7 Things Everyone Should Know About Low-Carb Diets


Last week, my staff nutritionist Laura Schoenfeld wrote a guest post for my blog called “Is a Low-Carb Diet Ruining Your Health”. Perhaps not surprisingly, it has caused quite a stir. For reasons I don’t fully understand, some people identify so strongly with how many carbohydrates they eat that they take offense when a suggestion is made that low-carb diets may not be appropriate for everyone, in all circumstances

In these circles low-carb diets have become dogma (i.e. a principle or set of principles laid down by an authority as incontrovertibly true). Followers of this strange religious sect insist that everyone should be on low-carb or even ketogenic diets; that all carbohydrates, regardless of their source, are “toxic”; that most traditional hunter-gatherer (e.g. Paleolithic) societies followed a low-carb diet; and, similarly, that nutritional ketosis—which is only achievable with a very high-fat, low-carb, and low-protein diet—is our default and optimal physiological state. 

Cut through the confusion and hype and learn what research can tell us about low-carb diets.

On the other hand, I’ve also observed somewhat of a backlash against low-carb diets occurring in the blogosphere of late. While I agree with many of the potential issues that have been raised about low-carb diets, and think it’s important to discuss them, I also feel it’s important not to lose sight of the fact that low-carb diets can be very effective therapeutic tools for certain conditions and in certain situations. 

With this in mind, here are 7 things I think everyone should know about low-carb diets.

#1: Paleo does not equal low-carb, and very low-carb/ketogenic diets are not our “default” nutritional state, as some have claimed.

Some low-carb advocates have claimed that most traditional hunter-gatherer societies consumed diets that were very low in carbohydrates. I’ve even seem some suggestions that nutritional ketosis was “the norm” for these cultures. 

These claims are false. The majority of studies have shown that traditional hunter-gatherer (HG) societies typically consume between 30–40% of their total calories from carbohydrate, though the range can vary between 3–50% depending on the population studied and the latitude at which they live. (2, 3) The only HG societies observed to eat fewer than 20% of calories as carbohydrate were those living at latitudes quite distant from the equator, often in marginalized environments where fruits, vegetables, starches, and honey were not readily available.

Yet even these cultures—such as the traditional Inuit—often made an effort to obtain carbohydrates from berries, corms, nuts, seaweed, and tubers whenever they could, as Richard Nikoley has recently detailed on his blogWhat’s more, contrary to popular claims, studies have shown that it’s unlikely the Inuit spent much time—if any—in nutritional ketosis. Their high protein intake would have prevented ketosis from occurring. (5)

So, while ancestral diets were certainly lower in carbohydrate than the diet currently recommended by the USDA (45–65% of calories), they were not typically “very low” in carbohydrate (<15% of calories). With virtually no historical examples of human beings following ketogenic diets for any significant length of time, and few examples of very low-carb diets, it’s difficult to imagine how these diets could be considered our “default” nutritional state or the optimal approach for most people.

#2: Low-carb diets are incredibly effective in certain situations

Lest low-carb advocates think that I am anti-low-carb, I’d like to reiterate that both the research and my clinical experience suggest that low-carb diets can be incredibly effective therapeutic tools for certain conditions.

These conditions include (but aren’t limited to):

  • Overweight and obesity
  • High blood sugar, metabolic syndrome, diabetes (both type 1 & type 2)
  • Traumatic brain injury
  • Epilepsy
  • Parkinson’s disease
  • Alzheimer’s disease
  • Other neurological conditions
  • PCOS

I have personally witnessed some remarkable transformations using ketogenic diets therapeutically in my practice. I recall an 84 year-old woman who came to see me complaining of dementia and early-onset Alzheimer’s. She was losing her memory and cognitive abilities at an alarming rate. After just two weeks on a ketogenic diet, this progression not only halted, it reversed: her memory returned, her mind was sharper, and she was far less confused and disoriented. Her family (and her doctor) were stunned, and could hardly believe the changes they were seeing.

Yet as impressive as very low-carb (VLC) and ketogenic diets can be in certain situations, that does not mean that these diets may not have some undesirable side effects over the long term—some of which we’re only beginning to understand. For example, as I discussed with Jeff Leach from the American Gut project in a recent podcast, some preliminary research suggests that long-term ketogenic/VLC diets may cause adverse changes to the gut microbiota. (6) In addition, a new paper soon to be published in the journal Cell by two Stanford microbiologists indicates that diets low in “microbiota-accessible carbohydrates (MACs)” contribute to modern, inflammatory disease. (7)

The phrase “microbiota-accessible carbohydrates” refers to the various fibers found in fruits, vegetables, starchy plants, nuts, seeds, legumes, and other foods that are poorly absorbed by us, but can be utilized as a food source by our intestinal bacteria. It’s worth noting that many of these fibers are found in foods with moderate to high carbohydrate content—foods that would typically be excluded on very low-carb diets. 

It’s important to note, however, that the beneficial bacteria-starving effects of ketogenic/VLC diets can be at least partially offset by consuming non-digestible, fermentable fibers like resistant starch and non-starch polysaccharides that don’t count toward daily carbohydrate intake. This is something I recommend to all of my patients following low-carb diets)

#3: The fact that ketogenic/VLC diets work therapeutically for certain conditions does not make them appropriate in all circumstances, for all people

This assumption is a basic failure of logic, but it’s remarkable to see how often it happens. A person has a life-changing experience with a VLC diet, so they assume that their friend will have a similar experience. Or a clinician that works primarily with people suffering from neurological conditions has great success with ketogenic diets, and then makes the assumption that all people (regardless of their health complaints) will benefit from them. 

This is akin to saying that since people with hemochromatosis (a genetic condition that causes iron overload) need to limit their iron intake, everyone should consume foods that are low in iron. 

The belief that “everyone” will benefit from one particular dietary approach—no matter what it is—ignores the important differences that determine what is optimal for each person. These include variations in genes, gene expression, the microbiome, health status, activity levels, geography (e.g. latitude and climate), and more. 

When it comes to diet, there is no one-size-fits-all approach

#4: Some people do better with low-carb diets than others

If you understand #3 above, then this should not come as a surprise. 

Some people may thrive on a long-term, low-carb diet. I have patients and even a family member in this category. And maybe you’re one of them too. But that doesn’t mean everyone will have this experience. If you talk to practicing clinicians who work with patients on a daily basis, or spend any amount of time in internet forums or the comments sections of nutrition blogs, you’ll find numerous reports from people who either experienced no benefit from or were even harmed by following a low-carb diet.

What blows my mind is that the “low-carb zealots” seem completely incapable of accepting these reports at face value. Instead, they’ll argue that anyone who doesn’t succeed with low-carb is either doing it wrong, cheating, or somehow imagining their symptoms.

What’s the more likely explanation here? That everyone who gets worse with a low-carb diet is either incapable of following directions, weak-willed, or delusional? Or that a low-carb diet simply does not work for everyone? You be the judge. 

#5: If a low-carb diet works as a therapy in a given condition, that doesn’t mean too many carbs caused that condition in the first place

This is another error of logic that is often made. Here’s an example:

“A low-carb diet is effective for treating type 2 diabetes. Therefore, eating too many carbohydrates led to this condition in the first place.”

This is like saying:

  • Restricting iron is helpful in hemochromatosis patients. Therefore, consuming too much iron is what caused hemochromatosis in the first place.
  • A low-FODMAP diet helps patients with Irritable Bowel Syndrome (IBS). Therefore, eating FODMAPs caused IBS in the first place.
  • A low-histamine diet alleviates the symptoms of histamine intolerance. Therefore, histamine intolerance is caused by eating too many histamine containing foods.

Or, more ridiculously, since wearing a cast on your arm will help the broken bone heal, the reason you broke your arm in the first place is because you weren’t wearing a cast. 

It’s true that VLC/ketogenic diets are effective for improving the metabolic markers associated with type 2 diabetes. But that doesn’t mean that eating too many carbohydrates led to the condition in the first place. It is certainly possible (and indeed likely) that eating too many refined and processed carbohydrates, in the form of flour and sugar, contributes to diabetes. But I have not seen a single study suggesting that eating whole-food carbohydrates (e.g. fruit or starchy plants) leads to diabetes or other metabolic problems. On the contrary, reviews of prospective studies looking at the relationship between fruit intake and diabetes have found that those with the highest intake of fruit had the lowest incidence of diabetes. (8, 9)

It is also worth pointing out that virtually all studies performed so far showing benefits of the Paleo diet in conditions like type 2 diabetes and obesity have used moderate carbohydrate (not low or very-low carb) versions of the Paleo diet. 

#6: If a low-carb diet is an effective therapy for a condition, that doesn’t mean it’s the only therapy for that condition

There’s little doubt, as I said above in #2, that low-carb diets can be remarkably effective in certain situations. For example, there are numerous studies showing that low-carb and ketogenic diets can help with weight loss and metabolic problems. (10

However, that doesn’t mean it’s not possible to lose weight and reset your metabolism through other means. Studies have also shown that calorie-restricted diets, protein-sparing modified fasts, and even low-fat diets can also be effective treatments. (11, 12, 13)  

This means that it’s not necessarily true, for example, that everyone with type 2 diabetes should be on a low-carb diet. They may be able to reverse their condition by following a high-protein, moderate-carbohydrate, moderate-fat diet (such as the Paleo diet with 32% of calories from carbohydrate in this study), or any of the methods I just mentioned. 

#7: Whole-food carbohydrates do not affect the body in the same way as processed and refined carbohydrates

This should be obvious to anyone with a basic understanding of nutrition and human physiology, so I’m amazed at how often I see experts talk about all carbohydrates as if they’re the same. 

In #1 above, I referenced studies indicating that most hunter-gatherer societies consumed about 30–40% of calories from carbohydrate. These carbohydrates came from starchy tubers and plants, whole fruit, and in some cases, honey. We also have evidence of specific ancestral populations—such as the Kitava, traditional Okinawans, and Tukisenta—that consumed between 70–95% of calories from whole-food carbohydrate. (14

Yet despite this liberal consumption of carbohydrates, these people were remarkably lean, fit, and free of chronic, inflammatory diseases like diabetes, cardiovascular disease, and neurological conditions. (15) If carbohydrates cause these conditions, regardless of their source, why don’t we see such conditions in these groups?

What we do see is that these cultures acquire modern disease when they adopt a modern diet and lifestyle, complete with the highly processed and refined foods that characterize it. 

When it comes to macronutrients, quality is much more important than quantity for most people. 

Final thoughts

I hope this helps to clarify some of the confusion that has surrounded this issue. Low-carb diets are an effective therapeutic tool in certain situations, and one that I (and many other clinicians) use in my clinical practice. That said, it’s equally true that low-carb—and especially VLC and ketogenic—diets are not appropriate in all circumstances, and they are certainly not our “default” or optimal nutritional state. 

Sadly, it doesn’t seem to matter how much scientific evidence, clinical experience, and common sense is brought to bear on this question: those who preach and follow low-carb dogma will not be swayed. Ah, well. As they say: “You can’t fight faith with facts.”

Now I’d like to hear from you. What has your experience with low-carb diets been like? Have you had success with them over the long term? Or have they caused you harm? What is your optimal intake of carbohydrate? Let us know in the comments section. 

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Comments Join the Conversation

  1. Alisha Mills says

    I need help with a concern I have about being in Ketosis for myself. I’m not sure where to put it and this thread seems best and Chris has become my trusted source.

    I have kidney damage from a baby. Doctor’s said I have about 60% use of my kidney function. I have a lot of other health conditions that I am unraveling and trying to get better from my younger life. One of them is obesity related to Hashimoto’s. With my change to all-natural living in the last 3 years I have found that the only way I lose weight is either pregnancy (and I’m done with that) or ketosis.

    My concern is every time I’m in ketosis (for me organic, high-fat 130+g, mod-protein 90g, low-carb ie 25g net) I get low back pain, strange sharp phantom pains in my ankles and toes (worry about gout?), and heavy thirst and urination. I know the thirst and urination are norms in ketosis. I was under the impression the worries for kidneys in ketosis were if you ate high-protein. Yet, my gut instinct and anxiety make me wonder if I’m in trouble being in ketosis because of my original kidney damage. The idea of taking away this form of weight loss from me is so disheartening but I don’t want to end up hospitalized and feeling stupid either. Any thoughts?

  2. Lori says

    Dr. Kressner, you are a life saver. I have been low carb since 2007 and initially I felt a miraculous turn around given that I couldn’t seem to break down carbs. At the same time my doctor prescribed dessicated thyroid which I couldn’t raise past 25mg. Two years later my health began to continuously decline until recently when I read some of your articles explaining that low carb shouldn’t be long-term and was not for everyone. I attempted to add complex carbs back into my diet while simultaneously raising thyroid medicine and I was finally able to raise successfully and significantly, thereby addressing my thyroid and I discovered that I was now able to tolerate carbs. After all these years and many doctors, none were able to make the connection between inability to raise thyroid and this low carb diet I thought I HAD to consume out of inability to break down carbs. Talk about a catch 22. You truly are a HEALER and I hope that more doctors in the medical community are enlightened by your true expertise. Thanks again for this life-changing information.

  3. Megan says

    I’ve been doing low carb for 10 months. First of all lost weight felt great and thought I had cracked it. Was lean, alert, energetic. Recently, although I have not changed my eating habits, the weight has returned and so has my stomach bloating. I read recently that low carb diets slow your metabolism? I’m not sure how to kick start my weight loss to get the kilos off again? Thoughts?

  4. says

    I believe Low Carb can be very effective in achieving weight loss. I am living proof having lost nearly 20 pounds in the last year due mostly to following a low carb diet using a meal replacement shake the ensures I am getting my vital nutrients. And of course, exercise :-)

  5. Nikki says

    I think it’s important to keep in mind that Paleolithic Man ate “Paleo” from birth, as did their parents.

    There’s a distinction to be made between how we should be eating as a society (from birth) and how I should eat to RECOVER from (or attempt to reverse) conditions brought on by poor eating and a toxic environment combined with my genetics.

  6. Maureen Berry says

    i have been a ‘low-carber’ for about 4 years and will be for life. Really, I’m low carb + red wine, I enjoy a glass or two of red wine daily and sometimes more. I am not slim, but I am lean for my height and weight and I feel fabulous. I lost about 40lbs initially, and now probably lose about 4 lbs a year. All of the health benefits that are described by the advocates of low carbing happened to me. My blood pressure went down from dangerously high to normal, no medication. My GERD disappeared virtually overnight (before I had lost any significant weight) I am now medication free and literally never have heart-burn / indigestion. My IBS, similarly, disappeared within a fortnight. I have never experienced any negatives, my skin glows, I have good energy. I have a small appetite (linked, I believe to prevention of the highs / lows in blood sugar / insulin levels) and I have never felt or looked better. So I eat real food, good quality protein, unrestricted healthy fats and salad / leafy green vegetables. And it’s brilliant. I do not know why the low carb diet attracts such negative attention, for me it has been a life changer / life saver!

    • Rm says

      Firstly congratulations!
      I have been doing low carb for probably about a year due to pancreas issues and a diabetes scare! Initially I lost a lot of weight and now plateau which is fine I am happy with my eight but I am not feeling as healthy as I did a year ago? I constantly have tummy aches and feel so sluggish. I am afraid it’s dairy! I am guessing. The dairy has inflamed my gut. I don’t think I have too much dairy but now when I do think about it, all the sites that I get my low carb recipes from always use cheeses and creams .
      I’m curious to know how much dairy you have?

  7. Diane says

    The GABA question was in reference to Laura Schoenfeld’s blog post.
    I have tried a ketogenic diet in the past and experienced very low energy and brain energy, so had to quit. I have been curious to know if, perhaps, my body was in the process of “switching over to ketogenic metabolism”, and I just didn’t give it enough time, so started researching again. Ironically, I have been looking to increase my very low energy state and loose 5-10 lbs of extra weight I’ve kept on the last couple of years. I have some low T3 issues and take cytomel… The information you have offered regarding the dangers of LC with hypothryoid have been very helpful. I’ll need to look to a different solution! Thank you!

    • Rosslyn says

      Hi Diane,

      The body does go through a transition period, since we have greatly changed how we eat. If you have been eating a lot of sugar and carbs your whole life, like the majority of people do, and then stop eating those things, it’s kind of a shock to your body. So give it more time. You didn’t mention how long you were on the ketogenic diet, but it’s going to take at least 4-6 months for your body to get used to the changes. My husband and I are both on this diet for almost 3 months now. I didn’t notice any ill effects yet, but my husband had a few minor issues, but it’s getting better. He has hyperthyroidism, and no longer needs his medication. He also lost 30+lbs. I lost 10 lbs. We feel great though, with lots of energy. So if you want to reverse your T3 issues and lose those 10 lbs, I encourage you to get back on the diet and stick it out for 6 months and see how your body responds.

    • Diane says

      The GABA question was in reference to Laura Schoenfeld’s blog post.
      I have tried a ketogenic diet in the past and experienced very low energy and brain energy, so had to quit. I have been curious to know if, perhaps, my body was in the process of “switching over to ketogenic metabolism”, and I just didn’t give it enough time, so started researching again. Ironically, I have been looking to increase my very low energy state and loose 5-10 lbs of extra weight I’ve kept on the last couple of years. I have some low T3 issues and take cytomel… The information you have offered regarding the dangers of LC with hypothryoid have been very helpful. I’ll need to look to a different solution! Thank you!

  8. cincin says

    I followed a low carb diet for close to 18 months about 5 years back.
    I lost 31kgs however, what I didn’t notice was the negatives. I never slept, I was defensive, aggressive, extremely hyperactive and thought I knew everything. I would cut people down and think it was hysterically funny. I was completely manic for the entire stint of the diet but couldn’t even see what was happening to myself. I started to grow great big curly thick white whiskers out of my chin. Not good for a 49 year old woman.
    After reintroducing carbs I began to relax enough to look back and see the monster I had become. I have kept the weight off since but I would never go low carb again. I have not had a big thick whisker since. I have not offended anyone since, I am once again rational and I sleep again.
    I have seen others this has happened to and like me they refuse to accept there is anything wrong with them mentally. (its everybody else) They are the ones who troll the internet scathingly attacking anyone with a differing opinion to them and thinking its perfectly normal behavior while obsessively dissecting their macronutrient ratios for all others to admire. (Yes. Creepy isn’t it.)
    Low carb = mental instability big time, for me and many others who haven’t noticed the aggressive, antagonistic mental imbalance in themselves yet.
    Good luck for those who do well on it, good for you. I wish I could join you as I totally enjoyed the food and the lack of hunger.
    I eventually settled for the middle ground with a small serve of solid carbs with each meal and it suits me well. Balance of diet = balance of mind for me.

    • says

      Very interesting about the manic condition and diet? How low a carb diet were you on? How can you tell it was your diet?
      I have experienced the manic condition, but believed it came from excessive physical activity. I worked very hard for a while. Cutting back on the work and relaxing more made It go away. I have a very high energy level and tried to use it all. I am diabetic and get almost all my carbs from fruits, vegetables and dairy. My diet is not that low carb. I would
      appreciate any more information you might have about the manic condition and diet.

    • Chaunta Black says

      I experienced the same and doc referred to my premenopausal age. Do you think it could have been menopause for you as well?

    • Annabel says

      I am on a low carb diet because I have been suffering from signs of type 2 diabetes. It has worked well for me and along with other issues my memory has improved. I would imagine that everything we do should be done in moderation.

      If my sharpness and energy would be compounded relative to the amount of carbs I do not eat may be it would be devastating like in your case.

      It is good to know you decided to be moderate and I believe that is why I am benefiting from the whole process

    • Brielle says

      Your post made me realize what may have been happening to me on the keto diet. I have was getting into trouble at work for flipping out and snapping at people and didn’t even realize it! Thanks for sharing!

  9. Garry Lee says

    I’ve several things to say about this.
    1. There is no doubt that as Stefannson and several others said, that the Eskimo ate almost no vegetables and had no interest in them.
    2. The assertion that hunter gatherers ate as much carbohydrate as this article asserts is NOT in accord with most of the stuff I’ve read on it, and it’s lots.
    3. Having been inclined to be fat all my adult life as my family is inclined to be, I’ve considerable experience of losing weight and putting it all back on again. I once lost 42lb on a low-fat diet and put is all back on again in a few months. I’ve been on numerous such diets down the years and have exercise prodigiously all my adult life, with poor effect on weight.
    Two and a half years ago I gave up all sweet things and lost 20lb. After 18 months of hunger, it had begun to creep back on. 18 months ago I went LCHF and lost 28lb from that weight. That’s down 42lb from the consistent weight. My weight has been stuck on my new weight, BMI 23 for a year. Not a budge. No hunger. Whether I’m ketototic or not I don’t know, but I probably am, somewhat as I’m a big man and max at 50g carbs per day and continue to exercise a lot.
    I’m 65.

    • says

      “There is no doubt that as Stefannson and several others said, that the Eskimo ate almost no vegetables and had no interest in them.”

      Nonsense. Consult an actual botanist like Arthur Haines. As I recall him documenting, the Eskimo utilized over 300 plants.

      Or try this 240 page book about how the “Eskimo ate almost no vegetables and had no interest in them”:

      Plants That We Eat: Nauriat Niginaqtaut – From the traditional wisdom of the Inupiat Elders of Northwest Alaska


      And Stefansson was a liar, opportunist, and fraud.


      “The assertion that hunter gatherers ate as much carbohydrate as this article asserts is NOT in accord with most of the stuff I’ve read on it, and it’s lots.”

      And it’s all wrong.


      Do you know what the composition of the Hadza (a true H-G society) is?

      Meat: 32%
      Berries: 20%
      Tubers: 19%
      Honey: 15%
      Baobab: 14%

      In other words, their diet is mostly carbohydrate. This rings true for most H-G societies actually studied rather than extrapolated from a pile of bones.

      Even the most recent research on Neanderthal demonstrates that they ate significant starch and even grains.

      Science moves forward but apparently, in the LC Paleo fantasy universe, there’s a bible, god wrote it, and that settles it.

  10. says

    Understanding what carbohydrates in general, do to your body really puts things into perspective. Realizing that dietary fat isnt going to make you fat or cause a heart attack puts things into perspective too. I think if you understand, that your body can either use carbs or fat as an energy source, it makes your macro composition much easier to figure out. For someone who is a heavy weight lifter, you will need more carbs to fuel that activity. Someone who is sedentary does not need the same amount of carbs. I think john kiefers approach to diet is best. Your basically always low carb, but spike insulin with carbs often or not as often, depending on how active you are, while never staying low carb long term (more than a week).

    • Susan says

      “…your body can either use carbs or fat as an energy source” This is true, as is all carbs are not created equal. Plus, carbs do differ from sugar depending on the source, like table sugar/sweets vs fruit (a natural carb/fiber).
      Back to using either carbs or fat as a fuel source, I recall reading about the Trim Healthy Mama “diet”. Reading about it sounded easy, you alternate each meal and snack with either being carb heavy (good healthy carbs that is) or fat heavy (good healthy fats), giving several hours between eating so your body uses that energy form. I’ve not read the book itself about this way of eating, and reviews were mixed. Some readers were off-put by a religious tone to it, others complained about poor editing, others thought it was too hard to learn. None of these would concern me as I’d only be interested in the basic information. One thing I noticed on the website for this eating plan was weight loss for women with PCOS. I have PCOS and my adult weight issues are from the insulin resistance symptom I have from the PCOS. Worsened by going into menopause a little early (I’m 45 and very close to fully being in menopause). Very low carb worked for me 8 yrs ago, for a good 3 yrs. When hormonal changes started interfering, I couldn’t get 10 lbs off that crept back on. After an 18 mo struggle I gained another 10 lbs in 1 month. Ugh. And over another 2 yrs, another 10. I am back to very low carb, but healthier than I did it before (a little whole grain and fruit and less unhealthy fats) along with Metformin. I’m more concerned with my blood sugar than the weight at this point. I’ve known I’ve been “pre pre-diabetic” for 7 yrs now, who knows how much longer but I suspect my whole life. This Trim Healthy Mama way of eating may be the ticket for some insulin resistant people and worth exploring if not trying. Just hoping this info from me helps some people :)

  11. pam says

    I have been solo frustrated lately. Been on low. Carb for 4 weeks and have gained 2.5kilos I really have stuck to under 25 grams of carbs and zilch .what’s going on. But I have felt better and had more energy but weight gain means I’m going to have to reevaluate the whole diet. Glad to hear others experience the same issues

    • Abdullah says

      If I were you, I wouldn’t change my diet if I was feeling better and more energetic, I would reduce my total calories consumption for two weeks while still on the low-carb diet, even if fat isn’t that effective in gaining weight as carbs remember that fat has calories too

    • Cindy says

      If you are eating too much protien on a low carb diet you will convert protein into glucose through a process called gluconeogenesis. Essentially this raises your blood glucose levels… therefore you might as well be eating carbs. The key is eating moderate protein based on your gender, your activity levels, age…

      • suzie says

        No, extra protein does not automatically turn into chocolate cake. Gluconeogenesis is demand-driven, not supply driven. Extra protein will be used as energy, but it will not turn into glucose.

  12. says

    I have had type 1 1/2 diabetes for over 20 years. I make some insulin, but not enough. I have learned by trial and error that the best strategy for diet is to get all carbohydrates from fruits and vegetables, not grains, rice or potatoes or anything made with flour or other starches. Dry beans, whole rye berries or whole barley are acceptable on occasion. They contain resistant starch fiber. I use fiber in the form of ground flax seed, oat bran and Hi maize 260 resistant starch fiber (bulk form) which I add to foods at every
    opportunity. I eat no processed foods and never have.
    I am now 77 years old and very healthy. No nerve damage or
    heart disease. I exercise every day. Inclu8ding lap swimming and resistance exercise.
    I take 20 units of long acting insulin once a day. No diabetes drugs at all.

    • Lisa Clark says

      Except everyone really is different. My endocrinologist, for instance says some of her patients are fine with coffee, tomato sauce–but for others it spikes their blood glucose. She encouraged me to test myself after meals for myself. I made various porridges with nuts and nut butter, flax seed, even egg whites to up fiber and protein, while keeping various grains to 1/4 cup dry measure–and here are some of the results of post-prandial blood glucose one hour after a meal keeping everything but the grain used constant:

      Quinoa: 115
      Millet: 116
      Cornmeal: 118
      Wheat Berry: 120
      Oats: 121
      Sorghum: 123
      Amaranth: 124
      Brown Rice: 125
      Teff: 127
      Buckwheat: 136
      Rye Berries: 137
      Barley: 147 (the worse of any grain I tried–and I’d heard how good barley was for diabetics so I tried it various times–a quarter cup in my porridge would go above 140 every time.)

      Basically, I’ve followed the advice of my endocrinologist (and Blood Glucose 101) and tinkered with meals until I get post-prandial blood glucose of below 140. For something like barley, I reduce the amount.

