Low carb or keto


Carbohydrate confessions: Stories (and data) from a low carb convert.

Have you ever been forced to change your mind? Even about something you thought was absolutely true? Well, that’s what happened to Dr. Spencer Nadolsky. A long-time low carb advocate, this high carb experiment rocked his world.

Like many recreational exercisers, or people who know at least a little about nutrition, Dr. Spencer Nadolsky was certain that his low carb diet was the secret to staying lean and healthy. Until he tried a high carb experiment… and the results astonished him.

In this article, we’ll share the results of his experiment. Even more, we’ll talk about how our assumptions can be challenged when we become our own guinea pigs, and follow the evidence of our experience.

Where nutritional rules get broken (maybe)

We all love being right. It feels good when the universe has clear rules.

If you’re a recreational exerciser or familiar with nutrition, one of the “dietary rules” you might “know” is that a low carb diet is “the magic secret” to staying lean and healthy. At the very least, you might have heard about the many benefits of a low carb diet.

Like Dr. Spencer Nadolsky, you might also have researched it. You might have trusted that nutritional wisdom so much that, like Spencer, you even recommended that everyone try it!

At one time, Spencer was so convinced of low carb diets’ value that he became a low carb promoter, appearing on podcasts and writing a popular blog to sing the praises of low carb eating.

Then he took up a new sport, and his coach persuaded him to try a higher carb diet.

The surprising result? His weight and health remained stable, while performance and energy skyrocketed.

His self-experiment proved his assumptions wrong. And in the face of new evidence, Spencer was forced to re-think his nutritional paradigm.

Darn you and your truth bombs, self-experimentation!

What this article covers

In this article, we’ll explore how self-experimentation can help you test nutritional theories and dietary “rules” on yourself, to see how your body responds.

But this article isn’t just about one guy’s journey. Or what’s “true”.

(That’s right, we’re not going to give you another “nutritional rule” to replace the “rule” that Spencer just apparently broke).

Instead, this article is also about the importance of having a critical, questioning, curious perspective. About not taking anything — not even what we say — at face value. About avoiding “one size fits all” rules and absolutes. And above all, trusting the evidence of your own unique body.

Who this article is for

If you’re a beginner who’s just learning about the basics of healthy eating, you might want to skip this article.

However, if you’re a little more advanced and have already tried various ways of eating, this piece may interest you.

You might also find this article valuable if you coach or educate others — for instance, if you’re a coach or fitness professional who might be advising clients on how to eat.

And finally, if you’re interested in self-experimentation, you’ll naturally want to find out about Spencer’s adventures and perhaps want to try something yourself!

Without further ado, here’s Spencer’s story, as told by the good doctor himself.

From high carb (big) to low carb (lean)

In college, I was an Academic All-American heavyweight wrestler — at one time, ranked third in the nation. Unlike my smaller teammates who were always trying to stay lean to maintain their weight class, I was always trying to gain.

For me, bigger was better. And I ate big to stay big.

During that time, I packed down 4000-5000 calories a day. Lots of carbs from pasta, rice, and cereals.

But in 2007, I retired from the ring and decided it was time to get leaner and healthier.

So I did what a lot of people might have done at the time: low calorie, low carb.

I cut my calories down to 2500-3000 a day. And I cut out all carbohydrates that didn’t come from vegetables or fruit. Since I wasn’t going to be competing and practicing so much anymore, I figured I didn’t need those starchy carbohydrates to fuel myself.

Guess what? My strategy worked.

In the few short months before I entered medical school, I lost about 25-30 pounds. What’s more, I felt fantastic on my relatively low carbohydrate eating plan.

Before and after: Spencer dropped the carbs to go from 265 to 235 lbs.

The low carb years

Now, I’d studied nutrition. I knew that carbs are important. In fact, they’re our principal source of fuel, and crucial to virtually every system in our bodies. (To learn more, see All About Carbohydrates.)

Yet despite my knowledge and expertise, I was one hundred percent convinced that a low carb diet was perfect for me.

The evidence seemed clear. I wasn’t getting a lot of activity besides weight lifting. I was easily staying lean. I seemed healthy.

So I figured low carb was a good choice.

Throughout the next six years, I ate an average of less than 150 grams of carbs per day — or roughly around 15% of my total calories.

Sure, once in a while I’d get more — at celebration times, dinners out, and so on. But most of the time, I kept my carbs lower.

