ASK FIVE PEOPLE IF THEY HAVE FOUND THE HOLY GRAIL FOR DIET, and you will get five different (often forceful) answers. There have long been arguments about which low-carbohydrate diet — The Mediterranean versus ketogenic — is best for those with prediabetes and type 2 diabetes. Keto or Mediterranean diet: Which is better?
Now we have some answers from a prospective randomized clinical trial comparing the two approaches. Do you prefer either of these two approaches to diet?
Keto versus Mediterranean
Stanford nutrition scientist Christopher Gardner, Ph.D., and colleagues randomized 33 adults with prediabetes or type 2 diabetes to eat a Mediterranean and a keto diet for 12 weeks each in random order.
Both diets incorporate non-starchy vegetables and avoid added sugars and refined grains. Still, there are three key differences between them: the Mediterranean diet incorporates legumes, fruits, and whole grains, whereas keto does not.
Here are the results:
- A measure of blood sugar (hemoglobin A1c) values improved on both diets, with no differences between the two approaches.
- Those on the keto diet had a greater drop in triglycerides (than the Mediterranean diet; 16 percent reduction versus five percent).
- LDL (“bad”) cholesterol appeared higher for those on the keto diet (up 10 percent versus five percent).
The researchers state that the potential harms of higher LDL associated with keto cannot be dismissed.
Other findings include similar results for weight loss at seven to eight percent), higher “good” HDL cholesterol on the keto diet (up 11 percent versus 7 percent with the Mediterranean diet).
Finally, those on the keto diet had a lower intake of fiber and three essential nutrients (folate, magnesium, and vitamin C).
What about adherence to the diet? At 12 weeks, participants appeared more likely to adhere to the Mediterranean diet. The researchers offer this takeaway message:
“Collectively, these comparative outcomes do not support a benefit sufficient to justify avoiding legumes, whole fruits and whole, intact grains to achieve the metabolic state of ketosis,” the researchers said. However, “in a clinical setting, patients should be supported in choosing a dietary pattern that fits their needs and preferences. There should be less focus on promoting one particular diet approach as best; rather, clinicians should allow patients to make an informed choice to help them establish which approach is most suitable for them.”
I am not advocating for any particular diet but wanted to share with you the results of this randomized clinical trial (with limited follow-up). Both approaches helped with diabetes, but the Mediterranean appeared easier to stick with.
Thank you for joining me in the loos at keto or Mediterranean diets.
