Ketogenic Mediterranean Diet

Rock of Gibralter

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?

  1. The Mediterranean diet is widely recognized as the healthiest diet.
  2. 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:

[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, version 2.3.  I also offer a Daily Log to help you keep track of compliance.  If you try it, I’d love to hear about your experience with it.  Email me at steveparkermdATgmailDOTcom.

Steve Parker, M.D.

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.

♦   ♦   ♦

After initial release of the Ketogenic Mediterranean Diet in 2009, my patients and blog readers asked for a more comprehensive approach to weight loss.  So I put together a book in 2012 called, oddly enough, KMD: Ketogenic Mediterranean Diet.  It’s not free, but you’ll find it very reasonably priced.  Here’s the description from Amazon.com:

Odd cover, huh?

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.  (Ebooks don’t have an index.)

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?

Purchase the book at Amazon.com (Kindle version at same link) or Barnes and Noble (Nook version here). The ebook version is available in multiple formats at Smashwords.

Last updated February 12, 2012

136 responses to “Ketogenic Mediterranean Diet

  1. Dean Havron, M.D.

    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

    • 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

  2. 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.

    • 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

      • 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.

      • Shawnie

        hello

        In reading your blogs and the others that you suggested, the name excapes me now, the Greek Doctor… Dr. Pappa is all I can remember, but he says stay away from Splenda and the other sugar alternatives and use Stevia. I will have to agree as stevia has been known not to raise the bld sugar – any comments? Thanks

      • Hi, Shawnie. I haven’t reviewed that issue carefully, so I have nothing helpful to contribute right now. I have some granulated Splenda (for cooking) in my cupboard and note that it contains some maltodextrin, which can raise blood sugar somewhat. I think Splenda in the small individual serving packets is a different formulation. Jennifer Eloff is a Splenda advocate and has probably addressed this issue at her blog. Jenny Ruhl at Blood Sugar 101 website is probably another good source.

  3. CherylB

    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!

  4. 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

  5. Alice

    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

  6. 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

  7. Suzanne

    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)?

  8. 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

    • Mark M

      Hi Dr. Parker, I’ve read that olive oil is atherogenic, perhaps because in addition to MUFAs, it contains significant amounts of PUFAs. There was a study where olive oil was fed to green monkeys and they developed atherosclerotic plaques at about the same rate as some other types of fats. Your thoughts?

  9. Deborah Kasprzyk

    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!

    • 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

      • Deborah Kasprzyk

        Thank you so much for your answers. I am not a diabetic, but am overweight with high cholesterol and a bad family history. As mental health professional, I teach the “behavior” portion of the weight management program at our hospital. I have been following the recommendations of our dieticians to our patients- the typical ADA low cal, low fat (of any kind) high fiber, moderate protein diet- and I am gaining weight! (which is definitely embarrassing!) As a person who was naturally thin until menopause, I decided to investigate other ways of eating not only to lose weight, but to be healthy. I am impressed by the science behind what you are saying and have decided to try this diet, but will add 1/2 cup of organic Greek yogurt (4.5 carbs) or 1 cup soy milk (5 carbs) occasionally as I have read the importance of calcium (not just in supplements) and know I am at risk for osteoporosis. I am keeping a diary and will let you know how I do!

      • Best wishes and good luck with it, Deborah.

        -Steve

      • Chelatenous

        I am confused about something. Deborah says she lost weight when she went to Spain and Greece. I am assuming that the food there was “Mediteranean”, correct?

        Why can’t we eat a Mediteranean “diet” here? Is the KMD the same as what they eat in Spain and Greece? If it is then we should be able to eat it forever like the spaniards and the greeks do!

        Why go through all this ketosis if the diet in the mediteranean is healthful, can be replicated here, and seems to be safe?

      • What we know as the traditional healthy Mediterranean diet is based on ways of eating in the region in the 1950s. Particularly Greece and Italy. Most folks there these days don’t eat that way anymore! Their diets have become Westernized, too much like the U.S.
        Regarding the ketogenic issue, it’s just that some people lose weight easier that way. Portion-controlled Mediterranean-style eating works better for others.
        -Steve

  10. Sarah

    I am on this diet now, and I feel good and though I am less than a week into it I have lost a couple of pounds and I am in ketosis (according to those sticks). What about cream in coffee? I have been having about a T of heavy whipping cream (since it has 0 carbs). Any other alternatives that are acceptable (whipping cream is really high in sat. fat and is expensive!). I can’t drink coffee black and I need that morning cup….

  11. Ressy

    Dr. Parker

    I too found your blog via the LCF website. Very interesting info!

    Can you speak to the idea of lowering carbs gradually and at the same time lowering insulin doses? I’m trying to avoid the rollercoaster effect that dramatic changes in diet can have. I currently eat about 120 net carbs a day. Once I start lowering carbs I need to make changes to background insulin and carb doses.

    Hope this is not too much to ask in this way!

    Ressy

    • Hi, Ressy-
      Gradually lowering carb intake would be reasonable for many people. I’m all in favor of what works. Might be best to work closely with a dietitian on that (for anyone taking drugs that have the potential to cause hypoglycemia). A home glucose meter would be indispensible.

      -Steve

  12. Ressy – speaking as a Type I diabetic who went Bernstein, I found I needed half my former insulin dose. I wandered around in a hypoglycemic daze for 10 days because I didn’t reduce my insulin fast enough. It’s worth it, tho, my HbA1c is now 5.5%, was 7.5%

    • Johathan-
      Great improvement in Hgb A1c! If I had type 1 DM I’d eat similar to Bernstein’s program, for sure. Many type 2’s seem to resist taking the plunge, or can’t stick with it.

      By the way, I don’t buy the recent studies (e.g., ACCORD) suggesting that HgbA1c’s under 7% are detrimental to health and longevity.

