Quick Summary tl;dr

 New study shows that LDL cholesterol elevation on a low-carb diet is associated with leanness and metabolic health (low triglyceride to HDL ratio).

Those individuals with the most extreme low-carb lipid triad (LDL ≥ 200, HDL ≥80, TG ≤ 70) are termed “Lean Mass Hyper-Responders and, true to their name, they were significantly leaner than other participants.

Moderate reintroduction of carbohydrate (50 - 100 grams) on very low-carb diets markedly lowers LDL in Lean Mass Hyper-Responders.

To quote my colleague, Dr. Adrian Soto-Mota, MD PhD, “This study is intended to start a discussion, not end one.”

The final version of the Lean Mass Hyper-Responder (LMHR) paper was just released!

I’m pleased to report that, even in the early days since the initial release of the unedited accepted manuscript (on November 30, 2021), this paper has stimulated vigorous discussion, risen to the top of its journal for all time reads, and is among the top 15 trending papers across all American Society of Nutrition associated journals for the year 2021. So, what’s all the fuss about? This blog is intended to get you up to speed so you can be part of the discussion and follow this exciting line of biomedical research as the conversation continues to heat up.

Lean Mass Hyper Responders, a History

Let’s start at the beginning. In 2017, a software engineer, Dave Feldman, made a curious observation: the people who adopted carbohydrate restricted diets who typically exhibited the most pronounced increases of LDL cholesterol (so-called “bad cholesterol”) were often very lean and/or athletic.

But the elevations in LDL exhibited by these lean persons on low-carb diets had two peculiar features that set it apart from other forms of high LDL:

Extreme LDL Increases

First, the LDL increases were much larger than those typically associated with living an unhealthy lifestyle. When most doctors think about high LDL related to being unhealthy and eating a poor diet, they think about levels in the high 100s. But lean people on carbohydrate restricted diets were anecdotally observing LDL levels of 200, 300, 400, and even 500 mg/dL or more.

In fact, some LMHRs exhibit LDL levels as high as persons with homozygous familial hypercholesterolemia, a rare and devastating genetic condition (1 in 1,000,000) that likewise associates with very early heart disease.

Very High HDL and Very Low Triglycerides

Second, when lean people do see increases in LDL on a carbohydrate restricted diets, they tend to be accompanied by high HDL (so-called "good cholesterol") and low triglycerides (TG), fat in the blood. This pattern of high HDL and low TG is exactly opposite the profile of “atherogenic dyslipidemia,” which is defined by low HDL and high TG, and is, at present, the predominant risk factor for cardiovascular disease ( Libby, 2021).

Simply put, when lean people on low-carbohydrate diets saw increases in LDL they were quite often in the context of otherwise excellent metabolic health markers. Therefore, Dave created a set of three cut points that combine to define what would become the LMHR phenotype:

  • LDL cholesterol ≥ 200 mg/dL
  • HDL cholesterol ≥ 80 mg/dL
  • TG cholesterol ≤ 70 mg/dL

Now for a couple comments on the definition of LMHR. First, why these cut points? Well, in addition to approximating threshold levels Dave Feldman was empirically observing in the world around him for lean athletic people who went low-carb, these triad of cut-points were chosen for just how extreme they are.

To meet someone with LDL ≥ 200 is rare. To meet someone with HDL ≥ 80 is rare, and to meet someone with TG ≤ 70 is rare. Thus, the probability of meeting someone who meets all the cut points by chance is highly unlikely. Otherwise put, if someone presents with this triad, it seems reasonable to hypothesize that the markers are associated with each other.

Other important point is that LMHR are only defined by this triad, and NOT by any measure of leanness. This is confusing because “lean” is in the name of the phenotype, but that’s only because the triad — at least in Dave’s point of view in 2017 – tended to occur in people who were lean and/or athletic. In other words, the name LMHR is the hypothesis — that this triad presents in lean people who go low-carb.

Study Suggests That LMHR Exist

Being Leaner & Having Lower TG/HDL Predicts Larger LDL Increases on a Low-Carb Diet

It was a long time coming, but we finally put that hypothesis to the test in a scientific study.

