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.”
Has anyone seen this video?
https://www.youtube.com/watch?v=ePzJbllNCPg
Could it be, that low carb diet are really the way to go?
The GABA question was in reference to Laura Schoenfeld’s blog post.
I have tried a ketogenic diet in the past and experienced very low energy and brain energy, so had to quit. I have been curious to know if, perhaps, my body was in the process of “switching over to ketogenic metabolism”, and I just didn’t give it enough time, so started researching again. Ironically, I have been looking to increase my very low energy state and loose 5-10 lbs of extra weight I’ve kept on the last couple of years. I have some low T3 issues and take cytomel… The information you have offered regarding the dangers of LC with hypothryoid have been very helpful. I’ll need to look to a different solution! Thank you!
Hi Diane,
The body does go through a transition period, since we have greatly changed how we eat. If you have been eating a lot of sugar and carbs your whole life, like the majority of people do, and then stop eating those things, it’s kind of a shock to your body. So give it more time. You didn’t mention how long you were on the ketogenic diet, but it’s going to take at least 4-6 months for your body to get used to the changes. My husband and I are both on this diet for almost 3 months now. I didn’t notice any ill effects yet, but my husband had a few minor issues, but it’s getting better. He has hyperthyroidism, and no longer needs his medication. He also lost 30+lbs. I lost 10 lbs. We feel great though, with lots of energy. So if you want to reverse your T3 issues and lose those 10 lbs, I encourage you to get back on the diet and stick it out for 6 months and see how your body responds.
Isn’t GABA a neurotransmitter, and not a hormone?
The GABA question was in reference to Laura Schoenfeld’s blog post.
I have tried a ketogenic diet in the past and experienced very low energy and brain energy, so had to quit. I have been curious to know if, perhaps, my body was in the process of “switching over to ketogenic metabolism”, and I just didn’t give it enough time, so started researching again. Ironically, I have been looking to increase my very low energy state and loose 5-10 lbs of extra weight I’ve kept on the last couple of years. I have some low T3 issues and take cytomel… The information you have offered regarding the dangers of LC with hypothryoid have been very helpful. I’ll need to look to a different solution! Thank you!
I followed a low carb diet for close to 18 months about 5 years back.
I lost 31kgs however, what I didn’t notice was the negatives. I never slept, I was defensive, aggressive, extremely hyperactive and thought I knew everything. I would cut people down and think it was hysterically funny. I was completely manic for the entire stint of the diet but couldn’t even see what was happening to myself. I started to grow great big curly thick white whiskers out of my chin. Not good for a 49 year old woman.
After reintroducing carbs I began to relax enough to look back and see the monster I had become. I have kept the weight off since but I would never go low carb again. I have not had a big thick whisker since. I have not offended anyone since, I am once again rational and I sleep again.
I have seen others this has happened to and like me they refuse to accept there is anything wrong with them mentally. (its everybody else) They are the ones who troll the internet scathingly attacking anyone with a differing opinion to them and thinking its perfectly normal behavior while obsessively dissecting their macronutrient ratios for all others to admire. (Yes. Creepy isn’t it.)
Low carb = mental instability big time, for me and many others who haven’t noticed the aggressive, antagonistic mental imbalance in themselves yet.
Good luck for those who do well on it, good for you. I wish I could join you as I totally enjoyed the food and the lack of hunger.
I eventually settled for the middle ground with a small serve of solid carbs with each meal and it suits me well. Balance of diet = balance of mind for me.
Very interesting about the manic condition and diet? How low a carb diet were you on? How can you tell it was your diet?
I have experienced the manic condition, but believed it came from excessive physical activity. I worked very hard for a while. Cutting back on the work and relaxing more made It go away. I have a very high energy level and tried to use it all. I am diabetic and get almost all my carbs from fruits, vegetables and dairy. My diet is not that low carb. I would
appreciate any more information you might have about the manic condition and diet.
ppreciate
I experienced the same and doc referred to my premenopausal age. Do you think it could have been menopause for you as well?
That was my thought, exactly. Those are all symptoms of perimenopause, which also effects brain chemistry and hence mood. You can go months without any symptoms and then all of a sudden, experience them frequently, then they die down again. I question whether it was just coincidence that bringing back carbs was the real solution. (It may have been, since carbs affect serontonin – so do hormones, and if they imbalance, then they set off changes in brain chemistry which include mood issues). I too would be curious to know how the OP is, now.
I am on a low carb diet because I have been suffering from signs of type 2 diabetes. It has worked well for me and along with other issues my memory has improved. I would imagine that everything we do should be done in moderation.
