The 3-Step Process to Determining Your Ideal Carbohydrate Intake
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The 3-Step Process to Determining Your Ideal Carbohydrate Intake

by Kelsey Kinney, RD

Last updated on

Cathy Yeulet/Hemera/Thinkstock

There’s been a lot of talk about the right amount of carbohydrates to eat lately. Laura Schoenfeld started us off with her article about the possible detriments of eating a low-carbohydrate diet for too long, and Chris Kresser followed this up with his discussion of the common misconceptions people tend to have about low-carb diets. They’ve done the heavy lifting here and provided lots of scientific evidence to back up cases where a higher or lower carbohydrate diet might be beneficial.

What I want to get into today is the practical aspect: how do you determine the amount of carbohydrates that’s right for you?

To do this, I’ll walk you through the step-by-step process that I take with clients so you can start to think about it for yourself. While many people find it easier to work with a professional on this, I think it can also be done on your own.  The important thing to remember is that there’s no one-size-fits-all approach.

When most people start a Paleo diet, they typically start a low- (and sometimes very low) carbohydrate diet. They get in the habit of not including starchy tubers and fruits.

Some people will thrive on a diet like this, which is fantastic. Others might feel great for a while, but then slowly start to feel more fatigued, have more difficulty during workouts (and even more problems recovering), and overall just don’t feel so great. Guess which clients I’m going to be seeing?

I see the clients who don’t thrive on low-carbohydrate diets. They come to me wondering what they’ve done wrong and why they’re feeling sick when all they’ve done is followed the Paleo diet to a T – and that’s why this conversation is so important to have. We need to make sure that folks starting the Paleo diet understand that there’s a range of carbohydrate levels that can be consumed, and that everyone will feel best at a different level. I can’t tell you how many of my clients have come to me legitimately scared to eat carbohydrates of any kind. I don’t think any diet should cause people to be afraid of an entire macronutrient. All of us here at believe in personalization, and that’s exactly what I’ll be teaching you about today.

Let’s go through the 3-step process I use to help clients determine their ideal carbohydrate intake.

Step 1: Consider Underlying Diseases/Conditions

This is critical. If you have diabetes, you’re likely going to do better on a lower carbohydrate diet (though check out some of the comments under Laura’s article – even diabetics don’t all thrive on low-carb). If you have small intestinal bacterial overgrowth, you’ll probably want to limit your carbohydrate consumption while you treat the SIBO. Note the emphasis there: for someone with a gut dysbiosis issue, a low-carbohydrate diet is used as a therapeutic intervention and isn’t meant to be continued for life. I see so many clients who started a low-carb diet because they wanted to use it therapeutically, only to never try reintroducing those foods again.

If you have adrenal fatigue, you’ll likely feel better on a more moderate carbohydrate diet along with eating snacks to keep your blood sugar stable. Breastfeeding? You’ll definitely want some carbs, too.

The point here is that there are many conditions that affect how your body deals with carbohydrates, so you need to take these into consideration when thinking about how much carbohydrate you might do well with.

Chris discusses the different levels of carbohydrates that work best for a variety of conditions in his book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014). I’ve listed them in the chart below:

Carbbohydrate Intake Chart

Step 2: Get Started!

If you are an overall healthy person (and you either don’t exercise or exercise moderately), I suggest starting on a moderate carbohydrate diet and experimenting from there. When I first start working with a client who has no underlying health issues and wants to find their ideal carbohydrate intake, I often have them begin by implementing what I like to call “The Rule of Thirds”. That is, their plate should be ⅓ protein, ⅓ starchy tubers, and ⅓ non-starchy vegetables. It ends up being a moderate carbohydrate diet (though it depends on their calorie intake of course) – not astronomically high like the Standard American Diet, and nowhere near a ketogenic diet. Eating three meals a day like this also means they’re less likely to skimp on calories (and I’ll work with them to make sure this is the case).

If you do have a condition that would affect your carbohydrate intake (diabetes, hypoglycemia, thyroid disease, adrenal fatigue, etc) and/or you exercise a lot, refer to the chart in Step 1 to know what carbohydrate level you should begin with.

If you have multiple conditions that place you in seemingly opposite carbohydrate levels, I suggest working with a practitioner to help you craft a diet that will suit you best.

Step 3: Experiment! (And Take Notes)

From there, we experiment. Sometimes the carbohydrate intake will feel too high. It might trigger cravings for sweets, or perhaps increase their blood sugar too much.

