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Is a Low-Carb Diet Ruining Your Health?

by Laura Beth Schoenfeld, RD

Last updated on

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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.

Pregnancy

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.)

Athletes

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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417 Comments

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  1. I started low carb in 2011 and lost 25lbs. I went back to carbs a few months after and gained it all back. Then I tried LC again and couldn’t lose any. I had blood work done and found out I was hypothyroid. I continued on LC and for a long time with meds, tried to get my thyroid levels back to normal. I struggled with it for years, all the while doing low carb on and off but mostly 90% on. This past January I had blood work done with once again high levels. I decided to end the low carb and just eat normal. After 2 months I went back for blood work and my levels are completely normal. For me I believe low carb greatly affects my thyroid. Since eating “normal” again I look better, feel better and my mood has greatly increased. I know everyone is different but I thought I would share my story to help anyone else who may be in a similar situation.

  2. My own recent experiences seem to back this up.

    I have diagnosed moderate hypothyroidism for which I am on medication, and found this article by googling “low-carb and hypothyroid” because I am beginning to suspect my condition was brought on from following a very low carb diet for about a year and a half (8 mos. strictly on/more cheats as time went on, but mostly vlc.) prior to and during the diagnosis.

    I lost 60 lbs. in about 5 mos. by keeping under 20 total (not net!) carbs per day. To put it bluntly: while my body looked better, my face did not. Folks would kindly tell me how “old” I looked (I was 38-40.) but I figured it was because I *was* getting old. We all do, right? I wasn’t careful in the sun and, too, didn’t have the puffy pudgy face anymore.

    But, I could really see that in addition to regular aging, on low carbs I just didn’t look like myself; I was sallow with odd-looking features, even. It’s hard to describe. But, when I would “cheat” with carbs, however, my face appeared brighter, I would wake up not with a food hangover but with renewed energy and vigor. My hair, which was falling out due to the hypothyroidism, came back a little (It’s all back now since I am on meds!). Since I have binge eating issues, though, I always went back to low carb as that’s the only thing that helped me stay structured because the food choices had more satiating fat and flavor and helped to prevent me best from overdoing it.

    After what can only be called a 5 month food and booze binge, I am now back on the bulletproof plan, which doesn’t have to be very low carb, but I am doing it that way for reasons I mention above. While I am now back to being 60lbs overweight, during my binge, I “looked like myself” again and, despite weight gain, felt better overall in terms of having a healthy glow, skin, etc. normal features. Now, a week back into low-carb (and 12 lbs. down) obviously getting rid of water, I look like hell again.

    In sum, I think I need more carbs and am really going to explore the issues here so that I can find a way to incorporate them into my diet, experimenting a little. I am not saying that low-carb “caused” my condition, just that perhaps it’s not the ultimate way for me to go, even though I experienced rapid weight loss. Yet again, it could have caused it! I am looking into St. John’s book “No-Fail Fat Loss for Women” to see if more frequent “re-feeding” with what she calls “safe carbs” (i.e. white rice, sweet potatoes, etc.) might help.

    Anyway, thank you for posting this article so all of us general google dieters can see it and begin on the way to figuring out own best relationship with carbs!

    • I feel great while low carb, My mind is sharper and my weight is ideal. However my skin and eyes dry out. Also I am losing eyelashes and eye brows. My thyroid tests are always fine according to my MD, but they are outside of okay for American guidelines. When I eat rice potatoes or sweet potatoes I feel brain fog. When I eat plantain I get post nasal drip (having to clear my throat all the time). I feel like I’m between a rock and a hard place.

  3. Well written. I appreciate the points made in this article, because though folks love to believe in whatever type of eating protocol helped them, the overarching truth is that it really all just depends. As other people eluded to, it depends on gut bacteria, physical activity, insulin sensitivity currently, thyroid function, stress, sleep, movement, and probably a whole host of other factors.

    I’ve been on both sides of the table. I went super low carb for a pretty long time. The first six months? I was like God, flying on a golden carpet, dominating the world. But eventually (like tons of other VLC or -50G a day low carbers), my body broke.

    Didn’t sleep a full night in a year. Frequent urination. Dizziness, energy issues, massive stress, the whole nine.

