By Dr. Josh Axe

Health magazine called 2018 the year of “high-fat fads, meat-only meals, and Bible-inspired eating.” What are two of the most popular diets that contributed to this reputation? The ketogenic diet and the “Carnivore diet” (aka the Paleo diet).

Given the fact that millions of people are now proponents for these two low-carb diets, let’s talk about Paleo vs. keto: Which of these massively popular eating plans is best, and is it possible to do both Paleo and keto at the same time?

What Paleo and Keto Have in Common

First and foremost, let’s get clear on what each of these popular diets entail. 

The Paleo diet is essentially a way of eating that seeks to ditch modern convenience/processed foods in favor of natural, nutrient-dense foods that were eaten by our hunter-gatherer ancestors. 

The ketogenic (or “keto”) diet is a very high-fat, very low-carb diet. It’s unique among other low-carb diets because it puts your body into the metabolic state called nutritional ketosis, in which your body burns fat, both your own body fat and fat from your diet, for energy rather than glucose.

Is Paleo low-carb? Generally, yes — especially compared to “typical Western diets.” 

Both Paleo and keto are overall low-carb, low-sugar diets that tend to be nutrient-dense, especially if approached the right way. Because the Paleo diet eliminates many processed foods made with added sugar, grains and dairy, this means that a lot of high-carb foods are off the table. However, the Paleo diet isn’t nearly as low carb as the keto diet.

What types of benefits do these diets offer? The Paleo and keto diets have been associated with a number of health perks, including:
  • Support for healthy weight management. Both cut out many “empty calories” from the diet and also tend to be high in protein and fat which help increase satiety/fullness.
  • Support for healthy cardiovascular function.
  • Support for metabolic health.
  • Higher intake of essential nutrients including healthy fats and protein, since the diets emphasize nutrient-rich foods including quality meats, nuts, healthy oils, fish and vegetables.

What foods are included in the Paleo diet? And how are they similar to keto diet foods?

The Paleo diet emphasizes these foods:

  • Grass-fed beef and other meats, like lamb, venison, etc.
  • Seafood
  • Poultry (ideally pastured-raised)
  • Fresh fruits
  • All types of fresh, non-starchy vegetables
  • Starchy vegetables, like potatoes, butternut squash, beets, etc.
  • Eggs (ideally organic and cage-free)
  • Nuts and seeds
  • Unrefined oils, such as olive, coconut, flaxseed, walnut and avocado oil
  • Natural sweeteners, including raw honey, maple syrup, in some cases coconut sugar, molasses and raw stevia

And here are the foods/food groups that are avoided while following a Paleo diet:

  • All cereal grains (even whole grains) and products made with grain flours
  • Legumes (including beans and peanuts)
  • Dairy
  • Refined sugar
  • Refined vegetable oils
  • Processed/junk food
  • Sugar-sweetened beverages
  • In some cases, white potatoes (depending on the person)

The keto diet includes the following foods (you’ll notice that meat, seafood, eggs, nuts, seeds and oils are included in both diets): 

  • Grass-fed beef and other meats, like lamb, venison, etc.
  • Seafood
  • Poultry
  • Full-fat, low-carb dairy products like cheeses, butter, cream
  • All non-starchy vegetables
  • Eggs
  • Nuts and seeds (up to 1/4 cup per day)
  • Unrefined oils, such as olive, coconut, flaxseed, walnut and avocado oil

Foods/food groups that are avoided while following the keto diet include:

  • All types of sugar (natural or refined)
  • All cereal grains (even whole grains) and products made with grain flours
  • Fruit (some choose to include about 1/4 cup of berries per day at most)
  • Legumes (including beans and peanuts)
  • Sweetened, low-fat dairy (like most yogurts and all ice cream)
  • Processed/junk foods, usually including those made with refined vegetable oils
  • Sugar-sweetened beverages
  • Starchy vegetables, like all potatoes, corn, etc.