In this new study, published in Current Developments in Nutrition, we collected survey data from people who were low-carb, who were not on statins, and who had lipid data from before they started their low-carb diet as well as recent lipid data from on their low-carb diet.

Then, rather than massaging the numbers to conform to our hypothesis, we engaged in a “hypothesis-naïve exploratory analysis” in which we took all the data we had on respondents — including age, sex, BMI, and current and pre-low carb LDL, HDL, and TG levels — and asked a computer to tell us which factors were most strongly and reliably associated with increases in LDL after starting a low-carb diet.

The results were clear. No matter how we approached the question (be it multivariate linear regressions or hypothesis-naïve computer-generated decision trees [Supplemental Figure 3]) we found that having lower BMI and a lower TG/HDL ratio associated with larger increases in LDL.

Hypothesis-naïve exploratory analysis finds that having lower BMI and a lower TG/HDL ratio associates with larger increases in LDL on a low-carbohydrate diet.

The relationship can be clearly seen in the bar graph below. The further you go to the left, the lower the BMI. The further you go to the back, the lower the pre-diet TG/HDL ratio. And the height of the bar is the median increase in LDL.

Picking Out the LMHR

After establishing that those who are leaner with lower TG/HDL ratios exhibited larger increases in LDL with carbohydrate restriction, it made sense to try to separate the true LMHR (those who met all three cut-points) from the larger cohort and see how different they really were…

Of the 548 participants that met the inclusion criteria, 100 were bona fide LMHR (which is a lot, considering many people don’t believe LMHR exist). And, true to their name, they were Lean!

The average BMI of a LMHR was 22.0, as compared to 24.6 for the rest of the low-carb sample in this study (between group p = 1.2 x 10-10). Furthermore, LMHR exhibited higher LDL, higher HDL, and lower TG, with mean values of 320, 99, and 47 mg/dL respectively.

And, importantly, LMHR did not differ in terms of their pre-diet LDL when compared to the non-LMHR population. In fact, median pre-diet LDL was 135 mg/dL in non-LMHR and 133 mg/dL in LMHR. No difference!

In the Lean Mass Hyper-Responders (LMHR) paper, the average LDL, HDL, and TG of LMHR were 320, 99, and 47 mg/dL on low-carb, respectively. This was despite normal pre-diet LDL levels.

A LMHR Case Report Shows the Phenotype is Reversible

Now, you’ve probably sensed a lot of enthusiasm from me, but don’t mistake intellectual excitement about a fascinating observation for a suggestion that high LDL levels in LMHR are benign.

Setting my own hypotheses aside, we do not yet know if the risk associated with high LDL is any different in the context of LMHR as compared to any other context. And most experts would agree that high LDL is dangerous, regardless of cause.

This very question — is high LDL harmful in LMHR? — is currently being assessed in a prospective study (data from which are expected to drop in 2023). And I will be vocal about the data when they emerge, whatever they say.

Nevertheless, for the time being, many or most LMHR patients and their doctors are concerned about their high LDL. That said, many of those same people find a low-carb way of life to be tremendously beneficial for their various metabolic disorders. This begs the question, can you “fix” the LDL problem (perceived or true) through lifestyle? The answer, yes — at least partially.

As part of this study, we also wrote up a case series of five patients who were LMHR or near-LMHR. These patients all exhibited extraordinary increases in LDL upon starting a ketogenic diet. And, importantly, all were tested for genetic mutations associated with high LDL and all tested negative, supporting the notion that being a LMHR is not a genetic condition but a metabolic phenomenon.

One patient saw his LDL increase from 116 to 665 mg/dL (no surprise, he was the leanest).

All of the patients refused, or were intolerant of, statins and instead opted to reintroduce a moderate amount of carbohydrate, ~50 – 100 grams, in order to transition from a very low-carb ketogenic diet to a diet that was still low-carb (<130 grams net carbs per day).

Impressively, all participants saw their LDL drop by at least 100 mg/dL, with larger drops occurring on those with high levels. The patient who saw his LDL increase to 665 mg/dL exhibited a 480 mg/dL drop in LDL by doing nothing more than adding about a small, sweet potato’s worth of carbs per day.

Stop and think about that for a second. In this context, a sweet potato per day could drop LDL by almost 500 mg/dL!

