Category Archives: Ketogenic Mediterranean Diet

Will Alcohol Wreck a Ketogenic Diet?

Jameson’s in a hotel bar near Chicago

Judicious alcohol consumption is a reasonable component of many successful ketogenic diets. But the practice can also be a dangerous minefield. Anne Mullins over at DietDoctor has a great article that will steer you away from the mines. An excerpt:

Nyström notes that alcohol is actually the fourth macronutrient after protein, fats and carbohydrates, and that in many nutrition studies its intake is often overlooked. In Mediterranean countries like Greece and Italy, alcohol makes up about 10 % of caloric intake and may partially contribute to the touted benefits of the Mediterranean diet, Nyström says.

Drinking alcohol, however, may slow weight loss for some. Dr. Sarah Hallberg [R.I.P.] advises her patients who are trying to lose weight and/or reverse diabetes to have a maximum 1 glass of wine for women and 2 for men, and not every day. “If they experience any weight stall, I recommend they stop the alcohol completely,” says Hallberg.

Both Dr. Jason Fung and Dr. Ted Naiman discourage any alcohol use among patients in their care who are still trying to lose weight, reverse diabetes or heal a fatty liver (see point 5). “I find alcohol is not conducive to steady weight loss,” says Fung.

Read the whole thing to learn about the dopamine reward system, alcohol abuse and addiction, liver diseases, and hangovers. If you often drink to the point of hangovers, that’s too much alcohol!

Steve Parker, M.D.

PS: The Advanced Mediterranean Diet includes a doctor-designed ketogenic diet as one option for weight loss.

Low-Carb High-Fat Diet OK for Heart

Photo by Malidate Van on Pexels.com

Mainstream physicians are still hesitant to recommend low-carb diets because they are usually high in fat, potentially with heart-toxic levels of saturated fats. A recent scientific article supported low-carb eating for heart health.

Link to article

ABSTRACT

Background

Carbohydrate restriction shows promise for diabetes, but concerns regarding high saturated fat content of low-carbohydrate diets limit widespread adoption.Objectives

This preplanned ancillary study aimed to determine how diets varying widely in carbohydrate and saturated fat affect cardiovascular disease (CVD) risk factors during weight-loss maintenance.

Methods

After 10–14% weight loss on a run-in diet, 164 participants (70% female; BMI = 32.4 ± 4.8 kg/m2) were randomly assigned to 3 weight-loss maintenance diets for 20 wk. The prepared diets contained 20% protein and differed 3-fold in carbohydrate (Carb) and saturated fat as a proportion of energy (Low-Carb: 20% carbohydrate, 21% saturated fat; Moderate-Carb: 40%, 14%; High-Carb: 60%, 7%). Fasting plasma samples were collected prerandomization and at 20 wk. Lipoprotein insulin resistance (LPIR) score was calculated from triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P). Other outcomes included lipoprotein(a), triglycerides, HDL cholesterol, LDL cholesterol, adiponectin, and inflammatory markers. Repeated measures ANOVA was used for intention-to-treat analysis.

Results

Retention was 90%. Mean change in LPIR (scale 0–100) differed by diet in a dose-dependent fashion: Low-Carb (–5.3; 95% CI: –9.2, –1.5), Moderate-Carb (–0.02; 95% CI: –4.1, 4.1), High-Carb (3.6; 95% CI: –0.6, 7.7), P = 0.009. Low-Carb also favorably affected lipoprotein(a) [–14.7% (95% CI: –19.5, –9.5), –2.1 (95% CI: –8.2, 4.3), and 0.2 (95% CI: –6.0, 6.8), respectively; P = 0.0005], triglycerides, HDL cholesterol, large/very large TRL-P, large HDL-P, and adiponectin. LDL cholesterol, LDL-P, and inflammatory markers did not differ by diet.

Conclusions

A low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia and lipoprotein(a), without adverse effect on LDL cholesterol. Carbohydrate restriction might lower CVD risk independently of body weight, a possibility that warrants study in major multicentered trials powered on hard outcomes.

