Advanced Mediterranean Diet

I’ve been experimenting with a very low-carb ketogenic diet that incorporates elements of the Mediterranean diet.  This is a progress report. 

Body Stats

My weight is 155 lb (70.5 kg) now compared with 160.5 at the end of Week 4.  I started this plan at 170 lb (77.3 kg) and a waist circumference of 36.5 inches.  I seem to have plateaued around 155 over the last few weeks.  Waist circumference is 34.25 inches, down an inch over the last three weeks.  This is a pretty good weight for me.

What am I eating? 

Ninety percent of my food consists of:

eggs (3/day), mozarella string cheese sticks, nuts (almonds, mixed, peanuts), steak, sausage, hamburger, chicken, canned tuna, canned sardines, tomatoes, onions, avocadoes, cucumbers, baby spinach, celery, romaine lettuce, red wine (7 fl oz/day), extra virgin olive oil, sugar snap peas, butter, Italian vinaigrette dressing, mayonnaise (on tuna), salt, pepper.  [I should eat greater variety of vegetables and nuts.]

Nutrient Analysis  (thanks to NutritionData.com)

Average daily calories: 1,800

Macronutrient percentages: 8% carbohydrate, 30% protein, 53% fat, 9% alcohol

Daily digestible carbohydrates: 25 g

Daily fats: 110 g total fat, 31 g saturated fat, 52 g monounsaturated fats

Daily cholesterol: 800 mg (mostly from eggs)

Daily fiber: 7-10 g

Daily sodium: 1,500 mg (not counting salt from shaker)

Any potential micronutrient deficiencies? 

Yes.  Considering the amounts of the various foods I’m eating, the un-supplemented Ketogenic Mediterranean Diet on many, if not most, days would be deficient in vitamins D, E, K, thiamin, folate, and pantothenic acid, and the minerals calcium, iron, magnesium, potassium, sodium, copper, manganese.  Less often, there are deficiencies of zinc and vitamins A, C, B12, riboflavin, and B6.  [I am using table salt from the shaker but not tracking it; sodium deficiency is very unlikely.]

These potential deficiencies are based on the % Daily Values recommended by the U.S. Food and Drug Administration for a healthy adult eating 2,000 calories daily.  Someone following the Ketogenic Mediterranean Diet but eating a different mixture of foods could have a better or worse micronutrient profile.

Version 1.01 of the Ketogenic Mediterranean Diet from the outset recommended one daily Centrum multivitamin/multimineral supplement, plus extra vitamin D 400 IU/day, and elemental calcium 500-1,000 mg/day.  These would prevent a large majority of these potential deficiencies. 

I started a daily magnesium supplement a week ago to suppress nocturnal leg cramps.  It’s working well.

Implications

I’m in the midst of revising my recommended supplements and will post them here within the next few days.  I’m likely to add magnesium, potassium, table salt, and fiber. 

Remember, this is not a life-long eating plan; it’s a temporary weight-loss program.  Natural sources of vitamins and minerals along with phytonutrients will be added later.

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 physician before making any dietary, nutritional supplement, or exercise changes.

A recent study suggests that fish intake may modestly increase the risk of developing type 2 diabetes. 

Harvard researchers examined the dietary habits of over 195,000 study participants over the course of at least 14 years.  Increasing consumption of fish and long-chain omega-3 fatty acids (mostly from fish) was linked to a higher onset of type 2 diabetes—up to 24% higher comparing the lowest with the highest consumers.

Implications

This is a preliminary research finding and requires validation by other studies.  The study authors write:

Given the beneficial effects of LCFA [long-chain fatty acids] intake on many cardiovascular disease risk factors, the clinical relevance of this relation and its possible mechanisms require further investigation.

At this point, I believe that the benefits of reasonable omega-3 fatty acid and fish consumption outweight the possible risk of developing type 2 diabetes.

Steve Parker, M.D.

References: Kaushik, M., et al.  Long-chain omega-3 atty acids, fish intake, and the risk of type 2 diabetes mellitus.  American Journal of Clinical Nutrition, 90 (2009): 613-620.

Numerous media outlets two weeks ago reported on a new study linking the Mediterranean diet with lower risk of depression.  Reuters is an example.