Future Directions

This is only step one, putting the LMHR phenomenon on the map. This paper suggests that LMHR are real and, if I do say so myself, really interesting!

In my opinion, no true student of health and/or medicine can observe this phenomenon and not be intrigued.

But what this paper does not do is explain the “how.” It likewise can’t evaluate the risk. Those are the subjects of upcoming projects.

  • We are working on formulating an official “Lipid Energy Model” manuscript, explaining the potential mechanisms at work behind the findings of this paper.
  • We are compiling some preliminary patient data as case series to provide clinical vignettes of this LMHR phenotype.
  • And, a LMHR responder study also recently launched out of ULCA, courtesy of Dave’s efforts, that will track plaque progression in the coronary arteries of 100 LMHRs.

This paper was just the first domino...

Additional Notes

  • This paper describes a phenomenon. It does not explain the mechanism nor comment on risk.

  • Saturated fat intake was not measured; however, it seems highly unlikely variations in saturated fat intake can explain the findings as this would assume that, across the study sample of 548 people, lean people and those with good metabolic health preferentially and reliably consumed more saturated fat.

  • The phenomenon is likely metabolic, not genetic. This is supported by at least three lines of evidence in this study:

    • LMHR have normal pre-low carb LDL levels. In fact, in the study, pre-diet LDL levels were the same between LMHR and non-LMHR.
    • It’s been anecdotally observed that LMHR who gain weight exhibit drops in LDL, despite no change in their genetics.
    • Most importantly, genetic testing in the five patients in the case series were negative. Genetic testing performed on other subjects not reported in this study have also been negative.
    • This does not rule out a polygenetic contribution or gene-environment interaction.

If you found this blog interesting and/or you think this line of research is important, my team and I would appreciate if you go directly to the paper, download it, and try to give it a read. Downloads really help the article metrics and will help to further amplify the discussion around this important phenomenon.

For a list of selected podcasts, videos, and media releases that cover this paper, please see the links below (Updated January 28, 2022):

Podcasts:

YouTube

Other Media:



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Support for the Existence of Lean Mass Hyper-Responders

This is the easiest ever Keto Pigs in Blanket recipe (or mini sausage rolls as we call them in the UK).

You only need 3 ingredients — sausages, mozzarella and almond flour (our simplified fat head dough). Plus we are using herbed butter to add extra flavor.

These piggies are the perfect bite-sized snack for any dinner party, game night or the next Super Bowl. Everyone will love them!

You can serve these sausage bites as they are, warm or cold, with mustard, sugar-free ketchup or pizza sauce.

Can't Eat Nuts? Use Our Super Simple Nut-Free Dough!

You can easily convert this recipe by adding 2 oz (57 g) of full-fat cream cheese in the shredded mozzarella before microwaving it, and then swapping the almond flour for either 6 tablespoons (48 g/1.7 oz) of coconut flour or 8 tablespoons (57 g/2 oz) of flax meal. Tried and tested!

Preparation time

Hands-on:    10 minutes
Overall:     20 - 25 minutes

Nutritional values (per serving, 2 pigs in blanket)

Total Carbs 4.2 grams
Fiber 1.2 grams
Net Carbs 3.1 grams
Protein 15.5 grams
Fat 25.4 grams
of which Saturated 10 grams
Energy 301 kcal
Magnesium 38 mg (10% RDA)
Potassium 131 mg (7% EMR)

Macronutrient ratio: Calories from carbs (4%), protein (21%), fat (75%)

Ingredients (makes 6 servings)

  • 6 small hot dog sausages or 12 cocktail weiners (250 g/ 8.8 oz)
  • 1 1/2 cups shredded low-moisture mozzarella (170 g/ 6 oz)
  • 2/3 cup almond flour (66 g/ 2.3 oz)
  • 2 tbsp melted butter (30 ml)
  • 1/2 tsp dried Italian herbs
  • 1/4 tsp garlic powder
  • 1/4 tsp onion powder
  • mustard, sugar-free ketchup or Marinara Sauce to serve