Parker here. These findings are no surprise to me.

Steve Parker, M.D.

PS: The Advanced Mediterranean Diet (2nd Ed.) includes a low-carb option.

PPS: Ketogenic diets are all low-carb.

Low-Carb Mediterranean Diet Recipes

Ketogenic compatible

Check out Diet Doctor for over 60 low-carb Mediterranean diet recipes! Diet Doctor usually provides carbohydrate counts, so you can fit these into the Low-Carb or Ketogenic Mediterranean Diet.

Click on “recipes” at left for my own low-carb Mediterranean diet recipes.

Steve Parker, M.D.

PS: If you have The Advanced Mediterranean Diet (2nd Edition), you already have the ketogenic Mediterranean Diet!

Ketogenic Diet Shows Promise in Alzheimer’s Disease

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss
“Sweat Pea, it’s not too late to go keto.”

Here’s the abstract of an article in Advances in Nutrition:

Alzheimer disease (AD) is a global health concern with the majority of pharmacotherapy choices consisting of symptomatic treatment. Recently, ketogenic therapies have been tested in randomized controlled trials (RCTs), focusing on delaying disease progression and ameliorating cognitive function. The present systematic review aimed to aggregate the results of trials examining the effects of ketogenic therapy on patients with AD/mild cognitive impairment (MCI). A systematic search was conducted on PubMed, CENTRAL, clinicaltrials.gov, and gray literature for RCTs performed on adults, published in English until 1 April, 2019, assessing the effects of ketogenic therapy on MCI and/or AD compared against placebo, usual diet, or meals lacking ketogenic agents. Two researchers independently extracted data and assessed risk of bias with the Cochrane tool. A total of 10 RCTs were identified, fulfilling the inclusion criteria. Interventions were heterogeneous, acute or long term (45-180 d), including adherence to a ketogenic diet, intake of ready-to-consume drinks, medium-chain triglyceride (MCT) powder for drinks preparation, yoghurt enriched with MCTs, MCT capsules, and ketogenic formulas/meals. The use of ketoneurotherapeutics proved effective in improving general cognition using the Alzheimer’s Disease Assessment Scale-Cognitive, in interventions of either duration. In addition, long-term ketogenic therapy improved episodic and secondary memory. Psychological health, executive ability, and attention were not improved. Increases in blood ketone concentrations were unanimous and correlated to the neurocognitive battery based on various tests. Cerebral ketone uptake and utilization were improved, as indicated by the global brain cerebral metabolic rate for ketones and [11C] acetoacetate. Ketone concentrations and cognitive performance differed between APOE ε4(+) and APOE ε4(-) participants, indicating a delayed response among the former and an improved response among the latter. Although research on the subject is still in the early stages and highly heterogeneous in terms of study design, interventions, and outcome measures, ketogenic therapy appears promising in improving both acute and long-term cognition among patients with AD/MCI. This systematic review was registered at http://www.crd.york.ac.uk/prospero as CRD42019128311.

Source: To Keto or Not to Keto? A Systematic Review of Randomized Controlled Trials Assessing the Effects of Ketogenic Therapy on Alzheimer Disease – PubMed

I haven’t read the full study yet.

Steve Parker, M.D.

PS: h/t to Diet Doctor

PPS: If you have my Advanced Mediterranean Diet 2nd edition, you already have a ketogenic diet at your fingertips.

Ketogenic Diet More Effective Than Low-Fat for Obesity and Diabetes

One of many ketogenic salads

From The Journal of Nutrition:

For >50 y, dietary guidelines in the United States have focused on reducing intakes of saturated and total fat. However, rates of obesity and diabetes rose markedly throughout this period, with potentially catastrophic implications for public health and the economy. Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

     Steve Parker, M.D.

PS: A ketogenic diet is one of the options in The Advanced Mediterranean Diet, 2nd edition.

