If you want to lower your blood pressure, cholesterol, or weight then you are probably researching on the best diet to follow. Both Mediterranean and Paleo diets claim to be the healthy, but which plan is actually better for your heart health? In this post i’ll give you an overview of both diets, and then compare which approach is best for weight loss and heart health. Let’s dive in! 

What is the Paleo Diet?

Back in 1975, gastroenterologist Walter L Voegtlin, MD, published a book called The Stone Age Diet. He argued chronic diseases are an outcome of humans eating foods they were not made to digest. This diet isn’t entirely new, yet in the 80’s and 90’s most people were dieting in the forms of weight watchers, cabbage soup diet, and Atkins.

Popularity of the diet really took off in 2002 when Loren Cordain, PhD, published their book The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. 

Paleo is also known as the “caveman diet”. The basis for this pattern of eating mirrors what humans ate as hunter-gatherers before modern agriculture. This would be a diet that would be nutrient dense and easy to digest foods. It includes foods like eggs, honey, meat, root vegetables, vegetables, and fruits. The diet advocates for grass-fed, wild-caught, and cage free products as those are how our ancestors would have retrieved their food. 

When followed, it tends to be a higher protein, moderate fat, and low carb pattern of eating. The protein is mainly from animal proteins like beef, poultry, fish, and eggs. This is because plant based proteins from lentils, beans, and tofu is not allowed. It is lower in carbohydrates because tubers like sweet potato, peas, and fruit are the main sources of carbs.

You might know people doing a round of the “Whole 30”. This is a 30 day challenge to eat the Paleo diet. Many people are drawn to Paleo because it is a more natural way to eat. It makes sense that if we want to be healthy, we should eat the same foods our ancestors ate, right? But what does the research say?

What are the Health Claims of Paleo?

Reduced inflammation, weight loss, and avoiding chronic disease like heart disease and diabetes. 

The European Journal of Nutrition looked at risk of cardiovascular disease (CVD) with Paleo diets, and observed a lower risk of CVD when on Paleo. However, it is most likely because of the removal of ultra processed foods.

Who Should Avoid a Paleo Diet?

Chronic Kidney disease

Paleo is higher in animal protein sources and higher in protein overall which can put more strain on kidneys. Plant proteins from legumes and lentils are a better choice over beef and chicken for this group of people to prevent to furthering of the disease.

Vegetarians and Vegans

The majority of proteins allowed on Paleo are animal based which makes it challenging to hit your protein needs. Foods like chia seed, peas, nuts, and seeds have protein, but not enough to meet your total daily intake.

Vegetarians could eat the foods above in addition to eggs for protein. However, I wouldn’t recommend this as you would have to eat a ton of eggs and nuts to hit daily protein needs.  Eventually, you will get tired of eating them!

Pregnant Women

My first concern is the fewer carbohydrate sources available on Paleo. Fruits and sweet potato have carbs, but to reach the 175g carb minimum to support you and your baby’s rapidly developing body, you are going to need to eat A LOT of sweet potato and fruit.

Here are some paleo-approved foods that have 15g of carbs.
– 1 Small apple
-1 Cup Grapes
-1 Cup Berries
-1/2 Cup Sweet Potato
-3/4 Cup Peas

If we broke this down, this means you will need to eat at minimum 11 servings of these foods above. It can be done, but it takes a lot of intentionality. Don’t even get me started on food aversions and cravings! When you are nauseas, I promise you will have no interest in eating an apple.

According to the Mayo Clinic, pregnant women needs more of these nutrients specifically:
1. Iron– red meat, oats, beans, lentils, spinach
2. Calcium- dairy, fortified non dairy milk and orange juice, leafy greens
3. Folate– dark leafy greens, lentils, citrus, asparagus
4. Folic Acid– this is the synthetic form of Folate. It is found in enriched breads, breakfast cereal, pasta and rice
5. DHA- fatty fish like salmon and sardines
6. Iodine– Iodized salt

Of these major nutrients, all of them except Calcium can be easily met with Paleo approved foods.

