Advanced Mediterranean Diet

I just read ”Low-Carbing Among Friends, Volume 1″ by Jennifer Eloff, Maria Emmerich, Carolyn Ketchum, Lisa Marshall, and Kent Altena.

♦   ♦   ♦

If you’re serious about low-carb eating, you’ll want this book.  Five well-known low-carb cooks and chefs present many of their best recipes in a straightforward format.  All 300+ recipes are gluten-free, wheat-free, and sugar-free.  I read through over half of the recipes and understood all the instructions; I’m confident I could make anything in this book.

Some of of the recipe ingredients will be a little hard to find. You may have to order a few of them online, and the authors tell you where to order. Unless you’re just dabbling in low-carb eating, you’ll want to stock up on some of these anyway. 

I have an incurable sweet tooth.  I like to share my cooking with my wife, but she has, um, (ahem)… ”gastrointestinal problems” with my usual non-caloric sweetener, Splenda.  That’s not very common, but is a well-known phenomenon.  I was glad to learn herein that erythritol is a trouble-free alternative, GI-wise.

One thing I miss about standard high-carb eating is baked sugary items like cakes and muffins.  Sure, I’ve read that if you stay away from those for four to six months, you’ll lose your desire.  Not me.  And I tried.  In my next stretch of days off, I’m making a batch of Jennifer Eloff’s Splendid Gluten-Free Bake Mix and spending some time in the kitchen!

Not being previously familiar with him, I was particularly impressed with Kent Altena’s background.  Starting at over 400 pounds (182+ kg), he lost over 200 pounds (91+ kg) and reenlisted in the U.S. National Guard and started running marathons (26.2 miles)!  Thank you for your service to our country, Mr. Altena.

The book is laced with commentary from low-carb proponents, including Dana Carpender, Jimmy Moore, Dr. John Briffa, Dr. Andreas Eenfeldt, Dr. Robert Su, and me.  I am honored to have been invited.

By the way, recipe measurements are given in both U.S. customary and metric units, which non-U.S. residents will appreciate.  Serving size nutrient analysis includes digestible carb grams (aka net carbs).  All recipe carb counts are under 10 g; most are under 5 g.  All of these would jibe with my KMD: Ketogenic Mediterranean Diet.  

If you’re tired of eating the same old things, I’m sure you’ll find many new dishes here that will become time-honored classics in your household.

Steve Parker, M.D.

Disclosure: As a supporter of low-carb eating, I contributed two pages to the book.  I did not and will not recieve any remuneration, and I purchased my own copy of the book.

PS: Recipes I want to try: Cinnamon Swirl Cookies, Green Bean and Bacon Salasd, Gingerbread Biscotti, Tuan Burgers, Blueberry Muffins, Pecan Sun-Dried Tomato and Bacon Cauli-Rice, Spicy Shrimp with Avocado Dressing, 24-Hour Chili, Harvest Pancakes, Breakfast Casserole, Bacon Wrapped Jalapeno Poppers, Stuffed Mushrooms, Broccoli Bacon Salad, Seven Layer Salad, Sausage Quiche, Low-Carb Pancakes, Stuffed Hamburgers, Eggplant Parmeson, Flax Bread, Splendid Gluten-Free Bake Mix, and Mock Danish.

I’ve seen “process cheese food” on packages of apparent cheese or listed with other ingredients on food labels.  Why don’t they just call it “cheese”?

If you’re curious, see what Vitruvius the Sagacious Iconoclast has to say about cheese production.  It’s all processed to some degree.  From the introduction:

I was recently involved in a discussion in which some folks were attempting to distinguish between what they were calling “processed” cheese and other (presumably non-processed) cheese, without defining what they mean by “processed” cheese. As I think that’s a less than optimal approach, I’d like to take a moment to sketch out why that is so; perhaps increasing, in the process, your enjoyment of cheese forever.

It’s a moderately lengthy article, but well worth it for the amusement and erudition.  You’ll learn how cheese is made, starting with the photons.

