Paleo vs Mediterranean: The Diet Face-Off by Associate Professor Antigone Kouris PhD APD AN

Happy Monday to all! 

The nutri-gossip on both the paleo and Mediterranean diets continue to make headlines, and I am absolutely delighted that my next guest expert will shed the light on both, talking about the science behind the two. A/Prof Antigone will walk you through the evidence behind each diet, where the take away message is this: Eat food, not too much, mostly plants. Over to you Antigone…Slide1

Study after study has shown that the Mediterranean food pattern and cuisine, high in legumes, fruit, vegetables and olive oil, moderate in grains, dairy, fish and low in meat, help people live longer. The study we did at Monash University in the 1990s, in conjunction with Athens University, was the first to show that following a Mediterranean food pattern in old age can reduce the risk of death by 50% after 5 years follow-up. Our novelMediterranean diet pattern score has since been applied to over 1 million study subjects by other researchers. These studies have also shown that the Mediterranean diet pattern reduces the risk of cardiovascular disease, can lower the risk or mitigate severity of diabetes, can reduce the risk of several cancers,  Alzheimer’s disease, depression and even help manage weight and fatty liver (despite high olive oil content). 

mediterranean_dietThe first randomized trial on the Mediterranean cuisine (where study subjects were advised to eat Mediterranean dishes) was conducted in Spain on over 7000 people. After 5 years on this diet, heart disease rates were 30 per cent lower than the control group who were consuming a low fat diet!  All this evidence on the Mediterranean food pattern and cuisine has given it the highest possible ranking by the NH&MRC (level 1 evidence) for the prevention of chronic diseases.  So convinced by the evidence, the Royal Australian College of General Practitioners has recently released a handout for doctors and dietitians on how to advise patients to follow a Mediterranean diet for the prevention of heart disease.

The low carb, high fat, high animal food “Paleo” diet is the latest craze for health and weight loss. It encourages lots of red meat, fish, poultry, eggs, nuts, fruit, vegetables but no dairy, grains, legumes or processed oils.  Quite the opposite to the Mediterranean diet with its plant food emphasis!  There is limited evidence that the Paleo diet can help with weight loss in the short term.  There have also been several small studies showing it may improve insulin sensitivity and several CVD risk factors in the short-term.  Unfortunately however, most of these “Paleo” studies have serious limitations:  small sample size and short time period. The Paleo diet is often described as a “lifestyle change” but unlike the Mediterranean diet studies, there doesn’t seem to be any longitudinal data on its long term safety.   

The Paleo diet discourages carbs from grains, legumes and potatoes. The Mediterranean diet is by no means “low carb”.  Some of the longest lived populations around the world eat bread, pasta and potatoes (elderly Greek Ikarians), rice (elderly Japanese Okinawans)  and legumes (elderly Californians in Loma Linda).  In fact our research at Monash University showed that the most protective aspect of the Mediterranean diet pattern was the legumes (banned on the Paleo diet)!  

The gut microbiome is emerging as an important contributor to human health. Diets high in animal protein and low in unrefined carbohydrates/resistant starch (found in rice, potatoes, bread, pasta, legumes) are associated with reduced microbiota diversity, increased relative abundance of undesirable bacteria and their toxic metabolites which in turn can cause low grade chronic systemic inflammation and chronic disease. The traditional Mediterranean diet is low in animal foods and animal fats and high in plant foods (especially legumes) and plant fats and is probably operating through the promotion of a healthy gut  (look out for our review paper in Asia Pacific Journal of Clinical Nutrition Kouris & Itsiopoulos in 2014).

Distinguished nutrition scientists from Yale University Dr Katz and Dr Meller recently conducted a thorough scientific review to answer the almost impossible question of what is “the” best diet for health. After assessing all the evidence on all the various diets, they condensed their recommendations to 3 key words and phrases:  food, not too much, mostly plants. 

