Low-Carb Mediterranean Diet

© 2010 Steve Parker, M.D.

After a year of intense research and analysis, version 2.0 of the Low-Carb Mediterranean Diet is ready.  It’s a work in progress that may be improved periodically.  Check back for updates.

Precautions and Disclaimer

The ideas and suggestions in this document are provided as general educational information only and should not be construed as medical advice or care.  Information herein is meant to complement, not replace, any advice or information from your personal health professional.  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.  Steve Parker, M.D., and pxHealth disclaim any liability or warranties of any kind arising directly or indirectly from use of this diet.  If any medical problems develop, always consult your personal physician.  Only your physician can provide you medical advice.  You should not follow this diet if you are a child, pregnant or lactating, have alcoholism or history of alcohol abuse, have abnormal liver or kidney function, or have gout or a high uric acid blood level.  If you take medications for high blood pressure or diabetes, they may need to be stopped or reduced by your personal physician.



The Low-Carb Mediterranean Diet is designed specifically for people who have one or more of the following conditions:

Diabetes and prediabetes always involve impaired carbohydrate metabolism; metabolic syndrome and simple excess weight often do, too.  Over time, excessive carbohydrate consumption can turn overweight and metabolic syndrome into prediabetes, then type 2 diabetes. 

The key feature of the Low-Carb Mediterranean Diet is carbohydrate restriction, which directly addresses impaired carbohydrate metabolism naturally.   

Why “Mediterranean”?  The traditional Mediterranean diet is widely recognized for its promotion of health and longevity.  Many of its components are compatible with low-carbohydrate eating.   

The foundation of the Low-Carb Mediterranean Diet is the Ketogenic Mediterranean Diet.  If you’re not familiar with the Ketogenic Mediterranean Diet (KMD), review it here.  The KMD and the document you’re reading now constitute the Low-Carb Mediterranean Diet. 

The Ketogenic Mediterranean Diet is simply the initial or conversion phase of the Low-Carb Mediterranean Diet.  The KMD is a conversion phase because your body is switching to an energy metabolism based on fats and proteins instead of carbohydrates.  Or we could call it a watershed phase since a watershed is “a critical point that marks a division or a change of course; a turning point.” 

Some may stay on the KMD long-term, so it’s free-standing. 

But others will move on to a long-term balance phase, hereafter referred to as the Low-Carb Mediterranean Diet (to distinquish it from the Ketogenic Mediterranean Diet).  It’s a move from very low-carb to low-carb eating.  The Low-Carb Mediterranean Diet (LCMD) adds more plant-based nutrients to the foundational KMD, balancing the benefits of plants against their potential adverse effects on blood sugar levels and weight. 

Eighty-five percent of people with type 2 diabetes carry excess weight.  The Ketogenic and Low-Carb Mediterranean Diets will help with that issue.  But just as importantly, they lower and smooth out the elevated blood sugars characteristic of diabetes and prediabetes, regardless of weight.

I assume readers of this document have been following the Ketogenic Mediterranean Diet for at least a couple weeks, if not for several months or more.  I recommend at least 8–12 weeks.  Most followers—diabetic or not—wanted to lose some excess weight with a Mediterranean-style diet.  Others, already at healthy weights, just wanted better control of blood sugars.

At this point you’re ready for a change either because you’ve reached your weight-loss goal or you want a greater variety of carbohydrates (“carbs”).  Stay familiar with the KMD because it is the basis for everything that will follow.  You’re not really done with it; you’re adding to it. 

Perhaps you’ve been losing weight steadily with the KMD and are not yet at your goal weight but need more food variety.  Many continue to lose excess weight with their expansion to the Low-Carb Mediterranean Diet.  If weight loss stalls, just return to the KMD.

The KMD may be perfectly healthy long-term; we just don’t know for sure.  On the other hand, there is at least some evidence that additional carbohydrates—as in the LCMD—may be even healthier.  For example, fruit and vegetable consumption is linked with lower rates of cancer, stroke, and coronary heart disease.  [Other studies find no benefit.]  Whole grain consumption is associated with lower rates of cardiovascular disease, including heart attacks and strokes.  Legumes are a great source of fiber to counteract the constipation common with very low-carb diets like the KMD.  Fruits and vegetables as components of the Mediterranean diet seem to contribute to longevity. 

And many carbohydrates just plain taste good!

Nearly all the studies linking fruits, vegetables, whole grains, and legumes—all prominent in the Mediterranean diet—with improved health were done in general populations, not specifically in diabetics.  Whether diabetics benefit is not entirely clear.  If such consumption raises blood sugar levels too much, then health outcomes will be worse.

