Both the Mediterranean and keto diets have a long list of potential health benefits. But if you've checked them both out and neither feels quite right, there's a possible solution: the Mediterranean keto diet. This nutrition plan combines both worlds, focusing on a diet high in healthy fats and protein, with a lower overall carbohydrate intake.
What is the Mediterranean keto diet?
Before getting into the specifics of the Mediterranean keto diet, it's helpful to dive into the basics of each of the individual plans.
A Mediterranean diet consists of foods that are commonly eaten by people who live near the Mediterranean Sea in countries like Italy, Spain, and Greece. The diet emphasizes whole grains, beans, nuts, legumes, fruits, veggies, and olive oil, leaving room for fish and seafood a couple of times a week. Eggs, cheese, and yogurt are recommended in moderation, and red meat and sweets are limited. While there isn't a specific emphasis on macros—meaning you have to count how many grams of fat, protein, and/or carbohydrates you're eating—the eating style typically consists of 50% carbohydrates (including grains and veggies), about 15% proteins, and 35% fats (more on Mediterranean diet macros here).
The keto diet is a high-fat, low-carb plan. Unlike the Mediterranean diet, the success of the keto diet relies heavily on macro counting. Typically, carbs are limited to about 5 to 10% of calories, while 75% of calories should come from fat. Protein makes up the rest of the plan, at 10 to 20% of calories.
"The downside of the keto diet is that to get and stay in ketosis—the state where your body burns fat rather than glucose as its predominant fuel source—you'll need to keep your carbohydrate intake between about 20 and 50 grams a day1," says board-certified internist and mbg Collective member Vincent M. Pedre, M.D. (For reference, a small apple has 20 grams of carbohydrates2.)
Because carbohydrates are so restricted on a keto diet, this usually means eliminating most high-carb foods, but that doesn't mean your plate should be stacked with meat and cheese. "Ask somebody what keto is, and the foods that pop up would be bacon and butter and steak and lard. Most of us don't appreciate that you can do keto without that," Ethan Weiss, M.D., preventive cardiologist and co-founder of Key Eats previously told mbg.
While you do eliminate many high-carb options like beans, fruits, legumes, starchy vegetables, grains, and low-fat dairy products, you're free to consume a wide variety of low-carb foods like meat, poultry, seafood, eggs, cheese, avocados, nuts, oils, butter, and some full-fat dairy.
Mediterranean keto diet
The Mediterranean keto diet combines aspects of both nutrition plans, offering a unique hybrid solution for those who aren't totally sold on either. It retains the Mediterranean diet's high-protein, healthy fat foods with nonstarchy veggies, but without the high-carb foods like legumes, fruits, beans, and whole grains.
What to expect.
There's no shortage of studies backing the Mediterranean diet—it offers many potential health benefits, like improved blood sugar control3, better cardiovascular outcomes (like lower blood pressure and cholesterol), and can help maintain healthy inflammatory response4. But adding the keto angle may take things up a notch.
In a 2021 study, researchers compared the outcome of following a keto diet versus a Mediterranean diet for 12 weeks in 33 people. While both plans resulted in a similar rate of adherence, the participants on the keto diet experienced better glucose control and a more significant decrease in triglycerides and LDL levels. They also lost more weight, on average.
In another 2021 study published in Nutrients, researchers set out to compare a Mediterranean diet with a low-carbohydrate diet5. They divided 36 participants into two groups—one group followed a traditional Mediterranean diet, while the other followed a low-carb (but not quite keto) nutrition plan with the same amount of calories.
While both groups experienced health benefits, like improved insulin sensitivity, the low-carbohydrate group lost about 60% more weight, on average.
Years ago, researchers also looked at an unlimited-calorie Mediterranean keto diet, specifically, and found that it can promote weight loss, normalize blood pressure, and reduce total cholesterol, LDL cholesterol, and triglycerides in individuals with obesity. It can also raise HDL, or "good," cholesterol.
A 2011 study showed similar results6, although it's worth noting that participants in this study also took plant-based herbal extracts daily (like mint, guarana, and ginseng, to name a few) to increase their overall phytonutrient intake and leverage functional botanical bioactives.
While there are potential benefits to both the Mediterranean diet and the keto diet7, there is very limited research on the combined effects of this diet, with all the studies mentioned previously lasting for only short periods of time with a small number of people.
Aside from the physical health benefits, the Mediterranean keto diet is also a bit more flexible than a traditional keto diet. Because there's no focus on strict macro counting, many people find it easier to adhere to long term than a traditional keto diet. It's also more adaptable to other diet preferences, like vegetarian or vegan plans.
But like any new diet plan, there may be an adjustment period when you're first starting out. If you're coming from a really high-carbohydrate diet, you may experience some signs of carbohydrate withdrawal8.
The most common signs of carbohydrate withdrawal are headaches, impacts on digestion regularity, bad breath, muscle cramps, muscle weakness, and lightheadedness. These issues usually resolve on their own within two weeks of starting a low-carb diet, during which time you may notice an ease in bloating and fewer sugar cravings. However, if these unpleasant side effects persist, reach out to a health professional for support.
Med-keto ingredient staples.
Weiss explains that there's a hierarchy of both fats and animal-based proteins. He recommends getting fats mostly from olive oil, avocado, and nuts, and eating plenty of fatty fish. "If you're a person who does eat animals, fish is the best," he says, adding that he tries to eat salmon five to seven times a week. And if that doesn't seem practical for you (let's face it: That's a lot of fish!), supplementing with a high-quality omega-3 supplement, like mbg's omega-3 potency+ can be a more convenient and enjoyable way to increase your marine omega-3 levels, EPA and DHA.*
And quality matters too. "Always opt for organic produce whenever possible," says Pedre. "With animal foods, choose grass-fed beef, wild-caught cold-water seafood, and organic free-range poultry and eggs [whenever possible]."
Here's a breakdown of what you can expect to eat on a Mediterranean keto diet:
Vegetables and Fruits
- Leafy greens (kale, spinach, Swiss chard, collard greens, arugula, Romaine lettuce)
- Brussels sprouts
Oils and healthy fats
Nuts & Seeds
- Pine nuts
- Sesame seeds
- Cheese (occasionally)
Meats & Poultry
- Red meat (occasionally)
You can also drink red wine on occasion—the participants in the 2008 study in Nutrition Journal drank about 7 to 13.5 ounces per day.
The Mediterranean keto diet is a low-carb plan that emphasizes eating fresh, whole foods that are high in monounsaturated fats and omega-3 fatty acids. This keto version of the well-regarded eating pattern may also help normalize blood sugar levels and promote heart health by lowering blood pressure, LDL cholesterol, and triglycerides. Based on research, the Mediterranean keto diet may also lead to a higher degree of weight loss in a short period of time.
When following a Mediterranean keto diet, you should eat plenty of fatty fish, like salmon, and other healthy fats like olive oil and avocado. Low-carb vegetables and nuts and seeds are the other foundational foods, with the occasional lean meats and cheese.
Lindsay Boyers is a holistic nutritionist specializing in gut health, mood disorders, and functional nutrition. Lindsay earned a degree in food & nutrition from Framingham State University, and she holds a Certificate in Holistic Nutrition Consulting from the American College of Healthcare Sciences.
She has written twelve books and has had more than 2,000 articles published across various websites. Lindsay currently works full time as a freelance health writer. She truly believes that you can transform your life through food, proper mindset and shared experiences. That's why it's her goal to educate others, while also being open and vulnerable to create real connections with her clients and readers.