Instructions

  1. Cut the sausages in half. You can also use whole cocktail weiners.
  2. Preheat the oven to 180 °C/ 355 °F (conventional), or 160 °C/ 320 °F (fan assisted). Make the dough by melting the mozzarella in a microwave for 60 - 80 seconds. (If you don't have a microwave, you can also melt the mozzarella in the oven. It should be just softened, not crisped up or browned, for 1 to 2 minutes.)
  3. Add the almond flour and mix to combine to make a dough. You may need to get your hands involved here!
  4. Roll the dough between 2 sheets of greaseproof paper or one sheet and a silicone mat. Fold it over to create a long 45 to 50 cm (18 to 20 inch) stripe of thinly rolled out dough.
  5. Using a sharp knife, cut the dough in quarters, and then cut each quarter into 3 equal slices.
  6. In a small bowl, mix the melted butter with Italian herbs, garlic powder and onion powder. Brush each slice with the flavored butter and then add the sausage. Wrap the dough around tightly and pinch to close. Brush any leftover butter on top.
  7. Place on a balking tray, seam side down. Bake for 15 to 20 minutes.
  8. Remove from the oven and set aside to cool down slightly.
  9. Enjoy warm or store in the fridge, once fully cooled, for up to 3 days. Serve with more mustard, sugar-free ketchup or pizza sauce. You can make your own mustard, sugar-free ketchup and Marinara Sauce.


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Easy Keto Pigs in Blanket

Making muffins in a blender is so easy! This recipe is based on my Keto Vanilla Blender Muffins but without coconut flour and with the addition of pumpkin puree, pumpkin pie spice and chocolate chips.

These keto muffins are made in a blender producing very smooth batter that will produce fluffy muffins with a delicious crust on top. And don't skip the protein powder, it will replace the missing gluten! Although there are 5 eggs to make 12 muffins, these muffins do not taste eggy at all. You need all those eggs to make these muffins fluffy!

You can enjoy these muffins for breakfast with a cup of tea, coffee or Hot Mocha, and or as an after-dinner treat.

Preparation time

Hands-on:    10 minutes
Overall:     30 minutes

Nutritional values (per muffin)

Total Carbs 7 grams
Fiber 2.8 grams
Net Carbs 4.2 grams
Protein 10.3 grams
Fat 17.6 grams
of which Saturated 5.2 grams
Energy 216 kcal
Magnesium 65 mg (16% RDA)
Potassium 282 mg (14% EMR)

Macronutrient ratio: Calories from carbs (8%), protein (19%), fat (73%)

Ingredients (makes 12 muffins)

Instructions

  1. Preheat the oven to 160 °C/ 320 °F (fan assisted), or 180 °C/ 355 °F (conventional). Measure out all of the dry ingredients. Place the butter in a sauce pan (or microwave) to melt.
  2. Add all the wet muffin ingredients to a blender, and then add the dry ingredients. Turn the blender on to the lowest speed, and once starting to combine, increase to medium speed and process until smooth.
  3. Line a medium muffin pan with paper muffin cups and brush each one with a small amount of coconut oil or melted ghee. (Or use a silicon muffin pan which doesn't require any lining or greasing.)
  4. Fill the muffin cups with the batter, leaving a small gap on top. Add chocolate chips (or chopped chocolate) on top of each and use the other side of a teaspoon to stir in. Place in the oven and bake for 20 to 25 minutes, turning the pan half way to ensure even cooking and browning on top.
  5. The muffins should be lightly browned on top and cooked through (you can use a wooden stick to test for doneness).
  6. Let them cool down before serving. Store in an airtight container for up to four days or freeze for up to 3 months.


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Keto Pumpkin Chocolate Chip Blender Muffins

I adore this chicken liver pate! It's one of the most flavorful recipes I've ever made and I tested and fine-tuned it for maximum flavor and creaminess.

The perfect balance of flavors come from lightly caramelized onion with fragrant garlic, fresh herbs such as sage, thyme and/or rosemary, bay leaf, allspice, nutmeg, butter and brandy. We're using chicken livers which have a mild flavor. You can also use turkey livers which are just as mild, creamy and delicious.

