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    Mediterranean versus Paleo: Which Eating Pattern is Best?

    The Mediterranean and Paleo diets both have their strong devotees and their fervent critics. Midtown Athletic Club in Rochester Nutritionist Sarah Guilbert takes over the blog to compare two popular diet patterns to help you discern which, if either, is the healthiest option for you.

    The word “diet” tends to be associated with negative self-image and restriction (“I can’t blow my diet” or “I need to go on a diet and lose these love handles”). It also implies that eating habits are temporary when healthy eating should be an enduring and sustainable lifestyle.

    An “eating pattern,” however, is comprised of lifestyle eating habits that serve as a guide to how many servings of different foods you should have each day. Both the Mediterranean Diet and the Paleo Diet fall into the “eating pattern” category.

    Before we dive into the specific aspects of each diet, keep in mind that I never recommend one specific eating pattern for everyone. There are benefits and drawbacks to every way of eating. It’s important to find one that is balanced, sustainable, enjoyable, and tailored to your specific needs.

    Now let’s take a closer look at these two popular eating patterns.


    Longitudinal evidence has demonstrated that the Mediterranean eating pattern lowers your risk of many developing several diseases, including cancer and heart disease (1, 2, 3).

    The Mediterranean eating pattern pyramid divides foods into ones that you should eat at every meal, foods that you should eat every day, and foods that you should eat weekly. It emphasizes fruits, vegetables, whole grains, olives/olive oil, nuts, and seeds. It encourages limiting starchy vegetables, red meat, and processed meat. White meat, fish, and legumes fall in the middle, with approximately two servings per week of each recommended.

    The Mediterranean eating pattern is a good choice for many other reasons. It promotes whole/natural foods, increased fruit and vegetable intake, and it does not restrict any major food groups. It emphasizes cardio-protective fats and encourages limiting the types of fats that have been shown to negatively affect your health (saturated fat and trans fat). The eating pattern promotes the consumption of healthy fat and fiber, which will help promote satiety, and includes potassium-rich food, because it is primarily plant-based and includes many fruits and vegetables.

    One criticism of the Mediterranean eating pattern is that it can be low-to-moderate in protein, which is a concern for athletes. It limits white meat to two servings/week and places fish/eggs higher up on the pyramid, which implies that they should be eaten less frequently (although it recommends having at least two servings of fish/week).

    For the sample breakdown menu shown below, lunch was low in protein (14 grams). Athletes who require 25-30g protein per meal may need to add more protein to their plates.


    The Paleo Diet boasts that it is the “world’s healthiest diet, based on wholesome, contemporary foods from the food groups that our hunter-gatherer ancestors would have thrived on during the Stone Age” (5). It aims to improve overall health, promote weight loss, and lower disease risk (6). It is a relatively new diet and does not have the longitudinal data that other eating patterns have to support it.

    Image via athleanx.com

    Let’s look at the breakdown of a typical day. The Paleo eating pattern encourages meat, fish, poultry, vegetables, and fruits (mostly berries and melons). It excludes grains, dairy, legumes, added sugar, and salt because people living in the Paleolithic age would not have eaten those foods.

    The Paleo eating pattern has many benefits. Natural foods and limited processed foods are a big part of this eating pattern, which helps to lower empty calorie intake and reduce sodium intake. It also emphasizes vegetable consumption and is higher in protein than the Mediterranean Diet. This combination will increase satiety and may promote weight loss. The Paleo eating pattern promotes the consumption of lots of fiber (the sample menu below has 47 grams), which can help healthy gastrointestinal function and lower cholesterol levels.

    However, this much fiber may be a shock if new followers of the eating pattern try to increase their intake too quickly. Fiber intake should be increased gradually and should be coupled with increased water intake. The typical Paleo eating pattern is also high in potassium, which helps prevent hypertension. By encouraging nuts, the Paleo eating pattern also includes many heart-healthy fats, like the monounsaturated and polyunsaturated fats found in almonds.

    On the negative side, this eating pattern eliminates multiple key food groups (dairy, grains, legumes). In a study of over 75,000 women, Harvard researchers showed that including 2-to-3 servings of whole grains per day correlated with a 30% lower risk of having a heart attack or dying from heart disease (8).

