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Is a Low-Carb Diet Ruining Your Health?

by Laura Beth Schoenfeld, RD

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Carbohydrates, and the role they play in a healthy diet, are one of the most hotly contested nutritional debates in the world, both in conventional and ancestral health circles.

One one side, you’ve got folks who say that carbohydrates are nonessential and increase your risk for diseases such as diabetes, cancer, and neurological disorders. On the other side, some say that carbohydrates are crucial for good health and should make up the majority of your calories.

It’s no wonder I have so many clients who come to me completely confused about carbs and whether or not they should eat more or less of them.

While some people do incredibly well following a low carb Paleo diet, there are many people who crash and burn on this type of dietary plan. So, how can you tell if you’re the type of person who shouldn’t be eating a low carb diet, and how do you figure out how many carbs you should be eating? I plan to teach you just that in this article.

Is your low-carb diet doing you more harm than good? Find out how many carbs YOU should be eating.


I recently discussed the role of carbohydrates during pregnancy in an episode of The Ancestral RDs Podcast. The most important reason why women need adequate carbohydrates during pregnancy is to ensure adequate fetal brain development and growth. Another reason is because a high protein diet can be dangerous during pregnancy, and when you cut out carbohydrate as a major macronutrient, you usually can’t help but increase protein as a percentage of calories. Protein intake greater than 25% of calories during pregnancy may lead to decreased mass at birth and increased perinatal morbidity and mortality for the baby.

The Institute of Medicine recommends a minimum of 175 grams of carbohydrates per day during pregnancy, which is 29% of calories on a 2400 calorie diet. Paul Jaminet advises pregnant mothers to restrict protein to about 15% of calories and to obtain 30% of calories as carbohydrates. Chris recommends a moderate carb approach for most pregnant women (except those with any type of diabetes) in his book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014).

Like these other experts, I generally recommend 30% of calories from carbohydrates for my pregnant clients, and also for those who are struggling with fertility. Unless you have diabetes or a serious neurological condition that requires carbohydrate restriction, it’s not worth the risk playing around with a low carb diet when you’re pregnant, and these diets aren’t conducive to fertility for many women either. (If you’re interested in more reasons why carbohydrates can affect fertility, read this great post by Stefani Ruper.)


If you’re a professional or recreational athlete who trains hard 4, 5, or even 6 days per week (I hope you’re not doing 7 days per week!) and trying to maintain this level of activity on a low carb diet, you may be doing more harm than good to your health and fitness.

While there are athletes who thrive on a well-planned low carb approach (LeBron James most recently!), there are many others who do not. Each athlete is completely unique in their ability to perform well on a low carb diet, and there’s nothing wrong with testing out the diet to see how it affects your athletic ability.

But if you’ve been trying a low carb diet for months now and your workouts are suffering, your weight isn’t budging (or maybe you’ve even gained weight!), and your recovery time is increasing, you’re probably not the type of person who can handle a low carb diet combined with regular intense physical activity.

I’ve had many clients come to me on a low carb diet who, after switching to a more moderate carb approach, found that their energy and endurance significantly increased, and they were able to make quicker strength gains than before. Many also were able to shed some of the stubborn body fat that they’d been retaining despite eating a low carb diet and training hard, which was a result they didn’t expect!

For my athletic clients, I usually recommend a minimum of 20% of calories from carbohydrate, and depending on the person’s health goals, training schedule, and current issues, I may actually recommend more like 40-50% of calories from carbs.

Again, each athlete is an individual and what works for one person, or even a thousand people, may not work for you. So don’t be afraid to experiment and pay attention to how your diet makes you look, feel, and perform! And don’t hesitate to get help if you need it!

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Hypothyroidism and HPA Axis Dysregulation (Adrenal Fatigue)

Hypothyroidism is one of the most commonly cited medical reasons for needing to eat a moderate carb diet. The main reason why carbs affect thyroid function so directly is because insulin is needed for the conversion of the inactive T4 hormone into the active T3 hormone, and insulin is generally quite low on very low carbohydrate diets.

So if you’ve suddenly started developing hypothyroid symptoms on your low carb diet, it’s a pretty good sign that you’d be better off upping the carbs (and getting your thyroid tested if you haven’t already!) For more about how low carb dieting affects your thyroid, listen to this great interview with Chris by Jimmy Moore.

HPA axis dysregulation, also known as adrenal fatigue, is another condition where a moderate carb intake is important for general health. Kelsey and I talked about adrenal fatigue on our first Ask the RD podcast, so listen to it if you’re unfamiliar with this condition. The main hormone that gets dysregulated in adrenal fatigue is cortisol, and cortisol has been shown to increase on a low carb diet. This means that a low carb diet is a potential adrenal stressor in susceptible individuals. Combine that with a stressful job, inadequate sleep, and overexercise, and you’ve got yourself a recipe for adrenal burnout.

So if you have adrenal fatigue, or if your current lifestyle is already high stress in a few different areas, you may want to increase your carb intake until you can get those additional stressors under control, as you may drive yourself into adrenal fatigue by having a chronically elevated cortisol output. Lara Briden has written a great article on the benefits of whole food carbohydrates in lowering cortisol and raising GABA, a calming hormone that is often low in adrenal fatigue patients.

If you’re experiencing symptoms of hypothyroidism or adrenal fatigue, you may be worsening them with a well-intentioned low carb Paleo diet. I recommend working with someone to help you figure out if your diet is indeed making these symptoms worse, and how to change what you eat to better support your thyroid and adrenal health.

Gut Health

One of the less discussed downsides of a very low carbohydrate diet over the long run is the potential for alteration of the gut flora. Chris recently covered this issue in a podcast with Jeff Leach, where they discussed evidence that a very low carb diet can lead to gut dysbiosis and a reduction in the diversity of the gut flora. A lot of the information on this topic is new and not fully understood, but it’s reasonable to believe that when you avoid carbs, you’re also avoiding important prebiotics (i.e. food for your gut flora) like soluble fiber and resistant starch.

These prebiotics are essential for promoting the growth of beneficial gut flora. Without them, your beneficial flora can’t produce as much gut-healing substances like butyrate and other short chain fatty acids, and your microbiome composition may even shift in an undesirable direction. And as Chris would say, you’re only as healthy as your gut is: an unhealthy gut contributes to everything from obesity and diabetes, to digestive illness, to autoimmune disease, to skin disorders.

Those who are doing very low carbohydrate diets, and who simply can’t increase their starch intake for whatever reason, should use prebiotic supplements such as resistant starch-rich unmodified potato starch or FOS powder. However, these products must be incorporated slowly into your supplement regimen, as you can experience severe gas and bloating if too many prebiotics are taken all at once, or if there is existing gut dysbiosis or bacterial overgrowth. In this case, it would be wise to work with someone who can help you get the prebiotics you need while on a very low carbohydrate or ketogenic diet to protect the health of your gut microbiota.

How Many Carbs Do I Need?

To determine how many carbs my clients need to eat in a day to reach their health goals, first I decide what percentage of calories from carbs they’d possibly do best with. As an example from above, a woman struggling with fertility issues may benefit from a carb intake around 30% of calories. I then determine her caloric needs using a calculator like this one. If we determine that her daily needs are roughly 2000 calories per day, 30% of calories from carbs is 600 calories. As there are 4 calories in a gram of carbohydrate, this works out to be 150 grams of carbs per day.

Usually I give my clients a target range to hit depending on their activity levels, and we use these targets to re-evaluate their food diaries and see if they’re hitting their goals. Most of my clients are surprised to learn how much carb-rich Paleo foods they have to eat to get up to 150-200 grams per day! But once they start making a real effort to hit those targets, the health benefits are immediate.