      -Steve

    • Christy Hitchens

      Jonathan, are you using an insulin pump or injections ala Bernstein’s recommendations? I love the convenience of the pump, but am considering switching as it may be difficult to manage bg very closely with a pump. Appreciate anything you can tell me.

  13. Carolyn

    Dear Dr.Steve,
    Thank you so much for this wonderful blog.I started a low carb diet today(my ultimate goal being to eliminate my 850 metformin 2 x daily,completley)
    I plan on following your ketogenic mediterrainian diet and will let you know the results.
    God bless you,
    Carolyn

  14. Carolyn

    Since April 5th, I have lost 3 pounds! (It was five, but I had a bariatric xray yesterday and gained back two)
    Within a few days, I am already losing my cravings for carbs,which is a good thing as I am a pastry junkie, LOL

  15. Suzanne W.

    Good Morning,
    I am researching your Ketogenic Diet and my question is what do you conisder excessively overweight? I am presently about 25-28 lbs overweight and Type 2 Diabetic.
    A1C runs about 6.6 w/morning numbers at 133.
    So is this diet for me?

    • Hi, Suzanne.

      The Ketogenic Mediterranean Diet is more of a glucose-control diet than a weight-loss diet. Generally speaking, it lowers glucose levels and hemoglobin A1c in people with diabetes, regardless of overweight or obesity. In someone previously under good control, it may allow reduction in drug dosages.

      I subscribe to the “healthy body mass index concept.” That is, a BMI around 18.5 to 25 is ideal. [A 40-year-old overweight for years rarely gets down to 18.5, and there’s usually no reason to aim for that.]

      Here’s a BMI calculator:
      http://advancedmediterraneandiet.com/bmicalculator.html

      The general population usually doesn’t get into serious weight-related health issues until the BMI is over 30.

      -Steve

    • My daughter in law was about the same as you and she remedied her situation by cutting out all simple sugars, white bread and potatoes.
      She lost over a stone in 2 months and was able to come off her medication ie. Metformin. You should, of course, take proper advice but that’s what worked for her.

      Good luck…..

  16. Nell

    I was recently diagnosed with type 2 diabetes and metabolic syndrome. I am overweight but have been relatively low carb for more than 5 years. I was surprised when I got this diagnosis. I told my doctor I wanted to try to solve this issue with diet and exercise instead of medication. She has given me 3 month to work on it. I told her that if things did not improve I would consider the medication. I am using your ketogenic diet. I have been on it for 3 weeks now and have lost 5 lbs. most of which were lost in the first week. I have been tracking my blood sugar and find that it never rises after I eat. My fasting is in the 140’s in the morning but steadily goes down all day long. I have had it as low as 95 but it is always high in the morning. Upon doing some research I believe this is dawn syndrome. Have you heard of this and is there a solution that does not involve medication?

    • Hi, Nell.

      I agree you are demonstrating the dawn phenomenon. If you’re not exercising regularly, that’s one non-drug thing you could try to get your fasting blood sugars lower, if your doctor clears you for exercise. Most people can start a brisk walking program, 30 minutes daily, without much risk (assuming no diabetic neuropathy affecting sensation in the lower limbs). How could that help? By increasing insulin sensitivity.

      I’m encouraged that your glucoses don’t go up much after meals.

      -Steve

  17. Nell

    I have been doing 30 min of exercise 6 days a week since iI was diagnosed. My BP is better and my daily BS is better but the FBS is still a problem. It maybe that I have to give it more time. Thanks for the advice. Nell

    • Nell

      I have been doing your Ketogenic Mediterranean diet for the last 3 months. I am happy to report that my #’s are all better than they were when I started. Dr. says no need for medications. Re test in another 3 months. I am very hopeful. Thanks Doc. Nell

      FBS 127 down from 165
      Cholesterol 195 down from 222
      Triglyceridesides 107 down from 244
      HDL 43 was 45?
      VLDL 21 was 49
      LDL/Hdl Ratio 3.0 up from 2.8
      I have lost 22Lbs.
      I walk 35 min @6 days a week

      • Many thanks for the feedback, Nell. Great job on your part!

        -Steve

      • Nell

        I have been doing your Ketogenic Mediterranean diet for a year now While I have not lost any more weight my lipids have improved.I wonder if metformin would be helpful in lowering the fasting BG. Is it worth it?

        Fasting Blood Glucose still 126
        most after meal BG less than before I ate
        Total Cholesterol up to 211 from 195
        Triglycerides 119
        HDL 59 was 43
        VLDL 128
        A1c 6.2 still high
        BP 120/78
        Over all my Dr seems happy she did say the LDL was still high but for my next test I will ask her to test for particle size

        Over the last month I have had a cold and blood sugar is erratic

      • Howdy, Nell. Sorry for delay in response.

        I like your idea about testing for LDL particle size; e.g., is your LDL cholesterol small/dense or light/fluffy. The latter is thought to be more advantageous in terms of cardiovascular disease risk.

        If I had your fasting blood sugars and hemoglobin A1c, I’d be trying to lower them. Assuming you have diabetes or prediabetes, I think metformin is a very reasonable option. Something else that may help is a regular exercise program involving both aerobic and strength training. That might help you avoid drug therapy. Other than gastrointestinal side effects, metformin is generally very weil tolerated and safe. Note that many metformin users have no adverse effects whatsoever.

        -Steve

        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 physician before making any dietary or exercise changes.

  18. Hi Steve,
    Should appreciate your advice. I am 73 years old and weigh 150lbs or thereabouts. My BMI is normal/low
    (around 19) but, despite all I try, I cannot get my body fat down below
    18% (as measured on Tanita scales which I know can be unreliable). My waist is 91cm and I have what you would call a bit of a pot. I think you can see where I’m coming from….I dont need to lose weight BUT I would like to get my body fat down to under 16%. I do two weekly sessions of weights and walk a couple of miles a day. My diet is about 1700 cals. a day and averages around a third each (by calories) over the 3 macro groups. I’m at my wits end to know what else I can do and any advice will be much appreciated.

