When Diets Collide: Mediterranean Keto - A Practical Guide

A few years ago, while pursuing my PhD in human metabolism at the University of Oxford, I co-wrote a cookbook on a Mediterranean ketogenic diet, or MediKeto for short. It was an incredible experience, not just because it gave me an excuse to step out of the lab and taste test delicious dishes, but because I wanted to provide a practical, accessible way for people to start a ketogenic lifestyle. A lifestyle that, in many cases, can be truly transformative—even life-saving. I've seen the power of ketogenic lifestyles firsthand—as a healthcare provider, as a lifestyle coach, as a PhD scientist running clinical trials, and, perhaps most potently, as a patient myself. I started a ketogenic lifestyle on June 1st, 2019, and it saved me from debilitating inflammatory bowel disease. And I've never looked back. But here's a hard fact: despite its many health benefits and use cases, including obesity, diabetes, mental health, autoimmune and inflammatory conditions, ketogenic diets, ketogenic lifestyles are still grossly misunderstood. Many people assume keto is all about bacon, butter, and steak, low in fiber and at at odds with what most people have been taught and internalized over their life courses is "healthy." But that is a huge misconception. Ketosis is not about specific foods, it's about a metabolic state where you're producing ketone bodies, and you can be keto while eating anything from a fully vegan diet to a fully carnivorous one. In general, ketogenic diets are moderate protein with about 70% or more calories from fat and very low carb, generally less than 25 grams of net carbs per day. But there is not just one ketogenic diet, there are infinite. To infinity and beyond! And a Mediterranean ketogenic diet is an excellent entry point for many people because it balances the perceived health benefits of Mediterranean eating with the metabolic advantages of a ketogenic lifestyle. So simply put, MediKeto is a low-friction dietary entry point to low-carb ketogenic diets for many people. And it's diverse and delicious. In this video, I'm going to prove that to you. First, here's a roadmap of what we're going to discuss. I'm going to start by telling you 4 musts for preparing to start on your ketogenic lifestyle. Then, we're gonna transition to reviewing my 9 favorite mediketo foods and help flush out your shopping list. Finally, I'll wrap this up by responding to common questions and answers, and even offer you some free recipes from my book. Of note, that is not a sales pitch per se, but if you do decide to buy our Mediterranean ketogenic diet cookbook, I don't pocket any of the money. My co-author and keto chef Martina Slariova and I split royalties 50/50, and all my royalties either go to charity or efforts to support metabolic health education. And hers I think go to support the health and growth of her new two adorable twins. So if you decide to get it, you're supporting good causes either way. Anyway, this preface has now been long enough that you're basically intermittent fasting anyway. So let's get started before you get too hungry. Alright, 4 musts to prepare for your ketogenic lifestyle journey. The key to success with any new lifestyle is preparation. Yes, it's true, change always takes willpower. It's not easy. But your goal should be to minimize your need to exert willpower and maximize your motivational factors. So here's how you do that. First, it's critical to construct your environment to support your new way of eating. That means, first and foremost, getting rid of sugar and processed carbs and temptations from your living spaces. I realize this might not be feasible for everyone, especially if you have family members or roommates who don't eat low carb. But as much as possible, purge your environment of temptation. This will really make it easier to transition. And over the long term, you might actually find your cravings and urges go away. I know they did for me. Next, it's important to find a community to support you. Honestly, the hardest part about a ketogenic lifestyle is not missing carbs, but the social element. So find an accountability buddy or support group. Online communities like Facebook groups, Twitter—I guess it's now X—or even the comments section of this video are great for that. But in the modern food and social environment, where there's still a stigma on not eating carbs, and saying no to sugar pushers, there is a risk of feeling like a social pariah when you go keto. Please be mindful of that and know who your supporters are and who your cheerleaders will be. Next, it's important to prepare your diet plan. Know what your general meal plan will look like. For a ketogenic diet, it's good to be aware of the carb contents of foods you commonly eat and have your go-to foods on hand and shopping lists at the ready. This next portion of the video where I talk about my 9 favorite medi-keto foods will hopefully help with that. And finally, 4, this one isn't a true must, but I strongly recommend you get a meter to track your blood ketones and/or your blood glucose because there are hidden carbs everywhere. As just one example, my friend