I’ll have my client track their meals and take notes along the way with how they’re feeling so we can really see what’s going on. This is a crucial (and often overlooked) part of the process. If you’re not taking notes and keeping track of your meals, the experimentation phase can feel downright overwhelming. Being able to look back and track how your symptoms change with a concurrent change in carbohydrate intake is vital to figuring out the right level for you. If there’s a disease we’re dealing with (i.e. diabetes or adrenal fatigue), we focus on tracking those symptoms (blood sugar and fatigue, respectively) to see how they change. I have my clients use an app called Meal Logger for this task, where they can take pictures of their meals and keep notes on their symptoms.

If the carbohydrate level seems to be a bit high for the client, we bring it down. If it feels too low (perhaps they’re still feeling sluggish and are having trouble with their workouts), we’ll try bringing it up and monitoring their reaction. Eventually, we settle on the sweet spot.

So there you have it – my step-by-step process for determining your ideal carbohydrate intake. I hope seeing this helps you start this experiment for yourself and find what’s right for you. Don’t feel like you need to put yourself in a low-carb or high-carb camp – you just need to do what works for you! There’s a huge spectrum of carbohydrate intake; it’s just a matter of finding where you should lie on it. This is something I help clients with all the time, so if you’re having any trouble, don’t hesitate to reach out.


Join the conversation

  1. I am 69 yrs old–from India –in USA 43 years –last two years mostly vegetarian –Type 2 diabetes –just found out about
    LCHF diet and working on it. Same time need to gain
    weight — hard to find high calorie with good fat and protein–without meat.

  2. I am a runner, training 6 days a week and averaging between 280-360 Km per month, depending on the training phase.
    I have never had problems with carbohydrates, but decided to switch to a LC regimen, to see if this could improve my performance. This did not happen, however knowing that ROS generation is much lower on LC and having seen that my performance has not worsened either on LC, I have decided to stay LC (actually LC-vegetiarian).
    At first my mistake was to go VLC (50-100g/day), actually quite ketogenic. That was taxing on my body and training, almost unbearable. I guessed I should have changed training strategy to keep on that diet (more of a polirised training). So I decided to up my carb intake a bit, towards 200g/day on average and that is my sweet spot. At that level I can keep my training regimen unmodified and actually enjoy my workouts. There are day where I stay around 150g, other slightly below 100g, others slightly above 250g, it depends on the workout that awaits me the day after. But in average 200g is the minimum intake of carbohydrates I need to feel well. And this is exactly what your table above lists for persons like me.

  3. I was VLC + low fat for about 2 years (I was 16/17 didnt knew anything about paleo and just wanted to lose weight quickly. I lost 14kg in 2 months, went from being a chubby girl to skinny). the problem is I kept eating that way and ended up looking very unhealthy. I was underweight, tired, dizzy and hypoglycemic all the time so just stopped and started eating what I ate prior to begin dieting. which means the SAD. Of course that going through one extreme to the other (I also have hashimoto’s since I was 14) I developed severe Reactive hypoglycemia (which is different than hypoglycemia) my blood sugar would drop to 60. I went to see a doctor she told me to eat carbs every 2h. The outcome – I almost died. ended up in the ER several times my BS would be 35, 40 every hour. I was desperate and about to go crazy. No doctor knew how to help me !! It wasnt until I read about the paleo diet that I got informed. Now I dont’ have hypoglycemia anymore and I am trying to transition to 3 meals a day but I’m starting to
    see a very strange pattern in my numbers. My fasting blood sugar is always 83-85 but if I eat breakfast at 8am only eat lunch at 1h30 my BS will be 130 prior to lunch. the same goes in the afternoon. if I eat lunch at 1h30 and measure my BS at 8pm it will be around 130. I suspect maybe cortisol dysregulation from what ive been reading ? or maybe Its because of hashimotos ? should I be worried since I had a past of severe hypoglycemia ? please help me…

  4. This topic is so relevant to me. I have digestive problems and blood sugar problems, but I’m also an athlete (long distance running). I have been following what is a relatively low carb diet for someone who is active (about 90 g/day, often less) which seems to be *alright* but I feel I could do better. For me I think it’s the type of carbs that I eat that matter. For blood sugar issues I’ve been avoiding grains (1 rice cake and I feel “off”), and I’m also avoiding FODMAPs, legumes, excess fiber and resistant starch to treat acid reflux – I don’t eat strict paleo, because then I would have so few food choices. This seems to keep my symptoms relatively under control, however I do still have some digestive trouble from time to time. Any tips for someone who needs to be careful with carbs – and the specific *types* of carbs – due to digestion and blood sugar, while also needing to maximize carb intake for running? Already tried keto diet which was great for blood sugar, awful for reflux, so I’m sticking to carbs for fuel.