      FWIW, I once took 20 units of insulin when I was first diagnosed with Diabetes and trying to get it fast under control to start chemo. That was a year an a half ago and my A1C was around 13. I had my latest A1C taken just last week and I’m at 5.1 after a year off diabetes meds–no orals, no insulin.

      And no, I don’t do paleo, though I’ve stolen ideas from it here and there, and I’m not particularly low carb. My endocrinologist recommends a limit of 45 grams of carbs per meal and I adhere to that, averaging about 150 grams per day. I did lose over 70 pounds in the year after diagnosis, did my first 5K last October, run 3 times a week, do resistance training. I’m sure all that helps.

      Point is–I’d try out various foods and carb levels out and use your trusty glucometer as your guide–because I don’t think it can be said everyone does badly with rice or well with barley. And one of my worse results testing out foods btw was with papaya–mango, banana, I’m fine, so go figure–but obviously you can have very individual reactions to fruit too.

  13. debbie says

    i have read and enjoyed what is said, i am putting together a book on low carb for diabetes, reason is i have been a diabetic 2 for 3 years, have had 3 trips to emergency, last one this Christmas eve. started to read about hidden sugar because the Canadian standard for diabetes is WRONG. i was up to 80 units daytime fast acting and 12 units slow night, on metformin, high blood pressure…..i weight 135 , went to low carb and i take nothing, it has been 6 months, i have been tested and my A1C is 7, i have it checked every 3 months, i feel we should be given low carb as a choice , not assume we all want medication. Anyway i feel low card for me has given me back control of my live. having type 2 diabetes i am choosing to treat as an allergy to sugar and treating it that way has help. if you have an allergy to peanuts do you carry a needle so you can have peanuts……no you do not eat peanuts. extreme example,but you know what i mean, find the sugars and decided can i handle this or is is going to be to much!

  14. Sinvanor says

    The article has some things wrong. Or rather the USDA is NOT being clear enough. If you’re having a 40-60% carb diet, eat those carbs from veggies and fruits. You do NOT need grains. They have no health benefit aside from fiber, which, you guessed it, is in veggies and fruits in spades. It’s a complete lie that you need grains in any form. I know they say switch refined grains to whole, but you don’t need grains AT ALL. And they never say that. In fact, all studies I’ve seen have only been about refined vs whole grains, but not whole grains vs no grains. We’re not built for grains, even if you’re tolerant, they still are void of nutrition you can’t get elsewhere at best and inflammatory and dangerous at worst (which sucks, because I love bread :( and pastries) So, eat grains in moderation. Like, I dunno, once a week? Get a nice baguette or some doughnuts to splurge (if you aren’t on a diet of course).

    Also, I’m sure everyone can agree with this, our ancestors did NOT eat processed carbs or grains (I’m talking nomadic people, people who go further back then 10,000 years which evolutionarily is not enough time to learn to process grains correctly, which explains why we can eat them, and they’re great if you don’t have many options, but also why so many are allergic.) So don’t eat processed food when you can. And get some variety of foods in your diet. I know that prices can be a problem, but when you find a new veggie or fruit on sale, give it a shot. It’s a great way to get in vitamins and minerals that you might be missing or don’t get in often enough.

    Um, 3-50% is a rather LARGE margin, isn’t it? Not everyone lives on the equator. In fact, you find less healthy people closer to the equator. I do agree that it can be healthy for a normal person to eat higher carb, so long as they exercise (Nomadic also means they moved A LOT, we don’t) so long as they vary where they get it from. I have no doubt that our ancestors eat say a whole goat or some other hoofed beast (bone, blood, guts and all) in a stew or raw and then one day and got berries and honey the next week when passing by. They still almost never ate 150+ grams of carbs a day (often recommended as a diet by doctors, nutritionists and the USDA) as a stable part of the diet. That’s not what our bodies adapted to. Period.

    Also, and I see this a LOT. Low carb doesn’t mean high protein UNLESS you work out like maniac. Excess protein turns into glucose when you’re low carb, due to the liver converting it for energy. Often when people go keto or low carb, they eat TONS of protein which just ends up being close to eating carbs instead. Also DRINK WATER and get in SALT. You will need the electrolyte re-balancing since it’s often a radical change in diet.

    All this said, I agree with the person who said don’t worry about your food too much. Eat mostly like we have for the last 100,000+ years, that is, nomadically. I think a huge part of the reason the Asian and Mediterranean diets are so healthy is because of two things. The culture encourages being wanted and loved by family. You are seen as valuable to those around you literally until the day you die. Mental health has just as much to do with health as what we put into our bodies. And last but not least, there is SOOO much variety in the diet. Try new veggies, try new fruits, meats, fat sources, nuts etc. If you’re trying to lose weight specifically though, remember two things. The way you eat now if you’re overweight is what is making you overweight. You can NEVER go back to that habit. This will cause massive weight rebound. And find something that works. If you hate your diet/exercise plan, you won’t stick to it. It’s a life style change, not a quick diet to lose a few pounds.

    My favorite saying is this. Meat, eggs, veggies and berries have been around LONG before obesity and diabetes type 2 have been. Refined carbs and grains have not.

    Also, fish is best meat. High in omega 3, can be low or high in fat, has lots of nutrients. It’s also a very common meat in what are considered the healthiest diets. Doesn’t mean you can’t have red meat sometimes though. Fish is really expensive where I live, unfortunately. But variety, is KEY. Don’t be afraid to try different parts of the body of an animal too (minus the brain) Liver, stomach, intestines, blood, bone (bone stock, eating bones can be dangerous) etc, all have so much nutrients we miss out on. I think it’s a huge part of the reason Inuits can live almost solely on meat. They eat pretty much all of the animal.

    • Jeane Pierre says

      Sinvanor said: “I’m sure everyone can agree with this, our ancestors did NOT eat…grains (I’m talking nomadic people, people who go further back then 10,000 years…)”


      Homo sapiens in Mozambique were processing grains, including sorghum, at least 105,000 years ago and likely earlier. Researchers found processed starch granules all over their tools.

      Starchy plants were being processed for flour at least 50,000 years ago at the 8-B-11 site at Sai Island, Sudan:

      Starches were being ground for flour in Italy, Russia, and the Czech Republic at least 30,000 years ago (Mid-Upper Paleolithic):

      Wild barley and wheat were being ground for flour 22,000 years ago, during the peak of the last glacial maximum:

      Sinvanor said: “Eat mostly like we have for the last 100,000+ years”

      Well, then that would clearly include sorghum and other ancient grains.

      “I think it’s a huge part of the reason Inuits can live almost solely on meat. They eat pretty much all of the animal.”

      That’s part of it. The other part of it is that they have CPT1a genetic mutations that allows them to shunt fatty acids away from their livers and burn those fatty acids for energy in their muscles, heart and brain, and for heat in their brown fat where CPT1b-c is found. Their metabolism does not apply to Westerners who have fully functioning CPT1a enzymes.

      In fact, much of the fish oil craze was originally based on the Inuit high-n3 diet, but these fish oil suppliers are either unaware or do not want to admit that the research is based on their highly unique metabolisms. Oops.

      • Kath says

        I’m thinking while there may have been grains way back then, it may not have been prominent in their diets. Laborious to produce, but staples still fats & some proteins, supplemented with berries & nuts! A delicacy perhaps, just like honey!

    • guillaume says

      Grains are absolutely fine. Including bread of course.
      The french eat a significant amount of bread daily (im french).
      We do have obesity and type2 diabetes pbs too, but we’re hardly at the top of the chart in this respect.
      People in France (as i know), ate twice as much bread 50/60 years ago as they do now (true, it was good heavy dense sourish bread mainly. White refined flour was not easily available. Obesity was hardly an issue.

      • Kath says

        The french are also well know for th eir substantial use of butter, & bread doesn’t taste good without lashings of butter…yum!

  15. Cheryl says

    I too spent a long time in food obsession analysis paralysis. I’ve done everything from vegan, raw vegan to low carb, to zone, paleo, back and forth round and round. Finally I’d had it. Some of us have to reach a certain age before we trust ourselves enough to go by how our own body responds. I’m approaching 50 and had finally had it. I knew I felt the best when I cut out all processed food. It was only hard a week or so. Now I eat farm raised real meat. The kind that has an odor.. the real stuff that doesn’t come from a Styrofoam package. I was raised in the country and decided to only get grass fed beef, raised in a pasture I drive by going to work. I realize I’m blessed to live that close to one. The meat is so vastly different.. so much richer tasting, and it takes less to fill you up. Anyway, that, organic when I can veggies, even potatoes if I want them, which isn’t that often. Fruit of all kinds are desserts. I used to make my own ‘healthy’ bread but felt bloated and congested afterward, even when omitting milk from the recipe, so.. pfft, I now eat what makes me feel good and this is the way.

    • Susan says

      Cheryl, your story sounds familiar. I too am approaching age 50 and *finally* last year, after decades of foolishly following this or that expert, find it freeing and even healthy to eat what makes me feel good; really good.

      Eating whatever I wanted to, including plenty of table sugar, white flour/rice/potato and overly processed foods did not work for me, nor did a low carb diet, although I stayed with it for far too long. I realized that I felt much worse eating low carb – fewer than 50 – than I’d felt eating relatively healthfully with a daily splurge thrown in. I really have tried just about everything. I’ve learned to pay attention to my energy. The low carb diet zapped it right out of me. Again and again I would return to the experts and their zealot confidence, believing that I was somehow doing it all wrong, when in fact it was just wrong for me.

      The diet that seems to work best is actually a mix of high complex carb, moderate protein, moderate healthy fat, and very very little refined anything. It consists of wild caught sardines, barramundi, wild trout, grass fed beef, free range eggs, a wide field of organic veggies and fruit (mainly berries, apples, and lemons for the latter), green smoothies, nuts and nut butters, extra virgin olive and coconut oils, avocado oil, organic milk kefir (homemade daily), quinoa, and a moderate carb spelt bread with no added sugar, (one slice a day slathered with nut butter), and lots and lots of cleansing water. I feel great, and have even lost the few pounds that I needed to. Thank goodness we don’t all need to eat the same to thrive.

  16. says

    I would like some help. I have had type 2 diabetes for over 20 years. I take no drugs for it. When I took drugs they didn’t help. However I have been taking 15- 20 units of Lantus for about 10 years. Twenty years ago when diagnosed I was 50 lbs overweight, but lost it quickly and have not regained it except about 20 lbs for a short time when taking diabetes drugs. I keep my weight normal and have for a long time. I do not and never had metabolic syndrome. I do not have high blood pressure Trigs are 68, cholesterol ratio is 2.5. I have no evidence of complications in my body at all. My A1c is 7 and has been for the last 20 years.
    I am very active and always have been. I have a lot of energy
    which is not affected by my blood sugar. My diabetes has never acted as expected. I decided to stop the insulin for 21 days to see if my pancreas can heal itself I understand all the cells in the pancreas will be replaced in that time. Taking insulin perhaps will prevent replacement of some cells. This is my experiment. My blood sugar on a low carb diet stays around 190. All carbs from vegetables and fruit I have always had a healthy diet. I have never eaten processed food. I lost 5 lbs all around my middle. If I lose another 5 lbs, I will be pretty thin. I have not caught a bug of any kind or been sick for 8 years straight. I am 76 years old.
    I swim laps for 30 minutes twice a week do resistance machines three times a week and garden etc. I have kept this exercise schedule and diet for 50 years. None of the type two diabetes stuff seems to fit me except for the A1c of 7. I would like to solve this mystery. Can anyone help.

  17. Hélène says

    Ellen, do you make your own yogurt (or kefir)? Homemade yogurt cultured for 24 hrs has alot less lactose left in it. The cultures eat it as long as theyre warm, meaning active and respirating. You can eat more of it, or have something else and stay under your carb limit. You can also buy the milk raw and make your own yogurt unlike in a store, even if you can find unhomogenized.
    I was always afraid it would be too sour as I’d read it was when cultured so long. I finally bit the bullet and even my kids eat it plain still. Today I let it go 30 hrs and it’s fine. I think 24 hrs is plenty long tho lol

  18. says

    I’ve been doing the ketogenic diet for 10 weeks now.
    My HDL went from 42 to 53, my Triglycerides went from 93 to 75 but my LDL went from 147 to 191 Not sure if they are large particles or small particles. Is that normal for the LDL to go up along with the HDL? also my testostrrone went from 612 to 683. I’m guessing from my total cholesterol going up.
    Do you have any thoughts?

    • says

      I have had the same results after 4 months.

      Checkout LCHF Sports medicine doctor Peter Brukner’s suggestion in the news article


    • JLH says

      I’ve heard of the HDL and LDL increasing on low carb. I looked into the opinions of Peter Attia and Tim Noakes and you are on the right track with the large (good) versus small (bad) LDL. I think its also important to look at other markers of cardiovascular risk like blood pressure, general inflammatory markers like CRP and ESR and blood sugar of course. Ideally if possible, a vascular scan to assess presence of atherosclerosis would clarify a lot of concerns too. If these things are normal, elevated cholesterol may not carry much weight, since underlying inflammation and vascular damage are often required to be present in synergy for high lipids to cause damage. Supplementing omega 3 and making sure your metabolism is fat adapted should help reduce risk associated with higher lipids.

  19. Amy says

    I’m wrapping up 10 months of Ketogenic eating. A type 2 diabetic, my A1C is 5.5 with zero meds. Blood pressure, trygl, and vitamin/mineral levels are all perfect. My “bad LDL” p-LDL is 22 with a range stating that 35 or lower is acceptable yet my overall LDL is 286 (76 point increase) Lost 109 lbs and then hit a stall, a 7 week stall that sent be back to the doctors office to discover that my TSH is now 7.76. Previously maintaining 15-25 net carbs a day, dr and I agreed going to a 40-50 net carb may resolve the thyroid levels by giving more carbs to my “team of glands” The result? Thyroid levels went down but A1C rose to 6.5 and I had terrible nerve pains, insomnia, inflammation and mood swings as a result. Daily strength and cardio conditioning suffered but TSH levels dropped as did HDL and triglycerides spiked. Weight gain of 5 lbs in 60 days.
    So I’m left with the dilemma spending a life stuck on medications that destroy my organs or back to obesity .
    I can fully understand your points on all aspects. Though what happens when a patient falls into both Low Carb and Moderate carb categories ? I refuse to accept that I will be forced to resume medications regardless of how I consume calories

    • GM says

      My thoughts are with you! I’m in a similar situation. Two things have helped me so far: i) Megafood mixed B vitamins supplement (to increase energy, help with adrenal fatigue); ii) 6 days of low carbing (not zero carb), 1 day you’re free to eat anything. I eat bread in all three meals! You can also read up on Tim Ferriss’s slow carb diet. Wish you the best in your journey.

  20. Beth says

    We must be the only species on the planet that spend so much time thinking and rethinking about what to put into our mouths! I first started the Paleo way of eating because it seemed simple, common sense and helped give a healthy body. I admit that after a while I became more than slightly confused and bemused as to what I should be eating, what proportions, what was allowed and what wasn’t. That’s because I like to read about a subject I’m interested in and unfortunately, there are enough tomes, websites, blogs to keep you occupied from now until doomsday.
    I don’t want to test my ketones, my doctor wouldn’t, couldn’t on his budget do regular blood tests and I certainly can’t afford to pay for them. Do I even need to know? I don’t want to calculate the percentages of carbs to fat to protein at each meal, it’s as bad as, if not worse, than the calorie counting days I was trying to get away from. Macro and micro nutrients? Oh for heaven’s sake, this is smacking of being obsessional. (Probably not a real word).
    Giving up processed food made sense to me. Giving up the majority of sugars, except for some from fruits and a little honey made sense to me. Even giving up grains made sense given how many people are gluten intolerant. I read about good fats and using them made sense to me. It seemed simple.
    Now what the heck do I put on my plate? I want to enjoy my food, I don’t want to obsess about it, over think it, worry about it. Isn’t that counter productive? All I want to do is to eat healthily. Give me a bit of meat, lots of veggies on the side, either cooked in olive oil or with a pat of butter on the side. Perhaps finished off with some blueberries, greek yoghurt _ full fat of course, with a drizzle of local heather honey and I’m happy. Or should I not be………

    • Lisa Clark says

      I feel much like you do–that the finickyness of so much you find in the Paleo community borders on neurotic and could push you to a eating disorder.

      Do you need to count carbs or know your ketones? I think it depends. The whole reason I became interested in nutrition was because I was diagnosed as a diabetic. It was my doctor–specifically my endocrinologist–who pushed me towards counting carbs. FWIW, changing my diet normalized my numbers and I’m off meds–and w/o Paleo, or going very low carb.

      But yeah, I count carbs, my endocrinologist wants me to keep them under 45 grams per meal, and FWIW it becomes easier and less obsessive as you learn the numbers for different foods. It’s not like I have to calculate and recalculate the carbs for the chicken salad that’s my go-to lunch. And aps like My Fitness Pal makes it easy. But if how you’re eating is working for you, I think it’s healthier (in every sense) not to obsess and stress about it, and if you’re not diabetic or pre-diabetic I don’t see the need.

      Someone on one of the boards here quoted Pollan’s rule about healthy eating–basically: Eat real food. Not too much. Mostly plants.

      Really, unless you have specific health issues surely all that’s needed?

  21. Dr. Laura says

    Let’s not forget that green vegetables are carbs. Even on a VLC diet, they are (and always should be) included.

  22. says

    For me, diet makes all the difference in managing a chronic illness! I have adopted a grain free, no refined sugar, no legumes diet over the past few months. I can’t say that I am loving it, but I can say that abstaining has made an incredible difference in the levels of joint inflammation and how I feel overall. I have found I can eat one of the three things about once a week now, depending on the type, without an issue. Also, for drinks I have resorted to low-carb beers.

  23. Jodi says

    I lost 40 pounds on a ketogenic diet and exercise( nothing intense just strolling the baby about 5 miles a day- power walking) but then I got extremely exhausted and drained and my weight loss just completely stopped. once I started adding carbs back in The wait just start falling off of me. I was excited but completely perplexed! now years later I just do Paleo and have already lost 8 pounds in about 10 days. I can attest for myself that I definitely need the carbs maybe for thyroid to turn T4 and T3? I love Paleo because it works for me! Bring on the sweet potatoes!

    • Michele says

      Can I ask what kind of carbs you added back in? I need more carbs to get the sleep cycle back to normal. I do not want to eat grains, have a problem with milk so gave up all dairy, including eggs and cheese now, don’t want to eat boxed or packaged foods, so am still having a hard time adding back in “good” carbs. And I would like to get a big variety to help the gut flora.

      • Jodi says

        Hi Michele,
        we are completely grain free dairy free and sugar-free at our house at this point except for the sugars in fruit and sweet potatoes which is where we get all of our carbs. we do also do some tapioca flour in some of our baking and I do occasionally make french fries out of parsnips and sometimes my daughter will have a baked potato but actually when i started adding carbs back in years ago after the ketogenic diet I was not as particular I just started eating carbs in general and the weight started falling off which was really curious to me but now after researching I think I learned that some people with thyroid (I have Hashimoto’s) and also women in general need some carbs for the liver to convert T4 to T3 but don’t quote me on the exact mechanism or reason why i’m sure Chris has a lot about it on the site somewhere…

        • Jodi says

          Oh and also i became a complete insomniac when I wasnt eating carbs I wanted to really stick to LCHF but if I wanted to sleep I had to start eating applesauce or sweet potatoes or honey or some kind of carb at night or I knew I was going to be awake all night I don’t know why that is either I’m sure there’s something on the site about it but I totally understand

          • Ellen says

            I’m doing modified Atkins for epilepsy. I discovered that I had difficulty sleeping at least partly because I was going to sleep hungry. So, I made a low carbohydrate grainless granola of almonds, hazelnuts, flax seeds, sunflower seeds, pumpkin seeds, sesame seeds, coconut oil, and a little maple syrup for a bedtime snack – 3-4 tablespoons depending on what I ate during the day (I keep net carbs around 20-25 g, calories around 1250, and the percent of calories from fat at 65-75%), together with 50-100 g yogurt made from full-fat organic goat milk. Dairy is supposed to help our bodies produce melatonin that helps us sleep. I also cut down on stress-causing experiences. Am sleeping much better.

        • guil says

          Interesting comment.
          I exercise regularily. Luckily, i’m rather slim by nature. I also tried cutting down carbs (for no particular reason, as an experiment on myself i guess. To see how my body would react) other than from fruits (not many) and veggies. Lots of protein and nuts.
          I thought i would lose more weight and simply get more ripped physically, with even less bodyfat.
          My energy levels got sensibly down, and my sleep was not so good. But overall, it was ok. A few weeks ago, i added back some carbs from unrefined grains mainly (plain oats and oatbran and wholerye bread + sourdough bread, which i ate all my life, in france) and dried fruits like dried prunes. So no refined grains really. Well, i can only speak for my self, but i lost bodyfat, thus got more ripped and didnt have all these sleepy spells during the day (my sleep improved). I can only tell what works for my own metabolism, but it seems that some people might be better off with “good quality” carbs versus “very”low carb. I must say that adding these grains (i have no allergy whatsover to gluten etc,,,) did me more good than erasing them from my diet. One important thing, is that it did not added in calories to what i ate before. By eating more of these kinds of carbs i ate less of the other, as i was less hungry. I guess there is no one size fits all.

  24. says

    I have adopted a grain free, no refined sugar, no legumes diet over the past few months to help deal with the inflammation caused by Lyme Disease. I can’t say that I am loving it, but I can say that abstaining has made an incredible difference in the levels of joint inflammation and how I feel overall. Shocking really. I have found I can eat one of the three things about once a week now, depending on the type, without an issue. For me, diet makes all the difference in managing a chronic illness!

  25. says

    “My fasting numbers are in the 80s. After a meal with low carbs but a little more than usual my blood sugar will rise to 122 and then 3 hours later be 103. Is that normal?”

    Corry. Chris can add what he wants but based on these numbers, you are not only not diabetic in the slightest, but have perfectly physiologically normal BG response.

    You have to understand that part of the VLC snake oil is to get you to try it for long enough that you confirm that you can’t have carbs, since VLC creates insulin resistance, so called “physiologically,” as in, if you cut off your finger, it bleeds, its a physiological response.

    …Thing is, you don’t give much info and the comment is a bit ambiguous. Perhaps VLC helped, if you were getting your carbs from lots of sugar water or crap processed hot pockets, before. I am solidly open to VLC for a period helping to resent. You can do the same with weekly fasts for a few months (preferable in my view).

    Otherwise, fasting in the 80s is stellar, as is a spike to 140 or less after a carboy meal, if you come back down within a couple of hours.

    Chris can say otherwise, I doubt he will, but I’ve been scanning all the comments and this one really struck me as a poor soul who thinks she can’t have much of a glucose spike and be normal and I HATE for someone to have to live under that fantasy.

    • blaine says


      Chris may respond but as someone who has successfully reversed diagnosed type 2 diabetes, I wanted to relate my experience and add to Richard’s comments.

      Richard is correct. Your current blood sugar levels are well in the normal range.

      After I lost weight and increased daily exercise (including resistance training twice a week), I discovered I was able to eat more complex carbs without raising my blood sugar beyond normal levels.

      Everyone’s carbohydrate tolerance is different so the only way to know for certain how many carbohydrates to add to your diet is to continue slowly adding them and track your blood sugars with a meter.

      If you find blood sugars are spiking over 140 two hours after eating and your fasting numbers are going into the 90s or over 100, just respond by cutting back on carbs and/or increasing exercise after meals until they are back to normal levels.

      I’ve found that exercise after large carbohydrate meals makes a big difference in blood sugar control vs. sitting on a couch watching TV.

      I used to follow a diet that was 50 to 75 carbs a day. I’m now at 100 to 150 without gaining weight or raising my blood sugar levels outside normal ranges.

      That being said, I have zero doubt that if I went back to eating processed foods and sugar and stopped exercising, my lost weight and diabetes would return with a vengeance.

      Proceed with caution. It’s a delicate balance to maintain the progress you have worked hard to achieve. It’s tempting and easy to fall back into addiction cycles. Stay vigilant.

      After two years of normal blood sugars, I no longer measure myself every day. I now measure my blood sugars for one week, three times a year and adjust my behavior accordingly.

      If I ever find myself gaining weight and creeping back towards diabetes, I will measure myself after every meal and adjust my behavior to return to normal levels.

      Here is a good link on what constitutes normal blood sugar levels.


      Hope this helps.

  26. Cori says

    Hi Chris, I have been very low carb for 6 months trying to reverse diabetes that I self diagnosed. I believe that it helped but would like to start adding in some carbs. My fasting numbers are in the 80s. After a meal with low carbs but a little more than usual my blood sugar will rise to 122 and then 3 hours later be 103. Is that normal? How would I go about adding more carbs in without it affecting my blood sugar? Thanks! I would really appreciate your advice.

    • Carl says

      I thought I would reply. If you have been following very low carb for six months your body will overreact initially and spike your blood sugars. I would only starting adding complex carbs at your dinner meal. If you eat low car all day and have carb with dinner it shouldn’t spike the blood sugar. Your body is always trying to balance itself out. It gets used to whatever you have been doing consistently and responds accordingly. These low carb diets can backfire when you go back to eating moderate to high carb. I recommend the book the carbohydrate addicts diet which shows how to eat low carb and have a reward meal which consists of carbs. They say you can do any meal as a reward meal with carbs but I found that if my breakfast or lunch included carbs it would spike my blood sugar. If I ate the first two meals of the day low carb and had my reward meal at dinner it didn’t spike and only went up a little bit. Carbs are tricky and you have to slowly reintroduce them. You will know you are off track if your appetite goes way up and you want more and more of them. If you add them and your appetite is able to be controlled you are onto something. Also GTF chromium is a good mineral for blood sugar control. Just be careful taking it if you already take a prescription like metformin.

      • says


        I’m sure you’re posting with the best of intentions. Moreover, trying to help others who might be in a rut. Kudos on that score.

        But, at a point, one has to wonder, why all the trouble? Should eating be so hard and complicated? How come animals in nature aren’t all obese, diabetic, suffering all manner of malady? Could it be that they aren’t capable, as humans are, of subjecting themselves to unnatural interventions?

        I submit for your consideration a different perspective because I don’t think it’s all that surprising that LC diets are often associated with marvelous honeymoons, even decent early marriages. Unfortunately for many (…truly unfortunate, because my personal proclivity would just be to eat huge grilled ribeyes with tons of browned butter—but that’s not a regular availability found in nature). But for so many, this marriage fails.