This pate will be a favorite on any party dinner table served alongside crunchy vegetables such as endive leaves, carrots, bell peppers and cucumbers, or as a dip with Keto Crackers. You can also serve this low-carb pate on hot buttered toast made from our Quick Keto Bread or Quick Keto White Bread.

Preparation time

Hands-on:    30 minutes
Overall:     2 hours 30 minutes

Nutritional values (per serving, 2 heaped tbsp/ 45 g/ 1.6 oz)

Total Carbs 0.8 grams
Fiber 0.1 grams
Net Carbs 0.7 grams
Protein 5.1 grams
Fat 18.8 grams
of which Saturated 11.3 grams
Energy 195 kcal
Magnesium 6 mg (2% RDA)
Potassium 81 mg (4% EMR)

Macronutrient ratio: Calories from carbs (1%), protein (11%), fat (88%)

Ingredients (makes 600 g/ 1.3 oz)

  • 400 g chicken or turkey livers (14.1 oz)
  • 1 small red onion, diced (60 g/ 2.1 oz)
  • 2 cloves garlic, minced
  • 1 tbsp chopped herbs such as rosemary, thyme and/or sage
  • 1 bay leaf
  • 300 g unsalted butter (10.6 oz)
  • 1 tsp sea salt, or to taste
  • 1/2 tsp black pepper, or to taste
  • 1/4 tsp allspice
  • 1/4 tsp nutmeg
  • 2 tbsp brandy or whiskey (30 ml)
  • melted ghee for topping to seal

Instructions

  1. Trim the chicken livers - remove any sinew. Chop the onion and mince the garlic.
  2. Melt about 3 tablespoons of the butter in frying pan. Add onion and sauté gently until fragrant, for 3 to 5 minutes. Add garlic and chopped herbs (rosemary, thyme and/or sage) and chopped bay leaf. Cook for one more minute.
  3. Place livers in pan and cook over a gentle heat until cooked. You want the livers to be just slightly pink in the centre but without any fluids seeping out. You will get juices in the pan, but this is normal, just make sure that they’re not oozing out of the livers. Don't overcook them or they'll be grey and the texture will be grainy instead of smooth and creamy.
  4. Once cooked, remove from heat and sit aside to cool. Transfer the mixture to a food processor together with the remaining butter, salt and pepper, allspice, nutmeg and brandy (or whiskey).
  5. Blitz until smooth and creamy. Taste and season more if needed.
  6. Transfer into small storage jars (we're using 120 ml/ 4 oz capacity fido jars) that can be sealed and use a spatula to level. Use a tissue to wipe any pate off the sides and then pour about 2 tablespoons of melted ghee on top of each. Optionally, add a sprig of thyme, rosemary or a sage leaf on top in the melted ghee.
  7. Refrigerate for about 2 hours to firm the pate up before serving. You can also add a layer of melted ghee to seal the top. This will keep the pate fresh for longer. Remove from the fridge 15-20 minutes before serving.
    Note: You won't be eating the ghee topping but it will keep the pate fresh for longer which you need to do when making a larger batch of pate. Do not use melted butter as it won't last for as long as ghee.
  8. Store sealed in the refrigerator for up to a week. Can also be frozen. Serve with crispy vegetables such as endive leaves, carrots, bell peppers and cucumbers, or as a dip with Keto Crackers. You can also spread this pate on a slice of our Quick Keto Bread!


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French Chicken Liver Pate

This recipe combines the flavors of a classic Bloody Mary cocktail with Shakshuka. It's my tasty twist on one of my absolute favorite breakfast meals that works just as well for lunch and dinner!

We've got sweet tomatoes, crisp-tender celery, mushrooms for bulk and extra nutrition, Worcestershire sauce for umami and lemon juice for zing. You can optionally add a few drops of Tabasco for extra heat.

Top tip: Use duck eggs instead of chicken eggs for extra protein and much bigger egg yolks. Enjoy!