    • PS, I’m 5’7″, 130# and would not like to weigh any less or lose muscle mass from protein breakdown.

  5. Healthy fit 65 year old woman on VLC for 13 years, feeling great, fasting blood sugar gradually creeping up and this year having an abnormally elevated A1c at 6.1. Been adding in starchy vegetables, rice, quinoa, sweet potatoes (in moderation at every meal) for about two months. Fasting blood sugar now less than 100 every morning for about two weeks, but still completely intolerant of any fruits (even a few berries or melon balls) – 1 hour post prandial BG always greater than 140 and 2 hours greater than 120. Take a brisk two mile walk every day. Is there hope? Should I just keep doing what I’m doing with the occasional fruit challenge as a test? Any suggestion would be greatly appreciated. I can’t be the only one in this boat.

    • I am 58, thin, and have low insulin, but HgA1c of 5.8-5.9 at least for the past year, even on a high fat, low carb diet. My current theory is blood glucose dysregulation due to high ferritin (over 200 ng/mL). (I do not have HH.) I have not been able to convince my doctor that the ferritin is a problem (“It’s not that high”).
      So my suggestion is have your ferritin checked, along with Transferrin Saturation %, Iron, UIBC, and TIBC. Women can store iron starting 10-15 years post-menopause, and the iron can cause all kinds of problems. Phlebotomy results in improved blood glucose control, shown by many studies. I want to give blood, but I weigh under 110 lbs., so need therapeutic phlebotomy.
      I would be very interested if you could post your follow-up, if you try this and have any results.
      Check out Chris Kresser’s presentation “Iron Behaving Badly”.

  6. Great article! Wish I’d seen it a couple of years ago. My process? Over 7 years ago I had some health challenges to heal so I went annoyingly strict Paleo and pretty low carb for about 1 year and resolved most of them. Then my sleep, moods and workouts began to suffer. Being stubborn it took me some time/experimenting to determine what worked best for me. At present I feel great, sleep well and can power through my workouts. For me that means eating about 1 g protein per bodyweight, I keep the carbs anywhere from 100-175 per day coming from vegetables, 1-2 fruits and starchy carbs like white rice, yucca and potatoes on training days. I lift heavy weights and sprint 4 times a week. Eat around 2400 cals a day to maintain 122#. Happy and healthy at age 54

    • The relationship between sleep cycles and low carbohydrate intake has certainly been studied.

      Sleep quality of adolescents worsens with decreased carb intake:

      “…decreased sleep duration was associated with increased consumption of calories from fats and decreased consumption of calories from carbohydrates.” [1]

      People fall asleep faster with carbs 4 hours before bed:

      “We showed that a carbohydrate-based high-GI meal resulted in a significant shortening of [sleep onset latency] SOL in healthy sleepers compared with a low-GI meal and was most effective when consumed 4 h before bedtime” [2]

      Interestingly, a VLC/ketogenic diet (obviously different from just a low carb diet) seems to significantly increase the deep Slow Wave Sleep (SWS) but significantly decreases the dreaming rapid-eye movement (REM) sleep. Perhaps this may help explain part of why ketogenic diets can be therapeutic for some neurological issues. (It might also help explain why increased resistant starch intake is associated with significantly improved dream recall).

      For me, my sleep quality crumbled when I was VLC. I developed insomnia and I actually developed acute anxiety, despite having zero history of either prior to going VLC. It was awful. What I soon realized is that since gut bugs produce the same neurochemicals that our brain needs to function normally—such as GABA, serotonin, norepinephrine, dopamine, acetylcholine and melatonin—reducing my fermentable carbohydrate intake caused a significant reduction in those neurochemicals from being produced by the gut bugs.

      Sure enough, increasing carb and fermentable fiber intake—while simultaneously focussing on replenishing gut buts with fermentable foods and fibers (particularly resistant starch)—completely reversed the insomnia and anxiety issues I had developed from VLC.

