyceride levels.
  • Eat plenty of monounsaturated and polyunsaturated fats. You can do this by eating olive oil, avocados, and avocado oil instead of butter and coconut oil, replacing red meat with fish, seafood, and poultry, and snacking on low-carb nuts, seeds, and hard cheese instead of processed meats. These simple swaps will increase your consumption of fats that optimize cholesterol and triglycerides levels (more so than high-saturated fat foods). It may also be worth it to supplement with DHA+EPA to help decrease inflammation, insulin, and triglyceride levels if these are an issue for you.
  • Get most of your carbs from keto-friendly vegetables. Eating plenty of leafy greens, colorful vegetables, and cruciferous vegetables is a must, with the goal of having them at every meal. These vegetables contain plenty of vitamins, minerals, and fiber to help optimize your health and prevent some common symptoms of the keto flu. However, many vegetables contain high levels of net carbs, so make sure you check our low carb vegetable list before incorporating them in your next keto meal.
  • Use fish, seafood, poultry, and eggs as your primary protein sources. These protein sources are packed with protein, unsaturated fats, and other health-promoting compounds. Wild-caught salmon and sardines may be the best option because they are relatively high in omega-3s and more environmentally sustainable compared to other fish. Pasture-raised eggs and poultry are great options as well.
  • Adjust your protein and fat intake based on your goals. Eating enough protein is what will help you keep on muscle or build it (if you are lifting weights), and manipulating your fat consumption is what will help you control your weight loss rate. To help you figure out good fat and protein intake goals to start with,

The Mediterranean Ketogenic Diet Food List

The Mediterranean keto diet primarily consists of these foods:

  • Mediterranean protein sources — fish, seafood, poultry, and eggs
  • Fats/oils — olive oil, avocado oil, and MCT oil
  • Low-carb vegetables — leafy greens, cruciferous vegetables, and other low carb veggies >
  • Low-carb fruits — avocados, olives, and tomatoes
  • Common Mediterranean flavorings — paprika, cumin, cinnamon, oregano, coriander, anise, Spanish saffron, lemon or lime juice, mint, parsley, garlic, etc.

Foods you can eat in moderation:

  • Nuts and seeds — macadamia nuts, brazil nuts, pecans, flaxseeds, and chia seeds are the lowest carb options
  • High-fat dairy — hard full-fat cheeses, full-fat low-carb yogurt, heavy cream, etc.
  • Low-carb fruits — low-carb berries, melon, and other low-carb fruits >
  • Red meat — beef, pork, veal, lamb, etc.
  • Saturated fat-rich fats/oils — coconut oil, butter, ghee, and animal fats

If necessary, limit these common keto foods to help lower LDL cholesterol numbers:

  • Coconut oil
  • Butter
  • Heavy cream
  • Fatty cuts of red meat

Foods to avoid:

  • Grains – wheat, corn, rice, cereal, etc.
  • Legumes — lentils, black beans, peas, etc.
  • Sugar – honey, agave, maple syrup, etc.
  • Fruit – apples, bananas, oranges, etc.
  • Tubers – potato, yams, etc.

By following the above principles, you will be able to experience the Mediterranean keto diet and its potential benefits for yourself. As with any diet change, however, make sure you are monitoring your health and following an approach that you can turn into a long-term healthy lifestyle.

Give the diet a try for 1-2 months and monitor your health throughout the process. If you find the Mediterranean keto diet is not improving your health and wellbeing, then a non-keto Mediterranean diet with more high-carb plant foods may be a better option.

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