Category Archives: My KMD Experience

Ketogenic Mediterranean Diet Now in Book Form

A number of my patients and blog readers have asked for a more comprehensive presentation of the Ketogenic Mediterranean Diet. The KMD, as you may be aware, is the basis for the Low-Carb Mediterranean Diet.  Both of them are in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

Odd cover, huh?

The new book is geared for folks who don’t have diabetes, but want to lose weight with a very-low-carb diet.  It’s called KMD: Ketogenic Mediterranean Diet.  Readers of Conquer Diabetes and Prediabetes will get nothing out of the new book: they’ve seen it all before.  Here’s the book description from

Dr. Steve Parker presents the world’s first low-carbohydrate Mediterranean diet. Nutrition experts for years have recommended the healthy Mediterranean diet. It’s linked to longer life span and reduced rates of heart attack, stroke, cancer, diabetes, and dementia. Dr. Parker (M.D.) has modified the Mediterranean diet to help you lose excess weight while retaining most of the healthy foods in the traditional Mediterranean diet. What’s the secret? Cut back on the fattening carbohydrates such as concentrated sugars and refined starches.

You’ll discover how to manage your weight without exercise, without hunger, without restricting calories, while eating fish, meat, chicken, vegetables, fruits, wine, olive oil, nuts, and cheese.

The book includes advice on how to avoid weight regain, instruction on exercise, a week of meal plans, special recipes, a general index, a recipe index, and scientific references. All measurements are given in both U.S. customary and metric units. This low-carbohydrate Mediterranean diet is included also in Dr. Parker’s Advanced Mediterranean Diet (2nd edition) and Conquer Diabetes and Prediabetes. Are you finally ready to lose weight while eating abundantly and without counting calories?

♦   ♦   ♦


KMD: Ketogenic Mediterranean Diet is available for purchase at (Kindle edition here, also) or Barnes and Noble (Nook version here).  The ebook version is available in multiple formats at Smashwords

Steve Parker, M.D.


Filed under ketogenic diet, Mediterranean Diet, My KMD Experience, Shameless Self-Promotion, Weight Loss

My Ketogenic Mediterranean Diet and Low-Carb Eating: Six-Month Summary

I started my Ketogenic Mediterranean Diet on September 1, 2009.  After two months, I stopped compulsive record-keeping and food measurement and made a few other intentional tweaks: fish five times a week instead of seven miminum, more nuts (often two ounces a day—I like nuts and they’re convenient), less salad, more dark chocolate.  Otherwise the last four months have been similar to the initial two months of strict KMD.  My daily digestible carbohydrate intake has probably crept up to 40 g compared to 20-25 g on the strict KMD—this is still considered very low-carb. 


Starting weight was 170 pounds (77.3 kg) on September 1.   After two months—8.6 weeks—my weight clearly stabilized at 155 lb (70.5 kg).  I lost the 15 lb (6.8 kg) over the first six weeks then just hovered around 155 lb.  So average weekly weight loss over the six weeks was 2.5 pounds.  Also lost a couple inches (5 cm) off my waist.

For the last four months—November through February—I’ve been eating the aforementioned liberalized KMD.  Weight has stayed around 155-157 lb (71 kg).  No calorie counting.  I eat as much as I want, except for carbs.  The experience of the first two months taught me how to eat 20-25 g of carbs in a day; it’s the gauge by which I estimate I’m eating 40 g daily now.

Has It Been Easy?

Yeah, relatively easy.  Two other adults in my house are also eating low-carb, which definitely helps.  Blogging here also helps me maintain compliance.  I promised myself to report everything—the good, the bad, and the ugly—honestly.  Accountability is important. 

Staying with the program may be easier for me than for others because I am heavily invested in it, psychologically and time-wise. 

It’s also been helpful for me to participate at two low-carb online communities: LowCarbFriends and Active Low-Carber Forums.  We support each other.  Thanks, guys.

I took diet holidays twice, for three days at both Thanksgiving and Christmas.  Gained three to five pounds (1.8 kg) each time on high-carb eating, but lost it over the next week by returning to the strict KMD.

Any Surprises?

Induction flu.  I’d never heard of it before.  Occurs typically on days 2–5 of very low-carb dieting: achiness and fatigue.  Others also experience headaches and dizziness, and it may last 1–2 weeks.

Rapid weight gain during my diet holidays (aka cheat days).  I was not gorging.  I figure the weight was mostly new glycogen in liver and muscle.  And water.

