They get cheated. If you're not getting what you want nobody's going to get it for you. Everything is a mixture of fats. For example, olive oil, which we typically call monounsaturated, is about 75 percent monounsaturated, 12 percent polyunsaturated, and 15 percent saturated. Butter, which has been vilified as a saturated fat bomb that must be avoided, is actually a little over one fourth monounsaturated fat. Don�t worry about that too much, though. If you eat mostly fresh foods, lots of vegetables, and get the majority of your fat from olives, olive oil, nuts and seeds, avocado, and fish, the fat percentages will balance themselves out. Your main source of monounsaturated fat will be olives and olive oil. Olives need little explanation save that they are available in a few different varieties and are occasionally stuffed with increasingly interesting things, like cheese and garlic. Be adventurous but be careful of the stuffing options, as these will affect the carbohydrate content. Oil requires a bit of a longer discussion. First off, here�s a list of common oils and their respective fat concentrations. My first year of medical school was academically the most challenging for me. I worked all the time�not to excel, just to pass. Nevertheless, I failed my first anatomy exam. On Friday or Saturday evenings, when other students were partying or relaxing in front of the TV, I was studying. I thought my chances of making it through the first year were reasonable, but not certain. An epiphany I had one evening was that if I flunked out, I�d still be okay, even though it would mean not becoming a doctor and having to find something else to do. In other words, I discovered that my basic sense of well-being was not reliant on achieving a career aspiration. Although I was consumed with becoming a physician, I had not been consumed by it.
This perspective was grounding. One might think it�s foolhardy to contemplate failure when one is striving to succeed. Life's a car you've been given. Where you drive it is largely up to you. It's futile to live for some future time when things will be different, believing that as soon as I'm older, richer, more educated, (or in a more sophisticated vein, when I finish my therapy) then all will be well; dream on, for these are but futile delusions. It's also futile to live in some past phase of your life when I was younger, stronger, my spouse was living, or before my marriage, my divorce, my surgery, my heart attack, I lost my job, the children were born. These are just more hopeless dead ends. Charles Dickens depicts the tragic figure of Lady Havisham, sitting in her bedroom in full bridal regalia decades after rejection by her would-be groom. Her monumental cowardice keeps her afraid to face her life as it is. If you want, you too can have dreams and cobwebs, fantasies about what was or might be. Thomas Wolfe made the same point in You Cant Go Home Again. New oils are available all the time, so keep an eye out for new ones to try. In general, oils should be fine for the Ketogenic Mediterranean Diet because a pure oil of any type will be all fat. Flavored oils may have additives, so check the ingredients. All of the values in the above table were taken from the USDA database and have been rounded. As you can see, olive oil, avocado oil, and hazelnut oil are all great for our purposes, but all of the oils (aside from soy) have a pretty good breakdown. There are also a few terms you should be familiar with when shopping for oils. Virgin and extra virgin are quality indicators. Extra virgin means that the oil is obtained through mechanical means and without the use of solvents, it was processed at a temperature never exceeding 86�F, it contains no additives, and it passed laboratory and taste tests.
