Another study came out this week illustrating the powerful health benefits of restricting carbohydrates. While this study was not a randomized trial comparing a low and high-fat diet (we already have dozens of those showing the superiority of a higher-fat diet), it added some new twists and turns to the traditional low-carb and ketogenic diet.
This group constructed what it referred to as the “Spanish Ketogenic Diet,”1 which is basically a merging of the ketogenic and Mediterranean diets. The resulting diet is, well pretty much what you would expect — the ketogenic diet with a European flavor.
In fact, they looked at a ketogenic diet that, in their words, encompassed “four important healthy components of the Mediterranean diet in Spain: olive oil, salad, fish and red wine.”
The Spanish Ketogenic (Mediterranean) Diet
In only a way that Europeans can, they took an already clinically useful diet, and made it better. In regards to the details of the diet, they were as follows:
1. Unlimited calories: like nearly all high-fat diets, one does not have to count calories. When humans eat satiating and satisfying foods rich in fat, hunger naturally subsides. These diets generally do not consist of the annoying and ineffective calorie counting or the painful starvation diets that many would have you believe are necessary to lose weight.
2. The major source of fat came from olive oil, with over 30ml consumed per day. This provided a hefty supply of monounsaturated fatty acids. Again, this was a European, Mediterranean-esque diet.
3. Green vegetables and salads were the major form of carbohydrates.
4. Fish was the major source of protein.
5. A moderate amount of daily wine consumption*
*By a moderate amount, they mean 200-400ml per day. To put that in context, a standard wine bottle is 750ml in size.
As a Side Note
When I was reading this study, I easily pictured the scientists and physicians as they discussed it:
Physician 1: This study layout sounds good, but are we sure that the subjects will follow and enjoy the diet?
Physician 2: Yes, good point. My colleagues in the United States give patients protein shakes full of vegetable oils and polyunsaturated fats and even high-fructose corn syrup to get them to follow meal plans. While I would never in a million years do that myself, what if we took that approach?
Physician 3: That sounds terrible. What if we don’t do either of those things, but just tell the patients that they can drink up to a half-bottle of wine per day?
Physicians 1, 2, 3, and the Entire Room: Of course! What were we thinking?! Red wine it is!
Sometimes the Europeans just do things better…
While I am not advocating drinking a half bottle of wine a day (though a glass of red is fine and has some established health benefits),2 I think you get the point.
The Study Participants
The study took place in Córdoba, Spain and included 40 overweight subjects (22 male and 19 female). They had a high body mass index of 37 (on average). Interestingly, they had to be consuming a diet with over 50% consumption of carbohydrates to be considered for the study, which oddly enough would likely be considered healthy by many low-fat advocates. They then followed the Spanish Ketogenic Diet for 12 weeks.
Ketosis was confirmed in the subjects through ketone strips in the morning; though they do not specify if these were urine or finger-stick tests (urine strips generally become unreliable after 2-3 weeks). Along these lines, I would question whether this was a ketogenic diet or simply a very low-carbohydrate diet.
So How Did They Do?
The improvements were globally quite drastic:
- Bodyweight was reduced from 240 to 208 lbs overall. The authors also described what they observed as a clear loss of fat over muscle.
- Body mass index (BMI) was reduced from 36.46 to 31.76 kg/m2.
- Systolic blood pressure was reduced from 125.71 to 109.05 mmHg and diastolic blood pressure dropped from 84.52 to 75.24 mmHg.
- Total cholesterol dropped significantly from 208.24 to 186.62 mg/dl.
- Triglycerides were reduced from 218.67 to 113.90 mg/dl.
- Glucose levels dropped from 109.81 to 93.33 mg/dl.
- There was a significant reduction in LDL cholesterol from 114.52 to 105.95 mg/dl.
- HDL cholesterol was increased from 50.10 to 54.57 mg/dl.
Overall, the largest reduction by far was the massive drop in triglycerides. This is especially important as elevated triglycerides are associated with the increased risk of stroke, heart disease, and cancer.3–5 A near 50% reduction of this potentially dangerous number is quite impressive. While many would be suspicious of a high-fat diet promoting the consumption of red wine, the weight loss, reduced blood pressure, and improvement of all lipid (cholesterol) numbers may make the skeptics rethink a few things.
Keep in mind that these changes occurred in rather obese individuals, so it remains difficult to tease out how many of these changes were a result of the large loss in weight. Regardless, the large loss of weight is a very important and impressive result of this diet.
The Spanish Ketogenic Diet was a successful lifestyle modification that led to significant improvement in weight and several important metabolic risk factors. It also sounds like a fun diet to try…
CONT’D: Follow the link HERE to continue reading the remainder of the article.
1. Pérez-Guisado J, Muñoz-Serrano A, Alonso-Moraga A. Spanish Ketogenic Mediterranean Diet: a healthy cardiovascular diet for weight loss. Nutr J. 2008;7(1):30. doi:10.1186/1475-2891-7-30.
2. Corder R, Mullen W, Khan NQ, et al. Oenology: red wine procyanidins and vascular health. Nature. 2006;444(7119):566. doi:10.1038/444566a.
3. Goodwin PJ, Boyd NF, Hanna W, et al. Elevated levels of plasma triglycerides are associated with histologically defined premenopausal breast cancer risk. Nutr Cancer. 1997;27(3):284-292. doi:10.1080/01635589709514539.
4. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3(2):213-219. http://www.ncbi.nlm.nih.gov/pubmed/8836866.
5. Freiberg JJ, Tybjærg-Hansen A, Jensen JS, Nordestgaard BG. Nonfasting Triglycerides and Risk of Ischemic Stroke in the General Population. JAMA J Am Med Assoc. 2008;300(18):2142-2152. doi:10.1001/jama.2008.621.
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