Cheese is a time-honored component of the traditional Mediterranean diet.  That’s one reason I left it in the Ketogenic Mediterranean Diet.  If you don’t like cheese but still desire the health benefits of the Mediterranean diet, don’t fret.  I’ve not found any important nutrients in cheese that you can’t get elsewhere.

Steve Parker, M.D.

LCHF Cheese

Dr. Eenfeldt of DietDoctor.com gave a talk at the recent Ancestral Health Symposium in California, on the rationale of the current low-carb, high-fat diet (LCHF) so popular in his home country of Sweden.  It’s very understandable to the general public and is a good introduction to low-carb eating.  The entire YouTube video is 55 minutes; if you’re pressed for time, skip the 10-minute Q&A at the end.

He also discusses the benefits of LCHF eating for his patients with diabetes.

If you reduce carbohydrates, you’re going to replace it with either protein, fat, or both.  As Dr. Eenfeldt recommends, the Ketogenic Mediterranean and Low-Carb Mediterranean Diets replace carbs more with fats than protein.

Steve Parker, M.D.

Compared to a low-fat diet, a very-low-carb diet yielded better fat loss and improved adiponectin levels, according to researchers at the University of Cincinnati.  So what?

Adiponectin is a hormone-like protein secreted by fat cells. But the fatter you are, the less adiponectin you have in your bloodstream.  This hormone has several effects: 

• it’s anti-inflammatory
• high levels of one form of it (a high molecular weight oligomer) are linked to lower rates of diabetes
• low circulating levels are associatedwith athersclerosis (hardening of the arteries), high blood pressure, and impaired function of cells lining our arteries
• it sensitizes the liver and muscles to insulin, which helps keep blood sugars under control

In summary, it’s a good thing to have around.  Low levels are linked to illnesses.  Overweight and obesity tend to lower your levels of adiponectin.  If you’re overweight and have low levels of adiponectin, you should be healthier if you can raise your levels.  How do you do that?  Lose weight.

U. of Cincinnati investigators wanted to know if a very-low-carb diet would increase adiponectin levels better than a common low-fat weight loss diet.  They randomized 81 obese women to follow either a low-fat diet (American Heart Association Step 1) or a very-low-carbohydrate diet based on the Atkins diet.  Women followed the diets for either four or six months.

Findings

Both groups lost weight, but the very-low-carb group lost more: 9.1 kg loss for very-low-carb vs 4.97  for the low-fat group.

The very-low-carb group lost more body fat: 5.45 kg vs 2.62 kg.  (Fat loss was determined by DEXA scan.)

Adiponectin increased in the VLC group but not the LF group.

Discussion

We can’t tell from this article if adiponectin results would be the same in men.  The authors didn’t mention.

In fairness, the authors cite another similar study that found equal degrees of weight loss and adiponectin increase in both low-fat and low-carb groups.  It was a year-long intervention and average weight loss was 13.5% for both groups, a greater degree of weight loss than in the study at hand, in which the very-low-carb group lost 10% of body weight and the low-fat group lost 5.4%.  So you can probably increase your leptin with a low-fat diet if you lose enough excess weight.

Would the Ketogenic Mediterranean Diet work just as well as the very-low carb diet used in this study?  I suspect so, but don’t have the $500,000 it would take to do the research.  Care to donate?

Steve Parker, M.D.

Reference:  Summer, Suzanne, et al.  Adiponectin changes in relation to the macronutrient composition of a weight-loss diet.  Obesity, 2011. doi: 10.1038/oby.2011.60

The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain. The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease.  Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure,  and abdominal fat accumulation.

Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened.  At baseline, average age was 41 and average body mass index was 36.6.  Investigators didn’t say how many diabetics or prediabetics were included.  No participant was taking medication.

What’s the Spanish Ketogenic Mediterranean Diet?