If my sharpness and energy would be compounded relative to the amount of carbs I do not eat may be it would be devastating like in your case.
It is good to know you decided to be moderate and I believe that is why I am benefiting from the whole process
Your post made me realize what may have been happening to me on the keto diet. I have was getting into trouble at work for flipping out and snapping at people and didn’t even realize it! Thanks for sharing!
Sounds like your testosterone levels were too high on the low carb diet. I’m not sure how those two relate or you may have been taking some supplements that would effect T levels during that time such as DHEA. Aggressiveness + hirsutism would indicate high testosterone.
I’ve several things to say about this.
1. There is no doubt that as Stefannson and several others said, that the Eskimo ate almost no vegetables and had no interest in them.
2. The assertion that hunter gatherers ate as much carbohydrate as this article asserts is NOT in accord with most of the stuff I’ve read on it, and it’s lots.
3. Having been inclined to be fat all my adult life as my family is inclined to be, I’ve considerable experience of losing weight and putting it all back on again. I once lost 42lb on a low-fat diet and put is all back on again in a few months. I’ve been on numerous such diets down the years and have exercise prodigiously all my adult life, with poor effect on weight.
Two and a half years ago I gave up all sweet things and lost 20lb. After 18 months of hunger, it had begun to creep back on. 18 months ago I went LCHF and lost 28lb from that weight. That’s down 42lb from the consistent weight. My weight has been stuck on my new weight, BMI 23 for a year. Not a budge. No hunger. Whether I’m ketototic or not I don’t know, but I probably am, somewhat as I’m a big man and max at 50g carbs per day and continue to exercise a lot.
I’m 65.
“There is no doubt that as Stefannson and several others said, that the Eskimo ate almost no vegetables and had no interest in them.”
Nonsense. Consult an actual botanist like Arthur Haines. As I recall him documenting, the Eskimo utilized over 300 plants.
Or try this 240 page book about how the “Eskimo ate almost no vegetables and had no interest in them”:
Plants That We Eat: Nauriat Niginaqtaut – From the traditional wisdom of the Inupiat Elders of Northwest Alaska
http://amzn.com/1602230749
And Stefansson was a liar, opportunist, and fraud.
http://freetheanimal.com/?s=stefansson
“The assertion that hunter gatherers ate as much carbohydrate as this article asserts is NOT in accord with most of the stuff I’ve read on it, and it’s lots.”
And it’s all wrong.
http://freetheanimal.com/2015/01/paleogate-cordains-coverup.html
Do you know what the composition of the Hadza (a true H-G society) is?
Meat: 32%
Berries: 20%
Tubers: 19%
Honey: 15%
Baobab: 14%
In other words, their diet is mostly carbohydrate. This rings true for most H-G societies actually studied rather than extrapolated from a pile of bones.
Even the most recent research on Neanderthal demonstrates that they ate significant starch and even grains.
Science moves forward but apparently, in the LC Paleo fantasy universe, there’s a bible, god wrote it, and that settles it.
Understanding what carbohydrates in general, do to your body really puts things into perspective. Realizing that dietary fat isnt going to make you fat or cause a heart attack puts things into perspective too. I think if you understand, that your body can either use carbs or fat as an energy source, it makes your macro composition much easier to figure out. For someone who is a heavy weight lifter, you will need more carbs to fuel that activity. Someone who is sedentary does not need the same amount of carbs. I think john kiefers approach to diet is best. Your basically always low carb, but spike insulin with carbs often or not as often, depending on how active you are, while never staying low carb long term (more than a week).
“…your body can either use carbs or fat as an energy source” This is true, as is all carbs are not created equal. Plus, carbs do differ from sugar depending on the source, like table sugar/sweets vs fruit (a natural carb/fiber).