These benefits include weight loss, elevated mood, skin improvements, increased energy, normal menstrual function, more satisfying sleep, and more. It’s so exciting to see what a couple of starchy tubers and pieces of fruit can do for a person’s health when they simply need to eat more carbs!

Final Thoughts

The purpose of this article was not to bash low carb diets. I truly believe that there are many people out there who get amazing health results from a low carb plan, and there are dozens of health conditions that benefit from a very low carb or ketogenic diet, especially severe neurological conditions. Paul Jaminet has written some great posts explaining when a ketogenic diet may be useful and necessary, so I strongly suggest reading those posts if you’re still on the fence about where you stand with carbohydrates and your health needs.

My hope is that by reading this article, you’ll be able to understand the many factors that play into how a person handles a low carbohydrate diet, and whether or not their health will improve on such a plan. Everyone is different in their ability to thrive on a low carbohydrate diet. If you’ve found yourself identifying with any of the issues I’ve written about in this post, you may be in need of a macronutrient adjustment in your diet.

Helping people optimize their carb intake is a challenge I truly enjoy. As a dietitian, I love to help people evaluate their diet to determine if they’re meeting their health needs with the food they’re eating. If you think you could benefit from a Paleo diet makeover, I’d love to chat with you about where you’re at and where you want to go with your health.

Your carb intake shouldn’t be the major factor that’s preventing you from reaching your health goals. I hope you use the information I’ve shared today to evaluate your own nutritional needs and make the changes that make sense to you.

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Laura Beth Schoenfeld, RD
Laura Beth Schoenfeld, RD

Laura Schoenfeld, MPH, RD, is a licensed registered dietitian and women’s health expert trained in Functional Medical nutrition therapy. She assisted in the creation of educational materials for both the ADAPT practitioner and health coach training programs.

Her passion is empowering women to nourish their bodies, develop true strength, and ultimately use their improved health to pursue their purpose. Laura guides her clients in identifying and implementing diet and lifestyle changes that allow them to live a healthy, fit, symptom-free life without being consumed by thoughts of food and exercise. She draws from a variety of sources to form her philosophy on nutrition, including ancestral diets, principles of biochemistry, current research, and clinical experience. Her areas of expertise include women’s hormones and fertility, gut health, autoimmune disease, athletic performance, stress management, skin health, and weight loss. Recognizing that health goes far beyond just diet and exercise, Laura teaches her clients how to focus on and implement life-changing mental and spiritual health habits as well, including changing their thoughts and beliefs to ones that drive health-supporting decision-making around food, fitness, and life in general.

Her greatest mission is to help health-conscious women realize that, while their health is priceless, they are so much more than a body. When she’s not educating and serving her coaching clients and community, Laura loves traveling with her husband, Sundays with her church family, hikes with her dog, beach trips, live music, and strength training.

Professional website: lauraschoenfeldrd.com

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Join the conversation

  1. I suffer from Hashimotos but always with “normal” labs. I’m always tired. What carbs should I eat? I’m so confused now.

    • Without seeing your numbers and reference ranges used for TSH, free T4 and free T3, it’s impossible to comment further.

      As an aside here, there are optimals-within-reference ranges, and for different situations (e.g. the normal healthy person who is not hypothyroid by any standard vs. the medicated hypothyroid patient). These optimals are commonly unknown or overlooked in conventional medicine including and especially by laboratories. That problem would be very easy to fix that with updated education and broad acceptance, laboratories using tighter reference ranges and noting optimals-within-range with further notes if needed, updates that would cost practically nothing as the guidelines could be outlined on one page or screen, but there doesn’t seem to be the will to do so in many or most cases. Many years ago I defined ethics as involving issues of the will and willingness, and that idea could well apply here.

        • Nearly all of the ‘net thyroid patient community have been in agreement about thyroid-related tests, reference ranges, and optimals within range for about 15 years now. You might start with reading Mary Shomon’s books on thyroid (amazon). However, ideas about treatment approaches to any and all hormone issues tend to have wide diversity of viewpoints.

          • OK, well I already know the basic stuff and Shomon’s info is well disseminated. I refer to the site ‘stop the thyroid madness’ but I was hoping there were some newer sites with more recent references, since other people’s anecdotes and rat studies don’t really cut it with my doc (they do have some human studies too, but not enough). Paul from Perfect Health Diet had some interesting info about slightly elevated TSH, totally within range, and increased miscarriages, but their site isn’t geared towards thyroid, so just wondering if anyone else collects the newer studies. But thanks for your help.

  2. You wrote: “…there are many people who crash and burn on this type of dietary plan.”

    What the heck does THAT mean!!!???

    I think that this is BS and you are making this up. I suspect that, IF FOLLOWED CORRECTLY, there are very FEW who do poorly on Paleo.

    And having cravings for doughnuts, bread or birthday cake, I don’t think equates with doing poorly, health-wise.


    • Christopher, could you please clarify. It appears that you are associating the paleo diet with a low carb diet–is that correct? And by paleo diet, do mean the actual (and many versions) of paleo diet or the one that is practiced here in the United States. Thank you very much in advance for helping me understand your comments.

    • Paleo does not equal low-carb. In fact, there are very few traditional Paleolithic cultures that consumed a low-carbohydrate diet. Most of them ate a moderate amount of carbohydrate—between 30–40% of total calories according to most studies (see http://www.ncbi.nlm.nih.gov/pubmed/20860883 and http://www.nrjournal.com/article/S0271-5317(11)00091-1/abstract for examples). This is most assuredly not a “low-carb” diet.

      The crucial difference between traditional Paleo diets with 30–40% of calories from carb is the quality of the carbs. In Western diets, the carbs are almost exclusively from processed and refined sources (flour and sugar). In traditional diets, they come from starchy tubers, fruit, and occasionally honey.

      I am constantly beating this drum, and I will continue to: it’s not the quantity of macronutrients that matters for most people, it’s the quality.

      • Thank you Chris. This was the point I was wanting to make, but I sought clarification from Christopher–in case I was misinterpreting his comment. Best wishes.

      • “Paleo cultures”?? I think you mean hunter-gatherer cultures. Paleo people were hunter-gathers but these hunter-gatherer cultures you cite were not Paleolithic. Also these people didn’t have computers, tv, and desk jobs. Of course they could handle more carbs (when they were available). The issue I have with the article is the lack of clear definition of “low carb”. Also, as PCOS is a major cause of female infertility and responds well to LCHF I find the author’s one-sided analysis of LC negatively affecting fertility inaccurate. Finally, the whole article was too one-sided. The average American (pry most) need to significantly curb carb intake and increase healthy fat, the question is usually just how much. The answer: it depends.
        – Tim Noonan, MD

        • “Finally, the whole article was too one-sided. The average American (pry most) need to significantly curb carb intake and increase healthy fat, the question is usually just how much. The answer: it depends.”

          Shorter Tim: I just spent 6 sentences slamming this article, 2 sentences telling you I don’t know the answer.

  3. Please answer me this question I don’t find an answer for! I’ve stopped eating rice and grain, and most sugar except for sugar from whole fruit. I eat a little potato every day. I have low blood sugar (62mg/dl fasting), and I have GERD and possibly SIBO, and gut disbiosis.
    What should I do? I have to reduce sugars to fight bad bacteria and I end up hypoglycemic. Please help!