Since I’m a doctor and love to geek out on this stuff, I did some very advanced blood testing to ensure my metabolic health wasn’t being hindered. According to those markers, everything looked terrific.

Well… almost everything. I was diagnosed with Hashimoto’s thyroiditis and subsequent hypothyroidism. But this seemed unconnected to my diet.

I felt great. I looked great. Best of all, I got to eat delicious food! All in all, my low carb diet seemed perfect for me.

What’s good for me is good for all… right?

It was easy to generalize my own apparently good results to others. Especially since the more I learned in my research and the more I saw in my clinical training, the better lower carb eating seemed.

Eventually, I became an eager advocate for the practice, appearing on podcasts, writing articles, and in general doing everything I could think of to sing the praises of low carb diets for everyone from couch potatoes to elite athletes.

The way I saw it, low carb eating promoted health and improved body composition for everyone.

So why wouldn’t I spread the word?

The low carb to higher carb experiment

Things might have gone on like this indefinitely, with me happily eating low carb, and happily preaching to the low carb choir.

But last summer my competitive itch came back. And as I started scouting around for my next challenge, a number of knowledgeable people suggested that I might be a good candidate for a bodybuilding competition. I decided to make that my next goal.

Now, as a PN advisor, I’m fully on board with the PN principle that everyone can benefit from mentors and coaches. So, once I’d decided to train for bodybuilding, I immediately hired one of the best natural bodybuilding coaches I could find.

You can guess what’s coming next.

I had to change my diet.

My coach asked me to switch from my lower carb, higher fat, moderate protein diet to a higher carb, lower fat, moderate protein diet.

He believed that the extra carbs would provide me with a little boost to maximize my workouts when my calories started to get low.

Ooops. Time to switch things up.

I can’t say I was all that eager to get started.

Keeping track

In order to get a baseline of what I was actually eating, I tracked my calories from the different macronutrients for several days. I then switched many of my calories from fat to carbohydrates. The charts show these changes.

(The first chart represents my typical low carb diet. The second represents my new high carb diet).

How did I make the changes?

I cut my fat down by:

  • going from my usual four breakfast eggs to one
  • cutting way back on bacon (*sob*)
  • no longer eating daily handfuls of nuts and frequent gobs of nut butter
  • choosing leaner red meats (a lot of sirloin)
  • getting a grip on my dark chocolate addiction, and
  • curtailing the blue cheese and olive oil combo that I liked to use on my salads. (I still use these, but in smaller portions.)

My new carbohydrate sources included:

  • oatmeal (a lot of it),
  • more fruit
  • rice
  • quinoa
  • potatoes
  • and even the occasional bowl of processed cereal – something that was forbidden on my old diet.

Quite a change.

Higher carb, higher risk?

Of course, I trusted my coach. But I’ll be honest — as a confirmed carbophobe, I hesitated to alter my diet so drastically.

I wasn’t increasing calories, so in theory, I knew that I shouldn’t gain any weight. Even so, given my assumptions about the superiority of my previous diet, I couldn’t help feeling a little nervous about getting… well… fat.

Meanwhile, potential weight gain wasn’t the only danger I worried about.

Some of my physician colleagues shared my views about the virtues of a low carb diet. And among them, rumor had it that eating high amounts of carbohydrates could change my cardio-metabolic health for the worse within a matter of days. Yes, days!

Specifically, they argued that a higher carb diet would cause my low-density lipoprotein particle numbers (aka LDL-P) to skyrocket.

According to this theory, eating a higher carb diet could actually put me at greater risk for heart disease.

No wonder some people (myself included) become carbophobes!

And no wonder I decided to continue with my advanced blood testing while I was on this higher carbohydrate diet. I wasn’t taking any chances.

About LDL-Cholesterol

LDL-C, or low density lipoprotein cholesterol is a measure of the cholesterol mass within LDL particles. Traditionally, LDL-C has been the marker used to assess a person’s risk of cardiovascular disease.

But LDL-C only provides an estimate of low-density lipoprotein levels. Studies suggest that the risk for atherosclerosis is actually more strongly related to the number of LDL particles (LDL-P) than to the total amount of cholesterol within the particles. That’s why a high LDL-P reading could be dangerous.

For more on cholesterol and why it is important to health, see All About Cholesterol.]