      You can buy all those neurochemicals from a pharmacy, and few people know that the corporations will actually use bacteria to synthesize those same neurochemicals. Or you can just get your gut bugs synthesize those neurochemicals for you just by eating the right kinds of fermentable fibers and making sure you have the right gut bugs in place.

  7. Great article, I’ve enjoyed the carb thread over the last couple of weeks and have been introducing back in more carbs and am feeling better. I have stage 3 adrenal fatigue and also SIBO and a parasite (blasto) – Im currently undergoing sublingual hormone therapy as well as a parasite cleanse. What would you say is the priority here? I feel much better eating more carbs so Im guessing thats my answer, but wanted to hear your thoughts on whether I should keep it lower while I clear the SIBO.


  8. Hi Kelsey,

    Thank you very much for your post.

    there is one think about what you mention that puzzles me and I´d like to get your advice.

    You suggest a fixed amount of Carbs in your table (e.g. 100 – 200 g for a man in moderate carb intake). I would like to know why don’t you use a g Carb/ Kg of mass instead or as a % of calories.

    It seems to me that using a fixed amount of carbs ignores very much the differences between individuals.

    Thank you in advance for your answer

    • Actually, I recommend a percentage of calories as carbs in the chart. The examples with specific gram recommendations are based on a 2,000 and 2,600 kcal diet. So if you’re eating a different amount of calories than that, you’ll end up with a different gram amount.

  9. The advice to measure your BG levels is good, irrespective of what diet recommendations you’re following.

    However, it might be helpful to introduce the following caveat that is especially relevant to metabolically deranged individuals:
    insulin levels & patterns may increase & change, respectively, to handle increased dietary levels of absorbable glucose.

    Figuring out whether this is happening when substantially increasing absorbable dietary carbohydrates would be fundamental to correctly managing metabolic syndrome.

    Solely relying on blood sugar is better than doing nothing, but still gives a very incomplete picture if insulin is ignored, unfortunately.

  10. I was marginally hypoglycemic most of my life and have suffered bouts of eczema as well. On adopting the Paleo diet my weight came down and for the first summer is a very long time the eczema has not been a problem.

    I’m familiar with traditional Asian medicine. An ancient admonishment is to “avoid grain.” Not to stop but stay away from as much as possible. It also says to avoid eating animal protein together with carbs as they require opposite pH based enzymes to digest causing a hamburger to pass through the stomach basically undigested resulting in putrefaction in the gut. How would you respond to this notion?

  11. I’m breastfeeding a 4 month old and dealing with Candida. The Candida diet my naturopath recommended is low carb (20-60 grams) but I’m concerned about that affecting my bf baby. At the same time, the Candida reignited my leaky gut/food intolerances which are affecting baby via b.milk so the Candida has to be dealt with. Would you suggest a gentle tapering down of carbs and how low to go?

  12. I have really been struggling of late with this. I have been ketogenic since Feb. (paleo before that) At first I felt amazing, I think from the high fat. With about 40% body fat, and about 40 lbs to lose, I only have lost 10 lbs and it has been painfully slow. A couple of months ago I found the value in eating enough protein, which I think most VLC diets don’t eat enough of and thought I was golden.

    I come from an adrenal fatigue background, but also Insulin resistance. I have been super dizzy lately (and also found out I was taking too much potassium and had low pulse, heart flutters and fatigue) Dr. took me off of it, pulse has bounced back, but fatigue and dizziness remains. My lipids have greatly improved, but I am afraid to increase carbs as I LOVE the lack of cravings, hunger and balanced blood sugar. I could fast for hours and hours without any effect, my blood sugar does not spike and remains level all day, so I suspect I have good blood sugar control on keto??

    I have yet to have someone explain clearly how keto makes adrenals worse?? I have listened to podcasts and read, people say it does, but now how and why? If my blood sugar is level all day is being low carb really hurting my adrenals?

    If I add carbs back in, which I have done this week, I retain water and am bloaty. Like a commenter said above, how on earth will I lose weight if add carbs?? Phinney and Volek tell you to slowly increase your carbs until you stop losing weight, what if you are not losing in the first place?

    Is there a viable option for consistently losing weight?

    Sorry for all the questions, but I feel like I am getting nowhere fast and feeling worse and worse. Desperate for answers.