    This study took place over ten years (compared to the ten days that some of the Paleo studies were conducted).  Yes, Americans tend to eat too much processed grains; however, this does not mean that grains should be eliminated from the diet completely.

    Another negative aspect is that this diet is excessively high in protein. Based on the 1,800-calorie plan outlined below, a Paleo eater would be getting 151g protein/day on the low end (there is an optional added 3 ounces of fish if protein intake was not satisfying for the day).

    Generally acceptable protein intake ranges from .8-2.0 grams of protein per kilogram that you weigh. For example, a 130 pound person would have an upper limit on protein intake of 118g protein/day. This diet also excludes the major source of calcium in the diet: dairy products.  Inadequate calcium intake can lead to developing osteopenia and can also be detrimental to heart health (9).

    Which Is Best?

    The Mediterranean eating pattern is a much more established, balanced way of eating for lifelong health. I would recommend it to most clients, but would also recommend increasing protein slightly at mealtimes. Is the Paleo diet the worst eating pattern out there? No. However, I would not recommend it unless it was modified slightly to reduce protein intake and include at least three servings of whole grains and two servings of dairy products daily. This would ensure that followers of this eating pattern obtain adequate healthy fuel and calcium sources while not overdoing it with protein.

    Image via www.naturalhealthadvisory.com

    In a future post, I will compare two diets: Advocare and The South Beach Diet. If you would like me to examine other eating patterns and diets, leave a comment on this post.

    Mediterranean Paleo (menu from bodybuilding.com)
    Breakfast 6 oz Greek yogurt

    ½ cup strawberries

    1 tsp honey

    1 slice WW toast

    ½ mashed avocado

    4 slices lean ham

    2 cups mixed berries


    AM Snack None Low sodium beef jerky

    1 apple

    10 almonds

    Lunch 1 WW pita

    2 Tbsp hummus

    1 cup fresh greens

    2 slices tomato

    1 cup minestrone soup

    1 medium orange

    4 oz salmon

    2 cups salad

    1 T olive oil

    2 cups melon

    PM Snack 1/8 cup sliced almonds

    1/8 cup peanuts

    3 oz grilled chicken

    1 serving raw vegetables

    2 kiwis

    Dinner 3 oz salmon

    1 tsp tarragon

    1 tsp mustard

    ½ cup couscous

    ½ cup zucchini

    4 spears asparagus

    Salad with ½ cup arugala, ½ cup baby spinach, 1 T shaved parmesan cheese, 1 T vinaigrette dressing

    5 oz red wine (optional)

    3 oz grilled lean steak

    2 cups steamed broccoli

    15 almonds

    Dessert/PM Snack Small bunch grapes

    ½ cup lemon sorbet

    1 handful walnuts

    1 orange

    3 oz grilled fish (optional)

    Calories: 1621 with wine, 1491 without

    Carbs: 194g (50.5%)

    Fat: 53g (31%)

    Protein: 71g (18.5%)

    Sodium: 1746 mg

    Fiber: 34g

    Cholesterol: 49mg

    Calories: 1796 without fish

    Carbs: 176g (39%)

    Fat: 77g (39%)

    Protein: 151g (34%)

    Sodium: 1975mg

    Fiber: 47g

    Cholesterol: 237mg


    (1) Couto E, Boffetta P, Lagiou P, & Ferrari P et.al.  Medierranean dietary pattern and cancer risk in the EPIC cohort.  April 26, 2011.  Br J Cancer 104(9): 1493-9.  Retrieved March 11, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/21468044.

    (2) Mitrou P, Kipnis V, Thiebaut A, & Reedy J et al.  Mediterranean dietary pattern and prediction of all cause mortality in a US population.  December 24, 2007.  Arch Intern Med (3) 167(22): 2461-2468.  Retrieved March 11, 2013, from http://archinte.jamanetwork.com/article.aspx?articleid=770019.

    (4) USNews Health.  Medierranean Diet-Sample Menu.  Retrieved March 11, 2013, from http://health.usnews.com/best-diet/mediterranean-diet/menu.