If following Paleo while pregnant, I would recommend to track your macro (carbs, protein and fats) and micronutrient intake during pregnancy and strategically map out how you want to fill in these nutrients.

Can’t I Just Supplement?

To make things easier while pregnant, I would encourage a whole food diet that includes all the paleo- based foods, but also includes grains, dairy, peanuts, and pulses. This will optimize your fiber, carbohydrate, and calcium intake easily.

You could argue that a prenatal supplement could just cover the necessary nutrients. However, vitamins and minerals in a vitamin form are not absorbed as effectively as if they are consumed from a whole food.

By relying heavily on supplements instead of sticking with whole foods you may also be missing components beyond just a single nutrient.

Lets say you take a calcium supplement instead of eating yogurt. You get in your calcium, but you are missing out on the added protein, probiotics, and potassium found in yogurt.

Let me be clear, I am not against tested high quality supplements. It can be hard to get in every vitamin/mineral, and especially in pregnancy! If you are battling fatigue or nausea, you might find yourself eating peanut butter crackers on the couch after work instead of cooking salmon and asparagus for dinner. I get it, i’ve been there!

Did Our Ancestors Actually Eat this Way?

Research is limited and its on a small scale, there is no conclusive evidence that the caveman diet was the way our ancestors ate.

Is Paleo Similar to the Mediterranean Diet? 

The commonality between these diets is the focus on whole foods found in fruits, vegetables, tubers, eggs, herbs, spices, animal proteins, nuts, and seeds. 

What are the biggest differences?

Below is a chart summarizing what each diet allows.

Alcohol isn’t really a food group, but Paleo does not include alcohol. However, Mediterranean has alcohol limits and notes benefits around red wine for its reverserol content.

Sugars- Paleo encourages unrefined sugars sourced from honey, maple syrup,stevia, monk fruit, or molasses according to Ultimate Paleo Guide. Mediterranean just emphasizes less added sugar. If you need heart health desserts, I created a list of them in Delicious Low Sodium Desserts (Dietitian Approved + Heart Healthy!)

Is Keto similar to Mediterranean?

Keto has more differences than similarities to the Mediterranean diet.

Both diets include lean proteins and non starchy vegetables. However, Keto is very different as it restricts carbohydrate sources found in grains, fruits, starchy vegetables (potato, peas, corn), 

Because of the restrictions on keto, the biggest difference is the macronutrient makeup. According to Harvard Health, Keto is a high fat, low carb and lower protein diet pattern. 

Unlike keto, the Mediterranean diet does not have a set limit on the grams of carbohydrates. The macronutrients tend to be more balanced with 45-60% of carbohydrate foods, 15-30% of protein, and 15-30% of healthy fats.

Which Diet is Better, Paleo or Mediterranean?

From a research standpoint, you can’t argue with the volume of studies that point to the benefits of a Mediterranean diet. Studies indicate it can improve chronic health conditions and prevent the development of chronic diseases. In fact, US News & World Report has named the diet the best for the past 8 years in a row.

This is a big deal as this panel includes Dietitians, Doctors, Researchers, and other medical staff.

I created a free downloadable heart healthy grocery list. Be sure to read, Low Sodium Grocery List PDF: [Includes 29 Healthy Snack Ideas] to download your list!

Pros of Mediterranean Diet:

1. Easy to Follow

If you are focusing just on whole foods, then this diet will be easy to follow! As with any health promoting diet, it can be challenging to find swaps for the packaged/ultraprocessed and high added sugar foods. Don’t let lack of healthy ideas stop you from improving your heart health! I created ideas inside Low Sodium Snacks- 16 Easy Heart Healthy Ideas from a Dietitian.

