Tag Archives: low-carb Mediterranean diet

Recipe: Frozen Fruit Smoothie #2

 

Similar to an Icee, but healthier for you

This is double the serving size below. Similar to an Icee, but healthier for you.

Fruits are thought to be one of the healthy components of the traditional Mediterranean diet. Try this smoothie for dessert instead of calorie-laden items like pie, cake, cookies, and ice cream. Unlike this smoothie, those aren’t very nutrient-dense, either. Since I provide the nutritional analysis below, you can easily incorporate this into the Low-Carb Mediterranean Diet.

At the Parker Compound, we mix this in a Vitamix. Other devices may work, but I’m not familiar with them.

It's all here

It’s all here

Ingredients

1 cup (240 ml) frozen raspberries

1/2 cup (120 ml) frozen blueberries

1 cup (240 ml) frozen strawberries

1 frozen banana (7 inches or 18 cm), cut into 3–4 pieces

1 tbsp (13 g) chia seeds

1 handful (1/2 ounce?) raw kale

2.5 cups (590 ml) water

1 cup (240 ml) ice cubes

Instructions

First item into the Vitamix is the water, then banana, all berries, chia seeds, then top off with the ice. Start mixing on variable speed 1 then slowly increase spin rate to 10, for a total mix of 45–60 seconds. Soon after you get started you’ll probably have to use the “plunger” a few times to un-clump the top items.

Loaded and ready to spin

Loaded and ready to spin

Depending on your batch of fruits, this drink may not be as sweet as you like. You could easily sweeten it up with your favorite artificial non-caloric sweetener. I used 1.5 tsp (7.5 ml) of Truvia to good effect, just thrown in with every thing else before or after the primary mix. Or you could use table sugar, about 4 tsp (20 ml), instead of the Truvia. Most of us eat too much sugar. If you go the sugar route, you’ll increase the calories per serving by 7, and increase carbohydrate grams by 2 per serving.

My able assistant wields the plunger

My able assistant wields the plunger

Number of Servings: 7 servings of 6 fl oz (175 ml) each

Nutritional Analysis per Serving:

7% fat

90% carbohydrate

3% protein

100 calories

23 g carbohydrate

3 g fiber

20 g digestible carbohydrate

3 mg sodium

150 mg potassium

Prominent features: Fair dose of vitamin C, homeopathic amounts of sodium

Steve Parker, M.D.

PS: I credit my wife with this recipe.

 

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Recipe: Cabbage Soup

You can incorporate this cabbage soup into any diabetic diet, even ketogenic ones. This version isn’t a powerhouse in any one particular nutrient but provides a fair amount of zinc, protein, and vitamins A, B12, and C.

If you’re a constipated, a bowl or two of cabbage soup may get things moving. It’s the raffinose in cabbage.

paleo diet, Steve Parker MD, cabbage soup

Plan well in advance because this takes a while to cook

Ingredients:

  • water, 4 quarts (3.8 L)
  • parsley, fresh, to taste (3 or 4 sprigs)
  • stew meat (beef), raw, 8 oz (230 g)
  • pepper, to taste (1/4 tsp or 1.2 ml)
  • salt, to taste (1.5 tsp or 8.4 mL) (don’t use this much if on a low-sodium diet)
  • tomato sauce, canned, 4 fl oz (120  ml)
  • carrot, raw, large (4.5 oz or 130 g), peeled and sliced into 1/4-inch (1/2-cm) thick discs
  • cabbage, green, raw, 1/2 of a small one (whole one weighs about 2 lb or 900 g), rinsed, cored, then sliced into quarters or smaller
  • fresh lemon (optional)

Instructions:

Add raw meat to the water in a large pot and boil gently for 30 minutes. Then add tomato sauce, carrot, salt, pepper, parsley, and cabbage. Bring to boil over medium heat and them simmer for 45 minutes.

If it’s too bland for you, add a squeeze of fresh lemon.  Or as a last resort, add some beef bouillon cube or powder.

Servings:

Makes four servings of 2 cups each (475 ml).

Nutritional Analysis Per Serving:

  • 46% fat
  • 23% carbohydrate
  • 31% protein
  • 200 calories
  • 12 g carbohydrate
  • 3 g fiber
  • 9 g digestible carb
  • 1,200 mg sodium
  • 495 mg potassium
  • Prominent features: see first paragraph

Steve Parker, M.D.

