Hi, Esther! Thank you so much for your kind comment. I am so glad you found The Mediterranean Dish and hope you’ll enjoy cooking some of the recipes here! I should preface my answer here by saying that I am not a dietitian or a nutritionist, what I share here is mainly from my experience as someone who grew up in the Mediterranean area and have continued to eat the Mediterranean way now as an adult living in the USA. So please always check with your health care provider or a registered dietitian if you are looking for professional advice or a specific diet plan to follow. But I’ll answer your questions as best as I know how.

Keep a food diary. In it, record your current daily eating habits. Write down what you eat for every meal of the day, and take note if you skip a meal. If you regularly skip breakfast, jot this down as well. Also write down any snacks you eat, even if you do this mindlessly - say, while watching TV. This diary will allow you to see where you stand right now in terms of eating practices and where you can start to make changes.[2]
The DASH diet is an acronym for Dietary Approaches to Stop Hypertension. As you can probably guess, this eating plan was originally developed to help people lower their blood pressure. But it can do a whole lot more than that: The DASH diet has been shown to reduce bad cholesterol and improve insulin sensitivity. Studies have also suggested that following a DASH diet plan can reduce the risk of serious health issues such as stroke, kidney stones, and diabetes. It's no wonder why so many doctors recommend the DASH diet to their patients and why the plan has been ranked as the "best overall diet" by US News & World Reports for eight years in a row.
Diabetes is one of the most common chronic diseases in the world. In 2014, diabetes affected about 387 million people worldwide and resulted in $612 billion dollars of health-related costs. [5] Unfortunately, as a conventional western lifestyle of poor nutrition and exercise habits becomes more popular, diabetes is expected to affect about 592 million people worldwide. [6] In the United States alone, diabetes increased from 5.58 diagnosed cases in 1980 to 22.3 million diagnose cases in 2013. [7]

How many times have you heard a doctor specifically name a diet that fights heart disease and helps you lose weight? By name? We’re always told to eat healthy, maybe you are given a list of foods to add or avoid but from that point it’s on you to bring the meal plan together. Not with the Mediterranean diet. “This diet is for anyone but specifically for those with high blood pressure,” says Susan. “This is a low sodium, low fat, low cholesterol diet. It’s also ideal for those that are at risk for developing cardiovascular disease. It’s also great for weight loss or management, so if you are looking to shed a few pounds this is a great diet to embrace.”
A review published in December 2015 in the journal Diabetes Therapy suggested ultra-low-carb diets were effective at managing blood sugar, decreasing weight, and managing cardiovascular risk in individuals with type 2 diabetes in the short term, but the benefits were not sustainable over the long term. When compared with higher-carb diets over a period of longer than about 12 weeks, the health results were similar.

The plan promotes long-lasting, sustainable changes, and undoubtedly a bounty of research backs this up. In fact, one December 2013 study in the American Journal of Medicine shows that people following Weight Watchers were close to nine times more likely to lose 10 percent of their body weight, compared to people following a self-help diet plan. (20)
A study recently published in the New England Journal of Medicine found that people who followed a Mediterranean diet for two years lost more weight than low-fat dieters and maintained their 10-pound loss. "You don't feel hungry," explains Meir Stampfer, MD, DrPH, a coauthor of the study and a professor of epidemiology and nutrition at the Harvard School of Public Health, in Boston. Don't believe us about protein's fill power? Dr. Stampfer suggests this little experiment: "One morning eat white toast and jam for breakfast. The next day have scrambled eggs." The egg meal, Dr. Stampfer promises, will leave you more energetic and a lot less hungry at 11 a.m.
A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >

Most dieticians I have met are over rated and under educated. This article somewhat proves me out. Congratulations on your accomplishments. I have been in Ketosis for a couple of months now. I have lost 28 pounds. I feel great. No sugar No Bread Nothing from a box lol. Only good fats and Meats and good veggies(dark greens mostly) and a few macadamia nuts now and again and a few berries now and then. I think even the dieticians being human are also addicted to sugar and unable to give it up so they play down ketosis unconsciously because they are just jealous! lol
So my question to all of you is: why do most people trying to improve their health appear to not care at all about how their food choices impact the earth and the future of all our children? (Not to mention the horrific conditions that the great great majority of animals bred for food endure?) Is it because you have not been told or do not believe how bad it is (our society has many many who are in total denial about global warning, for instance), or is it because you truly don’t care?
A small Feb. 20, 2017, study looked at the impact of a six-week ketogenic diet on physical fitness and body composition in 42 healthy adults. The study, published in the journal Nutrition & Metabolism, found a mildly negative impact on physical performance in terms of endurance capacity, peak power and faster exhaustion. Overall, researchers concluded, “Our findings lead us to assume that a [ketogenic diet] does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training.” The “significant” weight loss of about 4.4 pounds, on average, did not affect muscle mass or function.

