Both the ketogenic (keto) and Mediterranean diets can be effective for weight loss and improving health markers like blood pressure. However, the best choice isn’t a one-size-fits-all answer; it depends on how well you can stick to the plan over time.
Research Findings: A Small Study’s Insights
A 2025 study examined 26 participants—15 on keto and 11 on the Mediterranean diet—while controlling for calorie intake at around 1,300 per day. Both groups experienced weight loss, lower blood pressure, reduced waist circumference, and improved body composition after three months.
The key difference? The keto group saw a more significant drop in nighttime blood pressure, which may suggest better heart health benefits. However, this study was limited by its small size and lack of randomization. Participants chose their diet based on preference, not chance.
Core Differences: How These Diets Work
While the study showed similar results, the underlying approaches are very different.
- Keto: This high-fat, low-carbohydrate diet forces the body into ketosis, where it burns fat for fuel instead of sugar.
- Mediterranean: Focused on whole grains, fruits, vegetables, and healthy fats, this diet mirrors traditional eating patterns in regions with long-lived populations.
Both diets lead to weight loss through different mechanisms: keto by eliminating carbs and the Mediterranean diet by cutting saturated fats while emphasizing nutrient-dense foods.
Why Experts Lean Towards the Mediterranean Diet
Despite keto’s potential for rapid weight loss and blood sugar control, experts often recommend the Mediterranean diet for long-term sustainability. Keto’s strict restrictions can make it hard to follow, and it may lead to fiber deficiency.
Cutting out carbs can also have downsides, including higher cholesterol, digestive issues, cognitive decline, and the unpleasant “keto breath.” The Mediterranean diet, while not without its own risks (like lower iron or red wine intake), is generally considered less extreme.
“No food is off limits, which is the one feature about [the Mediterranean diet] that I really appreciate,” says Lisa Moskovitz, RD, CEO of NY Nutrition Group.
The Mediterranean diet boasts well-documented benefits, including reduced inflammation, improved heart health, lower diabetes risk, cancer prevention, and better brain function.
Which Diet Should You Choose?
The keto diet may be suitable for specific cases, such as pre-bariatric surgery weight loss, epilepsy management, or type 2 diabetes control. However, the Mediterranean diet is a viable option for almost anyone.
When deciding, consider:
- Long-term goals: What are you hoping to achieve?
- Realism: Can you maintain this diet for life?
- Enjoyment: Does the diet align with your preferences?
Consulting a dietitian can help tailor a plan to your individual needs.
In conclusion, while both diets can help manage weight and blood pressure, the Mediterranean diet stands out for its sustainability and wider range of health benefits.
