Earlier I mentioned that physical activity, cessation of tobacco use, moderate use of alcohol, longer meal times, and a greater sense of community are all associated with the Mediterranean life. In this chapter I will elaborate on these things and mention a couple of other lifestyle factors that I recommend including with the Ketogenic Mediterranean Diet in order to get the most out of it and of life in general.
I believe that the cessation of use of tobacco products and the moderate use of alcohol (meaning no more than one or two servings per day) are pretty self-explanatory, so we’ll leave those alone. Physical activity, longer mealtimes, stress management, finding a community you feel included in, and getting more (and better) sleep are the lifestyle aspects that warrant a longer discussion and will be covered in this chapter.
Physical Activity
Other than tobacco cessation, regular physical activity is the single best thing you can do for your health. Regularly engaging in moderate to strenuous physical activity is both directly and indirectly associated with every health metric you can think of. It strengthens your bones and reduces the risk of fracture, increases your lung capacity, reduces fat mass while increasing lean body mass, improves concentration and cognition, improves mood and emotional outlook, can alleviate insomnia, and is strongly associated with increased longevity.
I would like to address the idea that physical activity is a weight-loss tool: It is not and should not be thought of that way. I understand that I just said regular physical activity can reduce fat mass and increase lean muscle mass, and that is true. What I mean is that you can’t reasonably out-exercise a poor diet. You would need to walk for five miles or run for almost an hour just to deal with the caloric load of a single 20-ounce soda. That’s not a very good bargain, and it is not realistically sustainable as a means for weight loss.
Even if the math worked out better in our favor for “sweating off the pounds,” there is good evidence that indicates that most people unconsciously participate in what are called “compensatory behaviors” after exercise. Compensatory behavior is the term used for eating a little extra after a workout because you are extra hungry, or taking the elevator when you would normally take the stairs because you went for a run that morning. So, get physical every day, but don’t do it because you think it will help you lose weight. Do it because it will help you live a longer, happier life.
As far as type and amount of physical activity you should be getting, the World Health Organization (WHO) recommends that adults 18 to 64 years old participate in 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity aerobic physical activity per week. Moderate-intensity would be walking at a 15 to 20 minute mile pace, cycling at a 5 to 9 mile per hour pace, mowing the lawn or gardening, yoga, actively playing with children, golfing without a golf cart, Frisbee, Frisbee golf, or many other activities that you could fit into your day. The trick is to be honest with yourself about how often you are participating in these activities and for how long.
WHO also recommends including strength-building physical activity in addition to the 150 minutes of moderate-intensity physical activity per week. Unfortunately, I do not have suggestions for leisure-type activities that build strength, but on the bright side, once you get past the difficulty of building a routine, strength building can become a leisure activity. Weight lifting is not the only way to build lean muscle mass, either. All types of impact activities like running, or any activity that involves vigorous movement like dancing or playing sports, will also build muscle and strengthen bone.
If the idea of getting 150 minutes of physical activity a week seems intimidating to you, try breaking it down into daily increments. 150 divided by 7 is only a little over 21. Surely you could go for a 25-minute walk every day, play with your kids for 25 minutes, or go for a nice bike ride. When you break it down into daily pieces, it does not seem so scary or difficult to fit exercise into your busy day.
Taking that idea even further, you can break your activity into even smaller chunks. Most of us are active and awake for 16 to 18 hours per day. If you are moderately active for 10 minutes three times during those 16 hours, you’ve hit your goal. Go for a walk around your workplace during lunch. Do a sun salutation yoga routine in the morning. Take a nice after-dinner walk. Have three tiny dance parties throughout the day! What I’m trying to say is that getting a decent amount of physical activity does not have to be as daunting as it sounds, and it will make you feel worlds better.
In addition to all of the other benefits of physical activity, it will also help maintain ketosis. Physical exertion will use up more of the available glucose in your blood and prompt your body to break down fat for fuel. This will produce more ketones. It can also be used as a tool to prevent accidentally falling out of ketosis. If you overdo it on the carb load, a moderate amount of physical activity within two hours of the offending meal can effectively use the glucose from that meal up before it has a chance to stimulate insulin release and inhibit ketone production.
Longer Meal Times
This may seem like a strange thing for me to spend time discussing—who cares how long you take to eat your meals, right? Surprisingly, there are many benefits to slowing down with your meal preparation and time. To some degree, you will not have a choice if you follow the spirit and recommendations in this book. The Ketogenic Mediterranean Diet requires you to cook more and have a greater sense of connection with your food. Because most convenience foods are carbohydrate heavy and because you should strive to eat as many whole foods as possible, you really just have to cook. There’s no way around it.