Now, about that whole low-fat and low-sugar thing. It can be tricky come dessert time, but Gorin has a hack for surviving that as well: "One way to feel like you’re getting the dessert that you crave while still following the diet is to eat a fruit-based 'nice cream,' like my chocolate-banana recipe. By combining frozen bananas and unsweetened cocoa powder, you'll wind up with a treat that resembles the texture of ice cream yet contains no added sugar and also counts toward your daily fruit servings."
Don’t think that “Mediterranean diet” means gorging on pasta and pizza, though. People in Mediterranean countries traditionally eat small portions of grains – for example, a side dish of 1/2 to 1 cup of pasta, instead of the full platter of pasta Americans are used to. Fill the rest of your plate with vegetables to fill you up without many calories.
Some of us experience a rise in BG that’s hard to manage when trying Keto. This is one of the reasons why keto did not work out for me (plus weight gain and feeling lousy). That being said, there could be a lot of other reasons why he’s running high, so I’d highly recommend you work with a medical professional and dietitian if you decide to continue down this path. And if your doctor isn’t supporting you, find one that will.
A survey of 1,580 low-carb consumers published in late 2017 by the Journal of Insulin Resistance45 found that while more than 11% of respondents reported using sleep-aids before beginning their low-carb diet, less than 5% reported using them after their diet. Moreover, nearly seven in 10 reported improved quality of sleep after dieting while only 3.4% said their sleep quality had worsened.
Several recent studies indicate that a low-carbohydrate diet is effective at improving glycemia. A few studies have shown that in non-diabetic individuals, low-carbohydrate diets were more effective than higher carbohydrate diets at improving fasting serum glucose [13,14] and insulin [6,14-16], and at improving insulin sensitivity as measured by the homeostasis model [6]. One of these studies also included diabetic patients and noted a comparative improvement in hemoglobin A1c after 6 months (low fat diet: 0.0 ± 1.0%; low carbohydrate diet: -0.6 ± 1.2%, p = 0.06) [6] and 12 months (low fat diet: -0.1 ± 1.6%; low carbohydrate diet: -0.7 ± 1.0%, p = 0.019) duration [5]. In a 5-week crossover feeding study, 8 men with type 2 diabetes had greater improvement in fasting glucose, 24-hour glucose area-under-the-curve (AUC), 24-hour insulin AUC, and glycohemoglobin while on the low-carbohydrate diet than when on a eucaloric low-fat diet [7]. In a 14-day inpatient feeding study, 10 participants with type 2 diabetes experienced improvements in hemoglobin A1c and insulin sensitivity as measured by the euglycemic hyperinsulinemic clamp method [8]. Hemoglobin A1c also improved in an outpatient study of 16 participants who followed a 20% carbohydrate diet for 24 weeks [9].
The Mediterranean Diet was identified in the 1960s as research continued to show populations from Mediterranean regions, particularly Southern Italy, the isle of Crete, and Greece, were considerably healthier, with less incidence of disease and longer lifespans than seen in other regions. Studies indicated that the way these populations ate seemed to be the common denominator and through research, the Mediterranean diet was formally born.
“Intermittent fasting can be really challenging if you have an ever-changing schedule,” adds Hultin. “If you're traveling and crossing time zones, it could be very difficult to follow. It might be best for people with more stability in their lives.” Intermittent fasting isn’t safe for people with type 2 diabetes, children, pregnant or lactating women, or anyone with a history of an eating disorder.
At the conclusion of the intervention, both groups had improved in all metrics but “these changes were more significant in subjects who were on the LCKD as compared with those on the LCD.” [10]. As a result, the researchers supported the study outlined above and concluded that their “…study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects.” [10]
When it comes to the "best" diet for most people, this one consistently ranks at the top of every list. If you can't afford a cruise to the Mediterranean (yet!), at least you can eat like the beautiful, long-living, and famously healthy people from the region. The Mediterranean diet teaches you to eat like a Sardinian, one of the "blue zones" identified by researchers as having a high number of people living past 100—by eating more fish, olive oil, healthy fats, and fresh vegetables. The point is to have not just a longer life but also a healthier and happier one, whether you're trying to lose weight or not. (Really—research shows that you can reap the benefits of the Mediterranean diet without cutting calories.)
Cons: Teaching your body to burn fat instead of carbs takes time, so you have to be patient while you feel sluggish during the weeks it takes to become fat-adapted. And not every body burns fat as efficiently as carbs, so your endurance may never measure up (though, as we said before, others actually see an improvement here.) Without carbs, your body’s ability to generate explosive energy will most likely decline, so if you love sprinting or HIIT, you might need to consume more carbs than other low-fat dieters. And while you’ll probably lose body fat, this kind of diet is actually keeping you focused on the wrong macro: Studies have proven that the higher protein aspect of a low-carb diet helps promote weight loss, rather than the lower carb count.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar and handling illness.[18] The level of parental education and commitment required is higher than with medication.[43]
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[34] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[35] On the other hand, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism.[9] A person with a disorder of fatty acid oxidation is unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[36]
Many equate healthy eating, particularly lower-sodium eating such as DASH, with the idea that all meals have to be cooked from scratch. This is overwhelming for many (myself included), but there are plenty of tricks and tips to help you. First, understand that “whole foods” doesn’t exclusively mean fresh produce. Take advantage of time-saving, minimally processed foods like unseasoned frozen vegetables and no-salt-added canned veggies.
Dr. O’Brien proclaimed that the benefits of the Mediterranean diet as a push away from using animals as a protein source, introducing more fruits and vegetables in meals, while also cutting out butter in favor of using oils cooking. It seemed simple which made me skeptical. I know that in dieting nothing good is easy. When I got back to office I started my research and was surprised to learn that the Mediterranean diet was endorsed by the American Heart Association and Mayo Clinic.
2- Eat more vegetables, fruits, grains, and legumes. The base of the Mediterranean diet pyramid should make up the base of every meal. When you can, opt for vegetarian entrees like this Cauliflower and Chickpea Stew;  Spicy Spinach and Lentil Soup; or Spanakopita (Greek Spinach Pie). Rely more on satisfying, flavor-packed salads to make up a good portion of your plate. Some ideas: Kindey Bean Salad; Mediterranean Chickpea Salad; Greek Salad; Bean and Lentil Salad.
Also, if you listen to Dr Bernstein talk about his childhood (he is well into his 80’s), the “original” recommended diet was only ketogenic in the sense that it was high-carb and caused keto-acidosis, which he describes as almost killing him as a teenager. He still considers the ADA recommendations as ketogenic for this reason (you only have to listen to him a short time to hear him railing against the ADA).
Great article! Sustainability is key and Keto diet is extremely restrictive compared to others. Many of the comments I see don’t understand the importance of many years of research before stating something has a “significant difference” than the recommendations that are already in place. Also, understanding the pro/carb/fat balance in each meal instead of focusing on just carbohydrates. We have practiced the same modified Mediterranean diet at my practice where someone can enjoy life, eat complex carbohydrates and years later they are still successful and hundreds of pounds have been lost for good 🙂 Thank you for the reminder (and the comparison of Adkins supported research).

