Tag Archives: Spanish Ketogenic Mediterranean Diet

Spanish Ketogenic Mediterranean Diet

Ever heard of the Spanish Ketogenic Mediterranean Diet? It looks like a low-carb quasi-Mediterranean diet.

Researchers with the University of Cordoba in Spain studied 40 subjects eating a low-carb “Mediterranean” diet for 12 weeks. The results were strikingly positive.

Methodology

A medical weight loss clinic was the source of 40 overweight subjects, 22 males and 19 females, average age 38, average body mass index 36.5, average weight 108.6 kg (239 lb). These folks were interested in losing weight, and were not paid to participate.

Nine subjects were not included in the final analysis due to poor compliance with the study protocol (3), the diet was too expensive (1), a traumatic car wreck (1), or were simply lost to follow-up (4). So all the data are pooled from the 31 subjects who completed the study.

Blood from all subjects was drawn just before the study began and again after 12 weeks of the diet.

Study diet: Low-carbohydrate, high in protein [and probably fat, too], unlimited in calories. Olive oil was the main source of fat (at least 30 ml daily). Maximum of 30 grams of carbohydrates daily as green vegetables and salad. 200-400 ml daily of red wine. The authors write:

Participants were permitted 3 portions (200 g/portion) of vegetables daily: 2 portions of salad vegetables (such as alfalfa sprouts, lettuce, escarole, endive, mushrooms, radicchio, radishes, parsley, peppers, chicory, spinach, cucumber, chard and celery), and 1 portion of low-carbohydrate vegetables (such as broccoli, cauliflower, cabbage, artichoke, eggplant, squash, tomato and onion). 3 portions of salad vegetables were allowed only if the portion of low-carbohydrate vegetables were not consumed. Salad dressing allowed were: garlic, olive oil, vinegar, lemon juice, salt, herbs and spices.

The minimum 30 ml of olive oil were distributed unless in 10 ml per principal meal (breakfast, lunch and dinner). Red wine (200–400 ml a day) was distributed in 100–200 ml per lunch and dinner. The protein block was divided in “fish block” and “no fish block”. The “fish block” included all the types of fish except larger, longer-living predators (swordfish and shark). The “no fish block” included meat, fowl, eggs, shellfish and cheese. Both protein blocks were not mixed in the same day and were consumed individually during its day on the condition that at least 4 days of the week were for the “fish block”.

Trans fats (margarines and their derivatives) and processed meats with added sugar were not allowed.

Vitamin and mineral supplements were given.

Subjects measured their ketosis state every morning with urine ketone strips.

Results (averaged)

  • Body weight fell from 108.6 kg (239 lb) to 94.5 kg (209 lb), or 2.5 pounds per week
  • Body mass index fell from 36.5 to 31.8
  • Systolic blood pressure fell from126 to 109 mmHg
  • Diastolic blood pressure fell from 85 to 75 mmHg
  • Total cholesterol fell from 208 to 187 mg/dl
  • LDL chol fell from 115 to 106 mg/dl
  • HDL chol rose from 50 to 55 mg/dl
  • Fasting glucose dropped from 110 to 93 mg/dl
  • Triglycerides fell from 219 to 114 mg/dl
  • No significant differences in male and female subjects
  • No adverse reactions are mentioned

Researchers’ Conclusions

The SKMD [Spanish Ketogenic Mediterranean Diet] is safe, an effective way of losing weight, promoting non-atherogenic lipid profiles, lowering blood pressure and improving fasting blood glucose levels. Future research should include a larger sample size, a longer term use and a comparison with other ketogenic diets.

My Comments

The researchers called this diet “Mediterranean” based on olive oil, red wine, fish, and vegetables.

What’s “Not Mediterranean” is the paucity of carbohydrates (including whole grains); lack of yogurt, nuts, and legumes; and the high meat/protein intake.

The emphasis on olive oil, red wine, and fish could make this healthier than other ketogenic diets.

Ketogenic diets are notorious for high drop-out rates compared to other diets. But several studies suggest greater short-term weight loss for people who stick with it. Efficacy and superiority are little different from other diets as measured at one year out.

Many of the metabolic improvements seen here might be duplicated with loss of 30 pounds (13.6 kg) over 12 weeks using any reasonable diet.

Average fasting blood sugars in these subjects was 109 mg/dl. Although not mentioned by the authors, this is in the prediabetes range. The diet reduced average fasting blood sugar to 93, which would mean resolution of prediabetes. Dropping body mass index from 36 to 32 by any method would tend to cure prediabetes.

Elevated blood sugar is one component of the “metabolic syndrome.” Metabolic syndrome was recently shown to be reversible with a Mediterranean diet supplemented with nuts.

If you’re thinking about doing something like this, get more information and be sure to get your doctor’s approval first.

My Ketogenic Mediterranean Diet has much in common with the study at hand. One of several major differences is that it’s user-friendly and ready to implement as soon as you have your physician’s clearance. It’s posted at the Diabetic Mediterranean Diet Blog.

Steve Parker, M.D.

Addendum:

In April, 2008, had a delightful conversation with Jimmy Moore, of Livin’ La Vida Low-Carb fame regarding this study. I reviewed this article in preparation.  It struck me that the Spanish Ketogenic Mediterranean Diet is probably higher in protein and lower in fat than many other ketogenic weight-loss diets. Since fish is emphasized over other animal-derived foods, it’s likely also lower in saturated fat. (In low-carb diets, carbohydrates are substituted with either fats or proteins.)

References and Additional Reading:

Perez-Guisado, J., Munoz-Serrano, A., and Alonso-Moraga, A. Spanish Ketogenic Mediterranean diet: a healthy cardiovascular diet for weight loss. Nutrition Journal, 2008, 7:30. doi:10.1186/1475-2891-7-30 I like the idea behind Nutrition Journal. From the publisher’s website:

Nutrition Journal aims to encourage scientists and physicians of all fields to publish results that challenge current models, tenets or dogmas. The journal invites scientists and physicians to submit work that illustrates how commonly used methods and techniques are unsuitable for studying a particular phenomenon. Nutrition Journal strongly promotes and invites the publication of clinical trials that fall short of demonstrating an improvement over current treatments. The aim of the journal is to provide scientists and physicians with responsible and balanced information in order to improve experimental designs and clinical decisions.

With the advent of the Internet, has dawned a new way to exchange information and to publish biomedical journals. BioMed Central has been a pioneer in online publishing with Nutrition Journal being one of its many journals. Publication in Nutrition Journal offers many advantages over traditional paper publications; the journal offers free access to its articles; high quality and rapid peer-review; immediate publication; and most importantly, universal access to its content from virtually any place in the world.

Bravata, D.M., et al. Efficacy and safety of low-carbohydrate diets: a systematic review. Journal of the American Medical Association, 289 (2003): 1,837-1,850.

Gardner, C.D., et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Journal of the American Medical Association, 297 (2007): 696-677.

Stern, L., et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Annals of Internal Medicine, 140 (2004): 778-785.

Shai, Iris, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. New England Journal of Medicine, 359 (2008): 229-241.

Spanish Ketogenic Mediterranean Diet Cures Metabolic Syndrome

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