Some unexpected changes

My physician colleagues were right, in a way. Because within a week, I’d begun to experience some changes.

It’s just that those changes were not the ones they’d predicted.

First and most obvious were the “pumps” I started getting in the gym. This didn’t surprise me a whole lot; most fitness enthusiasts understand that fueling with carbs can provide a boost in performance.

A little more surprising, but still within the realm of what I’d anticipated, was my newfound ability to perform a set or two extra of the same exercise at the same intensity/weight.

For quite some time, I’d struggled to do this beyond the eight rep mark. Generally, I could go for four or five reps and then I would have to quit or cut back. So this was something new.

Meanwhile, in addition to these fairly predictable changes, there were a few unforeseen results.

First, instead of gaining weight quickly I actually lost about a pound and a half. Not only that, but even with that relatively minor weight loss, I was looking leaner and more vascular.

Second, all of my advanced metabolic markers improved, including glucose and lipid/lipoprotein metabolism labs. Talk about a shock!

When evidence meets dogma: The debate

After switching to a higher carb meal plan, I posted my initial weight loss results on Facebook.

That’s when the fun began.

Recall — at this point, I was pretty well known as a fan of low carb diets. And I’d gone on record, more than once, to argue for their benefits.

So within an hour, both low carb enthusiasts and pro carb enthusiasts began to speculate about what had happened.

The low carb promoters insisted that I must have lost muscle. After all, I couldn’t have lost fat with added carbohydrates! Especially since most people who increase carbs gain water weight due to the increased glycogen. Losing fat was an impossibility! (Except it wasn’t. Not according to the measurements.)

Meanwhile, those in favor of higher carb diets argued that my former low carb diet must have caused some subclinical hypothyroidism. On a higher carb diet, my thyroid was finally kicking into gear. And that, they believed, was why I’d been able to lose weight.

Ironically enough, as I mentioned earlier, I do have hypothyroidism caused by an autoimmune disease. But I keep close tabs on my symptoms and labs and these didn’t change. So a newly active thyroid wasn’t the explanation, either.

Mindfulness makes the difference

Until now, I haven’t said a lot about it, but I have my own theory as to why I lost fat despite adding carbohydrates.

Remember how I tracked my eating for a few days at the start of this change, and then switched my calories over from fat to carbohydrates?

Well, I believe that I subconsciously lowered my calories on those first few days. Quite simply, I was more aware of what I was eating.

Note: I wasn’t trying to eat differently than usual. On the contrary, I tried to eat the way I would on any other day. But when you write down what you’re eating, you automatically become more aware of the food you put in your mouth.

In the end, I think my baseline (around 2,700 calories per day) was on the lower end of what was normal for me (between 2,500 and 3,500 calories per day). So ultimately, it didn’t matter that I switched those calories from fats and protein to carbohydrates; as long as I maintained activity levels, I was going to lose weight regardless.

This would also explain the changes in my metabolic markers, because a hypocaloric (or lower calorie) diet will typically improve those as well.

Testing it out

To further test my hypothesis, I continued to monitor my progress over the next few months.

During this period, I wanted to gain a bit of weight before embarking on the long weight loss phase that precedes a bodybuilding competition.

Every day I weighed myself and tracked exactly what I was eating. Gradually, I increased my carbohydrate intake to around 400 grams of carbohydrates daily. And over the next four months, my weight steadily climbed.

As you can see in the chart below, after a few months of my high carb diet, I ended up at the same body weight. However, I had less body fat and more lean mass.

Starting measures Post weight gain Midway through weight loss
Weight 219 lbs 225 lbs 220 lbs
Body fat 9% 10% 8.5%
Lean mass 199.5 lbs 205 lbs 201.3 lbs

Right before the start of the weight loss phase, I underwent another set of advanced blood tests.

Guess what? The results were similar to my low carb baseline measures — which was exactly what I had expected.

Baseline After a week of low fat / high carb After period of weight gain
LDL Particle Number 1574 nmol/L 889 nmol/L 1421 nmol/L

(If you want to see all the numbers and track my contest preparation, visit my blog).

What have I learned?

Right now I am on my long descent to getting “shredded” (or super lean) for my bodybuilding show. I am staying relatively high carb (over 300 grams of carbs daily), low fat (75 grams daily), and moderate protein (225 grams daily), while slowly losing fat. My workouts continue to be great.

