The Spanish Ketogenic Mediterranean Diet- Weight Loss, Cardiovascular Health, Blood Sugar Regulation and Cancer Prevention


The global consensus regarding recommendations for carbohydrate and fat consumption is that carbohydrates should form the foundation of a healthy diet and that the best way to lose weight is by cutting back on calories, specifically from fat.

Furthermore, it is generally believed that ketogenic/high fat diets may lead to the development of several diseases (e.g. Cardiovascular,  metabolic and some cancers), whereas the recommended high carbohydrate/low fat diets are the best was to manage or prevent these diseases

Contrary to these beliefs, many studies have found that ketogenic diets are healthier due to their ability to:

  • Preserve muscle mass
  • Suppress appetite
  • Enhance metabolic efficiency
  • Promote thermogenesis
  • Favor fat loss
  • Promote a healthy lipid profile
  • Lower blood pressure
  • Decrease insulin resistance
  • Improve blood levels of glucose and insulin

The Mediterranean Diet

The Mediterranean Diet is associated with a longer lifespan and lower rates of coronary heart disease, certain cancers, hypercholesterolemia, hypertension, diabetes and obesity.

The mediterranean’s health promoting effects are believed to be based on the synergism of health promoting ingredients, such as polyphenols, antioxidants and fiber e.g. olive oil, red wine,  vegetables and fish.

A group of researchers is Spain decided to study the dietary effects of combining A ketogenic and Mediterranean style diet.

The study was carried out on 31 obese subjects (22 male and 19 female) and was called the “Spanish Ketogenic Mediterranean Diet” (SKMD) due to the incorporation of virgin olive oil as the principal source of fat (≥30 ml/day), moderate red wine intake (200–400 ml/day), green vegetables and salads as the main source of carbohydrates and fish as the main source of proteins.

Let Food Be Thy Medicine

Olive oil is a major component of the Mediterranean diet. Numerous studies have demonstrated a favorable relationship between olive oil consumption and a reduction in the major risk factors for cardiovascular disease. These effects are attributed to the monounsaturated fatty acids (MUFAs) and the anti-inflammatory polyphenols, tocopherols, sterols, and triterpenoids. A MUFA-rich diet also prevents central fat redistribution and improves insulin resistance.

Red wine- The combination of ethanol and phenolic compounds in red wine is thought to be responsible for the protective cardiovascular effect. Together with olive oil, red wine antioxidant polyphenols have anti atherogenic properties and can improve haemodynamics (circulation)

Fish (e.g. anchovy, shellfish, salmon, sardine) is high in Omega-3 polyunsaturated fatty acids (n-3 PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega 3 Fatty Acids have been correlated with Low rates of death from coronary heart disease. High omega-3 consumption also increases insulin sensitivity and reduces inflammatory markers

Supplements- Micronutrients (vitamins and minerals) were also given daily to each subjects in the study in the form of a multi-vitamin-mineral supplement and calcium carbonate 1500 mg.  

The following were the results after 12 weeks following the  Spanish Ketogenic Mediterranean Diet (SKMD)

  • Decreased Body weight (108.62 kg→ 94.48 kg)
  • Decreased Body mass index (36.46 kg/m2→31.76 kg/m2)
  • Decreased Systolic blood pressure (125.71 mmHg→109.05 mmHg)
  • Decreased Diastolic blood pressure (84.52 mmHg→ 75.24 mmHg)
  • Decreased Total cholesterol (208.24 mg/dl→186.62 mg/dl),
  • Decreased Triacylglycerols (218.67 mg/dl→113.90 mg/dl: 47.91% reduction)
  • Decreased Glucose (109.81 mg/dl→ 93.33 mg/dl)
  • Decreased LDLc (114.52 mg/dl→105.95 mg/dl)
  • Increased HDLc (50.10 mg/dl→54.57 mg/dl)- “Good Cholesterol”


The SKMD is safe, and effective way of losing weight, promoting non-atherogenic lipid profiles, lowering blood pressure and improving fasting blood glucose levels.

Practical Application

  • A maximum of 30 g of carbohydrates in the form of green vegetables and salad
  • A minimum of 30 ml of virgin olive oil (10 ml per principal meals- breakfast, lunch and dinner))
  • 200–400 ml of red wine (100–200 ml per lunch and dinner)
  • 3 portions (200 g/portion) of vegetables daily: 2 portions of salad vegetables (such as alfalfa sprouts, lettuce, escarole, endive, mushrooms, radicchio, radishes, parsley, peppers, chicory, spinach, cucumber, chard and celery), and 1 portion of low-carbohydrate vegetables (such as broccoli, cauliflower, cabbage, artichoke, eggplant, squash, tomato and onion)
  • Salad dressing: garlic, olive oil, vinegar, lemon juice, salt, herbs and spices
  • Proteins are divided into a “fish block” and “no fish block”. The “fish block” includes all the types of fish except larger, predators (e.g. swordfish and shark). The “no fish block” includes meat, fowl, eggs, shellfish and cheese. Both protein blocks should not be mixed in the same day and should be consumed individually during its day.  At least 4 days of the week should be a  “fish block”.
  • Avoid trans fats (margarines and their derivatives) and processed meats with added sugar
  • No more than two cups of coffee or tea and at least 3 litres of water per day.
  • No artificial sweeteners (saccharin, cyclamate, acesulfame, aspartame and sucralose), juices or non-nutritive fluids

*Focus on food not calories


Joaquín, P. G., Andrés, M. S., & Ángeles, A. M. (2008). Spanish Ketogenic Mediterranean diet: a healthy cardiovascular diet for weight loss. Nutrition Journal.

A note for athletes

This type of diet could be used cyclically for weight management as well as to promote molecular signaling adaptations, however, for competition and performance, the carbohydrates will need to be increased the day before and day of an an event/game

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin