What is Mediterranean Keto?

As I’ve written before, although most people’s lipid numbers improve across the board, some people get interesting cholesterol responses to Primal ketogenic diets. LDL skyrockets, even LDL particle number. The jury’s out on whether or not they indicate negative health concerns or if keto dieters are a special breed that hasn’t received enough study. (There may be a few genetic profiles, such as APOE4 carriers, that react differently to certain dietary inputs.) Either way some people just want their cholesterol numbers to look good in a conventional way. These days, whenever I run into someone in the real world with these or similar concerns, I tell them to try “Mediterranean keto.”

What is that, anyway?

The Mediterranean diet can mean a lot of different things depending on who you ask. On one side, you have the folks who make the ridiculous claim that the Mediterranean diet consisted of pasta, low-fat dairy, beans, green veggies, seed oils with a “drizzle or two” of extra virgin olive oil for good measure, a handfuls of nuts, and a single filet of sardine once every three days. They avoided salt and red meat and full-fat cheese, somehow ignoring the vast body of salt water on their shores and the large population of sheep and goats roaming the land. I guess that livestock is only there to keep the weeds down.

On the other side, you have the people claiming that the true Mediterranean diet consisted of fatty lamb, hard cheeses, fish filets dripping with oil, skins of homemade red wine, cured meats, endless olives, vegetables at will, and the occasional legume bathing in mutton juices and a tiny piece of bread crust submerged in extra virgin olive oil.

This is probably closer to the truth, but both are a bit hyperbolic.

It also depends on where you’re looking. The Mediterranean is a big sea. Spain, Italy, Portugal, Greece, Turkey, Morocco, Algeria, Israel, Lebanon, Egypt, and even France are all technically Mediterranean countries. Are their diets identical? No. Are there common threads running through their respective cuisines? Yes.

  • Olive oil
  • Fish
  • Wine (excepting Muslim dietary practices)
  • Cheese
  • Meat
  • Vegetables
  • Grains and legumes (Yes, they do eat beans and pasta and bread, although perhaps not in the quantities the grain-addicted would prefer)

And that’s not even mentioning all the various social, spiritual, and lifestyle components of the Mediterranean way of life. The sun, the walking, the hills, the family connections, the religious leanings. Today’s label is all about the diet.

The Mediterranean keto diet emphasizes olive oil, fish, cheese, meat, low-carb vegetables, and red wine. In other words, it takes all the keto-compliant foods readily available to denizens of the Mediterranean and constructs a nutrient-dense diet out of them.

And you know what? It seems to work really well.

In one of the most impressive studies, people with severe obesity and metabolic syndrome tried a Mediterranean keto diet for 12 weeks. That’s three months.

Here’s what the diet consisted of:

  • No calorie counting
  • Unlimited protein
  • Lots of fish. At least (and often more than) four days a week, subjects ate over a kilogram of fish each day, mostly sardines, trout, mackerel, and salmon. On the other days, they got their protein from shellfish, meat, fowl, eggs, and cheese.
  • Lots of omega-3s. Subjects were getting over 15 grams of omega-3s on their fish days and supplementing with 9 grams of salmon oil on their non-fish days.
  • At least 200-400 mL of red wine a day, 100-200 mL at lunch and dinner. That’s up to over half a bottle.
  • At least 30 mL (2 tablespoons) of olive oil a day, 10 mL per meal.
  • Maximum two portions of salad and one portion of low-carb vegetables (cauliflower, broccoli, eggplant, etc) per day.
  • A comprehensive vitamin and mineral supplement covering all the basics.

What happened to these subjects after 12 weeks on this Mediterranean keto diet regimen?

On average:

  • They lost 30+ pounds.
  • Their BMIs dropped from almost 37 to 31.5, from the middle of class 2 obesity to the bottom of class 1 obesity.
  • They lost 16 centimeters, or 6 inches, from their waist.
  • Fasting blood sugar dropped from 118 (pre-diabetic) to 91 (ideal).
  • Triglycerides dropped from 224 to 109.
  • HDL increased from 44 to 58.
  • They went from prehypertensive to normotensive.
  • Their liver enzymes and liver fat reduced and in some cases completely resolved.
  • All 22 subjects started the study with metabolic syndrome and ended it without metabolic syndrome.

