Mediterranean Diet vs. Paleo Diet: What's the Difference?

The Mediterranean diet and paleo diet both emphasize minimally-processed foods, but they differ in what specific food groups they encourage and limit.

Mediterranean diet basics

Rather than having strict dietary rules, the Mediterranean Diet is based on traditional eating patterns of some countries located along the Mediterranean Sea, including Greece, Italy, Southern France, Spain, and parts of the Middle East (1).

It focuses on flavorful ingredients like vegetables, fruits, legumes, whole grains, seafood, nuts, seeds, and olive oil. Animal products, like dairy and eggs, are enjoyed in moderate amounts. Even a moderate amount of red wine is encouraged.

On the other hand, red meat, refined grains, added sugars, and ultra-processed foods are discouraged.

Research associates this eating pattern with many health benefits, such as promoting heart health, supporting brain function, stabilizing blood sugars, and more (2).

Keep in mind that there are no concrete rules for how to follow the Mediterranean diet. Instead, there are general guidelines that you can incorporate into your daily routine.

However, there’s been criticism about the Mediterranean diet’s focus on Eurocentric foods. We need more research into how we can apply the diet’s principles to more diverse cuisines.

Remember that choosing an eating pattern rooted in the principles of the Mediterranean diet doesn’t have to mean giving up your cultural foods.

In fact, it’s important that your eating habits incorporate foods that are easy to access locally and meaningful to you culturally or personally.

For example, learn more about giving the Mediterranean diet a Caribbean twist here.

Paleo diet basics

The paleo diet has gained traction in recent years. Other names for the paleo diet include Stone Age diet, caveman diet, and hunter-gatherer diet.

Essentially, the paleo diet encourages modeling your diets after what some believe our Paleolithic human ancestors ate thousands of years ago.

While their diets would have differed based on where our ancestors were located in the world, the basic concept is to eat whole foods and avoid foods that require processing.

Thus, the paleo diet consists of lean meat, fish, vegetables, fruits, and nuts, while restricting grains, dairy, legumes, vegetable oils, added sugar, salt, and ultra-processed foods (3).

However, since Paleolithic humans thrived on various diets depending on geography and time, their eating patterns are hard to decipher. In fact, review of the paleo diet in 2018 found 14 different definitions of “paleo” (4).

Summary

Both the Mediterranean and paleo diets emphasize fruits, vegetables, nuts, seeds, and some meats while limiting highly-processed foods. The paleo diet also restricts legumes, dairy, and grains.

Both the Mediterranean diet and the paleo diet emphasize the following foods:

• fish
• vegetables
• fruit
• nuts and seeds

These are all minimally-processed foods. Since the definition of “processed” may be confusing, an international panel of food scientists and researchers developed NOVA, a classification system for food processing.

Both the Mediterranean diet and paleo diet fall into the same end of the NOVA spectrum — that is, encouraging more unprocessed and minimally-processed foods.

However, the term “processed foods” includes a wide variety of products, many of which are more convenient and less expensive than other foods. Not all foods that undergo processing are considered unhealthy. Learn more here.

Another similarity? Neither diet requires tracking or calculating portion sizes and numbers. However, the paleo diet calls for strict avoidance of certain food groups, some of which contain many nutritious foods.

Summary

Both diets emphasize unprocessed or minimally-processed foods. Neither requires tracking or calculating portion sizes.

Compared with the Mediterranean diet, the paleo diet is stricter. It calls for complete avoidance of grains, legumes, and dairy. Foods like tubers, fish, poultry, red meat, nuts, and seeds are encouraged instead.

As such, the paleo diet cuts out many nutritious foods. Dairy, whole grains, and legumes are not inherently unhealthy — in fact, they contain important nutrients like calcium, vitamin B12, iron, magnesium, zinc, and protein, to name a few.

These nutrients are important in preventing and managing disease. Depending on where you live, these foods can be easy to access and afford.

On the other hand, whole grains and legumes are strongly promoted on the Mediterranean diet. Dairy products, like yogurt and cheese, are enjoyed in moderate amounts. Finally, red meat like beef and pork are discouraged, though not restricted.

The paleo diet can include lard, coconut oil, and butter as cooking oils, in addition to avocado and olive oil. The Mediterranean diet discourages saturated fats like lard, coconut oil, and butter.

Summary

The paleo diet eliminates grains, dairy, and legumes, while the Mediterranean diet encourages these foods. Cooking oils also vary, with the Mediterranean diet focusing on olive oil while the paleo diet includes butter, lard, and coconut oil.

The Mediterranean diet and paleo diet may affect health in different ways. You may be wondering which one is better for your wellbeing.

The Mediterranean diet may improve blood sugar, but research is mixed on paleo

Many studies associate the Mediterranean diet with reduced blood sugar levels and reduced insulin resistance.

A review of 20 studies found that the Mediterranean diet appears beneficial for preventing diabetes and metabolic syndrome (5).

Another review found that greater adherence to the Mediterranean diet was associated with a greater reduction in risk for type 2 diabetes (6).

However, it notes that since these studies were conducted within specific settings, this effect may not be as strong in all populations (6).

In comparison to the paleo diet, a review of 56 studies concluded that the Mediterranean diet was more effective at reducing fasting blood glucose and A1c in those with type 2 diabetes (7).

A1c is a measure of your average blood sugar readings for the past 3 months (7).

It’s important to note that those who followed a paleo diet experienced significantly lowered blood sugars as well (7).

This is consistent with a review reporting that although the paleo diet was linked to reduced blood sugar levels, it wasn’t more effective than other eating patterns (8).

However, another randomized control trial found no changes in A1c after 12 weeks on the paleo diet (9).

