While diet fads come and go, the Mediterranean diet, one largely based on vegetables and proteins, has remained a nutritionist’s favorite for years thanks to its heart health benefits.

While Mediterranean diet advice can sometimes seem very broad (eat fewer carbs and use olive oil!), a new book, “The Ketogenic Mediterranean Diet: A Low-Carb Approach to the Fresh-and-Delicious, Heart-Smart Lifestyle” (Ulysses Press, 2017) by dietician Robert Santos-Prowse, espouses a food plan focused not only on the foods favored by those living in countries along the Mediterranean, but a ketogenic plan, which helps your body run on fat. Santos-Prowse, who overcame issues with weight through this diet, presents a thoughtful and detailed approach to his philosophy. He begins “The Ketogenic Mediterranean Diet” with a nutrition overview, explaining the digestive system and the roles that macronutrients and micronutrients play, before delving into the why’s and how’s of this diet, providing recipes, tips and a meal plan. Santos-Prowse answered a few questions via email.

In “The Ketogenic Mediterranean Diet” you discuss your personal journey to health. It is an inspirational story — when did you decide to change your life and how you eat?

“I love [the Israelis’] emphases on fresh vegetables and copious use of olives, olive oil and high-quality cheeses,” Santos-Prowse says.

“I love [the Israelis’] emphases on fresh vegetables and copious use of olives, olive oil and high-quality cheeses,” Santos-Prowse says.

I cannot pinpoint an exact moment I decided to get serious about my health. As I imagine is the case with most people, it was a long series of trials and errors. It took me several years of gradual changes to achieve and maintain a healthy weight.

However, my first experiment with ketosis was in January of 2015, and it did feel like a sea-change moment. When I achieved ketosis, I almost immediately felt more mentally clear, had more energy and loved what I was able to eat. It was truly life-changing.

Ketogenics is an unfamiliar term to most — what is it? Why should we know about it?

Ketogenic refers to an eating pattern or food item that promotes the metabolic state of ketosis. Ketosis is a state that the body enters when carbohydrates are restricted. Typically, the body relies on glucose (the end product of most carbohydrate metabolism) for fuel. In ketosis, the body is relying on fat and ketone bodies (a byproduct of fat breakdown) for fuel instead.

Research indicates that this state of ketosis can have beneficial effects on body composition, mental acuity and risk of several chronic diseases. In particular, the ketogenic diet has been shown to be incredibly beneficial for reducing the risk of heart disease. Most people will experience weight loss, a decrease in blood levels of triglycerides and LDL cholesterol as well as an increase in HDL cholesterol.

How can a combination of a Mediterranean diet and ketogenics be beneficial?

Because a ketogenic diet needs to consist of mostly fat, it is often portrayed as a “meat and cheese” diet. While it is technically correct that eating mostly meat, cheese and butter will put you into a state of ketosis, that type of eating pattern is not sustainable for the individual or the planet.

The Mediterranean diet is based on healthy fats and copious amounts of vegetables. The combination of the two provides people with a greater variety of choice and a diet that they are more likely to be able to maintain over a long period of time.

Additionally, the Mediterranean diet is traditionally more than just a diet. The lifestyle aspects that go along with the diet are beneficial for long-term wellness, stress management, regular physical activity, sleep quality and cultivating a sense of community.

What is a SAD diet and how is it different?

SAD is an acronym for Standard American Diet, and it’s characterized by a high intake of fat and simple carbohydrates and low intake of fruits, vegetables and whole grains. It can be thought of as the default diet that the Western food system promotes. Think double cheeseburger, fries and a huge soda.

This contrasts the Ketogenic Mediterranean Diet in that it is high in both fat and carbohydrates and it promotes weight gain and heart disease. The Ketogenic Mediterranean Diet is a high-fat, moderate-protein and very low-carbohydrate diet. It promotes weight loss and heart health.

Do you think fat has been misunderstood in our culture?

There is no question that fat has been inappropriately cast as the dietary devil since the late 1970s. There are many reasons for this misstep that involve low-quality science, political pressure and, eventually, a system of subsidies that promote the production of corn and wheat.

There are several excellent books written on this topic, but the short of it is that the evidence that fat causes heart disease is not nearly as compelling as we have been led to believe these past 40 years.

Why is a high-fat, low-carbohydrate diet so beneficial?

A high-fat, low-carbohydrate (ketogenic) diet is beneficial because it produces several beneficial changes within the body. Most people will find that it allows them to effortlessly lose weight, but weight loss is really just the tip of the delicious fatty iceberg.

Recently there has been an explosion of interest in the ketogenic diet’s potential uses beyond weight loss and the control of medicinally intractable epilepsy. The ketogenic diet looks to have promising applications for the treatment of a variety of neurological disorders including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer’s disease, dementia, Parkinson’s disease, chronic migraines and even stroke recovery. It makes perfect sense that the ketogenic diet could provide relief for individuals with these conditions because one of the primary effects of ketosis is a shift in neurologic fuel source, as the common thread between many neurological disorders is some form of glucose metabolism malfunction.