  4. Thanks for this article, Laura. I’m one of those skinny dudes who looks emaciated when I eat low carb for a stretch of time, but the temptation to do so is there because of the crowd that insists it is for everyone.

    Is there any evidence that carbs should be avoided in the morning, or is that another myth? I’m guessing it’s another thing that’s dependent on the person, but, again, there are those that make skipping breakfast or morning carbs essential to blood sugar regulation for ALL. Thanks again.

    • Well, I’m not Laura, but I’ll chime in anyway. 😉

      The only way to know how your blood sugar does with carbs in the a.m. is to test. One of the reasons people are sometimes cautioned against carbs in the morning is because it might set them up for cravings all day long — and usually not cravings for, say, yucca or sweet potatoes, but for junk carbs & refined sugars. If you find you can do carbs in the morning and *not* set yourself up for inordinate cravings soon afterward (and possibly later too, throughout the day), then I don’t see why you would need to avoid them. Some folks really *are* more “carb tolerant” than others.

    • Well, I wouldn’t say it’s essential for all people. What I’ve read is that people with poor blood glucose control, such as diabetics, found via self-experimentation that they could eat more carbs in the afternoon than the morning, because their blood glucose didn’t spike as much in the afternoon. I believe the explanation that was proposed had to do with the fact that cortisol has a diurnal variation, with high levels in the morning and lower at night. Cortisol increases endogenous glucose production, so if you already have poor glucose control, adding carbs on top of that cortisol-induced glucose will spike your levels too high. I think there are also some studies where they varied breakfast macronutrient composition, and a lower carb/higher protein meal did better in some physiological measures (I’m blanking on what those were) and improved satiety.

    • I say give up on any crowd who insist anything is for everyone 🙂 Join this crowd who respect and understand bio-individuality and then share with us what works for you.

  5. Thanks for this great article – this issue has been on my mind recently as I just got diagnosed with stage 3 adrenal fatigue, SIBO and I also have a parasite causing me lots of issues. I’ve been trying a ketogenic Paleo diet recently as I had read a lot about ‘taking blood sugar out of the equation’ of adrenal health etc, but I’ve been feeling increasingly fatigued and my sleep has gone out the window. i initially felt great being ketogenic but I’m starting to wonder if its doing me more harm than good. My blood sugar is also all over the place but Ive been too scared to eat more carbs for fear of making it worse.
    After reading this article and some of the comments I’m going to give it a go adding back in some carbs and see how I feel. Thank you for tackling this issue and providing some reasoning behind a more moderate approach!

    • Nicole, would you mind sharing how much protein you are eating while eating a ketogenic diet? Thanks

      • Hi Michelle, I wasn’t really tracking my protein grams as I used ketone blood testing strips to see if I was in ketosis or not. I would estimate around 80-100g of protein per day. I definitely had to scale back from the amount of protein I was eating before, and I felt fuller after doing this and replacing the calories with fat. It ended up being about a palm size portion of protein for each meal.

  6. I agree with this article. However, one thing this article doesn’t consider is that 150g of carbohydrates is still low-carb when compared to the Standard American Diet. As a result, many use the term low-carb as a comparison to the SAD. However, 100-150g of carbohydrates is fine for most healthy people and its only necessary to go lower if you’re dealing with health issues like epilepsy. Athletes and pregnant women obviously need more and people who have gut issues should consume more fiber. Low-carb, anywhere from 25-150g CAN be healthy as long as one is aware of their personal needs.

    • Higher than 150 grams per day can be healthy depending on the person. An elite athlete eating 8000-10,000 calories per day (or higher) may end up eating 600-800 grams of carbs per day (or more) and be perfectly healthy due to their high energy demands, along with the many other lifestyle factors that athletes prize such as adequate rest and recovery, stress management, and mobility work to keep them performing at their best.

      There’s no specific gram amount that’s appropriate for everyone, it’s completely dependent on the total amount of caloric intake. That’s why I tend to use percentages rather than grams.

      • My favorite n=1 experimenter, Dr. Peter Attia, even reports that he can stay in ketosis on hundreds of grams of carbohydrates per day–provided he is training heavily. So even if your goal is to mostly stay in ketosis, there is not a one-size-fits all prescription!

  7. Hey Laura,

    Good stuff. I think VLC and/or ketogenic diets can be extremely therapeutic in certain circumstances, but they’re certainly not ideal for everyone, across the board.

    That being said, I have just one (teeny tiny) bone to pick here…

    On your site, you gave this the title, “Do You Need to Eat More Carbs,” and here, it’s “Is a Low Carb Diet Ruining Your Health.” I like the former so much more than the latter. The “ruining your health” part just seems unnecessarily inflammatory. Not sure if you chose the title, or someone else who manages content for this site.

    Like I said — not arguing with the content, because I think you covered it very well and from a lot of different angles. I guess I almost see a “civil war” coming between the ardent low-carbers and the not-so-low-carbers, and this piece brings some much needed logic and calming common sense. Just wish it had a less incendiary title. (And then again, this probably where I go wrong with my own site — too vanilla, not enough “grab you” type headlines.)

      • Do you think there is a distinction to be made between pathogenically lowered thyroid function and lowered thyroid function?

        Would you not expect *some* adjustment in *certain* thyroid values when switching from a predominantly carb to predominantly fat diet?

        If your paradigm is a modern high carb intake, then it is not surprising any deviation from that is considered bad. I’m surprised this is the reasoning that is more and more popular in the paleo sphere?

        I’ve asked for information relating to thyroid issues and ketogenic diets and all I was provided was: anecdotes, rat studies addressing the issue peripherally and some 90s textbook explanation about LC affecting thyroid function who argues in the same breadth that this is linked to hypoglycemia.

        Is there *any* human, controlled experiments that show this? If so, please link to them. I will happily change my mind. Ballantyne’s AHS14 presentation does not provide this kind of evidence. Ramadan fasting is not representative an nutrient dense (e.g. organ meat) well formulated ketogenic diet. Rat fasting study? Not really directly relevant, once again. Scare-mongering of an animal study conflating gestational ketosis with gestational ketoacidosis in humans? That’s a stretch.

        Can increasing carb intake help for a large diversity of issues? Sure! Medicine is full of surprises and complex, so it’d be silly to rule that out. But to just jump to the other end about ketosis being niche and ‘last resort’ kind of thing of simply poor extrapolation from (a lot) of irrelvant science.

        I think it is important you address this. After all, echo chambers are tiresome! 🙂 Shoot me down if you think I’m tooootttaalllyy off base. That’s part of the process too.

        • You may want to read this article, I think it touches on a lot of the points you’re bringing up: http://perfecthealthdiet.com/2011/08/carbohydrates-and-the-thyroid/

          And I’m not sure why you’re dismissing clinical anecdotal evidence. Just because it’s not in a published paper doesn’t mean it’s not a legitimate way to determine a course of treatment. In many cases, it’s the only evidence we have to work from as practitioners – the collective experience of those who have come before us.

          • I’m familiar with the Jaminet’s views. I’m dismissing clinical anecdotal evidence because it is never seems (so far) to be supported by *controlled* clinical evidence

            Do you think it important to distinguish between a ‘case study’ versus a clinically controlled study? I think it is.

            Also, the critiques applied to Ballantyne’s work is also valid to Jaminet’s. He has been challenged on this and can only point to “in my experience” arguments. Not that they’re worthless, far from it – I find a lot of value in his material. It’s just that when challegend on these points no one is capable of producing evidence everyone can assess – anecdotes are not ‘free game’ for everyone.

            So when you write an article strongly suggesting LC = dangerous…they don’t match up with the available evidence.