Preparation time

Hands-on:    10 minutes
Overall:     30 minutes

Nutritional values (per serving, 2 eggs + veggies)

Total Carbs 15.5 grams
Fiber 5.9 grams
Net Carbs 9.6 grams
Protein 16.5 grams
Fat 30.6 grams
of which Saturated 6 grams
Energy 393 kcal
Magnesium 47 mg (12% RDA)
Potassium 918 mg (46% EMR)

Macronutrient ratio: Calories from carbs (10%), protein (17%), fat (73%)

Ingredients (makes 2 servings)

  • 3 tbsp extra virgin olive oil or avocado oil (45 ml)
  • 1/2 red onion, chopped or sliced (30 g/ 1.1 oz)
  • 2 cloves garlic, minced
  • 100 g oyster mushrooms, sliced (3.5 oz)
  • 2 celery sticks, sliced (80 g/ 2.7 oz)
  • 1 can tomatoes (400 g/ 14.1 oz)
  • 2 tsp fresh lemon juice
  • 2 tsp Worcestershire sauce
  • good pinch of sea salt and black pepper
  • 4 large eggs
  • Optional: fresh herbs such as parsley or celery leaves
  • Optional: few drops of Tabasco sauce for heat

Instructions

  1. Slice the onion, mushrooms and celery. Mince the garlic. (You can use oyster, white or brown mushrooms.)
  2. Heat a skillet greased with olive oil (or avocado oil) over a medium-high heat. Add the onion and cook for 3 minutes.
  3. Add the garlic, mushrooms and celery. Cook for about 5 minutes.
  4. Add the tomatoes, lemon juice, Worcestershire sauce and season with salt and pepper. Bring to a simmer and cover with a lid. Reduce the heat to medium-low and cook for about 10 minutes, or until the celery is crisp tender.
  5. Using a spatula, create 4 small wells. Crack one egg into each one of them. (It's better if you crack the eggs one by one into a small bowl rather than directly into the skillet as you don't want any egg shells of bad eggs.)
  6. Reduce the heat to medium and cook until the whites are opaque and the yolks are still runny. You can cover it with a lid to speed it up or place it under a broiler and cook for a few minutes.
  7. Remove the lid and optionally, sprinkle with fresh herbs such as parsley or celery leaves. You can also add a few drops of Tabasco for extra heat. Serve immediately while still warm.


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Bloody Mary Veggie Shakshuka

Love Reese's peanut butter cups? Then you'll love these healthy sugar-free peanut butter & milk chocolate cups!

The recipe is really simple and doesn't require any additional sweetener. We've got creamy peanut butter layer sandwiched between two layers of sugar-free milk chocolate. And if you prefer dark chocolate, you can use 85% or 90% chocolate chips instead.

Can't eat peanut butter? You can use almond butter instead or try toasted coconut butter like I did in these Toasted Coconut Chocolate Cups. You can even make them nut-free and coconut-free and try these White Chocolate Raspberry Cups!

When choosing sugar-free chocolate, opt for products sweetened with stevia, Erythritol, Xylitol or Allulose. Avoid chocolate chips and bars sweetened with Sorbitol, Maltitol or IMOs and these would spike your blood sugar levels despite being used in "sugar-free" products.

You can create your own recipes and make modifications to any of my recipes directly in the KetoDiet App by cloning any of the recipes from my blog and customizing them to fit your macros and preferences.

Preparation time

Hands-on:    15 minutes 
Overall:      1 hour

Nutritional values (per cup)

Total Carbs 11.7 grams
Fiber 7.6 grams
Net Carbs 4.1 grams
Protein 6.6 grams
Fat 25.6 grams
of which Saturated 12.1 grams
Energy 272 kcal
Magnesium 79 mg (20% RDA)
Potassium 158 mg (8% EMR)

Macronutrient ratio: Calories from carbs (6%), protein (10%), fat (84%)

Ingredients (makes 4 cups)

