Category Archives: Ketogenic Mediterranean Diet

Today’s Best-Selling Diet Books at Amazon

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As of 0130 hrs August 2, these are the top five diet and/or weight-loss books at Amazon.com. (If you’re not in the U.S., your country may have its own separate URL.) In order of top sellers first:

  • The Complete Ketogenic Diet for Beginners (#5 on best-seller list)
  • Instant Loss Cookbook (#8)
  • The Ketogenic Diet (#40)
  • The Plant Paradoz Cookbook (#42)
  • The Easy 5-Ingredient Ketogenic Diet Cookbook (#50-something)

I was fully aware ketogenic diets are popular now, but I didn’t realize just how popular! Both of my books on this page feature a doctor-designed ketogenic diet based on the healthy traditional Mediterranean diet.

Sadly, none of my books are best-sellers. I may have to start begging for donations from my blog readers. Poor, poor, pitiful me.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Ketogenic Diets Resurgent

https://platform.twitter.com/widgets.js

Click the top link above for a five-year Google trend on “ketogenic diet.” WordPress.com doesn’t allow me to embed the graph and I’m not smart enough to use WordPress.org.

A snippet from a recent NBCNews article:

“A main benefit of the diet, and why many of its followers praise the eating plan, is weight loss. Multiple studies show promising results: In a study in The American Journal of Clinical Nutrition, obese men dropped about 14 pounds after following the diet for a month. And in a longer-term study published in Clinical Cardiology, obese adults adhering to a ketogenic diet for about six months noticed significant weight loss — on average, 32 pounds — as well as reductions in total cholesterol and increases in beneficial HDL cholesterol. A review study in the European Journal of Clinical Nutrition also found that the weight loss seen within the first three to six months of following the keto diet was greater than the loss from following a regular balanced eating style.”

Source: Happier, Healthier, Smarter, BETTER: Life tips | NBC News

So I expect to sell more copies of my KMD: Ketogenic Mediterranean Diet book. Someone’s keto Mediterranean diet is even mentioned in the NBC News article.

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Ketogenic Diet: More Muscle Gains and Fat Loss

exercise for weight loss and management, dumbbells

Not P.D. Mangan. Visit Rogue Health and Fitness for his pic.

If you’re not reading Rogue Health and Fitness by PD Mangan, start today.

For example:

“What happens when you combine weight lifting with a very low carbohydrate ketogenic diet (VLCKD)? You get greater muscle gains and more fat loss than when compared to a conventional diet.

The study looked at a group of “college aged resistance trained men”, and put them on either a conventional Western diet or a VLCKD.

The conventional diet was 55% carbohydrate, 25% fat, and 20% protein, similar to what lots of people eat, though a bit higher in protein, a bit lower in fat.The low-carb diet was 5% carbohydrate, 75% fat, and 20% protein.

Note that protein, the main macronutrient responsible for muscle growth, was the same in both groups. Both groups did resistance training three times a week for 11 weeks.

The very low carbohydrate group gained twice as much muscle as the conventional group, 4.3 kg vs 2.2 kg.The very low carbohydrate group lost 50% more fat than the conventional group, -2.2 kg vs -1.5 kg.”

Source: More Muscle Gains and Fat Loss on a Ketogenic Diet – Rogue Health and Fitness

For an excellent version of a ketogenic diet, see KMD: Ketogenic Mediterranean Diet or The Advanced Mediterranean Diet (2nd Ed.)

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Ketogenic Diets Poised for a Resurgence

 

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Men’s Fitness has an article praising ketogenic diets, with a focus on effects on athletic performance. Inexplicably, the piece doesn’t mention my Ketogenic Mediterranean Diet. The KMD is also presented as an option in The Advanced Mediterranean Diet (2nd ed.). A quote:

“Timothy Noakes, M.D., is an emeritus professor in the Division of Exercise Science and Sports Medicine at the University of Cape Town. While his name may not ring a bell here in the U.S., he’s a full-blown celebrity in his native South Africa and one of the most accomplished exercise physiologists on the planet. You can’t walk by a restaurant in Cape Town that doesn’t offer a “Noakes option”—say, an avocado stuffed with breakfast sausage and eggs, or a double cheeseburger with lettuce sans bun—and evidence of his teachings seems to be everywhere, mostly in the form of the nation’s best-known athletes, including ageless golfing legend Gary Player and eight-time Ironman World Champion Paula Newby-Fraser. In fact, Noakes’ celebrity these days is such that he’s even been pulled into South African presidential politics: To echo the country’s papers of record, “Is President Jacob Zuma’s and his wife’s dramatic weight loss a result of the Noakes Diet?” No one is sure about the president, but his wife, definitely: She’s lost 66 pounds following the Noakes plan.

Source: The Truth Behind the World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: The Keto Diet

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Countering Constipation on a Ketogenic Diet

I’ll admit that constipation can be an occasional problem with my Ketogenic Mediterranean Diet. I usually recommend fighting it with higher fiber consumption, Metamucil, or cabbage soup.

Georgia Ede, M.D., has a good article on constipation that is sometimes seen with ketogenic diets. Some think it’s related to low fiber content of the diet. But Dr. Ede found a study that indicates cutting down on fiber consumption helps alleviate constipation! A quote from the good doctor:

If you experience constipation on a ketogenic diet, it is not because you are eating less fiber; it is most likely because you have started eating something that you were not eating before (or a larger amount of something you didn’t eat much of before) that is hard for you to digest. In order to eat a ketogenic diet, which is a high-fat, limited protein, ultra-low-carb diet, most people find themselves turning to high amounts of foods that are notoriously difficult to digest, including nuts, low-starch vegetables such as crucifers, and full-fat dairy products.These foods just so happen to be 3 of the top 5 causes of chronic constipation, regardless of what kind of diet you choose to eat.

Read the whole enchilada for her tips on countering constipation.

Steve Parker, M.D.

Recipe: Apple, Pecan, Blueberry Lunch Bowl

paleobetic diet, diabetic diet, low-carb diet

So simple even a redneck can make it (I is a redneck)

Since I provide you with nutritional analysis below, you can easily work this meal into the Advanced Mediterranean DietLow-Carb Mediterranean Diet, or KMD: Ketogenic Mediterranean Diet.

Ingredients:

2.5 oz (70 g) apple, diced (“red delicious” variety works well) (this is half a medium-sized apple)

2.5 oz (70 g) pecans, crumbled into small pieces

2.5 oz (70 g) raw blueberries

Instructions:

Mix all together in a bowl, then enjoy. I know a lotta you bros will just eat all the components individually—but try the mix once for new flavors.

Servings: 1

Advanced Mediterranean Diet boxes: 1.5 fruit, 2 fat

Nutritional Analysis:

76% fat

20% carb

4% protein

570 calories

30 g carbohydrate

10 g fiber

20 g digestible carb

1.4 mg sodium

421 mg potassium

Prominent features: Quick and easy. Rich in copper, manganese, and thiamine. Inadequate protein to get you through the day, but you’ll make up for it at breakfast or dinner.

Mediterranean Diet Helps With Maintenance of Weight Loss After Ketogenic 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 tho 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