The keto mediterranean diet has taken the health and wellness world by storm, offering a powerful way to lose weight, boost energy, and improve overall health. The Mediterranean Ketogenic Diet seeks to bring together the benefits of these two eating styles.
Introduction to the Keto Mediterranean Diet
The ketogenic diet, commonly known as the keto diet, is a high-fat, low-carbohydrate eating plan designed to shift your body into a metabolic state called ketosis. In ketosis, your body primarily burns fat for energy instead of relying on carbohydrates. The keto diet works by adjusting the ratio of macronutrients you consume, focusing on low carbs, high fats, and moderate protein.
On the other hand, the Mediterranean diet is well known to be one of the healthiest diets. This way of eating focuses on whole unprocessed foods, fresh fruits and vegetables, healthy fats, minimal refined carbs, less meat and more fish. The basic ingredients of such diet are olive oil, red wine and vegetables. In Spain, fish is an important component of such diet.
Understanding the Ketogenic Diet
The keto diet works by adjusting the ratio of macronutrients you consume, focusing on low carbs, high fats, and moderate protein.
- Low Carbohydrates (5-10% of daily calories): Usually, this amounts to about 20-50 grams of net carbs per day.
- High Fats (70-80% of daily calories): Healthy fats like olive oil, avocados, nuts, and seeds are essential.
- Moderate Protein (10-20% of daily calories): Protein sources include fish, poultry, eggs, and some dairy.
When carbohydrate intake is drastically reduced, the liver starts breaking down stored fat into molecules called ketones through a process called ketogenesis. One of the key reasons the keto diet is effective for weight loss is that fat becomes readily available as fuel, and insulin levels drop, making it easier for the body to access and burn stored fat.
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Benefits of the Ketogenic Diet
Many studies have found that ketogenic diets are healthier since they help to preserve muscle mass, reduce appetite, diminish metabolic efficiency, induce metabolic activation of thermogenesis, favor increased fat loss, promote a non-atherogenic lipid profile, lower blood pressure and decrease resistance to insulin with an improvement in blood levels of glucose and insulin. Ketones fuel the brain, improving mental clarity.
Exploring the Mediterranean Diet
If we ask 100 people on the street about what is the healthiest diet out there, more than half are likely to opt for the Mediterranean diet. Why? This reputation, more or less justified, has been given to it after several decades of studying this dietary model as the “gold standard” of health. The Mediterranean diet has its strengths and weaknesses. Firstly, we are not sure what “Mediterranean diet” means. In various parts of the Mediterranean area, the diet has varied (sometimes very much so). In other words, there is not “one” Mediterranean diet, there are many. The two most renowned proponents of the Mediterranean diet are the epidemiologist Leland G. Allbaugh and the even better known American physiologist Ancel Keys (author of the seven-country study).
Key Components of the Mediterranean Diet
The Mediterranean lifestyle includes, as we said, not only food, but also a Mediterranean “way of life”: family life, frugality, respect for circadian rhythms, plenty of physical activity, cooking and adequate rest. Beyond that, the foods included belong mostly to the plant kingdom. It should be a plant-based diet; and I say ‘should’ because in practice this is rarely the case.
The main food groups of a Mediterranean diet are:
- Vegetables and fruits in every meal.
- Legumes.
- Whole grains.
- Dried fruits, seeds and olives.
- Fish (of particular interest is blue fish).
- White meat and eggs.
- In smaller amounts: red meats.
Health Benefits of the Mediterranean Diet
Mediterranean diet has evident health benefits. Such diet is associated with a longer life span and lower rates of coronary heart disease, certain cancers, hypercholesterolemia, hypertension, diabetes and obesity.
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The characteristics and benefits of the Mediterranean diet are:
- Prevention of cardiovascular disease.
- Prevention of metabolic pathologies (obesity, type 2 diabetes, metabolic syndrome).
- Improved cognitive performance.
- Lower incidence of various neoplasms (colorectal, prostate, stomach, among others).
- Anti-inflammatory diet.
- Rich in polyphenols and antioxidants.
- Very active, frugal lifestyle and based on a vegetarian diet.
Combining Keto and Mediterranean: The SKMD
What if we took the benefits of the Mediterranean diet and the ketogenic diet and established synergies between them? Is it possible to do this? Transforming a Mediterranean diet into a low-carb diet does not require much juggling. We will mainly restrict four classic food groups of the Mediterranean diet: cereals, legumes, higher carbohydrate fruits and wine. In this way we already have a low or very low carbohydrate diet based on typically “Mediterranean” products. The idea behind this ruse is to obtain the benefits of the Mediterranean diet and at the same time take advantage of nutritional ketosis in those (mainly clinical) contexts where it is useful (mainly metabolic pathology).