Looking at these food lists, one thing that stands out is that the keto diet and Paleo diet both exclude foods with added sugar and grains (especially refined grains). Instead they emphasize healthy protein and fat sources, as well as vegetables.

The Differences: Paleo vs. Keto

The biggest difference between these two diets is that only the keto diet puts your body into nutritional ketosis. While in ketosis your body produces ketone bodies that help to burn fat and promote a healthy weight, while also contributing to other benefits. 

The keto diet is lower in carbs than the Paleo diet because it doesn’t include much fruit (only small amounts may be included), starchy vegetables like potatoes and beets, and in moderation, natural sweeteners like honey or maple syrup.

In order to get into ketosis and stay there, you need to strictly and drastically reduce your carbohydrate intake, emphasizing healthy keto fats and some protein and low-carb veggies instead.

The keto diet is higher in fat, while the Paleo diet tends to be higher in protein

While the Paleo diet still includes a variety of healthy fats, the keto diet is very high-fat, since fats provide about 75 percent or more of daily calories. The keto diet is very specific about the amount of carbs that should be consumed each day (about 20–30 grams of net carbs daily), since this is important for getting into nutritional ketosis.

The point of the Paleo diet is not to get into ketosis. It’s also not actually meant to be a “diet” like we usually think of diets, but rather a lifestyle change. The keto diet, on the other hand, is usually more short-term, although it can be followed for longer if keto-cycling is incorporated.

Which Diet Works Better? Depends On You!

So, keto vs. Paleo, which one should you try? Of course, before embarking on any new dietary or lifestyle regimen, you should always consult your healthcare practitioner beforehand. 

There isn’t a clear “winner” in terms of Paleo vs. keto, although you’re likely to experience certain results faster from being in ketosis. However, long term, the Paleo diet is a solid, sustainable way to eat — especially after ending the keto diet or if you find keto to be too difficult or restrictive. 

If you want to keep a moderate amount of carbs in your diet, and don’t want to strictly manage your carb intake, then the Paleo diet may be a better option for you. Another alternative is the “lazy keto diet” in which you make sure to eat below 20 grams of carbs, but not harp on hitting other macros much.

On the Paleo diet, the goal is not to get into ketosis but simply to eat a healthy, balanced diet. Most people on the Paleo diet are not aiming to eat a very specific amount of carbs, unless they are also counting "keto macros” (the amount of carbs, fat and protein in the diet).

In terms of keto vs. Paleo for bodybuilding (or building muscle), both diets can work to help enhance athletic performance, promote lean muscle mass and support healthy weight management. 

The Paleo diet is also popular among people with allergies/sensitivities because it eliminates many common allergens, such as dairy and gluten. The keto diet, on the other hand, may be most helpful for people who want to help manage a healthy weight.

Can You Be Paleo On Keto? 

It’s definitely possible to do a combination keto/Paleo diet. That’s because you eat mostly Paleo-approved foods (like meat, fish, vegetables, quality oils, nuts and seeds) on the keto diet anyway. To combine Paleo and keto, and get the benefits of both, you essentially need to:

  • Keep carbohydrate intake to 20–30 net grams per day.
  • Avoid all types of added sugar, all grains, all dairy products (including cheese, even if it’s low carb), all legumes/beans, all fruit (you may be able to have small amounts of low-sugar berries) and nearly all processed foods.
  • Get 75 percent or more of your daily calories from fat, which means monitoring your protein intake and keeping it “moderate.”

Dr. Josh Axe, DC, DNM, CNS, is a doctor of chiropractic, doctor of natural medicine, clinical nutritionist and author with a passion to help people get well using food and nutrition. He operates leading natural health website DrAxe.com and is co-founder of Ancient Nutrition, a health supplement company. He’s also author of the books Eat Dirt, Essential Oils: Ancient Medicine, Keto Diet, Collagen Diet and the upcoming Ancient Remedies.

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