Dave's dad tried to go keto but noticed his glucose was actually spiking upon eating scrambled eggs of all things, which should be zero carb, at a particular famous food chain. And lo and behold, it turns out they put pancake batter in their scrambled egg mix. Kinda stunning, right? Well, tools like ketone blood meters and continuous glucose meters are great ways to provide an honest check of how you're doing and adjust your protocol along the way. If you want to check out Keto Mojo for blood ketone meters and Levels for continuous glucose monitors, those are brands with which I'm well acquainted. I know the founders of Keto-Mojo and really trust them, they're great people, although I don't have an affiliate link, I'll still drop a link to their product below. And for Levels, I can offer you an affiliate link with a discount if you check out the link in the video notes. But with that, moving on, here are my 9 favorite medi-keto foods. And I'm just going to blaze through most of these to respect your time, but I'll link to much, much more information on I'll link to each of these in the video notes for those who want a deeper dive. So, let's begin. Number 1: Fatty fish. Fatty fish are a great source of protein, healthy fats, and micronutrients to support muscle growth, brain health, healthspan, and even longevity. Check out this video for more. Remember the acronym SMASH for salmon, mackerel, anchovies, sardine, and herring. For salmon, I give the edge to wild Alaskan sockeye salmon. And for sardines, I suggest getting whole sardines, with skin and bone if you can stomach it, packaged in BPA-free tins with water or brine rather than with oil, which can oxidize in the cans. My go-to is Wild Planet, although for taste, there's one high-end brand from Maine in olive oil that is insanely delicious and definitely worth a try. At least once. Alright, 2. Extra virgin olive oil. If I were to do a video on all the health benefits of a good, true extra virgin olive oil, it would be longer than the entire Lord of the Rings saga. But practically speaking, what you need to know is how to pick a real extra virgin olive oil, as many bottles labeled "extra virgin" aren't actually extra virgin and aren't as healthy. So my top 3 tips for choosing the real extra virgin olive oil are first, 1. Look for a dark glass or metal bottle, not plastic or clear. 2. Look for a pressed or harvest date within the last 2 years. 3. Look for a bottle that is transparent about where the olives come from, ideally from a single source. Picking a good extra virgin olive oil is kind of like online dating. You want to watch out for fakes, check for transparency, and if the story is shady, swipe left. And if you want more, I have a video literally dedicated to picking a good extra virgin olive oil. Here, and the link is in the video notes. Okay, food 3: macadamia nuts. The king of nuts. Macadamia are the lowest-carb nut, super versatile, with an amazing fat profile. They're even higher in monounsaturated fat, or MUFA for short, than olive oil, and rich in the rare omega-7 fat palmitoleic acid, which has an impressive array of health benefits. You can learn more about those in this video. Now, macadamia do have a reputation for being expensive, but they don't need to be. I've been eating House of Macadamia based nuts for about 6 years, and if you want to buy their kilogram bag of raw nuts, and yes, using my discount code NICK15, it's only 84 cents per serving. And I love using their macadamia oil for cooking, for my fish, my steaks, and my eggs, and making homemade mayo. One of my favorites. The recipe for that is below. Okay, moving on. 4. Avocado. Everyone's favorite keto fruit. It's high in monounsaturated fat, fiber if that's a goal for you, and great for dips, salads, or just to snack on on its own. My mother's favorite meal is an avocado salad with fried halloumi cheese. Alright, 5. Dark chocolate. Food of the gods. Yes indeed, dark chocolate is healthy. It's good for the heart, it's good for the brain, and it's good for the tongue too. But there's a catch. It needs to be real dark chocolate, not some 60% dark chocolate truffle. I take dark chocolate to be 85% and above. I know, kind of hardcore. You can check out the video notes for more on chocolate science, and I'll list some of my favorite brands as well, with which I have no affiliation. And if you're in the United States, my number 1 brand is Teza, specifically Teza Wicked Dark, which is stone ground, low in heavy metals, and comes in a few awesome flavors. My number 1 favorite is 95% Wicked Dark with ginger. Super delicious. Let me know if you buy it and if you like it. Okay, 6, sesame. Sesame and sesame products, in particular tahini, are great for adding texture to foods like seafood and as dressings, like a garlic anchovy tahini dressing for roast zucchini or eggplants or fish. Sesame is packed with healthy fats. In fact, sesame oil might be particularly ketogenic for reasons related to the high polyunsaturated fat profile and possibly particular lignan compounds found in the sesame. I personally find sesame oil is among the most ketogenic fat sources for me. I can get my levels up to 6 millimole in 20 hours