Mediterranean Diet vs. Paleo Diet

Elaine K. Howley

There are many different ways to eat. Two of the most popular -- the Mediterranean diet and the paleo diet -- cater to different tastes and health goals. With the Mediterranean diet, which features lots of fresh fruits, vegetables, grains and seafood, moderation is key. No food is off limits. With the paleo diet, fresh vegetables and in-season fruits are featured alongside lots of meat, poultry and seafood. However, grains and dairy are out of bounds.

Though quite different in their approaches, both diets can be healthy alternatives to the standard American diet when well planned and when the focus is on fresh, whole foods rather than processed foods.

[SEE: How the Mediterranean Diet Can Help Women's Hearts.]

Mediterranean Diet Overview

"The Mediterranean diet is not a diet at all, but an eating pattern that focuses on nutrient-rich, high quality whole foods," says Lindsey Kane, a registered dietitian and in-house dietitian and director of nutrition for Sun Basket, a meal delivery service based in San Francisco.

The Mediterranean diet seeks to codify the eating patterns of people who live around the Mediterranean Sea. This encompasses the traditional, plant-based ways of eating by people from Spain to Greece. In 1993, Oldways, a food and nutrition nonprofit based in Boston, in partnership with the Harvard School of Public Health and the World Health Organization, developed a Mediterranean diet pyramid that helps to define the features of a Mediterranean diet.

The Mediterranean diet features daily intake of:

-- Whole grains.

-- Fresh vegetables and fruit in season.

-- Beans and legumes.

-- Nuts and seeds.

-- Herbs and spices.

The diet also includes a few servings per week of fish and seafood, and moderate portions of dairy, eggs and poultry. Sweets and red meat are limited. The idea is to focus on whole, unprocessed foods that are close to the source. The Mediterranean lifestyle also encourages moderate physical activity and perhaps a small glass of wine with the evening meal.

Paleo Diet Overview

Like the Mediterranean diet, the p aleo diet seeks to limit the intake of processed foods and focuses on including a wide variety of plant-based food sources -- but only the ones that our ancient selves would have likely come across in their hunter-gatherer days.

"It's a diet based on the idea that we're supposed to eat like our Paleolithic ancestors, before farming and food factories," says Lori Chong, a registered dietitian nutritionist and certified diabetes educator at the Ohio State University Wexner Medical Center.

The idea is simple: If our Paleolithic ancestors didn't eat it, we shouldn't either. This translates into a focus on whole foods, raw fruits and vegetables in season and plenty of meat. Anything that requires intensive farming is out, so that means cutting out beans and legumes, cultivated grains and dairy. Alcohol is also out, as it's a grain-based product that's high in carbohydrates.

The idea of eating in tune with our biological ancestry has been around since the 1970s, but the diet gained in popularity in the 2000s with the development of CrossFit, an exercise regimen that espoused this approach to eating to fuel sports performance and the ideal body. Today, many food companies offer paleo-friendly products that make following a paleo diet a somewhat more convenient proposition.

[SEE: Plant-Based Diet Ideas.]

Health Benefits

Mediterranean Diet. The Mediterranean diet is very popular among health experts and dietitians because of the many health benefits it's been associated with, Kane says. "Those following this eating pattern not only experience low incidence of heart disease and greater longevity, blood pressure, as well as lower risk of diabetes, stroke, certain cancers and cognitive diseases including Alzheimer's."

Paleo Diet. The paleo diet can be a good way for people to cut weight quickly because eliminating processed foods, sugars and carbohydrates can jump-start a weight loss program. If the focus is on adding unprocessed foods, with lots of vegetables, it can be a healthy alternative to the standard American diet. Because being overweight or obese is associated with a higher incidence of Type 2 diabetes, the paleo diet may be a good option for reducing that risk.

Health Risks

Mediterranean Diet. The Mediterranean diet is considered one of the safest approaches to eating because it's more of a lifestyle than a diet and because everything is OK to eat in moderation. Its flexibility means you can be sure to cover all your nutritional bases and stay satisfied over the long term.

Paleo Diet. The paleo diet is considered a restrictive diet, and as such, can bring some health risks. It may also be more difficult to stick with long term. One area of concern is fiber. Because the diet eliminates grains, that can potentially lead to a reduction in the amount of fiber and other important nutrients.