Researchers at the University of Navarra in Spain followed 10,000 university graduates over the course of four years, monitoring the onset of depression.  Food consumption was gauged via a food frequency questionnaire.

Compared to the study participants with very low adherence to the Mediterranean diet, those with high adherence were 30% less likely to develop depression.  On the spectrum from low to high adherence, depression rates dropped in a dose-response pattern as adherence to the healthy diet gradually increased.

The researchers suspect that it’s the overall dietary pattern, as opposed to any one single component of the Mediterranean diet, that reduces the risk of depression. 

Visit the Advanced Mediterranean Diet website to learn how eat Mediterrranean-style and decrease your risk of developing depression.

Steve Parker, M.D.

Reference: 

 Sanchez-Villegas, A., et al.  Association of the Mediterranean dietary pattern with the incidence of depression.  Archives of General Psychiatry, 66 (2009): 1,090-1,098.

Kelland, Kate.  Study shows Mediterranean diet cuts depression risk.  Reuters online, October 5, 2009.

Walking is the best possible exercise.  Habituate yourself to walk very far.

                                                           -Thomas Jefferson

HealthDay TV has a short video about oleocanthol, a component of olive oil that may help prevent Alzheimer Disease.  Olive oil is the predominant form of fat in the traditional Mediterranean diet.  The Mediterranean diet is associated with lower rates of Alzheimer Disease and longer survival in Alzheimer patients.

 Steve Parker, M.D.

Despite popular belief, dietary fat - whether saturated or not - is not associated with higher risk of death or illnesss from coronary heart disease, according to a study just published in Annals of Nutrition and Metabolism.  The exception is trans fatty acids.

This is yet another challenge to the Diet-Heart Hypothesis.

New Zealand researchers re-examined all the high-quality science regarding the effect of dietary fats on coronary artery disease, the leading cause of death in the developed world.  Atherosclerosis in the heart arteries causes chest pain (angina), heart failure, heart attacks, and death.

Note the major findings of this meta-analysis:

• total fat intake is not associated with coronary artery disease (at fat intake ranges between 27 and 47% of total energy)
• higher trans fatty acid intake is linked to higher cardiac events and deaths
• saturated fatty acid consumption is not associated with heart deaths or events (within the range of 9-20% of total energy from saturated fat)
• data on polyunsaturated fatty acids and heart disease are “inconsistent and unreliable”
• monunsaturated fatty acid intake was not associated with heart disease (in the range of 13-20% of total energy from MUFA)
• higher omega-3 fatty acid intake (from fish, or fish oil supplements) is linked to lower risk of heart disease, although the data are not as strong as the authors would like  

With the exception of omega-3 fats and trans fats, the researchers report, “The available evidence from cohort and randomized controlled trials is unsatisfactory and unreliable to make judgment about and substantiate the effects of dietary fat on risk of CHD [coronary heart disease].”

But they have made a judgement: Saturated and total fats are not related to heart disease.

In an interesting post-script, the authors mention “Expert Consultation,” which sounds like an oversight panel.  This committee apparently insisted on modification of the article to the effect that “replacing saturated fat with polyunsaturated fat reduces CHD [coronary heart diseases] risk.”  Reading between the lines, I suspect that was a hard pill for the authors to swallow.

Steve Parker, M.D.

Reference:  Skeaff, C. Murray and Miller, Jody.  Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials.  Annals of Nutrition and Metabolism, 55 (2009): 173-201. Available free online September 15, 2009.

Talk sense to a fool and he calls you foolish.

                                                               -Euripides

Happy Healthy Long Life, a blog by an anonymous “medical librarian,” has a thought-provoking article on the best diet to prevent osteoporosis: high in fruits and vegetables, low in animal proteins.

Osteoporosis is a common disease of the elderly, affecting women much more than men.  It causes thin, brittle bones that break easily.  You know all those little old ladies with broken hips?  Nearly all have osteoporosis. 

The standard prescription for prevention is weight-bearing exercise on a regular basis, and adequate intake of calcium and vitamin D.  The aforementioned blog post rejects the calcium recommendation, at least.

I haven’t reviewed this issue for many years and I just discovered Happy Healthy Long Life, so I have no opinion on validity of the post.

Steve Parker, M.D.