Very low levels of thyroid hormone usually indicate an autoimmune reaction to the thyroid gland itself. This means you’ll have to take thyroid hormone supplements orally, usually the stable form T4 (Levaxin), which your doctor can prescribe for you. Your body will transform this into the active T3 hormone when necessary. The supplement dose should be adjusted so that you reach normal hormone levels (TSH, T3, T4) and sufficiently alleviate symptoms – though a few people feel best when keeping TSH slightly below normal.
Essentially, the Nordic Diet is based on 10 core concepts: eating more fruits and vegetables every day; eating more whole grains; eating more seafood; choosing high-quality meat, but less meat overall; seeking out food from wild landscapes; using organic produce whenever possible; avoiding food additives; basing more meals on seasonal produce; consuming more home-cooked food; and producing less waste.

“The DASH and Mediterranean Diet consistently rank as two of the best eating plans” The 2 diet plans that vegans have been pushing for 100 years. Look at how well they have worked. Look at how much weight you have never lost on these terrible diets. Doctors have 6 hours of nutrition training. Nutritionists must follow the Mediterranean Diet or they will loose there license. All i am saying is give Keto, NSNG, Palio or Atkins a try. Once you see the pounds fall off, you will not go back to sugars and grains.


The diet suggests a specific number of servings of the recommended foods listed above. The sample plans provided by the National Heart Lung and Blood Institute (NHLBI) are based on 1600, 2000, or 2600 calories daily. For 2000 calories a day, this translates to about 6-8 servings of grains or grain products (whole grains recommended), 4-5 servings vegetables, 4-5 fruits, 2-3 low fat dairy foods, 2 or fewer 3-ounce servings of meat, poultry, or fish, 2-3 servings of fats and oils, and 4-5 servings of nuts, seeds, or dry beans per week. It advises limiting sweets and added sugars to 5 servings or less per week. The plan defines the serving sizes of each these food groups.

In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants. Future research must further examine the optimal medication adjustments, particularly for diabetes and diuretic agents, in order to avoid possible complications of hypoglycemia and dehydration. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
This diet plan focuses on foods that are sources of protein and fat, which will help to keep you feeling full which may help you eat less overall. However, the keto diet is not a license to eat as much bacon and cheese as you want. It is even more critical to make good choices while on this diet because following a strict keto diet could result in vitamin and mineral deficiencies. And while the diet does eliminate many processed and ‘junk’ foods, it also limits many fruits, vegetables, and other important fiber-rich carbohydrate foods, which provide many health benefits.
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
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