    • David I

      Bodyfat scales are absolutely useless. I have had my bodyfat measured by hydrostatic weighing. When it was 14.4% by hydrostatic weighing–whcih is the usual standard for these things in studies, I managed to get values from 11% to 33% bodyfat on a biolelectrical impedence scale like you’re using, depending on whether I had just exercised, or just showered, or just had a glass of water.

      That’s worse than useless. That qualifies as wildly misleading. If you really want to worry about body composition, get hydrostatically weighed, or get a BodPod measurement, or go in for a DEXA scan. Sure, it costs money. But then at leats you have an accurate baseline.

      • Hi, David I.
        I agree that bio-impedence body fat measurements are not very accurate. I’ve never used them as part of my medical practice nor in my house. I’ve never even stepped on one. I agree also that DEXA and hydrostatic weighing are gold-standard. BodPod – not familiar with it.

        -Steve

  19. Hi, Peter.

    I’m conflicted about how to answer you.

    You’re at a healthy BMI. I don’t see any health-related reason to lose more body fat, regardless of the specific %. Comes down to vanity, I guess.

    If the pot belly bothers you, consider doing crunches to firm up your abdominal wall musculature.

    -Steve

  20. Mary

    So glad I found this site have been low carbing for a little over a a year and a half was diagnosed as Type 2 diabetic, started out as Insulin Resistant, then called Syndrome X finally was told by Doc that I was T2D. I have lost a little over 100 lbs, but have been a standstill for the past 2 or 3 months, I have been able to walk more now so try to do that about 3 times a week, any advice on how to start losing again, I have about 75-80lbs I would still like to loose.
    Thanks
    Mary

    • Hi, Mary. Good to hear from you. Congratulations on that 100 lb weight loss. Wow!

      If your body can stand the strain, it might help to increase your walking pace or duration of walking sessions or increase to 5 days of walking per week. Sometime adding some strength training helps – that’s also called weight training or resistance training. You may also find that your carb consumption has crept up since you started on this journey. It may be helpful to actually count your carb grams daily for three typical days, to be sure you’re not over 50 g/day. Several websites can help you with the food diary, such as FitDay (it’s free, BTW).

      -Steve

  21. I am coming here as a type 1 diabetec that was just diagnosed back in March. (I am what is known as a LADA – Latent Autoimmune Diabetes in Adults.)

    I now exercise pretty heavily, and I am concerned about the amount of carbs that I need to exercise. If I go super low carb, I find myself constantly having to correct my BG during exercise, and going low. It has gotten to the point where I need Gatorade in order to get through the training.

    I find that with whole grains like steel cut oats, it sustains me through my exercise, and my levels are normal afterwards.

    Does this match the Mediterranean diet concept? I have a lot of weight to lose to get to normal weight range, but I also want to keep within the Mediterranean lifestyle.

    What sort of advice would you have in my situation?

    (The training I do is a lot of hefty walking every day, plus P90X at home. I am burning off at least 600-800 calories in training/exercise per day, and I try to have my calorie count sitting at 2500 – 2800 per day.)

    What is happening is I find myself always hungry at night. Then supper gets out of control, and my bedtime snack (usually nuts and a touch of chocolate) gets out of hand. My eating habits go like so:

    Snack after workout – 200 to 300 calories
    Breakfast – around 400-500 calories
    Morning snack – around 200 calories
    Lunch – around 600 calories
    Afternoon snack – around 200 calories
    Supper – honestly, around 800-900 calories
    Before bed snack – around 400 calories

  22. Hi, Jason. I assume you are on insulin. Steel-cut oats are probably one of the better whole grain products out there, diabetes or not.

    You mention one of the ways to approach exercise-induced hypoglycemia: eating additional carbohydrates. The other is to cut back on insulin. If eating a reasonable amount of oats does the trick for you, it’s hard for me to argue against it. You’re probably aware that you exercise much more than the average person.

    Since I can’t be your personal physician, be sure to run these issues by your own doctor.

    -Steve

    • Was diagnosed pre-diabetic 3 years ago, lost a good amount of weight with exercise and low cal diet but blood sugar went up anyway and have been at the same weight plateau for over a year. Over Easter I saw a sister in law who was recently diagnosed type 2; she’s diet controlled and lost a phenomenal amount of weight. I asked her how she did it and she said strict low carbs. Hence my research and subsequent discovery of this website – –

      Anyway I wanted to address Jason’s issue. A while back I had trouble with hypoglycemia after workout and in research came across a body builders suggestion of immediately following up training with a high protein shake. This not only solved the post workout hypoglycemia I found I didn’t have that evening weariness that plagued my workout days and I woke with significantly less muscle soreness the next day.

      I use a whey based sugar free powder mixed with water. I simply put the powder in a mixer bottle that I take to the gym with me and when I step off the treadmill or elliptical I walk straight to the water fountain, pour fill half way with water, shake it up and start sipping…

  23. Felipe

    hello. I am a medical student from Chile, and I think that the above information is very valuable for people with type 2 diabetes mellitus. It is a very drastic diet (considering that in Chile carbohydrates are a typical food of our country) but in the long run I think it would work, because I have seen in many paper that a diet low in carbohydrates and high in protein, along with medicines efficient, can reduce weight and thus cardiovascular risk factors and type 2 diabetes mellitus.
    however, comes a crucial question me about the diet. To what extent can hold a person with heart problems as strict diet, whereas treatment for a year and if proper care, may raise triglycerides and cholesterol in the blood and increase cardiovascular problems rather than improve them?.
    waiting for your reply, I remain yours your reader.