That last bit is pretty interesting. Note that the majority of the participants were still obese (BMI over 30) by the end of the study, yet every single one had cured their metabolic syndrome. Sure, they lost weight, and the trend was fantastic and heading down, but they weren’t there yet. Something about the diet itself was incredibly powerful.

The only limitation? It was a pilot study, not a randomized controlled trial pitting the Mediterranean keto diet against a control diet in real time. But considering that these people were coming off control diets—which clearly weren’t working for them—and onto the Mediterranean keto diet, it has more real-world power than you might think. You can bet the participants weren’t complaining about a lack of placebo control.

I’m not saying this is the best incarnation of all the potential Mediterranean keto diets out there. But if you’re having mixed metabolic results from the keto diet and looking for a ketogenic option with more monounsaturated fat and omega-3s, it’s the one that has some clinical research behind it. It’s one that doesn’t possess any glaring red flags.

This is also a form of ketogenic dieting that most people will view as “healthy.” It can be hard to get people to accept that putting real cream in their coffee and steak on their plates is good for them, even if they’re approaching death’s door eating what they’ve always eaten. It’s not so hard to get people on board with a diet of olive oil, fish, red wine, and salad. That’s no small feature.

In the end, the ketogenic Mediterranean diet appears to be an effective way to treat metabolic syndrome without scaring people away. For that reason, it might be a good option to try if you’re having issues with cardiovascular markers, blood sugar, hypertension, body fat, or any of the components that make up the metabolic syndrome.

What do you think of the Mediterranean keto diet? Think you could stick to it?


Pérez-guisado J, Muñoz-serrano A. A pilot study of the Spanish Ketogenic Mediterranean Diet: an effective therapy for the metabolic syndrome. J Med Food. 2011;14(7-8):681-7.

Pérez-guisado J, Muñoz-serrano A. The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. J Med Food. 2011;14(7-8):677-80.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

If you'd like to add an avatar to all of your comments click here!

75 thoughts on “What is Mediterranean Keto?”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. Very cool … I like it! I’ll do without the wine and eat a lot more veggies, but I could see where under the right conditions and for the right people this approach could really be beneficial. Maybe something to cycle onto for a while and maybe some extra supplements to help chelate some of the mercury.

  2. I’m one of those that my LDL increased while on keto. My HDL also increased and my triglycerides were super low. The only problem was the LDL. I was not overweight and actually lost like 5-8 pounds but that wasn’t the reason I started keto. Either way, my diet consisted of a lot of sardines, eggs everyday, mostly hard boiled with olive oil and cayenne pepper. Veggies like broccoli, and spinach for salads. Almonds and cheese for sure as snacks. I don’t know if it was the butter or the mct oil that I added to my coffee. But the rise in ldl was slightly concerning. I wasn’t able to check particle size so I’m not sure what my levels were with that. Do you recommend the Mediterranean style keto daily or intermittently?

    1. Get a coronary artery calcium (CAC) scan. It’s about $150 – 250, but worth every penny. My LDL also shot up on primal, but fortunately I have a doc who knows that LDL is not a good predictor of heart trouble. My HDL also shot up and triglycerides are low. So the ratios (which ARE predictors) were all awesome. But the CAC tells you about actual damage, so my doc suggested it. If your calcium score is low (mine was zero), you are good to go and can basically stop worrying about the LDL.

      1. Terrible advice, with respect. This cholesterol denial is insane in this incestuous community. Everyone feeds everyone the same lines of BS. “You are good to go,” if a CAC scan comes back zero, so “stop worrying” about LDL cholesterol is horrid advice. “Don’t worry” is fine advice in general, but the ratios and CAC scores aren’t sufficient to advise someone to simply ignore troubling LDL cholesterol numbers.