    • Michelle

      From what I have experienced… Tue next hunger food thought part of keto was great…what happened though is I went longer and longer between meals and my cortisol levels started to make up for the hunger I was not responding to after eating huge pats of butter four hours previous. So after vlc I did lose weight but messed up my cortisol rythem…and not w I’m struggling w weight my adrenals crashed from having too much to do in my body.

      Not sure if that is relevant to you.

      • Thank you for sharing that, it is very relevant to me! My recent saliva test revealed that my rhythm is normal, thank God, but very LOW, like almost off the charts. I had begun lots of IF (I love how it feels) but I suspected it was demanding my already weakened body to do too much so I forced myself back to three meals. Hoping this helps. Thanks for sharing this and confirming what I was thinking. Bless you.

    • Michelle How much protein are you eating? If you have too much this converts to glucose and then stored as fat. You need to balance the PFCs. I eat around 65g protein per day

      • Hi Terri, I have been researching and researching and believe I have a full understanding, finally, of the what really happens and how much protein we need. I did the whole LCHF (what they called moderate protein, was actually way too low) I now believe I am an optimal level for my lbm, at around 88. Steve Phinney himself confirmed this is the minimum amount for me, going over is actually perfectly fine. I was a staunch proponent of lower protein, my kids could all tell you exactly what gluconeogenesis is! LOL

        • I agree. I have to eat 80-90g protein to feel good and not be hungry. I don’t feel well over 65% fat either so I really need the extra protein for the calories if nothing else. I can stay in ketosis with these amounts as long as my carbs are not much more than 20-25g net.

  13. I simply want to lose weight like about 60-70% of the population. As far as I am aware have no other health issues. I have been following a LCHF regime for a couple of weeks based on keto-calculators. I have around 32g carbs, 70 protein and 125g fat. Before then I followed a primal lifestyle for 6 months with no weight loss what so ever, since strictly following LCHF I have lost about 1.8kg (3 pounds). Are the carbs too low according to your chart? I feel if I ate 50g I would never lose weight? Thanks for your help

    • Weight loss is one of the applications of a VLC diet, so if you’re continuing to lose weight and aren’t experiencing side effects related to the low carbohydrate intake, I don’t see a problem with continuing. I imagine Kelsey would agree.

      • Exactly,

        There was a news story last week that obesity levels in the US have hit an all time high. Approximately 7 out of 10 Americans are overweight. Over 100 million people have diabetes or prediabetes.

        Your chart is terrific as far as it goes. It should be noted that the “high” carb diet recommendation threshold on your chart of 200 grams is about two thirds the number of carbs the American Diabetes Association and the USDA recommends and calls “moderate”! So by comparison, your “high” carb threshold is actually a low carb recommendation by ADA and USDA standards.

        The ADA recommends 45% of calories for diabetics should be carbohydrates. For me that translates to about 300 carbs a day which if I actually followed, would guarantee I would be overweight and diabetic which I no longer am on a low carb Paleo diet.

        Here is a link to the ADA calculator that shows what they recommend for diabetics based on age and activity levels. In my opinion their recommendations are insane… the modern equivalent to the old practice of blood letting.

        The best advise I ever received was to buy a blood glucose meter and regularly test myself. You don’t have to be diabetic to do this. Walmart has a meter and 50 test strips that you can buy for about $25. It’s the best investment I ever made to see how many carbs were safe for me to eat.

        Two years ago, I went on a very low carbohydrate Paleo diet. My blood sugar levels returned to normal within a week which is about the same result most diabetic bariatric surgery patients see when they leave the hospital.

        Staying on a low carb Paleo diet, I lost 100 pounds and when I started lifting weights and running, I found I could eat more carbs and still maintain my new lower weight and normal blood sugar levels. Today I try to eat around 100 carbs or less. I rarely go over 150 grams but I don’t think I would be able to eat this much if I hadn’t lost a lot of weight first and become very fit..

        I’ve found testing with my meter, that I can eat a high carbohydrate meal if I immediately follow it with lifting heavy weights or going for a long vigorous bike ride.

        In fact, I discovered my blood sugar levels are usually lower after intense exercise and a high carb meal than after a moderate carb meal with no exercise following it.

        The New York times ran a story last week on a NIH funded study that stated:

        “People who avoid carbohydrates and eat more fat, even saturated fat, lose more body fat and have fewer cardiovascular risks than people who follow the low-fat diet that health authorities have favored for decades, a major new study shows.”

        Works for me.