"Fiber is important because it feeds the good bacteria in the GI tract," Chong says. Because fiber intake could be reduced on the paleo diet, it could change the gut microbiome, which relies on fiber as a food source. Study of the gut microbiome is growing.

"A lot of research these days is focused on the microbiome and how it affects our health. We don't know everything there is to know about it," Chong says. But as our understanding grows, that may alter how we look at certain diets and their health impacts.

In addition, if you add lots of fatty cuts of meat to your diet, that could actually increase your risk of heart disease or certain types of cancer. Similarly, a 2015 report from the WHO found that processed meats, such as bacon and lunch meat, can elevate risk for colorectal cancer. So be sure to look for lean meats that have been minimally processed if you're switching to the paleo diet.

[See: The 10 Best Diets for Healthy Eating.]

Weight Loss

Both the Mediterranean and paleo diets can be used to lose weight, though if this is your primary goal, the paleo diet may cause faster weight loss because it's more restrictive. Protein-heavy diets may be associated with rapid weight loss for some people. In either case, portion size is the key to dropping weight, and most dietitians recommend striving for a 1 to 2 pound per week weight loss.

Maintenance of weight loss is also an important consideration. Because the Mediterranean diet is designed to be more of a lifestyle than an actual diet, it may be the better option for maintaining weight loss over the long term than a more restrictive paleo diet that may be harder to stick with over time. One 2018 study found that among 626 participants, a low-calorie Mediterranean diet in combination with other lifestyle changes was effective in losing weight and maintaining that weight loss 12 months later.

With the paleo diet, long-term results are less clear. One randomised controlled trial that followed 70 post-menopausal Swedish women with obesity for two years found that following a paleo diet helped participants lose fat mass and weight. When compared to dieters following the Nordic nutrition recommendations, which bears many similarities to a Mediterranean diet, participants following the paleo diet had lost more weight at 6 months, but not at 24 months.

Cost

The Mediterranean and paleo diets offer similar cost profiles, as both include plenty of fresh produce and some meat. Because the Mediterranean diet includes more grains and legumes, such as beans and lentils, which are often some of the cheapest staples in the grocery store, the Mediterranean diet may be more budget friendly than some interpretations of the paleo diet that include lots of more expensive red meat. In both cases, if you choose to use only organic produce, you can expect to spend more money than if you also include conventionally grown produce.

These two diets "may be higher than the average Western diet" in terms of cost, says Lindsay Collier, clinical dietitian specialist at Westchester Medical Center. This is because of the higher produce consumption by comparison to the standard American diet. "But with use of frozen or low-sodium canned options, the costs can be reduced. The best way to ensure you can fit these diet styles into your budget would be to work with a registered dietitian."

Which One Is Better?

The Mediterranean diet traditionally ranks as the No. 1 Best Diet Overall in U.S. News' annual diet rankings. To earn top marks, which are compiled with input from a panel of health experts, a diet must be safe, relatively easy to follow, nutritious and effective for weight loss. This description fits the Mediterranean diet, which is a favorite among many dietitians and nutritionists across the country.

In contrast, the paleo diet ranked 33rd out of 41 plans evaluated in 2019, reflecting the fact that it's more restrictive and may not be as sustainable as other ways of eating that offer more flexibility.


Mediterranean Diet
Paleo Diet
Food
Plant-based approach with seafood and limited meat, poultry and dairy.


Preference for whole foods over processed foods.

Restrictive eating plan that eliminates grains and other cultivated foods (potatoes, legumes, etc.).


Higher consumption of meat and poultry.


Focus on in-season fruits and vegetables.


Preference for whole foods over processed foods.

Weight Loss
If portions are controlled, weight loss can be achieved and maintained
A protein-heavy diet may be associated with rapid weight loss in some people, but may be harder to maintain because of the diet's restrictive nature.
Health Risks
Generally considered a healthy approach to eating with few health risks.
Elimination of certain food groups such as dairy and whole grains could reduce overall levels of fiber and calcium in the diet.


Increased intake of red meat and processed meats have been associated with increased risk of heart disease and certain kinds of cancer.

Health Benefits
Potential cardiovascular benefits, including lowered cholesterol and blood pressure; reduced risk of stroke.


Reduced risk of certain cancers.


Reduced risk of developing diabetes and better management of Type 2 diabetes.

Potential weight loss and better management of Type 2 diabetes