Over the last couple of weeks we’ve been discussing the benefits and risks of low-carb and very low-carb diets. Laura, one of my staff nutritionists, kicked things off with an article called “Is a Low-Carb Diet Ruining Your Health?”, and I followed up with an article called “7 Things Everyone Should Know About Low-Carb Diets”. Then Kelsey, my other staff nutritionist, wrote an article called “The 3-Step Process for Determining Your Ideal Carbohydrate Intake”. In the near future, we’ll be featuring an article about the therapeutic uses for very low-carb and ketogenic diets.
Are you on an “accidental” very low-carb diet? Find out here:
The takeaway from all of these articles is relatively simple and uncontroversial—at least according to anthropological and clinical research:
- Very low-carb (VLC) and ketogenic diets are useful therapeutic tools in certain conditions.
- Some (but not all) people experience adverse effects from following VLC and ketogenic diets—especially when done over an extended period of time.
- Very low-carb diets were extremely rare during the course of our evolution and are not the “default human diet” (as some have claimed).
Before we move on to cover the therapeutic uses of VLC/ketogenic diets, I want to address an issue that I see relatively frequently in my private practice. I’ve begun to think of it as the “accidental low-carb diet” phenomenon. The best way to explain this is to share a case study.
The accidental low-carb diet: Frank’s story
A few months ago I spoke to a patient—we’ll call him Frank. Frank is a 32-year old male who is on the SWAT team in a major metropolitan city. He came to see me complaining of extreme fatigue, insomnia, and exercise intolerance. These issues were obviously of paramount importance given his job.
About a year prior to our first visit Frank had started a low-carb Paleo diet. Some of his colleagues on the SWAT team were doing it with great results, so he figured he’d give it a try. He wanted to lean out and lose about 5 pounds of belly fat that he was having trouble getting rid of. After a few months on the low-carb Paleo diet, Frank did reach his target weight and body composition.
But then the fatigue and insomnia started. A few months after that, he noticed he was having trouble keeping up with his training routine (which is, as you might imagine given his profession, quite rigorous).
Frank reads my blog and listens to my podcast, and he had heard me say that some people can experience problems on a very low-carb diets. So he started to add some carbs back into his diet. This helped a little bit, but when he finally set up an appointment with me he was still struggling.
When I talked to Frank, I asked him how he would characterize his diet. He said he used to do low-carb, but now he was on a moderate carb. I’ve learned over time not to accept this at face value, so I probed further. I asked him specifically how much carbohydrate he eats in the form of starchy plants and fruit (more on this below) on a daily basis. His answer: a sweet potato and about a half a cup of blueberries 3-4 times a week.
Although Frank thought he was on a moderate carbohydrate diet, when we did the math, it became clear he was on a very low-carb diet with fewer than 10% of calories from carbohydrate. Here’s how it breaks down:
- Frank is 6’3 and 215 pounds (with a lot of muscle). He is extremely active. In order to simply maintain his weight, he would need to eat about 3,000 calories a day.
- If we define a moderate carbohydrate diet as 25% of calories from carbohydrate, that means Frank would need to eat 750 calories a day as carbohydrate. At 4 calories per gram of carbohydrate, that comes out to about 188 grams of carb each day, or 1,316 per week.
- A large sweet potato contains 37 grams of carbohydrate. 1/2 cup of blueberries contains about 10.5 grams of carbohydrate. In addition to these amounts of starch and fruit, Frank ate about 3-4 servings of nonstarchy vegetables each day (about 25 grams of carbohydrate on average). Given these numbers, Frank was eating about 365 grams of carbohydrate a week.
At 3,000 calories a day, this works out to about 7% of total calories from carbohydrate. That is most certainly not a moderate carbohydrate diet.
Do carbs cause weight gain? Frank’s experience.
When I explained all of this to Frank at our appointment, he was pretty shocked. He was under the impression that eating a few sweet potatoes and some berries throughout the week put him in the “moderate carb” category. Obviously, this was not the case given his weight and activity level.