using sesame oil. For more on the technicalities of how ketosis works in sesame, please check out this video, although it does get quite nuanced. Alright, 7. Eggs. I don't love the word superfood, but eggs are about as close as it comes. The cholesterol in eggs tends not to raise cholesterol in most people because of a hormone called cholecin that your gut produces when you eat more cholesterol, as in egg yolks, which really puts the brakes on your liver making more cholesterol. This is one way your body achieves balance. And as you may or may not know, I even did a kind of famous stunt where I ate 720 eggs in a month and it didn't increase my cholesterol even a smidge. Thanks, Kolihsan. Kind of wild, I know, and it might be a "don't do this at home" sort of experiment, but it's still not my craziest. I've done some wild things. Alright, 8. Low-carb fermented foods. In the universe of vegetables, fermented foods are top-notch. They can improve microbiome diversity and reduce inflammation throughout the body. Fermented foods can also increase levels of certain signaling molecules that activate receptors throughout the body, like the hydroxy carboxylic acid receptors, HCA receptors, which may improve immune function, help reduce visceral fat, and may even improve bone density. Now, the science of fermented foods, it's exploding, and I would really encourage you to check out this video all about new fermented food science where I go over a recent review in Cell Metabolism published out of Stanford. It's really a video not to be missed. But my top 3 fermented foods are natto, kimchi, and sauerkraut, and also goat milk kefir if you want a quick list of 4. Finally, 9, manchego Manchego and Roquefort cheeses. If I had to pick just two amazing cheeses that fit with a Mediketo lifestyle, they'd be Manchego and Roquefort. Manchego is made in the La Mancha region of Spain and has a firm, compact consistency and a buttery texture. It's really amazing for straight-up snacking, grating over salads, and for making my favorite dressing of all time, a homemade Caesar, the recipe for which I'll put in the video notes. It's absolutely incredible. It's also high in protein and calcium, like many hard cheeses. And Roquefort is the king of cheeses, an amazing French blue cheese that's anti-inflammatory, good for gut health, and goes well with nuts or bacon. And on which I have a whole video devoted. I really love Roquefort. So go there to learn more. But I will warn you, I do churn out a lot of Muenster puns, so you feta be prepared to yell "how dare he." Alright, now getting to the last part of our video, common questions and answers. First question: What about your cholesterol on a ketogenic diet? Now, most people who go low-carb or keto actually do not see lasting increases in cholesterol or LDL cholesterol more specifically. Interestingly, it's actually the lean insulin-sensitive people who tend to see increases in cholesterol and LDL cholesterol. Colleagues and I have actually shown in multiple studies, including a meta-analysis of 41 human randomized controlled trials, that people that are overweight or with obesity tend not to see increases in cholesterol or LDL cholesterol. So if you're starting with excess weight or have prediabetes or diabetes, This is probably a way of eating keto that is far less likely to increase your cholesterol, LDL, or ApoB numbers, and is far more likely to improve your overall cardiovascular risk profile. Yes, keto can be very good for heart health. That said, if you are lean, insulin sensitive, and active, then you might see increases in cholesterol. We're currently studying this and what it really means in terms of heart health. Alright, question 2: What about the keto flu? Some people develop fatigue and headaches when they start a ketogenic diet. To be clear, this keto flu isn't actually a flu. It's kinda just your body throwing a tantrum because you took away its sugar. Kinda like a toddler who just heard "no" at the toy store. Ehh! Throwing a tantrum. Anyway, the most common reason for this keto flu is a temporary imbalance in electrolytes as your body adjusts. Therefore, do not be afraid to salt your food liberally. Many people use a Himalayan pink salt or Redmond's Real Salt. You can also mix in some low salt which is really rich in potassium if that's a concern. It's generally recommended to get 3.5 grams or more of potassium daily, which you can get from foods like salmon, zucchini, and avocado, all very keto-friendly, and also you can supplement with low salt. That's what I do on occasion, and actually I kind of like the taste, although it is an acquired taste. You can also use electrolyte packs if you'd like. My favorite is Salt brand from Keto Chow. I like their flavors, and their flavor carrier is acacia gum, which is a low FODMAP, an IBS-safe ingredient, and blood sugar safe. Many people prefer this to maltodextrin, which is in some common other electrolyte mixes. You can see this video for more on a scandal around a common famous electrolyte brand element. And don't worry, this isn't just a gotcha hit video piece, but it was a big scandal at the time, so if you want the details or you like diet