        “Stalling” in Wheat Belly and LC Weight Loss After Amazing Strides”


        Here’s a comment I just got today on that post:

        “My story almost exactly. I started with the 4 hour body back in late 2011. I should have stuck with. Richard – I’d love for you and Tim Ferriss to have a chat about this whole thing. I was pounding beans along with protein and veggies and eliminated any food that was white. I went from 225 to 205 in about 4-5 months. Won a biggest loser contest at work! I was 43 yrs old and hadn’t been that weight since I was 20. I then discovered Paleo which outlawed beans and I wanted to drop below the 200 lb marker and I thought – wow- din’t know beans were so bad for me. Took them out and went even more low carb for about 2 years Guess what? Pounds started coming back. I am now back at 225. Here is the bio marker that really gave me a clue something was weird. My thyroid markers – TSH in particular went from 1.5 to 3.5 to 5.5 to eventually 9.0. My wife kept saying – why are you so tired? I started going to an endocrinologist a few months back and she put me on a low dosage of armour natural thyroid and things are better on that front. I also have low testosterone (~325 total). I was on chlomid for 18 months and it was awesome. Levels back up to 700 and other things back up (wink wink) and my mood was so improved. I don’t think that (Low T) is getting enough chatter on this blog as I think men in their 40s who have sat behind a desk for 25 years (like me) are not the same type of 50 years ago (like my dad who was an auto mechanic) who largely did manual labor all day and their T levels rose naturally based on their exertion levels. Low T does lots of things that mimic low thyroid and I think they are kinda connected. So I hope that as my thyroid comes back in shape by adding back beans and resistant starch and armour I will see my T levels go up – if not then I will need to address my low T. Thanks Richard for bringing this topic about stalls on LC to the forefront.”

  27. “Something is Bugging” ME says

    September 16, 2014

    Dear Chris,

    Thank you! Thank you! Thank you!

    YOU have been a LIFELINE for ME! I have met you and asked questions at “Your Personal Paleo Code” book signings/dinner in Berkely, CA and here in Portland OR, where I currently live. I am impressed with your work and have enjoyed your book and many articles since. You often “hit the nail on the head” as you have just now.

    I have been on a VLC Paleo diet for about a year. At first I felt GREAT…but now I am sick…and find that it is doing me more harm than good. Why?

    I am now presenting with hypothyroidism (T4-T3 conversion), adrenal fatigue, and SIBO. My liver is unhappy. So am I. I am not by nature a sad person.

    Hypothyroidism: I have never had this problem before. I am being told it is from stress, age, and/or hormonal changes. All apply, but this alone doesn’t make sense to me. Your article about being on a VLC Paleo diet for a long time does! I am a somewhat vain, attractive woman, but have now lost half my hair! My scalp is dry, flaky, itchy (no fungus), and I am often so tired I just want to sit in a chair all day. I am not by nature a sedentary person who prefers to stay home. Even so, I have lost 30 pounds, and am now too thin (Yes…too thin!) now at 5’9” 125 lbs.

    Adrenal fatigue: I have no energy for anything. Burnt out! I do not exercise too much. I walk briskly, do Yoga, or bike about 45 minutes to 1 hour daily…at best…when I am not too tired.

    Bugs: SIBO test results have been “off the charts” with astronomical numbers!!!

    I tested positive for the parasite Blastocystis Hominis recently, and about 25 years ago…when I was given about 3 courses of antibiotics…yet chronic diarrhea persisted. Dismissed as a “misdiagnosis” because I had not traveled to a third world country (Do New York City kitchens count?) I was ultimately diagnosed with IBS (irritable bowel syndrome)…a.k.a. “stress induced head case!” Yes, but what about the bugs?

    Blastocystis Hominis is now dead and gone. A good start!

    Treatment: I was put on Armor thyroid (We keep upping the doses!) and targetted SIBO antibiotics, while doing SIBO testing, since April 2014. It is now September!!! 6 months and at least 8 (14 day) courses of antibiotics with a week of SIBO testing in between! I am also treating hypothyroidism and SIBO with diet. I am on a strict (No FUN!) SCD low FODMAP (Dr. Siebecker), Paleo diet. I have to prepare and eat all my meals at home. I have a very limited social life…always having to eat before events. I would love to go out to eat with my husband here in Portland, OR (Food Mecca!) but cannot trust the restaurants even here! This is stressful and makes me sad.

    At first my numbers were going down nicely…but now, as I have added more whole food carbohydrates to my diet (e.g. organic, ripe bananas, coconut milk (no BPA or guar gum), coconut, currants, fruit, nuts, honey, butternut squash, zucchini, etc.) to improve the hypothyroidism and adrenal fatigue, the SIBO (methane/hydrogen) numbers are once again climbing!

    The good people (naturopaths) I have been working with for about 6 months do not understand all this and/or know what to do next, even though I give them your articles. “Man with meat seek fire!” They see so many people; all on different diets…and have little understanding of Paleo. I agree with you, there is not ONE Paleo diet that fits all. I also realize that ultimately…I am the one who needs to solve this problem! I cannot, however, do it alone. I need good help.

    Is it possible that I am not absorbing fructose well, as some of your articles have discussed? I have requested a test to determine this. What do you think is going on? If so, how do I up my whole food carbohydrates, without fruit (fructose) to treat the SIBO and hypothyroidism at the same time? I don’t want to take thyroid replacement pills…especially when my actual thyroid gland is fine!!! (No Hashimotos)

    Can YOU please come here to Portland, OR to treat me? I am (only mildly!) kidding. I get YOU are too busy (famous now!)…but can you refer me to someone like YOU in Portland, OR who “gets” this stuff? I can’t go on like this!

    Did I mention it all has me depressed? AND…it didn’t help that Robin Williams, one of my very lovably human heroes, offed himself this Summer! Though I have maintained my excellent sense of humor throughout this food/bug journey…long term chronic sickness with depression is no laughing matter. HELP!!!

    Your admiring fan in need,

    “Something is Bugging” ME

    • Martha says

      A starvation protocol is probably not the easiest approach to fixing SIBO (not saying it doesn’t work if stuck to religiously). Siebecker’s own site describes it as a starvation protocol and says: “Dietary Treatments for SIBO…as the main treatment for SIBO, without antibiotics or other treatment. Diet alone may reduce bacteria, just at a slower rate than antibiotics. 1 1/2 years up to 3+ years is usually needed.”

      Basically you are putting yourself on a weak antibiotic (i.e. starvation) for 1 to 3 years. I realize some people need this, and I’m not trying to criticize Siebecker, but starvation doesn’t work for everyone.

      Have you read Dr. Grace/BG’s “How to Cure SIBO” series? That’s a far quicker approach, that just sweeps the bacteria out of the small intestine. Dr. Grace prefers to focus on feeding the immune system, not starving it.

  28. Robin says

    I’m 58, female, and have had many health issues since having an emergency hysterectomy in my 30’s. Gallstones, kidney stones, candida, rosacea, osteopenia, migraines, and pre-diabetes to name a few. I’ve been losing hair at an alarming rate for a couple of years, and recently have beginning Parkinson’s symptoms (although my neurologist won’t diagnose it yet.) I read “Grain Brain,” and have gone low carb, my weight is down (although I’ve always been thin), and my neurological symptoms have leveled off, but not disappeared. However, my hair loss is even more severe, and, while my brain fog has improved, I feel weak as though I’m not getting enough fuel. I’m confused and afraid to add carbs back in due to the Parkinson’s symptoms. Does anyone have any experience with low carbs and Parkinson’s improvement or at least control of symptoms? I’m so hungry!

  29. Hawaiiana says

    Excellent article. I would say that while many prior cultures may have thrived on relatively high or seasonally high carbs, massive amounts of SUGAR (in all its forms) has irreversibly changed our metabolism (and even the microbiota), which is what has made very low carb diets now necessary. High or seasonally high carb diets were fine before, but SUGAR came in and changed everything.

    • Mr. Gutman says

      That’s quite an oversimplification. Sugar has been around since about 8,000 B.C.:


      The mass production of sugar contributing to a large portion of the modern diet is just one piece of the puzzle. Antibiotics, lack of fermentable fibers, lack of fermentable foods, lack of flora diversity, over-sanitized lifestyles, gluten, all contribute to problems in the gut.

      VLC is simply one therapy option. Not necessarily ideal for everyone. There are other approaches. Whole food moderate carb diets appear to work quite well for a wide range of health issues.

      VLC can certainly be therapeutic. However, VLC is also a starvation protocol for the microbiota. It’s not really intended to bloom a healthy/robust microbiota as VLC does not provide a diversity of prebiotic fibers.

  30. Libby says

    I’m currently doing a program that eliminates grains, sugar and processed foods. Been doing it for about a year and 3/4 and can say for the most part it’s been good. I’m overweight to be sure…BUT I’ve only lost between 20 and 30 lbs on this then stalled. My metabolism in my opinion was ruined years ago by yo-yo dieting. Doing anything extreme…be it low fat or low carb hasn’t worked for me. I have several auto-immune issues going as well. BUT in doing what I’m doing I have lost 3 clothing sizes and gradually my labs have improved and I do feel better. Just a little frustrated though as I think I could be doing better.

  31. Aimee says

    Thanks for the article, it confirms my own experiences which are that every body is different and so every person must find his or her own best diet. I am a 56-year-old woman. In my case, very low carb with moderate protein and high fat does the trick. I had to find this out myself, using what I read as a guide only and tweaking from there. I found that my body quickly learned to turn protein into glocuse so for me the key has been upping my fat intake (this was hard to get my mind around!). Once I did this my body immediately started burning fat (i.e. mild ketosis whithin 2 hours). The result for me is slow but steady fat reduction, moods that remain even throughout every day, sleep that is deep and restorative and real energy when I need it but that does not have me bouncing off the walls. Zealots be damned, I’ll do what works for me.

    • Michele says

      Can you please elaborate (or anyone else) what you mean when you upped your fat intake. I eat butter but no other dairy, eat meat with fat on it (although not grass fed), and cook in coconut oil and use olive oil in salad dressing. Other than that I need to up my fat but not sure what that would be. Thanks.

      • Tom B says

        Michele, I think her point is you can help nudge your body into ketosis by increasing fat intake. It doesn’t have to be a lot of fat and all the things you mention are good. Just use fat naturally in the way that it enhances the flavor of food. Generous butter or olive oil on veggies for example. Eggs are great. Soft cheese is high in fat and probably good. All things in moderation.

        If ketosis is your goal, I’d recommend buying keto sticks at Wal-Mart. Eventually you’ll know what ketosis feels like but initially it’s helpful to have the confirmation.

        Long term, especially if you are at a the weight you want to be, there’s no great need to stay in ketosis, the goal might be simply to be “keto-adapted” which means your body is geared up to burn fat but it can also burn some carbs at the same time. Some people would argue it’s better to have carbs in your life; I don’t think there is proof but the arguments (such as Paul Jaminet’s prescription to consume a little bit of starch) in some ways make sense.

        There is abundant scientific data that low-carb high fat is a good way to go and by implication that ketosis is really good for you. However exactly the right way to do it — not a lot of data. And even if there were a lot of data, it may well be the sort of thing that is different for every person.

        We all need to be scientists and pay attention to how our bodies respond to different habits of eating/fasting. If you lose weight, that is data. If you feel more alert, that is data. If your blood lipid profile is better, that is data too.

        • Tom B says

          ..and I hasten to add, the Atkins philosophy is really sound. Atkins is not a set diet for everyone, and it is also not a permanent very low carb regimin. It is about finding the right level of carbs for each person, which is going to depend on body chemistry, level of exercise, health of pancreas and insulin regulation system, liver function — lots of things. You can be following Atkins and eating 120-150 grams of carbs a day once you have reached your desired weight.

          • Matt says

            People here are forgetting that Professor Thomas Seyfried has recommended a VLC or ketogenic diet that is very moderate on protein intake. While Atkins was great, too much protein causes a host of issues.

            Also, it is entirely safe to assume that our bodies can be moved from using carbs or fat as fuel.

            Many of these studies that are cited seem to show correlation, not causation. The one about how people who consume the most fruit have the lowest incidence of diabetes is nice, but that could just be because those people are more aware of processed foods, don’t eat BPA (a known fat-storage inducer), and/or pay more attention to health trends. I like the stuff I’ve read about the Ketogenic diet because they use physical research about actual mechanisms in the body, not just vague testimonies in which a host of issues like BPA consumption, activity levels or calorie counting are not even taken into effect.

            Long story short, if you restrict your protein intake, get nearly 80-90% of your calories from healthy fats, and still consume leafy green veggies with some resistant starches or fermented foods, then you should be able to have a perfectly healthy, long-term experience on the VLC or ketogenic diet.

            • Tom Boyer says

              Excessive protein intake probably accounts for a lot of the symptoms reported on this thread.

              The problem with discussing Atkins is there is a huge difference between “Atkins” the myth (perpetuated by vegans and carb afficionatos) and official Atkins as recommended by the Atkins Foundation. That’s why people think Atkins is all about butter, steak and pork rinds. It’s not.

              Even in the “induction” stage of Atkins which is most aggressive, the diet INSISTS on 20 grams a day of carbs, mainly from vegetables. In fact the Atkins book says you lose weight faster on 20 grams than if you try to do 0 grams. So there’s that.

              But the second point about the real Atkins regimen is that after induction, it is all about adding back in carbs, mainly from vegetables, fruits and nuts until the person reaches the level of carb consumption that their body can handle. It is different for every person. Atkins is VERY pro vegetable and there are vegetarian/vegan Atkins menus.

              I think for an obese person, the risks of obesity are so high that you should do whatever works to lose weight. But once you’re at a healthy weight, there’s no need for a ketogenic diet.

              People still freak out about ketosis probably because it’s such a mysterious sounding word. All ketosis means is that you’re burning fat. And I think most people would agree that some burning of fat is desirable for virtually everybody from time to time.

              If you are obese, ketosis is by definition the only way you’re going to lose weight. So don’t be afraid of it. It
              is the ONLY path to a healthy weight.

              You can get to ketosis on a low fat diet by severely restricting calories, or you can there with unlimited calories but severely restricting carbs. The second option works better for a lot of people because the person isn’t walking around feeling like they’re starving. But your mileage may vary.

              Regardless of how you get to ketosis, it will feel weird sometimes, but most that weirdness is simply that your blood pressure has dropped significantly because eliminating carbs means a LOT less retained fluid. Going low carb is like taking a water pill.

              For most people the lower blood pressure is good, and your body adjusts over a number of weeks. But in the meantime salty liquids (we just drink chicken broth with extra salt sprinkled in) helps you feel better almost immediately.

        • Michele says

          Thank you Tom. No, I don’t want to go into ketosis. I have bought the keto urine sticks but haven’t tried them. Just wanted to make sure I wasn’t in ketosis, which I think I was originally with 40+ ketones showing on a standard test in March (and that may not even mean ketosis but I had extreme brain fog and losing too much weight on the VLC eating). I don’t want to lose any more weight. Just want to stop losing weight and get a little more energy without adding too many carbs. I think all the fat I can add would be good..

          • Duck Dodgers says


            A similar thing happened to me when I went VLC two years ago and lost too much weight while getting massive brain fog. It was debilitating. It was this Paul Jaminet’s analysis that finally got me on the road to recovery:

            From: Paul Jaminet:

            Low-carb diets generally improve immunity to bacteria and viruses, but not all is roses and gingerbread.

            Low-carb diets, alas, impair immunity to fungal and protozoal infections. The immune defense against these infections is glucose-dependent (as it relies on production of reactive oxygen species using glucose) and thyroid hormone-dependent (as thyroid hormone drives not only glucose availability, but also the availability of iodine for the myeloperoxidase pathway). Thus, anti-fungal immunity is downregulated on very low-carb diets.

            Moreover, eukaryotic pathogens such as fungi and protozoa can metabolize ketones. Thus, a ketogenic diet promotes growth and systemic invasion of these pathogens.

            As the fungal infection case studies on our “Results” page illustrate, low-carb dieters often develop fungal infections, and these often go away with increased starch consumption.

            Another issue is that mucus is essential for immunity at epithelial surfaces, and glycosylation is essential for the integrity of cellular junctions and tissue barriers such as the intestinal and blood-brain barriers. Thus, reduced production of mucus can impair intestinal immunity and promote gut dysbiosis or systemic infection by pathogens that enter through the gut.

            Finally, a very low-carb diet is not entirely free of risks of gut dysbiosis, and not just from fungal infections. Bacteria can metabolize the amino acid glutamine as well as mucosal sugars, so it is not possible to completely starve gut bacteria with a low-carb diet. Nor is it desirable, as this would eliminate a protective layer against systemic infection by pathogens that enter the body through the gut. As our “Results” page shows, several people who had gut trouble on the very low-carb (and generally excellent) GAPS diet were cured on our diet.

            I researched what Paul mentioned in that quote, and found a lot of research to support what he was saying.

            Fighting candida turned my life around and I’m forever grateful for Paul’s work.

            I suspect what determines whether people feel better or worse on a specific diet has more to do with what class of pathogens they have in them. So, it can be a kind of diagnostic tool. Paul mentioned this on a podcast here while back.

            Good luck.

          • Tom Boyer says

            Michele, if you want to stop losing weight (a really nice problem BTW), don’t add fat, add carbs. It may not really matter what carbs you add back — whatever you prefer.

            I would again recommend you read the “New Atkins” book by Eric Westman, which is very authoritative. Atkins has a lot of methods for adding back carbs and calibrating it so you don’t just put the weight back on that you work so hard to lose.

            I personally would start adding back some roots — sweet potatoes, parsnips, onions, then yellow potatoes — then moderately low sugar fruits — tomatoes, berries, apples. Then if you’re still losing weight, start adding in grains and legumes — wild rice before white rice, quinoa, French lentils, wheat (if possible, non GMO ancient wheat varieties like spelt). Some nuts if you are okay with them — walnuts and almonds are great.

            If you are STILL losing — you can open the door to sugary fruit like bananas, or grain products like beer, or pasta and bread. But I can’t eat much of those before my waistline starts to expand.

            The more carbs your body can tolerate without gaining weight, the more freedom you have to eat a wider variety of carbs.

        • Katy G. says

          “(such as Paul Jaminet’s prescription to consume a little bit of starch) in some ways make sense”

          Actually, Jaminet doesn’t prescribe “a little bit of starch.” He prescribes a rather large volume of starchy vegetables, but it only translates to a moderate level of actual carbs.

          Jaminet says 150g of carbs as some fruit and starchy carbs to help cure most health issues. It’s classified as a moderate carb diet, but few realize that it translates to a pound of starchy vegetables—which are mostly full of water when cooked. If you only ate a “little bit of starches” as your only carbs, you would likely be VLC.

  32. says

    very good and interesting article. Personally, I am in keto-state almost 4 months a was in also at the beginning of this year. This state is very helpful for me and I am professional soccer player in first czech league (Synot league).

    But I think it is very individual and someone doesn´t need ketogenic or low-carb-diet. You could mention Weston Price and his works as proof. But as you wrote, kind of carbohydrates is very important. It is difference to eat vegetables, fruits, tubers and some legumes and maybe grains, and eat refined carbohydrates. Also quantity of calories matter, because Okinawa, Kitava etc eat low calorie diet.

    From my point of view, one of most important things is fat metabolism most of times so that mitochondria was healthy and don´t overcome. But they can be overdose also by very high calorie high fat diet, so moderation is key. For example, herbivors like cow, sheep, goat and some monkeys are also in fat metabolism despite very high carb diet because of fermentation of food in stomach.

    Have nice day :)

  33. Liz Norman says

    Hi Chris -I am 70yrs old and have spent 55yrs yo-yoing between 10st and 16st most commonly just under 15st. I must have joined various slimming clubs nearly 200 times without succeeding. Last year I discovered the low carb way of eating and whilst I am still losing (about 35lbs so far ) I have settled for about 50-60g carb because I like fruit and veg too much to be under that. The carbs are about 15-20% of my intake. I never eat any added sugar nor grains except the occasional rye crispbread. I could live like this forever! Loved the article.

  34. says

    Hi Chris et al:

    You briefly mentioned that your experience suggests that low-carb diets can be incredibly effective therapeutic tools for traumatic brain injuries. As someone who’s recently suffered a rather severe TBI, I was hoping you could elaborate on any effective therapeutic tools you were aware of, or point me in the direction where I could learn more. thanks, pete

  35. Mr. Gutman says

    The whole carbs-cause-obesity-so-don’t-eat-ANY argument is over-simplistic for a complex problem. Many people and many entire cultures can eat high levels of complex carbs and never gain weight. With gut bug genes outnumbering human genes 150-1, the evidence seems to point to a wrecked gut biome as being a likely cause for carb intolerance in the modern world.

    Take poop from a lean mouse and put it in an obese mouse, and you get two lean mice. Wake up people!

    Chronic diseases, such as diabetes, are being linked more and more to gut health. Instead of giving up carbs forever, you’d *think* people would take their carb intolerance as a sign that things are not working properly in the gut.

    Nope, it must be the carbs they say — gotta give them up because somebody figured out a way to starve themselves of a macronutrient without being hungry and that’s the new gospel.

    • says

      “With gut bug genes outnumbering human genes 150-1, the evidence seems to point to a wrecked gut biome as being a likely cause for carb intolerance in the modern world.

      “Take poop from a lean mouse and put it in an obese mouse, and you get two lean mice. Wake up people!”

      And so on…. Spot on. Moreover, from that Cell paper that Chris mentioned and I summarized here (from the full text, not publicly available)…

      Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates


      “A single human gut can contain upwards of 60,000 carbohydrate-degrading enzymes…compared with the human genome with about 17 glycoside hydrolassss and no polysaccharide lyases involved in carbohydrate digestion in the gut.”

      And by the way, my promotion of resistant starch is just one piece of the gut biome puzzle. In the book I’m currently writing that’s over 400 pages, 2,000 references—many from 2013 and 2014—and 18 chapters, resistant starch is exactly ONE chapter. So, yea, total “zealotry.”

      As for anecdotes, there’s nearly about 120 billion of them, the estimated number of humans that have ever lived. A minuscule percentage of them ever practiced a VLC/Keto diet, the evidence is overwhelming that the vast majority of them consumed plenty of whole-food carbohydrate, and yet we’re here and a most successful species at that.

  36. Chris says

    Great work, Chris. It would be very helpful to me (and I’m sure many others, based on the frequency that I’ve seen this issue pop up) if you could provide some insight into why low carb diets can cause sleep disturbances in certain people.

    For example, when I go on a keto or VLC diet, I fall asleep easily, but continually wake up every 30 minutes starting at 4am (5 hours into my sleep); I never get back into a full sleep cycle. The next day I’m dragging and my memory falters (although I feel “alert”; maybe it’s ketones + cortisol?), go to sleep with a sleep debt, and the cycle repeats. Note that I’m not in a caloric deficit when this happens, and I’m taking in ~120 grams of protein, 20 – 100 grams of carbs, and the rest as fat.

    I also notice that my fasting blood sugar goes up from 85 (when I’m eating 150-300 grams of carbs) to 115 while in ketosis or low carb, and my low-carb postprandial blood sugar DECLINES to ~95!

    People have pointed to low carb possibly inducing high cortisol, physiological insulin resistance (is this even healthy?), a lack of serotonin -> melatonin, and everything else in between.

    Do you have any ideas? A quick bit about me: I’m 8% body fat, muscular, lift heavy weights or do cardio 5x /week. I’m intrigued by ketosis because of the potential improvements on cognition, but not for weight loss – I’m content with my physique.

    Thanks, and keep up the excellent work!

  37. ieva says

    I went low carb for one year when I was 20 years old. Ended up in a psychiatric hospital. Low carb diet made me extremely depressed, anxious and exhausted. And this is when my vitiligo appeared… Now I eat fruit almost every day, lots of potatoes, tubers and rice and my mental health is better than ever! Low carb is really not for everyone. I personally do well when I eat protein rich breakfast or fast instead and eat carbs for lunch or diner.

  38. Anita Abrams says

    With my physicians support, I’ve done lowcarb off/on for 20+ years. I’m 69 years old and had strayed from the plan for a few years. My caring and informed doctor encouraged me to go back to a lchf plan to manage the weight I’d gained and my increased BP and cholesterol values. After 8 months I’ve lost 55 lbs and my BP and cholesterol values are excellent. I do use potato starch daily and drink 8 oz of homemade kefir as well. I’ve never felt so good in all my life!!! I agree that lowcarb isn’t for everyone by it sure works for me. Thanks for your interesting article.

  39. says

    Chris, you mention “traditional Okinawans” as having health and longevity on a high-carb diet, but your sentence is a little misleading, because you don’t acknowledge that most of those carbs are rice! The Paleo concept, that 8-10,000 years of eating cultivated grains is not long enough to adapt, isn’t perfect.

    • Finny says

      Are you sure about that or are you just making an assumption?

      The data and references on Wikipedia say otherwise:

      “The traditional diet of the islanders contains 30% green and yellow vegetables. Although the traditional Japanese diet usually includes large quantities of rice, the traditional Okinawa diet consists of smaller quantities of rice; instead the staple was the purple-fleshed okinawan sweet potato. The Okinawan diet has only 30% of the sugar and 15% of the grains of the average Japanese dietary intake…The dietary intake of Okinawans compared to other Japanese circa 1950 shows that Okinawans consumed: less total calories (1785 vs 2068), less polyunsaturated fat (4.8% of calories vs. 8%), less rice (154 grams vs 328g), significantly less wheat, barley and other grains (38 g vs. 153g), less sugars (3g vs. 8g), more legumes (71g vs 55g), significantly less fish (15g vs 62g), significantly less meat and poultry (3g vs 11g), less eggs (1g vs 7 g), less dairy (<1g vs 8 g), much much more sweet potatoes (849g vs 66g), less other potatoes (2g vs 47), less fruit (<1g vs 44g), and no pickled vegetables (0g vs 42). In short, the Okinawan circa 1950 ate sweet potatoes for 849 grams of the 1262 grams of food that they consumed, which constituted 69% of their total calories.”


      • blaine says


        Correlation is not causation. Yes the Okinawan diet is sweet potato rich but might there be another possible explanation for their long lives?

        How about body size?

        The average Okinawan is considerably shorter than mainland Japanese and one of the shortest human beings on the planet. Think pigmys.

        “The Okinawans are shorter and weighless than mainland Japanese, and men aged 87 to 104 years average 145.4 cm (4ft 9 in) and 42.8 kg (94lb).”

        Okinawan women are even smaller.

        Could the reason Okinawans eat so little have anything to do with the fact that they are tiny?

        The average American Male and Female is nearly twice the size of your average Okinawan.

        I’m not saying diet is not a factor but it may not be the only factor.

        It’s just a fact that toy poodles live longer than Great Danes even if they are eating the exact same diet with the only difference being the quantities eaten.


        Samaras TT, Elrick H. Height, body size and longevity.Acta Med Okayama 1999;53:149-169.

        It’s amazing to me how many health advocates and scientists who love to quote “Okinawan” diet statistics to make a point completely ignore the elephant in the room.

        • Finny says


          Very interesting. However, maybe you should re-read my comment as I never said they lived longer “because” of sweet potatoes. You put words in my mouth.

          All I did was point out that they didn’t eat a lot of rice, but rather they ate a ton of sweet potatoes.

        • blaine says


          I apologize. I was in fact putting words in your mouth but please understand I was also responding to the post you were commenting on that referred to the Okinawan diet’s health and longevity benefits.