  24. Steve Parker, M.D.

    Felipe, thanks for visiting and commenting. Unfortunately, I don’t quite understand your question. I’ll just say now that very-low-carb diets tend to lower trigycerides (good for heart, if TGs elevated in first place) and raise HDL cholesterol (good for heart). LDL cholesterol may indeed also rise, which many consider an adverse effect. However, the LDL cholesterol seen with very-low-carb diets tends to be more the “light, fluffy” LDL, not the (allegedly) more atherogenic “small, dense” LDL cholesterol. For existing coronary artery disease, the Mediterranean diet has a good track record. Drs. Dean Ornish would say a vegetarian diet is best, along with meditation and group therapy and exercise.
    -Steve

  25. Kris

    Dear Dr. Parker,
    I was diagnosed with type 2 diabetes (HgBA1c 6.7) 1 month ago. I have used low-carb diets (e.g., Atkins) in the past and am presently using Atkins’ 20-g carb diet for diabetics at present. I am interested in using your ketogenic Mediterranean diet in lieu of my present diet. However, I am concerned about the impact of either diet on my kidneys with respect to having a higher than average intake of protein, especially if I’m spilling protein in my urine. My goal is to lose weight, lower my A1c, and improve my lipid panel results. Your thoughts would be appreciated.

    • Hi, Kris. I think it would be worth a try. Have your kidney function and proteinuria (protein in urine) monitored on a regular basis by your personal physician, and get his or her opinion. Sorry for the delay in responding – I’ve been tied up with other issues.

      -Steve

  26. carol smothers

    I am unable to print the grocery list and 1500 meal journal. Thanks for any tips.

    P.S. I just started the meal plan and had to decrease my basal insulin because my bs dropped after one meal. This leaves me very hopeful that I will be able to cut down on the 150 units I require daily. I also occ wear a CGM and noticed that toothpaste causes my bs to rise markedly as well as some diet drinks. Have you seen this before? I started brushing my teeth with Arm and Hammer-problem solved.

  27. Howdy, Carol. I had not seen that response to toothpaste and diet sodas before.

    • Fikat

      Be careful with diet sodas. Diet Crush, for example, contains high fructose corn syrup & aspartame. I didn’t understand the rise until I read the ingredients.

      • I didn’t know that, Fikat. When I hear “diet soda” I think zero or one calorie. Any drink with HFCS would have more than that. I need to remember that a producer could reduce total calories in the regular drink by just 10% and call it diet soda, I guess.

  28. Carol

    Hi, I was wondering what sort of results you’ve gotten with regard to hypertension. My fasting blood sugar is in the pre-diabeting range (hovers around 110 – 115), but the bigger concern is my blood pressure. I am currently on a diuretic, which seemed to do the trick at first, but now my blood pressure has risen again, and my doctor wants to put me on something stronger, which I am loath to do. Thanks!

  29. Hey, Carol.

    The KMD tends to drop blood pressures about 5 units (mmHg), but it’s highly variable. Some drop 10 units. No one’s reported an increase.

    To avoid blood pressure drugs, I personally would try to lose any excess weight and be sure to exercise on a regular basis. Also I’d try to reduce sodium intake to under 3 grams day for a couple months to see if I’m in the subset of the population with salt-sensitive blood pressure (about one in four people).

    Hope that helps.

  30. Vickie

    Hello. I have a question regarding the Ketogenic Mediterranean Diet in regards to my husband’s health. He is not a large person by any means but he does have high cholesterol and gout. He quit smoking in January of this year after being a smoker for approximately seven years. He has taken a variety of medications for his cholesterol but they tend to make him very nauseated and irritable. He doesn’t really care to exercise and drinking water is more of a sip of water or two. He also has mild secondary hypo-adrenalism so he is and has been on medications for years.
    I, on the other hand, exercise frequently, drink lots of water, have had just on the high end of low thyroid my entire life and struggle to keep my weight down. I have good cholesterol and have never smoked.
    My question is more for him of course, but could this possibly help with his cholesterol issues while not making me balloon like a helium balloon if we are wise and make good choices. I do know that good choices are always wisest but we are discussing two different people.
    Vickie

    • Hi, Vickie.

      Ketogenic diets have never systematically been studied in people with gout. In other words, we just don’t know whether gout would be affected one way or the other. Variou ketogenic diets put more emphasis on either protein or fat as a substitute for carbohydrate. Theoretically, the higher-protein-style ketogenic diets would be more likely to cause a gout flare, if at all. Until we have more data, I can’t recommend any ketogenic diet for someone with gout.

      No one has reported to me any ballooning effect from the Ketogenic Mediterranean Diet. Nor do I see any physiological reason it should occur.

      Best wishes,
      -Steve

  31. I have decided to follow your diet. Sure have been frustrated for such a long time with trying to do it on my own. Can coconut oil be a substitute for olive oil? I will track the diet on my blog.

  32. Steve, I have been following a low carb diet for 18 months. Consuming 100-120 grams per day was easy and my weight fell on average 1.6 kgms per month. Then it plateaued. A subsequent knee injury upset my exercise program and I started putting the weight back on. In two months of limping and reduced activity I was gaining the same amount at the same rate I had been taking it off.

    While I used your blog to format my activities — and got the book — I’m now tacking the Ketogenic diet but find it a hard master. My usual practice had been to allow myself “one serve” of the carb dense preference — in my case, Basmati rice or sourdough bread — per day , but it was clear that this approach got out of hand and my serving size climbed. Legumes, pasta and potatoes always blew my sugar levels out of the water — so they were out completely — but I thought I was doing OK despite sailing close to the carb winds.

    I’ve now adapted your Diet Log for online use using EditGrid so I’m out there.

    For those starting out, monitoring carb intake is routine after a while and you begin to see the nutrient world in ‘grams per…’ but I suggest that unless you blood test you won’t know what’s happening inside.