Virgin may be of lower quality and may have some taste irregularities. The terms refined and unrefined appear most often on coconut oil, and they mean pretty much what you would think: Refined oils are obtained from dried coconut and have been bleached, filtered, and deodorized. However, learning to separate who I am from what I am trying to do enabled me to focus on the latter. Becoming a doctor was simply something that I as a person wanted to accomplish. Now it was just a matter of saying I will take a lot of crap to get what I want - I shared this insight about being okay with failure in a short essay I published in 2002, in the journal Academic Medicine, titled Learning Medicine with a Learning Disability: Reflections of a Survivor. The piece was based on a talk I gave to a class of first-year medical students at Simon�s invitation. Simon was teaching a class titled Human Context in Health Care at the nation�s only military medical school, the Uniformed Services University of the Health Sciences. Regular panel discussions, often featuring physicians talking about challenges that were intensely personal, reflected the trust we all had in Simon creating a safe space. I was on a panel with two other physicians with disabilities: one was quadriplegic from a rugby accident that occurred while he was in medical school, and the other had a renal transplant as a result of a rare kidney disease. We were looking up at a couple hundred first-year students in military uniform, in a steeply angled auditorium. Sitting between these two guys I remember thinking to myself, Wow, do I have it that bad? An old vaudeville joke says the same thing in yet another way: Your money or your life, the robber demands. Take my life, I'm saving my money for my old age, the over-cautious hero replies. Incredibly, many people continue their old life-styles and habits even if they feel miserable, lonely, bored, inadequate, or abused. Why? Because habit is an easy place to hide. Life has inevitable risks. Heart attacks, auto accidents, tax assessment, business problems - every conceivable kind of bad news waits to spring upon you without warning.
You can't count on your next breath. So it's hard to play the gamble of life. It has less flavor but is good for cooking because the refining process makes it more stable. Unrefined oils come from fresh coconut and have not been altered. Unrefined coconut oil is also sometimes called virgin, but here virgin does not denote the same things as virgin for olive oil. Confusing, right? To add to the confusion, none of these labels are really regulated in the United States. Honestly, buying oils in this country is a bit of a guessing game. High-quality oils should have a very distinct, fresh taste of whatever they are derived from. I advise finding a brand that you like and sticking with it. You can buy the more refined oils for cooking because they will typically be less flavorful and be able to withstand more heat. The fancier, better-tasting oils are going to be more fragile and will need a bit of pampering. Interestingly, after I spoke I got the sense they were looking at me sympathetically and asking themselves the same question! While I was preparing for that presentation, Simon coached me to be unsparingly honest about my disability. I found that tough to do now that I�d made it. Having completed my training and passed my board certification exams, there was a desire to hide from others that part of who I am. The reality, however, is that I was as learning disabled then�and still am now�as during the years when I had to struggle to keep afloat academically as a student myself, and that can be hard to admit. I still have a recurring dream that I�m back in college and medical school, as a middle-aged adult with the training I have now, taking all those classes all over again. My classmates don�t know that I have twenty-five years of practice experience under my belt. I do well, without much effort, and enjoy the experience.
But, when I wake up, I wonder what it would really be like if I went back to the first year of medical school, and I think that it would probably be as difficult now as it was then. In my essay about my learning disability I wrote, I came to accept that I would be okay even if I did fail. It's a difficult balance. At times you might put too much on the next spin of the wheel, and at other times you might feel so hurt and cheated that you want to stop playing forever. But the goal, in a sense, is to find a style of playing the game of life that keeps your hand in without keeping yourself out. When you reach beyond the safety and familiarity of habits and behave in any way different from routine, you experience some tension. It may be mild, a slight tightness in the chest; or more pronounced, a rigid heart rate, nausea, diarrhea, fainting, or even panic. If you think about the possible consequences of a new change too long, fear may overwhelm you. The risk-taking in life is very much like investing money - the potential returns reflect in part the degree of risk. The higher the stakes, the more frightening the game. And the clock keeps on ticking. Keep them in a dark and cool place because both heat and light can cause these fats to oxidize, which makes them rancid. Keeping them in the refrigerator is not a terrible idea. MEDIUM-CHAIN TRIGLYCERIDES. Before we move on to protein, let�s talk about coconuts and medium-chain triglycerides (MCTs). Most of the fats we eat are composed of long-chain triglycerides and have to be transported to the liver in order to be broken down into smaller chains that we can utilize. Unlike almost all other sources of fat, most of the fatty acids in coconuts are MCTs, which can cross from the small intestine directly into the bloodstream. Medium-chain triglycerides have been shown to promote fatty acid oxidation and ketosis. Research indicates that while MCTs will not initiate nutritional ketosis, they do strengthen it.