A prospective study was carried out in 40 overweight subjects (22 male and 19 female) whose body mass index and age was 36.46 ± 2.22 and 38.48 ± 2.27, respectively. Subjects were selected with the cooperation of a database medical weight loss clinic. Inclusion criteria were: a diet based on carbohydrate foods (> 50% of dairy energy intake), achievement of desired weight loss, normal liver and renal function, not to have antecedents of gout or high uric acid, not to have exercise, alcoholic and smoking habits, not to be pregnant or lactating, IMC ≥ 30, age ≥ 18 years and ≤ 65 years and not to be under medication. This protein ketogenic diet was called "Spanish Ketogenic Mediterranean Diet" (SKMD) due to the incorporation of virgin olive oil as the principal source of fat, moderate red wine intake, green vegetables and salads as the main source of carbohydrates and fish as the main source of proteins.
The Spanish Ketogenic Mediterranean Diet (SKMD)
The objective of the present study was to determine the dietary effects of the "Spanish Ketogenic Mediterranean Diet" (SKMD). Such diet was a protein ketogenic diet under free-living conditions with 4 important healthy components of the Mediterranean diet in Spain: olive oil, salad, fish and red wine.
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. 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. No more than two cups of coffee or tea and at least 3 litres of water were intake each day. Micronutrients (vitamins and minerals) were given daily to each subject in the form of 2 tablets of a poly-vitamin-mineral supplement and one tablet of calcium carbonate 1500 mg.
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Benefits of SKMD
A well thought-out Mediterranean ketogenic or low-carbohydrate diet should bring us many ( but not all) of the benefits of the original Mediterranean diet:
- Very rich in monounsaturated fatty acids (MUFA), as the main fat will remain extra virgin olive oil.
- A clearly anti-inflammatory omega-3 and 6 profile.
- Very rich in antioxidants and polyphenols. The latter are bioactive compounds present in foods of plant origin that reduce the risk of many diseases.
- Includes raw food and some good processed food and excludes ultra-processed products altogether.
- Increases production of butyrate (not to be confused with beta-hydroxybutyrate). Butyrate is a molecule which, like BHB, is also ketogenic. As a signalling molecule, both increase BDNF levels, promote neuronal health, inhibit the so-called histone deacetylases that modify gene expression (epigenetic changes), inhibit the NFkB factor and activate regulatory T-lymphocytes to decrease inflammation and induce the FGF21 factor that increases beta-oxidation.
Study Results of SKMD
Of the 40 persons who started the study, data collected from 31 subjects were used in the final analysis. There was an extremely significant (p < 0.0001) reduction in body weight (108.62 kg→ 94.48 kg), BMI (36.46 kg/m2→31.76 kg/m2), SBP (125.71 mmHg→109.05 mmHg), DBP (84.52 mmHg→ 75.24 mmHg), total cholesterol (208.24 mg/dl→186.62 mg/dl) and glucose (109.81 mg/dl→ 93.33 mg/dl). There was a significant (p = 0.0167) reduction in LDLc (114.52 mg/dl→105.95 mg/dl) and an extremely significant increase in HDLc (50.10 mg/dl→54.57 mg/dl).
The data presented in this study showed that the SKMD significantly decreases the total cholesterol, LDLc, triacylglycerols, SBP, DBP and increases the level of HDLc. This healthy cardiovascular profile is probably due to the favorable interaction of the weight loss and the components of the SKMD: high protein ketogenic diet-virgin olive oil-fish oil-red wine-salad.
The SKMD is safe, an effective way of losing weight, promoting non-atherogenic lipid profiles, lowering blood pressure and improving fasting blood glucose levels.
What to Eat on the Mediterranean Keto Diet
We might think that this is a very restrictive diet in terms of food variety, but it is a well planned diet that can move away from monotony.
You can include:
- Sources of proteins: eggs, sardine, mackerel, bonito, tuna, seafood, white meat, beef, pork.
- Fats: olives, EVOO, avocado, butter.
- Fruits: red fruits, citrus fruits in small quantities.
- Vegetables: spinach, broccoli, artichoke, courgette and in general most of the vegetables that grow above ground.
- Seeds: chia, linseed, sesame.
- Nuts: walnuts, almonds, pistachios, macadamia nuts.
- Mushrooms.
- Dressings: pesto, aioli, vinaigrette, EVOO, chimichurri.
- Fatty cheeses.