Eating fish more than once a day is a lot of fish!  Quickly boring, even unappetizing.  But that’s just me.  I need to be a more creative.  Most of my fish lately has been canned tuna.

Assuming that the Daily Values of various nutrients recommended by the U.S. Food and Drug Administration are valid, the KMD foods come up short in many vitamins and minerals.  I bet this is an issue (a problem?) with many, if not most, very low-carb diets if supplements aren’t used.  Those Daily Values are debatable, of course.  For instance, Gary Taubes argues that you don’t need much vitamin C if eating few carbs.  My nocturnal leg cramps and constipation were proof enough for me that I needed at least some supplements.  The recommended KMD supplements remedy the DailyValue shortfall in vitamins and minerals.  Dr. Richard K. Bernstein has a 30-gram carbohydrate diet for his diabetic patients and himself, as outlined in his Diabetes Solution book: no supplements are required.  

As time passes, I worry less about getting enough of various micronutrients.   I feel fine.  I’m still taking the recommended KMD supplements (5 pills a day) plus sugar-free Metamucil.   

I never had hunger that I couldn’t satisfy within the guidelines of the diet. 

No major trouble with cravings or longing for carbs.  I’ve gone six months now without whole grain bread, oatmeal, pizza, and pasta—very unusual for me.  I’d be OK never eating them again.  What I do miss are sweet, often fat-laced, carbohydrates: pie, cookies, cinnamon rolls, candy bars, cake, ice cream.  I doubt that desire will ever disappear, although it does for some who eat very low-carb.   

I counted calories only during the first two months of this experiment.  Remember, fats and proteins are unlimited.  Nevertheless, I ate fewer calories than my baseline intake.   This calorie reduction is a well-documented effect of very low-carb diets.  Fats and proteins are more satiating than carbohydrates.  It’s possible I’ve limited total calories subconsciously. 

[An interesting experiment would be to try to gain weight by over-eating fats and proteins while keeping total digestible carbs under 30 g/day.  Has it been done already?]

What’s Next?

I’d like to answer some intriguing questions.

Why did my weight loss stop where it did, at 155 lb (70.5 kg)? 

If I’d started the KMD at 270 lb (123 kg) instead of 170 lb (77.3 kg), would my weight loss have stopped at 255 lb (116 kg), 210 lb (95.5 kg) or 155 lb (70.5 kg)? 

Will two people, 300 lb each (136 kg), end up at the same final weight when following the program religiously?  Probably not, but why not?    

Six months ago, I believed many scientific studies supported the idea that a higher intake of carbohydrates is healthier, long-term, than the very low-carb Ketogenic Mediterranean Diet and other very low-carb diets.  Studies seemed to support higher carbohydrate intake in the form of traditional fruits, vegetables, legumes, and whole grains.  After reviewing the scientific literature over the last few months, I’m not so sure that higher carb consumption is necessary or beneficial for long-term health and longevity.  The evidence is weak.  Nearly all the pertinent studies are observational or epidemiologic—not the most rigorous science. 

On the other hand, I still can’t help feeling that the recommended eating styles of people like Monica Reinagel, Darya Pino, and Holly Hickman may be healthier than the KMD over the long run, at least for people free of diabetes and prediabetes.  What features unify those three?  Food that is minimally processed, fresh, locally produced when able, including a variety of fruits, vegetables, nuts, whole grains, and legumes. 

It seems that the human body is marvelously designed to survive, even thrive, with multiple ways of eating—but not all ways.   

The strongest evidence for higher carb consumption supports whole grains as a preventative for heart disease (coronary artery disease).  But the effect is modest. 

The argument against higher carb consumption is simple for people with diabetes and prediabetes: carbs raise blood sugar levels, sometimes to an unhealthy degree.  

I don’t see much role for highly processed, refined carbohydrates except as a cheap source of energy (calories).

What’s next for me is to formalize an opinion on which carbs, if any, and in what amount, to add back into the diet of those who have lost weight with the Ketogenic Mediterranean Diet.  The answer will probably be different for two groups:

  1. those who have diabetes, prediabetes, or metabolic syndrome
  2. healthy people who just need to control weight

The goal is to maximize health and longevity without tipping over into excessive carb intake that leads to overweight and obesity with associated illnesses.  

The traditional Mediterranean diet—long associated with health and longevity—is rich in carbohydrates.  The Ketogenic Mediterranean Diet—much lower in carbs—has great potential to help with loss of excess weight and control of blood sugar levels.  Does the KMD incorporate enough of the healthy components of the Mediterranean diet?  We may never know for sure.