    Then, suddenly I was in the other camp, promoting carbohydrates for health, because of the deep deep trouble I landed myself in restricting them. Imagine that? I was that guy posting studies defending low carbohydrate diets, nebulously referencing inuit diets, and otherwise going on and on with as much dietary dogma as I could find and validate on the internet. Then, when low carb broke my metabolism, and a whole host of other things, I wised up and started looking at the bigger picture.

    Which is to find what really works for you, and keep in mind that it’s metabolism and sleep that you really want to work toward optimizing, rather than restricting particular macronutrients (generally speaking). For some people, a low carbohydrate eating protocol will ruin their health for a while, and they’ll have to eat 300-400G of carbs a day for a year, to get back to normal sleep, normal saliva production, and normal energy regulation and metabolism. For others, under 100G of carbs a day will be spectacular for the rest of their existence! Great for them.

    But my take, as a former United States Army combat soldier, and a now 5 year entrepreneur with a successful company, that’s been on both ends of the spectrum is: IT DEPENDS.

    And anyone who ruthlessly claims otherwise, just doesn’t have as much information as they need, and is temporarily unbudgable, locked in the grips of dietary dogma. A place I TOO, fell into and crawled out of.

    • Hi Ryan , great post, I have been low carbing since October to help me utilize fat while running ultra distances, but at the minute I have no energy or motivation to train . You have made me see the light and instead of getting more tired and stressed I’ll up the carbs ! cheers Leanne

    • That is very helpful to me, what you said. Is it the case that some people need to go high carb to get out of the situation they created from low carb? I read the comments and put the cart before the horse here. It sounds like I need to go back and read the whole article because it was very helpful to a lot of people. Thank you for posting your comment as well.

    • I was like you too. Trapped in the low carb dogma for about 18 months, thinking my ridiculously skinny, sinewey, aged face and body was just the healthiest and my concerned friends were all just jealous. It was like a mental illness and I could NOT see what was happening to myself mentally. I was right, everyone else was wrong. I couldn’t see that I was manic, in everyone’s face, aggressive, hyperactive, never slept or relaxed, drove away friends and thought everyone else had the problem. I went literally crazy. I also suffered physical degeneration. Split ridged fingernails, cold to the bones. Blue hands and feet. Gum disease, I lost all my teeth.

      Since I began eating carbs at each meal again, I slowly regained my mental health. Carbs put the “fire” in my brain out. I went from frenzied and manic to calm and rational within days. My weight has crept back up a little but really, what’s the price of sanity. Or false teeth?

      • I was definitely caught up in the joy of Paleo eating…..lol and as you said, I did have friends trying the diet because they wanted to look as you say “skinny”. I never thought of them as jealous, but I suppose there is an element of envy since the idea of becoming thin seemed to far outweigh the idea of alleviating health issues. My skin improved greatly and then after the long term, I began to notice dryness which probably does lead to wrinkles.
        The mental health problems went away when I went on the low Carb High Fat diet though, not the other way around. I went on a GAPs diet first, and I found that I was able to suddenly see the big picture. I stopped running around like a chicken with it’s head cut off starting projects here and there, forgetting what I had begun and then opening up another can of worms in the next room. Always anxious, always jumpy sleeping less than 3 hrs a night at the end. I did more than 30 years of insomnia (not counting my childhood) and Paleo brought an end to all of it. The problem is that I was not eating enough safe starches. I got too low for too long. I do have cold hands and feet all the time, but this is something I have always experienced (I mean bone aching cold) and I have noticed that my nails were getting brittle.
        I think the bottom line is that grains are not safe for me to eat if I don’t want to experience mental illness, but I had better keep my safe starches up if I don’t want to look old before my time…………and I suppose as well I should add more exercise to my regime so I don’t become as someone said a “fatty”.
        Probably my B12 deficiency was corrected more quickly with the switch to HFLC. This would explain why my mental health improved so much. When you remove the grains that keep you from digesting properly, things improve. I’m defiantly getting low now as I eat less meat and more safe starch (no B supplement) while waiting for my hydroxocobalamin.

