Rock of Gibralter
I’ve put together a very low-carbohydrate Ketogenic Mediterranean Diet for loss of excess weight.
Why ketogenic?
Your body gets its energy from either fats, or carbohydrates like glucose and glycogen. In people eating normally, at rest, 60% of the energy comes from fats. In a ketogenic diet, the carbohydrate content of the diet is so low that the body has to break down even more of its fat to supply energy needed by most tissues. Fat breakdown produces ketone bodies in the bloodstream. Hence, “ketogenic diet.” Also called “very low-carb diets,” ketogenic diets have been around for over a hundred years.
There are several practical advantages over other diets (disputed by some authorities):
- simplicity
- unlimited access to many high-protein and fatty foods
- less trouble with hunger
- better short-term weight loss than many other diets
- lower blood sugar levels, which is important to people with diabetes, pre-diabetes, and metabolic syndrome
- reduced insulin levels in people who often have elevated levels (hyperinsulinemia), which may help reduce chronic diseases like type 2 diabetes, high blood pressure, some cancers, and coronary heart disease
- improved levels of HDL cholesterol and triglycerides, which may reduce risk of heart disease
- it obviously works well for a significant portion of the overweight population, but not for everybody
- better adherence to the program compared with other diets, at least for the short-term
Why Mediterranean?
- The Mediterranean diet is widely recognized as the healthiest diet.
- Despite an emphasis on bread, pasta, fruits, legumes, and certain vegetables, the Mediterranean diet has several healthy components compatible with a very low-carb eating style:
- olive oil
- nuts and seeds
- wine
- fish
- cheese
- Mediterranean spices
[Although cheese is a component of the traditional Mediterranean diet, I can't argue that it provides nutrients you couldn't get elsewhere.]
Long-Term Issues
Long-term effects of a very low-carb or ketogenic diet in most people are unclear – they may have better or worse overall health – we just don’t know yet. Perhaps some people gain a clear benefit, while others, with different metabolisms and genetic make-up are worse off.
If the diet results in major weight loss that lasts, we may see longer lifespan, less type 2 diabetes, less cancer, less heart disease, less high blood pressure, and less of the other obesity-related medical conditions.
Ketogenic diets are generally higher in protein, total fat, saturated fats, and cholesterol than many other diets. Some authorities are concerned this may increase the risk of coronary heart disease and stroke, while others disagree.
Ketogenic diets have the potential to cause kidney stones, osteoporosis (thin, brittle bones), gout, deficiency of vitamins and minerals, and may worsen existing kidney disease.
It’s clear that compliance with very low-carb diets is difficult to maintain for six to 12 months. Many people can’t do it for more than a couple weeks. So, long-term effects haven’t come into play for most users. As with most weight-loss diets, regain of lost weight is a problem. I anticipate that the majority of people who try a ketogenic diet will stay on it for only one to six months, with significant loss of excess body fat. After that, more carbohydrates can be added to gain the potential long-term benefits of additional fruits and vegetables, legumes, and whole grains.
Or not.
Click here to view a three-page PDF of the Ketogenic Mediterranean Diet. Be sure you see the latest version, 2.1. If you try it, I’d love to hear about your experience with it. Email me at steveparkermdATgmailDOTcom.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physican before making any dietary, nutritional supplement, or exercise changes.
Last updated November 2, 2009
13 Comments
September 18, 2009 at 8:20 AM
I’m a family doctor and for the past couple of years I have counseled my patients, especially prediabetics, in a low-glycemic Mediterranean style diet. It seemed to me that hyperinsulinism secondary to excess refined carb intake is the key problem in most of these people. It seemed to me that if they could quit overstimulating their poor overworked pancreases, maybe they could benefit.
I was very pleased to see that most of them (several dozen) lost weight without feeling starved; their elevated liver enzymes (from fatty liver) returned to normal within a month; often their LDL cholesterol came down (big surprise to me, as I emphasized plenty of monounsaturated fats); and of course triglycerides improved. After a while the HDL came up in some. Fasting glucose also improved. This was not a ketogenic diet as I had them keep net carb intake to under 100 gm/day.
Of course no one approach works for everybody but I was initially shocked then became a believer in the low-glycemic Mediterranean style diet approach as one we can all benefit from. Unfortunately in the mainstream, it still seems that people assume that a “healthy diet” is synonymous with “low fat.” I am convinced that modest intake of healthy fats makes our food taste better, is more satiating, and is perfectly healthful—far more so than soda and pastries. Frank Hu of Harvard wrote an opinion piece in JACC a couple years ago saying the low-fat movement largely sparked the twin epidemics of obesity and diabetes in this country, and I think he’s exactly right.
M. DEAN HAVRON, JR., M.D.
Winchester, Virginia
September 21, 2009 at 3:23 PM
Thanks for your comments, Dr. Havron.
Here’s the reference to Dr. Hu’s comments:
Hu, Frank. Diet and cardiovascular disease prevention: The need for a paradigm shift. Journal of the American College of Cardiology, 50 (2007): 22-24.
[Dr. Hu de-emphasizes the original diet-heart hypothesis, noting instead that “. . . reducing dietary GL [glycemic load] should be made a top public health priority.”]
And you probably saw the very recent article showing much less need for diabetic-type drugs in type 2 diabetics following a low-carb Mediterranean diet over four years, compared to a low-fat diet. Unfortunately, physicians, dietitians, and patients can’t read the article and figure out exactly what (and how much) the Mediterranean dieters were eating. I’m assuming the low-carb Mediterranean diet had a relatively low glycemic index.
