When it comes to managing weight and high blood pressure, two of today’s most popular diets — the Ketogenic (Keto) Diet and the Mediterranean Diet — are often compared. So which one is truly better? A recent study suggests the answer isn’t so simple.

What the Research Says

A small observational study published in Nutrients compared the effects of the Keto and Mediterranean diets in 26 overweight or obese adults with high-normal blood pressure or grade I hypertension. Over a 3-month period, participants were assigned one of the two diets based on personal preference and nutritional assessment.

Both diet groups consumed approximately 1,300 kcal/day and engaged in moderate physical activity five days a week. Here’s how the two diets compared:

• Keto Diet Group (15 people):
  • 10–15% carbs, 55–60% fat, 25–30% protein
  • Higher sodium intake (5–8g/day)
  • Average age: 41.7 years; 73% male
• Mediterranean Diet Group (11 people):
  • 40–50% carbs, 35% fat, 15–25% protein
  • Lower sodium intake (<5g/day)
  • Average age: 52 years; 55% male

Results After 3 Months

The study found significant health improvements in both groups:

• Average weight loss: from 96.6 kg to 86.8 kg
• BMI reduction: from 32.9 to 29.5
• Reduced waist circumference and improved physical activity levels
• Blood pressure dropped significantly overall

However, the only notable difference between the groups was nighttime blood pressure. Participants on the Mediterranean diet experienced a healthy nighttime dip, which is linked to better heart health. Those on Keto saw an increase in nighttime BP, which may raise concerns about long-term cardiovascular risk.

What Should Patients Do?

While both diets resulted in improvements, experts emphasize that there is no one-size-fits-all approach to diet.

“The right eating plan depends on your preferences, health needs, culture, and lifestyle,” says Amanda Nash, registered dietitian with the Heart & Stroke Foundation of Canada. “What matters most is that the diet is sustainable, nutrient-rich, and avoids ultra-processed foods.”

She also points out that the DASH diet (Dietary Approaches to Stop Hypertension) — which emphasizes fruits, vegetables, whole grains, and low-fat dairy — also has strong evidence for lowering BP and improving metabolic health.

Key Takeaways for Our Patients

• Both Keto and Mediterranean diets can support weight loss and blood pressure reduction — if supervised by a healthcare professional.
• Sodium intake and overall lifestyle (physical activity, sleep, social connection) are just as important as calories and macronutrients.
• The Mediterranean diet may have an edge when it comes to heart health, due to its focus on whole foods, moderate salt, and lifestyle habits.
• For most Canadians, reducing ultra-processed foods, eating more plant-based meals, and following Canada’s Food Guide is a practical and effective approach.

Interested in finding the best plan for your health goals?

Our team of family physicians, dietitians, and clinical pharmacists is here to guide you. Whether it’s weight loss, blood pressure, diabetes prevention, or managing chronic disease, we help tailor nutrition and lifestyle plans to each individual’s needs.

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Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your healthcare provider first. Full Disclaimer.