    • Wow! I couldn´t say it better. I have been there too and thank God I found this article, I just wanted too much for me to work a VLC diet, that I left out of sight what my body was telling me. I now add more berries and an apple a day to my diet and I can sleep now and have energy to do exercise, and I don´t feel like a zombie all day. Like you said: “it all depends”.

  4. I have explored articles on nutrition for about 3-4 years now. I am 22 and since junior year of high school I started having more signs of hormonal imbalance. I’ve always had symptoms unknowingly of pcos but kept it in check with exercise and unfortunately LOW calorie eating (typical teenage girls, sadly). Well that eventually stopped working and I came across low carb eating. It created a constant conscious worry everytime I ate carbs but my weight fell off and I felt good…..for a little. My hair thickened, less acne, all was great. Until I got worse symptoms (hypothyroid symptoms) and pcos-like symptoms reappeared. I’m currently upping my carbs, but some days 200 doesn’t even seem to be enough! I wanted to share this because even for people with diseases or symptoms that improve with low carb might eventually need higher carbs. And it’s ok! Listen to your body, women get out of balance so easily, don’t be afraid to switch it up. Weight used to be an issue for me but now it’s not. I eat 2,000 cal. Do weight lifting 1-2 times a week( not insane or real heavy whatsoever) I don’t feel deprived of food or overworked with my exercise.

  5. Hello,I`d like your opinion on something.
    I have diabetes type 1, 5 months ago I cut out most carbohydrates,I now only consume around 7-8 cups of vegetables per day and occassionaly some nuts.Moderate amounts of animal protein and lots of fat. My A1c is 5.2. But :
    I have a “heavy sensation“ on my throat,where my thyroid gland is, I `m tired all the time, sometimes I do exercise but I`m usually fatigued dnd I have great difficulty in any type of mental work.I can`t concentrate.Mental tireness and tension. My TSH was slightly above the maximum limit.Do you think I should go back eating more carbs to support my thyroid-in the expense of my blood sugar control?
    Thank you.

  6. See Dr. Broda Barnes research from 1906. Even he explained a high fat, moderate protein, low carb diet (Keto) was most effective in maintaining weight in Hypo and Hashi patients. We process carbs the same way a diabetic does and grains are endocrine distruptors. This article is horrible and would leave me bed ridden if I followed its advice. Please dig deep into the research, people. These doctors from over a hundred years ago had the answers and remedy for Hypothyroidism. Cut the grains and use T3 along with T4 therapy. NDT’s are the proven method and it doesn’t cause weak bones like Synthroid does.

  7. If low carb inhibits the conversion from T4 to T3, does craving carbs when having the “hypothyroidism” can’t hardly stay awake episodes indicate there is a problem with conversion?
    My DR has never checked any T3s so just wondering. He says TSH is fine, T4s are fine, A1C 5.8 so it’s a sugar problem. I have Hashimotos and symptoms have never gone away even though Synthroid has my TSH in the normal range.

  8. Hi! My naturopath recommended that I go on a paleo diet with no sweets even no honey or maple because of Candida. I had a very compromised immune system and got sick a lot. I stuck to it for one year and have since then modified it by adding some carbs just recently. Now my bloodwork is showing that my TSH is high up to 635. It was always normal before the diet. I don’t sleep well and I get dizzy when I do eat sweet things like honey or maple syrup. My new Dr. Has put me on 200 mcg Selenium to help. I Eat a lot of chicken some shrimps, other selenium rich foods. Several years ago after an MRI was told I have old MS related lesions on my brain but no new ones for several years. I believe I was starting to get full blown MS before I started the low carb diet and taking probiotics and supplements. I think my thyroid problem is from the diet and no carbs and goitegins in almonds(almond flour) and brocolli and such. I use coconut products a lot too but am considering cutting them out too since my LDLbut was 95 triglicrides 55 which brought total chol. To 207. Dr. Said that’s ok because they ballance out. Now after reading your post I will add some rice to my diet. How much do I add? Otherwise I feel great. Walk most mornings, weights 2-3 times a week. Healthy weight 135 at 5’6″. What kind of diet should I follow now? Help my get back on track! Thanks!

  9. Everybody has a different tolerance level for carbohydrates, before they start causing health problems. For example for me this level is quite low, and I try to keep carbs under 40 grams/day. I’m also very picky when it comes to carb sources avoiding bread, pasta, rice, potatoes, and most fruits.