            Incredible claims require incredible evidence, that’s all.

    • I agree “Do You Need to Eat More Carbs?” is a much more effective title for many reasons, more inclusive and at the same time, more bio-individuality 🙂

  8. Caution must be taken when using resistant starch (i.e., Bob’s Red Mill unmod. potato starch), as it can raise BG levels in spite of it being “resistant.” My husband is one of those poor souls who can’t use it for this very reason. I use red potatoes (less starch) in 24-hour chilled potato salad, and it does the same thing without the huge rise–I just have to watch portion sizes with him. I alternate between fiber sources: glucomannan, psyllium, or vegetables, so he doesn’t develop a resistance to them.

    Maybe it has something to do with ease or difficulty in digestion, and how much energy it takes to do it? I’m not sure. I just know the Bob’s powder doesn’t work on him.

    • Good to know! I haven’t heard of anyone experiencing that response to RS so I’m glad you shared your experience. I’m surprised that actually eating whole potatoes has less of an impact on his BG than the isolated potato starch.

  9. Great article, I followed paleo for a good while felt great at the start and lost a fair bit of weight. It all changed though a few months later massive cravings for sweets, gym sessions were lackluster and ended up binging on weekends. I changed it up started to follow Paul Jaminet perfect health diet, the only starch i could really have was basmati rice, if I had any potato I would have cramps terrible wind. So having around 150grams of rice on training days if I go anymore i started putting on weight. The interesting thing that i have tried with the rice is adding a tablespoon of apple cider vinegar, it feels as if it aids me with digestion. Has anyone else tried this at all?

  10. In my personal experience, as I do a desk job, I do better with low carb (around 80g/d, so never really into ketosis), with a 24h fasting day once per week followed by a heavy workout before dinner (well, ketosis is inevitable that day).
    During holidays I tend to move much more, especially low level activities like walking (15-20 Km per day, when visiting a city for example). My body naturally responds with carb cravings, so I enjoy some additional fresh fruits, but also sourdough (the allowed version of the forbidden food 🙂 ). Carbs easily get to 150g/d or even more, however I never stored a single pound of bodyfat, meaning that’s a genuine requirement.
    In my opinion, (and sorry for being obvious) once the appetite regulation is working correctly, just listening to your body will make you do the correct thing. This may not work for everybody, I believe the reason is that the appetite regulation mechanism is still somehow not fully fixed in some people after years of messing up with excess of sugars. It would be interesting to define a way to identify these situations and think of strategies to get them working.

  11. I would like to know if it´s possible that the blood pressure rises when you eat low carb?

  12. Very informative article Laura, thank you! Can you please clarify whether the carbs in non-starchy veggies should be counted in the total carb count. While they are high in fibre, not all the carbs in non-starchy veggies are fibre! I eat about 90-130g of carbs a day (mostly from non-starchy veggies, plus some carrots, sometimes pumpkin, and snacks made occasional using coconut flour). Those carbs make up about 30-40% of my daily calories. I have developed hypothyroidism, I am hyper-cortisol and have severe chronic gut inflammation and dysbiosis issues. But I think I am getting plenty of carbs (though not much starch). Would appreciate your thoughts?

    • As I mentioned in another comment: “For many green non-starchy vegetables, the body burns more glucose in the digestion of them than it extracts from the vegetable itself! Not to mention the amount that gets digested by the gut bacteria before we even have a chance to absorb it.”

      Most of the nutrition experts I trust agree that leafy greens and most non starchy vegetables don’t count towards your total carbohydrate intake for these reasons. Carrots and pumpkin would contribute some, but you’d be surprised how much you have to eat to get over 100 grams per day. A cup of carrots has 12 grams and a cup of fresh pumpkin has 8 grams. (Canned pumpkin is a bit higher around 18 g per cup.)

      Coconut flour has only 40% digestible carbs, the rest is fiber. So the carb content may not be as high as you think. But it really depends on how much you’re eating of it. It also sounds like you’re not eating a whole lot in general. Based on those numbers it sounds like you might be eating around 1200-1500 calories per day. (Actually 900-1700 based on the math!) So that could be an issue for you as well.

      Hope that helps!

      • Thanks for the reply Laura – most helpful! The main reason I have limited starches in my diet is while I work on getting rid of SIBO and a resistant parasite infection in my gut. Have tried multiple natural based and conventional anti-biotics – but not successful yet. If my current diet it in fact lower carb than I thought and at the lower end of calories, shouldn’t that mean I should be losing weight (which I am not despite training pretty hard)? Thanks again for a such a thought provoking article!

  13. I’m female, and it is what happened to me. I was already Paleo (~100 gr of carbs net daily) for 4 months, and fat-adapted, when I went Paleo-ketogenic (40 gr of net carbs daily). At the time, everyone was talking about ketosis and IF, so I tried Paleo-ketogenic too, since I wasn’t losing much weight on Paleo (I only lost 10 lbs out of 50 I needed to lose).

    All h*ll broke loose 1-2 months later.

    I got weak, I got all the hypothyroid symptoms (e.g. super-cold in the middle of the summer in California!!), and I got dead-tired ALL the time.

    I wish that kind of information was out in 2012 when I wrecked havoc to my body by going Paleo-ketogenic. Two and a half years later and I’m STILL battling adrenal fatigue. I’m of course still Paleo, for life, but now I eat more starches. Still, my body just can’t get into the initial levels of energy as I got when I first went Paleo (the not too low carb version). I wonder if I wrecked it for life. I wonder if there’s a way out of this mess. I eat more DHA now btw.

    • @Eugenia – Same thing happened to me during a time of unremitting stress and LC dieting. It took a long time to overcome but getting LOTS of extra rest really helped. My doc told me to nap at every opportunity and I stopped the LC diet. My energy level is back up to where it should be now. Best of luck!

    • There may be changes you could make that would help your energy that you haven’t discovered yet. You might benefit from working with someone who might have some knowledge that you haven’t come across in your self study yet! But good luck and try not to worry that your health is “wrecked for life” – there’s almost always something that can be done to make improvements.

    • I’d recommend going Weston A Price for life rather than paleo since your results haven’t been going well (I am pretty well convinced WAP will become the final say in the dieting world some day due to it’s flexibility). The CRITICAL difference with WAP is the proper handling of grains/seeds/nuts/legumes which virtually all populations seemed to figure out in the past. Grains cannot be lumped into the same category if one is sprouted and the other is not. The composition changes quite dramatically. The human gut tends to be poorly equipped to handle grains/seeds/nuts/legumes UNLESS they are modified by soaking/sprouting/souring/fermentation. Same with dairy I might add. Paleo is dairy phobic also but WAP found several cultures that thrived on dairy. These populations were not paradoxes. The common theme is that every population found methods that suited them best and the diets varied considerably. The common threads are treatment of plants to make them better suited for human digestion and a lack of refined foods (WAP noted extensively the health decay that occurred within a single generation when populations stopped their traditional eating and began eating white sugar/white flour/industrial oils…here came tooth decay, poorly formed faces, TB, and all sorts of other ailments). Some ancestry clearly favors higher carb consumption than others. Perhaps you are one of them. Try it and see how you feel, but just be sure the traditional techniques are applied to minimize anti-nutrients (phytic acid in particular) and make available the other nutrients.

      • I’m sorry, but no WAPF please. I can’t have grains. I get sick if I eat any other than SOME kinds of rice. The reason why I went Paleo and I stayed with Paleo was health reasons, not weight loss (initially). Since then I have tried to incorporate grains and pseudograins, but I find that they make me sick. With rice, it depends on the cultivar: some types I can handle, others I can’t. I even tried sprouted fermented rice, which I didn’t handle well. It really depends on the cultivar for me.

