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Episode 92: Paleo vs Keto vs Mediterranean. 

Sapna and Danish explain the main differences between three meal plans: Paleo, Keto, and Mediterranean. Intro about fad diets.

Introduction: Fad diets.  
By Hector Arreaza, MD.  

It is estimated that 2/3 of Americans are overweight or have obesity (73% of men and 63% of women), but only 19% of people claim to “be on a diet”, and 77% of people are trying to “eat healthier”[1]. It seems like many of us are on the weight-loss wagon together, hoping for a cure for this disease.

These days it is commonplace to hear about fad diets. Fad diets are short-lived eating patterns that make unrealistic claims about weight loss and improving health, with little to no effort on your part. “The Super-Duper diet will make you lose 100 pounds, eliminate your cellulite, erase stretch marks, remove your wrinkles, and give you extra energy to fly to the moon and back, buy the super-duper diet now!” We surely have a lot of products that make senseless promises, claim many victims, and leave people with empty pockets.   

Today is May 6, 2022. Sapna and Danish will enlighten us again with more nutrition discussions. When you go around your grocery store, have you wondered what “keto-friendly” really means? We hope after today, you get a better idea about it. Today we are presenting a brief discussion to compare three common dietary approaches for weight loss: Keto, Paleo, and Mediterranean. I’m sure you have heard some things about these diets, but we want to add to your fund of knowledge. Whether they are fad diets or not, we’ll let you decide. Enjoy it!  

This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.

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Paleo vs Keto vs Mediterranean. 
Prepared by Sapna Patel, MS4, and Danish Khalid, MS4, Ross University School of Medicine. Comments by Hector Arreaza, MD.

Welcome back to our Nutrition series!

D: In our previous episode, we talked about calorie balance and macronutrients. The basics of nutrition. So, if you haven’t already listened to that, pause this, and go listen to that first. As we will only continue to build on that knowledge. Now, let’s begin…

S: Whether your goals are to lose fat or gain muscle. Nowadays, we’ve got so many ways to achieve our nutritional goals. It can be difficult and overwhelming to know which one is best for you. So today,  we will talk about some of the main “diets'' that are well known to all.

Comment: People hate the word “Diet”, should we call them meal plans or Nutrition plans?

S: The Paleo meal plan. The Ketogenic meal plan. The Mediterranean meal plan. And as we go through each of them, we will compare them and discuss which fit certain nutritional goals.

Comment: These meal plans are very trendy right now, some people call them fad diets, but only time can tell if these diets really work long term or not.  

D: Let’s start with the Paleo meal plan. What is it? Also known as the Paleolithic diet, Caveman diet, or Stone-Age diet, this meal plan revisits the way humans ate almost 2.5 million years ago—The hunter-gatherer lifestyle. Overall, the meal plan is high in protein, moderate in fat (mainly unsaturated fats), low-moderate in carbohydrates (restricting high-glycemic carbohydrates), high in fiber, and low in sodium and refined sugars. It includes mainly lean meats, fish, fruits, vegetables, nuts, and seeds.

Comment: It is low in carbs because carbs were so rare and uncommon in nature before agriculture was introduced to humanity. Animals (including humans) had to wait until the season when the fruit was ripe to enjoy something sweet.

S: So, what are some of the benefits of the Paleo meal plan? Well, studies have shown that the paleo meal plan produces greater short-term benefits, including

-          Greater weight loss

-          Reduced waist circumference

-          Decreased blood pressure

-          Increased insulin sensitivity

-          Improved cholesterol

D: You must be wondering, what’s the catch? Aside from the diminishing long-term effects. Although the meal plan focuses on many essential food groups, it also omits others such as whole grains, dairy, and legumes. This could lead to suboptimal intake of important nutrients. Additionally, the restrictive nature of the meal plan may also make it difficult for people to adhere to such a meal plan in the long run. With these confounding facts, there hasn’t been a strong link that the paleo meal plan improves cardiovascular risk or metabolic disease.

S: Basically, for those looking for a cleaner meal plan, the paleo meal plan is geared towards eliminating high-fat and processed foods that have little nutritional value and too many calories. Moving on to the Ketogenic Meal plan.

D: What is the Ketogenic Meal plan? Basically, the ketogenic meal plan is a high fat, moderate protein, and low carb lifestyle. It’s about creating ketones. For example, beta-hydroxybutyrate, acetoacetate, and acetone. Ketones are basically a fourth macronutrient. Although we don’t find it in our day-to-day food, it’s what our body creates.

So why do we need ketones, and why does our body create them in the first place? Our body uses carbohydrates, more specifically glucose, as the major source of energy for its daily needs. So, imagine, when we are in periods of starvation and deprive ourselves of carbohydrates. The body would resort to breaking down protein to create glucose for our demanding body in a process called gluconeogenesis. That seems illogical, right? Why would our body break down muscle?  That is where ketones come in. While our body is trying to keep up with demands, our liver is working on creating another source of energy. A process called ketogenesis, where ketones are made through fat, more specifically medium-chain fatty acids, to fuel our body.

S: So, what’s so great about the Ketogenic Meal plan? Well, for starters, during ketogenesis due to low blood glucose feedback, the stimulus for insulin secretion becomes low, which sharply reduces the stimulus for fat and glucose storage. Additionally, people will initially experience rapid weight loss up to 10 lbs. in the first 2 weeks or less. Although the first few pounds may be water weight loss due to the diuretic effect of this meal plan, eventually you obtain fat loss.

In this meal plan, lean body muscle is largely spared. So those who are overweight individuals with metabolic syndrome, insulin resistance, and type II diabetes mellitus, are more likely to see improvements in clinical markers for disease risk. Additionally, reducing weight, mainly truncal obesity, may help improve blood pressure, blood glucose regulation, triglyceride levels, and HDL cholesterol.