PS: Nutritional analysis done at FitDay.com. You can analyze you’re own recipes there, too.

low-carb mediterranean diet

Front cover of book

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Diabetic Diet Wars: Vegan Versus Low-Fat

 

paleo diet, Steve Parker MD, how to cook asparagus and Brussels sprouts

These might be allowed on the vegan Ma-Pi 2 diet

A vegan diet was superior to a low-fat diet over the course of three weeks, in terms of blood sugar, hemoglobin A1c, total cholesterol and LDL cholesterol. The vegans were also able to use fewer drugs.

A specific vegan diet (Ma-Pi 2) was compared to a low-fat diet in a study published by Nutrition & MetabolismCarbsane Evelyn dove into the study at her blog (recommended reading), or you can read the original research report yourself. Study subjects had fairly well-controlled type 2 diabetes and were elderly (66) and overweight (84 kg or 185 lb). The vegan diet was mostly whole grains, vegetables, legumes, and green tea.  The low-fat and vegan diets both probably supplied 200–300 calories/day fewer than what the subjects were used to: 1900 cals for men, 1700 for women. The study had 25 patients in each group and lasted only three weeks.

The vegan group ate 335 grams/day of carbohydrate compared to 235 grams in the low-fat group. In contrast, the Low-Carb Mediterranean Diet provides 30–100 grams/day of digestible carb and the Ketogenic Mediterranean Diet allows a max of 20–30 grams.

The vegans in the study at hand ate 15–20 more grams/day of fiber. High fiber intake is linked to better blood sugar control.

From the study abstract:

After correcting for age, gender, BMI at baseline, and physical activity, there was a significantly greater reduction in the primary outcomes fasting blood glucose and after-meal glucose in those patients receiving the Ma-Pi 2 diet compared with those receiving the control diet [low-fat]. Statistically significantly greater reductions in the secondary outcomes, HbA1c, insulin resistance, total cholesterol, LDL cholesterol and LDL/HDL ratio, BMI, body weight, waist and hip circumference were also found in the Ma-Pi 2 diet group compared with the control diet group. The latter group had a significantly greater reduction of triglycerides compared with the Ma-Pi 2 diet group.

The take-home point for me is that overweight T2 diabetics can improve short-term diabetes numbers despite a high carbohydrate consumption if they restrict calories and eat the “right” carbs. Restrict calories enough—600/day?—and T2 diabetes might be curable

I’ve written before about vegetarian/vegan diets for diabetes. My patients are more resistant to vegan diets than they are to low-carb.

Paleobetic diet, low-carb breakfast

Not allowed not on the Ma-Pi 2 diet. Bacon, eggs, black coffee, and Cholula hot sauce.

I scanned the original report and don’t see any problems with Evelyn’s summary.

Steve Parker, M.D.

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Lose Weight With Contrave, But Don’t Kill Yourself

Open wide!

Open wide!

The FDA recently approved a new weight-loss drug for the U.S. market. It’s marketed as Contrave, a combination of naltrexone and bupropion.

Neither of the components is new. Naltrexone’s been used to treat alcohol and narcotic addiction. Bupropion, e.g., Wellbutrin, is for depression and smoking cessation.

Contrave joins two other recent drugs for weight loss. Belviq and Qsymia were approved in 2012. I still haven’t run across anyone using those.

To qualify for the new formulation, you need a body mass index over 30, or over 27 plus one or more weight-related medical condition such as type 2 diabetes or high blood pressure.

If you haven’t lost over 5% of your initial body weight in the first 12 weeks of use, the FDA recommends stopping the drug.

Potential adverse effects include suicidal thoughts and seizures. More commonly, users may experience headache, nausea, constipation, diarrhea, dizziness, insomnia, and dry mouth. Constipation and diarrhea?!

Even with the drug, you still have to be on a reduced-calorie diet and exercise program.

Why not try the Low-Carb Mediterranean Diet or Paleobetic Diet first?

Steve Parker, M.D.

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Low-Carb Beats Low-Fat Diet for Weight Loss Once Again

…according to an article at MedPageToday.

Many physicians have been reluctant to recommend low-carb diets out of fear that they increase cardiovascular risk. A recent study compared low-carb to low-fat dieting over 12 months and actually found better improvements in cardiovascular disease risk factors on the low-carb diet (max of 40 grams a day).

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

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

After 12 months, folks on a low-carbohydrate diet had lost 5.3 kg (11.7 lb), while those on a low-fat diet with similar caloric value had lost 1.8 kg (3.9 lb). Both groups showed lowering of LDL cholesterol, while the low-carbers had better improvements in HDL cholesterol and triglycerides.