Instructions

  1. Place the peanut butter (smooth or chunky) and half of the coconut oil in a bowl and microwave for a few seconds, until soft enough to mix and combine.
  2. Place a bowl over saucepan filled with about 1 cup (240 ml) of water and bring to a boil. Keep on low heat and make sure the water doesn't touch the bowl (or you can use a double boiler). Add the milk chocolate chips or chopped chocolate bar and the remaining coconut oil and let it melt. Stir to combine and take off the heat.
  3. Use a silicon muffin pan and spoon about a tablespoon (15 ml) into each cup. Place it the freezer for 10 minutes to set.
    Note: We're using a medium sized muffin tray to make medium cups but you can use a smaller muffin pan to make more bite-sized mini cups.
  4. Add the peanut butter layer, a heaped tablespoon per cup. Place back in the freezer for 10 minutes.
  5. Once set, add the remaining melted milk chocolate, about 1 tablespoon (15 ml) each. Sprinkle with a few flakes of sea salt. Return back into the freezer to set for another 10 to 15 minutes.
  6. When set, pop out of the silicon pan and keep refrigerated in a sealed container in the fridge for up to 5 days. Freeze for up to 3 months for longer storage.
  7. Enjoy directly from the fridge or freezer.


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Sugar-Free Peanut Butter Milk Chocolate Cups

If you’re short on time but need a good-for-you keto side dish that’s also impressive enough to serve to guests, you can’t do better than this buttery herbed spinach & cauliflower mash!

Cauliflower is the perfect alternative to starchy potatoes, and if prepared the right way, you won't even know there are no potatoes. You can do that by adding flavor from caramelized onions, garlic and butter, and by blending it until very smooth and creamy.

This cauliflower mash is different because it uses two nutrient-packed vegetables — spinach and watercress. It's so good for you that I decided to call it "superfood" mash. This mash is diabetic-friendly and has the perfect balance of healthy fats and nutrient-dense vegetables. This recipe is a great example of a healthy Mediterranean keto approved recipe which emphasizes the importance of healthy fats and nutrient density (even better if you swap the butter with extra virgin olive oil!)

You can serve this creamy cauliflower mash with any proteins such as roast chicken, pan-fried salmon, pork chops, tenderloin, lamb chops, and any seafood.

This creamy green mash recipe is originally from my Beginner's KetoDiet Cookbook. Check it out for over 100 more delicious low-carb recipes!

Preparation time

Hands-on:     15 minutes
Overall:      20-25 minutes

Nutritional values (per serving, about 1 cup, 220 g/ 8 oz)

Total Carbs 10.9 grams
Fiber 4.3 grams
Net Carbs 6.6 grams
Protein 4.6 grams
Fat 15.8 grams
of which Saturated 9.6 grams
Energy 191 kcal
Magnesium 58 mg (15% RDA)
Potassium 740 mg (37% EMR)

Macronutrient ratio: Calories from carbs (14%), protein (10%), fat (76%)

Ingredients (makes 4 servings)

  • 1 medium cauliflower, cut into florets (600 g/ 1.3 lb)
  • 1 small yellow onion, chopped (70 g/ 2.5 oz)
  • 1 clove garlic, minced
  • 1 tbsp ghee or extra virgin olive oil (15 ml)
  • 150 g fresh spinach (5.3 oz)
  • 50 g fresh watercress or more spinach (1.8 oz)
  • 1/2 stick butter or ghee (57 g/ 2 oz) or 1/4 cup extra-virgin olive oil (60 ml/ 2 fl oz)
  • 1/4 cup fresh basil or parsley
  • sea salt and black pepper, to taste

Instructions

  1. Place the cauliflower florets in a steamer, and cook for 10 to 12 minutes. Once the cauliflower has cooked, remove from the heat, remove the lid and let the steam escape.
  2. While the cauliflower is cooking, peel and dice the onion and mince the garlic. In a pan greased with ghee or olive oil, cook the onion over medium-high heat until lightly browned, 5 to 7 minutes. Add the garlic, and cook for 1 minute more. Take off the heat and set aside.
  3. Boil water in a kettle and pour in a bowl with spinach and watercress. Leave in the hot water for 30 seconds to wilt and then strain and transfer to a bowl filled with ice water to stop the cooking process. Drain and squeeze excess liquid out.
  4. Place the drained greens in a blender with the cauliflower, caramelized onion and garlic, butter (or olive oil for dairy-free), and fresh herbs (basil or parsley), plus salt and pepper to taste. Process until smooth and set aside.
  5. To serve, optionally add some more butter or olive oil on top. To store, let it cool, cover, and refrigerate for up to 5 days.
  6. Reheat before serving and try with pan-fried salmon, roast chicken, steak or pork chops.


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Superfood Mediterranean Cauliflower Mash

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