          The only reason anyone ever brings up the Okinawan diet is to make the case that it leads to longevity.

          Google, “Okinawa Diet” and “Longevity” and you will find over 7,500 hits. The most frequently viewed have titles like “The Okinawa diet, the key to longevity and living to 100.”

          Usually the Okinawa diet is hijacked to promote a vegan or vegetarian agenda.

          The same Wikipedia article you site that documents Okinawans eating more sweet potatoes than rice also reports Okinawans eat twice the amount of pork as main Island Japanese.

          Granted, it’s still not a lot of pork but it is an inconvenient truth for those beating the Vegan and Vegetarian drum.

          There is a lot of scientific support that longevity is tied to size. Short people, on average, live longer than tall people, even taking into account confounding variables.

          It’s why vegetarians rarely point out elderly Okinawan men are on average 4′ 9″ tall and weigh 94 pounds. Not realistic role models unless you are five inches shorter than Mickey Rooney who lived to 93.

          Here is a link to a very large study that indicates shorter American men of Japanese descent live longer than taller Japanese American men and the FOX3 gene may be responsible.


          Shorter Men Live Longer: Association of Height with Longevity and FOXO3 Genotype in American Men of Japanese Ancestry

          PS: And no, I’m not accusing you of being a vegetarian or putting words in your mouth. I’m using this as a teaching moment.

          • Finny says

            I think the take away is that eating lots of sweet potatoes doesn’t predispose Okinawans to obesity or an early death.

            It’s very interesting that short people live longer. I wasn’t aware of that!

            Though, while we are on the subject, I have also heard theories about some tubers being particularly high in certain health-promoting compounds — rather than just the bags of sugar that low carb advocates make them out to be. For instance:


            Maybe it’s nothing, but my guess is that there are dozens of phytonutrients and compounds in tubers that mostly go unnoticed.

            Anyway, the only point I was trying to make is that they don’t eat as much rice as mainlanders and they ate a heck of a lot more of their Okinawan sweet potatoes. And yes, they are shorter!

            • blaine says


              My own guess (and it’s only a guess) as to why Okinawans live so long is they eat a relatively spicy whole foods diet; they haven’t historically eaten much in the way of processed foods and sugar, they use lard to cook with rather than manufactured vegetable oils and… they are tiny people with a longevity gene… at least the ones who make it to 100.

              Okinawans have had thousands of years to evolutionarily adapt to eating sweet potatoes so I’m not surprised they are well adapted to eat them anymore then I’m not surprised by the people in the seven separate geographic areas of the world that evolved lactose persistence to digest and thrive on dairy.

              Also, anyone who is 100 years old today on Okinawa went through decades of severe calorie restriction during World War 2 and the decades that followed. Modern processed foods simply weren’t available at all for the first half on a current centenarian’s life

              Some animal studies have shown calorie restriction may extend life although those studies have come into question in recent years.

              I think it actually comes down to the fact that toy poodles live longer than Great Danes and Shetland Ponies live longer than Clydesdale Horses even though the only difference in their diets is the quantities they consume.

              Darwin made the observation 150 years ago that domestic animals that were kept in pens and not worked grew bigger and less healthy then their wild counterparts.

              Sounds to me like he was saying we need to eat less and move more to be healthy.

              • Finny says

                Very interesting, Blaine!

                But, of course, Okinawans aren’t the only culture with high longevity. There are others.

                The “Blue Zones” are:

                Okinawa, Japan

                Sardinia, Italy

                Loma Linda, California (7th Day Adventists)

                Nicoya Peninsula, Costa Rica (Hey, they’re short, too! But also eat lots of rice, beans and maize)

                Icaria, Greece

                Funny, the one thing they all eat is legumes.

                • blaine says

                  Every single “blue zone” area you mention has a similar climate range year round and they are all either islands, or coastal area populations. (Costa Rica is a bit hotter with more rain)

                  One thing is certain, none of them have snow. All have lots of sunshine and the vitamin D that goes with it.

                  All blue zone areas.except California have shorter than average populations but Seventh Day Adventists “Loma Linda” are less likely to drink alcohol, smoke, do drugs and consume caffeine which includes most sodas and the sugar that goes with it. Sodas are the number one source of sugar and excess calories in the American Diet.

                  SDAs encourage exercise and are also less likely to engage in many other risky behaviors of the general population.

                  Many SDAs are lacto-ovo vegetarian which is a whole lot better diet than the SAD diet.

                  I am not saying it’s not legumes that are responsible for the blue zones but there are certainly other potential reasons for the longevity found in these areas.

                  You will notice on the Seventh Day Adventist Ven diagram to promote their vegetarian, “plant based” diet that population height, climate and proximity to the sea are all left off.

                  Why would they want to include these other commonalities that could distract from their agenda and the conclusions they want people draw.


                  I’m not saying it’s a deliberate oversight but if I can see other similarities in Blue Zones, you wonder why they couldn’t.

                  As far as I can tell the Seventh Day Adventists are the only vegetarians in the blue zones and none are vegan.

                  Both Okinawans and Costa Ricans consume a lot of lard, other wise known as pig fat, which I suspect isn’t something SDAs want to talk about.


                • Finny says

                  Again, very interesting! I’m aware of the SDA biases. They fudge their data to make vegetarianism look better than it is. I get it. I know all about it. But I’m not talking about vegetarianism and don’t care about it. We need meat and fish. Let’s move on.

                  All I’m saying is that these cultures aren’t afraid of eating complex carbs alongside their meat/fish and they do very well on their balanced diets. You can say that they are adapted to eating complex carbs, but most People of European descent come from a very long ancestry of carb adaptation.

                  There isn’t any evidence, as far as I can see, of complex carbs causing diseases in the traditional cultures that ate them. If anything, they seem to thrive on them.

  40. Helene says

    I’ve been diagnosed with Lipedema and have read that weight loss diets don’t work with this condition. I have been on a diet forever. Desperately need to lose weight. Got the book about diets for Apple and Pear shapes. It is suggested in the book that Pear shaped people need to eat every 3 hours and eat a diet high in complex carbohydrates. Then I got a video which said “Butter makes your Pants fall down” suggesting a diet low in carbs and high in protein and fat. The results shown were nothing short of amazing. I am totally confused. Help!! I am 67 years young and very healthy except that my weight is affecting me. Need to lose 30kg. I would appreciate any help from anyone who has this condition and has had success losing weight, particularly below the waist. Thanks in anticipation

    • Tom Boyer says

      Helene, three good starting points would be

      — the “New Atkins” book edited by Dr. Eric Westman of Duke University. Scientifically mainstream and reflects the wisdom of 50 years of patient experience with low-carb. Atkins is NOT a butter/meat diet and it is not no-carb. It is about finding each person’s individual threshold for handling carbs.

      — dietdoctor.com — a blog by Dr. Andreas Eenfeldt, a Swedish physician who has championed low-carb in that country. His blog is so popular around the world it is translated into other languages now. It’s a mixture of advice, discussion of the science and stories and pictures from people who have used carb restriction to lose weight and restore normal metabolic function.

      — Why We Get Fat by Gary Taubes — the clearest explanation there is of the insulin hypothesis, why low-carb tends to work so well for overweight people.

      Westman, Eenfeldt and Taubes all have great reputations. They are all advocates for low-carb, but their writing is pretty clear about what is supported by the science and what is not.

  41. Mary says

    The wheat in today’s market is a very different plant from what was around in even 1900. I saw one article that said the way wheat was altered is more drastic than GMO modification is.

    Try at least reducing your consumption and notice any differences you do (or don’t) feel.

    Some flexible doctors recommend elimination diets to find out who the bad and good guys are for YOU.

  42. Debbie says

    I laughed when I read your intro to this. And it’s so interesting how we’re all so attached to our beliefs, and how although we say the point of talking about all this is to get at the truth, we don’t always want it when it contradicts our beliefs. And it’s so interesting the way really this is about beliefs and not truth or science. It’s almost political. And we want a label, we want to belong to a group! No wonder “Paleo” has taken off – really it’s not that different from Weston Price’s ideas, or Atkins’ but for lots of reasons it’s taken off and it’s cool. And it’s great – but, as you say, there is a risk of ending up as insular as the vegetarians. Great article!

  43. says

    One of the biggest challenges with untangling from the Debate and moving into Self Experimentation…is the way our human brains (don’t) deal (well) with delayed response.

    I mean, obviously, if eating a candy bar threw a person into anaphylactic shock, they wouldn’t eat it any more. But we’re talking here about responses to diet that can take years or decades to manifest…so when we try any new Diet, it’s easy to focus on the short-term effects, and very difficult to figure out what is going on, metabolically, and what _might_ happen, if we continue on a particular path.

    What I’m trying to say is: even if a diet is or isn’t good for us, it’s sometimes hard to tell.

    When my son was six, and suffering from worsening symptoms of anorexia and autism-spectrum-disorder, we were eating a Whole Foods Vegetarian Diet. I am certain that our switch to a low-carb, GAPS-type diet was very important to his survival, and incredibly increased health…OVER TIME (the next two years). In the short term, he reacted horribly, and was really, really sick. By the time he started getting healthy, it was easy for me to get stuck on the idea that he would “need” to eat this way forever, in order to get more and more healthy. (I was thinking this way even despite what Natasha Campbell-Mcbride, who originated the GAPS protocol, says about GAPS being a short-term, gut-healing protocol: http://chriskresser.com/7-things-everyone-should-know-about-low-carb-diets ).

    Over the past nine months, we have been transitioning to a much higher-starch, “PHD”-style diet, with an emphasis on resistant starch: http://www.lifeisapalindrome.com/updates/thinking-about-gaps-resistant-starch-and-beyond . This is a very good thing, at this point, I think. I _don’t_ think we could have eaten this way at the beginning of my son’s healing path, although I think that if I hadn’t been so wrapped up in his challenges, I should have switched up my own diet sooner. (VLC was initially super helpful for my hormonal issues…but then I experienced some horrific mood issues, possibly as a result.)

    Anyway…the journey continues. Adding more starch has helped a whole lot of things, and it has also uncovered new challenges. When I am playing scientist, I am fascinated and interested and want to read and read and understand and experiment. When I am feeling like an exhausted mama-of-three…I just wanna have us all feeling good, all at the same time, for once!! At these latter moments, popping a Perfect Human Diet Pill sure sounds appealing…

    Thanks so much, Chris and Laura, for these food-for-thought articles. I really appreciate them, and all the comments.


  44. T. says

    I tried the paleo diet when it first became “all the rage”. I am a small 100lb female. I was pretty strict for a month, ate absolutely no grains or sugar, but still ate sweet potatoes. Guess what happened? I lost my menstrual cycle. I don’t deny that a low carb diet can help some, but for me it obviously wasn’t healthy. It took me a few months of eating good ol’ white potatoes, brown rice, beans, quinoa, corn, and even (gasp!) bread and sugar to get my menstrual cycle back. I unashamedly eat carbs.

  45. PC says

    I’ve also found that I do better with a higher carb intake. On low carb I had very little energy, blood sugar crashes, problems with attention and focus, and adrenal issues. I am more functional and productive when I eat more carbs, able to think more easily, and feel happier and more positive to boot!

    I always worry that the crabs are killing me and I’ll get dementia….because of books like Grain Brain…

    • Mary says

      Dr. Perlmutter has some valid points about grains.

      Maybe you can aim for those grains lower in gluten than the intensely changed wheat now sold in the grocery store.

      Plus grains are NOT the only carbs out there.

  46. says

    Thanks for writing this post Chris,

    I’m very happy more people are starting to come out against the extreme low-carb approach. I was on a low carb paleo diet for two years untill its downsides finally caught up with me. In the beginning I had a lot more energy and my focus was increased tremendously (I have ADHD). But I found out that there IS such a thing as too low carb. I started having pain in my thyroid and liver and I lost a lot of hair. I finally found Danny Roddy’s blog and purchased “Hair like a fox” which also has some extreme advice, but it did put the whole low carb issue into a different perspective for me. I still have some thyroid and liver issues, but my hair is back to normal 😉
    In short, yes, I believe that the ‘pro-low-carbers’ are taking things over board and things can be dangerous if taken to extremes. I also vote for a balanced approach. Everything in moderation.

  47. Mike says

    Here we go again! There’s is no end to theorizing about diet. Paleo is “out” and carbs are back in.

    Anybody think that maybe we are just omnivorous and just eat a little bit of everything?

  48. KarenP says

    I have been following a low-carb, whole-foods diet since 2006 and it has turned my life around. Prior to that, for most of my adult life, I was eating a high-carb, ultra low-fat, low-protein diet with lots of processed foods. After years on that diet, I was in a lot of pain and diagnosed with Fibromyalgia. I also had lots of “female” problems (surgery for endometriosis, amenorrhea, infertility, low progesterone, high prolactin, 3 miscarriages after fertility treatment, 2 surgeries for ovarian cysts, early and rough menopause).

    My pain, insomnia, and hormone problems kept getting worse until an integrative doctor suggested I try an elimination diet. I did, and within 10 days I was shocked at how much better I felt. After trying to add foods back in, I determined that carbs (even complex ones) do not agree with me.

    Now I eat lean meat/fish/poultry, egg whites, olive oil, nuts low in Omega 6 (e.g., raw walnuts, macadamia nuts) , and lots of low-starch vegetables (e.g., Brussels sprouts, broccoli, asparagus, leafy greens). I eat no sugar, dairy, grains, soy, fruit, or processed foods. I eat a total of about 50 grams of carbs/per day.

    Whenever I try to add more carbs (e.g., an apple or a slice of cantaloup) or even veggies that aren’t low-starch (e.g., yam or sweet potato), the old fibromyalgia symptoms return (extremely painful, knotted muscles; insomnia; fatigue).

    I also get symptoms that seem to be related to insulin/blood sugar and hormones (sleepy during the day, especially about an hour after eating lunch; irritability; ravenous hunger if I go longer than 2-3 hours without eating; weight gain around waist that is disproportionate to the calories ingested; oily hair and oily skin plus pimples; increased facial hair; hair around nipples).

    No one ever diagnosed the cause of my “female” problems, but I wonder if I had/have PCOS. I’ve read that low-carb helps PCOS, and it certainly helps me. I’ve never read WHY low-carb helps PCOS, though, and I wish I knew that.

  49. LindaN says

    Amen Cris! And Laura Schoenfeld for her article “Is a Low-Carb Diet Ruining Your Health”

    Finally some sanity in the low carb debate! I too have witnessed these dogmatic beliefs on Paleo blogs including the mistaken idea that nutritional ketosis is the default nutritional state, and many of these beliefs are being promoted by MD’s.

    Too high a carb diet and I don’t do well at all. But too low and I do just as poorly. Had to find the right level for me.

  50. scooter65 says

    I’m ready to give up here…..everyone seems to have the “scientific evidence” on their side of the argument…..everyone I read has many impressive letters after their names……I eat a vlc diet and I lost the weight etc…and I get the difference between natural occurring carbs and the processed variety, but I’ve read from other “authorities” about carb intake and the effects on cholesterol and fat in the body……ie. cholesterol and fat only become an issue when combined with a diet high in carbohydrates…..regardless of the source….I’ve been reading and tinkering with my diet for years because I want to be healthy, but all this conflicting “evidence” makes me just want to give up on the whole thing!…….:P

  51. says

    Thanks for this reminder. I loved the previous article that caused so much uproar as well. Personally, I have many reasons to keep my carbs a bit higher: I have secondary adrenal insufficiency, I am trying to get pregnant, AND I found out last spring that I am ApoE 3,4! I was eating lots of saturated fat and not paying a ton of attention to my carb intake prior to that, and since I found out my ApoE status I have really made a conscious effort to trade out some of that fat for carbs.

    Let me tell you, it’s hard to do after eating low-carb for so many years! I find that I absolutely have to work in white rice or potatoes ever day (which feels “wrong” if not working out), and I still eat more fruit than I’d like. Veggies (even squash) just don’t have enough carbs to add up. Any other ideas?

  52. Todd B says

    My way of eating is real food and low carb. And I like South Africa Prof Tim Noake’s take on LCHF, as he recognizes it needs to be individualized. Eating fat helps with satiety, but I also find when I restrict carbs too much, my appetite seems to increase. The Jaminet’s Perfect Health Diet helped me dial in “safe carbs,” and the result for me is better satiety with the occasional apple and cheese, rice and sushi, sweet potato, and my favorite- banana egg pancakes with yogurt. Intentionally adding in such real carbs is a much better plan than dipping into a bag of corn chips or chocolate due to being hungry. Chris, thanks, your blog and Personal Paleo book has helped me greatly. The reset dramatically reduced an alcohol habit, and I am sleeping better and am more conscious of my relationships.

  53. Gina says

    I believe that low carb diets work well for me, but I think I follow a low carb diet inadvertently out of lack of creativity in my own paleo diet. What are your suggestions for the best sources of paleo carbs other than sweet potatoes and fruit?

  54. LisaMC says

    A year ago I was diagnosed with both cancer and diabetes. My A1C was almost 14, my fasting glucose was tested 311–discovered when I tried to have a Pet Scan to see if the cancer had spread beyond the lymph nodes.

    So, that changed the way I eat dramatically, and I’m still working things out. I started out on insulin to get the diabetes under control and because I was going to be starting chemo. I started out with the recommendations of my Diabetes educator–losing weight was a side effect, but I noticed that as I lost weight my insulin dose was going down. (I’d lose 70 pounds over the next 9 months.) Next changes came with meeting with a nutritionist connected with the cancer treatment center who recommended 50 to 55 grams of carbs for each meal and 15 grams for snacks–she recommended one or two snacks a day. My endocrinologist feels that much carbs is to high for a diabetic and recommended 35 to 45 grams per meal, 15 for one to two snacks, for a total of 130 to 165 grams per day, and typically–I’ve been keeping a food diary for several months, I’ve been keeping to that recommendation.

    This would be considered at the low end of a moderate carb diet. By the time the full course of chemo ended about 4 months later I was off insulin. My next A1C was 4.8 and I was taken off Januvia, my one oral. Three months after that I was at 5.1–but without meds. My fasting glucose has only gotten better (particularly after going off statins), Typically it’s in the mid 80s. My endocrinologist encouraged me to take readings one hour post-meals and I’ve been tweaking my meals accordingly to get them under 140. (Often reducing carbs, upping protein and fiber in a meal to reach the “safe” range.)

    I’m not (yet) doing Paleo, although I have been using some ideas and recipes and am considering trying it for 30 days. I have dairy, I have grains and legumes (although in careful amounts) and I have about three servings of fruit every day–and not always “low glycemic.” I’d say the one major change I’ve made from the standard American diet is that I avoid sugar, refined flours and juices and try to eat foods as “whole” and unprocessed as possible, though I don’t bother with organic or non-GMO. And i have tons more veggies and fish than I used to.

    And I’ve done very very well so far. Could I do better? Maybe. Which is why I picked up The Paleo Code and have been browsing this site. And it hasn’t even been a year since my diagnosis, But I’d note I have “reversed” diabetes–and without eating low carb–or paleo.

  55. says

    Yeah, I followed Paleo lifestyle for 2-3 years with good and best result in my life at almost 40 year old. Many instances when I wanna shred the last 2-3 kgs for the sake of super leanest belly 6-pack, I experiences tingly toes and fingers, cramps, and etc. Googling the net, I found it could be one of the case called euthyroid sickness syndrome. Last time I experimented 1 clean month of VLC with all the supplements mentioned in the low carb community, the symptom apparently reoccurred clearing my understanding to what Chris laid out right here. Thanks, Chris! for all info/analyzing/reasoning/clearing. Love your site and this lifestyle!

  56. Eileen says

    I used to be strict Paleo. After all of my neurological symptoms cleared up, the amount of animal protein in the Paleo diet started making me jittery (like too much caffeine). I felt much better after I reduced my animal consumption by 25% (roughly a meal) and replaced them with low-moderate glycemic index unrefined carbohydrates. My carbohydrate consumption is a little less than half of my total calories, with increased high quality fats replacing the lost protein.

    Never felt better in my life than now. Being a doctor myself, I have seen remarkable results with people who are chronically ill go on a Paleo or neo-Paleo diet. IMHO, once a person is healthy with a strong nervous system, it is no longer necessary to go strict Paleo, although limiting the carbs to the percentage and types in the article keeps people healthy.

    • says

      Can you give me examples of what your carbohydrate sources are on a regular basis? (See my comment below.) I have had to increase my carbs but find it hard to get enough.

  57. Cindy says

    I am an example of low-carb/ketogenic diets doing harm, so I would like to share my personal experience in the hope it may be helpful to others.

    I read a book by one of the most respected writers in the Paleosphere, which unequivocally promotes a ketogenic diet as the only solution to repair adrenal fatigue and the concomitant leptin/insulin etc. dysregulation. It all made logical sense and had science to back it.
    As a sufferer of 16 years of severe CFS type illness, I thought “this is it!” So I excitedly commenced my low carb/starch diet. I was not to eat anything that grew “underground”! No fruit, only a few organic berries here and there, not a skerrick of sugar! I ate loads of non starchy veg, whilst proudly congratulating myself on sticking to my healthy diet, knowing that soon all the benefits would kick in and I’d feel amazing.

    Around this time I saw a new practitioner who also started me on some new treatment, which unfortunately muddied the waters. As I got sicker and sicker with the passing months, I didn’t even CONSIDER that it was my perfect diet, it must be the new treatment! I was so ill I became bedridden, so weak I could barely stand for a minute or two, yet somehow doggedly persisted in hauling myself into the kitchen to prepare my nutritionally dense food. I’m no stranger to hair falling out (chronic iron deficiency) but now I was losing handfuls at a time! My confidence was shattered. I started adding in sweet potatoes and fruit, with no change. So 7 months in, in desperation I made myself some congee with chicken broth, carrots (gasp!) and basmati rice (double gasp!)and within 2 days I had the most energy I’d had in months. I have since discovered that white potatoes are my friend and a necessary addition to my diet; I realise now I am so energy deficient my body needs simple starches in the form of whole foods as an easy energy source.

    Unfortunately, by the time I came to my senses I was experiencing tenderness in the thyroid area and difficulty swallowing. A recent ultrasound revealed thyroid inflammation and nodules which led to a diagnosis of Hashimoto’s. It’s probable I have had hashimotos for a long time, but I am in no doubt the low carb diet caused this acute flare, and after months of a better diet I am still experiencing a level of fatigue I never had before. I dont think I yet understand fully how my body systems have been affected.
    So it’s going to be a long road to recovery.

    I’m now seeing a new practitioner who better understands the role of diet and a healthy gut, and I really appreciate writers like Chris Kresser who emphasise BIOINDIVIDUALITY! For me, this is key now, and I will in the future put more focus on how I am feeling on any given diet/treatment. And in the meantime, I am hoping to see the aforementioned keto-advocate soon acknowledging it is not for everyone. She is amazing-smart and I have so much respect for her, but I’m pretty disillusioned that her advice was so harmful to me personally.
    So I’m really thankful to Chris, and others like him, for having the courage in bringing this important issue to the fore. Hopefully this will prevent other vulnerable ones from taking the same harmful course as I did, and will still take some time to correct.
    Thanks Chris!

  58. Michelle Cruse says

    Interesting reading – soooo much information! I have no idea what carbs I eat – I flatly refuse to count! I don’t often eat junk, I am NOT a cook or a foodie (nor is my partner), my family was big so food was fuel not a big social affair and we never over ate (portion size). So, we eat basic & boring and food is about as important to me as putting fuel in my car!
    The moral of this story is that I DO think my food intake can be very much improved and may help my hormonal peri-menopausal issues (dumping coffee will help too, but thats a hard one!) As to obsessively counting carbs? TOO HARD! Unsustainable (I did it once for 3 months body building trial – ate more than I ever had in my life, lost weight – I don’t have much to lose either! and get terrible). I have enough trouble trying to remember to eat at all!!!!!

  59. Chris S says

    Great article Chris. I would like to see you have a discussion/debate with Nora Gedgaudas( Primal Body Primal Mind) Overall her book is the best health, diet/nutrition book I’ve read. She claims to be open minded, but seems pretty dogmatic on the low carb ketogenic diet. I start experiencing leg cramps, low body temp, slow transit time of stools, and sluggishness on strict very low carb diet. Maybe even less than 125 grams of carbs.

  60. Federico Nadal says

    One thing you din’t mention is, that people who have suffered of gout should not follow a low cargo diet. If they do, they, sooner or later, are going to have a gout attack. That for sure

  61. Laurel says

    I see several people on here claiming that a LC diet “reversed” their T2D. I don’t think this is possible. It’s possible to control T2D with diet, but not to reverse it. If you’ve really reversed it then you can eat like an average ordinary person and not have BS issues.

    Also, someone above claimed that overeating carbs causes diabetes. They must’ve not even read Chris’ article. Sheesh.

    • blaine says


      “If you’ve really reversed it then you can eat like an average ordinary person and not have BS issues.”

      The average ordinary person in the United States (70%) is overweight and over 100 million people have diabetes or prediabetes according to the CDC.

      This means almost no one should be eating like the average ordinary person regardless of whether they have diabetes or not.

      When I weighed 260 pounds and was a complete couch potato, I had full blown type two diabetes.

      Since my pancreas was still producing insulin, when I lost 100 pounds, began vigorous exercising and went from 35% body fat down to 12%, I found I could eat more carbs and even an occasional high carb junk food meal without pushing blood sugar levels outside normal ranges.

      Does that mean my type 2 diabetes is reversed. I think so by any definition. My fasting blood glucose is never over 90 and rarely over 120 following meals. I can and have passed a glucose tolerance test. There isn’t a doctor in the country, who based on lab tests, could diagnose me today with type 2 diabetes.

      However, I have zero doubts that if I go back to eating like an “ordinary” person and stop exercising, I will again develop full blown diabetes.

      It’s also possible that I may have damaged my pancreas to the point that I will develop diabetes in the future regardless of what I do. I’m keeping my fingers crossed.

      As to whether too many carbs can cause diabetes, it may be a matter of semantics but Chris is simply wrong about this.

      Carbs don’t cause diabetes in the same way alcohol does not cause alcoholism. Some people have a genetic predisposition for type 2 diabetes in the same way there are people with a predisposition for alcoholism.

      You feed an eight year old kid a two liter bottle of coke every day of his life and odds are you will eventually have a metabolically damaged fat kid or adult with a very good chance of developing diabetes.

      It is exactly the same for a person who is drinking two quarts of vodka every day damaging their liver.

      Too much alcohol causes fatty liver disease in an alcoholic in the same way too much sugar causes non fatty liver disease in someone with diabetes.

      Everyone has different levels of how much alcohol or sugar they can tolerate before it metabolically damages them.

      The best way not to become an alcoholic is to never start drinking alcohol.

      Does this mean everyone should refrain from drinking a glass of wine or having alcohol in moderation? Of course not. It’s the dose and a person’s tolerance to alcohol that is relevant.