Back to using either carbs or fat as a fuel source, I recall reading about the Trim Healthy Mama “diet”. Reading about it sounded easy, you alternate each meal and snack with either being carb heavy (good healthy carbs that is) or fat heavy (good healthy fats), giving several hours between eating so your body uses that energy form. I’ve not read the book itself about this way of eating, and reviews were mixed. Some readers were off-put by a religious tone to it, others complained about poor editing, others thought it was too hard to learn. None of these would concern me as I’d only be interested in the basic information. One thing I noticed on the website for this eating plan was weight loss for women with PCOS. I have PCOS and my adult weight issues are from the insulin resistance symptom I have from the PCOS. Worsened by going into menopause a little early (I’m 45 and very close to fully being in menopause). Very low carb worked for me 8 yrs ago, for a good 3 yrs. When hormonal changes started interfering, I couldn’t get 10 lbs off that crept back on. After an 18 mo struggle I gained another 10 lbs in 1 month. Ugh. And over another 2 yrs, another 10. I am back to very low carb, but healthier than I did it before (a little whole grain and fruit and less unhealthy fats) along with Metformin. I’m more concerned with my blood sugar than the weight at this point. I’ve known I’ve been “pre pre-diabetic” for 7 yrs now, who knows how much longer but I suspect my whole life. This Trim Healthy Mama way of eating may be the ticket for some insulin resistant people and worth exploring if not trying. Just hoping this info from me helps some people 🙂
I have been solo frustrated lately. Been on low. Carb for 4 weeks and have gained 2.5kilos I really have stuck to under 25 grams of carbs and zilch .what’s going on. But I have felt better and had more energy but weight gain means I’m going to have to reevaluate the whole diet. Glad to hear others experience the same issues
If I were you, I wouldn’t change my diet if I was feeling better and more energetic, I would reduce my total calories consumption for two weeks while still on the low-carb diet, even if fat isn’t that effective in gaining weight as carbs remember that fat has calories too
If you are eating too much protien on a low carb diet you will convert protein into glucose through a process called gluconeogenesis. Essentially this raises your blood glucose levels… therefore you might as well be eating carbs. The key is eating moderate protein based on your gender, your activity levels, age…
No, extra protein does not automatically turn into chocolate cake. Gluconeogenesis is demand-driven, not supply driven. Extra protein will be used as energy, but it will not turn into glucose.
Sorry Suzie,
But you are wrong and Cindy is correct, too much protein will indeed be converted to glucose via the process of gluconegenesis, see the following link, this has be scientifically proven, to get into ketosis i.e. fat burning, you have to eat a “moderate” amount of protein.
http://authoritynutrition.com/5-most-common-low-carb-mistakes/
Never believe that fat won’t cause weight gain. Any excess energy will do that. I found myself in this dilemma and simply trimmed my fat. Easy to do because I had been “shoving” fat in a misplaced interest on high fat. Otherwise I changed nothing.
Hi Pat, can I ask you your age? There are various issues to look at when it comes to age. Also, are you male or female. I prefer to ask questions before giving answers .
http://www.biznews.com/health/2015/10/27/fat-is-not-your-enemy-tim-noakes-is-right-says-top-british-cardiologist/
I have had type 1 1/2 diabetes for over 20 years. I make some insulin, but not enough. I have learned by trial and error that the best strategy for diet is to get all carbohydrates from fruits and vegetables, not grains, rice or potatoes or anything made with flour or other starches. Dry beans, whole rye berries or whole barley are acceptable on occasion. They contain resistant starch fiber. I use fiber in the form of ground flax seed, oat bran and Hi maize 260 resistant starch fiber (bulk form) which I add to foods at every
opportunity. I eat no processed foods and never have.
I am now 77 years old and very healthy. No nerve damage or
heart disease. I exercise every day. Inclu8ding lap swimming and resistance exercise.
I take 20 units of long acting insulin once a day. No diabetes drugs at all.
Except everyone really is different. My endocrinologist, for instance says some of her patients are fine with coffee, tomato sauce–but for others it spikes their blood glucose. She encouraged me to test myself after meals for myself. I made various porridges with nuts and nut butter, flax seed, even egg whites to up fiber and protein, while keeping various grains to 1/4 cup dry measure–and here are some of the results of post-prandial blood glucose one hour after a meal keeping everything but the grain used constant:
Quinoa: 115
Millet: 116
Cornmeal: 118
Wheat Berry: 120
Oats: 121
Sorghum: 123
Amaranth: 124
Brown Rice: 125
Teff: 127
Buckwheat: 136
Rye Berries: 137
Barley: 147 (the worse of any grain I tried–and I’d heard how good barley was for diabetics so I tried it various times–a quarter cup in my porridge would go above 140 every time.)
Basically, I’ve followed the advice of my endocrinologist (and Blood Glucose 101) and tinkered with meals until I get post-prandial blood glucose of below 140. For something like barley, I reduce the amount.
FWIW, I once took 20 units of insulin when I was first diagnosed with Diabetes and trying to get it fast under control to start chemo. That was a year an a half ago and my A1C was around 13. I had my latest A1C taken just last week and I’m at 5.1 after a year off diabetes meds–no orals, no insulin.