        I do eat legumes btw. This is one of the starches I added on my diet as I mentioned. I can handle soaked legumes fine most of the time (1 out of 5-6 times I get gas, but usually I don’t). But no grains/pseudograins please.

          • Japanese rice (treated with vinegar), I never have trouble with. California rice is ok most of the times. “Carolina” rice is rather fine too.

            I have trouble with Chinese, Indian Basmati, Thai rice (cooked them myself, no soy).

            Japanese vinegar-treated rice is the least problematic for me.

    • Eugenia, do you have any idea what your protein levels were in grams when you were paleo-ketogenic? I am trying to understand what is going on with my own body. It would help me to know what your protein level was. Thanks so much for your time.

  14. Laura,
    First and foremost: great article on a very HOT and confusing topic. Well done in breaking down some of the issues, especially as it pertains to pregnancy and athletic performance. My wife and I really enjoyed reading it. I would like to add a couple of thoughts to your points.

    Distinction between carbs:
    In my experience, one of the primary reasons why people are confused with carbs is what they hear in the media or read in general blogs. These practices have historically labeled carbs as the evils of nutrition and health because they ALL contribute significant calories. One thing that one has to realize is that carbs are NOT created equal.

    We have the simple carbs (mono or di-saccharides). These are glucose, fructose, lactose, sucrose, etc. They can easily be broken down by salivary and digestive enzymes (Amlyases, etc) and are mostly absorbed in the small intestine, before they make it to the colon. Glucose is the basic sugar that every cell in the body needs to make energy. You can’t avoid it. It’s in (almost) every food we eat.

    Then we have the complex carbs (basically fiber). These are typically the same sugars, but they are attached/linked together in linear, branched (or a combination) fashion such that the same enzymes cannot easily break it down. Some fibers are more fermentable than others. By virtue of being more resistant to enzymatic degradation, they cannot be broken down to basic monomeric or simple sugars and thus do not contribute much to the calorie output as simple sugars do.

    Fiber’s benefits can be generally divided into two components; a) non-fermentable, and b) fermentable. non-fermentable benefits are things such as toxin cleanup, binding and trapping bile salts, lowering of cholesterol, and a slew of others. Fermentable benefits are associated with the breakdown of these fibers in a colon. By remaining undigested, These complex carbs make their way to the colon, where they feed your gut bacteria. This is where the magic happens. These bugs digest fiber into short chain fatty acids (e.g., bytyrate, propionate, acetate, etc), providing you with many benefits. These critters also provide many other direct and indirect benefits which we won’t get into but Chris and team have done a good job outlining in other posts

    This is a topic near and dear to my heart (even though I am not a woman) and an incredibly important one. There’s more and more evidence indicating that when a woman gives birth, she transfers her microbiome to her child. This bacterial community plays a critical role in the development of the child and starts taking shape and changing within the first days, months and years of life. There is even evidence showing that vaginal birth provides an much richer flora to the child compared to caesarian section.

    So, since every parent wants to give their child the best chances of a healthy life, it is important for pregnant women (and their spouses) to ensure that they have a rich and diverse bacterial community in their gut…this means eating plenty of good carbs like fiber.

    This is another interesting but long topic of discussion, which I leave for later.


  15. Nils, I’ve followed Laura’s thoughtful writing and podcasts for the past couple of years. I’m sure she would completely agree. I think what some of the current dialog is saying is the following: Weston A. Price and Paleo are huge leaps forward from the standard American diet. However, everyone is different. You can go beyond a “cookbook” approach to WAP or Paleo by personalizing your diet. If you want to be high fat/low carb that’s great. But rather than dive right in and say well, that means I can’t eat more than 50 grams of carbs a day, perhaps you can experiment by gradually lowering your carb intake and taking measurements (both subjectively and objectively) about how your body is responding to the reduction in carbohydrate intake. Find your optimal HF/LC set point. The same would go for food sensitivities, etc. Maybe you have issues with detoxification, SNPs that require some dietary modification. Nutritionists and functional medicine practitioners can help.

  16. A practice that might benefit some people is just cycling your carb intake rather than keeping it mostly steady-state. What is called a CKD (cyclical ketogenic diet) common with some bodybuilders today and has been around since at least the 60’s. The “Iron Guru” Vince Gironda suggested this way of eating. 3-4 days of low carb eating followed by a carb “re-feed”. This is often done as a weekday low-carb diet followed by a high carb weekend or single “splurge” day or meal. You can find lots of recent books that prescribe some kind of spin on this type of diet, mostly combined with strength training… you are lifting heavy things, right??? If not, that should be the first thing to fix!

    I personally think that cycling carbs, beit X hours per day or Y days per week, is the best way to maintain optimal body composition for the genes you were born with.

  17. I am adding some research gathered from other posts on this site regarding Candida, as I suspect it will help people whose Candida infections are getting worse, or are not improving, while on a low carb diet.

    As Jeff Leach has pointed out, when people switch to very low carb diets their fermentation drops considerably — which means that there is less acid being produced as Short Chain Fatty Acids (SCFAs).

    Candida is a dimorphic fungus, which means that it can be either benign or pathogenic (extending hyphae). Candida is only hyphal when it gut pH is extremely acidic (somewhat rare, but can happen with gut diseases like ulcerative colitis) or too alkaline (which happens from not eating enough resistant starches and fibers).

    Alkalinity promotes Candida overgrowth

    If you read through the half dozen studies in that link, you’ll see that Candida has a number of growth genes that are sensitive to pH. These hyphal growth genes switch on when gut pH is too high or too low.

    In other words, Candida is benign when gut pH is normal. It’s the SCFAs from our fiber and RS fermentation that keep our guts slightly acidic. And it’s no coincidence that acids like acetate or caprylic acid are well known to inactivate candida. Virtually any acid would inactivate candida and it’s the SCFAs from our own gut bugs that do a particularly good job.

    So, people on very low carb diets have guts that aren’t fermenting and are therefore too alkaline, which as we can see from above promotes candida overgrowth. For these people, increasing their safe starch consumption and taking RS will increase SCFA (acid) production, which helps normalize gut pH and switch off the candida growth genes — returning candida to its benign and harmless state. Simultaneously, RS and fibers tends to bloom good bacteria (which also contributes to increased SCFA production), which will crowd out candida. It’s also a good idea to use a candida biofilm disruptor so that good bacteria can move in to candida’s territory.

    Here’s some additional research that shows very low carb diets, and starvation protocols, may make candida worse:

    The following study shows that Candida will stay benign as long as we keep it happy, by feeding it moderate levels of glucose (and keeping the gut pH normalized). If we starve it of glucose, it automatically changes its own pH so that it can become hyphal to search for tissues to feed on.

    The Fungal Pathogen Candida albicans Autoinduces Hyphal Morphogenesis by Raising Extracellular pH

    The next three studies are from a quote on Gestalt’s blog, explaining why conventional low carb anti-candida diets are likely counterproductive:

    From: How to eliminate Candida & biofilms

    It is the conventional belief out there that to get rid of candida one must consume little to no carbs in order to stop their growth. This logically means putting the body into ketosis. What most people don’t know however is that ketones can also fuel candida growth and the fungi themselves use ketones to evade the bodies immune system. The following is the collection of a few days research that completely shifts the conventional paradigm on the various forms of Candida diet out there.

