The ketogenic diet (KD) has long been used in the treatment of drug-resistant epilepsy, demonstrating significant beneficial health effects. Various modifications of the KD have been introduced as alternatives to the classical, more restrictive form, aiming to improve patient’s adherence while maintaining therapeutic efficacy. Among these adaptations, the Mediterranean ketogenic diet (MedKD) has been primarily implemented in populations in the Mediterranean region. The MedKD integrates elements of the traditional Mediterranean diet, with olive oil as the primary fat source, leveraging its unique properties. This narrative review examines the possible connections between olive oil and the mechanisms of KD, proposing the extra virgin olive oil-rich MedKD as a healthier option with the potential for reduced adverse effects.
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