Antigone2012frontreduced copyAbout the Author: Antigone is an Accredited Practising Dietitian with over 28 years experience. She has been an Adjunct Associate Professor in the Department of Dietetics and Human Nutrition at La Trobe University in Melbourne since 2011 where she is involved in teaching and research on the Mediterranean diet. Antigone has over 40 published papers, mostly on the Mediterranean diet and longevity, runs a busy private practice and is the founder of a company that develops a range of nutritious high fibre reduced sugar/starch FODMAP friendly Spelt and gluten free Lupin cookies under the name Skinnybik. Go to for more info! 

For more information and scientific references on:

References on Mediterranean diet 
References on Paleo diet 
References on Microbiome 

  1. Great blog post, defiantly a difficult one to discuss with Paleo followers. It seems the diet is more of a community belief/ideology than nutrition science.
    Keep up the good work 🙂

  2. Ah, sensible and healthy eating. Why is it so difficult to promote? Maybe it needs a fancy name. The Ikarian Diet? The Kouris Longevity Protocol? Thanks for the refreshing article Antigone

  3. Great summary! Another thing I really like about a Mediterranean style of eating is that it is tasty! No point eating in a certain way if you can’t keep it up over the long-term.

  4. Antigone has done a great job summarising the evidence behind both! Such a shame that we are becoming such a diet crazed society, where healthy eating is being promoted via “Diet Labelling”. Whenever the myths are revealed, dietitians are attacked for promoting “false-science” and our profession is now being questioned by the public, thanks to “investigative journalists” who claim to “reveal the truth” about food and nutrition.

  5. I am glad you liked my article. I forgot to mention that the Mediterranean diet which promotes vegetarian legume based eating at least twice a week is also more environmentally friendly and sustainable than the Paleo diet which does not support vegetarian eating with all the protein primarily coming from animal foods/fish.

    • Sustainable in mass scale is nothing. Not even vegetarianism, although it might seem in theory better. So don’t pinpoint that as fact or advantage of one above other. Enviromentally friendly, frankly, hard to say what you mean by that .. the GMO-crop fields that had to be made of rainforest deforrestation in order to have huge companies making there the so needed legumes and grains?
      But yeah, it is more expensive to breed grassfed cattle, consumes more watter and produces more waste than some single persons field with all-they-can consume in one year. But again, this is not sustainable in people count we have right now and will have in future on our small planet.

  6. Me as Paleo promoter, now more on Whole 30 side, I have to say, although evidence (on side of paleo there is almost any) might say something, both of the comparisons are just evaluating that and not the same measures.
    Frankly I have nothing against other diet styles especially Mediterranean sounds kind of cool and proof of having long-living people with lower amount of chronical diseases is just there, undoubtedly.

    What I have problem is that author is kind of getting Paleo wrong. Although there is no promotion of carbs from some forbidden sources, it is not in general low-carb diet and it is high-fat (It was not even in summer during paleolithical time, it is not even now apart from people just trying to do weight loss). If in Mediterranean is legumes counted in amount of veggies consumed, paleo is definitely not behind on the rate and I would even say that some more strict diet pieces of that would even challenge and overcome some of the numbers.

    Only time might say if Paleo has better influence and anyways, I don’t think if someone is trying to say what diet is the superior as just one holistic approach is not possible for all human beings (different composition, allergies, genoma, predispositions etc.) and yet as there is not much to pick from (Paleo is known in its new look for just couple of tenths of years, promoted in higher scale just recently and definitely more driven in discussion by opponents who just show true misunderstanding than facts).

    Last thing to say, if Paleo promotes lifestyle change, Meditteranean ignores that completely, are you sure there is any evidence to say that under same conditions it is not better? I would challenge you on that, because food habits can make a lot of difference, but it is not all.

    But I like this article as it shows professional approach than just another random kick to Paleo just because someone is proponent of different kind of eating style.

    Have a nice day, I will definitely browse your web a bit more.
    Mirek from Czech Republic

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