Calories are unlimited, but dieters are encouraged to keep carbohydrate  consumption under 30 grams day.  They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil,  and 200-400 ml of red wine daily ( a cup or 8 fluid ounces  equals 240 ml).  On at least four days of the week, the primary protein food is fish.  On those four days, you don’t eat meat, chicken, eggs, or cheese.  On up to three days a week, you could eat non-fish protein foods but no fish on those days. 

How’s this different from my Ketogenic Mediterranean Diet?  The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.

Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged. 

What Were the Results?

Metabolic syndrome resolved in all participants.

Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet.  Another one was lost to follow-up.  Final analysis was based on the 22 who completed the study.

Eight of the 22 participants had adverse effects.  These were considered slight and mostly appeared and  disappeared during the first week.  Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia. 

Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).

Body mass index fell from 36.6 to 32.

Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).

Triglycerides fell from 225 mg/dl to 110 mg/dl.

Average systolic blood pressure fell from 142 mmHg to 124.

Average diastolic blood pressure fell from 89 to 76.

So What?

A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years.  That’s because they don’t do anything effective to counteract it.  These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.

Very-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol.  Overweight dieters tend to lose more weight, and more quickly, than on other diets.  Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome.  It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet.  In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content. 

Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program.  The program at hand worked without exercise.  I recommend regular exercise for postponing death and other reasons.

Will the dieters of this study still be cured of metabolic syndrome a year later?  Unlikely.  Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.

Steve Parker, M.D.

Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461

The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain. 

The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease.  Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure,  and abdominal fat accumulation.

Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened.  At baseline, average age was 41 and average body mass index was 36.6.  Investigators didn’t say how many diabetics or prediabetics were included.  No participant was taking medication.

What’s the Spanish Ketogenic Mediterranean Diet?

Calories are unlimited, but dieters are encouraged to keep carbohydrate  consumption under 30 grams day.  They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil,  and 200-400 ml of red wine daily ( a cup or 8 fluid ounces  equals 240 ml).  On at least four days of the week, the primary protein food is fish.  On those four days, you don’t eat meat, chicken, eggs, or cheese.  On up to three days a week, you could eat non-fish protein foods but no fish on those days. 

How’s this different from my Ketogenic Mediterranean Diet?  The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.

Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged. 

What Were the Results?

Metabolic syndrome resolved in all participants.

Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet.  Another one was lost to follow-up.  Final analysis was based on the 22 who completed the study.

Eight of the 22 participants had adverse effects.  These were considered slight and mostly appeared and  disappeared during the first week.  Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia. 

Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).

Body mass index fell from 36.6 to 32.

Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).

Triglycerides fell from 225 mg/dl to 110 mg/dl.

Average systolic blood pressure fell from 142 mmHg to 124.

Average diastolic blood pressure fell from 89 to 76.

So What?

A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years.  That’s because they don’t do anything effective to counteract it.  These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.

Very-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol.  Overweight dieters tend to lose more weight, and more quickly, than on other diets.  Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome.  It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet.  In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content. 

Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program.  The program at hand worked without exercise.  I recommend regular exercise for postponing death and other reasons.

Will the dieters of this study still be cured of metabolic syndrome a year later?  Unlikely.  Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.

Steve Parker, M.D.

Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461

Loss of excess weight is a mainstay of therapy for nonalcoholic fatty liver disease.  A very-low-carb diet works better than a reduced-calorie diet, according to a recent study in the American Journal of Clinical Nutrition.

Nonalcoholic fatty liver disease (NAFLD) occurs in 20 to 40% of the general population, with most cases occuring between the ages of 40 and 60.  It’s an accumulation of triglycerides in the liver.  For every week I work in the hospital, I see five or 10 scans (either CT scans or sonograms) that incidentally show fat build-up in the liver.

Nonalcoholic steatohepatitis (NASH) is a subset of NAFLD, perhaps 30% of those with NAFLD.  Steatohepatitis involves an inflammatory component, progressing to cirrhosis in 3 to 26% of cases. 