Sample Mediterranean Keto Recipes
Mediterranean Keto Salad
Ingredients:
- Chopped cucumber
- Cherry tomatoes
- Yellow pepper, chopped
- Half a spring onion
- Black olives
- 1 cup cooked and shredded cauliflower
- 100g sliced Feta cheese
- Olive oil
- Salt
- Garlic and Spice Sauce from FoodSeries
Nutritional Information per serving:
- Calories: 499kcal
- Fat: 36,3g
- of which saturates: 19,9g
- Carbohydrates: 24g
- of which sugars: 10g
- Fiber: 7g
- Proteins: 19,2g
- Salt: 5,8g
How to make:
- In a bowl we mix all the ingredients.
- Dress with a pinch of salt, olive oil and the garlic and spice sauce to taste.
Other Recipes to Try
- Chicken piccata with garlicky greens & new potatoes: After lightly frying the chicken in olive oil, lemon, capers and stock are added to the pan. Ready in 20 minutes, it's nutritious and low in calories too.
- Grilled vegetables with cannellini beans & vegan pesto: Plate up a colourful dish of grilled veg, tomatoes, cannellini beans, homemade pesto and an extra scattering of pine nuts. For an extra helping of greens, serve with a salad dressed with olive oil and lemon.
- Sardines & peperonata on wholemeal toast: Make a quick peperonata with pre-roasted peppers, capers, shallot and garlic - the punchy flavours work wonderfully with the oily fish.
- Cod & anchovy bake: Delivers four of your five-a-day, thanks to the addition of tomatoes, spinach and red pepper.
- Smoky paprika seafood rice: In this healthy, low-fat rice dish we've combined prawns, baby squid and mussels with smoky paprika and paella rice.
- Avocado panzanella: Chunky of crust bread add texture and soak up all those lovely juices from the tomatoes.
- Feta, beetroot & pomegranate salad: This bright salad combines salty feta, sweet beetroot and tart pomegranate with mint, parsley, cinnamon and cumin. It's an explosion of flavours that you're guaranteed to love.
- Pasta primavera: We've used broad beans, leeks and asparagus tips to make this healthy primavera dish but you could use whatever greens are in season. Kale, spinach and chard would all make great additions.
- Quick chicken hummus bowl: It can be thrown together in just 10 minutes using a pouch of mixed grains and delivers three of your 5-a-day. It's also packed with good fats, thank to the avocado and hummus.
- Spicy Spanish rice: We've combined pork tenderloin fillet with brown rice, prawns, smoked paprika, peppers and green beans to make this hearty Spanish-style paella.
Sample Mediterranean Keto Meal Plan
This unique combination allows you to follow a keto diet, while taking into consideration the options we have when on a Mediterranean diet. When we were building this meal plan, we used 1,600 calories as the basis of the energy requirement. You can customize snacks to increase or decrease the calories, if needed.
Recipes That Need to be Prepared in Advance
- Creamy scrambled eggs with mushrooms (3 servings)
- Avocado Salmon Breakfast (2 servings)
- Breakfast Bowls (2 servings)
- Italian Chicken Thighs (3 servings)
- Becky’s Dinner Salad (4 servings)
- Asparagus and parmesan (3 servings)
- Chicken & Avocado Salad (2 servings)
- Avocado Tuna Salad (2 servings)
- Keto Bread in 90 Seconds! (3 servings)
- Greek Meatball Bowls | Low Carb Meal Prep (3 servings)
- Salmon with Lemon and Herbs (2 servings)
- Keto Steak Salad (2 servings)
Potential Concerns and Considerations
The most frequent attacks on the ketogenic diet are:
- Its high protein content: the well-planned keto diet rarely exceeds 1.2 g of protein/kg body weight;
- Its low fibre content: with a Mediterranean keto this should not be a problem; and,
- Its high content in saturated fats: when the main source of fat is the OVE, the avocado or the seeds, this simply does not happen.
Is it a Long-Term Diet?
The ketogenic diet should not be considered as a long term lifestyle except in very specific contexts (such as refractory epilepsy and some other situations). That said, you can go on a ketogenic Mediterranean diet for an initial period lasting several weeks and then switch to a low carb diet. Even later use a moderate carbohydrate diet as a long-term maintenance diet.
Conclusion: Embrace the Flavors and Health Benefits
The Keto Mediterranean Diet is a delicious, sustainable way to improve your health while enjoying the bold flavors of Mediterranean cuisine. By focusing on healthy fats, quality proteins, and low-carb vegetables, you can reap the benefits of both diets while staying in ketosis.
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