And no, I don’t do paleo, though I’ve stolen ideas from it here and there, and I’m not particularly low carb. My endocrinologist recommends a limit of 45 grams of carbs per meal and I adhere to that, averaging about 150 grams per day. I did lose over 70 pounds in the year after diagnosis, did my first 5K last October, run 3 times a week, do resistance training. I’m sure all that helps.
Point is–I’d try out various foods and carb levels out and use your trusty glucometer as your guide–because I don’t think it can be said everyone does badly with rice or well with barley. And one of my worse results testing out foods btw was with papaya–mango, banana, I’m fine, so go figure–but obviously you can have very individual reactions to fruit too.
i have read and enjoyed what is said, i am putting together a book on low carb for diabetes, reason is i have been a diabetic 2 for 3 years, have had 3 trips to emergency, last one this Christmas eve. started to read about hidden sugar because the Canadian standard for diabetes is WRONG. i was up to 80 units daytime fast acting and 12 units slow night, on metformin, high blood pressure…..i weight 135 , went to low carb and i take nothing, it has been 6 months, i have been tested and my A1C is 7, i have it checked every 3 months, i feel we should be given low carb as a choice , not assume we all want medication. Anyway i feel low card for me has given me back control of my live. having type 2 diabetes i am choosing to treat as an allergy to sugar and treating it that way has help. if you have an allergy to peanuts do you carry a needle so you can have peanuts……no you do not eat peanuts. extreme example,but you know what i mean, find the sugars and decided can i handle this or is is going to be to much!
The article has some things wrong. Or rather the USDA is NOT being clear enough. If you’re having a 40-60% carb diet, eat those carbs from veggies and fruits. You do NOT need grains. They have no health benefit aside from fiber, which, you guessed it, is in veggies and fruits in spades. It’s a complete lie that you need grains in any form. I know they say switch refined grains to whole, but you don’t need grains AT ALL. And they never say that. In fact, all studies I’ve seen have only been about refined vs whole grains, but not whole grains vs no grains. We’re not built for grains, even if you’re tolerant, they still are void of nutrition you can’t get elsewhere at best and inflammatory and dangerous at worst (which sucks, because I love bread 🙁 and pastries) So, eat grains in moderation. Like, I dunno, once a week? Get a nice baguette or some doughnuts to splurge (if you aren’t on a diet of course).
Also, I’m sure everyone can agree with this, our ancestors did NOT eat processed carbs or grains (I’m talking nomadic people, people who go further back then 10,000 years which evolutionarily is not enough time to learn to process grains correctly, which explains why we can eat them, and they’re great if you don’t have many options, but also why so many are allergic.) So don’t eat processed food when you can. And get some variety of foods in your diet. I know that prices can be a problem, but when you find a new veggie or fruit on sale, give it a shot. It’s a great way to get in vitamins and minerals that you might be missing or don’t get in often enough.
Um, 3-50% is a rather LARGE margin, isn’t it? Not everyone lives on the equator. In fact, you find less healthy people closer to the equator. I do agree that it can be healthy for a normal person to eat higher carb, so long as they exercise (Nomadic also means they moved A LOT, we don’t) so long as they vary where they get it from. I have no doubt that our ancestors eat say a whole goat or some other hoofed beast (bone, blood, guts and all) in a stew or raw and then one day and got berries and honey the next week when passing by. They still almost never ate 150+ grams of carbs a day (often recommended as a diet by doctors, nutritionists and the USDA) as a stable part of the diet. That’s not what our bodies adapted to. Period.
Also, and I see this a LOT. Low carb doesn’t mean high protein UNLESS you work out like maniac. Excess protein turns into glucose when you’re low carb, due to the liver converting it for energy. Often when people go keto or low carb, they eat TONS of protein which just ends up being close to eating carbs instead. Also DRINK WATER and get in SALT. You will need the electrolyte re-balancing since it’s often a radical change in diet.
All this said, I agree with the person who said don’t worry about your food too much. Eat mostly like we have for the last 100,000+ years, that is, nomadically. I think a huge part of the reason the Asian and Mediterranean diets are so healthy is because of two things. The culture encourages being wanted and loved by family. You are seen as valuable to those around you literally until the day you die. Mental health has just as much to do with health as what we put into our bodies. And last but not least, there is SOOO much variety in the diet. Try new veggies, try new fruits, meats, fat sources, nuts etc. If you’re trying to lose weight specifically though, remember two things. The way you eat now if you’re overweight is what is making you overweight. You can NEVER go back to that habit. This will cause massive weight rebound. And find something that works. If you hate your diet/exercise plan, you won’t stick to it. It’s a life style change, not a quick diet to lose a few pounds.