Ketogenic Mediterranean Diet Improves Psoriasis

What an odd study I found…

Abstract

Objectives

Very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies likely possessing anti-inflammatory properties. We evaluated the efficacy of an aggressive WL [weight loss] program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis.

Research methods & procedures

Adult overweight/obese drug-naïve (never treated excluding use of topical emollients) patients (N=37; 30% males; age, 43.1±13.8 years) with stable chronic plaque psoriasis underwent a 10-week two-phase WL program consisting in a 4-week protein-sparing, VLCKD (<500 kcal/day; 1.2 grams of protein/kg of ideal body weight/day) and a 6-week balanced, hypocaloric (25-30 kcal/kg of ideal body weight/day), Mediterranean-like diet. The primary endpoint was the reduction in the Psoriasis Area and Severity Index (PASI) at week 10. Major secondary endpoints included: PASI50 and PASI75 response, reduction in body surface area (BSA) involved, improvement in itch severity (visual-analogue scale) and Dermatology Life Quality Index (DLQI) at week 10.

Results

With a mean body weight reduction of 12.0% (-10.6 kg), dietary intervention resulted in a significant reduction in PASI (baseline score, 13.8±6.9 [range, 7-32]): mean change, -10.6 [95%CI, -12.8 to -8.4] (P<0.001). A PASI50 and PASI75 response was recorded in 36 (97.3%) and 24 (64.9%) patients, respectively. Treatment resulted also in a significant reduction (P<0.001) in BSA [body surface area?]  involved (-17.4%) and an improvement in itch severity (-33.2 points) and DLQI (-13.4 points).

Conclusions

In drug-naïve adult overweight patients with stable chronic plaque psoriasis an aggressive dietary WL program consisting in a very low-calorie ketogenic regimen followed by a balanced, hypocaloric Mediterranean-like diet appeared to be an efficacious first-line strategy for improving disease severity.

Source: Aggressive weight loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: a proof-of-concept, single-arm, open label clinical trial – ScienceDirect

Steve Parker, M.D.

PS: My book includes both a ketogenic diet and hypocaloric Mediterranean diet. But I don’t ask you to reduce calories to less than 500/day!

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Mediterranean Diet Ranked as Best Overall of 2020

Santorini, Greek seaside

Not surprising!

Every year, the U.S. News and World Report puts together a panel of experts to rank various diets.

From MedScape:

For the third year in a row, the Mediterranean diet has been named the best diet overall in the U.S. News & World Report annual rankings.

In 2018, the Mediterranean diet shared top honors with the DASH (Dietary Approaches to Stop Hypertension) diet. Both focus on fruits, vegetables, and whole grains. The ketogenic diet, one of the most popular, again fared well in the annual survey, but only in the fast weight loss category. Overall, it was not rated highly.

Angela Haupt, managing editor of health for the publication, says this year’s list has ”no surprises,” as it includes many diets that have been named outstanding before. Trendy diets typically won’t be found on its list, she says, explaining that its experts look for plans that have solid research and staying power.

Source: Mediterranean Diet Repeats as Best Overall of 2020

Click for the traditional Mediterranean diet.

Steve Parker, M.D.

Click pic to purchase book at Amazon.com. E-book versions are also at Smashwords.com.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

What’s the Best Approach to Fatty Liver (Hepatic Steatosis)?

Excessive accumulation of fat in the liver can lead to liver inflammation and ultimately liver failure. Trust me, you don’t want liver failure.

For years, the mainstays of treatment for fatty liver has been loss of excess weight and alcohol abstention.

From Dr Bret Scher at DietDoctor:

Fortunately, we have emerging evidence that low-carb and ketogenic diets improve fatty liver while also helping with glycemic control and weight loss, an impressive combination rarely seen with medications. As we reported earlier, studies have shown that carbohydrate restriction changes liver metabolism, stimulating the breakdown of liver fat. Another study mentioned in the same post showed that when children substitute complex forms of starch to replace sugar, they experience reduced amounts of liver fat.