A quick reminder for readers here for the first time: Low-carb eating has the potential to drop blood sugar levels dangerously low in people with diabetes who take certain medications to control blood sugar.  If this applies to you, you must work closely with your personal physician and review “T2 Diabetes and Low-Calorie Diets” and “T2 Diabetes and Low-Carb Diets.”  By the way, I use “blood sugar” and “glucose level” interchangeably. 

Overview of the Low-Carb Mediterranean Diet (LCMD)

You’ve been eating 20–30 grams of carbohydrate daily on the KMD.  Now you’re going to increase to 40-100 grams daily, gradually adding carbs that may have beneficial effects on health and longevity.  Adding excessive carbs will lead inevitably to elevated blood sugars in diabetics and prediabetics, to regain of excessive body weight, or a stall in weight-loss progress.

Most people reading this have type 2 diabetes, prediabetes, or metabolic syndrome and have had trouble controlling their weight or blood sugar levels with their former ways of eating.  A few readers are entirely new to the world of diabetes.  In all these cases, we want to avoid adding carbohydrates that sabotage control of blood sugars and metabolic syndrome.  That sabotage may take two forms:

  1. eating particular carbs that will spike your blood sugars too high and for too long
  2. excessive amounts of carbs, which will do the same

For non-diabetics and those with normal carbohydrate metabolism, carbs that potentially raise blood sugar too much are not an immediate issue.  But even for non-diabetics, these glucose-producing foods are associated—at least in women—with excessive body weight, future diabetes, heart disease, and gallbladder disease.  So we may as well avoid them.  For more information, read about high-glycemic-index eating.

If you are not at your goal weight already, adding too many carb grams now will impair your ability to convert your body fat into energy.  Eat too many carbs, and your body will use them for the energy it needs rather than your body’s fat.  You may well continue to lose weight eating 40, 60, or 100 grams a day, but maybe not.  Everybody is different.  Many diabetics will not be able to handle over 70 grams of carb daily.  Some, not even that much.  Continue to weigh yourself daily.  Diabetics must monitor their blood sugar levels as discussed elsewhere.    

Implementation of the LCMD

So, what healthy carbs are we going to add to the Ketogenic Mediterranean Diet?  Fruits, more vegetables (including starchy ones), legumes, yogurt and other dairy products, and whole grains.

To avoid carb overdose and loss of glucose control, we’re adding back carbs incrementally.

I’ve divided the new carbs into groups and specified a serving size for each source of carbs.  Each serving has about 7.5 grams of digestible carbohydrate.

What you do next is add one daily carb serving from the list of Carb Groups and Serving Sizes (PDF) and see what happens with your weight—and glucose levels if you’re diabetic or prediabetic—over the next week.  This is not one carb serving on Monday, two on Tuesday, three on Wednesday, etc.  It’s seven carb servings during a week, one on each day.

Essentially, you still eat the Ketogenic Mediterranean Diet but are adding a daily carb serving.  If your weight loss stalls, you gain weight, or glucose levels rise significantly, you’ve added too many carbs and must cut back, or try different carb sources.  I’ve written elsewhere about acceptable blood sugar levels.   

On the other hand, if you handled the extra carb serving without trouble for a week, you may add one more daily carb serving.  Monitor your progress for another week. 

A Daily Log will help you keep track of your eating and blood sugars.

If you’re handling those carbs, you may increase by one additional carb serving every week.  You’ve added too much carb if your weight loss stalls, you gain excessive weight, or your glucose levels rise too much.  Then you must cut back or try different carbs—especially different carb groups.      

Many people who have diabetes or weight management problems will not be able to increase carbs to more than six additional daily servings.  Either weight or glucose levels will rise.  But that’s OK because you don’t necessarily need more carbs for a long and healthy life.  For many folks, additional carbs are unhealthy. 

Diabetics and prediabetics should probably distribute, eventually, their additional carbs evenly among two or three daily meals.  Eating two or three new additional carb servings all at once as a bedtime snack, for example, is likely to cause high blood sugars through the night and into the next morning.  On the other hand, those same carbs eaten at breakfast and followed by an exercise session an hour later might be handled just fine.  Your home glucose monitor will be indispensable in this respect. 

By the way, if you wish to cut back on your animal protein consumption at this point, feel free.  It’s your choice. I’d continue to eat cold-water fatty fish at least two or three times weekly, along with the usual olive oil and nuts.

Are you with me so far?