    • Hi, Dave.
      I hadn’t heard of EditGrid before. Nice work.
      One of the thinks I like about very-low-carb eating is that you don’t HAVE to exercise regularly to reap the benefits of weight management (in general – there are exceptions). I am a big advocate of exercise for reduction of heart disease and cancer risk and other long-term health benefits. And exercise does seem to help many folks prevent weight regain. I hope that knee heals soon and completely.
      -Steve

  33. Jess

    I have been doing a ketogenic diet for 6.5 months and I’m still alive! 🙂 ..I actually find it incredibly easy to stick to.

  34. allana richmond

    Dr. Parker, I am following the advanced ketogenic diet and am concerned about the high fat I’m eating. I have limited my nuts to 1 oz daily, cheese no more than 3 oz, butter and olive oil and find I’m hovering around 80-100 grams of fat a day. Is this okay?

    Thanks,
    Allana

  35. Kristi

    Hi Im on day 2 of this plan – I had a quick question – I dont see lamb on the menu – is this a good source of “meat protein” – I found some great organic shop that sells lamb sausage (great for morning breaky) theres no nitrates or any garbage in them… anywho take care and thanks for this!

  36. Hey, Kristi.
    Lamb is fine. Leaving it out was just an oversight on my part.

    -Steve

  37. David I

    “[Although cheese is a component of the traditional Mediterranean diet, I can’t argue that it provides nutrients you couldn’t get elsewhere.]”

    I lknow I’m very late to the discussion here, but some of the firm and hard aged cheeses are great for some of the Vitamin K2 subtypes.

    That’s not to say they can’t be found elsewhere (you could eat natto, although it’s not very Mediterranean!), but K2 from cheese seems to have beneficial effects on bone mass and on cardiovascular health…

  38. Hi and thanks so much for the information you have put forth on this site. I have been pre-diabetic for several years with blood sugar around 108. However, in early October, it spiked to 154 and between that number and my Doctor, I became terrified. I found your site, implemented the Ketogenic Mediterranean Diet and I am pleased to share the results of one month of concerted effort. (I also began a rigorous exercise program, centered around resistance training). I lost 25 pounds, my blood pressure dropped 20 points on the top end and 4 on the bottom and my blood sugar dropped 50 points to 114! I also lost 5 inches off of my waist! I have a ways to go but my doctor was thrilled and I he doesn’t even want to see me for 4 months now.

    I do have a question or two. I am very interested in continued weight loss and the loss of inches off of my waistline, but what I am most concerned about is my blood level sugar. My doctor feels it is entirely possible for it to drop into the normal range as I continue to do what I have done in the last month. My question is this. What affect on my blood sugar and my weight loss do you think my switching off of the Ketogenic Mediterranean Diet to just the normal Mediterranean Diet? You should probably know that for some reason, I have never liked and as a consequence never consumed very much red meat or poultry. I love seafood of all kinds, but I am not crazy about fish. I do love pasta and bread and have always felt they were my downfall when it comes to my weight related issues. I also love any kind of cheese. This is one thing that has drawn me to the Mediterranean Diet because I love whole grain breads etc., and the seafood and cheese that is part of that diet. My final question is if you were me, what would you do; continue on the Ketogenic Mediterranean Diet or switch to the Mediterranean diet?

    Thanks in advance for you help and thanks again for all the great information you have provided!

  39. Hi, John.
    Many thanks for providing the feedback. Your results are better than average. I wish more of my personal patients had your degree of motivation, discipline, and willpower.

    I can’t give you medical advice without a 45-minute office visit which would include a physical exam and lab work. Nevertheless, I can make a few general comments about what some of my personal patients have done to good effect in this situation. Those with more excess fat weight to lose tend to do better by sticking with the Ketogenic Mediterranean Diet (KMD) for a while longer, perhaps one or two months. Those who are getting tired of the relatively high fish intake have substituted eggs, cheese, meat, or poultry. Or the other types of seafood you like, such as shrimp, crab, oysters, mussels, etc.

    As you eventually transition toward a more traditional Mediterranean diet, go easy on the concentrated sugars and refined starches. E.g., try whole grain pastas and breads instead of the more refined products. If weight management deteriorates, you may need to count calories and not exceed your safe limit, or go back to reduced total carbs.

    Good idea also to check out my page above called “Low-Carb Mediterranean Diet.”

    You may have already changed your metabolism enough that you could switch to the traditional Mediterranean diet immediately without adverse effects on weight and blood sugar. Every case is different. If it were me, I’d sure keep exercising.

    Best wishes,
    -Steve

  40. I’ve been on the low carb diet for over a year now and I find if very easy to maintain except when away from home confronted with take away..So I’m not eating grains and my one primary starchy intake is sweet potatoes.

    [I’m experimenting with sweet potatoes because they are such a useful food for diabetics).

    I think that the ‘Mediterranean’ angle is a template to build on as there are many cuisines in the Mediterranean.– it may determine the primary foodstuffs but it’s not the whole shebang. Giving up bread was the hardest challenge for me and despite my continued use of sour dough breads which have a lower GI impact for some time, I finally gave that up to.

    One slice of bread: 15-20 grams of carbohydrate.

    My rule of thumb when adopting the diet was that I’d try not to put in my mouth any substance over approx 15 grams of carbohydrate per serve. So for a time I allowed myself that 15 gram leeway for one item per meal.: esp as it related to rice or bread.

    So I’m more or less maintained –with medication– in the 5.8-6.8 mmol range but with continuing blood pressure issues I’d like to surmount and my weight loss has plateaued.

    Not a bad result….

    The KMD diet is a bit roughage light unless you add that extra to make up for the whole grain shortfall. (Sweet potatoes are useful there. Oven roasted at high temps: much better than french fries.).