DietDoctor Andreas Eenfeldt can add this study to his list of others that show better weight loss with low-carb diets compared to low-fat.

Regular readers here know of my Low-Carb Mediterranean Diet for diabetes and prediabetes. My Advanced Mediterranean Diet for non-diabetics also offers a low-carb option in addition to traditional reduced-calorie portion-control eating.

Steve Parker, M.D.

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Prevent Weight Regain With the Mediterranean Diet

Italian seaside tangentially related to this post

Italian seaside tangentially related to this post

Investigators affiliated with universities in Italy and Greece wondered about the effect on obesity of two ketogenic “Mediterranean” diet spells interspersed with a traditional Mediterranean diet over the course of one year. They found significant weight loss, and perhaps more importantly, no regain of lost weight over the year, on average.

This scientific study is right up my alley. I was excited when I found it. Less excited after I read it.

The Set-Up

This was a retrospective review of medical records of patients of a private nutritional service in three fitness and weight control centers in Italy between 2006 and 2010. It’s unclear whether patients were paying for fitness/weight loss services. 327 patient records were examined. Of these, 89 obese participants met the inclusion and exclusion criteria and started the program; 68 completed it and were the ones analyzed. (That’s not at all a bad drop-out rate for a year-long study.)  The completers were 59 males and 12 females (I know, the numbers don’t add up, but that’s what they reported). Ages were between 25 and 65. Average weight was 101 kg (222 lb), average BMI 35.8, average age 49. All were Caucasian. No diabetics.

Here’s the program:

  1. 20 days of a very-low-carb ketogenic diet, then
  2. 20 days of a low-carbohydrate non-ketogenic diet for stabilization, then
  3. 4 months of a normal caloric Mediterranean diet, then
  4. repeat #1 and #2, then
  5. 6 months of a normal caloric Mediterranean diet

In the ketogenic phases, which the authors referred to as KEMEPHY, participants followed a commercially available protocol called TISANOREICA. KEMEPHY is combination of four herbal extracts that is ill-defined (at least in this article), with the idea of ameliorating weakness and tiredness during ketosis. The investigators called this a ketogenic Mediterranean diet, although I saw little “Mediterranean” about it. They ate “beef & veal, poultry, fish, raw and cooked green vegetables without restriction, cold cuts (dried beef, carpaccio and cured ham), eggs and seasoned cheese (e.g., parmesan).” Coffee and tea were allowed. Items to avoid included alcohol, bread, pasta, rice, milk, and yogurt. “In addition to facilitate the adhesion to the nutritional regime, each subject was given a variety of specialty meals constituted principally of protein and fibers. “These meals (TISANOREICA) that are composed of a protein blend obtained from soya, peas, oats (equivalent to 18 g/portion) and virtually zero carbohydrate (but that mimic their taste) were included in the standard ration.” They took a multivitamin every morning. Prescribed carbohydrate was about 30 grams a day, with macronutrient distribution of 12% carb, 36 or 41% protein, and 51 0r 52% fat. It appears that prescribed daily calories averaged 976 (but how can that be prescribed when some food items are “unrestricted”?).

I found little explanation of period #2 mentioned above, the low-carb non-ketogenic diet. Prescribed macronutrients were 25 or 33% carb, 27 0r 31% protein, 41 or 44% fat, and about 91 g carbohydrate. Prescribed daily calories appear to have averaged 1111.

After the first and second active weight loss ketogenic phases, participants ate what sounds like a traditional Mediterranean diet. Average prescribed macronutrient distribution was 57% carbohydrate, 15 % protein, and 27% fat. Wine was allowed. It looks like 1800 calories a day were recommended.

Food consumption was measured via analysis of 3-day diaries, but you have to guess how often that was done because the authors don’t say. The results of the diary analyses are not reported.

What Did They Find?

Most of the weight loss occurred during the two ketogenic phases. Average weight loss in the first ketogenic period was 7.4 kg (16 lb), and another 5.2 kg (11 lb) in the second ketogenic period. Overall average weight loss for the entire year was 16.1 kg (35 lb).

Average systolic blood pressure over the year dropped a statistically significant 8 units over the year, from 125 to 116 mmHg.

Over the 12 months, they found stable and statistically significant drops in total cholesterol, LDL cholesterol (“bad cholesterol”), triglycerides, and blood sugar levels. No change in HDL cholesterol (“good cholesterol”).