More leisurely meal times and a greater amount of time spent preparing food will necessarily give you a greater sense of connection with your food and with your body. If you slow down, your body will have time to process the signals indicating that you have had enough food, and this will likely lead to eating a little less. This would be beneficial for our collective waistline for sure, but would also be desirable because eating to the point of satiety instead of to the point of fullness would prevent the heaviness and drowsiness that many of us feel after a meal. It would additionally keep your insulin level more even. There are stretch receptors in the lining of the stomach that induce the release of insulin when activated. These stretch receptors are activated by physical pressure on the inner walls of the stomach. If you give yourself enough time to recognize you’ve had enough before you physically fill your stomach, these receptors will not be triggered, and you can avoid the additional insulin dump.
Based on a study by the Organization for Economic Cooperation and Development (OECD), Americans spend the least time preparing and consuming food compared to people from the 34 countries studied. According to this study, we spend only 30 minutes per day on meal preparation (fast food, anyone?) and about one hour and 14 minutes per day actually eating. If you assume that the average American is only eating three times per day, that is just under 25 minutes per meal. It takes roughly 15 to 20 minutes for you to become aware of the signals your stomach is sending to your brain indicating that it is full. If your total meal is only 25 minutes long, there is just no way that you could catch these signals before overdoing it.
Finally, increasing the amount of time that you allow for meals will help with the community aspect of this diet, as well. There are few joys in life equal to sharing the pleasure of a good meal with people you love. To once again borrow from food writer Michael Pollan, “The shared meal elevates eating from a mechanical process of fueling the body to a ritual of family and community, from the mere animal biology to an act of culture.”
Stress Management
Just about every health professional touts the benefits of stress reduction and knows the dangers of too much stress. Of course, the difficulty is that our lives are stressful. We as Americans work long hours, often for too little pay. We do not get as much time off from work as people from most other developed countries do and many of us don’t use the vacation time we have available to us. When you add in bills, kids, commutes, the modern news cycle, health concerns, and the rest, stress management becomes critical.
Much of what we have already discussed will help you manage the stress in your life. Taking control of your eating habits, learning to cook, enjoying more leisurely meals, and getting adequate physical activity will all produce the nice side effect of lowering the impact of the stressors in your life. Improving your sleep habits and finding some sense of community will, of course, help, as well. All aspects of the Ketogenic Mediterranean Diet should help you more effectively manage your stress level.
There are many different approaches to stress management and what works for one person may or may not work for someone else. Many people manage stress through prayer and religious belief. Others turn to family or friends. It is common to use entertainment in the form of television, movies, and games to unwind and de-stress. I personally find that attempting to practice mindfulness helps me deal with the aspects of my life I find to be stressful. The key is to find something that resonates with you.
Community
Carbohydrate restriction is not yet an entirely mainstream pattern of eating. If you think about it, many of the foods we associate with gathering are carbohydrate-based: pizza, beer, chips, and birthday cakes are all carbohydrates. Even the common term for sharing a meal is “breaking bread together.” When following the Ketogenic Mediterranean Diet, you will likely be eating in a different way than most of those around you, and that can feel very isolating. Of course, it does not have to be this way.
First off, many of the foods that are low enough in carbohydrates to be included in the Ketogenic Mediterranean Diet are foods that will not be viewed as strange. Secondly, a polite decline of that piece of pizza or cake does not have to be a big deal. Just say that you are trying to change the way that you eat for the better and that you have a difficult relationship with carbohydrates. Tell your friends and family that though you won’t partake of the birthday cake, you’d still love to share the happy occasion. If you bring the focus back to the occasion, most people will be happy to forget that you are not eating chips or whatever else is being offered. You can also easily prepare foods that are Ketogenic Mediterranean-friendly and still appeal to people eating carbohydrate-based diets. Invite your friends over for a dinner party and cook a meal using any of the recipes you find in Chapter 10.
If you can talk any of your friends or family into changing their eating and lifestyle habits with you, great! Lifestyle changes are much easier to adhere to if you are doing them with someone. You can support each other and hold each other accountable. If, however, you do not have anyone in your life that is interested in making these changes, there is always the Internet. There are many, many ketogenic websites and forums on the Internet. You can find recipes, books, research studies, or just people to chat with on these sites. I’ll include a list of some of the best I have found in Resources on page 98.