My favorite saying is this. Meat, eggs, veggies and berries have been around LONG before obesity and diabetes type 2 have been. Refined carbs and grains have not.
Also, fish is best meat. High in omega 3, can be low or high in fat, has lots of nutrients. It’s also a very common meat in what are considered the healthiest diets. Doesn’t mean you can’t have red meat sometimes though. Fish is really expensive where I live, unfortunately. But variety, is KEY. Don’t be afraid to try different parts of the body of an animal too (minus the brain) Liver, stomach, intestines, blood, bone (bone stock, eating bones can be dangerous) etc, all have so much nutrients we miss out on. I think it’s a huge part of the reason Inuits can live almost solely on meat. They eat pretty much all of the animal.
Sinvanor said: “I’m sure everyone can agree with this, our ancestors did NOT eat…grains (I’m talking nomadic people, people who go further back then 10,000 years…)”
False.
Homo sapiens in Mozambique were processing grains, including sorghum, at least 105,000 years ago and likely earlier. Researchers found processed starch granules all over their tools.
http://www.sciencemag.org/content/326/5960/1680
Starchy plants were being processed for flour at least 50,000 years ago at the 8-B-11 site at Sai Island, Sudan:
http://www.sciencedirect.com/science/article/pii/S0047248403001039
Starches were being ground for flour in Italy, Russia, and the Czech Republic at least 30,000 years ago (Mid-Upper Paleolithic):
http://www.pnas.org/content/107/44/18815
Wild barley and wheat were being ground for flour 22,000 years ago, during the peak of the last glacial maximum:
http://news.sciencemag.org/archaeology/2004/08/ice-age-cereal
Sinvanor said: “Eat mostly like we have for the last 100,000+ years”
Well, then that would clearly include sorghum and other ancient grains.
“I think it’s a huge part of the reason Inuits can live almost solely on meat. They eat pretty much all of the animal.”
That’s part of it. The other part of it is that they have CPT1a genetic mutations that allows them to shunt fatty acids away from their livers and burn those fatty acids for energy in their muscles, heart and brain, and for heat in their brown fat where CPT1b-c is found. Their metabolism does not apply to Westerners who have fully functioning CPT1a enzymes.
In fact, much of the fish oil craze was originally based on the Inuit high-n3 diet, but these fish oil suppliers are either unaware or do not want to admit that the research is based on their highly unique metabolisms. Oops.
I’m thinking while there may have been grains way back then, it may not have been prominent in their diets. Laborious to produce, but staples still fats & some proteins, supplemented with berries & nuts! A delicacy perhaps, just like honey!
Grains are absolutely fine. Including bread of course.
The french eat a significant amount of bread daily (im french).
We do have obesity and type2 diabetes pbs too, but we’re hardly at the top of the chart in this respect.
People in France (as i know), ate twice as much bread 50/60 years ago as they do now (true, it was good heavy dense sourish bread mainly. White refined flour was not easily available. Obesity was hardly an issue.
The french are also well know for th eir substantial use of butter, & bread doesn’t taste good without lashings of butter…yum!
very true. It’s overall intake and lifestyle as well as individual suitability to a diet or food group. I know many a bagel eating thin people. The French and Northern Europeans used to eat much more bread than they do now.
I too spent a long time in food obsession analysis paralysis. I’ve done everything from vegan, raw vegan to low carb, to zone, paleo, back and forth round and round. Finally I’d had it. Some of us have to reach a certain age before we trust ourselves enough to go by how our own body responds. I’m approaching 50 and had finally had it. I knew I felt the best when I cut out all processed food. It was only hard a week or so. Now I eat farm raised real meat. The kind that has an odor.. the real stuff that doesn’t come from a Styrofoam package. I was raised in the country and decided to only get grass fed beef, raised in a pasture I drive by going to work. I realize I’m blessed to live that close to one. The meat is so vastly different.. so much richer tasting, and it takes less to fill you up. Anyway, that, organic when I can veggies, even potatoes if I want them, which isn’t that often. Fruit of all kinds are desserts. I used to make my own ‘healthy’ bread but felt bloated and congested afterward, even when omitting milk from the recipe, so.. pfft, I now eat what makes me feel good and this is the way.
Cheryl, your story sounds familiar. I too am approaching age 50 and *finally* last year, after decades of foolishly following this or that expert, find it freeing and even healthy to eat what makes me feel good; really good.