      The best way to not become a type 2 diabetic (which like alcoholism is an entirely preventable disease) is to not eat highly processed manufactured carbohydrate foods.

      One of the problems in discussing this is that the definition of carbs is too broad. There is a huge difference between a natural whole food carb and a highly processed carbohydrate Frankenfood.

      There is a strong correlation between too much sugar, Frankenfoods and chronic preventable illness. Not so much for natural whole food carbs eaten by healthy adults.

      • Laurel says

        Hi Blaine – I’m glad you were able to get healthy.

        One of my grandmothers who was always a skinny little person had a very bad case of T2D to the point where she lost her eyesight and both legs. How can we say that her disease was “entirely preventable”?

        Most people, eating the SAD, do not develop T2D. How can we reconile the two sides of this seeming paradox?

        Don’t underestimate the genetic component. Should we blame the victim? Should we blame my old granny, who never overate that I could see, for her horrendous T2D?

        • blaine says


          There is a misconception that you have to be fat to develop type 2 diabetes.

          In fact all you need is a fatty liver and pancreas to develop type 2 diabetes and you can do that even if you are relatively “skinny.”

          There is an explosion in type 2 diabetes and heart disease in India right now with people who have a much lower BMI than the average American with heart disease and diabetes.

          It’s the junk food vegetarian, high carb, high sugar, high fried foods diet that is causing Indians to have the highest heart disease rate in the world along with an explosion in type 2 diabetes.

          There are two things that can explain why a “skinny” old person can develop type 2 diabetes. One is that it is actually misdiagnosed late onset type 1 diabetes which is an autoimmune disease where the pancreas is no longer producing insulin.

          The other is that an older person is not eating enough calories to gain or maintain weight. However, what they are eating is an unhealthy high carbohydrate, low protein diet and because they have no muscle mass to burn off the elevated levels of blood glucose this diet causes, the excess glucose is turned to fat and stored in the liver and pancreas diminishing normal function and causing diabetes.

          In other words, many older people are “skinny fat,” meaning they look skinny but they have low muscle mass. Because they are frail with no muscle mass, their body composition has a very high percentage of fat including a fatty liver and pancreas that is impairing insulin production normal liver function.

          Getting enough protein and maintaining enough muscle mass is a real challenge for older people. Mainstream medicine just exacerbates the problem by prescribing diets and nutritional supplements like Ensure which is a high carbohydrate, high sugar drink which just makes the problem worse… and as the problem worsens, the doctors just go on increasing the diabetes medication as their patients go blind and body parts get amputated.

          If I sound cynical, it’s because this is what happened to my parents. If I knew then what I know now, it never would have happened.

          The mainstream medical approaches to treating type 2 diabetes today is equivalent to physicians who used to bleed patients or more recently cut out their stomachs to treat ulcers because it wasn’t understood that bleeding made a patient weaker and ulcers were caused by a virus and surgery could not cure.

          Hope this answers your questions.

    • Bill says

      “If you’ve really reversed it then you can eat like an average ordinary person and not have BS issues.”

      Laurel, I’m sure you don’t mean it, but you’ve made several remarks implying that people with diabetes aren’t normal, or like ordinary people.
      I’m a Type2 and I can assure you I’m very normal and ordinary.

      Low carb has given me great control over my diabetes, but I realize it hasn’t been reversed, nor have I been cured. I will have to maintained this type of eating in order to keep my BG in check.

      Please choose your words in describing diabetics with a bit of forethought. We already have enough issues to deal with.
      In good health. Thanks

  62. Kent A Howard says

    Have been Paleo for 4 years and ketogenic (<100g/day) for 1 year. The latter resulted in a dramatic reset of my lipid panel results (dropped triglycerides and VLDL, raised HDL and LDL) but aside from another few pounds of water weight (which I no longer care about) has largely inconsequential. Was easy enough to drop the last few high GI starches, so happy to believe I've improved my risk of a host of neurological disorders. And I am eating well.

  63. Sarah says

    Hello Chris! I see above that you mentioned low-carb diets being effective in dealing with PCOS. I have PCOS, but mildly so. I’d really appreciate it if you could briefly explain in what ways the low-carb diet benefits PCOS women. I’ve heard people talk about how it helps with the insulin resistance that a lot of PCOS women experience, but my blood tests indicate that I don’t suffer from IR. So I’m not sure whether the diet is actually relevant for me.

    • Alison Moore says

      Hi Sarah. I think with PCOS it can help because insulin spikes cause estrogen to surge, and estrogen dominance relative to progesterone is part of the PCOS problem. My cycle went haywire when I tried to reintroduce carbs, and I consider part of the reason ketogenic eating works best for me is that I may be a bit PCOS too. I was slim and not insulin resistant either….

  64. Elizabeth says

    What is your view of the candida diet? What if a low carb diet isn’t necessarily great for someone in general, but is necessary for the resolution of candiasis?

  65. David Locker says

    Low carb diets work mostly ok for myself. I find that when on a low carb streak sometimes (by accident, not design) I get a little light-headed when I squat down for a time to get something or working in the garage. Overall, I feel fine otherwise. Also, when I eat a piece of particularly sweet fruit (peaches are prime right now in Louisiana), my throat feels a slight tinge sore. It’s not so much that I need to spend money or time to find out why, however.

  66. Brenda kemp says

    Just found out I am pre-diabetic and am on low carb diet for now. I have lost 21 lbs. still learning a lot about food and how it behaves in my body. I am feeling a lot better. I have 30 more lbs. to go. I don’t eat any processed food white/sweet potato’s, bread or pasta. My mother and brother are diabetics, I refuse to love with it. Why would you if you can reverse it. Giving it up was easy! Creating and find different and better food not so much. It is truly an on-going process. But I am excited and I share everything that works for me. If you have a belly get your sugar tested.

  67. Cindy M. says

    Firstly, I want to just say THANK YOU CHRIS! In reading your articles and listening to your podcasts, you keep an open mind, which is rare.

    I have recently try to eat moderate protein, increase fat, and reduce carbs (starchy vegs and fruits) as I wanted to get that non-hunger feeling between meals. I get that benefit every now and then but I am not counting my carbs/proteins/fats to ensure I get into a ketogenic state.

    Like you said one diet doesn’t fit everyone. We have to be a student of ourselves and learn what works best for us. Thanks again for sharing your wealth of knowledge and enthusiasm with the world.

  68. Blaine says


    There shouldn’t be surprise that there was such strong reaction to Laura’s post, “Is a low carb diet ruining your health?” because the headline runs counter to the personal experience of so many people where a low carb diet has been the only effective approach to loosing weight and reversing chronic diseases like diabetes, multiple sclerosis and the other diseases you list.

    Here is a link to a New York Times story this week on a study funded by NIH that shows the effectiveness of a low carb diet in loosing weight and reducing the risk of heart disease.


    “Dariush Mozaffarian, the dean of the Friedman School of Nutrition Science and Policy at Tufts University, who was not involved in the new study (stated). “It shows that in a free-living setting, cutting your carbs helps you lose weight without focusing on calories. And that’s really important because someone can change what they eat more easily than trying to cut down on their calories.”

    You did a good job clarifying the position that low carb diets do not work for everyone and that low carb diets work well for many people with health problems.

    Had Laura made the same points in her post to the same level of detail, there may not have been such strong reaction.

    Laura made a good case that low carb diets may not be the best option for pregnant women, athletes and hypothyroidism. No argument there. She also made a good case that not all carbs are equal… there are good carbs and bad carbs.

    Carb phobia is not healthy. Part of this phobia has been fueled by the absolute ban on all grains, legumes and dairy that Loran Cordain and many Paleo thought leaders advocate (although Cordain has always stated that Paleo does not mean low carb…many hunter gatherers have historically eaten high carb diets.)

    One of the reasons I follow your blog is you have not adopted the banned food dogma. There is overwhelming evidence that humans did not stop evolving 10,000 years ago and that some people may even be adapted to thrive on dairy and complex carbohydrates.

    However, the elephant in the room is there are 200 million elephants in the room. Here is a link to another story this week that obesity rates in the United States have hit an all time high with no indication the trend is reversing anywhere.


    There is no question the reason for the obesity, diabetes and chronic disease epidemic in the US is the consumption of too much sugar, highly processed carbohydrate rich foods and manufactured oils coupled with ever increasing sedentary lifestyles.

    Regardless of the macro nutrient composition of a diet, almost everyone will see some health improvement if they eliminate or greatly reduce these modern manufactured processed foods. That is the real reason the Paleo approach works so well for so many people.

    It’s appropriate that there has been push back to the extreme low carbers who think a stick of Kerrygold butter at every meal and a ketogenic diet is the only healthy way to eat.

    The problem with a headline like, “Is your low carb diet ruining your health?” is that it can cause confusion and risks throwing the baby out with the bath water for those that never get past the headline.

    You did a good job saving the baby.

  69. says

    GREAT article Chris. Thank you. The dogma surrounding LC diets is rather astounding. After putting well over 1000 people through our primal weight loss and wellness program in the past 6 years, we’ve absolutely seen that “one size does not fit all.” It simply doesn’t. While some clients get rock star results with LCHF, other’s don’t experience the same results and some even get worse. People need to keep an open mind and figure out which approach works best for them. There is still so much we don’t know, so people need to stop acting like this is all “settled science” because it’s not. We’re far from it.

  70. kathy says

    I really appreciated seeing the original article that came out last week or so regarding low carb diets. I think it is so important to get this message out to people. I have been on low carb diets on and off for more than 10 years. Weeks before this article came out I made a change.

    My low carb diets started with atkins a long time ago which made me feel the best I had felt in my life. At the time I had no idea it had anything to do with grains/wheat. But after getting pregnant atkins wasn’t an option for me so I went back to some of my old grain filled ways and after the births of my children my health got worse 10 fold. That was 9 years ago. I won’t into the great length of issues that occurred and the countless doctors I saw and tests I underwent.

    Paleo was my cure but then it wasn’t. For years I followed it trying to regain my energy, lose that little bit of weight around the middle, resolve mostly minor recurrences of terrible issues that just wouldn’t seem to go away completely. And after several years, new major issues arose – kidney stones, ovarian cysts, inability to recover from workouts, constant joint injuries, horrific PMS and depression (although denied depression much more like lethargy).

    I dabbled with adding starches at times but my weight would always go up, presumably because of the high protein and fat + added carb diet. Not long ago I came across the Perfect Health Diet (from looking for other blogs via Chris’ interviews and articles that might address my issues). It was a leap for me to make the changes recommended in Jaminet’s book, a very desperate leap. I had not realized how afraid of carbs I had become, how fearful I was that old problems would return. I’m still cautious but there can be NO denying the improvements I’ve experienced.

    – For the first month in years I have had no cramps at ovulation or before my period. Very little breast tenderness and very minor irritability. Most months in recent years I would often feel like I had the flu in the 2 weeks before my period.

    – My libido almost immediately returned. It has been virtually nonexistent for years.

    – My back pain and joint pain continues to improve.

    – I have much more energy and am able to do workouts I haven’t had the energy or the recovery ability to do in years.

    – My sleep has improved dramatically.

    – My weight is stable and possibly even very slowly starting to decline but more importantly my body shape and structure appears to be changing for the better in just under a month. This is something that caused me endless frustration over my years of low carb paleo. I tried and tried to workout but my body seemed to get worse. My ability to recover got worse. It was as if working out was eating up my muscle and adding fat even when I would count calories and watch my fat and protein intake like a hawk.

    – I’m not hungry. Previously, I would have cravings all day it seemed. I craved chocolate after lunch but would only allow myself a small square of dark chocolate. I craved wine after dinner but could never drink more than half a glass or I would be hungover in the morning. I was eating well over 1600 calories some days. Now I’m eating around 1300-1400 and feel great. I don’t feel the need to snack all the time and I don’t have those intense cravings for intense things.

    There is probably more I could write. I don’t know all the science that lies beneath all my health issues and I can’t say that my change will help anyone else. But I searched for years for help, I cried in doctors offices, I poured energy into internet research, I read countless books and tried endless programs trying to find my lost health. I knew pieces of the answer but never the whole story.

    When I looked for articles relating paleo to hormonal problems I found so many comments from woman saying paleo or paleo/low-carb had solved their hormonal problems and very little that told me to re-think or modify this diet. Maybe I was just looking in the wrong places.

    I hope that if there are others who have had my experience they will find articles like these or comments like mine and maybe it will help them find answers.

    From my years of research I knew that the article about low-carb diets was a bold move for your blog. Thanks for being bold.

  71. Foxygodzi says

    Excellent article! One of the best ones I’ve read in a very long time! I used to be one of those people who would bash carbs as evil, being very strictly paleo. All in the meanwhile, I started experiencing more and more problems with my health, including the inability to digest fats, fibers properly (SIBO), which lead to me having to expand my horizons and including foods in my diet that I would have thought of as travesty to eat just a few months ago. Right now, pretty much the only things that don’t cause me digestive discomfort are Asian white(!) rice, steamed spinach, fish, and I can have maybe a Granny Smith apple blended with my rice in the morning. Most veggies are out, I can’t even tolerate carrots or squash..This way, however, I’m not constantly bloated, tired and irritable. The conclusion: there are NO absolute truths in life!

  72. Kristina says

    I must say, I find anyone saying all people should do the same thing very amusing. Another blog I read was just all up-in-arms because a study said that low-carb is better for weight loss than low-fat. That blogger is a proponent of a low-fat, virtually vegan diet (he does eat fish on occasion). The reason I find all of this amusing is because people become so indignant and defensive of their choice of diet. If low-carb serves your nutritional and treatment purposes, great! If low-fat serves your nutritional and treatment purposes, great! But to tell anyone there’s only one nutritional way to health is absurd, since everyone is a different body with different nutritional needs and issues.
    In other words, I agree with Chris.

  73. says

    GREAT post. This is exactly what I have been thinking. It is so tempting to want to eat low carb when you see photos of ladies dropping tons of weight doing so, but I have realized that I really need some carbs in order to do well. Thanks, Chris!

  74. serenity says

    Hi Chris,

    I’m glad that you take such a balanced view on low-carb diets. I started eating a low-carb diet in April of 2012, hoping to lose the 7 vanity pounds that I had gained during law school. At 5’5″ and 132 pounds, I was by no means overweight. I was an avid runner, fit, and healthy despite the fact that I ate plenty of processed crap.

    I went primal in April of 2012, and when I first started, I kept my carbs around 100 g per day. That was pretty moderate. It worked at first. I lost some weight very quickly (most likely water weight). Then I added intermittent fasting to the mix and lost even more weight. By June, I was 126 lbs, close to my goal. But something weird started happening by the end of June. I started to gain weight despite keeping my macros, IF schedule, and average caloric intake constant (I didn’t really count calories, but I didn’t change anything). Bewildered, I cut my carb intake further. By August, I had gained back all the weight I’d lost. The weight kept creeping up. By October I was on a ketogenic diet, using ketone test strips to ensure that I stayed in ketosis. But nothing helped. I kept gaining weight.

    I’d like to note that during this time, I kept up a heavy workout routine. At first it was very difficult to run on a low-carb diet. A previously easy run (at a pace that had been easy for me) felt really hard. I figured that everything would get better once I became fat-adapted. There was something to that, perhaps, because the runs did start to get easier again. But during the process of becoming fat-adapted, a lot of my training runs were so hard that I would throw up afterwards. Throwing up after an especially hard run had happened to me a few times in the past, but it was happening quite frequently during that time.

    Anyway, I kept gaining weight, and only with the most extreme dietary interventions (such as the Alternate Day Fast, where I would fast every other day) could I maintain my weight. This kind of thing had never happened to me before. Usually, my weight stabilized around some set point, and I wouldn’t really gain no matter how much I ate.

    Fast forward to November of 2013. I was finally able to afford some blood tests. I got a full thyroid panel and a sex hormones panel. My free T4 was 0.87 ng/dL, and my free T3 was 2.1 pg/mL. I was definitely hypothyroid. On top of that, my progesterone was also very low.

    I started Cytomel to fix the hypothyroidism. And at 50 ug per day, my weight has finally stopped creeping up. But I’m currently 147 lbs. At my heaviest, I was 151 lbs. (Recall that I weighed 132 lbs when I started eating low carb).

    I’m working with a naturopath to optimize my medication. I’m going to switch to natural dessicated thyroid because I’ve heard that it works better than T3 alone. Hopefully, I’ll be able to lose this weight eventually.

    So, yeah, I’m not a huge fan of the low-carb cult anymore. I think it’s important to listen to your body. If you start gaining weight on a moderately low-carb diet, the answer probably isn’t to go VLC.

    • says

      Thanks for your story. I started the keto/primal diet in July of 2014 (3 months ago) and it started out fantastic. After about week 10, I started to have funky symptoms. Low energy, thrumming in my throat (probably thyroid), fast heart rate, higher blood pressure, very low morning basal temps 97 and below, muscle twitching, ringing ears, and waking during the night.

      I immediately began to add in more carbs and within two days, things had normalized. Tonight I am making the first rice I have had in three months. Sweet potatoes and some bananas are back on my list. I’m just glad I didn’t wait years to listen to my body. I will go in for full thyroid tests soon, including antibody test and Free T-3 and all others. I want to make sure I have not done damage to my precious thyroid.

  75. Nancy Douglass says

    Thanks for your wonderful articles. Both my husband and daughter have ankylosing spondylitis. My husband was diagnosed back in the 70’s when no one was talking about diet and it’s relationship to inflammatory diseases. My husband took it upon himself to do some digging and discovered how refined carbs were an absolute pain trigger for him. He cut out all refined carbs as well as tomatoes and potatoes which were a particular problem for him. Our 28 year old daughter was diagnosed a few years ago and has learned, through process of elimination and reintroduction, the foods that trigger her. We liken refined carbs to poison in our family and everyone is feeling healthy and for the most part pain free. Thanks again for your wonderful articles. I have learned so much!

  76. says

    A low carb diet was great for me for a good while, and helped a lot with some of the issues I was having (blood sugar, OCD, etc). After eating low carb for a while, while doing too much high intensity training, I eventually got into trouble. Adding back in some starchy carbs helped with my energy and general well-being.

  77. Greg says

    My direct experience with LC/VLC …..

    Excellent and transformative, but just for a short time, 3 months. It took me from a state of chronic life marginalizing chronic exhaustion for 12 years, to feeling like I was completely healthy and 20 years younger. Physical, mental, emotional, complete recovery. I cut out all processed carbs, starch, sugars and ate only veg, moderate protein and lots of good fat.

    But … the last 4 months have been declining. I’ve tried adding back some rice and potato but no effect, exhaustion and non-recovery are returning. My FBG went from 110 to 100, A1C 5.7 to 5.5, BP 160/110 to 135/85, waist 42 to 38, all good transformational number and looking like I had a case of undiagnosed pre diabetes or MetSy.

    So isn’t LC/VLC the way to go? If I add back carbs on a permanent basis won’t these numbers go back up? Shouldn’t I be attempting to drive them even lower? I just added metformin, is that counter productive to adding back some carbs?

    Any ideas?

    • Tom Boyer says

      Greg, see a doctor. Don’t self-treat this. Maybe get your thyroid checked? Thyroid could have been part of the reason you were having issues in the first place.

      I don’t think it’s bad that you lost the weight and improved your blood markers. And there’s no evidence that low-carb high-fat doesn’t work over the long term for most people, but there are certainly some for whom it doesn’t work.

    • blaine says



      I second Tom’s advise to see a doctor. Something else appears to be wrong. If I was you I would want to rule out thyroid problems and cardio vascular disease.

      Have you had your Vitamin D levels checked? If you live in Canada, every diet you eat could be insufficient in Vitamin D and could manifest some of the symptoms you describe.

      You don’t say how much you weigh or how tall you are but a 38″ waist indicates you have a significant amount of visceral fat loosing more weight would probably help.

  78. says

    Once again, your insight and research are very useful and appreciated!!
    I can’t remember who coined the term “chatecholamine honeymoon”, but it always comes to my mind when this topic is discussed…low carb is stimulating to the adrenal system and that can feel good for a quite a while…but…..
    I also believe low carb can be helpful for certain issues….my concern is the hormonal shift from the long term use of such a strategy…low carb long term is likely to cause a strong pull on Cortisol and Adrenalin and eventually lead to a crash….IMO….
    Thank you.

  79. Jen R says

    I’m not a doctor, scientist, nutritionist, etc. I’m just someone trying to gather information and make healthier choices for myself and my family. I find myself overwhelmed with making these choices. Does anyone else find that in general you’re just flat out not eating enough because you’re scared of eating the “wrong” thing?

    • Lisa says

      Yes! I came into all this a few years ago. I have done PSMF, low carb, gluten free, raw food (aka my Nutribullet) and read more blogs than I would care to count. I am still about 80 lbs overweight but remarkably, my blood lipids, blood pressure, cholesterol and blood sugar numbers are now very good. I know this won’t be the case forever if I don’t drop these pounds though. I’m 50 and female.

      I have narrowed my reading to a select few blogs (Chris’ is one), I am now focusing on the non-nutritional reasons I eat and starting to learn to stay tuned to my body through help with a professional who specializes in this. I read “Women Food and God” by Geneen Roth earlier this summer (an amazing book). It covers what is often missing from all these blogs – the social, emotional and spiritual connection to food and eating… and learned you don’t have to have a full blown eating disorder to identify with the topics she writes about.

      Perhaps not quite related to your question but in summary, I definitely find a lot of this completely overwhelming. My grandparents didn’t know what a macro nutrient was. They ate whole foods, grew their own produce, made their own sausage, prized fat and lived until their nineties without heart disease, diabetes or auto immune illnesses.

  80. Michele says

    As a person who doesn’t eat but one or two meals a day to begin with, going very low carb had immediate amazing results but messed up my sleep. It started when I noticed in January I was always bloated and having stomach/intestinal pains, and hand and leg cramps. At the same time a friend wanted to lose some weight so we went on the Atkins diet and I also gave up milk. Within one week the bloating was gone, the pain was gone, the chronic sinus infection was gone, the chronic heartburn was gone, I lost 10 pounds very quickly. But within the next 7 months I had very bad brain fog and couldn’t sleep more than 3-4 hours a night and had no energy. I discovered paleo and started adding in a few things and finally the brain fog lifted. But, still no good sleep and kept losing unnecessary weight and still had the leg and hand cramps which I finally got rid of when I quit taking salt, potassium, calcium, and magnesium). I am still trying to figure out what I messed up (cortisol?) but did get some Valiums from my doctor this August and this has been a miracle for me getting sleep. I am trying to add in as many carbs as I can but refuse to eat grains, processed foods, milk, GMO and sprayed veggies and fruits, which doesn’t leave me with much since I live in the middle of nowhere and there are no health food stores or organic anything. The sinus infection starts to flare back up with the added carbs so am experimenting with unmodified potato starch and this seems to fix that. After that I will try the bone meal someone recommended to get some calcium and maybe better sleep. All in all I feel much healthier but that sleep is so necessary and I also want my normal energy back, then things will be great. (female, age 64 on no meds except the valium). I have always been a big meat and butter eater.

    • Tom Boyer says

      Replying to Michele: Sleep problems are a common side effect. Look up reactive hypoglycemia. There are things you can do. Exercise helps. Some people eat a small bite of protein before bed.

      Another thing some people (including me) notice after going low-carb — I just need less sleep period. I have much more energy late into the evening. Sometimes I used to pass out an hour after dinner with a blood sugar crash. Now I have pretty decent energy until 11 or so.

      Robert Perlmutter (neurologist, author of Grain Brain) argues that low-carb high-fat is really good for brain health — the brain apparently does much better on ketone fuel than it does on glucose.

      Perlmutter asserts in his book that the human brain is actually designed to function at full capacity until the day we die. All the memory and other neurological problems that we take for granted in old age are just the result of the western grain-based diet, Perlmutter argues.

    • Duck Dodgers says

      Every single one of the neurochemicals your brain needs to function come from your gut bugs:

      “Gut bacteria both produce and respond to the same neurochemicals—such as GABA, serotonin, norepinephrine, dopamine, acetylcholine and melatonin—that the brain uses to regulate mood and cognition.”

      Source: http://www.apa.org/monitor/2012/09/gut-feeling.aspx

      When fermentable fiber intake drops considerably — as what typically happens on a very low carb diet — the neurochemicals that your brain requires to function normally do not get made in the ideal amounts. This can lead to anxiety in some people, sleep issues in others or sometimes both.

      One may be able to remedy the situation by taking some GABA and L-Theanine (perfectly safe amino acids found in any pharmacy… ask your pharmacist) just before bed. Even GABA alone is a very safe alternative to sleeping pills.

      As you increase the amount of fermentable fibers in your diet, and replenish your gut bugs with a wide range of fermented foods and probiotics, your gut bugs will start to make those neurochemicals again, and you will become normal again. Depending on how bad it’s gotten, it could take a few months, but eventually you should be able wean off of the exogenous amino acids and your body should go back to normal.

      Starving your gut bugs can have consequences. Neurochemical deficits due to lack of dietary fiber — such as Resistant Starch — are just one of them.

      Good luck to you.

    • Michele says

      Update. Well the valium worked great for about two weeks. I got some real sleep and could think a lot clearer. I took the advice from earlier posts and started eating a lot more carbs. I even ate what I thought were bad carbs, white potatoes, noodles, chili beans, fruits, even ate some cheap bread but really don’t want to eat gluten anymore. My chronic sinus infection started to come back but my body was able to overcome it by using the nedi-pot. The only time I had a gut ache was when I added back in milk…which I promptly took back out. I added probiotics. I am halfway fixed in the sleep department. Now instead of waking up in three hours, I wake up in 4-5 hours. The 5 mg valiums don’t work at all. I am saving the 60 I have and try again in about three months. I went back to a Sominex which I have had to take for 25 years due to hot flashes waking me up. They had quit working but now work again. Now I think I will work on why I have these hot flashes and try to fix that naturally somehow. I figured some day they would go away but I am almost 65 and no such luck. Thanks for all the great tips. I did not gain any weight or lose any weight so all is good. Not tired during the day any more.

  81. Superchunk says

    Chris and Laura,

    Great articles. Thanks again for the effort to post these. A comment and two questions.

    It seems reasonable that what is “optimal” for many people may not have been a diet that ever existed in a large or “traditional” population. Given that, it would be interesting to get your thoughts on whether there is validity in using a periodic (for example, several weeks or months per year) ketogenic diet as means of mimicking the anti-aging and/or anti-cancer mechanisms previously attributed to low-calorie diets, for people who tolerate the ketogenic diet well.

    A related question would be around any dangers you see in using a shorter term “cyclic” ketogenic diet such as John Keifer’s Carb Nite approach.


    • says

      I think a cyclic ketogenic diet is a far safer way to do it long term for most people than a strict low carb/ketogenic diet. The carb cycling allows you to replenish glycogen stores and maintain insulin sensitivity in a way that constant VLC doesn’t.