    At the end everybody is unique and they have different dietary requirements, that’s why no diets works well for everybody.

  10. Wow, this sounds a lot like me! I was diagnosed with adrenal fatigue in June 2012 by an ND after the birth of my second child. I was tandem nursing both children and running marathons on a regular basis. I got campylobacter in March 2011 and it destroyed my gut. It was never the same again. I had crazy gut dysbosis from it and the strong antibiotics they put me on to kill it. After dealing with the ill effects of that for over a year, I started having major blood sugar crashes and couldn’t sleep at night. I would wake up ravenously hungry and couldn’t sleep without getting up and eating some high protein/fat food like peanut butter. I finally got sick of this and went to the ND who diagnosed me. He’s the one who suggested paleo and getting off grains and sugar. I did and felt way better initially, after going through the three week withdraw from bread and sugar. I kept going to the ND for three months but he didn’t take insurance and I simply didn’t have enough money to keep going and spending $250 a month on supplements he prescribed. I felt great and lost all the baby weight and then some. I was as thin as I was in high school. After a year of this, I started gaining weight and the blood sugar crashes increased. I have major crashes in the afternoon where I can’t do anything and can’t sleep at night unless I eat three boiled eggs before bed. I had no idea I needed more carbs. I’ve started adding them back and it’s helped a lot. I’m also going to see an integrative doctor who’s running tons of labs. I think in the past two years I’ve gone from AF to full on hypothyroidism and possibly Hashimotos. I think I made my situation so much worse by eliminating carbs and all forms of sugar for so long.

  11. When I read the article, it just made me wonder to see how those Canadian inuits, or any other society where carbs were not even on the table survived for so many years. To me, the idea of a low carb-life makes perfect sense. The only point I am struggling with this ketogenic diet is to see how it can be sustained as a vegeterian. I tried loading myself with all the fat and egg/butter but didnt feel good, because I have never been so much loaded with animal protein and fat before. So, I wonder if vegeterian eating and ketogenic diet matches.

    • I think you must be confused about what the research actually says. The Inuit are not an example of a ketogenic culture.

      See: Lies, Damned Lies, and The Inuit Diet

      With more than 20 studies spanning over 150 years, there is zero evidence that the Inuit were ever in ketosis while eating their traditional diet.

      To remain ketogenic, a person must restrict protein and consume high level of fat. But, what we see from the literature is that the Inuit were consuming way too much protein and not nearly enough fat. Rather, the large amount of blubber they collected was too valuable to eat, since they needed to burn it in their oil lamps for heat and light during the long dark winters.

      Excess protein is converted to carbohydrates in the body and the Inuit were said to have had abnormally large livers to assist them with this process.

      Every culture went out of their way to obtain carbohydrates wherever they could find them. Even the Inuit.

      Cheers.

      • I lived in Alaska for several years, and yes, the Inuit eat blubber, lots of it (whale tastes really good too, like beef). No, they don’t consider the little oil lamps they use the most ideal use of what is a valuable food (especially with kerosene and battery powered lights now easily available). No they do not eat anywhere near as much protein as they do fat, which they prize highly as a food. Yes, I’ve eaten their diet and managed to light up a keto stick consistently, besides losing a ton of fat off my waist (granted I went more toward the fresh salmon and other wild game than the frozen fish dipped in oil). A caveat: very few Inuit eat the traditional diet anymore. This is just my observations and experience, but I’m sick of reading nonsense written by people who get their info second or third hand.

        • Graachus:

          While I’m sure many will be delighted to take your single MODERN observation over a few years of a few Alaskans as gospel that THE INUIT ARE HIGH FAT KETOGENIC.

          The problem is, people should actually go with the 150 years of research on the Inuit, research which contradicts virtually every of your statements (at least of a few decades ago). What Inuit currently eat has little relevance to the myth that has been propagated.

          All the research is detailed in these 17 posts and 1,500 total comments:

          http://freetheanimal.com/2014/11/leaving-behind-hormesis.html

          BTW, I lived in Japan for 5 years and France for 2. Can’t imagine using that experience to assert “The Japanese eat…,” or “The French eat….” Hell, I can’t even say “The Americans eat….”

