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)
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
#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.
Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!
#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.”
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.
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….
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?
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.
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.
Oops! Should read live with it.
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.
Chris,
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.
http://www.nytimes.com/2014/09/02/health/low-carb-vs-low-fat-diet.html?action=click&contentCollection=Television&module=MostEmailed&version=Full®ion=Marginalia&src=me&pgtype=article&_r=0
“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.
http://news.yahoo.com/obesity-rates-reach-historic-highs-more-u-states-122401918.html
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.
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.
This article is awesome!
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.
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!
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.
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!
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.
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.
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!
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.
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?
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.
Greg,
Greg,
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.
Chris,
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.
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?
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.
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.
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.
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.
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.
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.
Thanks!
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.
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.
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!
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.
Thanks!
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.