He was even more shocked when we calculated how much carbohydrate (again, from starchy plants and fruit) he’d have to eat to get to the “moderate” carbohydrate level of 25% of total calories. For Frank, to reach this target of 188 grams per day, he could eat the following:
- Four servings of nonstarchy vegetables (25 grams)
- One large Russet potato (64 grams)
- One cup sliced cooked plantain (48 grams)
- One medium banana (27 grams)
- One cup of strawberries, halved (12 grams)
- One half-cup of blueberries (11 grams)
This meant having a full serving of a starchy plant with two meals, and some fruit either with each meal or between meals—far more carbohydrate than Frank was eating previously.
Frank was initially reluctant to eat this much carbohydrate. He told me that he had noticed that carbs caused him to gain weight. But again, when we I dug a little deeper it became less clear that it was carbohydrate in general that caused weight gain, but a certain kind of carbohydrate (namely, processed and refined carbs).
Turns out that Frank had very strong cravings for carbohydrate after a while on the VLC diet. Instead of increasing his intake of starchy plants and fruit, he’s stay extremely low-carb and then fall off the wagon by eating bread, pizza, or something like that. Not surprisingly, he would gain weight after these “indiscretions”. (Interestingly enough, he would also feel more energetic and sleep better afterwards.)
I asked Frank whether he gains weight when he eats carbs from whole-food, Paleo-friendly sources like starchy plants and fruit. He said he didn’t know, because he had never tried eating the quantities of these foods that I was recommending. So of course that became our next experiment.
When I spoke to Frank about ten weeks later, he was ecstatic. His insomnia was completely resolved. His energy levels were not only restored, but higher than they’d been in recent memory. But what he was happiest about was his increased performance at work; Frank had recently placed highly in a national SWAT competition that his team competed in.
What’s more, he accomplished all of this without gaining a single pound. On the contrary, he had lost a further 3 pounds of fat and was more “lean and ripped” than he had been on the VLC diet.
If this had been an isolated experience with a single patient, I wouldn’t even bother writing this article. But in fact it’s a fairly common occurrence in my practice. I have every patient I see fill out a diet diary which shows me exactly what they eat on an average day. Then I ask them what their carbohydrate intake is like. I’d say about 50% of the time—if not more—my patients are consuming significantly less carbohydrate than they think they are.
If you think you might fall into this category, you can use the guidelines below to calculate your optimal carbohydrate intake.
How to calculate your carbohydrate intake
The first important thing to understand is that it’s far more useful to think in terms of of percentage of calories for carbohydrate than it is to think in terms of grams per day. I often hear people make recommendations for the number of grams of carbohydrate someone should eat. But this is meaningless when you don’t take weight and activity level into account. 75 grams a day may be a moderate-carb diet for a sedentary woman eating 1,600 calories a day, but it would be a very low-carb diet for a highly active male eating 3,000 calories a day.
The table below illustrates the ranges for “very low carb”, “low carb”, “moderate carb”, and “high carb” using percentage of calories for carbohydrate. I’ve also included examples for how many grams of carbohydrate an average, moderately active male and female might consume per day given those ranges, as well as a list of health conditions/goals that might do well for each range.
In order to calculate your exact target range, follow these steps:
- Figure out how many calories you should eat per day. This depends on your height, weight, activity level, and goal (weight loss, maintenance, or gain). You can use any number of online calculators to get this information.
- Once you have your daily calorie intake, multiply that number by your target percentage of carbohydrate. So, if your daily calorie target is 2,000 calories and your target carb intake is 20%, multiply 2,000 by 0.2.
- Once you have the number of calories per day from carbohydrate you need to eat (from step 2 above), divide that by 4 to obtain the number of grams of carbohydrate you should eat. In this example, you’d divide 400 calories by 4 to get 100 grams. That is the number of grams of carbs you need to eat each day.
- With this number in mind, you can then consult the charts below, or use online tools like NutritionData.com, to figure out which foods you can eat to meet your goals.
If you’ve never done this before, I’d encourage you to give it a try. If you’re like many of my patients, you might be surprised to learn that you’re eating a lot less carbohydrate than you thought.
Now I’d like to hear from you. When you calculate your carbohydrate intake as I described above, are you lower-carb than you thought? What was the difference? Have you found that eating more “real food” carbs addresses your carb cravings without causing weight gain or other symptoms? Let us know in the comments section.