2. Fits a Variety of Taste Preferences

This could be argued for Paleo as well, but because Mediterranean incorporates more carbohydrate rich foods, I believe it can be easier to adapt culturally relevant recipes to be Mediterranean. I also find that recipes are more family friendly, which is important if you want to have your whole family eat healtheir.

There is nothing worse than trying to change your eating habits, while everyone else at the table is eating fried chicken and biscuits.

3. Includes Heart Healthy Powerhouses

The 3 food groups below are not included in a Paleo diet, yet have so much research on positive heart health outcomes, that it is worth mentioning them here.

Whole Grains and Heart Health

The reason whole grains are heart protective is their soluble fiber content. In a study cited in Advances in Nutrition, it was observed that soluble fiber has a significant impact on lowering cholesterol. It is especially high in whole grains like barley and oats.

This fiber creates a barrier in your gut and binds to cholesterol so your body doesn’t absorb it and go into your bloodstream. Think of soluble fiber like a mini vacuum cleaner that keeps your blood stream free from plaque build up.

While eating Paleo you could easily get soluble fiber from citrus, berries, pears, sweet potatoes, avocado, and cruciferous vegetables. There are plenty of other high soluble fiber foods, not just in grains.

If you want lower blood pressure and cholesterol while following Paleo you will need to strategize to make sure you pick the high soluble fiber veggies and fruits. As eating carrots, tomatoes, lettuce and green beans will not get you the 5-10g of soluble fiber that is recommended for improving cholesterol.

Pulses and Heart Health

Pulses include lentils and all the beans (black beans, chickpeas, great northern, pinto beans etc). Research from Harvard Health indicate plant proteins can protect against cancer, diabetes, obesity, and heart disease. 

They also contain high amounts of soluble fiber, a good source of protein, potassium, and are low in saturated fat. Pulses make an excellent food group to lower bad levels of cholesterol and blood pressure.

Dairy and Heart Health

In the Journal of Hypertension, it was found that dairy (yogurt, milk and cheese) can reduce risks for developing high blood pressure. Yogurt reduced risk for high blood pressure by 30% in both middle aged men and women. That is HUGE!

Another meta-analysis from Advances in Nutrition that looked at over 40 studies of eating dairy and disease also observed that dairy can reduce risk for hypertension, obesity, and type 2 diabetes.

Pros of Paleo:

Paleo is helpful for those wanting a very rigid way of eating. It is helpful for someone wanting a very clear roadmap of “allowed” vs. “not allowed” foods.

Over the years, I’ve noticed many people do much better with defined limits of what and what not to eat, but that does not mean it is always sustainable.

Cons of Paleo

1. More restrictions

For some it makes it easier to follow with more restrictions because what they can eat is very black and white. However, this does make socializing somewhat harder if you and the girls are going to happy hour and there aren’t many alternative menu options.

Have you ever talked to someone who completed the Whole30? Most of the time they are talking about how they are counting down the days until it’s over because it has so many restrictions!

Socially, it can be hard to tell your bestie, sorry I can’t eat those brownies unless they are made with almond flour. Or going to your friends kid’s birthday and you are sitting in the corner with a seltzer water and celery sticks because you can’t eat the pizza.

Yes, you can always eat before attending a social gathering with food. There are strategies for restaurants you can visit. Some people truly are not bothered by being around food they can’t eat. If that’s you, then more power to you!

2. Higher Grocery Bill

There is a huge cost difference when following this diet. Im not going to leave that part out in case that is something that you might need to consider before starting Paleo. At the time of this post, I went through the grocery store to look at the cost differences.

Eggs
Regular eggs ~2.99/dozen
Pasture Raised eggs- 7.99/dozen (this is different from cage free)

Nut Butter
Natural Store Brand Peanut Butter- 2.99/16oz
Organic Natural Almond Butter- 9.99/10oz

Meat
Ground Turkey 4.99/lb
Grass Fed Beef- 8.99/lb

Flour
King Arthurs Whole Wheat- 6.99/5 lb bag
Almond Flour- 7.99/1 lb bag

Don’t get me wrong. There is nothing wrong with eating higher quality food if you can afford it! Just be prepared at checkout to spend 20-30% more on food costs.