Eating whatever I wanted to, including plenty of table sugar, white flour/rice/potato and overly processed foods did not work for me, nor did a low carb diet, although I stayed with it for far too long. I realized that I felt much worse eating low carb – fewer than 50 – than I’d felt eating relatively healthfully with a daily splurge thrown in. I really have tried just about everything. I’ve learned to pay attention to my energy. The low carb diet zapped it right out of me. Again and again I would return to the experts and their zealot confidence, believing that I was somehow doing it all wrong, when in fact it was just wrong for me.
The diet that seems to work best is actually a mix of high complex carb, moderate protein, moderate healthy fat, and very very little refined anything. It consists of wild caught sardines, barramundi, wild trout, grass fed beef, free range eggs, a wide field of organic veggies and fruit (mainly berries, apples, and lemons for the latter), green smoothies, nuts and nut butters, extra virgin olive and coconut oils, avocado oil, organic milk kefir (homemade daily), quinoa, and a moderate carb spelt bread with no added sugar, (one slice a day slathered with nut butter), and lots and lots of cleansing water. I feel great, and have even lost the few pounds that I needed to. Thank goodness we don’t all need to eat the same to thrive.
I would like some help. I have had type 2 diabetes for over 20 years. I take no drugs for it. When I took drugs they didn’t help. However I have been taking 15- 20 units of Lantus for about 10 years. Twenty years ago when diagnosed I was 50 lbs overweight, but lost it quickly and have not regained it except about 20 lbs for a short time when taking diabetes drugs. I keep my weight normal and have for a long time. I do not and never had metabolic syndrome. I do not have high blood pressure Trigs are 68, cholesterol ratio is 2.5. I have no evidence of complications in my body at all. My A1c is 7 and has been for the last 20 years.
I am very active and always have been. I have a lot of energy
which is not affected by my blood sugar. My diabetes has never acted as expected. I decided to stop the insulin for 21 days to see if my pancreas can heal itself I understand all the cells in the pancreas will be replaced in that time. Taking insulin perhaps will prevent replacement of some cells. This is my experiment. My blood sugar on a low carb diet stays around 190. All carbs from vegetables and fruit I have always had a healthy diet. I have never eaten processed food. I lost 5 lbs all around my middle. If I lose another 5 lbs, I will be pretty thin. I have not caught a bug of any kind or been sick for 8 years straight. I am 76 years old.
I swim laps for 30 minutes twice a week do resistance machines three times a week and garden etc. I have kept this exercise schedule and diet for 50 years. None of the type two diabetes stuff seems to fit me except for the A1c of 7. I would like to solve this mystery. Can anyone help.
Ellen, do you make your own yogurt (or kefir)? Homemade yogurt cultured for 24 hrs has alot less lactose left in it. The cultures eat it as long as theyre warm, meaning active and respirating. You can eat more of it, or have something else and stay under your carb limit. You can also buy the milk raw and make your own yogurt unlike in a store, even if you can find unhomogenized.
I was always afraid it would be too sour as I’d read it was when cultured so long. I finally bit the bullet and even my kids eat it plain still. Today I let it go 30 hrs and it’s fine. I think 24 hrs is plenty long tho lol
I’ve been doing the ketogenic diet for 10 weeks now.
My HDL went from 42 to 53, my Triglycerides went from 93 to 75 but my LDL went from 147 to 191 Not sure if they are large particles or small particles. Is that normal for the LDL to go up along with the HDL? also my testostrrone went from 612 to 683. I’m guessing from my total cholesterol going up.
Do you have any thoughts?
I have had the same results after 4 months.
Checkout LCHF Sports medicine doctor Peter Brukner’s suggestion in the news article
WHAT BLOOD TESTS SHOULD I HAVE DOC?
I’ve heard of the HDL and LDL increasing on low carb. I looked into the opinions of Peter Attia and Tim Noakes and you are on the right track with the large (good) versus small (bad) LDL. I think its also important to look at other markers of cardiovascular risk like blood pressure, general inflammatory markers like CRP and ESR and blood sugar of course. Ideally if possible, a vascular scan to assess presence of atherosclerosis would clarify a lot of concerns too. If these things are normal, elevated cholesterol may not carry much weight, since underlying inflammation and vascular damage are often required to be present in synergy for high lipids to cause damage. Supplementing omega 3 and making sure your metabolism is fat adapted should help reduce risk associated with higher lipids.