-Steve
October 18, 2009 at 6:41 PM
Great blog! Fascinating low-carb diet! It is so wonderful that doctors are beginning to become believers in low-carbing for their patients who have diabetes, or who desperately need to lose weight. Even the ADA, to their credit, is coming around. I hope the CDA will follow suit.
October 19, 2009 at 3:20 AM
Thanks for the comment, Jennifer.
I bet “CDA” refers to the Canadian Diabetes Association since you live in Canada.
[For those who don't know, Jennifer has a series of low-carb cookbooks, probably with an emphasis on use of Spenda as a sugar subsitute. I'm going to have to try some of her dessert recipes soon! You can order cookbooks from her website or Amazon.com.]
-Steve
October 19, 2009 at 10:16 AM
Thank you for the plug. That’s really kind of you. I do use Splenda Granular, but any sweetener of choice may be substituted. Today I like combining Splenda and erythritol for the synergy the sweeteners provide. I don’t do nearly as much baking as I used to in the past, whilst developing my books. I have plenty of good, regular food in my books too, but my forte just happens to be baking and desserts.
The CDA is indeed the Canadian Diabetes Association. We lived in Canada almost 30 years, but now we live in the Tropics in Central America.
December 18, 2009 at 4:22 PM
I am a LCF member and just read a post you made on another thread. That lead me here, and I’m glad I found this site! I will read your material and see if this is right for me.
In fact, after reading your post a few minutes ago, I had an epiphany. In times past when I was avoiding flour and starchy veggies, I wasn’t obsessing about the number of carbs that I ate, the way I do now on DANDR. But then I remembered that I used to use Olive oil and almost no butter! I think that may be a key for me.
Thanks!
December 19, 2009 at 9:16 AM
Hi, CherylB!
For those who don’t know, LCF is LowCarbFriends.com. It’s a website run by Netrition that supports low-carb eating and has a very active forum for low-carbers.
Butter and olive oil are both good. Olive oil may have more going for it in the health department.
-Steve
January 24, 2010 at 2:53 PM
I am going to try this for 30 days
is there a second phase however?
because I will be progressing and adding foods back after a month
I have been an avid supporter of 2002 DANDR and until I recently had a pretty significant eating reaction to a medication I took! (AKA binge at steadily for 6 months!!!) I have loved eating and do well on a diet that has about 60 carbs a day ..
so one month at 20 then I want to move up
and I would like to know what you suggest or if you point me in the right direction this is a big site
January 25, 2010 at 1:05 AM
Hi, Alice.
I’m feverishly working on phase 2 right now, and it does progress upwards, carb-wise. I should have something to post here within the next three weeks. It should be as a blog post and a page.
This project is tougher than I anticipated. I can understand now why no one has ever done it before!
-Steve
February 7, 2010 at 12:29 AM
Establishing new eating habits for my Type II Diabetes (diagnosed in 2004) was a huge wake-up call, but what a fascinating journey it has been. Blogs have been enormously helpful, and yours stands out as truly exceptional. I’m down to my last 15-20 pounds within goal and have struggled to overcome plateaus.
I would like to know whether I can consume avocado on the ketogenic plan, and whether I should consider its use similar to olive oil, or count it as a vegetable serving (though not a vegetable per se)?
February 7, 2010 at 12:41 AM
Hi, Suzanne. Thanks for the complement!
Avocados are definitely part of the Ketogenic Mediterranean Diet, counted as a “vegetable.” Olive oil is unlimited, within reason. Avocado is part of the 400 gram daily vegetable allotment.
-Steve
February 8, 2010 at 11:13 AM
Dr. Parker,
I found your article when researching the Spanish Ketogenic Meterranean Diet (SKMD), but I like your explanations and format better. Having lost weight with extended stays in Spain and Greece, I have found it very frustrating to gain weight eating the typical USA diet! How long is it safe to be on your low ketogenic diet? Additionally, you make the statement that whole grains, yogurt, legumes and pasta “come later”. Do you have anything posted on when and how to add these back to your diet? I have read about the positive impact of calcium on weight loss, so wonder when you would add yogurt (preferably Greek) back in. You do not mention soy – is it okay to drink soy milk (5 carbs, 60 cal per cup) if we are not drinking milk? Thank you so much for your article and any response to these questions!
February 8, 2010 at 6:01 PM
Good to hear from you, Deborah.
No one at this point has been on the Ketogenic Mediterranean diet long-term, so long-term safety is unclear. The more research I do, the more I tend to think it may be quite safe in the long run.
I read Dr. Richard K. Bernstein’s “Diabetes Solution” over the last month and note similarities between his recommended diabetic diet and Atkins induction phase and my Ketogenic Mediterranean Diet. Dr. Bernstein has had years of experience treating diabetes and swears his diet is safe, and the healthiest for diabetics. His followers eat about 30 g carb per day. He would even say you don’t need any supplements, if you are careful.
I understand many people do Atkins induction for months or years without apparent ill effect.
I’m feverishly working on adding carbs to the KMD and should be able to post something here within the next two weeks.
I like your idea about the Greek yogurt. That will be eventual “Diabetic Mediterranean Diet,” or whatever I call it.
I hadn’t thought about the soy milk. You mention it has only 5 g of carb per cup – that’s low-carb in my books. I found one source stating it had only 2 g (reliable?). Wouldn’t be much of a problem in most people, but a diabetic might want to check blood sugar 1-2 hours after consumption, at least once, to see what happens. There are so many brands that the most reliable carb count is what’s on the carton of the product you buy. I need to learn more about soy milk.
-Steve
-Steve