OK, so you’re going to add some carbs to your diet, but which ones?  I’ll assume at this point you have diabetes, prediabetes, or metabolic syndrome.  For the potential health benefits, I’d add carbs in this order:

  • fruits
  • more vegetables
  • legumes
  • yogurt and other dairy products
  • whole grains

This is just a loose guideline, not a commandment.  I suggest everyone eventually add one or two servings of fruit daily, classic fruits rather than technical fruits like tomato and avocado already on the KMD.  Berries, in particular, have much to recommend them.  Legumes, yogurt and other dairy products are listed after fruits and veggies because the evidence in favor of their long-term health benefits is not as strong. 

For people with normal carbohydrate metabolism, I’d list whole grains second or third rather than last, but in diabetics…

grains are problematic.  Diabetics are prone to developing blockages in their heart and brain arteries that can cause heart attacks, strokes, and premature death.  Consumption of whole grains on a regular basis is associated with significantly lower risk of developing these problems.  But there’s a fly in the ointment.  Grains, even whole grain products, have a relatively high glycemic index, meaning they cause spikes in blood glucose which could have adverse long-term impact.  Nearly all the studies linking whole grain consumption with less heart disease were done in the general population, not the diabetic population.  Whole grains could be even healthier for diabetics than the general population—we just don’t know.

Diabetics who see a significant spike in blood sugar after grain consumption could address that with higher dosages of diabetic medications.  Would that be healthier than avoiding grains?  In 2010, we just don’t know. 

Eating grains in a meal containing fat and protein also tends to smooth out or eliminate blood sugar spikes.  That goes for other high-glycemic-index carbs, too, like white potatoes. 

Yogurt deserves special mention because it’s a component of the traditional doctor-recommended Mediterranean diet.  It’s a great source of calcium.  Does it have anything special you couldn’t get elsewhere?  Probably not.    

Now you’re ready to enhance the KMD with an extra carb serving daily.  Why not start with a fruit?  Choose a variety of items within any given carb group, and try eventually to eat from multiple carb groups.  Variety ensures you get adequate vitamins, minerals, and phytonutrients. 

Nevertheless, just to be sure, continue your supplements as on the KMD.   

Things are getting a little complicated now.  If you lose your way and regain weight or glucoses get out of control, you can always return to home base: the Ketogenic Mediterranean Diet.

Welcome to the Low-Carb Mediterranean Diet!

Steve Parker, M.D.

Summary of Documents for the Diabetic Mediterranean Diet:

Updated December 20, 2010

72 responses to “Low-Carb Mediterranean Diet

  1. Doc, I’m Type I and I cannot add carbs beyond the minimum contained in 5% vegetables! I do the 30g Bernstein advocates, my HbA1c stays at 5.5%. I add any more to that, I’m back on the rollercoaster.

    I can enjoy carbs when my blood sugar’s low – I’ve calibrated berries etc so I know exactly how much I need to eat to bring my bg up to normal – these little treats delight me.

    Antother thing – I’m an MFT, a psychotherapist – every carb-craver and hypoglycemic I’ve seen has stabilized on the Bersnstein Diet and then lost control of their carb intake when they began to add them back. I don’t know if low-dose naltrexone would help, but these people are carboholics.

    I think it may be true that all Type II diabetics and MetS are carboholics

  2. Steve Parker, M.D.

    Thanks for your comments, Jonathan. Dr. Bernstein’s ideas should have wider currency.


  3. Hi Dr. Parker.

    Nice article. However, you said:

    “Whole grains could be even healthier for diabetics than the general population—we just don’t know.”

    I am unaware of any health benefits that grains bestow upon anyone. In fact it appears that grains either who or refined contain many anti-nutrients that are best avoided by everyone.

    Dr. Loren Cordain writes about this extensively. His paper Cereal Grains: Humanities Double Edged Sword goes into great detail about the dangers of grain to human beings.

    That said, it’s great to read another doctor that is promoting a low carb approach to eating for the gen pop as well as for diabetics.

    You might be interested in the Nutrition and Metabolism Society’s work. http://www.NMSociety.org.


    • I’m not sure how whole grains – essentially sugar – would reduce the risk of stroke and heart attacks. The paper you use in your blog post is a meta not a study so while it suggests an association, there is not proof of cause and effect.

      I think it’s a bit dangerous to use meta’s when trying to determine anything of value. They are only useful for sparking the funding of a good study.

      • Very good points, Fred. I can’t disagree.

        Compared to pure sugar, whole grains would provide some vitamins, protein, minerals, fiber, and phytonutrients that might confer some health benefit. But, yes, the starch in grain is readily converted to simple sugars.


  4. Hi, Fred. Thanks for your input. I really should join the Nutrition and Metabolism Society.

    There’s some observational evidence that whole grains may reduce the risk of stroke and heart attacks in the general population. I wrote about it here:



  5. Teresa

    Hi Dr. Parker,
    I’m researching the Mediterranean diet for my cousin’s husband. He went to the doctor 2 days ago and the doctor told him to do a mediterranean diet. His sugar was in the 300’s, he’s overweight, and has high blood pressure.