I’m wrapping up 10 months of Ketogenic eating. A type 2 diabetic, my A1C is 5.5 with zero meds. Blood pressure, trygl, and vitamin/mineral levels are all perfect. My “bad LDL” p-LDL is 22 with a range stating that 35 or lower is acceptable yet my overall LDL is 286 (76 point increase) Lost 109 lbs and then hit a stall, a 7 week stall that sent be back to the doctors office to discover that my TSH is now 7.76. Previously maintaining 15-25 net carbs a day, dr and I agreed going to a 40-50 net carb may resolve the thyroid levels by giving more carbs to my “team of glands” The result? Thyroid levels went down but A1C rose to 6.5 and I had terrible nerve pains, insomnia, inflammation and mood swings as a result. Daily strength and cardio conditioning suffered but TSH levels dropped as did HDL and triglycerides spiked. Weight gain of 5 lbs in 60 days.
So I’m left with the dilemma spending a life stuck on medications that destroy my organs or back to obesity .
I can fully understand your points on all aspects. Though what happens when a patient falls into both Low Carb and Moderate carb categories ? I refuse to accept that I will be forced to resume medications regardless of how I consume calories
My thoughts are with you! I’m in a similar situation. Two things have helped me so far: i) Megafood mixed B vitamins supplement (to increase energy, help with adrenal fatigue); ii) 6 days of low carbing (not zero carb), 1 day you’re free to eat anything. I eat bread in all three meals! You can also read up on Tim Ferriss’s slow carb diet. Wish you the best in your journey.
We must be the only species on the planet that spend so much time thinking and rethinking about what to put into our mouths! I first started the Paleo way of eating because it seemed simple, common sense and helped give a healthy body. I admit that after a while I became more than slightly confused and bemused as to what I should be eating, what proportions, what was allowed and what wasn’t. That’s because I like to read about a subject I’m interested in and unfortunately, there are enough tomes, websites, blogs to keep you occupied from now until doomsday.
I don’t want to test my ketones, my doctor wouldn’t, couldn’t on his budget do regular blood tests and I certainly can’t afford to pay for them. Do I even need to know? I don’t want to calculate the percentages of carbs to fat to protein at each meal, it’s as bad as, if not worse, than the calorie counting days I was trying to get away from. Macro and micro nutrients? Oh for heaven’s sake, this is smacking of being obsessional. (Probably not a real word).
Giving up processed food made sense to me. Giving up the majority of sugars, except for some from fruits and a little honey made sense to me. Even giving up grains made sense given how many people are gluten intolerant. I read about good fats and using them made sense to me. It seemed simple.
Now what the heck do I put on my plate? I want to enjoy my food, I don’t want to obsess about it, over think it, worry about it. Isn’t that counter productive? All I want to do is to eat healthily. Give me a bit of meat, lots of veggies on the side, either cooked in olive oil or with a pat of butter on the side. Perhaps finished off with some blueberries, greek yoghurt _ full fat of course, with a drizzle of local heather honey and I’m happy. Or should I not be………
I feel much like you do–that the finickyness of so much you find in the Paleo community borders on neurotic and could push you to a eating disorder.
Do you need to count carbs or know your ketones? I think it depends. The whole reason I became interested in nutrition was because I was diagnosed as a diabetic. It was my doctor–specifically my endocrinologist–who pushed me towards counting carbs. FWIW, changing my diet normalized my numbers and I’m off meds–and w/o Paleo, or going very low carb.
But yeah, I count carbs, my endocrinologist wants me to keep them under 45 grams per meal, and FWIW it becomes easier and less obsessive as you learn the numbers for different foods. It’s not like I have to calculate and recalculate the carbs for the chicken salad that’s my go-to lunch. And aps like My Fitness Pal makes it easy. But if how you’re eating is working for you, I think it’s healthier (in every sense) not to obsess and stress about it, and if you’re not diabetic or pre-diabetic I don’t see the need.
Someone on one of the boards here quoted Pollan’s rule about healthy eating–basically: Eat real food. Not too much. Mostly plants.
Really, unless you have specific health issues surely all that’s needed?
I wish Pollan had left out the last words: “mostly plants.” There is no good evidence that I’ve ever seen to support that last sentence, but there’s a certain sweet simplicity in the first 2 comments.
Amen Amen Beth! This is my favorite post!
Let’s not forget that green vegetables are carbs. Even on a VLC diet, they are (and always should be) included.
For me, diet makes all the difference in managing a chronic illness! I have adopted a grain free, no refined sugar, no legumes diet over the past few months. I can’t say that I am loving it, but I can say that abstaining has made an incredible difference in the levels of joint inflammation and how I feel overall. I have found I can eat one of the three things about once a week now, depending on the type, without an issue. Also, for drinks I have resorted to low-carb beers.