  12. Thank you for this article. I tried Atkin’s diet many years ago and within a week I felt so sick with a myriad of weird symptoms that I felt it necessary to stop, though I didn’t know why. Fast forward 5 years and I decide to give it a go again, this time with South Beach diet. I followed phase 1 plan almost to the tee. By day 4 I was feeling really sick again. Many strange symptoms. I kept going because people told me it was must my body in ketosis and I needed to adjust. Within another week I was still sick and I noticed lumps in my neck. They seemed to grow overnight. Went to my doctor and she ran a thyroid test and found my TSH was 76+ and my FT4 was almost non-existent. She called me right away to tell me she had never seen numbers like this in her 30 years in medicine. She then sent me for scans and more bloodwork. My thyroid antibodies were sky high and I had tumors on both sides of thyroid. That is when I was diagnosed with Hashimoto’s thyroiditis. I ended up taking thyroid meds for about a year and re-vamped my diet ( I have to include healthy carbs or else I crash and burn.)

    • It’s probably a good thing you went low carb, otherwise the thyroid issues might not have shown up until you were very ill.

      I doubt the diet caused it – it happened way too quickly, but it may well have made it a lot more obvious….

  13. I have been tending toward low carbs for weight management but also because I have reactions to specific types of carbs which seemed to have caused increase inflammation. I have Hashimotos, had adrenal fatigue previously, early hormonal disturbances in my 40’s (now 52), had severe small intestinal problems – very sensitive, lactose, fructose, polyol intolerant although ok on other FodMap and diagnosed with SIBO. My sensitivity to carbs comes from grains, sugar and I think also pseudo grains eg buckwheat. I would be curious to know if anyone else gets hot, sore and prickly skin (but no visible problems), fluid retention, indigestion, and inability to shift weight. I have been working with nutritionist, but its been a long journey. I want to know how long I have to be really strict to be able to have a more varied diet. I also want to be able to do intense exercise (long and hilly bike rides) but I fear running out of energy for lack of carbs to support the exercise. I have been on restricted plans for years, and my sensitivities don’t seem to be getting progressively better. Is anyone else experiencing this level of problem?

    • i get intensely hot when i eat dates, figs, dried fruit, fodmap fruit and veg and rice (and all grains) give me horrific instant abdominal retention to where my clothes don’t fit for days after. i have tests for sibo coming up. Have you tried l-glutamine?

  14. I’m very thankful to come across this article. I’ve been low-carb for a while because I think I either have SIBO or candida problems, so I’ve been going very low-FODMAP. In return, my mood has plummeted, my hair is falling out in clumps, and I haven’t laughed in a while.

    I’m going to try upping my carb intake (the low-FODMAP ones), while still trying to stay true to the Autoimmune Paleo Protocol and see where that gets me. I’m very happy to see that not everyone bashes carbs — I was starting to get worried!

    • Catie, I had similar issues. This past week I increased carbs from 50 grams to 150 within AIP guidelines and I have never felt better. I also sleep so sound!!!

  15. I think it’s nonsense and destructive to discuss “low-carb” without dealing with what you do with the other two macro-nutrients – not to mention total energy intake and micro-nutrients.

    I don’t eat “low-carb”. I eat low-glucose. That means restricting BOTH carbs and protein. I started it for diabetes and will continue for life for that and lots of other health reasons.

    I think its completely proven that glucose (from diet) is not an essential nutrient. We can make what we need from protein and other things. That shouldn’t even be an issue of debate at this point.

    BUT, replacing carbs with protein is often not a positive move. The excess mostly become glucose, so little has changes. It also stimulates glucagon and that may cause additional problems.

    Now, for low-carb/HIGH-FAT which is what we should be discussing here, a problem could occur for someone with impaired fat absorption or fat metabolism. In that case, maybe what’s broken is what should be looked at (fat metabolism). Or, if high-carb is not harmful to them, they can just stick with that.

    I can’t see that high-protein is EVER a good idea above what is needed for tissue growth and repair. It seems that the vast majority of bad experiences on “low-carb” come back to this – excessive protein and not enough fat (or, if the fat is Omega-6 PUFA, that’s just about as bad or maybe worse then lots of glucose in terms of AGEs, inflammation, etc.)