        I like and appreciate everyone here, so I am only using strong wording because it’s important.

        1. Given that you seem to think “LDL” is a type or measure of “cholesterol” would suggest you may need further education on the topic of what lipoproteins are.

          Then we can talk about what they do.

          THEN we can talk about what they can’t do, which is where the widespread “cholesterol” hypothesis disintegrates.

        2. 1. The LDL number in standard cholesterol tests is a calculated number, not measured.

          2. There are two types of LDL cholesterol, the large, fluffy, benign kind (LDL) and the small, dense, dangerous kind (VLDL) The basic cholesterol test doesn’t distinguish between the two.

          More important in testing is: the ratio of the HDL to triglycerides, the type of LDL cholesterol you have (LDL vs VLDL), and the particle number of your cholesterol. VLDL is primarily comprised of triglycerides whereas LDL is primarily cholesterol. Cholesterol is an essential element to health for a variety of reasons.

          There is an excellent video on YouTube that explains why LDL goes up on Keto and why this isn’t an issue: https://youtu.be/qXtdp4BNyOg

      2. That is exactly what my doctor recommended (calcium coronary CT scan) when my LDL rose. She said the same thing- if it shows no damage, you can stop worrying about LDL and continue to refuse statins forever.

  3. OMG! I may need to consider this, my cholesterol shot up over 8 and the doctor was worried (I’m still ketoing on though) my next blood test will be next month, if the results are still bad I’ll give this a try.
    Thing is, I’m feeling great.
    Thanks for sharing the discovery , a few things in there I’d have to train myself to enjoy.

    1. See my reply to Dee. Ask your doc about getting a coronary artery calcium scan. A good result really puts your mind at ease about the LDL!

  4. Mediteran is a much better fit for.me, long term. This us interesting

      1. That’s way too much fatty fish IMO. You really have to be confident you have normal iron levels are inflammation is low if you’re eating that much fish PUFA. Chris Masterjohn recommends no more than 2 servings of fatty fish per week.

    1. I was thinking that too! Insane. I’m wondering if there were any women in this study because I can’t eat that much of any meat in a day. Half a bottle a wine a day is ridiculous too.

      1. That’s two glasses a day, one at lunch and one at dinner. Why is that ridiculous?

  5. I’m a 36 year old male who competes in the fitness industry and has 3 autoimmune diseases (type 1 diabetes, addison’s disease and hypothyroidism). I smoked myself early on in life, despite always being athletic and active, with a standard American diet. I’ve been keto for the last 4 years now and it has dramatically improved my hemoglobin A1C levels down to pre-diabetic levels and I’ve almost completely removed having to bolus insulin around mealtimes. That said, I’m one of the ones who’s cholesterol shot up over 300 with LDLs and triglycerides through the roof despite feeling fantastic, being leaner than I’ve ever been and having more energy than I ever did in my “prime”. I adjusted to a diet VERY close to this and my blood work cleaned up in 3 months time. I’ve stuck to it since and won’t go back. I eat wild fish at least 3 times per week (salmon, sardines and mackrel), a big salad of leafy greens (2 servings of kale, arugula and shredded brussel sprouts), berries (blueberries, strawberries and raspberries), 1 small serving of cruciferous veggies (broccoli, cauliflower, asparagus, artichokes and red peppers), a small avocado, a serving of nuts or seeds (walnuts, brazil nuts, macadamia nuts or pumpkin seeds), and 2-3 tablespoons of EVOO and/or avocado oil at each of my 2 meals or 4 tablespoons on days I ate a single meal…I eat pastured chicken and grass-fed grass-finished beef on days I don’t eat fish. No alcohol save for the occasional glass of red wine (maybe a couple glasses per month) no dairy, and minimal pork. I won’t even start on supplements as I take a whole bunch to keep balanced but they definitely include extra Omega 3’s and Thorne’s Elite Multi-Vitamin (to keep with the spirit of this post). I’m strict about this stuff but I have a heck of a lot going on on a metabolic level and following this protocol almost completely cleaned up my blood work…and I feel better than I ever did doing the standard keto thing. An organic Mediterranean Keto lifestyle works fantastically well for me and would recommend anyone who has also been “crushed by autoimmune disease” to give it shot if you have the discipline.