Steve Parker, M.D.


Filed under ketogenic diet, My KMD Experience

My Ketogenic Mediterranean Diet: Day 60 + Zucchini

MPj01779580000[1]Weight: 153 lb (69.5 kg)

Transgressions: blew it big time!

Exercise: 60 minutes horse grooming and trail riding



In an effort to add variety to my diet, I ate zucchini with my breakfast eggs.  Sautéd this summer squash in 50:50 butter and extra virgin olive oil.  A small serving of raw zucchini—100 g—provides 1 g fiber, 2 g digestible carbs, 7% of the Daily Value for vitamin K and folate, 8% of riboflavin, 9% of manganese, 11% of B6, and 28% of vitamin C.  Many very low-carb diets by themselves don’t provide enought vitamin C to satisfy most dietitians.  28% is a good start on reaching 100% naturally. 

You can look at various individual foods in detail and find some that are high in this, low in that.  Eating a great variety of foods will make it easier to get all the nutrients you need for optimal health.  The food database at NutritionData will give you a breakdown of 30-40 nutrients in most foods.   

Darya Pino at Summer Tomato has great ideas on choosing and preparing fresh vegetables.

Today’s Transgressions

We had another family celebration today.  I had mentioned to my wife four months ago that I wanted an ice cream/cake combo from Baskin-Robbins: chocolate cake on the bottom, mint chocolate chip ice cream on top.  My son also remembered that I love candy corn, so he got me a bag.  Overall today I ate 2,970 calories, including 240 g of digestible carbs.  I’m not proud of my behavior, but I’m not going to beat myself up over only my second major “cheat” in 60 days of very low-carb eating.  Tomorrow’s a new day!

I may have someone hide the candy corn.

Going Forward . . .

I’ll not be reporting in this fashion daily anymore.  I plan on sticking with very low-carb eating for a while longer, partially to encourage someone I love to stay with it.  I don’t expect to lose any more weight.  The question is, what will happen now that I’m stopping my compulsive record-keeping?   


Update October 31, 2009

Weight today is 155.5 lb, up 2.5 lb after my carb overdose yesterday.  There’s a lesson here.

Update November 1, 2009

Weight: 155 lb


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My Ketogenic Mediterranean Diet: Day 59 + Updated Supplement Recommendations

888894Weight: 154 lb

Transgressions: none

Exercise: 90 minutes horse grooming and trail riding


I’ve finalized the latest supplements for dieters on the Ketogenic Mediterranean Diet, and tinkered with the original plan: Version 2.0 is published.

Daily supplements:

  • 1 or 2 plain Centrum multivitamin/multimineral supplements (two if over 250 lb or 114 kg)
  • Magnesium oxide 250 mg
  • Calcium carbonate 500 mg elemental calcium  (500 mg twice daily if over 250 lb or 114 kg)
  • Extra vitamin D to reach total of 1,000–1,2000 IU (each Centrum has 400 IU)
  • Potassium gluconate 2,750 mg (450 mg elemental potassium) or Morton Salt Substitute (potassium chloride) ¼ tsp (1.2 g)
  • If prone to constipation: sugar-free Metamucil powder 1–2 rounded tsp (5.8–11.6 g) in water
  • At least three quarts or liters of water 


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My Ketogenic Mediterranean Diet: Day 58


Can't get enough

Weight: 155 lb

Transgressions: 1 Metamucil fiber wafer

Exercise: none


At least I didn’t exceed my quota of veggies again today.

I sautéd spinach and mushrooms in butter to accompany my eggs this AM.  Good combo.


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My Ketogenic Mediterranean Diet: Day 57 + Week 8 Recap

APE034Weight: 154 lb

Transgressions: Exceeded veggie quota by 4.5 oz

Exercise: 90 minutes of horse grooming and trail riding


After lunch I was already over my veggie allotment by 4.5 oz.  It’s the tomatoes.  They’re heavy.  Will have to cut back. 

I disagree with those who say, “You’ll lose your desire for carbs after you’ve done the low-carb lifestyle for a while.”  Is eight weeks enough?  Not for me!  Set me loose on an apple pie or Cinnabon and I’ll show you a desire for carbs. 