      • Alison Moore says

        I tried carb night then carb backloading for about 6 months to see if it would improve my athletic performance but it did not. I think partly because it messed up my ketones and worked against the hormetic effects of ketosis in terms of mitochondrial function. I went back to full time ketosis a month ago and have felt much better since. But my perfect level for carbs is really low…between 15-30g a day, just veggies, small berry snacks, whatever carbs come in nuts and cream (bugger all), and the occasional single square of 85% chocolate.

        Self-experiment…it’s the only way.

        I should say too that I have to eat more salt when keto, and I consume a lot of saturated fat, fatty meats and fish especially and bone broths, not too much diary, lots of eggs, some nuts, loads of leafy greens, and fermented root vegetables.

        I think this way of doing keto has NOT been studied by those who insist that we need tubers for our gut microbiome….

        Rather than trying to scare people off keto, I would prefer to see more recognition that it is a very finely tuned way of eating, easy to stuff it up, and the ketone drop out is very sudden for most people past their specific carb pub tolerance level, and there is not much room for error. So it is not for everyone, in large part, because it takes a lot of knowledge for most people to make to work well. But of course there may be some people too who are better suited to more mixed diets.

        • Elle says

          I eat almost exactly the same and it does me quite well. I stay solidly in ketosis and have never experienced such consistency in energy. Thankfully now no more mental fog!

          But… the ride in is seriously difficult- tired, fatigue etc. You have to really be systematic and conscious about entry into this approach. Using the “New Atkins” book by Phinney Voleck and Westman is a good source if you are not likely to do the research yourself.

          Many times people cannot endure the shift of the body toward a fat based metabolism that occurs in the first two weeks and they abandon the LCHF way of eating too soon to experience the benefits.

          I think many times people are not getting enough sodium, potassium and Mag. Bone salt broths are essential!

      • says

        Laura, are you saying then that Low Carb diet can create problems with insulin?

        I had fantastic results with Paleo for 10 weeks and then began to have symptoms that felt like thyroid issues (euthyroid sickness perhaps)? Curiously, my blood sugar went UP. Morning levels higher, middle of night, higher, rarely was I ever below 95 after 10 weeks in low carb. This surprised me, as I was 80’s to 90’s when I began. I also tended to feel too hyped up (cortisol/adrenaline) so just a week ago I started adding in more carbs. Sweet Potato, rice, bananas! Yum. I’ve never been a wheat or processed carb girl, so I’m fine with lots of veggies and meats and fats.

        Have I screwed up my insulin response?

        I plan to get a full array of tests in the next few weeks. All thyroid, serum insulin, A1C, and full blood panels on everything else.

        I’d love for you and/or Chris to say more about the Thyroid’s use of glucose and insulin for proper function. I listened intently to his conversation with Keto-Clarity’s Jimmy Moore for answers to some of my odd symptoms 10 weeks into Ketogenic eating. Chris made mention of the Thyroid’s need for both, but didn’t go into detail. I have searched high and low for more info on this, but cannot find any. I want to know more, and I think there are a lot of folks who need to hear it.


        • Michele says

          I FINALLY got my cortisol/adrenal fatigue problem back to normal after waking up 3 hours after going to sleep and being hyped up all day but having no energy at the same time. This all came about by, I guess, going too low carb, eliminating all grains, milk, sugar, etc. I suffered brain fog for about 5 months, lost about 15 pounds, lost a chronic sinus infection, gut pain and bloating, leg cramps, heartburn, etc. But I guess I burned out my adrenals or something. How did I just get back to normal. For about two weeks I have been eating anything and everything I wouldn’t eat before. French bread, noodles, potato salad, rice, even had a quart of milk, -a-roni, tea with sugar, processed sausage, maple syrup. Suddenly I feel normal again. No weight gain or gut pain or bloating but I am not going to press my luck. I will remove bread and milk only for a while, then try to remove things more slowly. I have never felt better. I figure in the 9-10 months of doing the low carb and removing certain foods I must have healed my gut but burned out my adrenals. My fasting glucose was higher in the morning also but now lower. I’ll be more cautious this time.

  82. says

    I get asked this question over and over again in my clinical nutrition practice (along with “why don’t I feel better on the Autoimmune Paleo Diet?”). But those who see an array of different health problems clinically quickly find out as you state so well in this article, that there is no such thing as a ‘one sized carbohydrate fits all’ when it comes to health. I sometimes see two cases that seem identical (same blood work, diet, lifestyle) and one feels better being ketogenic and the other feels worse. But thankfully there are clinicians who understand nutrition, lab work and supplements, and can embrace an individualized approach to improving health. And what you lay out so well is that clearly this individualized approach is more complex for clinicians, yet will yield better outcomes for clients. Taking every person case by case solves this issue quite a bit for me.

  83. Mark Gaw says

    My adventure with a low-carb dietary system began over four years ago. I adopted this way of eating due to over eating refined foods and due to my body’s inability to digest proteins and carbs together without making me sluggish and giving me brain fog. The first year I ate low-carb I lost 20 pounds. That wasn’t my intention. It just happened that way. My carb intake is primarily from tubers and other veggies.

  84. David says

    What if a low carb ketogenic diet is not causing fat loss, but anytime I try to eat even 100-200g carbs from tubers and fruit, I don’t fit into my pants within a week? In other words, I can’t find any kind of sweet spot to drop body fat. Am I doomed?

  85. Tom Boyer says

    This endless debate over whether paleo person was a carnivore or herbivore is truly pointless and academic.

    We have recent historical accounts, quite detailed accounts, of aboriginal people getting their calories from meat, from whale and seal blubber, shellfish, root vegetables, grubs, cheese from goats and cows, and even grasshoppers and locusts.

    It is abundantly clear that we are dual-fuel creatures. We can survive and live a relatively long life on many diets. What is our optimal diet is simply not answerable right now based on the data that we have.

    But we do at least know what is clearly wrong, what is bad thinking and bad science, And that is the notion — stubbornly insisted upon by everybody from Archer Daniels Midland and industrial bakers to Pepsi to fanatical vegans — that our optimal diet is grains.

    My cats lived for 25 years on cheap cheap food made from corn meal and fiber filler (similar to what a lot of American processed food is basically made of). The cats lived normal lifespans. But that does not mean that was the optimal food for cats. Now we feed our cat a diet of raw chicken, and the cat is healthier in every way — no longer overweight, with a beautiful silky coat.

    The philosophy of Paleo is great because it tries to make us think about the kinds of foods we are evolved to eat. But that doesn’t mean we should obsess on anthropology and archeology. Ultimately we should be guided by our own health.

    If we are maintaining healthy weight, if we have good energy, if our skin and teeth are healthy, if our digestive systems are running smoothly, if our blood lipid markers are good — that’s what should guide us.

    But if we’re carrying an extra 20 or 30 pounds, if we are suffering from reflux and snoring, if our skin is starting to produce tags and other benign lesions, if we get a lot of cavities, if our blood lipids aren’t good, if our brains aren’t performing as well — we shouldn’t take that as the inevitable decline of aging or blame ourselves for not exercising enough (not that exercise isn’t good!).

    All these things should be telling us that there needs to be a change in diet — probably a change in macronutrient ratios, with a fairly high likelihood that we should be increasing dietary fat and decreasing carbohydrates.

    • Finny says

      ***This endless debate over whether paleo person was a carnivore or herbivore is truly pointless and academic.***

      There are many people who believe the “Paleo Diet™” was an accurate depiction of what the natural-human diet should look like, and got sicker doing it. Chris apparently sees this in his practice all the time. So, I think the discussion may be more than an academic exercise. It’s probably about clearing up misconceptions to keep people from blindly jumping into a diet relatively few people have ever attempted, aside from a few Inuit.

      ***All these things should be telling us that there needs to be a change in diet — probably a change in macronutrient ratios, with a fairly high likelihood that we should be increasing dietary fat and decreasing carbohydrates.***

      Or just decreasing the “refined” carbohydrates/sugar and gluten. As Chris said, above, “whole-food” carbohydrates do not affect the body in the same way as processed and refined carbohydrates do.

      • Tom Boyer says

        Finny writes: “Or just decreasing the “refined” carbohydrates/sugar and gluten. As Chris said, above, “whole-food” carbohydrates do not affect the body in the same way as processed and refined carbohydrates do.”

        We would have a lot fewer sick people in the country if we based dietary decisions on thoroughly proven science instead of winging it.

        This notion that “whole foods” are not carbohydrates or do not act upon the body in the way carbohydrates do is bogus. I don’t think Chris says what you think he says.

        Sugar is going to raise your blood sugar and insulin whether it is in a Pepsi or in a glass of orange juice, and a whole orange is going to perform only marginally better than the juice. (In fact it has been pointed out that the only healthy way to eat an orange is to juice it, pour the juice down the drain, and eat what’s left. But people unfortunately do the opposite.)

        The notion that “whole grain” products are better than products made from white flour seems to be hard for lay people to resist, but there is no scientific evidence of this. They raises your blood sugar and insulin just the same — as any diabetic knows.

        If you’re eating a bagel or muffin for breakfast, it matters not to your pancreas whether it was made with whole wheat or white flour. Your pancreas is being called upon to blast insulin into your bloodstream to handle the blood sugar, with all of the long term impact that has on your body..

        If carbs are problematic for you (and if you’re fat, probably the answer is yes), then you need to cut carbs period. It doesn’t mean you need to eliminate them completely but you should reduce your carb consumption.

        I think people cling to this “whole foods” mythology because the thought of cutting down on things like bread and pasta, or fruit and cereal, is emotionally difficult for them.

        Rather than being in denial, I recommend dealing with this by not banning bread and pasta but by eating it on occasion, as a treat. When I do, I want the quality to be excellent, and for me that compensates somewhat for the lack of quantity.

        • Finny says

          “Sugar is going to raise your blood sugar and insulin whether it is in a Pepsi or in a glass of orange juice, and a whole orange is going to perform only marginally better than the juice.”

          Ever hear of the “bean effect” or “second meal effect”?


          Not exactly like a Pepsi ‘eh? Fiber makes a difference. Seems like you have a lot to learn about carbs.

          • Tom Boyer says

            Finny, that video was produced by nutritionfacts.org which is run by Dr. Michael Greger who is a prominent vegan physician — he is an employee of Human Society International.

            (see link: http://en.wikipedia.org/wiki/Michael_Greger)

            Their every waking minute is spent trying to convince people to stop eating meat and dairy — their concern is animal rights — NOT your health.

            People need to be really cautious when looking up nutrition information because there are so many faux information sites that are basically just fronts for vegans or grain producers or drug companies. It’s a real serious problem.

            Best to stay with blogs of people who can be trusted — Kresser is one of the good guys.

            And actually I know about beans. I like beans. But they are definitely fattening — very calorie dense a high glycemic impact.

            If you don’t think people get obese and become diabetic on beans and tortillas, I suggest you tour the low-income areas of the Southwest U.S.

            Finny wrote:
            Ever hear of the “bean effect” or “second meal effect”?
            Not exactly like a Pepsi ‘eh? Fiber makes a difference. Seems like you have a lot to learn about carbs.

              • Lisa says

                Finny – He didn’t say that all Mexicans are fat – calling him out as a racist is irresponsible on your part.

                There is an obesity problem in the Native American population. We can debate the cause but let’s not go down this road, please.

                • Finny says

                  Please, Lisa.

                  He thinks that eating lots of beans and tortillas makes people obese. Well, those happen to be 10,000+ year old staples of the Mexican diet and up until recently, Mexico didn’t have an obesity problem.

                  He made an uneducated and stereotypical comment about a culture and their traditional eating habits.

                  It’s well known that obesity is a relatively new problem in Mexico:


                  So, it doesn’t take a genius to realize that it ain’t the beans and traditionally prepared tortillas that are the problem.

                  Mexico’s relatively new obesity problem is often blamed on processed foods.

    • says

      “All these things should be telling us that there needs to be a change in diet — probably a change in macronutrient ratios, with a fairly high likelihood that we should be increasing dietary fat and decreasing carbohydrates.”
      Not necessarily so! I can tolerate dietary carbohydrates better now that I am 59, than when I was 10.

      I managed to rectify a problem that I have had for most of my life. This problem reduced my insulin sensitivity considerably.

      • Tom Boyer says

        Nigel, I don’t know how you did it, but low-carb high-fat regimen, even for a few months, can often significant lessen insulin resistence. So can conventional calorie restricted dieting and exercise. But the latter is a lot harder for most people to sustain.

        Anyway, if you get your insulin sensitivity back, you don’t want to go back to the eating habits that got you in trouble do you?

        Metformin is a wonderful life-saving drug that helps with insulin sensitivity. But if a low-carb diet can accomplish the same thing as taking metformin, why take a pill for the rest of your life that will inevitably have side effects?

        People are just overthinking this. If something is making you sick, stop doing it. If you are a smoker and your lungs are performing poorly, you know what to do. If you eat a high-carb diet and you are getting fat and insulin-resistent, you know what to do — cut down on the food that is making you sick and eat food that won’t make you sick.

  86. rs711 says

    Yes – I am generalizing in the statements below. Nevertheless…

    1) Evidence from traditional populations show that healthfulness is possible on both high-carb or high-fat diets.

    2) Evidence in modern civilizations (randomized clinical trials etc.) show that healthfulness is much more readily achieved with a high-fat diet and only exceptionally on a high-carb diet.

    I think the question worth asking is: What is it about modern living that makes health easier to achieve – **on average** for a population – on a high-fat diet rather than a high-carb one?

    The answer would hopefully provide ways to return to what we observe traditionally: both high-fat and high-carb diets seemingly working well.

    Chris, I’ve followed you for years now, listened to all your podcasts, bought & read your book and even bought some of your products recently. However, Laura’s last article was unnecessarily divisive (look at the title) and although your are more even keeled, this article does seem to pigeon-hole LC or ketogenic diets. Now they are made to appear useful only ‘therapeutically’. This also ends up mis-representating the diversity of foods that can be had on a VLC diet.

    1) Healthfulness defined in this context: longevity, performance, absence of disease etc.
    2) High-protein diets are a misnomer, as protein is a macronutrient playing the role of a structural component that cannot act as a fundamental, long-term fuel.

  87. Tara says

    Have you found low carb essential for treating candida/fungal issues in your practice? I feel awful on low carb, but all of the practitioners I seek out tell me the elimination of carbs is the only way to keep the overpopulation of the ‘bad’ flora at bay.

    I’ve been on GAPS for a year at a time. I feel miserable and exhausted, my adrenals fizzle, but my stomach issues get better. As soon as I start introducing starches, the symptoms of candida overgrowth reappear.

    Man, I wish you would take Canadian patients..

  88. Tom B says

    Chris, this is a thoughtful, informative post, but most of the push-back against low-carb is not.

    The grain and processed food industry is clearly on a p.r. offensive about this and they clearly have employees and paid professionals posting to forums like this. They will fight as hard as the tobacco industry fought to deny the science.

    The other big opposition to low-carb is anti-scientific for different reasons — it’s the vegan/vegetarian community, which worries that low-carb means more animal products will be consumed.

    Vegans are constantly circulating dubious claims that eggs, cheese and meat are toxic poisons and carcinogens — not because they care about people’s health but out of concern for animal rights. To a lot of committed vegans, lies of this sort are justified.

    People who have benefited from low-carb and keto eating have always had to swim through a river of misinformation from the medical establishment, so we’re used to dealing with lies.

    But the sad thing is, every time the falsehoods are circulated (meat is carcinogenic, low-carb is dangerous), that represents obese people who might really benefit from keto approaches but become too scared to try.

    So I think it is appropriate that people who have benefited (and benefit every day) from low-carb lifestyle should aggressively battle the lies every time they encounter them. Which is why I am posting here today. This is a propaganda battle worth fighting.


    • Chris Kresser says


      I agree, but the push-back against low-carb in the mainstream media and by vegans is not really what I was addressing. I’m referring, as I think you know, to the “low-carb police” who insist that a LC or VLC diet is appropriate for everyone, in all circumstances.

      I have defended and promoted higher-fat diets in the past, and will continue to do so, where they are appropriate.

      • Tom B says

        Yes I agree 100% Really there were two mistakes made by the American scientific/dietary establishments that produced the obesity-diabetes epidemic.

        One was a bet on bad science (Ancel Keys and his followers) who believed dietary fat was the cause of heart disease, and that refined carbs and sugars were relatively benign.

        But the second, equally important, was the whole notion that everybody could follow the same food pyramid and achieve good health. The advice should have been (and should be today): Watch your waistline and your blood lipids and balance your carb/fat/protein consumption according to what works.

        Low carb works for me, but I have friends who thrive on diets of vegetables and starch. We all have to be scientists and figure out what works for us.

      • ValerieH says

        Who are these low carb police? I read a LOT of nutrition blogs in the low carb/Paleo/Real Food (WAPF)/ camps. I don’t see them saying this diet is for everyone. There are many people who do benefit from low carb, as you pointed out. Compared to the SAD diet, 150g a day is low carb for some. I do well on 50-60g/day.

        I was very interested in the part about the gut bacteria.

        • JZ says

          There are few if any “low carb police”, whatever that even means. There are loads of high carb (my way or the highway) police, however. I’m fine with the mantra that there’s not a one size fits all nutritional silver bullet. But let’s be realistic here. LCHF proponents are far far outnumbered by the food pyramid (viz, agri business) police. I think Dr Kresser’s energy could be better spent throwing cautions and darts their way

          • Tom Boyer says

            > JZ writes: LCHF proponents are far far
            > outnumbered by the food pyramid (viz,
            > agribusiness) police.

            I agree, and it’s really funny because the food pyramid was never even remotely based on science.

            As Nina Teicholz details in her new book, the food pyramid was a creation of American agribusiness.

            No doctor or scientist ever, ever said 11 servings of grain a day is a good thing. That’s insanity. The grain industry just had Earl Butz’s agriculture department put that in.

            • JZ says

              Since science hasn’t settled the issue of what a perfect diet consists of–even a several sizes fits all approach–I’d like to pose a practical question. Is a low carb, (say 50-100 grams per day) high fat, moderate protein diet, absent sugar and refined carbs, significantly better metabolically and weight maintenance wise for the vast majority of people than the USDA recommended diet?

              Remember, science hasn’t settled the issue on what’s optimal, so absent a definitive answer, what should responsible people say works best and what ethically speaking should be recommended people eat absent definitive scientific proof?

              It’s one thing to question low carb folks motives, but given the dietary realities most people partake of, I see far more compelling reasons to be cynical of government pushed dietary guidelines than anything proffered by so called low carb zealots. Tempest in a teapot.

              • Gerry R says

                “Is a low carb, (say 50-100 grams per day) high fat, moderate protein diet, absent sugar and refined carbs, significantly better metabolically and weight maintenance wise for the vast majority of people than the USDA recommended diet?”

                I don’t think anyone thinks that SAD is ideal. And it’s probably not even physically possible to eat SAD-levels (300-500g) of whole food carbs. I’d like to see someone try though :)

                By “low carb police” I think Chris is referring to people who make the claim that ***a LCHF diet is the best diet for optimal performance and health and its supposedly how our Paleolithic ancestors ate and therefore everyone is naturally programmed to eat that way, and if you feel worse when you remove carbs from your diet you must be doing it wrong.***

                The mainstream media is jumping on the low carb bandwagon and makes no distinction between complex and refined carbohydrates. So, pretty soon everyone in the country is going to be convinced that carbs are the devil and a good fraction of the population will probably get adrenal fatigue, thyroid problems, and become insomniacs while all the mainstream doctors will have absolutely no clue what’s going on or how to fix them.

                Meanwhile, we’ll still be arguing over the difference between a sweet potato and a bowl of Cap-N-Crunch.

                • JZ says

                  @ Gerry,

                  First, where is the settled science that a LCHFMP diet will lead to a significant amount of the population being afflicted with “adrenal fatigue, thyroid problems, and becoming insomniacs “?

                  I don’t follow a paleo diet, but I do follow the trending science and I don’t think it’s unreasonable, absent definitive science, to explore different dietary options. I’m more interested in the diet per se than I am in the proponents thereof. That doesn’t mean I don’t have a jaundiced view of fad diets not supported by any science whatsoever. However, the government recommended diet is gleaned vis a vis by so called cientific rigors as a one size fits all bromide and yet you don’t have to be a cynic to understand the food industry and its myriad lobbyists, not to mention other academic self interested types have a boatload of say in what that pyramid looks like.

                  So my question still stands, but I’ll pose it from a more utilitarian perspective. Does a LCHFMP diet as I outlined above benefit significantly more people metabolically and weight wise than the USDA diet (which most people attempt to pattern their diets after)? Forget about personalities or the lack of absolute science supporting its implementation. Absolute science doesn’t support the USDA nor are their a lack of unsavory ill informed peddlers of its nostrums.

                  If you favor one or the other as healthier yet ultimately reject both diets then what is the best of the imperfect diets out there?

                • Gerry R. says

                  “Does a LCHFMP diet as I outlined above benefit significantly more people metabolically and weight wise than the USDA diet”

                  JZ, Sure. Big deal. Literally any diet that eliminates or reduces refined carbs would be a benefit for anyone’s health.

                  I don’t understand why do you cut off your hypothetical diet at 100g carbs when some people seem to thrive at 150g of carbs as starchy plants. Many of those success stories came from increasing carbs from <100g to 150g.

              • Tom Boyer says

                The USDA diet shouldn’t even be used as a baseline. The USDA diet shouldn’t be used at all really.

                The USDA recommendations were really not designed with human health in mind. The USDA officials who originally wrote them were basically steamrolled by lobbyists for American agribusiness, which is why it is largely a grain-based diet.

                I know it is hard for people to get past this, but getting all your calories from grains and sugars is just not good for most people.

                Yes you can survive on it but most people will put on fat and slide toward diabetes and heart disease.

                If you eat grains all the time and you are fat or getting fat, that should tell you what you need to know — reduce your grain consumption; eat more foods that will not spike your blood sugar.

                When they want to fatten up pigs and cows, what do they feed them? Why would the result be different for human beings?

  89. Marcia says

    I think the diet issue includes not only carbs but fat, and having enough fat (especially EFA’s and saturated fat) has helped me. For years I avoided fats thinking they weren’t good for me. Fructose malabsorption has also been a problem for me, and gluten was damaging my intestines, I think. When I cut out all the grains I started to feel better, and ate minimal vegetables, just the low sugar ones. Probiotics, Betaine HCl, l-glutamine, B12, folate, MTHFR testing. Lots of things help. You just keep experimenting. I prefer doctors like Chris and other naturopaths. And researching on my own. There’s a lot of good information out there now.

  90. Joni Bott says

    I was on a very low carb (50 g/day, I crave them all day long. It’s very hard for me. I’m always 20 – 30lbs overweight, I have terrible digestion, and my resting metabolism is <1500 cals/day. I feel like low carb, which was low cal in my experience (since I was so satisfied), messed up my metabolism as well. Or, I could have just been born unlucky. To boot, I married a man who is vegan (his predominant diet being super high carbs) AND has the metabolism of a workhorse.

    Generally, I think low carb is great for fast weight loss for someone who needs it for whatever reason. But I wouldn't recommend sustaining it indefinitely, based on my experience.

    • Tom Boyer says

      Joni, you may be right but it’s also possible you didn’t give your body enough time to adjust and do the right things to be comfortable during the adjustment period. (like, just for example, drinking some salty broth to maintain fluid levels)

      I’d strongly recommend getting the “New Atkins” book (Dr. Eric Westman) from the library and just read up on how to do it. It’s really the most scientifically sound explanation for lay readers of what happens when you restrict carbs and allow your body to burn fat. And Westman’s advice can be applied to any kind of low-carb high-fat approach including Paleo — there are dozens of different ways to reduce carbs, you don’t have to do Atkins per se.

      Another problem for you clearly will be being married to a vegan. You can do vegan low-carb but it is much more difficult without cheese, fish and eggs. And if you have tasty rice and grains and legumes and fruits on your table every day, it is extremely difficult not to eat them.

      But still, if you are 30 pounds overweight and having belly issues — things like snoring, reflux, indigestion — and particularly if your blood lipid profile is not good — it is very likely you need to cut your carb intake significantly. You don’t have to do anything radical, but reducing your carbs to even 120-150 grams a day might help you feel better and lose weight.

      • Kristina says

        Just an FYI- you’re doing exactly what the vegan camp does- telling her if it’s not working for her then she must be doing it wrong. It may not be working for her because it’s not right for her body. In my case I did Atkins. While in Phase 1 I lost weight, but I had to stay below 15ng/day or I gained a lb/day back. That’s ridiculously low. And after 3 months of this, and 12 lbs lost, I started feeling like crap and gained 17 lbs in 3 months. I found out it fried my adrenals. Now I’m tried to recover from wicked adrenal fatigue, and can’t even walk across the room most days, let alone exercise to any extent. Some people just aren’t built for withstand low-carb.

        • Joni Bott says

          Thanks for responding Tom & Kristina. It’s funny, my husband is convinced I must be “doing it wrong” if veganism doesn’t work for me. When I went vegan for 2 weeks, I felt like you did on Atkins, Kristina – completely weak. I know that low carb works for me – I feel AMAZING and my energy soars. But I do think I had to be extremely low (<80 gms/day probably) in order to sustain it. That usually meant I'd drink a glass of wine instead of eating a bowl of broccoli (if I'm being honest.)
          I still recommend low carb to anyone who has a lot of weight to lose. If it works for you, I don't think anything else is as easy or effective.
          I'm eager to read the book you recommended (Westman), Tom. I agree that there is WAY too much propaganda out there about nutrition, which is a tragedy. Even as a smart person, it is almost impossible to feel like you're 100% sure about what you should eat for optimal health. Nothing appears to be "safe" anymore.
          Bottom line: Eat what makes you feel good. Listen to your body. Avoid processed foods; whole foods are best.

  91. Hemming says

    Hi Chris,

    I don’t argue with any of the points. My problem is that I have an eating disorder which makes me so scared of carbs including fruit and starch, eating an apple is something I have to plan days in advance. I’m so scared of getting fat from eating any carbs even though I weigh 60kg at 5’9″.
    I have the same fear of protein, just to a lesser extent.

    Just saying that there are a lot of nuances to this debate.

    • Debbie says

      I relate to this too. I just bought a box of blueberries and ended up eating the whole thing in one sitting. After losing weight and maintaining it for years. Oh well!

  92. says

    It’s so refreshing to hear someone else back the possible requirement for higher levels of carbs by some people. I am a little tired of hearing about Ketogenic diets knowing very well when I personally reduce my carbs to under 30% my thyroid slows and my adrenal system starts to slow. Having suffered adrenal fatigue in the past I know my body thrives on good quality carbs, especially post training (I lift heavy). As a Nutrition Counselor I tailor the nutritional intake individually for each client, rather than a ‘one size fits all’. Awesome write up! Thanks.