    1. This is very interesting to me. I’m in a similar situation and also hypothyroid. I’m getting that stabilized, but my numbers are off the chart otherwise. I’ve been kept for over a year but am not losing weight or improving my numbers. This could very well be worth a try for me.

      1. This is very interesting to me. I’m in a similar situation and also hypothyroid. I’m getting that stabilized, but my numbers are off the chart otherwise. I’ve been keto for over a year but am not losing weight or improving my numbers. This could very well be worth a try for me.

        1. No sweat, Lori. I’m always happy to share and glad anytime it proves helpful in any way.

          Cindy, I probably came off a bit more prescriptive than I intended to in my initial response. While my typical diet holds true to what I described, my personal “keto fundamentals” boil down to high fat/low carb/moderate protein (duh), I stick to unsaturated fats (and when I have them no more than 20% of my total fats for the day), wild fish as my primary protein, grass fed/pastured meats to fill in the gaps, and organic produce. It costs more than life did prior to going this route but I figure it’s an investment in my health so I can either “pay now or pay later”. Obviously not trying to give medical advice, just my anecdotal experience as there are also additional hormetic factors to consider in a men vs women approach to diet and exercise, and there’s no one size fits all with this stuff, due to the unique bioindividuality of each person’s needs. All that said, I’d advocate for this being a safe place to start before making tweaks or adjustments based on how your body responds and the story your bloodwork tells. I wish you the best moving forward and hope anything I share might prove worthwhile for you to consider in the name of good health 🙂

          1. I was hype thyroid (post-menopause). Much better numbers now as have been taking lugols iodine and a dessicated (grass fed) thyroid supplement. Also found I was anaemic at the same time and solved this by eating oganic chicken liver once a week. Chicken liver is the highest in iron.
            Hope this helps

  6. That sounds a lot like where I have been drifting to lately. One thing I wonder is if the seasons have anything to do with it. I tend to love a lot more seafood in the summer, and tend to eat a lot of the above during that time frame. Come fall and winter, my desire for fish drops and I turn into more of a meat and potatoes (and other root veggies) kind of guy.

  7. Mark,

    Are you saying these people are 2 pounds of fish per day? Is that per week?

    1. I think it depends on how it was measured (bones and the such) and what fish. Lean fish is pretty low in caloric density. And if you’ve been out to a Mediterranean seafood taverna, it is really easy to eat that much in grilled sardines/small fish.

      If you are a larger person for any reason (sex, activity, fitness level), I don’t really see how that would be difficult. Assuming you aren’t also inhaling cheese and red meats.

  8. Thank You for the great food ideas. My diet is limited to the edible food I can forage from the local supermarket. I live 2 hours from any city.

    At 63YO I have been Paleo for years but recently decided to get back to 180 pounds when I had normal Blood Pressure. My Dr. says the real problem is finding the right medicine. NOT!

    I never counted calories before but now that I am serious I am surprised to find just how calorie dense a serving of fatty meat is.

    I cut my calories to about 700 a day, mostly fatty meat and some cheese. I cut out the morning Latte with molasses which totaled 25 grams of carbs. and 210 calories.

    The big treat is a 1 lb bag of frozen Asparagus soaked in home made gelatinous bone broth. Plenty of fiber, some vitamins and no significant carbs or calories.

    I heavily supplement with Magnesium and Potassium based bullion. Half Sour Pickles for salt as needed. Also 1 pack of E-Mergency vitamin C.

    I ride my bicycle hard 7 to 10 miles every other day up and down the Adirondack Mountains. Despite the diet, I am itching to do it every day.

    I have lost 7 pounds in ten day with 7 more pounds to go. My belt buckle is coming into view a little.