D: That sounds awesome! What do I have to eat? Well, the dietary macronutrients are divided into approximately 55-60% fats, 30-35% protein, and 5-10% carbohydrates. Specifically, no more than 50 grams of carbohydrates.

Comment: The difference between ketosis and ketoacidosis is a frequent question done by patients and medical providers. The main difference is that in ketosis your glucose level is normal or low and your pH is still physiologic, but in ketoacidosis, the pH is lower than 7.35 and glucose is above 250 mg/dL. So, when a person is in ketosis, you will not see the, for example, Kussmaul’s breathing pattern, but in ketoacidosis, you will see that breathing pattern. If you want more info about the keto meal plan, you can listen to our episode 59, done by a great medical student Constance.  

S: Finally, the Mediterranean meal plan.

The hallmark of this meal plan is simple…minimally processed foods. The main characteristic of a Mediterranean meal plan includes a low-moderate protein intake (very low consumption of red meat, moderate consumption of fish and shellfish), moderate-high fat (rich in unsaturated fats, lower in saturated fats), and moderate to high carbohydrates (legumes, unrefined grains). A very different take from the previous two meal plans.

D: What is the hype all about? Why year after year does the Mediterranean meal plan come out on top? Well, the reason why it’s one of the better options is because of the style of eating. It encourages vegetables and good fats (limiting bad fats) and discriminates against added sugar. No preservation, no packaging, no processing. This style of eating plays a big role in preventing heat disease, and reducing risk factors such as obesity, diabetes, high cholesterol, or high blood pressure.

S: In fact, numerous studies have shown that the Med meal plan promotes weight loss and prevents heart attacks and helps with type 2 diabetes by improving levels of hemoglobin A1c, blood sugar levels, and decreasing insulin resistance. No wonder why out of all these meal plans, it’s the only one that meets the AHA dietary recommendations.

D: In a meta-analysis of randomized trials including the large PREDIMED trial, a Mediterranean meal plan reduced the risk of stroke compared with a low-fat diet (HR 0.60, 95% CI 0.45 to 0.80) but did not reduce the incidence of cardiovascular or overall mortality. By contrast, in observational studies, a Mediterranean meal plan was associated with lower overall mortality and cardiovascular mortality.

Following a Mediterranean meal plan may lead to a reduction in total cholesterol. For example, in a 2011 meta-analysis of six randomized trials comparing the Mediterranean approach with a low-fat diet in 2650 individuals with overweight or obesity, a Mediterranean meal plan led to a greater reduction in total cholesterol (-7.4 mg/dL, 95% CI -10.3 to -4.4) but a nonsignificant reduction in LDL cholesterol (-3.3 mg/dL, 95% CI -7.3 to +0.6 mg/dL [5]. A Mediterranean meal plan may also decrease LDL oxidation.

S: Additionally, in observational studies, a Mediterranean meal plan was also associated with a decreased incidence of Parkinson disease, Alzheimer disease, and cancers, including colorectal, prostate, aerodigestive, oropharyngeal, and breast cancers. 

Comment: I am excited to try the Mediterranean meal plan when I visit Spain this coming summer. It will be my first time in Valencia. 

Keep in mind, with any meal plan, it will work differently for everyone. Just because it worked for an individual doesn’t mean it’ll work for you. And vice versa. Besides, everyone has different goals we want to achieve, like all of us here.

What do you call someone who can't stick with a meal plan?  A deserter.

Conclusion: Now we conclude our episode number 92 “Paleo vs Keto vs Mediterranean.” The take-home messages are: Paleo is a style of eating that encourages unprocessed foods, mainly lean meats, fruits and vegetables in their natural state; Keto consists of eating less than 50 carbs a day and encourages high-fat foods; and the Mediterranean plan promotes good quality fats from vegetable sources, moderate protein and low to moderate carbs. These meal plans have a main goal in common: help your patients lose weight, improve their overall health, and decrease mortality. Even without trying, every night you go to bed being a little wiser.

This week we thank Hector Arreaza, Sapna Patel, Danish Khalid, and Shantal Urrutia. 

Audio edition: Suraj Amrutia. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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References:

Weight Loss Industry Analysis 2020, Cost & Trends, franchisehelp.com, https://www.franchisehelp.com/industry-reports/weight-loss-industry-analysis-2020-cost-trends/. Accessed on May 2, 2022. 

Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2021 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

Taylor B, Rachel M, Adrien B, et al. The Paleo Diet For Health Professionals. In: University of California, Davis - Nutrition. 2018.

Miguel A. Martínez-González, Alfredo Gea and Miguel Ruiz-Canela, originally published on 28 Feb 2019, https://doi.org/10.1161/CIRCRESAHA.118.313348. Circulation Research. 2019;124:779–798.

Gerber, M., & Hoffman, R. (2015). The Mediterranean diet: Health, science and society. British Journal of Nutrition, 113(S2), S4-S10. doi:10.1017/S0007114514003912. 

Colditz, Graham A. “ Healthy Diet in Adults.” UpToDate, 11 Dec 2019, https://www.uptodate.com/contents/healthy-diet-in-adults.

Fitó M, Guxens M, Corella D, Sáez G, Estruch R, de la Torre R, Francés F, Cabezas C, López-Sabater MDC, Marrugat J, García-Arellano A, Arós F, Ruiz-Gutierrez V, Ros E, Salas-Salvadó J, Fiol M, Solá R, Covas MI; PREDIMED Study Investigators. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007 Jun 11;167(11):1195-1203. doi: 10.1001/archinte.167.11.1195. PMID: 17563030.