Liver and kidney function tests didn’t change.

The authors didn’t give explanations for the drop-outs.

Although the group on average didn’t regain lost weight, eight participants regained most of it. The investigators write that “…the post dietary analysis showed that they were not compliant with nutritional guidelines given for the Mediterranean diet period. These subjects returned to their previous nutrition habits (“junk” food, high glycaemic index, etc.) with a mean “real” daily intake of 2470 Kcal rather than the prescribed 1800 Kcal.”

Comments

A key take-home point for me is that the traditional Mediterranean diet prevented the weight regain that we see with many, if not most, successful diets.

However, most formulas for calculating steady state caloric requirements would suggest these guys would burn more than the 1800 daily calories recommended to them during the “normal calorie” months. How hard did the dieters work to keep calories around 1800? We can only speculate.

Although the researchers describe the long periods of traditional Mediterranean diet as “normal caloric,” they don’t say how that calorie level was determined  and achieved in the real world. Trust me, you can get fat eating the Mediterranean diet if you eat too much.

I’ll be the first to admit a variety of weight loss diets work, at least short-term. The problem is that people go back to their old ways of eating regain much of the lost weight, typically starting six months after starting the program. It was smart for the investigators to place that second ketogenic phase just before the typical regain would have started!

There are so few women in this study that it would be impossible to generalize results to women. Why so few? Furthermore, weight loss and other results weren’t broken down for each sex.

I suspect the results of this study will be used for marketing KEMEPHY and TISANOREICA. For all I know, that’s why the study was done. We’re trusting the investigators to have done a fair job choosing which patient charts to analyze retrospectively. They could have cherry-picked only the good ones. Some of the funding was from universities, some was from Gianluca Mech SpA (what’s that?).

How much of the success of this protocol is due to the herbal extracts and TISANOREICA? I have no idea.

The authors made no mention of the fact the average fasting glucose at baseline was 103 mg/dl (5.7 mmol/l). That’s elevated into the prediabetic range. So probably half of these folks had prediabetes. After the one-year program, average fasting glucose was normal at 95 mg/dl (5.3 mmol/l).

The improved lipids, blood sugars, and lower blood pressure may have simply reflected successful weight loss and therefore could have been achieved  by a variety of diets.

The authors attribute their success to the weight-losing metabolic effects of the ketogenic diet (particularly the relatively high protein content), combined with the traditional Mediterranean diet preventing weight regain.

The authors write:

The Mediterranean diet is associated with a longer life span, lower rates of coronary heart disease, hypercholesterolemia, hypertension, diabetes and obesity. But it is difficult to isolate the “healthy” constituents of the Mediterranean diet, since it is not a single entity and varies between regions and countries. All things considered there is no “one size fits all” dietary recommendation and for this reason we have tried to merge the benefits of these two approaches: the long term “all-life” Mediterranean diet coupled with brief periods of a metabolism enhancing ketogenic diet.

I’ve attempted a similar merger with my Low-Carb Mediterranean Diet. Click here for an outline. Another stab at it was the Spanish Ketogenic Mediterranean Diet. And here’s my version of a Ketogenic Mediterranean Diet.

Steve Parker, M.D.

Reference: Paoli, Antonio, et al. Long Term Successful Weight Loss with a Combination Biphasic Ketogenic Mediterranean Diet and Mediterranean Diet Maintenance Protocol. Nutrients, 5 (2013): 5205-5217. doi: 10.3390/nu5125205

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Live Longer and Reduce Risk of Cancer and Heart Disease With Vegetables and Fruits

MedPageToday has some of the details.  A quote:

The largest benefits were seen in people who ate seven or more servings of fruits and vegetables a day compared with those who ate less than one serving, with the higher level of consumption associated with significantly lower all-cause mortality (hazard ratio 0.67; 95% CI 0.58-0.78), lead researcher Oyinlola Oyebode of University College London, and colleagues, reported online in the Journal of Epidemiology and Community Health.

Spaghetti squash, an under-utilized vegetable

Spaghetti squash, an under-utilized vegetable

The population under study was English. In addition to lower risk of death, the heavy fruit and vegetable consumers had lower rates of cancer and cardiovascular disease. Click for the actual research report.

If seven servings a day seems like a lot, note that a typical serving is only half a cup. You’ll get those with the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

1 cup spaghetti squash with minced black olive, sweet pepper, garlic, salt, pepper, celery

1 cup spaghetti squash with minced black olive, sweet pepper, garlic, salt, pepper, celery

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