      • CK, can you point out any well designed trials that show low carb results in weight loss when protein and calories are controlled? People switch to vlc for weight loss, but results are wrongheadedly attributed to carbs.

        Radical approaches such as vlc have a very poor long term track record for weight loss. I know you prefer a balanced approach, but a comment like “Weight loss is one of the applications of a VLC diet, so if you’re continuing to lose weight and aren’t experiencing side effects related to the low carbohydrate intake, I don’t see a problem with continuing” perpetuates the low carb myth.

        FTR, I don’t disagree with your message or recommendation here, just the takeaway that most folks will have – namely less carbs nets weight loss. That is a myth. Those looking to learn more can google Alan Aragon who has brilliantly covered this many times.

        • Tim,

          At the risk of stating something that seems so obvious, loosing weight and keeping it off requires a permanent lifestyle change and refraining from doing those things that made you overweight in the first place.

          Any diet that results in eating fewer calories than the body uses will result in weight loss so there is more than one route to the promised land.

          The real question is since there are many paths to weight loss but 95% of people fail to keep their weight permanently off, which restricted lifestyle is easiest to maintain?

          Here there is quite a bit of research that a diet higher in fat and lower in carbs is more satiating than a high carb, low fat diet.

          Since there has been an explosion in obesity and diabetes rates following the high carb, low fat strategy promoted for years by health professionals, it is understandable that people who have had personal success following an opposite strategy will be quite passionate about it.

          For me, as someone who was an obese type 2 diabetic, I can testify I was addicted to sugar, grains and highly processed foods containing salt, sugar and fat. My addiction is not that different from an alcoholic’s.

          I’ve known some alcoholics that can still have an occasional drink without going off the wagon but for most alcoholics, total restriction works best.

          Here is where carb restriction and the definition of carbs comes in because there is a language problem in differentiating between good and bad carbs.

          For me, I don’t have a choice in eating highly refined carbs because sugar, refined grains and highly processed carbohydrate rich foods trigger sever food cravings and historically raised by blood sugar levels to unacceptable levels.

          I am not strong enough to eat manufactured processed carbs in moderation. I’ve never understood people who can leave a bread basket untouched along with half the food on their plate and then have a one fork taste of piece of pie. I know these people exist but if I was one of them I would never have become an overweight diabetic. I think most of America is more like me or 7 out of 10 of us wouldn’t be overweight.

          For me, a Paleo diet that eliminates sugar and highly processed foods was easier than trying to eat these foods in moderation. For me, total restriction of highly processed manufactured high carbohydrate foods is the only approach that ever worked long term.

          This is not to say I have eliminated all carbs. I am not addicted to fruit, green beans, peas, sweet potatoes, squash, corn and plantains. I can eat these foods in moderation and they do not effect my blood sugar now that I have lost 100 pounds and become fit.

          I wish I could say the same for white rice and mashed potatoes but that’s just me. Other people may have a different experience.

          There should be a different word for whole, complex carbs. Some people have tried with “safe starches” and “low glysemic” foods. Not all carbs are equal and there is evidence, as Chris’s posts report that some whole food, unprocessed carbs even deliver health benefits for people who can tolerate them.

          • Exactly, Bill! VLC took 150+ lbs off of me and I’ve maintained it for more than 10 years eating LC. The low carb hate/ignorance is so tiresome.

          • Low-carb and high-carb both work, it’s all about calorie density, nutrition density, satiety, etc.

            I’m eating a pound of bread a day, and losing weight. I also exercise a lot.

    • The 50 grams of carbs was based on a 2,000 calorie diet. The same ratio of carbs on a 1,500 calorie diet is about 38 grams. I’m doing a pretty similar formula as you are: 30 carbs, 46 protein, 133 fat. It varies a bit every day, but that’s what I shoot for. Good luck!

  14. Thank You!!
    I’ve had CFS for about 12 years(Probably due to diagnosed adrenal fatigue),
    I also have type one diabetes, thyroid issues, AND SIBO!!!!
    What would you say is the priority?
    I’ve always thought it was the diabetes and my adrenal specialist agrees, when I add too many carbs, my BG tends to spike, And often the insulin used to mitigate it can result in an insulin reaction which I know is not good for my adrenals. The thyroid issues seem to have developed over the last year. I tried a little NDT, But felt worse on it. Doctors and I agreed that I need to work on my adrenals, But most adrenal supplements also tend to produce high blood sugar.
    I live in Boston but it seems so hard to find a practitioner that can deal with the complexity. Even though I have good insurance. Help!!!!