    The following 1st paper shows that the ketone beta-hydroxybutyrate will feed candida, and the 2nd shows that the ketone Aceoacetate is used by Candida to evade the body’s immune system. The 3rd shows that starvation makes candida grow exponentially.

    “The ability to neutrophils from diabetics to kill candida was inhibited by increased concentrations of glucose and beta-hydroxybutyrate, both independently and in combination.

    These data indicate that although phagocytosis occurs at similar levels in diabetics and controls, killing of candida by the diabetic neutrophil is impaired under conditions of hyperglycaemia and ketosis.” (reference)

    “Therefore, prolonged ketosis may be a significant risk factor for candidiasis. This study was undertaken to investigate whether C. albicans itself produces a ketotic metabolite as a virulence factor which can effectively undermine host defense by neutrophils.” (source)

    Starvation of yeast cells induces exponentially grown cells (and usually non-germinative) to germinate. This phenomenon is also observed in cells that are transiently treated with metabolic inhibitors. During each of these treatments (starvation, metabolic inhibition), expression of a growth regulatory gene (CGRI) increases. Candida albicans: adherence, signaling and virulence.” Calderone et al. http://www.ncbi.nlm.nih.gov/pubmed/11204138

    Glucose obviously feeds candida as well however I have not seen evidence that it impairs immunity against candida such as ketones. Glucose therefore appears to be the lesser of two evils in this case when compared to ketones. From a blood point of view it’s impossible to eliminate glucose anyways. Ketogenic diets and many Paleo diets therefore in the long term are counter-productive. Starch and specifically resistant starch is necessary to feed the good guys which are your primary defense against candida.


    For those interested in using RS to combat candida, I highly recommend reading Gestalt’s full article for a protocol including necessary biofilm disruptors:

    How to eliminate Candida & biofilms

    The author of that article was able to inactivate candida in less than 1 month using that approach.

    The research clearly suggests that a diet rich in fermentable fibers and moderate levels of glucose are ideal for keeping Candida in its benign state, where it can more easily be crowded out by commensal bacteria.

    • Wow! Thank you Duck, I think you just saved my life.
      Really do appreciate the effort involved in factually shedding light on Candida and providing all the research links.
      Just such great information

        • It’s possible that some of the successes from ketogenic diets are actually bacterial or viral in nature — and perhaps mistaken as Candida. Just a theory.

          From: Chris Kresser: Episode 15 – Dr. Paul Jaminet on chronic infections, depression & more

          Paul Jaminet: …So pathogens that have mitochondria like fungi and protozoa can metabolize ketones for energy. Bacteria and viruses can’t, and so if you go on a ketogenic diet you’ll starve bacteria and viruses but you’ll feed fungi and protozoa. And so a simple thing to do is go on a ketogenic diet for a while, do your symptoms get worse or better. And that can tell you which class of pathogen you have, one with mitochondria or one that doesn’t have mitochondria. And those kinds of tests can be a big help.

          • Btw… you guys might want to restyle/reduce the font-size of “blockquote” tags in blog comments. 🙂

            • Better. But, not sure italics was the best choice for restyling the block quote. Now there’s no way to use italics in a blockquote!

              • what if you don’t suffer from candida…does ketosis still make it so that you can GET it from this diet?

                • “what if you don’t suffer from candida…does ketosis still make it so that you can GET it from this diet?”


    • Duck, your informations are very essential. Do you have an idea, what is the minimum of glucose/carbs to keep candida under control? If one responds not well to rice and potatoes and sweet potatoes, for fibres one can take potatoe starch, LAG and various fibres for the SCFA´s for gut flora, But is there anything one can do for supporting glycolyse?
      My thought is, that one can again eat enough carbs, when enough SCFA´s were produced.

      • For anti-candida, Paul Jaminet his standard Perfect Health Diet, which recommends 150 grams of carbs per day (for someone eating 2,000 calories. That worked well for me, personally.

        Mark Sisson writes:

        From: A Primal Primer: Candida

        Avoid very low carb.
        Paul Jaminet, who suffered from candida overgrowth, argues that since candida (being eukaryotes) have mitochondria that can feed on both ketones and carbs (as opposed to prokaryote bacteria without mitochondria), going very low carb or ketogenic will only provide more fuel for the overgrowth. Furthermore, since ketones are water-soluble and pass easily through cellular membranes, ketones will actually be a more accessible food source for candida. Don’t go high-carb, since any extra glucose will just be food for the yeast, but don’t go ketogenic, either. Stick to around 100-150 grams of carbs while still limiting sugar. Although other sources do recommend going as low-carb as possible, my money’s on Paul.

        Keep in mind that if you are eating these carbs as “safe starches,” which I highly recommend, that’s a lot of starches — more than most people are probably used to eating. 150g of carbs would translate to about a pound of potatoes per day. I ate a banana per day (as Paul recommends some of the carbs to be fructose) and was fine.

  18. What about people who are doing a Perfect Health Ketogenic Diet for intractable migraines?

    • The point of Laura’s article is not that low-carb diets aren’t useful in some circumstances (they most certainly are), but that they aren’t a panacea and can even cause problems in certain situations.

    • So… I’m 25, on a Paleo diet for about 2 years now and was pretty high carb for most of the time. I felt fine but had a few more pounds to lose so I thought about trying a ketogenic diet.
      I’ve been on and off a keto-primal diet for the past few months and have been feeling pretty good. It’s only when I try to eat something that has a higher carb content I feel a bit more bloated and gain some weight. I also have more energy on a low carb diet and feel better emotionally (less mood swings) and have less carvings.

      Yet, I agree with Laura about the gut bacteria issue, and that’s why I’m trying to add some resistant starch lately. I also agree that too much protein can be a problem in low carb diets and that it’s important to try to replace the carbs mostly with fat.

      On the other hand my husband is also on a Paleo diet and felt awful on a low carb diet when he tried it. He was weak and had no energy. So his carb intake is high most days and that’s what works for him.

  19. I knew a lot of this already, but what really caught my eye was this line: “The main hormone that gets dysregulated in adrenal fatigue is cortisol, and cortisol has been shown to increase on a low carb diet.”

    So, if a person has LOW cortisol, does this mean a low-carb diet would be a good thing? I have been taking an adaptogen and a glandular for low cortisol (under direction of my functional med practitioner) and have been going back and forth with low carb (which to me is lower than 50g a day…since going Paleo, I rarely eat more than 100g of carbs a day). I had thought since I had a problem with my HPA axis that I should increase carbs, but doc said it wouldn’t matter. What’s your opinion?

    • If you’re already in the stage of adrenal fatigue where cortisol is chronically low, a low carb diet won’t help raise the cortisol. The problem is that the adrenal glands aren’t producing adequate amounts of it anymore regardless of the stimulus.

      Anything that causes constant high cortisol output (inadequate calorie/carb intake, overtraining, emotional stress, job stress, etc.) can put a person at risk for developing an issue with LOW cortisol when the adrenal glands can’t keep up with the demands anymore.

      Make sense?

      Here’s some more info about the condition itself: http://www.drlam.com/articles/adrenalexhaustion.asp

      I’d probably do a moderate carb approach (20-30% of calories) since in treating adrenal fatigue we’re trying to minimize the amount of stress from all sources, and VLC diets can be a source of stress for some people. Starchy vegetables and some fruits are ideal, possibly white rice as well as a component of a protein and fat containing meal. Keeping blood sugar stable is key!

