Laura Schoenfeld wrote a guest post for my blog called “Is a Low-Carb Diet Ruining Your Health.” Perhaps not surprisingly, it 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. #lowcarbdiets #myths #truths
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 blog. What’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)
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#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.
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#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.”
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.
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.
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?
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.
***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.
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.
“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”?
http://youtu.be/NYdi0RpI1SU
Not exactly like a Pepsi ‘eh? Fiber makes a difference. Seems like you have a lot to learn about carbs.
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”?
http://youtu.be/NYdi0RpI1SU
Not exactly like a Pepsi ‘eh? Fiber makes a difference. Seems like you have a lot to learn about carbs.
I don’t understand your comment. Are you dismissing the video because a vegan is speaking? Or because you think the science is bad?
The second meal is pretty well documented.
http://www.ncbi.nlm.nih.gov/pubmed/16600933
And I don’t think you want to imply that all Mexicans are obese. That’s pretty racist.
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.
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:
http://en.wikipedia.org/wiki/Obesity_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.
“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.
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.
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.
Clarification:
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.
If healthfulness is defined in as longevity, performance, absence of disease, you might want to rethink that. A new study shows that the Inuit weren’t necessarily as healthy as we were led to believe.
Slate: The Fishy Origins of the Fish Oil Craze
“Fishing” for the Origins of the “Eskimos and Heart Disease” Story: Facts or Wishful Thinking?
(Free access to the manuscript can be found here).
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..
Tara,
You’re not alone. My fungal infection became quite severe by avoiding all carbs. Most doctors don’t have time to look into the research that closely. I’ve compiled a fair amount of evidence suggesting that moderate whole-food carb intake may be the best approach to neutralizing candida.
Please see the compiled research here:
http://chriskresser.com/is-a-low-carb-diet-ruining-your-health#comment-544369
Good luck.
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.
Tom
Tom,
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.
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.
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.
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
> 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.
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.
“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.
@ 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?
“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.
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?
I suppose low carb could be looked at as anything less than the 240 grams per day the average person in the USA eats. Of course if you’re healthy and not obese then don’t worry about it. For anyone though staying away thee main killer carbs – raw and refined sugar, anything with added sugar, anything that ends in “trose”, like dextrose – it’s sugar, high fructose corn syrup, fruit juices and of course carbonated soda.
White flour has no nutritional value (other than if the manufacturer adds it and I’m not sure how well the body does at absorbing these added nutrients). The body then rapidly turns the flour into glucose, so why eat it?
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.
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.
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.
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.
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.
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.
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!
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.
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.
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.
“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?
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 🙂
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.
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.
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)”
———
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.
“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.
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
sapiens 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
Cheers.
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.
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.
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.
Hurrah!!!
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.
That’s your adrenals screaming for carb fuel. Mine did the same thing on VLC.
It is also a classic sign of sodium deficiency which needs to be increased in ketosis. Just sayin…
I agree; drinking broth with sea salt would likely correct the problem.
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.
“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]
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.
“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.
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.
Great article Chris and the reason I come back to you for information and guidance. I just wish I could see you for a personal appointment (I’m in Australia).
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.
What studies have been done for TBI related to low-carb diet?
Here’s a list of relevant studies (some of which are animal studies): http://www.ncbi.nlm.nih.gov/pubmed?cmd=search&term=traumatic+brain+injury+ketogenic
Interesting thanks. Every neurologist-specialist I saw post-injuries said that diet was unrelated, and they were convinced of it. Perhaps informing doctors is harder than patients.
PubMed is abstracts, but found this study.
http://www.nap.edu/openbook.php?record_id=13121&page=249
Informing doctors is most definitely more difficult than patients, especially when those doctors are specialists. Specialists tend to be the most deeply invested in the dominant paradigm, and less open to new ideas (which seems strange, but that has been my experience).
Yes the most egregious example of this is the American Diabetes Association which is still determined to recommend everything BUT reducing carb intake.
They seemingly would rather a patient take drugs for the rest of his life, or invest $50,000 in stomach surgery with all the complications, than to try cutting the carbs.
This for a disease (Type II) that is undoubtedly, in most patients, caused by excessive carb intake over time. The level of arrogance is hard to comprehend.
While many folks have without a doubt controlled or reversed their T2D with a low carb diet it seems the same results can consistently be obtained with a whole foods high carb diet. http://www.youtube.com/watch?v=ktQzM2IA-qU
Tom – There is a strong genetic link to T2D. My skinny little grandmother developed a very bad case of it and she never overate. Don’t blame the victim.
Your blog technology needs a “Like” button.
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!