    • Salim Morgan makes a really excellent point. There is not a lot of study data, but low-carb high-fat is probably better and more sustainable than low-carb high-protein.

      I think a lot of people fall into excessive protein intake partly because the fear of fat is so deeply ingrained in us after a lifetime of listening to the government and the American Heart Association tell us, without any scientific basis, that fat would “clog our arteries.” As it turns out it was the carbs and trans fats clogging our arteries and creating the inflammation that causes heart attacks.

      • “I can’t see that high-protein is EVER a good idea above what is needed for tissue growth and repair. It seems that the vast majority of bad experiences on “low-carb” come back to this – excessive protein and not enough fat”

        Funny you should say that. The Inuit were overwhelmingly documented, in the scientific literature, to have been high protein, low carb. They had to conserve their fat as it was their lamp and heating fuel.

        ——
        Studies on The Metabolism of Eskimos, by Peter Heinbecker (1928)

        “According to [Krogh & Krogh’s] analysis the metabolism of the food contained in the Eskimo dietary would not be expected to cause ketosis, because the calculated antiketogenic effect of the large amount of protein ingestion was somewhat more than enough to offset the ketogenic effect of fat plus protein…Average daily food partition is about 280 gm. of protein, 135 gm. of fat, and 54 gm. of carbohydrate of which the bulk is derived from the glycogen of the meat eaten.”
        ——-
        ——-
        Clinical and Other Observations On Canadian Eskimos In The Eastern Arctic, By I.M. Rabinowitch (1936):

        “Eskimo catches a walrus he immediately opens the stomach and eats all of the clams, which have some glycogen. He also relishes the skin on the whale and narwhal, both of which are rich in glycogen, and he eats enormous quantities of meat. The Eskimos eat the livers of practically all animals, except that of the white bear. These are rich in glycogen. As stated above, when food is abundant a healthy adult will eat 5 to 10 or more pounds of meat a day, and, only when in need does he consume very large quantities of fat. Blubber is not regarded as a delicacy. It is also of interest to note that though whale, walrus and seal have enormous layers of blubber, the accumulations of fat in the musculature seen in some land animals are practically unknown; the meat is, therefore, lean. When consideration is given to these facts and to the additional fact that about 58 percent of protein is convertible into sugar, it is obvious that the ratio of fatty-acid to glucose is well below the generally accepted level of ketogenesis. I estimate that when food is abundant, the average daily diet of the adult Eskimo consists approximately of 30 to 40 grams of carbohydrate (which includes glycogen), 250 to 300 grams of protein, and about 150 grams of fat (FA/G=1.2). These amounts of meat are apparently not heroic, for it has been alleged that the Yakuts, on the Low Steppe, east of the Lena, eat as much as 25 and 30 pounds of meat a day.”
        ——–
        ——–
        The Diet of Canadian Indians and Eskimos, by H. M. Sinclair (1953)

        “The skin (mattak) is greatly relished and tastes like hazel-nuts ; it is eaten raw and contains considerable amounts of glycogen and ascorbic acid…There is in fact nothing unusual about the total intake of aliments ; it is the very high protein, very low carbohydrate and high fat intakes that have excited interest. It is, however, worth noting that according to the customary convention (Woodyatt, 1921 ; Shaffer, 1921) this [Inuit] diet is not ketogenic since the ratio of ketogenic(FA) to ketolytic (G) aliments is 1.09. Indeed, the content of fat would have to be exactly doubled (324 g daily) to make the diet ketogenic (FA/G>1.5).”
        ——–
        ——–
        Basal Metabolism of The Eskimo, by Kaare Rodahl (1952)

        “It is well known that considerably higher amounts of pro tein are regularly consumed by the Eskimos (DuBois, ’28), who generally speaking, prefer a diet where approximately 50% of the calories come from protein and the greater part of the remaining 50% are derived from fat. August and Marie Krogh (’13) report that the normal diet of the West Greenland Eskimos contained an excessive amount of animal protein—280gm daily—and they noted that there seemed to be a considerable delay in the metabolism of protein and excretion of nitrogen, only 60% of the nitrogen being excreted during the first 24 hours after eating large meals rich in protein. In East Greenland the Eskimos consume an average of 300 gm of protein daily (Höygaard, ’41). In Alaska a daily protein consumption of more than 300 gm has been observed among the most primitive Eskimos.”
        ———-
        ———-
        Carbohydrate and lipid metabolism in the Alaskan Arctic Eskimo, by Feldman et al. (1975)

