While the diets have similarities, the Mediterranean diet relies on whole grains. The Paleo diet on the other hand does not allow any grains. And while numerous studies show greater health and longer life from the Mediterranean diet, there is far less evidence for the Paleo. Actually, these diets have many more similarities than differences. However, the issue of whole grains is a sharp difference and the evidence would favor their inclusion based on the marked health outcomes improvements documented for the Mediterranean diet.