  93. Mina says

    I tried going low carb and it completely threw my body out of whack. I got very intense sugar cravings (which I don’t usually get), was irritable, didn’t sleep well…it only lasted a week, I couldn’t stand how horrible I felt. I seem to do very well on a high carb diet (maybe 50% or so)…I’ve been vegetarian for 20 yrs (gasp) but feel amazing and not one dental problem ever. Absolutely love the unbiased nature of your work Chris.

  94. Celestine says

    There are six billion people on this planet and counting. All of these people have different metabolisms, life styles, health issues. No one type of diet is going to suit everyone and thank god for that, because it probably wouldn’t be sustainable. If a particular way of eating works for you, great! Keep doing it. Everyone is on their own path; let others discover what works best for them.

    • says

      “No one type of diet is going to suit everyone and thank god for that, because it probably wouldn’t be sustainable.”

      Great point! Imagine if everyone wanted to do a ketogenic diet… how could there ever be enough fat produced to feed everyone?

      • rs711 says

        sorry, I must be a bit thick – but I can’t tell.

        If you’re serious: that must be one of the silliest statements I’ve seen lately. You do know that you can (for e.g.) make fatty cheese more than once before you slaughter a cow/goat/sheep, right? Ever heard of Alan Savoury using animals (which are sources of fats) to reverse desertification?

        If you’re joking: that’s funny :)

        • says

          I’m not joking. Feeding 7 billion people a diet consisting of 80%-90% calories from fat would be impossible.

          What would you do with the leftover protein from the animals once you stripped them of the fat? How would you get the animals to produce enough dairy to make butter and cheese for that many people? Where would you start growing coconuts beyond the tropics so that everyone could use coconut oil in vast quantities?

          There’s a reason why most traditional diets are not structured that way – it just makes no sense based on the types of food that is available in most climates.

          • rs711 says

            Traditional diet-eating populations were developed out of necessity. Modernity changes that. We can make choices to different extents. (whole other subject, but) Population sizes are neither immutable nor poised to endlessly grow. Much depends on how we organize our society. If you ask hard questions but assume the current paradigm will never shift, then of course that solutions seem impossible. That’s why we must attempt to change the paradigm and hence (as an e.g.) my pointing to techniques from the Savoury institute. There are other if you care to seek them out. The (average) higher caloric density of fat per gram certainly makes it interesting if not advantageous.

            What ‘makes sense’ isn’t always what is ‘best’ – enter science.

            I eat nose-to-tail so I don’t even consider wasting animal parts. There are a million and 1 things to do with ‘left-over’ protein which people smarter than you or I could think of. It’s not ALL about food.

            • Duck Dodgers says

              Well, it’s worth noting that even the Inuit were unable to obtain enough fat from their animals to keep them ketogenic. [1][2][3][4]

              From: The Diet of Canadian Indians and Eskimo by Sinclair, H. M. (1953)

              “It is, however, worth noting that according to the customary convention (Woodyatt, 1921 ; Shaffer, 1921) this diet is not ketogenic since the ratio of ketogenic(FA) to ketolytic (G) aliments is 1.09. Indeed, the content of fat would have to be exactly doubled (324 g daily) to make the diet ketogenic (FA/G>1-5)”

              • Karl says

                I knew Inuits weren’t in a keto state. Since fresh meat has glycogen, I don’t think there are any groups of people whatsoever that stay in keto.

                • Paul. S. says

                  “I don’t think there are any groups of people whatsoever that stay in keto.”

                  That’s silly! At least some of the Inuit were almost certainly in ketosis for a good portion of the year. Read about Vilhjalmur Stefansson’s expeditions to the arctic.

                  I am no genius, but to me it also seems logical that humans having survived several ice ages, the last one lasting over 50,000 years may have lived and survived on very little plant food and did well enough for us to still carry on their genes today.

                • Duck Dodgers says

                  Paul. S. said: “That’s silly! At least some of the Inuit were almost certainly in ketosis for a good portion of the year”

                  Perhaps a small percentage of Eskimos did ketsosis, but not many based on new genetic information.

                  See, the overwhelming majority of Eskimos have a very rare autosomal recessive CPT1a mutation, which makes it so that their liver cells cannot easily oxidize fatty acids (where ketosis takes place). This allows them to protect their livers and divert dietary fats to their muscles, brain, and brown fat where it the fatty acids can also be burned for thermogenesis (i.e. increased body heat). The gene makes them highly adapted to the Arctic environment. (Due to its autosomal recessive inheritance, the gene should be extremely rare, but it is highly prevalent (68%) in Eskimo populations—indicating that it is “normal” in Eskimos and may have been even higher before intermarriage with whites).

                  The downside of this mutation is that the Eskimos tend to have difficulty fasting, particularly children, which results in hypoketotic hypoglycemia when fasting—low blood sugar and low ketones. They get woozy and lightheaded. In other words, their genetics prevents them from doing ketosis very well.

                  The Eskimo’s CPT1a mutation appears to explain the Eskimo practice of snacking constantly:

                  See: Clues emerging about Arctic gene, diet and health

                  As you can see, there’s just not much, if any, evidence for ketosis being a normal chronic state for humans. Most Eskimos had genes that appeared to protect them from generating too many ketones in their livers.

                  Paul. S: “I am no genius, but to me it also seems logical that humans having survived several ice ages, the last one lasting over 50,000 years may have lived and survived on very little plant food”

                  Think very carefully about that statement. If there were few plants, then what do you suppose animals like Wooly Mammoths ate??

                  The answer is that the “ice age” was not a barren landscape as you were taught in Elementary school. Recent studies have shown that the ice age landscape was filled with plants, many of which had starchy pollens and roots/tubers/rhizomes (i.e. forbs and grasses).

                  See: Nature: Fifty thousand years of Arctic vegetation and megafaunal diet

                  And there’s evidence that humans were grinding wild barley and wheat 22,000 years ago, during the peak of the last glacial maximum:

                  See: Science Magazine: Ice Age Cereal

                  Finally, we see evidence that Homo
                  in Mozambique were processing grains, including sorghum, at least
                  105,000 years ago and likely earlier. Researchers found starch granules all over
                  their tools.

                  See: Mozambican Grass Seed Consumption During the Middle Stone Age


                • says

                  Dear Paul S.,

                  The comment made by Karl isn’t silly. It turns out that the Inuit and other far-northern people do not exist in constant ketosis. They consume carbohydrates (in the form of glycogen–a starch storage molecule found in animals, and especially rich in their organ meats) from the fresh animal foods they consume. They also create glucose from protein (through gluconeogenesis) and eat lots of carbohydrates when available, even storing these into the winter (such as a species related to raspberry called “cloud berry”).

                  The Inuit don’t just eat fat, they consume lots of protein and get more carbohydrates that most people realize. While they certainly would have been in ketosis some of the time, they did not exist in this state continuously and throughout the year (research demonstrates this). I think you would also be interested in the amount of plant foods they consumed (and stored for the winter). Forty different species have been counted as food species even in extreme northern groups. While it is a constantly reported myth, humans did not exist solely on animal foods (though they can and do go long periods of time with only these foods). Best wishes.

                • Duck Dodgers says

                  And as far as Paleo starch consumption goes, it used to be easy for archeologists to find a pile of bones and conclude that early humans ate meat. But these days, archaeologists are looking for microscopic evidence to determine plant consumption, and the microscopic evidence is slowly coming to light. For instance:

                  In addition to the starches found at the 100,000 year old Mozambique site, starchy plants were being processed for flour at least 50,000 years ago at the 8-B-11 site at Sai Island, Sudan.

                  Starches were being ground for flour in Italy, Russia, and the Czech Republic at least 30,000 years ago (Mid-Upper Paleolithic).

                  Wild barley and wheat were being ground for flour 22,000 years ago, during the peak of the last glacial maximum.

                  Starches appear to have been found on stone tools from Aurignacian sites dating to just prior to 30,000 years ago in Germany.

                  Ground nuts (i.e. sedge tubers) were likely eaten 70,000 years ago (Middle Stone Age) in Sibudu, South Africa.

                  Neanderthals (as late as 40,000 years ago) are now believed to have incorporated plants and starches in their diets. New data has shown that the Neanderthal diet appears to have included grass seeds, dates, legumes, and tubers (USOs), and that several of the consumed plants had been cooked.[1][2][3]

                  The new evidence shows very clearly that the old pile-of-bones=carnivory archaeology is obsolete.

                  And that doesn’t even begin to touch upon the mounting evidence for honey consumption and hominid/human/honeyguide co-evolution going back 3-5 million years.

              • Ved1 says

                Its not the presence of fat, but the lack of insulin response that unlocks ketosis. -> ingested protein causes 30% of the insulin response of the equivalent amount of ingested carbs, and fat causes practically no insulin response. So, atleast theoretically, depending on how much total protein is ingested by the inuits independently of fat, they may or may not go into ketosis.

  95. Kathy says

    My attempts at low carb (40-50 grams/day) yielded the following within two weeks time: Unable to sleep more than three-four hours at night; heart palpitations most of the time, worse at night (part of the reason I couldn’t sleep); gout in one foot, and anxiety through the roof even tho I have never experienced anxiety like this in my 60 years on this planet. Although I did lose 10 pounds (need to lose 30), it has stalled at this point and I think I need to find another way to lose the next 20.

  96. Karl says

    Neandertals ate predominately meat with significant plant intake. I’m not sure what’s considered “significant” in the research article. This is direct evidence from using faecal biomarkers. A different article stated finding traces of fossilized plants like legumes and grains extracted from Neandertal teeth, too.

    • Duck Dodgers says

      “Our data show that Neanderthals in both environments included a spectrum of plant foods in their diets, including grass seeds (Triticeae cf. Hordeum), dates (Phoenix), legumes (Faboideae), plant underground storage organs, and other yet-unidentified plants, and that several of the consumed plants had been cooked. The identified plant foods from Shanidar match well with the soil phytoliths and macrobotanical remains found at other Neanderthal sites in the Near East, whereas those from Spy show use of USOs as predicted for European Neanderthals. Neanderthals’ consumption of these starchy plant foods does not contradict data from isotope analysis, because nitrogen isotopes record only the consumption of meat and protein-rich plant foods.” [1]

  97. Cody says

    Chris, one thing you didn’t mention is that metabolism will slow on any reduced calorie diet

    And the lower the calories over time, the bigger the crash.

    I do agree that the likelihood is there that some folks won’t do well on low carb diets.

    But. And this is a huge but. People blame feeling like crap on being on a low carb diet. But has anyone looked at their nutrition to see if they were deficient in one or more key nutrients?

    And as you pointed out, being low carb doesn’t mean you have to consume zero fermentable fibers in your diet.

    I was on a PSMF with 2 cheat meals per week and after 4 to 6 weeks on this I would stall and feel exhausted.

    But I suspect anyone on an 800 to 1000 calorie diet for any extended amount of time will feel like dog crap.

    I wish people would be a little more thoughtful about the changes they made. I wish they’d make sure they are getting their nutritional needs met vis a vis vitamins and minerals, as well as not going overboard with the caloric defecit.

    And quoting ol Tricky Dick Nikoley? Mr. Professional crap stirrer?

    Have you seen his recent tirades against low carb? He’s making the same mistakes you mention, assuming that what works for him works for everyone and ignoring outliers. And he’s become an RS zealot. Car won’t start? RS. Bad relationship? RS. Want to create world peace? Dehydrate a plantain.

    There are a lot of unknowns here. People need to calm down, engage their brains, and figure out what works for them.

    Be methodical. Be patient. And keep an open mind.

    Nutrition is a black hole of poorly done science and preaching on high by many with less than pure intentions.

    • rs711 says

      “he’s become an RS zealot. Car won’t start? RS. Bad relationship? RS. Want to create world peace? Dehydrate a plantain”

      hahahahahahahha. so true.

      He’s becoming increasingly facile with the ‘f*ck the science, look at my blog anecdotes’ attitude. The blog is polarizing and it is becoming an echo chamber. [yes – I’m aware VLC echo chambers also exist]. I tried making (I thought) a simple self-evident point, that “150g of CHO is too much for more and more people” specifying that 150g of CHO wasn’t inherently bad. Apparently, in his words “this is absurd”. He lost all credibility there. Denying reality. See for yourself: http://freetheanimal.com/page/2

      Everyone is wrong, biased and misguided at times. Being purposely inflammatory, trolling and dogmatic is not ‘acceptable’ though.

    • Debbie says

      I agree regarding caloric intake. I lost a huge amount of weight many years ago, and over the years have watched the weight go up somewhat and the caloric intake go down just to stay at not-obese. Very depressing – but that is metabolic syndrome. Perhaps if I’d followed a healthier diet from the beginning of my weight maintenance years my metabolism would have been a little more robust. But, bottom line is, if you’re under-eating in terms of calories – ANY kind of calories – you will have poor energy. And then one has to decide: is it healthier to be a little fatter and feel pretty good, or a little thinner and feel lousy?

      For me in all honesty it has to do with calories/weight.

  98. Xochitl Martinez says

    Great article! It definitely depends on the circumstances of every person. If it wasn’t for a LC diet I’ll be right now in very serious problems! I read about LC-HF diets a few years ago but never got interested. I was pretty happy with my diet: no processed foods, plenty of veggies and fruits, fish, nuts, moderate dairy and whole grains, not refined. I was fit, did exercise and my energy was generally good. But then little by little, in the lapse of 5 years or so, I started loosing energy and mental focus, got adult acne and I started noticing how bad I felt after every meal. Then I discover I had Diabetes Type 1; at 33 years old! I remembered about the LC diet and changed my diet. My pancreas stopped working in the lapse of 6 months but thanks to this diet, I inject the minimum of insulin, and like this I avoid hypoglycemic episodes (which I’ve never had) and my energy, and well being came back. I don’t think being a diabetic gives me the opportunity of eating starchy foods again, it’s risky so for me this is the only diet.

  99. Jane says

    Eating low-carb has allowed me to control glucose intolerance and prevent it from becoming diabetes. Wish I didn’t have to eat this way but it’s the only choice right now. Enjoy your (good) carbs, everyone!

  100. Anna says

    Thanks for clarifying. One group that stands out from the rest on this topic is diabetics. Since the diabetes is characterised by impaired ability to regulate blood sugar, which is directly impacted by dietary carbohydrate, it stands to reason that a low carb diet can offer a clear therapeutic benefit for diabetics. I have personally had great success in “reversing” my diabetes this way. On the other hand, my overweight partner tried low carb, initially lost a significant amount of weight, but lost interest in the diet and put all the weight back on. He tried a second time to no avail. Somehow with low carb, the weight loss only works the first time. So unfortunately it is not a magic bullet for him.

    • Laurel says

      Anna – If your diabetes is truly reversed you’ll be able to eat like a “normal person” and not have high BS. If, on the other hand, you have to keep your carbs low in order to have normal BS then your diabetes is not actually reversed. IMHO.

  101. Janis Wilds says

    I follow the Paleo lifestyle and have found your book to be the perfect resource. At 53, with NCGS, SIBO and problems with FODMAPS, I limit my carbs to tubers at breakfast and dinner. This has helped my hypothyroid get under control and keep the yeast at bay. Interestingly fermented foods caused my SIBO. Finding my Paleo code has been a journey with a winding road. As my intestines heal from antibiotics perscribed for teenage acne and years of un diagnosed gluten sensitivity I will be continuing to adapt the code. I started on this journey three years ago and I can’t even list all the positive physical and mental changes I have experienced. My health was failing and I was desperate. Thank you for sharing all your research and the knowledge you have acquired.

  102. SJ says

    My experience with VLC and LC for weight loss:

    I went from South Beach diet to eating real food (Weston Price) then to the low carb end of Paleo.

    I hated being on a low carb diet, but I was desperate to lose weight.

    Well, it worked for a while, then my weight loss stalled and some health issues that had previously disappeared in the early days of low carbing returned.

    I’m now eating according to Perfect Health Diet plan. Hoping to feel better and lose weight.

    Low carb may work for some, but I know several people who have acquired thyroid and GI issues on low carb diets.

    Everyone has to do what is right for them.

    • Elle says

      I’m in a similar situation as you. I did great on low-carb paleo, lost weight and skin cleared up. But after a year the weight loss stalled and I felt very deprived and cranky on VLC Paleo plus my TSH numbers were going in the wrong direction so I started following PHD (eating starchy carbs and fruit).

      As I result, I gained 20 pounds in 6 weeks! :( I’m guessing I over did it on the starchy carbs (or was too low carb for too long). I feel more sane and satiated having starch but, really don’t like going up two sizes.

      Waiting on lab work to see if my thyroid has improved or not.

      Confused as to what to do next.

  103. Marce says

    I don’t count my carbs but I eat a lot of sweet potatoes, bananas and many other real foods. I rarely get migraines now and when I do, it is from eating something I knew I should not have. I have lost around 20 pounds (and my belly) since changing to real foods and I was not big to begin with. My HDL was tested at >100 last week. :) Since reading “Your Personal Paleo Code”, I have made a personal commitment to eliminate processed foods. I have bought 3 copies of the book for other people. My son’s asthma has improved since changing the groceries I buy. His numbers (breathing tests) have dramatically improved and his asthma medication has been lowered and one of his medications eliminated. Some of my friends call it the “placebo effect” but I am a believer.

  104. Kenny says

    I lost 100lbs on low-carb. It was an extremely effective weight loss tool for me. About 20lbs from my goal, the weight loss stopped, I started feeling really tired and irritable, and I couldn’t make gains in the gym. Increasing my carbs helped all of those things (thanks for the advice Chris!). I still go low-carb and fast regularly, and even my “high carb” days are pretty low compared to most people. Experimentation and self-awareness are key.

  105. Suzie says

    I need to lose weight for my sciatica issue so I tried low carb which worked v well for short time but it made my adrenal fatigue worse. I’m not fat but being lean is less painful. :(

  106. Sima says

    Thanks for this article! I joined the paleo-bandwagon several years back. I initially ate a fairly low carb diet (I was doing a lot of cross fit so I ended up adding in sweet potatoes, but little else). The diet worked so well – I went from a 10/12 to a 4/6, I felt great, I had so much energy, and my brain was on super drive. I got pregnant and maintained a lower carb diet, but then after having a baby everything went haywire. I tried to maintain my low carb diet (have to lose that baby weight!!) and I was just miserable and starving all the time (breasfeeding is a lot of work!). I actually started eating a lot of sugar because I was depressed and hungry and couldn’t get my appetite and mood under control. Then I recognized that I needed a source of carb with my meals to achieve satiety. I have realized that as a nursing mom, I need a lot more carbs than I did as a non-mom. And now, as I’m tapering off nursing (2 years later 😉 I am needing fewer carbs again. Chris really gets the point that you have to tailor your diet to your body’s needs. I appreciate his accommodating approach to diet in a world of paleo “experts” who doom everyone to hell who eats slightly differently.

  107. chimbo23 says

    All very reasonable points, well made too. Pandering to addicts was the criticism from the LCHF crowd. There’s too much evangelism in this field. I can understand ex fatties getting excited about what works for them, but some go too far and clearly they forget the mistakes they made getting ‘broken’ in the first place. No one has all the answers, but even if someone did know it all they don’t have to be dicks about it.

    • Paul. S. says

      I love it!

      “No one has all the answers, but even if someone did know it all they don’t have to be dicks about it.”

      Can’t tell you how many times that same thought has crossed my mind. There are so many people out there that have a little intelligence, but are so cocky and arrogant, which in my opinion automatically makes them stupid!

  108. Whitney says

    Excellent points – the “low carb zealots” are difficult for me to deal with and understand, too.

    I’m a 30 year-old female, and undertook an experimental ketogenic diet recently to try to deal with some digestive and brain fog issues I was having. I have never felt worse in my life! The first two weeks were amazing – my brain fog cleared – but then came back with a vengeance as my energy levels tanked. Both my thyroid and progesterone levels plummeted as well, and I lost my period for the first time in my life. I stayed quite low carb (but not ketogenic) for a period of time before and after my keto experiment, but am finally realizing that I feel better on a more moderate carb approach – and my body fat percentage is lower when I do, too.

  109. says

    It’s possible that someone who has Insulin Resistance, Impaired Glucose Tolerance or Type 2 Diabetes believes that their condition is permanent and can only be managed by a low-carb, or very-low-carb diet.

    This is incorrect. If the above conditions are caused by “A”, or “B”, or “C”, or “D”, … and the cause is rectified before permanent damage is done, the above conditions can be permanently reversed and a relatively “normal” diet can be resumed.

    • Chris Kresser says

      It’s also possible for T2D to be reversed without a VLC diet, as I pointed out in the article. PSMF, restricted calorie diet, even low-fat diets have been shown to work (though the latter are not as effective as low-carb diets).

      • says

        Prof. Roy Taylor’s PSMF reverses T2DM in 8 weeks. A PSMF is the quickest way to deplete liver glycogen AND ectopic liver fat.

        That said, Walter Kempner’s mind-boggling rice, fruit, fruit juice & white sugar diet (2,200-2,400kcals/day at 94%E carbs, 4%E protein, 2%E fat) also reversed T2DM!

        • Tom Boyer says

          Well keep in mind PSMF (essentially, a fast) IS a low-carb diet. Fasting works really well.

          Fasting does the same thing as low-carb because it keeps your blood sugar stable (low) so insulin stays out of the way and you move into ketosis and burn fat instead of depositing fat. To the extent it reverses pre-diabetes it is doing it the same way low carb high fat is doing it — by keeping blood sugar low.

          Fasting is great and, like low-carb, has really been vindicated by recent science. Just 10 years ago people would tell you fasting was unhealthy and you were ruining your body. Now we know intermittent fasting (in a controlled medically sound way of course) is good for almost everybody.

          For people like me, low-carb and intermittent fasting work really well together because if you’re keto-adapted, you don’t get ravenously hungry on fast days.

          As for Kempner’s rice diet, first of all people were NOT losing weight and reversing T2DM on 2,400 calories of 94% carbs. That was not happening unless people were somehow burning 2,400 calories, which requires a heck of a lot of exercise.

          The Kempner rice diet is like like any other calorie restricted carbohydrate-based diet. They definitely work for weight loss but people go crazy from hunger and the blood sugar roller coaster, which is why they generally don’t work.

          Low carb diets inevitably do better in studies when run against calorie-restricted low-fat diets. It’s probably in excess of 20 studies that have demonstrated this.

          (BTW the Kempner foundation at Duke University folded up a couple of years ago. Not that it wasn’t valid science, not that it can’t work, but it just wasn’t as effective as other approaches.)

          • Hélène says

            when i was 38, and thats over a decade ago, boys and girls, i lost 15lbs quite rapidly by fasting completely (water only) for 3 days and then almost fasting for a few wks. i then lost 25lbs in a month by eating very little fat, no protein to speak of and everything i did eat was raw. raw corn on the cob is delish! i would eat no more than 1/2 pc of fruit at a time. i ate whenever i was hungry, which was all day just about. but it was almost all vlc veggies. i was lifting some at the time too and walking 4 mi daily so i didnt get any hanging skin problems.
            seeing the wgt pour off me was THRILLING. i had been obese for more than a decade, easy. nothing had worked. i then got in a bad relationship with a sociopath. wgt loss stopped but i maintained, even thru a pregnancy and ended up at 6wks postpartum, down 20lbs from where i’d started–hyperemesis gravidarum, baby! i did gain back during the pg, almost all i lost puking but after the pregnancy, lost it quick as I always do…isnt THAT interesting???
            BUT i started gaining again (WHILE NURSING COMPLETELY) a few mos later and by 1.5yrs postpartum was nearing obesity again. my body is the most screwed up mess ive ever seen. it makes no sense.
            but damn, i wish i could eat unknowingly put myself in ketosis again, albeit starvation ketosis, and lose some friggin wgt that STAYS off now. i lose, i gain.
            if i eat carbs, blammo–cravings, wgt gain, carbo-belly etc.
            metformin did nothing for my wgt either. T3 did zip for me anywhere.
            but i think about ketosis.

            • Hélène says

              my longwinded point was that fasting works REMARKABLY well.
              hi fat just isnt necessary to go into ketosis. i bet my urine and breath were FULL of ketones. i wasnt tired tho nor foggy like u would think due to a) starvation and b) such low calories…Fitday was tabulating my food intake at 600-800 cal a day LOL
              AND I WAS EATING CORN sometimes (it was summer) and rare small bowl oatmeal (cooked), no milk or sweetener but still a grain. i didnt eat any tubers (yuck raw) but did try grated swt potatoes once–not bad. i didnt use hardly any salt, nor potassium. but I was chowing veggies down. hmmmmm, a lesson here? lol

  110. Judy says

    I was able to lose 120 lbs 9 yrs ago by learning how to control my carb intake and staying around 80-100 grams a day. I have kept this weight off for 9 yrs and counting by continuing to eat the same way I did as I lost the weight. I never did go vlc or ketogenic. It worked better for me this way.

    • Kristina says

      Out of curiosity, how did you find your carb “sweet spot”? Did you do like Dr. Atkins suggested, which is to go VLC and add 5g per week until you stop losing, and then go back down? How did you do it? I have issues losing weight, tried VLC, lost a bit, but then crashed my adrenals. Now I’m not sure how to eat carbs at all. I’d love to know how you figured it out.

      • Kristina says

        I forgot to mention- I had gestational diabetes a year and a half ago and have had mild glucose intolerance since. If anyone can tell me how to figure out what carbs/ how many carbs to add back in I’d appreciate it.

      • jake3_14 says

        Jaminet, author of the Perfect Health Diet, suggests that we eat 30% of our calories from starch. That might be a good percentage to start with. Personally, I’d do a poor man’s post-meal blood sugar response test when trying to determine how many and what type of carbs to eat, though.

        Buy a cheap glucometer that comes with some test strips. Cook a batch of the starch you intend to eat (white rice is easy). Take your blood glucose reading before you eat 1/4 C of rice, 1 hour after, and 2 hours after. If your adrenals are normal, your BG will peak at or below 140 at the 1-hour point, then drop significantly at the 2-hour point. If your results are worse than that, eat less than 30% starch to begin worth, and test yourself periodically to see if your insulin sensitivity improves.

        • Kristina says

          Thanks, Jake. I do still test occasionally with the meter I had from the pregnancy. When I have eaten something like a white potato and feel awful afterwards I test, and I usually end up in the 180-200 range 1-2 hrs post meal. Never higher than that though, even on the one occasion I splurged for a kid’s birthday party and had chocolate cake. I’ve been thinking my best bet might be to not count grams or even percentages, and just stick to whole foods that are non-grain, non-legume, and no higher than moderate glycemic load (apples, peaches, etc.) Does that make sense?

    • Michele says

      I’ve been ketogenic and carb cycling (carb nite solutions) for a while now (6 mos) and haven’t lost any weight. I keep hanging in thinking it will eventually work but after reading this wondering if I should up my carbs. on a daily basis. I have thyroid and adrenal problems (take meds for both).

  111. says

    OK, having trouble getting past this:

    “#1: Paleo does not equal low-carb”

    Kenniwick man: “But the teeth were cavity-free (signaling a diet low in sugar and starch) and worn down to the roots—a combination characteristic of prehistoric teeth.”