Researchers at the University of Texas Southwestern Medical Center assigned 18 obese subjects (average BMI 35) to either a very-low-carb diet (under 20 grams a day) or a low-calorie diet  (1200 to 1500 calories a day) for two weeks.  Liver fat was measured by magnetic resonance technology.  The low-carb groups’ liver fat decreased by 55% compared to 28% in the other group.  Weight loss was about the same for both groups (4.6 vs 4 kg). 

Bottom Line

This small study needs to be replicated, ideally with a larger group of subjects studied over a longer period.  Nevertheless, it appears that a very-low-carb diet may be one of the best dietary approaches to nonalcoholic fatty liver disease.  And I bet it’s more sustainable than severe calorie restriction.  The Ketogenic Mediterranean Diet, by the way, provides 20-30 grams of carb daily.

Steve Parker, M.D. 

Reference:  Browning, Jeffrey, et al.  Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction.  Am J Clin Nutr, May 2011 vol. 93 no. 5 1048-1052.  doi: 10.3945/​ajcn.110.007674

Ketogenic diets have seen a resurgence in the last two decades as a treatment for childhood epilepsy, particularly difficult-to-control cases not responding to drug therapy.  It works, even in adults.  That’s why some brain experts are wondering if ketogenic diets might be helpful in other brain disorders, such as Alzheimer’s disease and Parkinson’s disease. 

I’ll save you some time and just give you the conclusion of a 2006 scientific article I read: maybe, but it’s way too soon to tell.

The article is called “Neuroprotective and disease-modifying effects of the ketogenic diet,” from researchers at the National Institutes of Health’s National Institue of Neruological Disorders and Stroke.  Sounds promising doesn’t it?

The article goes into detail about how the ketogenic diet might be good for brain health.  Dr. Emily Deans would be very interested in that, but most of my readers not.  Two-and-a-half pages on non-human animal studies, too. 

What is this ”Ketogenic diet” used for epilepsy?

The most common ketogenic diet for childhood epilepsy is the one developed by Wilder in 1921.  It was a popular treatment for epilepsy in the 1920s and 1930s.  Fats provide 80 to 90% of the calories in the diet, with sufficient protein for growth, and minimal carbohydrates.  Since carbs are in short supply, the body is forced to use fats as an energy source, which generates ketone bodies—acetoacetate, acetone, beta-hydroxybutyrate, largely from the liver.

So what?

Not much.  This article may have been written to stimulate future research, and I hope it does.  I just searched PubMed for “ketogenic diet AND Alzheimer” and came up with nothing new since 2006. 

Could the Ketogenic Mediterranean Diet prevent or alleviate Alzheimer’s disease?  At this point, just flip a coin.

Steve Parker, M.D.

Reference: Gasior M, Rogawski MA, & Hartman AL (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17 (5-6), 431-9 PMID: 16940764

Followers of my Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet may appreciate a Daily Log I’ve put together and published as a one-page PDF.  You actually track seven days of eating on a standard sheet of printer paper.

Daily logs aren’t essential, but may help dieters keep track of the major components of the programs.  For instance, you simply check off when you’ve had your olive oil, vegetables, nuts, fish, wine (or alternative), and supplements.  It also has slots for blood sugar levels.

As long as you have a printer, ink, paper, and electricity, the Daily Log PDF is free.   

I’m trying to make this as easy as possible.  What else can I do for you?

Steve Parker, M.D.

My 2007 book, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer is now available in PDF format for $9.95 USD.  It’s not a low-carb diet book, but a calorie-restricted, balanced diet incorporating the healthy features of the traditional Mediterranean diet.  The physical book is also available from Amazon or CreateSpace. 

As we learned in yesterday’s post, loss of excess weight can be accomplished by measuring either carb grams or calories.  If you can handle monitoring your calorie consumption—and I make it as easy as possible in the book—then the Advanced Mediterranean Diet is a good way to go.  Due to the relatively high carbohydrate content of the traditional Mediterranean diet, however, people with diabetes or prediabetes should do better with carb-counting, as in the Low-Carb Mediterranean Diet or Ketogenic Mediterranean Diet.

Either way, I got you covered.

Steve Parker, M.D.