    • Suzanne – there are several doctors at Visions Healthcare in Dedham that practice functional medicine. They might be able to help you.

        • I see Dr. Chen. It’s been a long road, but I am getting better. There’s been a lot of supplements. I added acupunture which helps with stress immensly. If you are in the needham area, New England School of acupuncture has discounted rates and the student are great – otherwise, look for community acupuncture (I go to metrowest wholehealth in Medway – they are moving to milford) for super cheap rates. FWIW, I have adrenal fatigue, and as a result, thyroid and other hormonal issues, as well as positive for 1 copy of mthfr. My most helpful supplements are vit. d, massive amounts of various magnesium (cholride & malate pills, magnesium oil), vitamin c, folate, and a emeral labs prenatal (slightly cheaper than phyto-multi, and the goal is to be well enough to be TTC)…It takes time, and a MAJOR slow down of life.

      • I second the recommendations for Visions – they are the best in the Boston area. They area also in Wellesley and Needham.

    • Hi, Suzanne.

      Herbalist, and also have adrenal fatigue and other overarching health problems.

      For the adrenals….

      Have you tried adrenal cortex extract, or better yet — nettle seed?

      Nettle seed (with nutritional “calyx” — if you don’t know how to gather it, here’s a post with links as to where to buy them, dried. Also gives you information as to how to gather it, but be careful as to where you gather it from.) seems to help and not induce dependence — you need less over time as you go.

      As with adrenal cortex extract, you shouldn’t use it to tire yourself out more by going “more into debt” with the energy it gives you, but ACE was making me feel more dependent.

      Nettle seed seems to be giving me my energy back.

      Careful not to take too much. 🙂

      Good luck.


      Oh, also, you may want to look into adequate levels of magnesium and boron — from what I understand, chronic stress will deplete magnesium, and it’s been a crucial part of my healing.

      (Although I have a particular health problem that also prevents retention of magnesium, so that may be why it’s been so crucial to get that supplementation right.)

      Epsom salt soaks/baths help a lot with magnesium and sulfate levels, too.

  15. I can completely resonate with Michelle. I have naturally become very low carb in a bid to lose fat, but my health and vitality has steadily deteriorated and my weight is at an all time high. Unfortunately when I up the carb I then seem to get blood sugar swings, I actually suspect some insulin resistance but haven’t gone as far as confirming this yet.

    Am I right in thinking that someone who is metabolically inflexible may benefit more from low carb? or do we need to prioritise the areas that need more carb, such as hypothyroid/adrenal fatigue etc

    Great article but still so confused with my own body!!

    • Hi,
      I do a VLC diet for a major health problem. Going very low carb didn’t work for me until I went very high fat. If you’re going low carb enough to approach ketosis, you’re going to be exhausted and starving until you get your ketones up enough to provide your cells with an energy source other than glucose, and that means eating at least 65% of your calories as fat. I also find that eating more salt than usual often takes care of fatigue problems. The silver lining for me has been major and effortless weight loss. I lost a modest amount in the 18 months I ate regular-carb paleo, but the speed and ease of weight loss for me (a middle age woman with long-standing weight problems) with ketosis has been surprising. Not the reason I eat VLC, but I’m not complaining.

    • Great article!! I have found that looking at the “makeup” of the carbs is really important when trying to overcome specific conditions. Taking into consideration what makes up the grams of carbs such as sugar, fiber, protein can make all the difference when trying to reach your nutrition goals. For example, someone with an autoimmune conditions will have more adrenal issues, weight imbalances related to inflammation or thyroid, imbalanced blood sugars and a leaky gut which may mean more issues tolerating carbs with the protein gluten or sugars such as fructose or even the protein and sugars in dairy. It gets down to how our body sees and reacts to these protein/sugar molecules. I have noticed a lot of the clients I work with have secondary issues tolerating foods that break down into fructose. Those commenting on autoimmune conditions involving adrenal, thyroid, and imbalanced blood sugars, are you truly 100% gluten and dairy free? If so, how long and are you staying away from the processed gluten free options? All thoughts to consider when healing the gut which is 70% of our immune system.

  16. Do you have a recommendation on how many carbs to start with while breastfeeding my 13 month old AND trying to lose weight? I also just recently started exercising. My body just doesn’t seem to want to let go of my baby weight. Was mostly Paleo before and during pregnancy, gained weight after baby was born.