        “Such an isolated people presents an opportunity to identify genetic and/pr induced adaptive phenomena to this diet which is characterized, in comparison to the general American cuisine, as being of a relatively low carbohydrate, low confection, moderate fat and high protein composition.”
        ———-

        It appears that the only population eating LCHF are modern ketogenic dieters. Perhaps LCHF is highly beneficial, but we’ll never know since it’s never been observed or tested long term in any human population.

    • Exactly what I was thinking! Most of the objections to a low carb diet are based on the assumption that the carbs are being replaced with protein. In a LCHF diet that is not the case at all. The other common objections is that you can’t be eating fruit or veggies either. There are lots of low carbs veggies and fruits that you can fill up on; broccoli, cauliflower, spinach, kale, green apples, berries, lemons, limes, oranges and I am sure many more.

  16. I totally agree with @Nils at top of conversation and think the point was lost in the whole grain vs seed debate.

    You can incorporate more carbs through a lot of different ways – yams/carrots etc and don’t have to rely on grains. I thought it was interesting to consider @Ken’s Healthy Living comment regarding eating foods raw as well – especially his position that beans were bad – haven’t heard this before any comments on this?

    source: http://www.healthlisted.com/10-foods-high-carbohydrates-good-bad-ugly/

  17. Hey Laura!

    Great article, I really appreciate your work! Just wanted to let you know I was listening to the Jillian Michael’s podcast (shameful, i know!) and she had a segment on her podcast about low carb diets and pretty much took your blog post word for word in some parts. Im not sure if you were aware, since I dont think she gave any credit to anyone. It’s the one titled “Jillian Gets Chickens” The segment starts around 30:00. Just wanted to let you know!

    • Wow… just listened to the podcast, she definitely READ the article a few times in that segment! That’s far more shameful than you listening to the podcast itself! :-p

  18. As much as people condemn the Atkins diet for being this horrible no-carbs cheese-and-bacon diet, it’s clear to me such people never read the book, because it *provides tools* for figuring out how much carbohydrate you personally can handle in your diet. Instead of jumping all over the place with different carb intakes, you start out low and gradually reintroduce.

    When someone works hard to give you a tool for good health and you just spit in their face, it’s no wonder you continue to struggle. (I mean “you” here in the general sense.)
    Meanwhile, I’ve heard of people whose hypothyroid symptoms *improved* on a low-carb diet, and there have been people who’ve seen leptin and cortisol do better as well. And I wonder how many of the athletes who “can’t perform” on low carb were failing to increase their fat intake. That is not an unheard-of error for people to make. Dietary quality matters too. Just more stuff to think about.

    That said, not only can carbs help in pregnancy (*don’t* overdo it, nobody needs to have a nine-pound baby), but they can also be important in lactation. You don’t need to go overboard and gorge yourself, but if you’re breastfeeding you will learn how it feels when you’ve got proper milk production going on, so eat just enough carbohydrate to keep that going. Reason: Starch breaks down into glucose which your body converts first to galactose and then to lactose. You make some glucose but your native production is meant to support those tissues with an absolute glucose requirement; it’s not meant to feed a baby too.

    • Let’s not be dramatic. I’m not sure anyone who observes scores of their clinical patients failing miserably on low carb diets — and shares those observations — is “spitting” in anyone’s face. Atkins was not a deity. To suggest that those who failed on a low carb diet were somehow ‘doing it wrong’ is pure dogma. This article was specifically written to challenge those attitudes.

      We all have different flora and pathogens in us that respond to different levels of macronutrient intakes. Most people will do just fine with a moderate whole foods carb intake. Low carb diets certainly have their place, for those who need it, and no one is challenging that. But for those who feel worse on a low carb diet, it’s a breath of fresh air to have a clear and concise resource that people can access.