Yet another impressive study found that despite equal weight loss, a low-carb Mediterranean diet was better than a low-fat diet for reversing liver fat and signs of NAFLD. And finally, Virta Health published a subset of its data showing that one year on a ketogenic diet improved non-invasive tests for NAFLD and liver scarring.

Source: Limiting Carbs Likely Better Than Drugs for Fatty Liver — Diet Doctor

Steve Parker, M.D.

PS: The Advanced Mediterranean Diet book includes the very low-carb Ketogenic Mediterranean Diet.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Probably under $12 at Amazon.com in the U.S.

The Jerusalem Post: Has The Mediterranean Diet Gone Keto-Crazy? 

Olive oil is a prominent component of the Mediterranean diet

The Jerusalem Post has an article comparing and combining the Mediterranean and ketogenic diets:

Why choose a favorite when you can have both? Instead of making the tough Keto vs Mediterranean diet decision, many people have instead decided to combine the most appealing parts of the two diets to create a new option called the Keto Mediterranean Diet (KMD). Macronutrients are divided as follows:

• 7-10% carbs

• 55-65% fat

• 22-30% protein

• 5-10% alcohol

What is The Keto Mediterranean Diet Food List?

• Fats – olive oil, coconut oil and avocados

• Proteins – fish, cheese, eggs and lean meats • Vegetables – non-starchy varieties

• Red wine – moderate amount

• No sugars, starches, grains allowed

Carbs are limited, the way they are with the Keto diet and red wine is allowed, like in the Mediterranean diet. For people who want keto results and still enjoy going out at night for a drink, this seems like a good compromise!

Keto Mediterranean Diet Pros and Cons

Pros:

• Benefits of the Keto diet while still enjoying a glass of red wine

• More flexibility in food choices

• Healthy option  for diabetes sufferers

• Lower risk of experiencing keto-flu symptomsCons:

• Constant checking to make sure you are still in ketosis

• No strong boundaries which could weaken the results you experience

Source: Has The Mediterranean Diet Gone Keto-Crazy? – Special Content – Jerusalem Post

Unfortunately, I see nothing in the article that you can use from a practical standpoint unless you’re a dietitian or nutrition nerd, like me.

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

Are Ketogenic Diets Nutritionally Deficient?

From the journal Nutrition:

Objective

A 12-week ketogenic diet was shown to have many beneficial effects in healthy obese adults, but it is not clear if the supply of micronutrients is adequate.

Methods

In 35 adult individuals with BMI above 30, the intakes of minerals and their serum levels were analyzed at baseline and at weeks 4 and 12 of the ketogenic diet intervention. The intake of vitamins and serum antioxidative potential were also investigated.

Results

Throughout the diet the intakes of magnesium, calcium, iron, phosphorus and potassium were below recommended values, but their serum levels always remained within the reference range. Nevertheless, the level of calcium decreased significantly (from 2.52 ± 0.10 mmol/L at baseline to 2.36 ± 0.07 mmol/L at week 12, P < 0.001) which could be due to the omission of legumes and reduced dairy intake or due to the high fat intake alone. The levels of phosphate increased concomitantly. Calcium serum levels were negatively associated with ω-6 but not with ω-3 unsaturated fatty acid intake. The intakes of water-soluble vitamins were also too low. However, the antioxidative potential of serum did not change during intervention.

Conclusion

Careful choice of foods which would provide the necessary micronutrients is of utmost importance when consuming ketogenic diet. In the 12 weeks the decreased intakes did not reflect in serum values, but special attention to calcium should be advised if such diet is recommended through longer periods.

Source: Assessment of micronutrients in a 12-week ketogenic diet in obese adults – ScienceDirect

Steve Parker, M.D.

A ketogenic diet — including a “careful choice of foods which would provide the necessary micronutrients” — is one of two options in The Advanced Mediterranean Diet.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com