      • Thanks! It’s nice to know I’m thinking the right things. 🙂 I’ve also had gut problems all my life (30+ yrs IBS and recently diagnosed SIBO) and know that there is a high correlation between gut issues and low cortisol. It can be so hard to fix these complex issues!

      • HI Laura,

        I have been researching LC diets and adrenal issues. Is there any scientific evidence that you can show me as why/how low carb and ketogenic (VLC) diets do indeed raise cortisol and affect adrenal fatigue? Not at all questioning your opinion, just wondering if you could either lead me to something explaining what actually happens to the cortisol levels/adrenals when eating low carb or explain it to me. Thanks so much. I find this article quite interesting (though my understanding may be lacking a bit) and it is what put me to ease when I was researching it. Any and all thoughts would be greatly appreciated, as I am so curious to learn.

        • Well it’s based on a combination of biochemical understanding of how blood sugar is regulated along with combined clinical experience of dozens of practitioners.

          As Sarah Ballantyne PHD put it: “Ketogenic and very low carbohydrate diets necessarily increase cortisol expression in order to create glucose for the few cells in the body that cannot run on ketone bodies.” This means that when blood sugar drops too low and there are no glycogen stores to bring it back up, the adrenal glands release cortisol to stimulate gluconeogenesis (i.e. the creation of sugar from protein).

          This doesn’t necessarily cause adrenal fatigue, but combine that with other cortisol-raising stressors like overtraining, poor sleep, emotional stress, etc. and you’re at higher risk for it. And if you already have adrenal fatigue, then a very low carb diet can make recovery difficult.

          The article you linked to was making the point that high cortisol doesn’t necessarily cause heart disease, which is true. It’s much like high cholesterol doesn’t cause heart disease. However, both high cortisol and high cholesterol can be symptoms of an underlying issue that can eventually lead to chronic disease, so the levels aren’t irrelevant.

          I hope that makes sense.

          • Yep, that would be a problem on a low carb but not ketogenic diet, or in someone trying to eat a ketogenic diet but with poor adaptation to that fuel substrate.

            Some of us actually do thrive in ketosis though, and see improvements in our gut function, without adrenal overstimulation.

            But if the blood ketones are not getting over 1mmol, then it is tough to get enough energy, and the body will tend to turn on its protein stores in the cortisol driven gluconeogenisis that you are referring to here. Moderating protein is important here, as is eating enough fat and enough salt.

            Thyroid downregulation can be offset quite easily with just an occasional carb feed. But it does not in any case appear to be a problem for many people on well conceived ketogenic protocols.

            I am sure that low carb diets are not for everyone, but sweet tubers everyday likewise are not for everyone. We need to stop acting as if there is a one size fits all (template even). There may even be numerous templates….

          • Laura, you were asked for scientific evidence to support your statements on cortisol and adrenal fatigue yet none were provided.

            I have searched for studies backing up these statements myself … and can find none.

            Do you know of any studies supporting the cortisol and adrenal fatigue statements?


            • I haven’t been able to find any peer reviewed studies that test this hypothesis. So if you’re looking for a journal article that decidedly points to either an effect or no effect of a low carb diet on HPA axis dysregulation, I have yet to see one in publication.

              Can you direct me to scientific evidence that clearly refutes my observational recommendations? (PS – it has to include women in the analysis, not just male athletes!)

      • Hey, as long as someone with 3 letters next to their name spelling out “PhD”, they must be right!

        How do you reconcile the protein sparing effects of ketosis with this supposed, “necessarily” increased cortisol breaking down protein tissue for converting amino acids into sugar?

        Are you ready to make the jump between rodent studies and humans studies Ballantyne focused on?

        How certain are you about fertility? The study by Zhao & Liu discussed on Suppversity that made the rounds actually says “extra energy intakes successfully restored the ovary function in adult female rats”. They achieved this using carbohydrates. Did they say this was the only macro capable of this? No. They further say “Tomten et al. found calculated energy intake and total energy expenditure were in balance in athletes with regular menstruate, while a statistically significant negative energy balance was found in female athletes with irregular menstrual cycles”. Macro ratios? Nope, total energy.

        The adrenal-ketois straw-man is clearly misunderstood and is becoming a blogosphere meme. CAN you have thyroid or adrenal issues while in ketosis? Of course! Does it have to necessarily be *because* of LC/Ketosis? No!

        Your cholesterol analogy doesn’t work due to differences in age groups – lower overall mortality in the elderly the higher the total cholesterol.

        You are painting a monochromatic picture despite your attempt to carve out a tiny niche of therapeutic utility for the ketogenic diet. It certainly is more than a last resort for the very sick.

        No need to ‘praise’ ketosis obviously – just an absence of a double standard would be nice.

        • Woah easy there! So it’s not ketosis causing adrenal issues no, but your body has a demand for glucose and when it’s not met it goes vampire on the muscles with cortisol fangs. Eating enough protein to “spare” the muscles doesn’t mean that muscle breakdown isn’t happening either. Oversimplification? Absolutely but the recognition of an adrenal/low carb interaction isn’t just dreamed up by “PHD’s” and functional practitioners. It’s a very common issue. Sorry just had to get that out.

      • I’ve had Addison’s disease for years. I had a brief bit of hope that my low carb diet might raise my endogenous cortisol while reading your article. Thanks for clearing that up. Low carb has helped somewhat with weight gain from taking steroid replacement hormones, but nothing will bring back my adrenal glands.

        • The different steroid medications might be tolerated differently – see if your doctor will work with you to find one that doesn’t have quite such bad side effects. Not all steroids have this effect.

        • I take Dexamethasone to treat secondary adrenal insufficiency – Addison’s. I’m also hypothyroid. Adopting the autoimmune paleo diet a year ago turned my health around. Glucocorticoids are notoriously harsh on the gut and open the door to systemic Candida. Gone is the bloating, mind fog, fatigue and other side effects of Dex. Also lost is the weight I gained after starting on it. I can’t tell you how relieved I am, having read numerous posts from people resigning themselves to living with these issues. Eating low carb in this way presents an alternate perspective to the thesis above if the goal is to mitigate the side effects of steroids, because replacement cortisol and thyroid medications already fill the role of maintaining healthy thyroid and cortisol levels. Veggies, yes! Grains? Not with glucocorticoids. Exercise is also key to taming steroidal side effects.

      • Oliver!!! Thank you for the link to the video. It was amazing and answered a lot of my questions!!

  20. The article makes some interesting points, but the author doesn’t differentiate between carbs and grains (which many people mistakenly equate with carbs).

    Adding healthy carbs like low-glycemic fruit, berries and vegetables is a good idea. But adding in more grains (which tend to be high in gluten, and full of phytates which prevent the body from absorbing minerals) isn’t going to help anyone.

    Paleo dieters who eat a lot of green leafy vegetables, roots, seeds, etc. (all of which our ancestors would have eaten in abundance) are already eating a lot of carbs.

    If people read this article and add more healthy veggies and berries to their diets, that’s great. If they start eating junk like wheat bread again, I can’t imagine that doing them very much good.

    • @nils, last time I checked “grains” are “seeds”, so it doesn’t make sense that you say Paleo eaters should eat seeds but not grains. Weston A Price found that freshly ground grain helped repair teeth, so that goes against your grains hurt mineral absorption claim. Now could be that back in his day it was a healthier variety of grain – perhaps Emmer, Barley, Spelt, etc. not the crap dwarf wheat highly processed white flour we mostly consume today. Sprouted grain breads would be good. Soaked and sprouted lentils/beans too. Undercooked tubers high in resistant starch as well.