    • I think the simple answer here is you can’t expect to breastfeed AND lose weight/fat. The body’s main priority is feeding that child and it will want to keep a little more fat on us if needed so that if for some reason food is scarce, we can still feed our babies. I hear ya though. I’m currently breastfeeding as well and would love to shed 5-10lbs, but my body does not care about that right now. I’m fine with that and I’ll deal with fully getting my body back when I’m done breastfeeding. I think our hormone profile while breastfeeding will also challenge us when it comes to fat loss.

      • I found with breastfeeding the weight just fell off of me – over 4 stone. In fact I lost too much weight and found sitting down uncomfortable. In the end I was eating chocolate bars to try & stop my weight from falling even further. I should add that at no point was I trying to lose weight it just naturally fell away!

      • I lost 20 lbs the moment I stopped breast feeding. I heard it was evolutionarily stubborn brown fat. I don’t know how true that is, though. Despite the rapid weight loss, It wasn’t all fun and games; I concurrently broke out in male-pattern acne that, 6 years later, has persisted.

          • I would think that it depends on where your fat stores are. For myself I like to keep a lot junk in my trunk so to speak which is sex specific fat that women store for the purpose of gestation and breastfeeding. Your hormones during pregnancy and lactation actually encourage your body to use those fat stores if there is a need for the extra energy. For myself I found that I didn’t loose much weight breastfeeding until my babies were around 1 year old and then it basically fell off. I think because their calorie requirement increased with there size and activity level. Unfortunately for me all the “junk” I lost found its way back and I have no plans for any more babies to help me burn it up.

  17. This is so timely! What would you suggest for someone who has thyroid, gut, and adrenal and needs to lose weight (10 lbs that came on due to adrenal issues from VLC for two years)? I tried upping my carbs ( 5-10 g every few weeks) but just end up even more bloated…

    Thank you!

    • JM, I could have almost written your post! I did VLC for a few years and my blood sugar was great. Then my adrenals crashed in 2012, my gut started having really major problems, and I also started having thyroid problems converting hormones. I’m now on T3 and trying to figure out the diet component. RS seems to be helping my gut issues, but does little for blood sugars.

      If I go even moderately low carb any more, I gain weight like crazy – my body just won’t take it (is this thyroid, adrenals, insulin resistance, or an evil trifecta?). My adrenals are clearly unhappy with low carb.

      At moderate carb levels I feel better and my weight gain is much slower, but my blood sugars start to drift up (into the space between normal and pre-diabetes). I am not sure how to find the sweet spot for adrenals, thyroid, and blood sugar.

      I need to lose about 15#, but anything I do that causes my body stress results in weight gain. It’s incredibly frustrating.

      • Hi,
        I recently did a juice diet to help me with the Step 1 and to transition to a healthier diet and I lost 13lbs. I only gained 4lbs the first two weeks but then I gained 7 more pounds. Every time I lose some weight I gain it all back and I do not know what I’m doing wrong I read Chris Kresser’s articles and try to do what he advices to do. I just started to lower my carb intake and I gained 2lbs this week.

        (I also have gut issues, ulcerative colitis and I tested my thyroid and my TSH, T4, and T3 uptake came back normal)


  18. Thanks for the excellent article. This is exactly why I recommend this website to anyone who asks. I have benefited greatly from all the info posted on this website and have worked long and hard to resolve my digestive issues. I have reintroduced most of the foods I like again, but the one I continue to have difficulty with is legumes. I really like them and want to eat them. I no longer have the digestive problems, brain fog and itching skin I used to with them, but I find the day after I eat them I feel very sluggish and tired. I am very curious as to what is still going on and why this starchy food and no others is causing this continuing problem. Any ideas or referrals to other sources of information? Thanks in advance!

    • Thanks for reading! It’s likely that you’re just sensitive to the legumes themselves, and it’s not necessarily the starch that’s causing the problem. Probably not the answer you were hoping to hear, but it’s the first thing that comes to mind!

    • Tammy, I used to have problems with legumes as well – have you tried soaking them for a fairly long time (I soak them up to 20 hours) and cooking them in a pressure cooker? This has made a big difference for me.

      • Yep. soak the legumes. This is a good idea for everyone as it neutralizes the phytic acid and makes the B vitamins more bioavailable. All native cultures soaked legumes for a reason.

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