      • Truth ! For me the low carbohydrate diet just made me gain weight !!! Great comment thank you

      • Not true! For me the low carbohydrate diet was just perfect! Bad comment thank you

        I guess my point should be clear.

        P.S. so far 100% of people I’ve met with “low-carb didn’t work for me” -issue were doing it wrong. And I’m not talking about 1 or 2 people here. I’m not saying this is ALWAYS the case but it has been the case 20+ times in my experience…

        • Well, then meet one of the exceptions. I did Atkins the first time in late 1994 or early ’95 WITH the original book borrowed from the library (don’t think the “new” one was out yet…) and dropped all the weight I needed at the time during induction (about 11 or more, and mostly fat because at a higher weight I fit into my old smaller clothes). However, the moment I increased the carbs I began to gain again, and after that it seemed it was easier for me to gain weight than before. Three years later I tried again, with the new book, hoping for another dramatic loss but it was disappointing. The 3rd time maybe a couple of years later I even tried the pork rind/cream cheese no-carb “fast” when I began to stall but I think I just gained some weight back so I had to quit. I was diagnosed with hypothyroidism probably within a year and ever since, every time I try low-carb, even for 2-3 days, Iike just this past week, I stop losing, feel colder than normal and my body temperature drops significantly. Conversely, I remember a time when I was able to lose on a moderate carb diet, which is what I’m going to have to try from now on.

          So, the real point is that we’re all DIFFERENT, and there is no “one size fits all”. When I was skinny and didn’t gain easily (until I had my first child at age 30) I believed people who said they didn’t lose while on a diet were all lying, then many years later I had to go through it myself to believe it, in fact, last year I gained 2 lbs. while on a week of low-carbs.

          Just thank your “lucky stars” that low-carb works well for you, but don’t park yourself in an inflexible belief system or else life will teach you a lesson for being judgemental, many of us have done the diet right (I defended Atkins for years…) but our bodies don’t cooperate. Listen to this podcast with KK and hear what he had to say about it: http://www.askthelowcarbexperts.com/2012/03/10-all-things-thyroid-thyroid-101-chris-kresser/

          • As I said before, we all have unique pathogens and unique microbiomes. Metabolic syndrome is almost certainly due to a disruption of our microbiomes, rather than a specific ratio of whole food macronutrients.

            High carbohydrate indigenous populations (and there are many examples), who ate ridiculous quantities of honey and starches, do not develop metabolic syndrome. Yet, Westerners do.

            Dr. Ayers explains a theory that makes more sense:

            ————
            Obesity is a Symptom of Antibiotic Damage to Gut Microbiome

            We may enjoy a fat marbled steak, but the corn and antibiotics used to produce that mouth-watering plate of satiety, is not so healthy. Corn and antibiotics make that meat on the hoof fit for human consumption, but the cattle are quickly dying and the fat marbling is a symptom of cattle metabolic syndrome. The corn and antibiotics disrupt the bovine gut microbiota and alter energy flow. The result is prime beef.

            As It Is with Cattle, so It Is with Middle Americans

            General descriptions of Americans with metabolic syndrome and steers ready for the abattoir are similar. That should not be surprising, because both are caused by damaged gut microbiota and consequences of metabolic syndrome. Americans routinely damage their gut microbiota with antibiotics (processed food, etc.) and the major symptoms of the resulting gut dysbiosis are chronic inflammation, depression, autoimmune diseases, obesity and metabolic syndrome. Repairing gut microbiota reverses all of these symptoms.”
            ————

            In other words, if you damage your microbiome—whether it be from antibiotics or junk food (or both)—you may develop an inability to properly metabolize carbohydrates.

            That does not mean that carbohydrates cause metabolic syndrome. No, it just means that you’ve damaged your ability to properly metabolize carbohydrates (i.e. metabolic syndrome). Luckily, this damage can be repaired in many people.

  19. Thanks for taking the time to reply to my comment Tom. I’m actually adding carbs back in at the moment as I’m pregnant and keep hearing dire warnings about being too low carb in pregnancy. It’s a complete disaster: I’m hungry all the time, craving the wrong foods as in ready to open a bag of Doritos, my nasal congestion has come back and my IBS is flaring. It makes it difficult to know what to eat.

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