What are some foods everyone should avoid?

Sugar sweetened beverages like sodas have no value and should be avoided. Similarly, simple carbohydrates like candy, cakes, donuts, etc. bring very little to the table, nutritionally speaking. I understand that while total avoidance of sweets is very difficult for most of us, they are also likely not doing us any favors.

Conversely, what are some foods everyone should keep in their kitchen?

You really can’t go wrong with high-quality olive oil and dark green leafy vegetables.

What do you admire about the Israeli diet with regards to The Ketogenic Mediterranean Diet?

I love the emphases on fresh vegetables and copious use of olives, olive oil and high-quality cheeses. As with the broader Mediterranean diet, the abundant use of whole foods and good fats really makes blending the Israeli diet with a ketogenic diet much easier. Many of the traditional dishes can be included in moderation or tweaked very slightly and enjoyed in greater quantities. Take hummus, for example. The traditional version made with chickpeas and tahini has five net carbohydrates per 1/4 cup serving, but if you replace the chickpeas with cauliflower, the net carbohydrate drops to about three grams. Two grams may not seem like a lot, but when your daily goal is 20 to 50 net grams, every gram matters.

Of course, because a ketogenic diet has to be a very low-carbohydrate diet, the difficulty comes with the inclusion of a variety of grains and sweets in the Israeli diet. Unfortunately, there are not ready substitutions for things like challah and baklava.

How could someone wishing to follow your diet prepare a healthy Shabbat meal?

Thankfully, many of the recipes I developed for this book would make wonderful Shabbat additions. For the traditional first course of wine and challah, be sure to use red wine as it will be lower in carbohydrates than white and only have a morsel of the challah. While delicious and traditional, unfortunately challah is too carbohydrate heavy to fit within a ketogenic meal. Substitute the egg-based cloud bread flavored with rosemary and garlic in my book for the rest of your bread needs.

A fresh Mediterranean salad replete with kalamata olives and feta cheese paired with creamy asparagus soup will comprise the next course. The soup will be delicious served warm or cold, you choose!

Your main Shabbat celebration course will be lemon dill salmon fillets with sides of artichoke and olive salad, cauliflower hummus with cucumber slice chips and tomato basil zucchini pasta.

For dessert, you can serve my rich and decadent peanut butter fat bombs. They are similar to truffles and best served chilled.

All of these recipes can be made in advance so you will not have to cook on Shabbat.

Recipes from “The Ketogenic Mediterranean Diet”

Artichoke Salad

Artichokes are underappreciated. They are a great source of prebiotic fiber (the type of fiber that aides the microbes in your gut), they are delicious fresh or pickled and they are decidedly Mediterranean. This salad combines artichoke hearts, a variety of olives and cheese to make a wonderfully flavorful and filling salad.

Yield: 8 (½-cup) servings

The Dressing Stuff:
2 tablespoons red wine vinegar
1 tablespoon chopped fresh
oregano
1 lemon, zested
Salt and pepper, to taste
¼ cup extra virgin olive oil

The Salad Stuff:

2 (12-ounce) jars marinated
artichoke hearts
¼ cup green olives
¼ cup black olives
¼ cup Kalamata olives
½ green pepper, chopped
¼ red onion, chopped
6 cherry tomatoes, halved
6 ounces feta cheese, crumbled

What to Do:

Drain the artichoke hearts.

In a mixing bowl, mix together the first four dressing ingredients until well combined. Add the olive oil and stir again.

In a separate mixing bowl, combine all salad ingredients except for the feta. Add the dressing and toss to coat. Fold the feta in until evenly distributed. Serve.

Fat Coffee

You may have heard that this recipe, sometimes referred to as “bulletproof coffee,” has the ability to burn fat extra hard and give you some sort of magical powers. That’s all marketing hype, unfortunately. Coffee with fat in it is delicious and can hold you over until lunchtime or beyond, but that’s all it is: coffee with fat in it. Don’t fall for the hype and spend extra on branded bulletproof coffee, butter or anything else with that much nonsense marketing behind it.

Yield: 1 serving

The Stuff:

2 cups strong coffee
½ tsp. cardamom
½ tsp. cinnamon
¼ tsp. salt
2 tbsp. butter
2 tbsp. coconut oil
2 tbsp. heavy whipping cream

What to Do:

Put all ingredients in a blender and blend until frothy and decadent, and drink.

Tip: If you enjoy this recipe and think you’ll make it often, I recommend getting an ice tray and freezing your butter and coconut oil into cubes. This makes them easier to handle and provides the added benefit of cooling your coffee down to a reasonable drinking temperature faster.