    My comment is more about where you say people taking medications should not do the diabetic mediterannean diet. Is that “any” medications or specific ones? The doctor did give him medicines to take but she also said to do a mediterranean diet so we aren’t sure if he can do this diet or not.

  6. Hi, Teresea.

    I can see where my Disclaimer would be confusing and misleading regarding drugs.

    The point I was trying to make (not very well) pertains mostly to people who are on medications that have the potential to cause dangerously low blood sugars. Sulfonylureas and insulin immediately come to mind. Folks on those drugs and eating the typical 250 grams of carbs daily may well get in to trouble with low blood sugar when they cut back to 20 grams of carb daily.

    So a personal physician should be involved, reducing drug dosages as needed.

    Very low-carb eating also tends to lower blood pressure. People taking drugs to control high blood pressure may find that their blood pressures are too low when they cut way back on carbs. Blood pressure pill dosages may need to be reduced, or even stopped in some cases.

    My page on “Low Carb Diets and Diabetes” has more information on this:

    For some reason, unusually low blood pressures don’t seem to be a problem in people not already being treated for high blood pressure.

    Thanks for your interest.


  7. Tom


    Any word on the pdf for LCMD and the shopping list?

    I was recently diagnosed T2 and I am very interested in your work.



  8. Good question, Tom. I may have time to do them in a couple weeks.

  9. david wilson

    It’s great to see that there are doctors who don’t feel bound to parrot the doctrine that a low fat, high carb regime is right for diabetics, despite its forty-year record of abject failure. Type 2 low carbers like me know that it’s possible to get blood sugars down almost to non-diabetic levels, and to keep them at those levels without any apparent progression for many years, simply by diet alone (or diet + metformin). Of course we are warned that we run a big risk of heart disease – despite the great improvements we make in all the important CVD risk factors! How’s that for cognitive dissonance?

  10. I like your diet very much and it is basically the way I eat these days. I used to do very low-carb, but rarely these days. I find I do better with some good carbs. I have Hashimoto’s thyroiditis and I’m on thyroid hormones. I take my oral temperature several times a day (think I should do it in the ear – lol) to monitor how much I need. This is the most scientific way I have found to montior my metabolism and need for hormones based on how I feel.

    • Jadwiga (Linda) Michalowski

      Hi Jennifer,
      I have Hashimoto, very low energy, very bad metabolism. I never know about taking temperature. For years I use homopatic dr and my family dr. I have Synthroid 150mg. Please help me. What kind of carbs you eat. I reduce fruit very much problem with weight, diabetes.

  11. Jennifer, it seems logical to monitor body temperature when being treated with thyroid hormones. Most physicians don’t have much experience with it, depending more on lab tests.


  12. Jim E. Garrett

    Thank you Dr. Parker, I have been looking for a way to help control my newly diagnosed Type 2 (diagnosed just after New Year’s Day) and this seems to be a great way as I LOVE food. I am overweight and have hypertension, too. Also being physically disabled which makes exercise difficult doesn’t help me much. My drugs seem to keep me on the hypo side of the blood sugar problem – I know that can be very dangerous too. Thanks for being part of my learning experience, and I will discuss this with my doctor who is very supportive of patients gaining knowledge and taking an active hand in treatment.

  13. vickie ferrell

    i love what you recommend, tell us more.

  14. Andy Narain

    Hi Doc, I’m a per-diabetic who started to regularly exercise (doing strength, resistance, aerobic, anaerobic, and yoga) for at least an hour EVERY DAY since I became serious about taking care of my per-diabetes. I’m a male, 5′ 10”, and weight 151, so I think I’m in the BMI range. I don’t need to lose weight, in fact I’m trying to keep my weight, since I lost ten pounds in a month. I also have high cholesterol and high blood pressure, so I got three things to take care off.

    I’m taking supplements, but it’s only temporary until I can get my blood sugar to where I want it to be. I’m starting to see signs of blood sugar decrease, and my blood pressure starting to go down near the per-hypertension stage, better than when it was near stage 2.

    I can do the low carb diet. I’m not attached to sodas, grains, sweets, or anything. The problem I’m having is that I’m still hungry after eating a low carb diet. I have high metabolism, so foods leave my stomach rather quickly. I try to eat food full of fiber, but stuff like legumes and eggplants have good amount of carbs. And I can’t eat brown rice, because that shoots my blood sugar up, no matter what GI it suppose to be.