It’s sad because cost effective foods like oats, peanut butter, greek yogurt, beans, and lentils are really affordable if you are aiming to eat healthier without breaking the bank. Please don’t think that eating healthy has to equal expensive. If you strategize on what foods to buy and how to make more meals at home you can save a lot of money.

For that very reason I created a guide Smart Ways to Save Money on Groceries | Top Tips from a Dietitian if you want to eat better but aren’t sure how to save money on groceries.

Cooking can be a pain, so I included a list of easy meals you can make inside How To Eat Healthy Without Cooking: Tips and Meal Ideas from a RD

3. Potentially Higher In Saturated Fats

Depending on your protein choices while on Paleo, you might be taking in significant amounts of saturated fats. A diet higher in saturated fats can raise bad levels (LDL) of cholesterol. 

Many Paleo recipes include high saturated fats like bacon, coconut oil, and tallow. It doesn’t matter if your bacon is organic and nitrate free, it is still animal fat.

There is a lot of debate over saturated fats especially over the past decade. Its also EXTREMELY challenging to isolate one factor and conclude that one factor is the root of health problems. I did find it interesting in a study

Genetics, physical activity, stress, and what else people eat all make a difference. Consider two people who eat bacon.

Person #1- Eats only bacon daily for breakfast, hot pocket for lunch, and spaghetti for dinner. They hardly eat any fruits of vegetables.

They have a sedentary desk job, and do not engage in other physical activity aside from mowing the law 1x a week. 

Person #2- Eats bacon daily for breakfast with a side of berries and oats, packs a wrap with veggies, turkey, and avocado for lunch, eats rice and beans for dinner. They are a nurse who is on their feet for 12 hr shifts, and they swim on their days off of work. 

Do you see how its not just the bacon? It’s literally everything else in your diet that might also benefit heart health. 

Will using butter here and there lead to a heart attack? No.

However, there is a lot of research that shows the reverse. A diet high in plants it is heart protective.

Without writing a novel over here, it’s safe to say that ANYTHING that is too much in your diet can be bad. So please don’t use a cup of coconut oil for your cauliflower gratin okay?

4. Potential Gaps in Nutrients

Calcium

This can be found in leafy greens, but the amount is not as high as in dairy. 1 Cup of cow milk has 300g of calcium. Whereas, 1 Cup cooked Spinach has 240mg. However oxalates in leafy greens blocks the absorption of the calcium. There are fortified non-dairy beverages, but unless you plan to drink 24oz a day, then you will want to consider supplementing.

Vitamin D

Non-dairy products are also fortified with Vitamin D.
The sunlight is our greatest source of this vitamin, but if working a traditional desk job and don’t spend time outside, you are missing out on a big source of this vitamin.

It should be noted, millions of Americans are Vitamin D deficient, and they aren’t even eating paleo. Vitamin D deficiency is something we all need to be aware of and get checked at our annual physicals.

Takeaway:

Bottom line, the Mediterranean diet has more studies that are longer in duration for tracking heart health outcomes. While there are some studies around Paleo improving heart health, it could be primarily due to removing ultra processed foods. This should make us all reconsider that whole grains, pulses and dairy are not nutrition spawns of satan that cause inflammation and heart disease.

The overarching principles of cutting out ultra processed foods and added sugars is something everyone can do to improve their health! So instead of following a diet that includes unnecessary avoidance of food groups, why don’t you place your focus on going back to the basics. Start eating whole foods and limiting ultra processed empty calorie foods like candy, soda, pastries, and chips. 

Laurie Thenedy, RD

Laurie is a Registered Dietitian passionate about helping healthcare professionals lower their weight, blood pressure, and cholesterol so that they can regain confidence and energy to live a more full life.