I lost 40 pounds on a ketogenic diet and exercise( nothing intense just strolling the baby about 5 miles a day- power walking) but then I got extremely exhausted and drained and my weight loss just completely stopped. once I started adding carbs back in The wait just start falling off of me. I was excited but completely perplexed! now years later I just do Paleo and have already lost 8 pounds in about 10 days. I can attest for myself that I definitely need the carbs maybe for thyroid to turn T4 and T3? I love Paleo because it works for me! Bring on the sweet potatoes!
Can I ask what kind of carbs you added back in? I need more carbs to get the sleep cycle back to normal. I do not want to eat grains, have a problem with milk so gave up all dairy, including eggs and cheese now, don’t want to eat boxed or packaged foods, so am still having a hard time adding back in “good” carbs. And I would like to get a big variety to help the gut flora.
Hi Michele,
we are completely grain free dairy free and sugar-free at our house at this point except for the sugars in fruit and sweet potatoes which is where we get all of our carbs. we do also do some tapioca flour in some of our baking and I do occasionally make french fries out of parsnips and sometimes my daughter will have a baked potato but actually when i started adding carbs back in years ago after the ketogenic diet I was not as particular I just started eating carbs in general and the weight started falling off which was really curious to me but now after researching I think I learned that some people with thyroid (I have Hashimoto’s) and also women in general need some carbs for the liver to convert T4 to T3 but don’t quote me on the exact mechanism or reason why i’m sure Chris has a lot about it on the site somewhere…
Oh and also i became a complete insomniac when I wasnt eating carbs I wanted to really stick to LCHF but if I wanted to sleep I had to start eating applesauce or sweet potatoes or honey or some kind of carb at night or I knew I was going to be awake all night I don’t know why that is either I’m sure there’s something on the site about it but I totally understand
I’m doing modified Atkins for epilepsy. I discovered that I had difficulty sleeping at least partly because I was going to sleep hungry. So, I made a low carbohydrate grainless granola of almonds, hazelnuts, flax seeds, sunflower seeds, pumpkin seeds, sesame seeds, coconut oil, and a little maple syrup for a bedtime snack – 3-4 tablespoons depending on what I ate during the day (I keep net carbs around 20-25 g, calories around 1250, and the percent of calories from fat at 65-75%), together with 50-100 g yogurt made from full-fat organic goat milk. Dairy is supposed to help our bodies produce melatonin that helps us sleep. I also cut down on stress-causing experiences. Am sleeping much better.
Interesting comment.
I exercise regularily. Luckily, i’m rather slim by nature. I also tried cutting down carbs (for no particular reason, as an experiment on myself i guess. To see how my body would react) other than from fruits (not many) and veggies. Lots of protein and nuts.
I thought i would lose more weight and simply get more ripped physically, with even less bodyfat.
My energy levels got sensibly down, and my sleep was not so good. But overall, it was ok. A few weeks ago, i added back some carbs from unrefined grains mainly (plain oats and oatbran and wholerye bread + sourdough bread, which i ate all my life, in france) and dried fruits like dried prunes. So no refined grains really. Well, i can only speak for my self, but i lost bodyfat, thus got more ripped and didnt have all these sleepy spells during the day (my sleep improved). I can only tell what works for my own metabolism, but it seems that some people might be better off with “good quality” carbs versus “very”low carb. I must say that adding these grains (i have no allergy whatsover to gluten etc,,,) did me more good than erasing them from my diet. One important thing, is that it did not added in calories to what i ate before. By eating more of these kinds of carbs i ate less of the other, as i was less hungry. I guess there is no one size fits all.
Eggs are not dairy – cows don’t lay eggs. Plus, they have a lot of precious nutrients that are hard to find in other foods. Always be sure to buy free-range and organic.
Hi Michelle; be careful that you don’t get tempted to go full-on high carb veg in order to correct the lack of sleepiness. Many can add 1 tsp of raw honey or some extra veg a few times a week to correct this situation. I’ve seen some recommendations that have people eating far more high carb veg than they want, just to get the extra sleep. Sweet potatoes, for example have been touted as ‘super foods’ but they only differ from white potatoes in their vitamin A amounts. We need to proceed with caution to avoid ‘carb creep’ which has led to weight gain in so many. Do your own experiments–best wishes.
I have adopted a grain free, no refined sugar, no legumes diet over the past few months to help deal with the inflammation caused by Lyme Disease. I can’t say that I am loving it, but I can say that abstaining has made an incredible difference in the levels of joint inflammation and how I feel overall. Shocking really. I have found I can eat one of the three things about once a week now, depending on the type, without an issue. For me, diet makes all the difference in managing a chronic illness!