    I feel frustrated because the only things that stick to my stomach are foods full of carbs or foods that will spike my blood sugar.

    • Hi, Andy.
      Some of my patients report that they have less trouble with hunger if they consume lots of water around mealtime or add a tsp of sugar-free Metamucil to 8 oz water and drink that. Other get relief be eating a couple hard-boiled eggs, a chicken breast, or a 4-oz can of tuna.


    • Hey, Andy. Thanks for stopping by. I wonder if you’d still feel hungry after eating, in addition to your regular meals, a couple hard-boiled eggs or 4-6 ounces of chicken.


  15. Kay Hawkins

    What do you think about protein shakes with low (3g) carbs and high protein (20g)? And what about almond milk? Thanks for all!

  16. I myself is following a mediterranean diet and have been very happy with the results. I was diagnosed to have type 2 diabetes about 5 years ago and was advised to lose weight. It was really a struggle for me but thankfully because of this diet that I am trying to follow for several years now I achieved the weight my doctor has required me. I hope many would be able to read this article so they will have an idea how essential it is to follow a healthy diet. I also found an article which may also be helpful for people like me who wants to become well again. You can find it here http://www.mediterraneandietrecipebook.com/.

  17. I’ve combined the Mediterranean Nutrition Plan with my Blood Type O Nutrition Plan. Being Blood Type O, my body has a harder time digesting grains, even if they are whole wheat. I eat rye bread / crackers instead. I’ve almost completely let go of white flour and sugar – they have no nutritional value. Fresh fruit and dried fruit combined with nuts make a great dessert.

    • When I look for rye bread or rye crackers in my local supermarkets, I find them. But the first ingredient listed on the back is usually refined wheat flour. They mix in some rye flour so they can call it “rye bread.”

  18. Hi Dr. Steve,
    I’m a 20 year old Type 1 diabetic. I was diagnosed at 5 years old, so I’ve had it for 15 years. Now, my problem is this, I want to lose weight, but I can’t seem to do it. All the info on weight loss is for Type 2s! I’m not overweight, it’s just that I’ve gained some extra pounds over the years though I was very slim for most of my life. Please help me out. If possible could I consult you via email. Please. My Dr. is great, but all he’s concerned about is my HbA1C and doesn’t get how important my weight is to me. He says ‘it’s my body type’, yet I’ve been slim most of my life. Heck Halle Berry is diabetic, and look at her.

    Evelyn (Kenya).

    • Yes….Halle Berry…..look at her!
      Evelyn, I don’t think email consultations are legal where I live (Arizona, USA) – The licensing board here seems to require a physical exam.
      Here’s a trend I’ve notice among overweight type 1 diabetics: They seem to eat high-carbohydrate diets and take all the necessary insulin to keep the associated blood sugars in check. The insulin/carb combo promotes body fat accumulation. If you think cutting back on dietary carbs and insulin is a solution, you’re probably right. Of course, that could raise the risk of hypoglycemia if not done right.

  19. I have to have to be gluten free! I the Med. Diet ok for me? Thanks so much for your help!! Carol

  20. mary romano

    Hello Dr. Parker,
    I am a type 2 and of cause always having problems with my weight, I read your KMD and I thought that’s what I was looking for. My Endo just dropped me and I was shocked. I am no saint my a1 goes up and down just like a lot of folks and I try but some days it’s harder then others. I guess I am not healthy enough for her. But she never really gave me any direction just more drugs, so now I must find another doctor. But before i do i am going to try this diet, I have enough medication for two months. It looks easy enough even for me.

    • Hi, mary. That’s disconcerting when your doctor drops you. When I have to do that, I always give the patient an explanation. You deserve one, too. Maybe it’ll be for the best. I certainly hope so. Best wishes.

  21. mary romano

    I started doing your kmd and in seven days I have dropped my BS 100 points and have lost 8 pounds. I have only walked a few times but will now start every day for 15 mins. So being dropped made me mad and she always wanted me to drop the meat and eggs and use egg beaters. they are not good and use more grain. but that made me want to eat something i don’t seem to be able to do. I bought the book and am waiting for it to come in. Thanks.

  22. Hamzah Mustak

    Hi Dr. Parker,

    I have familial hypercholesterolemia. I recently had great weight loss success with a low carb/high fat diet but found that my cholesterol (both LDL and total) were elevated. I was advised to try a Mediterranean diet but want to avoid the grains. Do you have any thoughts / experience with the KMD and LCMD and its effects on cholesterol?

    • It varies from person to person, Hamzah. HDL (the “good cholesterol”) tends to go up; LDL usually stays the same or rises a bit but not to the degree that HDL does. Total cholesterol up, down, or no change.