    While I feel a little hungry, it is not a problem unless I go into the kitchen and then the cravings take over.

    I feel a bit ditzy at times but just go with it and if I have to be alert I will have a few sips of a zero carb energy drink. (I keep them for emergencies. Sucralose …ugh but other good vitamins). Other times I just take a nap and wake up alert.The real emergency plan is the Molassas Latte and a bag of Frozen Garlic Potatoes along with going back on my regular diet.

    I am amazed at how much I can do with so few calories but I think getting the proper electrolyte supply is critical.

    1. JatF … I commend you for striving to be healthy and to drop some pounds, but 700 calories a day … wow … hope this is just a short term experiment on your part.

  9. That’s a lot of fish!!!

    You said “Lots of fish. At least (and often more than) four days a week, subjects ate over a kilogram of fish each day,”.

    Did you really mean 2.2 lbs of fish each day??? I’ve never heard of a diet eating that much.

  10. My husband recently had a cardiac cath done and the Dr was thinking he was going to need a stent. Turned out he didn’t need it but during our visit we discussed the keto diet with him and even though my husbands labs are the best they’ve been in years he warned against the keto diet but did recommend thr Mediterranean diet. So this might just be the ticket

  11. I am writing this from Croatian island of Hvar.

    We just ate coal grilled pork chops and peppers, with tiny bites of corn-bread (handmade), all drenched in olive-oil.

    Yesterday it was grilled piece of tuna and some zucchini.

    BUT you can also see locals drowning themselves in potato and white bread with cooked beans.

    Red wine is a must. So yeah …. it all depends on your discipline and frame of mind.

    1. I ate grilled octopus salad on Hvar every day and dry cheese with lightly pickled weed that grows wild in the rocks at the waters edge. What is that weed called? I love it. Goes great with the local wines

    2. Croatia has nothing to do with the “Mediterranean world” … They have different patterns of eating there, with completely different diets..

  12. We have the same question as several others, did you really mean 2.2 lbs of fish per day??

  13. I think it really was a kg/day!

    Here’s a link to more info:
    From this report: “Low rates of death from coronary heart disease has been report among individuals with very high consumption of fish, although these people should limit intake of species highest in mercury levels. Larger, longer-living predators (swordfish, shark) have higher tissue concentrations, while smaller or shorter-lived species (anchovy, shellfish, salmon, sardine) have very low concentrations [18].”
    But I can’t find the 1kg/day reference.

  14. The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?

  15. This is extremely helpful. I gleefully jumped into keto until I gained a bunch of weight and found out that I have the APOE 3/3 gene and was warned that my body doesn’t tolerate saturated fat well. This plan looks like it’s worth a try – will try to get more fish.

    1. Do you mean apoe4? If so, there is a really helpful forum with “apoe4” in the name that you might want to check out. There are lots of Keto types there, following something close to Dale Bredesen’s Ketoflex 12:3 eating plan.

    2. Hi Lorna
      I have been on the Mediterranean krto for about 2 months no and I am slowly losing weight, despite being hypothyroid. I was like you and gained weight and had my LDL readings skyrocket when on keto and felt really sick. I just cannot stomach a high fat/protein diet. Since being in the Mediterranean keto, I feel a lot healthier my cravings are gone and I look forward to my food. I don’t eat any red meat or diary now and have substituted with fish and almond milk/yoghurt. It’s very easy for me to stick to, alot easier than the original keto and I can easily see me eating this way for the rest of my lifetime.

      1. I cut out diary too – feel much better now – it was probably all the dates.

  16. I may present this as a possibility for my Brazilian fiance when he finally gets here. He doesn’t like red meat, but loves fish, appreciates a little alcohol with his meals… and coincidentally is a descendant of Italian immigrants. Maybe it will help him manage his blood pressure and lose some weight (which he wants to do).

  17. Wow, that’s a lot of fish, and expensive too! I worry about contaminated fish, so many reports of trash fish replacing the slots of good fish in the markets.