      • My research found grains are not seeds. That is why there is a differentiation in the names. Just Google’what is the difference between grains & seeds?”. Grains are mostly carbs, seeds protein & fat (& no gluten).

        • Grains are seeds. They carry the genetic information to grow a new plant. Thus is was defines a “seed” as a “seed”…. Not it’s nutrient breakdown.

          • Dear Barb, a grain is not a seed. Again, it is a type of fruit, like a berry, capsule, or pome. By your definition, an apple or a pear are also seeds, because they contain (within them) genetic information. You are asserting something that is not true. Simply because a grain (or any other fruit) happens to have a seed-like form doesn’t mean it is, in fact, a seed. A seed is a mature plant ovule, a fruit is a mature plant ovary (which contains one or more ovules). Best wishes.

              • Dear Pierson, no, grains are not grass seeds, they are grass fruits. A grain (or caryopsis, as it is technically called) is homologous with an apple. Just as an apple is a fruit that contains seeds, a grain is a fruit that contains a seed. The confusion is coming from the fact that the fruit of a grass happens to morphologically similar to some seeds, but it is not a seed. Best wishes.

                • It is my understanding that grains ARE seeds. They are seeds of monocots – and the term “grain” is a culinary/agricultural name, not a botanical one. While all grains are seeds (of monocots/grass species), not all seeds are grains. e.g. flax, sesame are dicots and thus not grains.

                  That isn’t to say that all seeds of dicots are safe to eat. Some people have cross-reactions to them if they have gluten sensitivity or may have problems with the lectins they contain.

                • Heather,

                  Arthur is actually correct. Do some research on Caryopsis:


                  “The caryopsis is popularly called a grain and is the fruit typical of the family Poaceae (or Gramineae), which includes wheat, rice, and corn.”

                  Arthur knows his stuff. You should read his blog!

                • This is the problem with discussing anything: people will assert various facts, even when they are incorrect, and even when they have been corrected (politely) numerous times.

                  Heather Jacobsen, I have a graduate degree in plant systematics, have written two regional floras, have over 20 botanical publications in peer-reviewed botanical journals, have named new plant species to science, and have taught plant taxonomy for two decades (none of that is to brag, all of that is help you understand I have credentials in this field).

                  One more time:

                  A grain (technically called a caryopsis) is the fruit of members of the Poaceae (the grass family). Fruits are the mature ovaries of angiosperms (flowering plants). There are many kinds of fruits, including achenes, capsules, berries, drupes, siliques, multiples, aggregates, etc., etc. Fruits contain one or more seeds. A grain is a fruit and it contains a seed (surrounded by integuments of the plant ovary).

                  I’m sorry if this does not square with information you have been presented. You need to be open to the fact that the information you have about grains is incorrect. I’m sorry for the abrupt tone, but you are asserting something that is incorrect. Best wishes in your study of botany.

      • Weston price fed his school children in the study you are referring to White Bread with lots of pastured butter. He went on to conclude that it was the fat soluble mineral activators in the butter, not the grain that was responsible for repairing the teeth

      • Brad, a grain is a fruit (technically called a caryopsis), and is the fruit produced by the Poaceae (grass family). It differs from some closely related families (such as the sedge family) by having an adnate pericarp. A seed is found within a fruit (such as the seeds within an apple, the solitary seed found within an avocado, or the seeds you may eat from the fruit of a mustard). Grains have a seed within them. My point is that the words grains and seeds are not synonymous, though they are often confused. For the record, species like quinoa, amaranth, and goosefoot have different kinds of fruits (called an achene or pyxis, depending on the species we are discussing). They are not grains, even though they are frequently called as such. Best wishes.

        • sorry – but I don’t think that is correct. There is no fruit attached to a grain. The grain is the seed of the plant. But not all seeds are grains. Grains are the seeds of monocots/grass species. All grains are seeds but not all seeds are grains. At least that is my understanding of the botany.

          • Wow, Heather, you’re stubborn! In botany, grains are in fact fruits. Grains do contain a seed, though, so perhaps that is confusing to you.

            • No need to be rude, Nick! I wasn’t being stubborn. In fact, I see what you guys are saying. From a botanical standpoint, your point IS correct, and I should have conceded that. But since most people are reading this blog post from a nutritional standpoint, and simply trying to figure out what to eat, I think it confuses people to stick to the botanical nomenclature. We all know the fruit (yes, as it IS called) that surrounds a grain, is not the same, nutritionally speaking as the fruit that surrounds apple seeds or (the no longer existent) banana seeds. This is the problem with nutrition – there is no agreed upon classification system. And I don’t think the botanical system quite applies.

      • Grains and seeds are different. Just look up “pseudo grain”. As for which ones to eat and which to avoid, that really depends on your body! Some people are sensitive to gluten, others are sensitive to. The fructans in wheat, rather than gluten. If you are sensitive to particular carbs, like high FODMAPS, for instance, you really need to stay away from those things (including the prebiotics high in inulin). You have to listen to your body and find out what specific substances work or not for you. Eating more wheat likely doesn’t help anyone. But other grains can be benificial. I agree, however that fruits and veggies and seeds are far more important, full of carbs and fibre.

    • Don’t confuse fibre with carbs, leafy greens have essentially zero carbs as they mostly contain fibre which will be broken down into fat in the colon. Seeds have limited carbs as well… Chris is talking about fruit and high starch veggies like potatoes or sweet potatoes. Paleo is great but there is wayyyy to much carb-phobia. I always appreciate Chris’ reasonable perspective on carbs.

      • For many green non-starchy vegetables, the body burns more glucose in the digestion of them than it extracts from the vegetable itself! Not to mention the amount that gets digested by the gut bacteria before we even have a chance to absorb it.

        • Sorry Laura I didn’t even think about the fact that Chris didn’t write this article! I appreciate yours and Chris’ reasonable approach to carbs!

      • “…..fibre which will be broken down into fat in the colon.” What?
        And how is it that the experts on this page are NOT correcting this info??

          • Some soluble fibers/resistant starches are fermented by the microbiota in the gut, resulting in the formation of SCFA such as butyrate. There are a lot of variables, including the type of “prebiotic” susbtrate and the composition of the microbiome. Insoluble fiber–the hard stuff in celery, for example–mostly passes through the gut unchanged.

    • Dear Nils, you note to make a distinction between carbohydrates in general and grains. Though I understand why you are doing this, you are not representing grains accurately. It is members of the tribe Triticaea that contain gluten (e.g., wheat, rye, barley) and not all fruits of grasses. Further, the phytic acid content is present in modern whole grain foods only because this society (the US) has such a poor understanding of proper food preparation. To provide an example, we harvest our own wild rice (Zizania palustris) from waters here in Maine. This is a gluten grain that we prepare to reduce phytic acid content through traditional practices established by the Anishinaabe. It is also a grain that contains 30% of its lipids as omega-3 fatty acids. The main stream information on grain seems to be almost entirely based on wheat and does not include wild or heirloom grains that can be harvested or purchased. Though I do feel wheat and gluten-containing grains should be restricted (or even eliminated) by many people, historical evidence clearly shows that certain grains can be a part of healthy diets. You might enjoy this article that critiques some of the anti-grain arguments: http://www.arthurhaines.com/blog/2014/6/5/dear-mark-sisson-where-paleo-recommendations-stand-in-contradiction-to-real-world-observations. Best wishes.

    • Amen – My thoughts exactly as I was reading…….. Not everyone can eat grain/wheat types of carbs… She needs to differentiate because most people think of carbs and don’t think fruit/vegetables – they think rice/pasta/bread……