Category Archives: ketogenic diet

Are You Nuts?: Combine Mediterranean and Ketogenic Diets

The Jerusalem Post has an article comparing and combining the Mediterranean and ketogenic diets:

Why choose a favorite when you can have both? Instead of making the tough Keto vs Mediterranean diet decision, many people have instead decided to combine the most appealing parts of the two diets to create a new option called the Keto Mediterranean Diet (KMD). Macronutrients are divided as follows:

• 7-10% carbs

• 55-65% fat

• 22-30% protein

• 5-10% alcohol

What is The Keto Mediterranean Diet Food List?

• Fats – olive oil, coconut oil and avocados

• Proteins – fish, cheese, eggs and lean meats • Vegetables – non-starchy varieties

• Red wine – moderate amount

• No sugars, starches, grains allowed

Carbs are limited, the way they are with the Keto diet and red wine is allowed, like in the Mediterranean diet. For people who want keto results and still enjoy going out at night for a drink, this seems like a good compromise!

Keto Mediterranean Diet Pros and Cons

Pros:

• Benefits of the Keto diet while still enjoying a glass of red wine

• More flexibility in food choices

• Healthy option  for diabetes sufferers

• Lower risk of experiencing keto-flu symptomsCons:

• Constant checking to make sure you are still in ketosis

• No strong boundaries which could weaken the results you experience

Source: Has The Mediterranean Diet Gone Keto-Crazy? – Special Content – Jerusalem Post

Unfortunately, I see nothing in the article that you can use from a practical standpoint unless you’re a dietitian or nutrition nerd, like me.

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

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Ketogenic and Very Low-Carb Diet Effective Over Two Years in Type 2 Diabetes

This Avocado Chicken soup is very low-carb. Use the search box to find the recipe.

It’s well-established that very low-carb and ketogenic diets over the short-term usually do a good job for folks with type 2 diabetes: better blood sugar levels, fewer diabetes drugs needed, improved lipids, lower blood pressure, etc. Many people—from patients to dietitians to physicians—question whether the diet and associated improvements can be sustained for more than a few months. The study at hand looked at results two years out, and found definite clinical benefit and sustainability.

First, a quick point to get out of the way. In the U.S., HgbA1c is reported as a percentage. But other countries often report HgbA1c in mmol/mol. It’s not easy to convert one to the other accurately, so when you see values in mmol/mol below, be aware they’re only my approximations, not the researchers’.

Here’s how the researchers did their study, published in the summer of 2019.

Scientific Method

262 adults with type 2 diabetes (average age 54) were enrolled in the intervention group, called CCI (digitally-monitored continuous care intervention via a web-based app). 87 were assigned to “usual care.” For all participants at baseline, body mass index averaged 37-40, HgbA1c averaged 7.6% (60 mmol/mol), and they had diabetes for an average of eight years. The CCI group monitored beta-hydroxybutyrate (a ketone) levels, glucoses, body weight, etc, and uploaded results via the web-based app. The app also facilitated an online peer community for social support. For those who preferred in-person education (about half of the total), clinic-based group meetings were held weekly for 12 weeks, bi-weekly for 12 weeks, monthly for six months, and then quarterly in the second year. Continuous Care Intervention included individual support with telemedicine, customized nutritional guidance (emphasis on sustained nutritional ketosis), and health coaching.

The 87 Usual Care folks were recruited from the same geographic area and healthcare system. The received care from their primary care physician or endocrinologist and were counseled by a dietitian (ADA recommendations) as part of their diabetes education. Medical care was not modified for the study. This group had less intense clinical measurements than the CCI cohort.

Of the 262 participants who started with the CCI group, 218 remained after one year. So 44 drop-outs. Of these 262 pioneers, 194 remained for the entire second year (so 24 more drop-outs). If those drop-out numbers seem high to you, be aware that they are NOT. Even the Usual Care group of 87 had 19 drop-outs over the two years.

So what happened?

Reductions from baseline to two years in the CCI group included: fasting insulin, weight (down about 10% or 11.9 kg), blood pressure (systolic and diastolic), HgbA1c, and triglycerides. Those are all going in the right direction.