    Over time my rice substitute became ….grated cauliflower! It was my means to continue to risotto; and pumpkin has become a diet staple. Chayotes are useful…but these vegetables are not Mediterranean standards so you need to consider your eating options outside the box.

    Nonetheless, Spanish cuisine — and recipes — I found very KMD friendly. The Spanish tend to separate the grains from the rest of the meal — except for paellas.South American foods are different, though, because of the corn and beans.

    My olive oil intake has gone up along with my consumption of olives. I buy Kalamata olives now in 6 km pales! But then I’ve always eaten Mediterranean influenced diet and am a keen cook.

    There are some work arounds that can enable you to consume the edge foods like bread such as adding a strong acid — like vinegar or yogurt — to marry your consumption of higher GI foods .(This is why sour dough is preferable to normally yeasted breads: its’ acidic). But in my experience, nothing moderates the impact standard dried legumes have on my blood sugar –although my work around is to eat peanuts which are also a legume but with a much lower GI.

    (So imagine: strawberries dipped in no sugar dark chocolate and rolled in crushed peanuts then chilled and served semi frozen)

    • Dave, those strawberries sound delish (as Rachel Ray might say). Reminds me of a simple recipe I saw involving strawbs, vinegar, and chocolate nibs. I couldn’t find the lattter – don’t even know what they are – so I gave up.

      Sweet potatoes have a certain health halo about them. Compared to regular white baking potatoes, they seem to have about twice the vitamin C and much more vitamin A. Otherwise I’ve seen lots of confusing and conflicting comparisons of the two on the Internet, including the issues of glycemic index and load. Some of the confusion stems from ignoring the potato skin in the analysis. For a diabetic concerned about blood sugar effects of potatoes, self-monitoring of blood glucose is the answer. Not with every serving, but until a pattern is clear.

  41. Rebecca

    Thank you for your research in this area, and for providing some ‘alternative routes’ for those of us trying to find a new way of eating. At 40, physically active, and of normal weight, I was surprised to have a A1C of 6.5. With one sib a T1 and another sib a T2, I’m hoping I can stick with T2 instead of later finding it to be LADA, which I’ve just recently heard of. I was only diagnosed a month ago, and the fatigue of spiking blood glucose along with the frustration of figuring out what to eat to both satisfy my hunger and not cause those spikes was starting to get to me. 🙂 Thanks again for your website, I’m reading it with great interest.

  42. Hi, Rebecca. I’m sorry you have to deal with this. I like your proactive approach. If not doing so already, consider adding some strenght training to your exercise program. It could increase your insulin sensitivity. Check with your personal physician, as always.

    Best of luck to you.

    -Steve

  43. peter

    Hi Steve, i was tempted about 3 months ago to use coconut oil which I realise is a saturated fat. I had a cholesterol check a month later and my reading had soared to 9! very, very high indeed. Various websites say that coconut oil doest affect cholesterol and I wondered if you had a view on this.

  44. Sorry, Peter, I’ve not looked into that issue.

    Saturated fats do tend to raise total cholesterol, both LDL (bad) and HDL (good). The percentage increase is usually higher for LDL than for HDL.

    For U.S. readers: cholesterol of 9 mmol/l equals 348 mg/dl (very high). Before I get too exercised about a cholesterol level, I like to see it confirmed by a repeat test within the next month or two.

    -Steve

  45. I’ve tried various LC styles over the last 3.5 years. I’m a type 1 diabetic with insulin resistance, and unfortunately my doctors don’t support my efforts.

    My latest version is closer to Dr. Bernstein’s diet. I shoot for 70% fat and 10% carbs. I’m down another five pounds iin the six weeks of following it. My performance varies, of course. Lots of temptations in the world.

    I approach cholesterol from the “quality” perspective, and it seems larger, fluffier lipoproteins are of much higher quality than small, dense varieties. I’ve learned that these VLDL packages are created in the liver from mostly, if not all, sugars. Nearly all fructose passes through this gate to become a saturated fat packed for delivery in these things. After their trips to cells and they return to the liver, they then become LDL particles. Exogenous fats, btw, are packed in the intestines in chylomicrons. These suckers never see the LDL pathways. I then look at the Friedwald. It’s a vlolume measurement. If particles are bigger, the value grows, and vice versa. So it seems logical that we’ve misinterpreted these friedwald results. Yes consuming sugars reduces LDL values – the LDL sizes are smaller. Yes fats increase LDL values – the LDL sizes are bigger. But, this can only be true if results corroborate failings of LDL as an indicator of heart risk. In 2009 UCLA released results showing 3/4 of all heart attack victims had normal LDL values. Dr. Krauss’ 2010 meta analysis of cohort studies shows no correlation of saturated fat consumption and heart disease. I’ve alse looked intensely for the evidence supporting cholesterol and saturated fat as causes of heart disease. I find zero level one evidence. None! Even the NHLBI in their definition of atehrosclerosis admits they do not know what causes it.

    I ask my opthalmologist to check for atherosclerosis during my all too frequent eye exams. He sees none. And I’ve had zero signs of retinopathy in tehse past four years after a vitrectomy followed by bleeding in 2006. Not a valued attribution by any menas. Vitrectomies and sugar control have wonderful results, generally. But really, after three and a half years of high SF consumption, shouldn’t I see at least some atherosclerosis in my eyes? Shouldn’t my aerobic performance be degrading isntead of improving? Shouldn’t my energy levels be falling instead of rising? My 60% fat brain can find zero reason to avoid saturated fats and plenty to maximize them.

    Have a great day!

  46. John, thanks for your comments.
    In Spring/Summer of 2009, I spent 80 hours reviewing the literature in support of dietary total and saturated fat as causes of atherosclerosis. I was surprised to find there wasn’t much, if any. That opened up my mind to the idea of low-carb, high-fat eating (LCHF). I put together the Ketogenic Mediterranean Diet that Fall.