  18. To lower my cholesterol I take Bergamot capsules,made from Italian lemon, works great.

  19. I had to laugh out loud at your first picture of the Mediterranean diet! Just to back you up, here, I have to point out that pastas were side dishes in Italy, until the press of American tourists changed things… And pizza was developed from a Neopolitan savory pie that – like so many regional savory pies in Italy – had a very thin bit of crust to it. These were holiday food. Fish, vegetables, meat when you could get it, and cheeses – mostly goat cheeses, olive oil, nuts, and fruit in season were the way it was…

  20. Without getting expensive tests done, is it possible to find out if you’re the kind of person who doesn’t tolerate saturated fats well? Is this something you can feel the difference of or is it only shown in the lab numbers? Any experiences?

    1. In my experience, I always felt ill after eating saturated fats. I could do one week easily but after that I struggled to put any saturated fats in my mouth. Not so with plant based fats eg avacado, nuts, seeds, coconut. They full me up, don’t raise my LDL and I feel great eating them

  21. Great, but why the wine? Is it not a contradictory with ketosis?

  22. Wow… this sounds very similar to my own diet. I have severe Crohn’s disease and have found a diet of lots of fish (I eat 4-6 pieces a day of wild good quality Local fish) Lots of vegetables and salads, some celery juice, the only thing that differs is I don’t have much olive oil and have more berries and some cooked and cooled potatoes and some other safe starches (especially cold chickpeas) instead.

    This diet above feels best for me, I might add I’m a thin active female who has always been thin naturally- but I actually have energy on this diet! Unlike my trials of a wholefoods based higher fat low carb style eating plan.

    Are there any downsides to eating like this long term, or anything you would add or subtract Mark?

  23. You could differentiate between the current Med diet of today, with that of the past or better yet reclassify it Marc.
    I’m Greek and trust me, it’s all bread and deserts made with nasty syrups instead of the old traditional mountain honey…your normal Std. SAD diet.

  24. Now this is a coincidence! Me and my wife were just talking about how easy it is being keto and primal here in our Spanish little mountain village, overlooking the Mediterranean.

    Mackerel in olive oil, fatty meats, perfectly ripe avocado and the most amazing veggies are readily available in bars and supermarkets. The scenery makes impossible to not go out and explore – which, before you know it, results in a couple of thousand vertical feet and a few hours of aerobic work.

    Compared to our grown up lives in urban Sweden, it’s just so much easier easier to do the good stuff!

    Apologies for going off topic, but it was such a cool coincidence.

    1. Krisroffer, where do you live in Spain? It sounds like heaven!

      1. It’s in a little village called Gaucín. At the moment it’s just a vacation home but me and my wife are pondering a permanent move. We’re blogging about it at mountainsofspain.life if you want to check it out 🙂

  25. I have been Keto for a couple of years and put on weight if I don’t watch calories though, so I can’t see how unrestricted food can lead to weight loss.

  26. This is very interesting. My wife and I are currently somewhere between paleo and Keto. My natural Dr. has me fasting 26-18 hours per day and eating salad 3 days per week. I tried the Mediterranean diet for a while (my family background is Italian) but did not get great results. I may give this a try!

  27. I love fish/seafood and eat a lot of it–mostly sardines and salmon—but I seriously doubt that I could force myself to eat anywhere close to 2.2 pounds a day, 4 days a week. I wonder if something got lost in translation with that number.

    The 2010 version of the Mediterranean Keto Diet that I looked at just now indicates 4 oz. of fish daily, which would be much more doable for most of us, as well as less expensive. Decent quality fish and seafood aren’t cheap in most parts of the US. There’s also a concern of ingesting too much mercury.

    I would also add more veggies and a little fruit, but then, I’m not really interested in remaining solidly in ketosis. Drifting in and out of it with a more Paleo approach is much more my cuppa. Either way, the incorporation of more fish in one’s diet is probably an excellent idea.

  28. Great article!

    This is why “personalized” nutrition and lifestyle is so important and there is no “one sized fits all”, especially when it comes to the nutrition side of things.