Other findings for the CCI group: HDL-cholesterol (“good cholesterol”) went up. Excluding metformin, the use of diabetes control drugs in the CCI group dropped from 56% of participants to 27%. Some dietitians fear the ketogenic diets are bad for bones, causing calcium to leak out of bones, weakening them since calcium is the main mineral in bones. But spine bone mineral density in the CCI group was unchanged over the two years.

The “usual care” group had no changes in those measurements or diabetes medication use.

Now, to understand some of the investigators results, you need to know their definitions. Diabetes remission = glycemic control without medication use. Partial remission is “sub-diabetic hyperglycemia of at least 1 year duration, HgbA1c level between 5.7-6.5% (39 to 48 mmol/mol), without any medications (two HbgA1c measurements).” Complete remission is “normoglycemia of at least 1 year duration, HgbA1c below 5.7% [39 mmol/mol], without any medications (two HgbA1c measurements).” Diabetes reversal per Supplementary Table 2: Sub-diabetic hyperglycemia and normoglycemia (HgbA1c below 6.5% or 48 mmol/mol), without medications except metformin.

The CCI group had resolution of diabetes (partial or complete remission in 18%, reversal in 53%), which was not seen in the usual care group. Complete remission was achieved in 17 (6.7%) of the CCI group. HgbA1c in the CCI group at two years dropped from average of 7.6% (60 mmol/mol)  to 6.7% (50 mmol/mol).

Conquer Diabetes and Prediabetes

Metformin is the most-recommended drug for type 2 diabetes

“CCI diabetes reversal exceeds remission as prescriptions for metformin were usually continued given its role in preventing disease progression, preserving beta-cell function and in the treatment of pre-diabetes per guidelines.”

The average dose of insulin in CCI folks who were using insulin at baseline decreased by 81% at two years. (Have you noticed the price of insulin lately?)

Beta-hydroxybutyrate is a ketone, and at a certain level in the blood, indicates the presence of ketosis on a ketogenic diet. “The 2 year beta-hydroxybutryate (BHB) increase above baseline demonstrated sustained dietary modification.”  “…the encouraged range of nutritional ketosis (> or = 0.5 mM) was observed in only a minority (14.1%) of participants at 2 years. On average, patient-measured BHB was > or = 0.5mM for 32.8% of measurement over the 2 years.”

Bottom Line

In summary, the CCI group—eating ketogenic and/or very low-carb—showed sustained beneficial effects even two years after start of the study. I suspect the Virta app, clinic-based group meetings, and individual support and coaching contributed significantly to the participants’ success.

Steve Parker, M.D.

PS: By the way, many of the study authors are affiliated with Virta Health Corp., which I assume is a for-profit company. Virta provided funding for the study. Could that funding have unduly influenced the results? It’s always possible but I have no evidence that it did. If not already available, I expect a commercial version of the program will be within 12-24 months.

Reference: Athinarayanan, S.J., et al (including Sarah Hallberg, Jeff Volek, and Stephen Phinney). Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial. Frontiers in Endocrinology, Vol. 10, article 348, June 19, 2019.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

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Can Diet Alter Your Gut Bacteria and Thereby Lower Your Risk of Dementia?

The short answer? We don’t know.

Low-carb salad

The gut bacteria (aka microbiome) seem to be able to decrease or increase inflammation that could cause or exacerbate Alzheimer’s dementia. The  microbiome’s effect on inflammation depends on the species of bacteria present, and the amount of those bacteria. At least one study found that Alzheimer’s patients have a greater abundance of the pro-inflammatory species and less of the anti-inflammatory species, compared to other folks.

Researchers with Wake Forest School of Medicine tried to find answers to the questions in the title of this post. (Click for full text.) They studied 17 experimental subjects, average age 64, who had mild cognitive impairment (11) or “cogni/subjective memory complaints” (6). God bless them for submitting to three spinal taps apiece. The experimental diets were 1) Mediterranean-Ketogenic (under 20 g carb/day), or 2) Low-fat American Heart Association diet (under 40 g fat/day). Participants were on each diet for six weeks.