  23. Rachel Resnikoff

    Page 2 of the low carb Mediterranean shopping list looks like all the foods NOT TO EAT on a low carb diet! BANANA!? really? if that’s low carb, what’s NOT allowed? (well besides banana covered in chocolate and whipped cream.)

  24. Linda

    I get so many conflicting recommendations on low carb eating. I used to miss eating sandwiches and pizza on the weekends. I make cauliflower pizza crust now and that took care of pizza forever. I also make garlic bread out it too; just add more mozzarella to the cauliflower “dough” and use it for sandwiches as well.

    What about brown rice? I am on Atkins 1972 version and our carb count is about 4g per day. I have lost about 8.8 pounds, but no more and my husband has lost about 15 lbs. and he’s not as diligent as I am. I’m 59 years old and he’s 66. I rejoined a gym last week and have had two cardio classes. I will be mixing it up with resistance and cardio. Hubby just plays golf and he’s active in little league sports. He’s always running around.

    I have Mediterranean and low carb cook books and am confused about weight loss. I know all of the health benefits as my health markers are excellent, but I need to lose more weight. I lost a lot of weight in my 40s on Atkins, but it doesn’t seem to be working as quickly as then.

    Am I doing something wrong? I haven’t had sugar in over 20 years. I use pure sucralose with no fillers. We eat until satisfied, I’ve given up my nightly wine with dinner and I DO miss that. We do not eat an abundance of food, just regular portions, i.e., 4-5 oz of meat and maybe some roasted grape tomatoes, a mixed greens salad w/avocado and onions and grape tomatoes. The dressing is usually lemon juice and olive oil, garlic and thyme.

    What’s my problem for not losing more weight? We’ve been on-plan 100% since March 16, 2015.


  25. Linda

    We don’t have all of those carbs in one meal. I didn’t clarify that. With our protein, we’ll sometimes have a salad of mixed greens, avocado and grape tomatoes, or we’ll have roasted grape tomatoes with it.

  26. Sherry

    Do you think it is possible to do KMD if you do not eat meat, only fish? I did Atkins over 10 years ago with success but was eating meat at the time.

  27. Linda Shepherd

    Hi Dr Parker,
    Do you have any blogs or information on using the advanced mediterranean diet to MAINTAIN weight! I lke the keto principles, I prefer the mediterranean route, which the nutritionist I saw yesterday prefers. I am living with cancer – breast cancer which has metastasized into my peritoneum and spine. I have been using keto macros: 20g net carb, 66g protein an 129g fat in order to reduce the amount of glucose available for the cancer cells to gorge on! Problem I have is eating enough calories, so I continue to lose weight! I do need to make changes as I have lots of cramps as well as on-going weight loss. The nutritionist I saw yesteday suggests I return to 30% carb, 20%proten and 50%fat ( 125g, 84g and 93g respectively.) BUT He knows nothing about keto – I have had to leave him lots of information! I don’t feel happy about raising carbs too much, yet I have great difficulty in consuming the relevant fats. What do you suggest? I am 63, with a normal BMI is 22.3; weight I want to maintain is 63kg, no less! Virtually all blogs and information about these life-style changes assume weight loss is the reason for following them. It would be so nice to read another perspective – maintaining a healty weight, optimizing the body’s immune system etc etc.

    Many thanks,

    • Good to hear from you, Linda.
      So sorry to hear about your cancer diagnosis.
      All I can say is that you probably need to find a way to get more protein and fat calories into you. By my calculations, you’re eating 1,505 cals/day. Use more butter? Eat more nuts? Drink your favorite oil by the spoonful?
      Best of luck to you!

  28. Chelatenous

    Dear Dr. Parker,

    I am a 50 year old female who weighs around 270 pounds. I am 5′ 6″ tall. I am so confused about everything. I know that the Mediteranean lifestyle is best. Do the Meditteraneans eat this much fat?

    To lose weight, should I start on the KMD and then after about 12 weeks switch to the LCMD? Or can I just start on the LCMD and stay there?

    I am not diabetic or pre-diabetic and my heart, cholesterol and blood pressure are normal. I have had thyroid cancer and my thyroid is gone. Also, because I am BRCA1, I have had a radical hysterectomy.

    Thank You

  29. Ron Ingeman

    This was a very informative blog. Thank you
    I’ve been trying this on my own for four months and have lost 20.lbs.and lowered my
    A1c to 6.0 . I am 72. I am experimenting with
    Balance of fats, proteins and carbs. I would like to add in an occasional slice of rye bread.
    Is that o.k.?