  47. Philip Thackray

    Dr Parker,

    I just scanned these comments and saw the one a while back about Dawn Phenomenon. I recalled reading about this on Peter’s Hyperlipid site – was surprised how long ago I read it. Here it is:

    http://high-fat-nutrition.blogspot.com/2008/05/physiological-insulin-resistance-2-dawn.html

    There may be more on his site but I did not search diligently.

    Best Regards,

    Philip Thackray

    • Philip, muchas gracias for that link.
      It adds a level of complexity to the dawn phenomenon. In fact, it seriously questions, Dr. Bernstein’s explanation. For those who don’t click through, I’ll summarize by saying Peter found evidence that nighttime growth hormone elevations (this is normal) lead to lipolysis (breakdown of body fats into free fatty acids to be used by various tissues for energy) and the FFA’s cause a degree of insulin resistance, leading to higher blood sugar levels in the early morning. As a practical side note, some people with diabetes (should I start using PWD’s?) seem to suppress Dawn Phenom by drinking alcohol at bedtime.

      -Steve

      • Hey that alcohol thing really works, I once saw a 60!! point drop in 3 hours after 2 or 3 rum & REAL COKE when I checked my BG as an afterthought & thought the drinks would have skewed the results & shot my BG higher, I was shocked that it actually went DOWN to 83mg/dl after a couple oz. of regular Coke. CrAzY!!

  48. Nell

    I am a type II diabetic. If I have slept well my blood sugar is only moderately higher in the morning than when I went to bed. It will continue to rise until I eat. On nights when I have not slept well my blood sugar is significantly higher in the morning. My blood sugar is well controlled during the day and it continues to drop all day. I eat very low carb as low as 10 mg most days and no higher than 25. I have found that anything higher elevates my blood sugar too much. None of the little tricks seem to change anything not alcohol or vinegar or a protein snack,only sleep seems to make any difference with the DP. . I eat lots of red meat ,eggs and bacon, my last cholesterol test showed elevated cholesterol but only the hdl went up. I just had a new test and we were testing for particle size when I find out what that is I will let you know.
    Nell

    • peter

      Everything I read indicates that high cholesterol can be caused by ingesting too much saturated fat and your diet suggests that you are probably way over the top on this. Like you I had high cholesterol (which incidentally, on its own might not be a problem) and I have cut my saturated intake but NOT cholesterol containing foods like prawns which, it is said, doesnt affect levels much. Has your GP suggested anything? Maybe you should swap higher fat meats for fish
      and limit butter and cheese intake (if you are consuming a lot). Hope this helps.

  49. Nell

    I am not worried about my cholesterol it is only moderately over 200. My triglycerides are low. My LDL is high but as I said we are testing for particle size. I believe that I have the large fluffy kind which are more protective. I also have a normal blood pressure. I believe that saturated fat is not bad for you and I eat plenty of fish as I am doing the doc’s Ketogenic Mediterranean diet. Sleep seems to be my only issue which I believe causes my DP. Nell

  50. Nell, thanks for the follow-up. I’ve read some of the literature indicating the harmful LDL is small, dense LDL cholesterol, whereas light, fluffy LDL is not harmful to arteries. This is still considered cutting edge science.

    • Nell

      My LDL’s are indeed the large fluffy kind and my cholesterol went down below 200 but my HDL also went down. Fasting BS still higher than normal. I have since split my metformin er to 1 at breakfast and 1 at dinner,this seems to b helping that pesky morning BS. It’s an on going process. I am beginning to feel like a lab experiment Nell

  51. Dear Steve
    I have been on your diet for 4 months and have lost 21 lbs which is good, however my annual blood test has not changed my high cholesterol 8..2
    or my blood sugar 6.2 and my Doctor keeps telling to go on Statins and a low fat diet, which i wont do, how long will it take for my cholesterol to come down?
    I am in the UK and love your diet

  52. Ellen Morgan

    After buying your book, I decided to look at your website and am very pleased at all the information especially the blogs. In one, I noticed that there was a problem with elevated blood sugars and diet pop. A cousin of mine with severe diabetes was living on salads and diet pop because he couldn’t control it. He was taking two shots a day and the doctor wanted to add a third.

    At the time, I had read a book by the Doctors Michael and Mary Eades. They mentioned a study showing apspertame, Nutrisweet, saccahrine and similar artificial sweetners raised blood sugar. My cousin read labels very carefully so his pop had either aspertame or Nutriseet and nothing else. The book recommended Splenda for artificial sweetening. i don’t believe Stevea and some of the newer current choices were available.

    After one month of drinking pop with Splenda- Walmart brand at that time-, his sugar numbers were much lower and within 3 months he was down to one shot and able to control his BS and eat more varied meals. I hope this helps someone as much as your advice is helping me.

    As a good Norweigan who loves her bread more than any candy, you are helping keep me on a healthy life choice for eating that will let me enjoy cooking again. Ellen

    • Ellen, thanks for that information.
      I checked the 2011 version of Dr. Bernstein’s diabetes book and he lists acceptable artificial sweeteners: saccharin tablets or liquid, aspartame tablets, acesulfame-K, stevia, sucralose tablets and liquid Splenda. He says to be wary of any of these in POWDERED form because they are usually then mixed with dextrose (glucose) or maltodextrin or other type of sugar to increase bulk. So blood sugars go up.

      -Steve

  53. Eloise

    Hi there
    Thank you for all the helpful/interesting imformation. I would like to enquire about the supplement CLA – good or not ??
    Thx Eloise

  54. peter

    This supplement is supposedly is good for fat loss and lean gain. As with all these things, you have to make up your own mind as it is dificult to get an unbiased opinion. Try typing in cla in your search engine…there are many websites covering with this.