Week 8 Recap

Weight is hovering around 154–155 for several weeks now.  I doubt I’ll lose any more weight unless I exercise more or consciously cut back on calories, or both.  It’s possible that simply monitoring my caloric intake is somewhat inhibitory, subconsciously.  I see no health or vanity reason to shoot for a lower weight at this point. 

Average Daily Calories: 1,750

Micronutrient Percentages: carbohydrate 9%, fat 53%, protein 25%, alcohol 13%

Average Daily Digestible Carbohydrates: 28 g

Average Daily Fiber: 12 g

Daily fats, cholesterol, micronutrients:  Not calculated.  See Week 5-7 Recap.  Should be about the same.


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My Ketogenic Mediterranean Diet: Day 56 + Hidden Carbohydrates + Oysters

MPPH02842J0000[1]Weight: 155 lb

Transgressions: Ate oysters instead of fish, and 22 oz salad greens instead of maximum 14 oz

Exercise: Four hours of barnyard chores: clearing brush, moving rocks, adjusting fences.


My recent cheat day didn’t seem to set me back, other than increasing temporarily my desire for more carbs.

I tried the Morton Salt Substitute on my eggs this morning.  Tastes fine.  Even drank 8 fl oz of water containing one quarter teaspoon (1.2 g) of this potassium chloride product.  That’s 610 mg potassium in one fell swoop.  Regulators in the U.S. limit potassium in over-the-counter supplements to 99 mg.  But remember the potential health benefits of high potassium diets are tied to fruit and vegetable consumption—markers of potassium intake—rather than potassium supplements. 

My leg cramps could be related to deficiency of magnesium, calcium, or potassium.  This is probably an issue with most very low-carb ketogenic diets.  Easy enough to supplement, especially if you know that salt substitutes contain much more potassium than bottled potassium supplements.

I found an example of carbs sneaking into food you might not suspect: ham.  I bought some “fully cooked cubed ham, water added, ground and formed.”  A two-ounce (56 g) serving has 3 g of carbohydrate: dextrose and modified food starch.  Like many processed meats, it also contained sodium nitrite, which might be good to avoid.  Some studies link nitrites—a preservative added to processed meats—to cancer.  Others do not

Tracking nutrients in processed foods like this ham is also a little problematic.  The food database at NutritionData has about 60 entries for ham.  The closest product I found was “pork, cured, ham and water product, slice, boneless, separable lean and fat, heated, roasted.”  Close enough.

Smoked oysters were right next to the canned tuna on my last shopping trip, so I grabbed a couple cans.  Turns out they are relatively high in carbohydrates—6 g per 2 ounce serving.  Also found out they are an excellent source of protein, B12, zinc, copper, and iron.  This is an example of why food variety is important.  The other foods I’ve been eating tend leave me lacking iron, copper, and zinc. 

Again, I lost track of my veggie intake and exceeded the max.


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My Ketogenic Mediterranean Diet: Day 55

CB044404Weight: 155

Transgressions: Pork rinds?

Exercise: none


Weight not up nearly as much as I feared.  Since eating a relatively large amount of carbohydrates on my cheat day yesterday, I have noticed that my cravings for carbs are back.  But I haven’t given in. 

Pork rinds aren’t on the original 7.01 version of the Ketogenic Mediterranean Diet.  But why not?  No carbohydrates whatsoever. 


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My Ketogenic Mediterranean Diet: Day 54 + Potassium Deficiency

The Monument Valley Navajo Tribal ParkWeight: 154 lb

Transgressions: TNTC (too numerous to count)

Exercise: none


The Potassium Problem

My current food intake on the Ketogenic Mediterranean Diet appears to be low in potassium, which might have long-term health consequences if followed for many months or years.  According to the Linus Pauling Institute’s Micronutrient Information Center, adequate potassium intake apparently decreases blood pressure, reduces salt sensitivity, decreases risk of kidney stones, and protects against osteoporosis and stroke. 

These associations between higher potassium intake and lower condition rates are based mostly on observational studies of populations in which some people eat little potassium and others eat a lot.  It’s assumed that people with higher potassium intake are eating more fruits and vegetables, not taking supplements. 

The Linus Pauling Institute agrees with the U.S. Institute of Medicine’s  “Adequate Intake” value for potassium of 4,700 mg daily for average adults.  The current U.S. Food and Drug Administration Daily Value is about 3,500 mg.  I’m only getting 2,000 mg/day now. 