  30. Sandy

    Hi. Glad I found this site.
    I am 75, 5’6″. 3 yrs ago my husband was Dx as diabetic. Since we mostly eat the same food, I was tested and am pre-diabetic. We attended Diabetic classes and began to follow the ADA recommendations for the “plate method”. For me, I found the 180 ADA carbs per day to be too much food, too many times to eat and yo-yo BG readings so I began to tinker with the ADA carb recommendations and eating meals when I was hungry. Cutting all sweetened drinks and then starchy carbs started a weight loss from 144 to 133 lbs, which was OK but played hob with my wardrobe.
    My husband did not lose weight and had, in fact, gained weight. Last year, our daughter, in an effort to lose a little weight and encourage her father toward weight loss, introduced us to the Keto concepts and sites. As I researched, I found that, over 3 years, I had unintentionally “backed” into an nearly Keto Low Carb way of eating so I tinkered with my eating again to incorporate a more Keto concept.
    As I have added more Keto concepts over the year, unfortunately for me, I have lost weight to 126 lbs. I am in a quandary. I like it that my BG levels are usually 80-119 and this is comfortable. When I go above 130 I become very sleepy. I am hoping that the Diabetic Mediterranean Diet can help stabilize my weight loss but I have questions about the Carb Groups and Serving sizes chart.
    1. I know Keto is basically a weight loss diet but is there any way to stabilize at a particular level?
    2. What does digestible carb mean?
    3. How do I interpret Apple, 1/3 medium (54 g), What is the 54 g or other numbers in the parentheses?

    Thanks very much.

    • Good to hear from you, Sandy! Good questions.

      apple, 1/3 of medium (54 g) : 54 g means 54 grams (the metric system of weights for those who live in one of those countries). That’s the serving size. I mainly included that weight in case someone’s conception or reality of a medium-sized apple is much different from mine. A typical American medium-sized apple may not be the same as one in New Zealand, which may be different again from an apple in Germany. A piece of apple between 50 and 60 grams is close enough. I’m not suggesting one has to weigh every thing they eat. Apples can be classed as small, medium, and large. If someone already knows what a medium-sized apple is, the serving size is a third of that. [I’ve never eaten a rutabaga may not recognize one if you put it in front of me. I couldn’t tell a small from a large. But tell me how much to eat by weight, and I’ll figure it out.] I can understand your confusion. With the next edition of the book, I should make this issue clearer!

      Digestible carb is simply another way to say net carbs: Take the total carb grams in a serving then subtract the fiber grams. The result is net carbs or digestible carbs. For instance, Blue Diamond brand Smokehouse almonds serving size (reading from their can) is 28 nuts (1 oz or 28 grams). That serving contains 5 total grams of carbohydrate, but fiber grams are 3. So the net or digestible carbs is 2. Fibers are indeed carbohydrates but our bodies don’t digest them, so they don’t raise blood sugar.

      Regarding question #1, it’s a little too complicated to explain here in the time I have available. I suggest re-reading the article above one more time. There are clues. Briefly, the Ketogenic Mediterranean Diet is great for weight loss. When that goal is reached, many folks switch to the Low-Carb Mediterranean Diet which gradually adds more carbohydrates to their diet. How much? It’s very individual and depends on one’s degree of insulin resistance, how much insulin the individual’s pancreas is still able to produce, diabetes drugs in the body, etc. Carb grams are gradually increased week by week until unacceptable weight regain starts, or blood sugars get too high.


      • Sandy

        Thank you for these clarifications. Frankly, I understand ounces, lbs and grams better than 1/3 medium of “whatever”. If I know the weight of the “whatever” portion size then it doesn’t matter if the “whatever” is small, medium or large. I know what 3 oz of meat off a cow looks like.

        Since the “jargon” of food (and most everything else) switches from person to person, it is always a good idea to check to see if we are talking about the same thing.

        I have picked up on the clues regarding Low-Carb but this is the first time I have seen any thing about how to move from Keto to something else. You are correct about it being a bit tricky, but I think it will be worth it in the long run.

  31. People shouldn’t typically sit in front of the TV and don’t eat in a rush. On the contrary, they have to relax and enjoy their meals and the company they’re in. The point is that mindful eating and physical activity might be just as crucial for your long term health as what you’re eating 🙂

  32. Elizabeth

    Dr. Parker I’m a 59 year old, overweight female (by 65 pounds) and I have the capability to exercise and get around well. My problem is that every single time I start a low carb type diet (20-30 grams) I cannot get much sleep – I toss and turn all night. Then I get sick with any flu bug that comes along. This past January I was literally ill all month with upper respiratory issues. I would so much love to get through the first several weeks without sickness and sleeplessness. I love to exercise (denise austin) but everything goes down the toilet when I cut the carbs, get sick and worn out. Can you offer me some suggestions that allow me to succeed with the low carb dietary method? Thank you – I appreciate your books and blogs. Elizabeth.