The investigators didn’t find anything useful for those of us trying today to avoid Alzheimer’s or prevent the progression of mild cognitive impairment to dementia. Their bottom line is, “The data suggest that specific gut microbial signatures may depict [characterize] the mild cognitive impairment and that the modified Mediterranean-ketogenic diet can modulate the gut microbiome and metabolites in association with improved Alzheimer’s disease biomarkers in cerebrospinal fluid.”

So we won’t know for several more years, if ever, whether intentional modification of diet will “improve” our gut microbiomes, leading to lower risk of dementia.

What we have known for many year, however, is that the traditional Mediterranean diet is linked to lower risk of Alzhiemer’s dementia.

For more details, see Science Daily:

In a small pilot study, the researchers identified several distinct gut microbiome signatures — the chemicals produced by bacteria — in study participants with mild cognitive impairment (MCI) but not in their counterparts with normal cognition, and found that these bacterial signatures correlated with higher levels of markers of Alzheimer’s disease in the cerebrospinal fluid of the participants with MCI.

Through cross-group dietary intervention, the study also showed that a modified Mediterranean-ketogenic diet produced changes in the gut microbiome and its metabolites that correlated with reduced levels of Alzheimer’s markers in the members of both study groups.

Source: Diet’s effect on gut bacteria could play role in reducing Alzheimer’s risk — ScienceDaily

Steve Parker, M.D.

Click the pic to purchase the world’s first practical ketogenic Mediterranean diet at Amazon.com. E-book versions also available at Smashwords.com.

If you own this book, you already have a ketogenic Mediterranean diet.

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Are Ketogenic Diets Nutritionally Adequate?

Sardines and a good source of calcium on a ketogenic diet

I was concerned about inadequate calcium consumption during the design of my ketogenic diet. Many experts believe that inadequate calcium intake causes thin, easily broken bones (osteoporosis). But his may not be true. And high calcium consumption seems to have increased risk of premature death in Swedish women. Furthermore, calcium supplementation almost doubled the risk of having a heart attack, at least in Germans. Yeah, it’s complicated.

From the journal Nutrition:

Objective

A 12-week ketogenic diet was shown to have many beneficial effects in healthy obese adults, but it is not clear if the supply of micronutrients is adequate.

Methods

In 35 adult individuals with BMI above 30, the intakes of minerals and their serum levels were analyzed at baseline and at weeks 4 and 12 of the ketogenic diet intervention. The intake of vitamins and serum antioxidative potential were also investigated.

Results

Throughout the diet the intakes of magnesium, calcium, iron, phosphorus and potassium were below recommended values, but their serum levels always remained within the reference range. Nevertheless, the level of calcium decreased significantly (from 2.52 ± 0.10 mmol/L at baseline to 2.36 ± 0.07 mmol/L at week 12, P < 0.001) which could be due to the omission of legumes and reduced dairy intake or due to the high fat intake alone. The levels of phosphate increased concomitantly. Calcium serum levels were negatively associated with ω-6 but not with ω-3 unsaturated fatty acid intake. The intakes of water-soluble vitamins were also too low. However, the antioxidative potential of serum did not change during intervention.

Conclusion

Careful choice of foods which would provide the necessary micronutrients is of utmost importance when consuming ketogenic diet. In the 12 weeks the decreased intakes did not reflect in serum values, but special attention to calcium should be advised if such diet is recommended through longer periods.

Source: Assessment of micronutrients in a 12-week ketogenic diet in obese adults – ScienceDirect

Steve Parker, M.D.

PS: If you have my Conquer Diabetes and Prediabetes book, you already have my ketogenic diet, plus much more.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

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Does the Keto Diet Prevent or Treat Alzheimer’s Dementia?

Sunny’s Super Salad

Maybe…we don’t know yet.

Have you noticed references to “keto diet” like there’s only one ketogenic diet? There are many ketogenic diets and some of them are dangerous. When choosing one, at least look for one designed by a registered dietitian or physician.