Multivitamin/multimineral supplements in the U.S. provide a maximum of 99 mg potassium (by law?).  I bought a potassium gluconate supplement at CVS Pharmacy last night: 90 mg potassium, a drop in the bucket.  I dropped into a Hi Health vitamin store (health food store?) today and would swear I saw a combined magnesium and potassium supplement that contained 150 mg potassium. 

Excess potassium intake can be life-threatening in certain situations such as kidney impairment and use of medications like potassium-sparing diuretics and ACE inhibitors. 

Relatively high meat intake tends to create an acidic environment in the body, which our bones help to buffer or counteract.  In the process, calcium in our bones is mobilized and can be lost through urine.  The end result after many years is osteoporosis: thin brittle bones easily broken.  And perhaps calcium-containing kidney stones.  These are traditional concerns about high-protein diets. 

Many fruits and vegetables are considered naturally alkaline, tending to counteract the acid production of other foods. 

I see sporadic reports about potassium bicarbonate supplementation acting as an acid buffer and reducing urinary calcium loss.  Potassium citrate may do the same.  Even potassium chloride may reduce urinary calcium loss separate from any acid buffering capacity (which it shouldn’t have, anyway).  Are those supplements available without a physician’s prescription?  Health food store perhaps?  [Not in Hi Health.]  Would a salt substitute containing potassium chloride be a reasonable source of potassium? 

How about reducing fruit and vegetable consumption, replacing them with a potassium bicarbonate supplement?  Probably not a fair trade.  The food has myriad other nutrients that probably promote health and longevity. 

These potassium-related health concerns are much less bothersome, perhaps nonexistent, when I admit that very few people will follow a very low-carb ketogenic diet for longer than several months.  But it’s an issue.

On the other hand, maybe I worry too much.  Remember, the foods I choose are giving me 2,000 mg potassium daily.  The total potassium could be lower or higher depending on one’s choice of food items.  I have the 1993 edition of Understanding Nutrition, a popular college textbook in basic nutrition.  The table of Recommended Dietary Allowances doesn’t even list potassium.  The text mentions an estimated minimum requirement for potassium of 2,000 mg/day.  The Canadian minimum requirement was 1,170 mg/day. 

About My Diet Transgressions

After 53 days of very low-carb eating, I decided to take a break, a cheat day.  The family was celebrating a milestone.  We drove 2 hours and 20 minutes, one way, to eat at Eat At Joe’s Barbecue in Wikiup, Arizona.  Best Texas-style barbecue outside of Texas.  I had brisket, baked beans, half a roll, cole slaw, stuffed jalapenos, Shiner Bock beer, and cherry pie.  Probably ate 3,500 calories today instead of my usual 1,850.  Expect my weight will be up 2–3 lb tomorrow.  We’ll see how far and how long this transgression sets me back.  All in the name of Science, of course.


Update October 25, 2009

At the supermarket today I found an over-the-counter potassium supplement for anyone wanting more non-food potassium in their diet:  Morton Salt Substitute.  A quarter teaspoon has 610 mg potassium.  It contains potassium chloride, fumaric acid, tricalcium phosphate, and monocalcium phosphate.  The container carries a warning: “Consult a physician before using any salt substitute.”  I found it on the shelf near the regular salt.  I also saw a product that was half salt (NaCl) and half potassium chloride (KCl).  I haven’t tried Morton Salt Substitute yet.  It’s a cheaper source of potassium than a potassium gluconate supplement.   



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My Ketogenic Mediterranean Diet: Day 53

42-17244849Weight: 153 lb (155 lb two days ago)

Transgressions: none

Exercise: none


I weigh myself first thing in the morning right after emptying my bladder, before getting dressed.  Part of my weight being down 2 lb over the last two days likely reflects a degree of dehydration: I slept 12 hours last night.  It’s so dry in the Sonoran desert that we lose quite a bit of water through respiration (water vapor).  Water losses through respiration and sweating are called insensible losses.

Why is it that so many essays on the health benefits of fish consumption are accompanied by a photo of a cold dead fish, head and fins still on, by itself on a white plate?  Usually a trout.  I like fish as much as the next guy, probably more so, but that photo always turns me off!  Who eats fish like that?  The French? 

Nocturnal leg cramps returned last night.  I thought my magnesium oxide supplement—250 mg—had them under control.  Those cramps could, however, just reflect my hour-long hike up and down Pinnacle Peak yesterday.  I’m used to walking briskly on the flat for 30-45 minutes.  Everybody gets muscle cramps now and then, especially after unaccostomed physical activity.


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