    (5) Innocenzi, L.  Academy of Nutrition and Dietetics.  Should we eat like our caveman ancestors?  Retrieved on March 11, 2013, from http://www.eatright.org/Public/content.aspx?id=6442471551.

    (6) The Paleo Diet.  Retrieved on March 11, 2013, from www.thepaleodiet.com.

    (7) Life Expectancy-what is life expectancy.  Retrieved on March 11, 2013, from http://www.news-medical.net/health/Life-Expectancy-What-is-Life-Expectancy.aspx.

    (8)  Harvard School of Public Health.  Health gains from whole grains. 2013.  Retrieved on March 11, 2013, from http://www.hsph.harvard.edu/nutritionsource/health-gains-from-whole-grains/#references.

    (9) Office of Dietary Supplements: National Institutes of Health.  Dietary Supplement Fact Sheet: Calcium.  November 16, 2012.  Retrieved on March 11, 2013, from http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/.

    (10) Clark, S.  Body Building.  What is the Paleo Diet?  Dec 29, 2010.  Retrieved on March 11, 2013, from http://www.bodybuilding.com/fun/what-is-the-paleo-diet.html.

    26 Responses to Mediterranean versus Paleo: Which Eating Pattern is Best?

      1 COMMENT FROM Caryn Nolen April 1, 2013 at 4:58 pm

      Excellent information. I just finished a clean eating challenge group and would love to learn more about the Mediterranean diet. I have actually never heard of that diet. Can you recommend a good book that would illustrate a daily diet plan?

      2 COMMENT FROM Sarah Guilbert April 1, 2013 at 8:02 pm

      Hi Caryn, this website gives a brief synopsis of ten different books on the eating pattern: http://www.abebooks.com/blog/index.php/2009/08/12/the-mediterranean-diet-ten-books-to-get-you-started/. #6 on the list (The Mediterranean Diet by Marissa Cloutier and Eve Adamson) looks like it would give you both general information and a sample plan to show you what the pattern looks like. Bonus-it is written by a Registered Dietitian! Any of the other books on the list look good, as well.

      3 COMMENT FROM Eric Kittell July 1, 2013 at 2:15 pm

      Not so fast, the study that showed 30% less chance of heart disease or hear attack was in comparison to other people who’s diet included processed grains, and who know how much and what else! It wasn’t comparing whole grain consumption to no a no grain, paleo diet.

      4 COMMENT FROM sarah guilbert July 2, 2013 at 6:46 am

      Hi Eric, It’s Sarah, the Dietitian from Midtown.

      Thanks for your comment. The study was, indeed, referring to the benefits of including whole grains in the diet.

      The article I cited was examining a review article of seven different studies (two of which were meta-analysis which drew from multiple studies).

      Some of these studies compare whole grains to refined grains while some just examine whole grain intake vs. lack thereof.

      To go into detail on the design of each of the many studies used in the review would be excessive. If you would like to email me privately to discuss whole grains vs. refined grains vs. no grains, please feel free to do so (sarah.guilbert@midtown.com). Thanks!

      5 COMMENT FROM harjeet90 July 31, 2013 at 1:00 am

      nice article, this diet plan is fantastic, it’s really works,i think eggs helps too much in improving your health,weight loss, i have also tried this, eggs are too good for healthy life..seggested reading eggs good for weight loss

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      12 COMMENT FROM Jasper May 11, 2014 at 2:18 pm

      I wanna try a combination out of those two diets actually. Lots of Fish and olive oil and less milk, but dairy products in general. I also get that goat milk or sheep milk is better than cow milk. So far I’m informed. But a very reduced level on grains. I don’t see what’s wrong with legumes!?

      I’m eating way too unhealthy and way too many carbohydrates at the moment. :(
      I reduced them and noticed that I suddenly started eating a lot more healthier! I’ve the feeling since a long while that my body has difficulties with too much grains. Also with too much milk, but I always ate some cheese. I guess it’s the lactose I just tolerate up to a certain amount.
      I don’t see much sense in following one restricted program. I guess everyone has to pick the points he or she finds the best and make an individual diet program. At least that’s my opinion. We are talking here about healthy way of eating and personal eating habits and not a new religion. ;)

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