Mediterranean Paleo Diet

Who Is This For?

• Patients with elevated LDL cholesterol that is not due to metabolic dysfunction (i.e., hypercholesterolemia rather than dyslipidemia)
• Patients with familial hypercholesterolemia (FH), APOE4, or other genetic predispositions that experience an increase in LDL on a low-carb, high-saturated fat diet

Diet Recommendations

Increase intake of whole-food carbohydrates; aim for approximately 25–40 percent of calories, depending upon activity level and carbohydrate tolerance. Carbohydrate choices may include:

• Fruit, starchy plants (e.g., sweet potatoes, potatoes, plantains, yuca, taro, etc.), full-fat dairy, and rice (either white rice or brown rice that has ideally been soaked for at least 18 hours prior to preparation)
• If tolerated: properly prepared grains (e.g., oatmeal, soaked prior to cooking), pseudograins (e.g., amaranth, quinoa, buckwheat, etc.), and legumes (e.g., lentils)

Reduce Saturated Fat Intake

• Favor leaner cuts of red meat, chicken, turkey, and fish over fattier cuts of beef and lamb Fine to eat saturated fat as it naturally occurs in nutrient-dense foods like egg yolks
  Limit added saturated fat (i.e., no Bulletproof coffee, cook with monounsaturated fats like olive, macadamia, or avocado oil rather than coconut oil and ghee)
• Emphasize monounsaturated fats like avocados, olives, nuts, and cold-water fish and shellfish (for long- chain omega-3 fats EPA and DHA)

How to Think About Saturated Fats

No need to limit to specific number of grams; following above guidelines will naturally reduce intake. Once LDL normalizes, you may be able to add more saturated fat (butter, coconut oil, etc.) and fattier cuts of meat without increasing LDL-P.

Example Day of Meals

Breakfast: Two soft-boiled eggs, potatoes roasted in olive oil, and sautéed spinach

Lunch: Poached salmon with white rice or soaked brown rice and green salad with avocado

Dinner: Grass-fed, lean ground beef, sweet potato with olive oil, steamed chard

Food Categories to Focus On

Cold-water fatty fish and shellfish

• Salmon, mackerel, herring, sardines, anchovies, caviar, and bass, as well as shellfish like oysters and mussels

Monounsaturated fat

• Macadamia nuts, avocado, and olive oil

Antioxidant-rich foods

• “Eat the rainbow,” choosing a variety of colors of fruits and vegetables as well as organ meats, meats, eggs, and grass-fed dairy.

Polyphenol-rich foods

• Tea (particularly green tea), blueberries, extra-virgin olive oil, red wine, citrus fruits, hibiscus tea, dark chocolate, coffee, turmeric, and other herbs and spices

Nuts

• Tree nuts, which include almonds, Brazil nuts, cashews, chestnuts, filberts/hazelnuts, macadamia nuts, coconut, pecans, pine nuts (pignoli nuts), pistachios, and walnuts

Fermented foods

• Sauerkraut, kimchi, beet kvaas, kombucha, yogurt, and kefir

Soluble fiber

• Fruits, vegetables (especially starchy tubers), and some grains