drama, you can check that video out too. Alright, question 3: Can I go keto if I don't have a gallbladder? Yes. In a word, yes. The gallbladder doesn't make bile or fat-digesting enzymes, it just stores some. I know many people who are keto happily with no problems without a gallbladder. But you should of course talk to your doctor to help you formulate your new ketogenic lifestyle in a way that will work best for you personally. So I always encourage you to talk with a professional. Okay, 4. Will a ketogenic diet hurt my thyroid? Typically no, this is more or less a big myth. The way to check is by getting a TSH, which stands for thyroid stimulating hormone. Having a TSH that's too high does suggest you're not making enough thyroid hormone. But one tricky matter of interpretation that arises is with respect to the reference ranges on T4 and T3 thyroid hormone, which— T3 is active thyroid hormone— and are based on population studies with people on mixed macronutrient diets, basically those eating carbs. And because thyroid hormone supports carb metabolism, the thyroid demands go down on a ketogenic diet. Therefore, your active thyroid hormone needs can drop on keto, resulting in low T4 or T3 or low free T3, although TSH remains normal. And very importantly, in these cases, generally there are no signs of low thyroid, hypothyroidism, like feeling cold all the time or reduced energy expenditure. In fact, data show that low-carb diets can help maintain energy expenditure and metabolic rate during weight loss, providing another metabolic advantage over other diets when it comes to weight loss. Even when T4 and T3 do drop. Now, some say women have more trouble with keto and fasting, and there are certainly more nuances here. I'm not communicating the whole picture in this quick Q&A. But I think most people do just fine. But if you do feel or experience symptoms of hypothyroidism, especially as a woman, please seek personal medical advice and get more information. Next question: What about fiber? Fiber is a really complex topic. I have a video all about fiber here and linked below which you really should watch, it's an important one. But at a high level, you can design a ketogenic diet to be as high or low fiber as you personally want. Some very high fiber keto foods include avocado, flaxseeds and chia seeds, 90-100% dark chocolate, and leafy greens. It's honestly not even hard to get 30-50 grams of fiber per day on a ketogenic diet even without fiber supplements if you so choose. It's all about personal preference. Finally, question 5: Should I measure my ketone levels? And if so, what should my ketone goals be? I do suggest measuring ketones to start with a blood capillary meter like Keto Mojo, which I went over earlier in this video. I think it really helps troubleshoot and reveals if you're doing the diet right, by which I mean if you're actually getting into ketosis. Aiming for levels between 0.5 millimoles and 4.0 millimoles is a good start. Although, having given that range, the actual number only really matters if you're using it for a specific disease where higher ketones can be therapeutic, like inflammatory bowel disease or a mental health or neurological disorder. Also, values fluctuate a lot throughout the day, so it's important to measure at the same time every day. For example, try measuring 60 minutes after waking up but before eating. You don't want to measure your ketones right upon waking because there's a normal, healthy morning cortisol response that will drop your ketone levels temporarily, so you don't want to hit that valley. And then you can measure, tweak, and find what feels good. And really try to be observant about the connection between your ketone levels, your diet, and your subjective state of well-being. For me, I find slightly higher levels strongly correlate with less GI upset. And for others, higher levels appear to improve mental health. So observe your levels, how they influence or how they're connected to your well-being. You can really gain a lot of insight. Okay, that's more or less all for now. I hope this was helpful. Let me know what other questions you have, and please feel encouraged to go down the rabbit hole in the video notes. I've dropped a ton of resources there. And finally, I hope this is the very beginning of your ketogenic journey or just metabolic health journey, and that I hope you feel welcome to engage with me and our metabolic health community here on this channel and in the comments and in other social media spaces. I do all this because I lived this. I know its impact. And I have devoted the rest of my life to trying to make metabolic health mainstream, which means I want to support you whether this MediKeto approach ends up working for you or not. Stay curious, stay hopeful, you got this. And now I'm going to flash 5 free keto recipes from our MediKeto Diet Cookbook. Again, no pressure to purchase the book at all. But if you do, all my royalties go to charity or supporting metabolic health education, like the things we do here. But I thought I'd share these 5 to hopefully show you how diverse and delicious this lifestyle can be. I hope you feel encouraged. Best of luck.