Now you’ve made the decision to follow the diet, it’s time to choose the type. There are four options. The standard ketogenic diet is the ones that we’ve already looked into, where your diet consists of 70% fat, 25% protein and the rest carbs. You can also follow a high protein option, which cuts your fat intake to 60% and your protein intake up to 35%.
Milk is limited. There are no long-term risks to eating Mediterranean, says Cohen. But you may be put off if you’re big on eating a lot of milk and rely on it to get all the calcium you need. You’ll get to eat cheese and yogurt, but in smaller amounts. "To get enough calcium in the diet without milk, one would need to eat enough yogurt and cheese, or seek nondairy calcium sources," says Cohen. If needed, drink skim milk. Otherwise, nondairy calcium sources include fortified almond milk, sardines, kale, and tofu made with calcium sulfate. (30)
When examining the studies, the researchers noted that, on average, the participants in the VLCKD groups lost about 2 lbs. more of bodyweight compared to the low-fat diet groups.  This difference was statistically significant and described as “moderate”. The researchers also noted greater improvements in triglycerides, blood pressure, and HDL cholesterol in the VLCKD group compared to the low-fat diet group.
In this phase, you may continue to lose 1-2 pounds per week, or it could slow down. If your weight loss slows down, that’s okay! Remember, as you lose weight, your metabolism will slow down a little as well. Your caloric needs will also lower, which means you’ll have to eat less to maintain your deficit. Stick with it. The CDC suggests that people who lose weight gradually and steadily at a rate of 1 to 2 pounds per week are more successful at keeping that weight off.
One thing you’ll find people love about the Mediterranean diet is the allowance of moderate amounts of red wine. “Moderate” means 5 ounces (oz) or less each day for women (one glass) and no more than 10 oz daily for men (two glasses). (1) Above all else, these meals are eaten in the company of friends and family; strong social ties are a cornerstone of healthful lives — and a healthful diet. Here, food is celebrated.
Some negative side effects of a long-term ketogenic diet have been suggested, including increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid (a risk factor for gout). Possible nutrient deficiencies may arise if a variety of recommended foods on the ketogenic diet are not included. It is important to not solely focus on eating high-fat foods, but to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc)—nutrients typically found in foods like whole grains that are restricted from the diet. Because whole food groups are excluded, assistance from a registered dietitian may be beneficial in creating a ketogenic diet that minimizes nutrient deficiencies.
However, the researchers noted that it was still substantial and noted that “Evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to 1 year.”  They emphasized, however, that more research needs to be done to evaluate the long-term effects of the ketogenic diet on weight-loss.
What is surprising is that the one group that had significantly less atherosclerosis than the other two was the group with the lowest levels, by far, of HDL good cholesterol. It was the polyunsaturated-fat-rich group. “Most likely, this group’s higher intake of essential polyunsaturated fatty acids provided some protection against the blood cholesterol-raising effect of their high dietary cholesterol intake,” notes Dr. Tom Rifai, MD, FACP, Founder/CEO, Reality Meets Science® LLC and member of the Pritikin Scientific Advisory Board.
“The eating style with the most impressive evidence to support its health benefits is the Mediterranean diet. However, this is not the American version of the Mediterranean diet, which tends to be heavy on pasta, pizza and meat. Instead, it's the traditional peasant Mediterranean diet, whose followers could not afford refined sugar, processed foods, butter and meats. Instead, they grew and ate their own vegetables and berries, and tended orchards of olives, nuts, and fruits. They fished the seas and rivers for their protein, which was rich in omega-3 fats. They consumed modest amounts of fermented dairy such as yogurt and cheese. Many of them during their largest meal of the day would enjoy a glass of red wine from their own vineyards. This diet and lifestyle has been proven in many large studies to be the healthiest eating pattern in the world; and it helps that it is delicious as well as nutritious.”
You won't need to roam the frozen food aisle or hit a fast-food drive-thru. The focus is on seasonal food that's made in simple, mouth-watering ways. Build a yummy salad from spinach, cucumbers, and tomatoes. Add classic Greek ingredients like black olives and feta cheese with a Quick Light Greek Salad recipe. You can also whip up a colorful, veggie-filled batch of Grilled Tomato Gazpacho.
In 2013, a landmark study of more than 7,000 people in Spain was published. The study’s subjects were split into three groups: those receiving advice about following a Mediterranean diet and getting extra-virgin olive oil delivered to their home; receiving advice about following the Mediterranean diet and getting nuts delivered to their home; and, in the control group, receiving advice about following a low-fat diet.
According to the Centers for Disease Control and Prevention, even modest weight loss — anywhere from 5 to 10 percent of your body weight — can provide huge health benefits including improvements in blood sugar levels, cholesterol, and blood pressure. Furthermore, a study in the National Weight Control Registry cited that participants who maintained significant weight loss reported increased “energy levels, physical mobility, general mood, and self-confidence.” In other words, losing weight on the keto diet won’t just help you look better, it will be better for your overall health, energy, mood, and confidence. Keeping all of this in mind will help you stay motivated on your ketogenic journey.
“Dietary fat is rewarding,” said Dr. Andreas Fritsche, study co-author and nutritional medicine professor at the University Hospital Tübingen in Germany. So rewarding, in fact, that it could be used as an effective dieting tool, though further studies are needed. “If you eat a fat-free aroma extract which is commonly associated with fat, it is possible that you get the rewarding effect of fat-triggered sensations without calories,” Dr. Fritsche said.
Picking through the data, the researchers found that the extra olive oil group did slightly better than the extra nut group, but both were clearly superior to low fat diets. The research was also much more reliable than many diet studies because it was a randomised control trial that looked at a large group of people over a long period of time, rather than just monitoring people on one diet for a few days or weeks.
Fat is a macronutrient with many benefits, one of which is the absorption of fat-soluble vitamins A, D, E and K. It is also a building block of every cell membrane in the body. It provides energy, slows the absorption of other nutrients (so you feel full longer after a meal) and is required for healthy liver function. Plus, let’s face it, fat makes food taste better.
Consuming three tablespoons of EVOO isn’t enough to start shedding the kilos, Flynn says, explaining that the weight-loss effect kicks in when it’s combined with a healthy Mediterranean-style diet. This is rich in vegetables, fruit, legumes and whole grains, moderate in dairy and low in meat (about three serves of white meat or fish a week for women, and red meat only once or twice a month).