The evidence for reducing blood sugar is strong for the Mediterranean diet but mixed for the paleo diet, so we need more research. Plus, it’s tough to characterize effects of the paleo diet since there are so many definitions and variations.

The Mediterranean diet may benefit heart health, but it’s unclear if paleo does

The Mediterranean diet has long been promoted as heart-healthy.

One reason for that is its emphasis on whole grains, legumes, nuts, seeds, and fruits and vegetables, which make this eating pattern very high in fiber.

A review of 45 studies found that following the Mediterranean diet principles is linked to significantly reduced rates of total cardiovascular (heart) disease (10).

Once again, researchers emphasize the need to adapt the Mediterranean diet to different geographic settings and cultural food preferences (10).

Regardless, a diet rich in whole grains and legumes — components of the Mediterranean diet — is shown to reduce heart disease risk and improve metabolic health outcomes (11, 12).

We also know that incorporating more nuts — a component of both the Mediterranean and paleo diets — is associated with reduced risk of heart disease (13).

For the paleo diet, however, the results are unclear.

A review of eight studies found a link between the paleo diet and improvements in heart health markers like blood pressure, cholesterol, and triglycerides. However, researchers emphasized the studies were not well-designed, so more evidence is needed (14).

Research also suggests that those who followed the paleo diet for more than one year experienced unfavorable gut microbiota changes.

Specifically, TMAO — a metabolite derived from gut bacteria and a predictor for future risk of heart disease — was found to have increased. This could be from the lower overall fiber, since the paleo diet restricts legumes and whole grains (15).

Keep in mind that the paleo diet can differ greatly based on individual interpretation.

For example, some people may choose more saturated fats like red meat, butter, and lard, while others opt for unsaturated fats like olive oil, nuts, and seeds.

Replacing saturated fats with unsaturated fats can help reduce risk for cardiovascular events, which suggests that paleo’s effects on heart health can be made greater based on individual people’s choices (16).

Despite popular claims, it’s unclear how either diet affects inflammation levels

Chronic inflammation can cause metabolic stress and increase the risk of many diseases, such as type 2 diabetes, heart disease, and cancer (17).

A cross-sectional study among 646 adults suggests that both the Mediterranean and paleo diets are linked to lower levels of inflammation and oxidative stress (18).

Furthermore, a review of 13 studies found that the Mediterranean diet was associated with reduced inflammatory marker C-reactive protein. However, when other indicators of inflammation were included, the results became mixed (19).

Since inflammatory markers like C-reactive protein can also increase due to infection, a single indicator of inflammation may not be an accurate measure of chronic inflammation. Therefore, it’s important to include other indicators.

Conversely, another review of 11 studies concluded that the Mediterranean diet had no effects on inflammatory cytokines in those with coronary heart disease (20).

Inflammatory cytokines are proteins that are believed to play a role in causing heart disease and heart attacks (21).

Proponents of the paleo diet claim that this eating pattern can reduce inflammation by positively affecting the gut microbiome. However, a 2018 review found no high-quality studies that supported this notion (22).

A later study also found that those who followed a paleo diet for one year actually experienced unfavorable gut microbiota changes (15).

Summary

The Mediterranean diet appears to support heart health and improve blood sugar levels, but it’s unclear whether the paleo diet has the same effects. Neither diet has strong evidence supporting the idea that it reduces inflammation.

Both diets emphasize unprocessed and minimally-processed foods, which is an excellent guideline to follow.

However, the Mediterranean diet ultimately has more evidence to support its health-promoting benefits. Plus, the paleo diet is restrictive, which can be harmful for many reasons.

Restrictive diets can increase your risk of engaging in disordered eating habits and can cause bingeing, according to decades of research. It can also lead to an unhealthy obsession with eating “clean,” known as orthorexia nervosa (23, 24).

Food restrictions can also cause social isolation and loneliness — which is no surprise, as eating with others is a bonding experience across cultures (25, 26).

Finally, food restriction reduces food variety. Variety may help protect your health, since eating a lot of different foods ensures that you get all of the nutrients your body needs (27).

Learn more about potential side effects of the paleo diet here.

Which diet you choose, if you choose one at all, may depend on many factors — including your health goals, needs, preferences, and access to foods.

For example, if you prefer plant-based eating, you may find that the paleo diet is inappropriate for you. Or, if you’re intolerant to legumes, it may be difficult to adopt the legume-heavy Mediterranean diet.

Since the paleo diet can be restrictive, our best advice if you choose this pattern is to try and eat a wide variety of foods to make up for the extensive restrictions.

For example, choose a large variety of fruits and vegetables to rotate weekly, eat fatty fish more often, and fill up on tons of different tubers, nuts, and seeds.

Keep in mind that regardless of which diet you choose, what matters more is that you make nutritious choices within its guidelines and individualize it to your own health, culture, and preferences.

Summary

When determining which diet is right for you, consider your health goals, needs, preferences, and access to foods. Paleo diets may be too restrictive for some people, so if you want to follow it, ensure you eat lots of variety.

Both the Mediterranean diet and paleo diet have evidence suggesting that they can help promote health and reduce risk for disease. However, the evidence for the Mediterranean diet is much stronger.

The Mediterranean diet appears particularly well-suited to managing blood sugar and promoting heart health. Research remains mixed for both diets’ effects on inflammation.

The paleo diet is restrictive and lacks variety, unlike the Mediterranean diet. As such, some evidence suggests that the paleo diet can harm gut and heart health in the long term, as well as promote disordered eating habits.

However, different people will interpret and follow the paleo diet differently, and some of its effects may come down to personal food choices.

Regardless, both dietary patterns emphasize minimally-processed foods, which is an excellent principle to follow.