    Cavity-free due to a low-carb diet is in fact the defining trait of Paleolithic teeth. The only Paleolithic group we see that ate a high-carb diet of acorns and snails also had rotten teeth.

    How to explain this? It seems that one of the defining traits of the food eaten by those in the Paleolithic was that their diet did not include enough carbs to promote tooth decay…

    Are we sticking with the scientific knowledge of what constitutes a paleo diet, or the marketing definition?

    • Duck Dodgers says

      It’s not very surprising, since Kennewick man was believed to be a seal hunter whose diet was low in sugar and starch.

      Here’s just some of the “scientific knowledge” you’ve conveniently ignored:

      There is good evidence that Paleo Indians consumed starch. In fact, starch granules were found all over their harvesting tools at the Sandy Hill site (9,000 B.P.) in Mashantucket, Connecticut.[1]

      Furthermore, five recent studies examining carbon isotopes in fossilized tooth enamel from scores of human ancestors and baboons in Africa show that human ancestors expanded their menu 3.5 million years ago, adding C4 tropical grasses and sedges to an ape-like diet.[2][3][4][5][6][7] This is especially relevant as this past January, Oxford University researchers found that baboons today eat large quantities of starchy C4 tiger nut tubers and the wear patterns on their tooth enamel, from these sedge tubers, are a perfect match with the wear patterns on the enamel of Paranthropus boisei (‘Nutcracker Man’)—a hominid, with a high C4 isotopic signature, who lived in East Africa between 2.4 million and 1.4 million years ago.[8] The Oxford University study therefore concluded that P. boisei survived mainly on a diet of starchy tiger nut tubers.[9]

      Dr Gabriele Macho, the lead researcher on the Oxford University study said, “I believe that the theory—that ‘Nutcracker Man’ lived on large amounts of tiger nuts—helps settle the debate about what our early human ancestor ate. On the basis of recent isotope results, these hominins appear to have survived on a diet of C4 foods, which suggests grasses and sedges. Yet these are not high quality foods. What this research tells us is that hominins were selective about the part of the grass that they ate, choosing the grass bulbs at the base of the grass blade as the mainstay of their diet.” [10]

      Starchy tiger nut tubers were among the earliest plants cultivated by the Ancient Egyptians [11] and Paleo-Indians [12].

      Starch granules were even found on 22,000 year old grindstone, which dates back to the ice age—the peak of the last glacial maximum.[13].

      Finally, most modern humans have many copies of the AMY1 gene for starch digestion—suggesting that the ability to digest starch is what makes us human.

      Keep in mind that as a hungry hominid, you would have to be a complete moron to avoid the most energy positive plants when trying to survive in the wild. Tiger nuts are literally nutrient-dense invasive weeds in Africa. And they taste sweet, like candy — perhaps explaining our innate penchant for sweets.

      While most primates forage for up to 8 hours per day (it’s their full-time job), humans needed sufficient free time to invent new technologies. Tiger nuts are actually more nutrient-dense than red meat [14] and the Oxford University researchers estimated that based on the conservative harvesting habits of modern baboons, an early hominid could have harvested 80% of his caloric needs with no more than 3 hours of foraging. [15]

      Searching for “Underground Storage Organs” (USOs) on pubmed and Google Scholar turns up literally hundreds of studies postulating their role in the early hominid diet. You would have to be extremely biased to ignore all the literature about USOs in human evolution — particularly given the fact that most African wild game is extraordinarily lean and no existing African hunter-gatherers rely heavily on meat. (And in case you were wondering, the Masai are “pastoralists” and they drink milk, eat tons of honey, and trade their meats for sweet potatoes and bananas).

      • says

        “It’s not very surprising, since Kennewick man was believed to be a seal hunter whose diet was low in sugar and starch.”

        Now you’re getting the point.

        You’ve got an amazing ability for bias reinforcement, DD. This, “the ability to digest starch is what makes us human.” is most certainly not true. Hunting down USO’s does not require running, or a big brain.

        • Duck Dodgers says

          Tuck, most (if any) anthropologists don’t subscribe to a VLC or ketogenic paleolithic diet these days. It’s just not supported by the scientific literature anymore.

          It takes a special kind of VLC bias to invent such wild theories while ignore all the compounding evidence for starch consumption.

          In fact, the latest issue of National Geographic—you know, the magazine that spends each issue examining the latest research on cultures and ancient anthropology—ridiculed the notion of a highly-carnivorous Paleolithic Diet.


          National Geographic (Sept 2014): The Evolution of Diet

          The real Paleolithic diet, though, wasn’t all meat and marrow. It’s true that hunter-gatherers around the world crave meat more than any other food and usually get around 30 percent of their annual calories from animals. But most also endure lean times when they eat less than a handful of meat each week. New studies suggest that more than a reliance on meat in ancient human diets fueled the brain’s expansion.

          Year-round observations confirm that hunter-gatherers often have dismal success as hunters. The Hadza and Kung bushmen of Africa, for example, fail to get meat more than half the time when they venture forth with bows and arrows. This suggests it was even harder for our ancestors who didn’t have these weapons. “Everybody thinks you wander out into the savanna and there are antelopes everywhere, just waiting for you to bonk them on the head,” says paleoanthropologist Alison Brooks of George Washington University, an expert on the Dobe Kung of Botswana. No one eats meat all that often, except in the Arctic, where Inuit and other groups traditionally got as much as 99 percent of their calories from seals, narwhals, and fish.

          So how do hunter-gatherers get energy when there’s no meat? It turns out that “man the hunter” is backed up by “woman the forager,” who, with some help from children, provides more calories during difficult times. When meat, fruit, or honey is scarce, foragers depend on “fallback foods,” says Brooks. The Hadza get almost 70 percent of their calories from plants. The Kung traditionally rely on tubers and mongongo nuts, the Aka and Baka Pygmies of the Congo River Basin on yams, the Tsimane and Yanomami Indians of the Amazon on plantains and manioc, the Australian Aboriginals on nut grass and water chestnuts.

          “There’s been a consistent story about hunting defining us and that meat made us human,” says Amanda Henry, a paleobiologist at the Max Planck Institute for Evolutionary Anthropology in Leipzig. “Frankly, I think that misses half of the story. They want meat, sure. But what they actually live on is plant foods.” What’s more, she found starch granules from plants on fossil teeth and stone tools, which suggests humans may have been eating grains, as well as tubers, for at least 100,000 years—long enough to have evolved the ability to tolerate them.

          The notion that we stopped evolving in the Paleolithic period simply isn’t true. Our teeth, jaws, and faces have gotten smaller, and our DNA has changed since the invention of agriculture. “Are humans still evolving? Yes!” says geneticist Sarah Tishkoff of the University of Pennsylvania.

          They call them hunter-“gatherers” for a reason.

          Honestly, Tuck. I don’t know how you still believe in such fairy tales given what anthropologists now know.

          • jake3_14 says

            That article was full of factual errors:

            • A paleo diet does not diet encourage us to replicate the exact same foods our early ancestors ate. Paleo eating focuses on fresh, nutrient-dense animal products, plants, and fermented foods (yogurt, sauerkraut, kvass, kefir) that have kept people healthy for tens of thousands of years. The paleo diet is a template that recognizes that we are all biochemically similar but have enough differences to justify us customizing what we eat. In fact, most people I know took a while to tweak the specifics of their paleo diet.

            The fact that paleolithic and early neolithic peoples (and modern HGs) eat a subtantial amount of starch doesn’t change the fact that animal protein is more nutrient dense.

            • The information on Neu5Gc is misleading by omission. The studies on this glycan were done on knockout mice that lacked the Neu5Gc enzyme. I’ll never forget the message I once sent to you asking if a mouse study was significant. You replied “You are not a mouse.” It’s still true.

            • “We have gotten so good at processing foods that for the first time in human evolution, many humans are getting more calories than they burn in a day.” The question is — how do you measure expenditure in a biological system like the human body over the course of a day? The laws of classical thermodynamics apply only to inorganic systems, not living ones. Weight regulation is a complex interplay between the feedback loops that regulate internal hormonal environment, the foods eaten that influence that hormonal milieu, the way a person reacts to stress (and the resultant cortisol levels), and other external factors too numerous to mention.

            • There isn’t and never was a “Mediterranean diet.” Next time you’re online, pull up a map of all the countries that have a Mediterranean coastline. They include Portugal and Spain on the East, and Egypt and Libya on the West. Is it credible to believe that they all have (or had) the same diet? The two Greek and Italian researchers who spearheaded the research into this concept never even agreed on what a Mediterranean diet actually was. And both of them disagreed vigorously with the recommendations that Harvard researchers made for the “Mediterranean diet” in the special supplement of the American Journal of Clinical Nutrition in 1993, which not-so-incidentally, the publication of which was funded entirely by the olive oil industry.

            I could literally go on for pages explaining the mistakes, explicit and implicit, in this Nat. Geo piece, but I think you get the idea.

            • jake3_14 says

              Oops — the comment about the Neu5Gc implications were from a personal email. The statement should have read “I’ll never forget the message I once sent to my uncle, a cancer specialist, asking if a mouse study was significant. He replied, “You are not a mouse.” It’s still true.

            • Rollbocke says

              Your comment [“The laws of classical thermodynamics apply only to inorganic systems, not living ones.”] is as wrong a statement about physical reality as a person can make. It absolutely applies to organic systems. But organic systems are so complex that understanding them from the perspective of physics is too complicated a task. That’s why disciplines representing different levels of understanding evolved. I agree totally when you stated [“Weight regulation is a complex interplay between the feedback loops that regulate internal hormonal environment, the foods eaten that influence that hormonal milieu, the way a person reacts to stress (and the resultant cortisol levels), and other external factors too numerous to mention.”]. But it’s not because thermodynamics doesn’t apply to these systems. All organic systems owe their very existence to fundamental physical reality. And thermodynamics is about as fundamental as one can get. But as an analytical tool for extremely complex systems it’s often out of reach for contemporary research in the biological sciences.

      • Paleophil says

        Duck, On a technical note, the tigernuts our African hominid ancestors ate are not “literally an invasive weed” in Africa, as they are indigenous to Africa, whereas invasive weeds by definition are not indigenous to the area they are growing in. I think what you mean is that they are quite pervasive and easily acquired in marshy areas of southern and northeastern Africa, which were also the habitats of ancient humans and ancestral pre-human primates.

    • Duck Dodgers says

      Well, cavities aren’t a recent phenomenon. Australopithecines was said to have caries over 1 million years ago.

      Here’s a study exploring the very long timeline of cavities in the fossil record:


      “Caries is a very old disease and it is not exclusive of the human species. Evidences of dental lesions compatible with caries have been observed in creatures as old as Paleozoic fishes (570-250 million years), Mesozoic herbivores dinosaurs (245-65 million years), pre- hominines of the Eocene (60-25 million years), and Miocenic (25-5 million years), Pliocenic (5-1.6 million years), and Pleistocenic animals (1.6-0.01 million years – Clement, 1958; Kear, 2001; Kemp, 2003; Sala et al., 2004). Caries has also been detected in bears and other wild animals (Pinto & Exteberria, 2001; Palamra et al., 1981), and it is common in domestic animals (Gorrel, 2006; Shklair, 1981; Wiggs & Lobprise, 1997)…

      …Paleodietary reconstructions have provided a high amount of data on the presence of caries in ancestral lineages. An approximal groove located in the cementum- enamel junction (CEJ) of bicuspids and molars has been noticed in several lineages of fossil hominines like Paranthropus robustus, Homo habilis, H. erectus, H. heidelbergensis and H. neanderthalensis (Bermúdez de Castro et al., 1997; Frayer, 1991; Milner & Larsen, 1991; Ungar et al., 2001). Although some scholars have reported that lesion as caries (Clement, 1956; Grine et al., 1990; Robinson, 1952), more recent analyses done in an specimen of Homo erectus from Olduvai Gorge (1.84 million years BP4) suggest that it could be an erosion produced by the habitual (possibly therapeutic) use of tooth-picks (Ungar et al., 2001)…

      …The unquestionable oldest evidence of caries comes from a fossil found in 1921 in Broken Hill, Northern Rhodesia (Zambia) during the exploration of a zinc mine. The specimen denominated Broken Hill 1, a Homo rhodesiensis cranium (African version of the Homo heidelberguensis 650,000-160,000 BP) shows extensive dental caries and coronal destruction. Except for five teeth, all the rest is affected by rampant caries and several crowns are almost completely destroyed.

      It’s also possible that the invention of cooking made cavities more prevalent, but the study seems to get confused by Homo erectus not really getting cavities after the control of fire. The author seems to not be aware that Homo erectus apparently didn’t use fire for cooking. So, cooking might still explain the increase in cavities.

      • says

        From your link:

        “Nevertheless, it is supposed that H. erectus, a hunter-gatherer, obtained approximately 50% of its calories from carbohydrates (Wrangham, 2009) and under the hypothesis of cooking (that obviously included meat and vegetables), caries should have been present much earlier in the fossil record. However, caries appears clearly much later. So, the data on oral does not support the idea of a cariogenic diet based on cooked vegetables from the earliest periods. Maybe, in
        the beginning, fire was employed only for cooking meat.”

        I’ll agree with that.

        • Duck Dodgers says

          Tuck said: Maybe, in
          the beginning, fire was employed only for cooking meat.” I’ll agree with that.”

          Again, most researchers do not believe that H. erectus cooked his food. And it should be noted that the most carnivorous cultures did not cook their meat. They ate it raw.

      • says

        “The author seems to not be aware that Homo erectus apparently didn’t use fire for cooking. So, cooking might still explain the increase in cavities.”

        Duck Dodger seems not to be aware that Wikipedia is not the sum of all human knowledge.

        “Humans and our apelike ancestors have lived in Wonderwerk Cave for 2 million years — most recently in the early 1900s, when a farm couple and their 14 children called it home. Wonderwerk holds another distinction as well: The cave contains the earliest solid evidence that our ancient human forebears (probably Homo erectus) were using fire.”


        • Duck Dodgers says

          Unlike you, Tuck, I’m happy to admit when I’m wrong. Good find!

          Although, I will point out that many anthropologists still believe that the “habitual use of fire” did not occur until much later. Though, as your article points out, it’s “possible” that they just haven’t found it yet.

          Makes no difference. There’s still plenty of evidence for USO consumption in early hominids that’s been uncovered in the past few years.

        • Duck Dodgers says

          As I was saying, good find. But, this is still the current thinking in the anthropology world:

          Nature: Million-year-old ash hints at origins of cooking

          “But using fire and mastering it are not the same thing, cautions Wil Roebroeks, an archaeologist at Leiden University in the Netherlands.

          “I think it likely that humans were using fire at this site, but I don’t think that this means these hominins were regular fire users. For a claim like that to be made, we would need to see hearths and fire places, and we do not,” he says. “If we were to discover many more fire sites at this time in history and find that natural cave fires look distinctly different, that would support an early-cooking hypothesis, but we are not there yet.”

          The earliest unequivocal evidence for regular human cooking dates back 400,000 years”

          So, again. Earliest evidence of fire and “habitual use of fire” are two different things. But, still interesting nevertheless!

    • Michelle Cruse says

      ….and Kenniwick man was ONE MAN….hardly a large enough sample to base across the board assumptions on????
      What other influences were there in his life? What did he eat, when, glut & starvation patterns? Was his general health good/bad COMPARATIVE to his peers etc? We don’t know.

    • says

      Tuck, your assumption that carbohydrate ingestion cause cavities is a flawed one (and I write this with politeness). There are many primitive groups who ate large amounts of carbohydrates and had excellent dental and periodontal health. For example, look at California natives (while still living on their traditional diets). As much as 50% of their calories came from the fruit of the oak tree (the acorn), and some peoples were eating members of the white oak group (which could have upwards of 70 or 80% carbohydrates, depending on the species). And that doesn’t include all the other carbohydrates they consumed in other foods (including berries, leaves/shoots, other nuts, tubers, achenes, etc.). High carbohydrate does not equal dental carries. Considering that pathogenic bacteria need more than just fermentable food, they also (for example) need to adhere to teeth and not be presented with antimicrobial compounds (anti-adhesion and antimicrobial compounds are abundant in wild plant foods–much more so than cultivated foods). We could discuss other groups as well.

      Of course, you can state these aren’t paleolithic people and, therefore, they don’t count. But we aren’t exploring human evolution with your statement, only whether or not high carbohydrate consumption implies the presence of dental carries (it does not). If you have read about the paleolithic group from northern Africa (Grotte des Pigeons) that had extensive dental carries with a diet rich in acorns, that is a perfect example of the need for proper processing (the paleolithic people ate a food with phytic acid and tannins intact, the California natives learned how to prepare the foods to eliminate such antinutrients, which would inhibit re-mineralization of teeth).

      Also, Homo erectus almost certainly did use fire for cooking. The anatomical evidence is compelling. Decreased jaw muscles (softer food from cooking), decreased size of teeth (softer food from cooking), reduced rib cage size (shorter digestive tract, foods predigested from heat), increased brain size (fewer neural resources needed for the reduced digestive system, due to cooked food, which could be then allocated to the brain), changes in shoulders (not sleeping in arboreal settings with fire keeping large predators at bay), and so on. Keep in mind the oldest physical evidence of controlled fire use dates back ca. 1,000,000 years (amazingly enough). It will be very difficult to find physical evidence that dates back to the time period around the emergence of this hominid (Homo erectus) given the kind of artifact we are seeking (i.e., highly biodegradable).

      My comments here aren’t to attack all your writing, just to suggest there may be some items you haven’t fully immersed yourself in enough yet to draw strong conclusions. Best wishes to you.

  112. CAmom says

    The zealotry reminds me a lot of when I was vegan. People would swear left and right that if someone ate so much as an egg or piece of cheese they’d die of heart disease. And you’d be blamed for “doing it wrong” if being vegan (or vegetarian) didn’t work out well.

    I tried low-carb paleo for a while, but my anxiety went through the roof, my already-iffy thyroid was off, and my fasting blood glucose went up. It wasn’t high, but the increase was significant enough to concern me. I personally feel loads better eating a moderate carb diet. I actually eat some gluten-free grains now as well, for budget reasons, and because I am very sensitive to many FODMAPS foods. That cauliflower rice was killing my stomach!

    Thanks to you and Laura for being a voice of reason with carbohydrate intake. I know for some people low carb is necessary, but is tiresome to hear that everyone would be 100% healthier if they just went low carb!

    • says

      Thanks for sharing your story. My fasting glucose has gone up on a low carb ketogenic diet too. I was flabbergasted! I am now heading back up with the carbs to soothe my thyroid and adrenals.

  113. MamaDub says

    Lots of sense here – thanks! I’m weary of the Paleo Police who like to stand on their soapboxes and say that you shouldn’t eat carbs unless you’re a cross-fitter or a high-endurance athlete. I’m neither — I’m a 40-something average woman who tries to be as active as possible. I do moderate exercise 5 or 6 times a week. After being low-carb for quite a while, I realized I didn’t feel as great as I wanted to feel, and I was also struggling with adrenal issues. I started adding back some healthy, unprocessed carbs (along with supplements for adrenal support) and low and behold — I started feeling better! More energy, better sleep, improved moods, quicker recovery from exercise. I will continue to eat a moderate-carb diet because it works for me.

    • Rhys says

      Hi MamaDub, I’ve also experienced adrenal problems on very low carb diets and I’m in the process of trying to repair it. Can you let me know what supplements you used to facilitate your recovery? Any pointers here would be greatly appreciated.

    • Sean says

      This comment is spot on. Listening to one’s body is crucial to wellness. I personally do not track macros, but am likely pretty low-carb. This is a great way of eating for me, but if I am feeling the urge for some tubers, honey, I know my body is on the right track.

  114. Katie says

    Thanks for this! So very important to keep in mind the difference between processed carbs and natural, whole food carbs. I went down the very low carb road for awhile and my body just couldn’t handle it. I think with my activity level, I was doing harm to my metabolism and body by trying to maintain an insanely low carb routine. Now, I eat 55% of my calories from whole food carbs – fruit, starchy veggies, and GASP! occasionally rice. It has made all the difference in my performance and energy levels. Really, it comes down to avoiding food in packages when you’re looking for optimal health.

  115. says

    Another important thing to keep in mind is that men and women might have different adaptations and requirements for carb intake.

    Much higher carbohydrate intake among women has been observed in HG groups like the Hadza. And there is a lot of anecdotal evidence showing women just don’t do as well on low carb.

    • Chris Kresser says

      Agreed that sex is one of the many factors that can influence what is optimal from a dietary/macronutrient perspective.

      • Alison Moore says

        I read this comment a lot…women don’t do well on low carb. Funny because I do really well on it, much better than when ai try it eat tubers every day and sweet fruits.
        I applaud the insistence that no one diet suits everyone. But this should also include acknowledgement that those who have made ketosis work and love it should not be assumed to be dogmatists by virtue of our personal commitment to ketosis and our desire to let others know that this a possible way of eating that MIGHT suit them if other wholefood ancestral diets are not working for them.

        • Pierre says

          Keep track of about 50 blogs having to do with diet. Lost about 55 pounds with combo of VLC, LC and Intermittent Fasting.

          Have heard that some on the VLC diet bandwagon are attacking others for not going VLC. Have not witnessed this…but have witnessed Richard Nikoley and others related to his blog attacking VLC dieters as being dogmatic. Seems like all the fight is coming from one side…too bad because perhaps both sides have something to contribute.

          Some examples of the sorts of attacks I am talking about…
          yet, but I’m gratified to understand that the VLC/Ketogenic are taking it in the shorts to such an extent that panties are bunching.

          Now I understand that arguments sell books and Richard has a book coming…but is that sort of language really required? I condemn that sort of behavior on both sides but haven’t seen it on the VLC side yet.

          • Louise says

            I agree with the comments of both Alison and Pierre. As a woman I have done well on a low-carb diet. On a moderate amount of carbs I experience fatigue, but with low carb I have great energy. And as Pierre observes, the labeling of people tends to be coming from those who want to portray VLC eaters as fanatical and dogmatic, not the other way around.

            However, if the ultimate point of this article is to affirm that there’s no one diet that works for everyone, this is something which with I agree wholeheartedly.

    • Darlene says

      I’m in accord with this article. While personally experimenting with low carb – I lost too much weight, some muscle mass, energy( I usually have good energy all day) and my menses stopped. Found my balance with carbs – regained energy, muscle mass and weight, then my cycle, in that order. Women definitely have different requirements, and not all women are the same. Have spoken with many other women who haven’t done well and found their balance or went to functional medicine for hormonal balance etc.

      • Maja says

        Experienced quite the same thing. Going from LCHF and excluding dairy except butter, to autoimmune paleo to heal my leaky gut and gastritis. Can’t eat/digest nuts/seeds and even eggs at the moment. Have been added a lot more of carbs since the transition to paleo but I dont know if its enough, or if I eat enough. Haven’t had my period in one year. I’m 22 years old and doing olympic lifting och heavy workouts several times a week. I’ve just ordered progrestrone cream and will try to get my hormones back on track, because I really dont feel “like myself” mentally all the time. Just wondering how much carbs do you eat right now?? I soo need to let go of counting the carbs, its still hanging in the back of my mind. Guess I need to listen to my body, but it’s hard when having issues with the gut.

        • Ellen says

          Have resistent starches: sweet potatoes, rice (preferably cold), potatoes (cold as well), and squash (any).
          My sister had major problems on very low carb Paleo diet after being on it a while and feeling better than she’d felt for 20 plus years. Then insomnia, hair loss, and hair graying, and her hormones got all messed up…amongst other problems…

        • Michele says

          I tried the progesterone cream one day and not sure whether it was that or two other things I took but broke out with about 50 big itchy spots on my back. I am just like you said with these bad things happening to me on low carb. Listen to Ellen’s post below. That is what I have been doing–adding starches and carbs. Hadn’t been able to sleep more than 3 hours in six months, lost hair, felt bad. Got some Valiums from my doctor and the sleep helped remarkably. Have gone from 5 mg to 2-1/2 mg to two nights in a row with none (and got 6 hours sleep without any), and as soon as I get enough good carbs back in to me, I hope I will get back to normal except I don’t eat grains or milk any more. Low carb can really mess up women who do not eat enough in a day. I feel a lot better and stopped taking all vitamins/minerals except fermented cod liver oil. Everything people recommended to get back my sleep only made things worse (magnesium, calcium, etc.) Good luck.

    • Michelle Cruse says

      Agreed! I tried a VLC diet and it did not help at all! I was already suffering badly wither peri-menopause (P/M) symptoms and taking out the carbs made sleeping worse (and P/M already messes with that! Genetics, gender, activity, body type all makes a difference. I have always been a fast metaboliser, and never ate much junk anyway. I had to add back rice and potatoes (used to only eat sweet potato but even that was not enough!).
      As Chris & so many say…..individualise it! What works for me does not work for others!
      Great post!

  116. leslie says

    Thanks for this. I was fairly low carb and doing great (lost weight, gobs of energy, etc) until I got pregnant. I had to increase my carb intake to keep up my energy. I’ve had people tell me my baby will be fat and ruined for life because of this. It’s not like I mainline sugar. I try to make the healthiest choices that keep me feeling good. And maybe I overdo it sometimes, but who cares. I pay attention, correct myself and keep going. I did the same thing with my first baby (before i knew so many paleo people, especially the judgy ones) and she was 7lb 9oz and remains the healthiest baby ever with regards to every indicator (quantitative and qualitative) available. Even her docs comment on it. Throughout nursing I’ll continue to keep up my carbs and slowly reduce them as I see fit.
    These low-carb zealots remind me of the anti- gluten free zealots. Plus, haven’t we learned that demonizing an entire macro-nutrient (like fat) can lead to disastrous results? Balance is key. Give me a break. Why other people care so much what I personally eat to make me feel well is beyond me. Find info, use what works and let others do the same.

  117. Ankleface Wroughtlandmire says

    “#7: Whole-food carbohydrates do affect the body in the same way as processed and refined carbohydrates”
    Ooops, missing a “NOT” here?

    • Caroline says

      Wow Chris, thank you for posting this. Its really important to acknowledge the differences in human physiology when responding to certain forms of eating. I think the paleo framework as a whole has been really liberating in terms of health for many people yet many shy away because the media at large does slap the label low carb on there any chance they get. I think placing this way of eating and life into a more fluid and changing framework is most beneficial. Boxing it in to be another extreme diet will only turn people away.
      As a female with autoimmune issues low carb did not work for me. It certainly appealed to be based o. What I read but my bodies digestion came unaligned and I felt dizzy and exhausted. The minute I thre w some butternut squash into the mix I was ready to go!
      Its really incredible what low carb can do for even cancer patients but its also important for people who experience the benefits to move into a place of understating we’re not all there. This will hopefully lead to everyone as a whole eating more whole unprocessed foods. Carbs or no carbs

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