    There are a few no-brainer, common sense things most people can agree on: eat real foods, avoid processed carbs and sugar, and modern grains are probably best avoided because they offer no real nutritional value (at best) and can be absolutely detrimental to health (at worst).

    On the topic of cholesterol. An LDL level by itself is useless. If you think you are fine and dandy if you have a low triglyceride and high HDL but your LDL is elevated, you cannot assume you are in the clear. You need to know LDL particle number, size and distribution as well as Lp(a) lipoprotein a and ApoB (apolipoprotein B)–to name a few. If these are elevated you are at increased risk for atherosclerosis. These lipoproteins are transported by LDL, VLDL, chylomicrons and other remnant cholesterol and play a role in atherosclerosis. So if you have elevated levels of these, especially ApoB, it’s probably best to try and lower LDL. This, of course, can be achieved partially by minimizing saturated fats (no, saturated fats are not bad for everybody, just possibly some people), eating lots of plants and getting plenty of exercise–cardiovascular and probably strength training. Of course, pharmaceutical intervention is always an option/last resort and comes with it’s own set of issues.

    Regarding APOE4. I found out I am a heterozygous APOE4 carrier, meaning I carry one copy (as opposed to 2). This potentially increases my risk for Alzheimer’s as APOE4 is thought to have disrupted metabolism of saturated fats and various proteins (the exact mechanism(s) is not completely understood) so I have adopted a lower saturated fat diet that is very similar to this “Mediterranean Keto” approach combined with time-restricted feeding/IF to fluctuate in and out of ketosis and keep blood glucose and insulin levels low.

    Those who are homozygous (carry 2 copies) of APOE4 have a much high risk for Alzheimer’s and will need to take this into consideration with dietary and lifestyle choices.

    I’m a firm believer in epigenetics–our genes are not our destiny, but our lifestyle influences how our genes are expressed. That being said, if we carry the genetic material that results in a fundamental flaw in the metabolism of saturated fats (such as APOE4) we need to take this into consideration.

    Thanks for addressing this topic Mark!

  29. My favorite way to eat, especially in summer is basically an antipasto plate consisting of meat/seafood, cheese, olives, pepperoncinis, leftover roasted vegetables, hard cooked eggs, and maybe some liver pate with crudités. I can also combine most of these ingredients with some arugula and make it a salad with a vinaigrette. A couple of dates or dried apricots/figs/nuts for dessert. So easy and flavorful.

  30. The Spanish Ketogenic Mediterranean Diet that was referenced may indeed have had some people who ate up to 1 KG of fish per day, as the protein component of the diet was unlimited. It did not state how much fish (or other protein) was required, so portion size is up to the individual.


    Other than the prevalence of high lectin and dairy foods that are often included in other descriptions of a “Mediterranean Keto Diet,” and the fact that I can only fit in one glass of wine on weekends, this works quite well for me. I eat on the lower end of the protein spectrum, but it still works.

  31. A kilogram (2. Pounds) or more a day of fish seems like an awful lot of protein for me! I wish I loved fish, the ones I like such as crab and shrimp would be prohibitively expensive.

  32. Can someone please tell me what to do if my calcium score was “through the roof” at 537? I have been trying to do keto as much as possible for the last six months. My daughter tells me I smell of an old buttery plastic container! Help there!
    I have read Ivory Cummins/Dr Malhootra and am on K2 and ip6 fish oils etc. Exercise well and always though I was doing it right. Evidently not! Any opinions please

  33. This sounds like something I can do. Is there a book with the how to get started? I did not see one on Amazon.

  34. Can you recommend any good Keto Mediterranean diet books please?

  35. “Spain, Italy, Portugal, Greece, Crete, Turkey, Morocco, Algeria, Israel, Lebanon, Egypt, and even France are all technically Mediterranean countries.”
    Crete is not a country. It’s a Greek island.

  36. I’ve been doing something similar to this since the lockdown started.

    I lost 20 something pounds without trying, I love what I eat, great energy almost all the time