    • Hi, Elizabeth. A magnesium supplement may help with the insomnia. E.g., mag oxide 400-800 mg/day. Folks with renal insufficiency need to be careful they don’t overdose. Regarding the propensity to infection, I’m at a loss. A multivitamin might help.

  33. elizabethamywillis58

    Dr. Parker – I’ll take your suggestion and restart your Ketogenic Mediterranean Diet taking the magnesium supplement with a vitamin regimen. I just questioned whether continued sleeplessness might be an early side effect of keto diet leading to a weakening of the immune system. Sincere thanks! Elizabeth.

  34. LeeAnn

    I just wanted to thank you for this site and all the information you have freely given out. So may people struggle so hard with their weight, including myself. I am looking forward to beginning your eating plan and find this info invaluable.

  35. Evelyn Wang

    Dr. Parker, thank you for this site and all the info you’ve provided. I don’t have diabetes nor metallic problems. However I do want to lose some fat. (5’4″, Goal 127lb. to 110lb., BF 25% to 20%) I do yoga 3-4 times a week and weight lift 3 times a week. Fasted cardio 3 mornings a week. I don’t want to do keto diet and am interested in Mediterranean diet but found the traditional Mediterranean diet is relatively lower in protein (20%) and higher in carbs (50%) for my fat loss preference.

    My question is, can I just implement LCMD to start my weight loss plan? Do you have a macro ratio for this plan other than 100g of carbs (I’m comfortable with this)? How much for protein and fat if my daily calories is 1350?

    Sorry it’s a lot of questions and thank you in advance!

  36. indiaatnetin

    Grass fed ghee: the super fat that helps in burning body fat
    Life has become quite a large sedentary for majority of people, and as a result obesity has become a global threat. Besides exercise, adequate rest, and quality lifestyle, diet is one of the efficient remedies of fighting obesity by burning unwanted body fat from body.

    Gone are those days when low calorie foods were only recommended as weight loss diet and fat free lean cooking oils are prescribed for cooking foods for people pursuing weight loss programs. Modern dieticians prefer nowadays moderate use of cow ghee as it is proven now that cow ghee, if consumed in moderation, can help in burning body fat in a faster and natural way.

    But before that let’s take a look what grass fed ghee is made of.

  37. Jim DelVasto

    Dr. Steve
    I saw Dr. Oz on The Today Show talking about a recent study which showed that not only is low carbs the way to go but also that the old adage “calories in vs calories out” is not true. He stated that the study showed that those who had a daily breakdown of nutrients with 20% carbs, 20% proteins, and 60% fats lost weight and kept it off. It was a 20 week study. What they did not talk about was how to break the individual groups down into more specific number. For example, If I am on a 1500 calorie a day diet my carbs should be at 75 grams based on that 20%, but is that total carbs or net carbs? Also my fats should be at 100 grams. We know not all fats are created equal, so what’s the breakdown for saturated fats vs unsaturated fats and don’t forget about trans fats. I have dropped 30 lbs over the last 100 days by doing a time restrictive eating diet incorporated with a low carb/high protein diet. I am considering using some of this latest data to tweak my eating habits even more. Any suggestions would be greatly appreciated.
    Jim DelVasto

    • Hi, Jim.

      “If I am on a 1500 calorie a day diet my carbs should be at 75 grams based on that 20%, but is that total carbs or net carbs?” Should be net carbs.

      “Also my fats should be at 100 grams. We know not all fats are created equal, so what’s the breakdown for saturated fats vs unsaturated fats and don’t forget about trans fats.” I would always minimize trans fats. I wouldn’t worry much (at all?) about saturated vs unsaturated ratio. The industrial seed oils (e.g., soybean oil, rapeseed oil) are rich in unsaturated fats, as you probably know, and are criticized in recent years for potential to cause systemic inflammation and associated disease. I like olive oil an omega-3 fats and try to avoid omega-6s.


  38. tm48827

    Has this diet been updated since 2010? Any recent articles you can point me to? Thank you
    Tom Murray

  39. Debbie easton

    I am probably prediabetic. Battled with weight whole life. Been searching for ages, never seem this site appear on google search before. Exactly what i have been looking for. Very excited. Love the style of writing, thorough, informative but not excessive or overwhelming. Objective approach. Excellent. Start KMD tomorrow!

  40. Thank you for stating no major changes made or needed, as of July 7, 2020. I was wondering the same thing. I love your work. more i suggest you visit one time on doraas kitchen site

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