  55. Eloise

    Thank you Steve and Peter – reason for me asking is the wide spectrum of opinions about this supplement on the internet. Another product that you have a lot of different options are the supplement Whey protein for weight loss and some say it help you to gain wait.

    • Eloise, I hadn’t heard of whey protein powder for weight loss. It’s supposed to help build new muscle tissue for those doing weight training (resistance exercise). If you search Alex Hutchinson’s blogs, I bet you’d find reliable information on whey. Try Darrin Carlson’s blog, too.

      -Steve

  56. Sarah

    Hello,
    I just received the KMD book today, read it page to page, and am contemplating starting this diet. My BMI is on the high limit of normal, but I do believe loosing 20lbs wouldn’t hurt. I have PCOS, and while my test results (including glucose tests) are normal, I have a horrible case of hirsutism, alopecia, and acne, and have noticed it getting worse over the last two years, as I also gained 20lbs (from 125 to 145lbs). I am currently on bcp (Diane), flutamide, metphormin, using rogaine and contemplating adding spironolactone to the cocktail. I am looking for a more diet-based approach to dealing with this, since I don’t believe taking this many pills is ok for someone who is 33, and hoping to conceive some time in the near future. I will give this diet a try while staying on my meds for now, and slowly see how it progresses. I am of mediterranean origin, my diet for the time being is quite healthy by regular standards, based on organic fruits, veggies, fish, lean meats, legumes, and whole grains and contains some exercise. Let’s see what some carbo trimming will do!

  57. I’m shifting from using the term “diet” to using the term “nutrition plan”:
    ie: my nutrition plan includes the Mediterranean Nutrition Plan. The word diet has become synonymous with ‘restricting oneself’ and ‘hunger’. Whereas, nutrition implies that I will be well nourished in a delicious and nutritious manner.

  58. Louse

    Is bread made with coconut or almond flour permitted on this “diet”?

  59. Rik

    Hello Dr Parker,
    My physician recently recommended the Low-carb Mediteranean Diet.
    No diabetes, but I need to lose weight and control cholestrol.

    Great information!
    Thank you much!

  60. Louise

    Enjoy your blog immensely…it’s working… But I am unable to access the three-page PDF of the Ketogenic Mediterranean Diet Thanks!.

  61. Dilip

    What’s an alternative for vegetarian?

  62. Dee Leggett

    I will definitely be looking into this. I just had genetic testing done again and all have recommended a Mediterranean diet, my concern was that I also show symptoms and have for most of my life of mild NARP (Neurogenic muscle weakness, Ataxia, and Retinitis Pigmentosa). One recommendation is using MCT oil. Thank you so much for this diet!

  63. Kim

    Dr. Parker:
    Is there a vitamin/supplement available to eat in place of eating fish? Fish and/or seafood makes me sick (don’t like taste, texture, smell, etc). I would like to utilize this plan, but want to know if you can substitute or just skip the fish portion. Thank you.
    -Kim

  64. Tahm Reed

    I have been trying to get follow the link to get the printable daily log and the printable shopping lists for the past few weeks and am unable to get onto the web site. Is the Advanced Mediterranian Diet website down?

  65. seda

    i wanna ask a question but my english is not so good …so i ask with the basic words i am a pre-diabetic and also i have insulin risistance i do low carb low fat diet so i just eat lean meat and vegatebles ..and it’s make me so tired and hungry…so do you think should i do ketogenic diet?…because i hear many times “ketogenic diet bad for diabetic” iam not exact diabet but i am pre-diabetic and i have insulin resistance like i said … should i do keto diet ? pls answer with the basic words because my english very bad…i just wanna know should i do ketogenic diet or not ? / ketogenic diet is bad for me or not?

    • Hi, seda. Are you from India?
      In general, a ketogenic diet that is well-designed should be helpful and safe for an overweight person with prediabetes and insulin resistance. I cannot know enough details about your particular circumstances to know if a ketogenic diet would be best for YOU. In general, regular exercise also helps with insulin resistance and prevention of diabetes.
      You mention “low carb low fat.” If that is accurate, you must be eating lots of protein. That’s difficult for many folks over the long run. I assume you meant low-carb, high-fat.

  66. Nita

    I have just found your site, but it seems like you have a lot of information available on it. I get very tired of those that seem they are just out to make money by offering all the supplements etc. I am type 1 diabetic for almost 45 years and am wondering if there is anything special I would need to do with this diet. I like what I have seen here so far. 🙂

  67. mary romano

    well it will soon be a year since i started the Ketogenic diet program. I have lost 40 pounds. The last 2 months I have added low carb items such as more berries and low carb wraps. my sugar is 89 in the morning which i never would have thought possible a year ago. Although my Doctor isn’t saying anything about my low carb life he hasn’t told me not to. But he isn’t taking me off my 2 oral and one insulin meds. I have told him that I think I am ready to loose at least one now and by the end of the year all of them. I don’t want to make him made at me though even when he smiles and says my lab is wonderful ac1 has been 5.6. Any ideas.

  68. Kitty Herchenroder

    I am 81 years old and have been a TD2 for over 20 years. I used to take 4 mg of avandia for about 10 years with exelent results. My doctor has refused to provide me with Avandia because of the “black box” warnings. I want to try to reverse my TD2 with diet and exercise. Because my kidneys are at 50%, which diet would you recommend. I am willing to give it a good try. Presently I am not on any diabetic medication because none of them treat insulin resistance. I would appreciate your advise.

    • Hi, Kitty.
      Unfortunately, I can’t give you specific advice since I don’t know the details of your case and physical exam results. You might want to consult an endocrinologist in your area for a second opinion on management.

  69. Christine

    I have been a Type 1 diabetic for 30 years. I need to lose weight. I also have RA. Does this diet help with inflammation from RA

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