Sleep
According to a 2013 Gallup poll, Americans sleep an average of 6.8 hours per night, which is down more than an hour from 1942 and about 40 percent less than is recommended. Getting an inadequate amount of sleep has all sorts of negative health consequences. We cannot focus as well, we do not have as much energy, we do not metabolize foods as well, our systemic stress hormones are higher, we tend to overeat more throughout the day, and we sometimes develop bad hair. OK, I made up the last one, but all of the rest are supported with good science. Sleep deprivation is such a problem in America that the CDC even acknowledges our collective grogginess to be a public health issue.
How much sleep we need varies between individuals, but the amount generally changes as we age. The National Institutes of Health (NIH) suggests that school-age children need at least ten hours of sleep daily, teens need nine to ten hours, and adults need seven to eight hours. If you have trouble getting enough sleep or find your sleep quality to be less than optimal—for example, if you find yourself waking up in the night or waking up in the morning feeling like you have not rested—there are several tips that can help you get more sleep and improve the quality of the sleep you are getting.
First, it is helpful to understand a little bit more about how sleep works. Humans sleep in cycles that are roughly 90 minutes long, with some variation between individuals. There are four stages of sleep that we cycle through, called Stage One, Stage Two, Stage Three, and rapid eye movement (REM). We progress from Stage One through REM and then start over. Stage One and REM are semi-wakeful while Stages Two and Three are deeper, with Stage Three being thought of as “deep sleep.” The closer we are to a deep sleep stage when we are awakened, the groggier we will feel. On the other hand, if we are awakened in an earlier stage, it is more likely that we will feel rested and refreshed.
Because of how these cycles work, it is best to try and sleep in 90-minute increments. The best way to determine when you should go to bed is to pick when you need to be awake and then count backward by multiples of 90. You should shoot for five or six full sleep cycles to feel the most rested. This way, you get either seven and a half or nine hours of sleep, respectively. For example, if you need to get out of bed at 6:30 a.m., you should attempt to be asleep at either 9:30 p.m. or 11:00 p.m. You also need to account for the time it takes you to fall asleep. It takes an average of 14 minutes from the time you lie down and close your eyes to the time you are in Stage One of sleep.
If you, like me, find 14 minutes to be a really silly underestimate (it used to take me anywhere from 30 minutes to 2 hours to fall asleep before I started reading about the science of sleep), there are several easy bedtime tweaks you can perform to make falling asleep easier.
For starters, no more checking Instagram in bed. It is recommended that you actually avoid all screens (TVs, computers, phones, tablets, etc.) for two hours before you want to fall asleep. The particular blue and white wavelengths of light that these devices emit inhibit the release of melatonin, one of the hormones responsible for telling the body it is time for sleep. Electronic reading devices, like the Kindle, only get a pass if they do not emit light. The newer backlit models emit the same sleep-damaging blue-white light.
The habit of checking your phone or watching Netflix right before or even in bed is very hard to break. I found it helpful to move my charger all the way across the room and set my phone so that after a certain time it would silence all notifications, including vibrations, so that I would be less tempted to see what the notification was about.
Related to the above point, be sure your sleeping area is dark. If you want a night light of some kind, purchase one that emits soft amber light. It won’t interfere with your hormone levels the same way that blue-white light will. Also, research has found that cooler temperatures are more conducive to good sleep. Somewhere around 65°F appears to be optimal.
If you are sensitive to caffeine, you should also consider avoiding it after about 2 p.m. This is a general recommendation, so you may need to stop earlier or later. Caffeine has an extremely variable effect depending on the individual; it can be metabolized very slowly and may still be exerting an effect many hours after ingestion in susceptible individuals.
The CDC also recommends trying to go to bed at roughly the same time each night, avoiding large meals close to bedtime, and avoiding nicotine. See, quitting smoking can even help you sleep better!
A final piece of advice for making the lasting lifestyle changes that will allow you to get the maximum benefit from the Ketogenic Mediterranean Diet: Make one change at a time. Research indicates that individuals actually have a finite amount of willpower at their disposal and that every day is a zero-sum game. If you spend some willpower on avoiding that sugar-laden latte that you are used to in the morning, you will literally have less willpower to spend on your workout later in the day. Make one change at a time and give it a week or two to become a habit before embarking on your next change.
Now, onto the exciting part: recipes!