From a recent scientific article:

Highlights

•Impaired brain glucose metabolism and amyloid β plaques are associated with Alzheimer’s disease pathology.

•Ketones provide an alternative metabolic precursor to glucose in the brain.

•Ketogenic diets likely reduce amyloid plaques and may reverse their neurotoxicity.

•Modern diets high in carbohydrates may contribute to increasing Alzheimer’s incidence.

•The ketogenic diet (including carbohydrate restriction) might be useful in the management of Alzheimer’s disease.

Source: The ketogenic diet as a potential treatment and prevention strategy for Alzheimer’s disease – ScienceDirect

Steve Parker, M.D.

PS: If you have Conquer Diabetes and Prediabete,  you already have the Ketogenic Mediterranean Diet

Click pic to purchase at Amazon.com

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Often Imitated But Never Duplicated: My Ketogenic Mediterranean Diet

I don’t know Dodie’s Doodles but she reviewed a competitor to my KMD: Ketogenic Mediterranean Diet at Amazon.com on May 30, 2018. She gave it two stars out of five. Here’s her review in toto:

This book, by Robert Santos-Prowse, a dietician, is not what you want. It’s a little over 180 pages, and the first 50 PAGES are how your digestive system works. Seriously, from the fact that your teeth chew your food all the way down your intestine, as if that’s why you bought the book. Yawn. No offense, but stick with the original by Dr. Steve Parker, who also has an acclaimed cookbook, and I recommend that. He’s the one you want and he has an author’s page here on Amazon.

The book Dodie reviewed is The Ketogenic Mediterranean Diet: A Low-Carb Approach to the Fresh-and-Delicious, Heart-Smart Healthy Lifestyle.

For a free taste of my Ketogenic Mediterranean Diet, click here. If you have my Conquer Diabetes and Prediabetes book, you already have the KMD and much much more.

Steve Parker, M.D.

low-carb mediterranean diet

Click the pics to purchase at Amazon.com in the U.S.

Probably under $13 at Amazon.com in the U.S.

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Recipe: Sous Vide Chicken and Sauteed Sugar Snap Peas

Sous vide chicken and sautéed sugar snap peas

Click the pic for our YouTube demonstration.

This is so low-carb that you can eat it in a ketogenic diet.

Ingredients:

2 boneless skinless chicken breasts, 8-9 oz each (225-255 g each) (raw weight)

2.5 tbsp (37 ml) extra virgin olive oil

few sprigs of fresh rosemary (optional)

2 cloves garlic, diced

lemon-pepper seasoning

Montreal Steak Seasoning to taste

garlic salt to taste

Morton sea salt (coarse)

black pepper to taste

9 oz (255 g) fresh sugar snap peas

Instructions:

Choose one of two seasonings: 1) Montreal Steak or 2)  Rosemary lemon-pepper.

Brush one side of the breasts with about 1/2 tbsp olive oil. For Rosemary-style chicken, sprinkle the breasts with lemon-pepper seasoning, sea salt, and pepper to taste. Garnish with rosemary sprigs.

For Montreal-style, that seasoning is all you need; it already contains salt and pepper. Rosemary sprigs are optional.

Then cook the breasts in a sous vide device (see video) at 142°F for two hours.

When that’s done, my wife likes to sear the breasts in a frying pan (with a little olive oil) over medium-high heat, 1–2 minutes on each side. The chicken is fully cooked after two hours in the sous vide device, but the searing may enhance the flavor and appearance. It’s optional.

When the chicken is close to being done, sauté the garlic in two oz of olive oil over medium high heat for a minute or two, then add the sugar snap peas and a little garlic salt and pepper to taste, and cook for two to four minutes, stirring frequently.

Number of servings: 2

AMD boxes: 1 veggie, 2 fat, 1 protein

Nutritional analysis per serving:

Calories: 500

Calorie breakdown: 42% fat, 8% carbohydrate, 50% protein

Carb grams: 10

Fiber grams: 4

Digestible carb grams: 6

Prominent nutrients: protein, B6, iron, niacin, pantothenic acid, phosphorus, selenium

 

 

 

 

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