Mindful eating makes the difference

But I need to emphasize that during this experiment, I have been weighing everything and tracking it in my journal. And I think this weighing and tracking are important.

In the past, I had tried adding carbohydrates to my diet freely. Surprise, surprise: This resulted in quick fat gain. Just what a carbophobe most fears!

But if you think about it for a minute, it’s obvious why I gained unwanted fat. In adding carbs, I was simply adding calories — without looking at the whole context of my diet! Had I tracked what I was actually eating, I would have fared a whole lot better.

I suspect that a lot of people who try, and fail, with a higher carb diet, may be making the same mistake that I made in the past.

And if tracking is useful, it’s equally important to measure. If you’re anything like me, you find it a whole lot easier to guesstimate an appropriate serving size of apples or bananas than one of rice, pasta, or cereal — and you also find the rice, pasta, and cereals a whole lot easier to overeat.

And for low carb eaters, the same is true too. Bacon, avocado, nuts, and butter are delicious. And easy to over-eat.

That’s why if you’re trying to make any kind of physical change, no matter what diet you choose, I strongly recommend you measure and track your food for a little while.

Don’t make yourself crazy with it. But do make yourself more aware.

Later, once you have a fairly good idea of what a portion looks like, you can estimate using the PN method.

Higher carb or low carb… what’s right for you?

Does my success with a higher carb diet mean that I’ve completely turned my back on low carbohydrate diets? No.

Does it mean that you should immediately go face-down in a bowl of oatmeal? Not necessarily.

In fact, most of my new patients still get the low carb prescription. Why? Because if you’re inactive and overweight, it’s much easier to get your blood sugar and blood pressure controlled on a lower carb diet.

When I recommend a lower carb diet and ask patients to focus on lean proteins, veggies, and fruits, they automatically eat fewer calories and more protein. This makes them feel full for longer, which in turn helps them lose weight. By eating more vegetables, they also get more phytonutrients. They’re eating less processed food.

And altogether, this diet helps to rid them of the diabetes or hypertension that brought them to me in the first place.

But while low carb diets have their place, I no longer think they’re necessarily the right choice, or the only choice, for everyone. In fact, many of us might benefit from adding some healthy carbs to our diet. (To learn more, see Carb Controversy: Why Low Carb Diets Have Got It All Wrong.)

The fact is, restriction almost never works well over the long term. And most of us feel, look, and perform our best with a balanced diet that includes some lean protein, healthy fats, and quality carbs.

How to decide what could work for you

Your individual carb requirements depend on your:

  • goals (fat loss, muscle gain, maintenance)
  • genetics (different body types, medical conditions)
  • carb source (refined versus minimally processed)
  • activity level (sedentary, weight-training, endurance athlete).

And don’t just speculate on what you think you might need. Actually try it. Get some evidence.

Track and measure your intake; observe your workout performance and overall energy levels — heck, even get some bloodwork done if you’re willing to put your money where your quinoa-eating mouth is.

Gather data on yourself. Think of it as writing your Owner’s Manual.

What to do with all of this

If you’re a healthy exerciser whose blood sugar levels are normal and you’ve been eating low carb for a while, I recommend trying a higher carb diet. You might be surprised at the results.

And remember these simple guidelines:

  • Don’t overly restrict; don’t over-think it; don’t waste time with detailed “carb math.”
  • Enjoy a wide variety of minimally processed, whole and fresh foods.
  • Observe how you look, feel, and perform.
  • Decide what to do based on the data you collect about yourself, not on what you think you “should” do.
  • The only “rules” come from your body and your experience. Don’t follow a dietary prescription for anyone else’s body.

And above all, for most active people, carbs are your friend.

About the author

Dr. Spencer Nadolsky is the director of Examine.com and a practicing physician in Virginia. His personal blog is DrSpencer.com.

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On Keto? 8 Signs the High-Fat, Low-Carb Diet Isn’t Right for You

Just because a diet is trending or your coworker/brother-in-law/neighbor swears it worked for them doesn’t mean it’s the right fit for you.

“People often feel pressured to jump into the latest diet trend due to social media hype and marketing,” says Maria Zamarripa, RD, a functional medicine dietitian in Denver. The ketogenic diet (or keto diet for short) isn’t actually unique in this regard. “History has shown us that these trendy diets will come and go throughout the years,” she adds.

Right now, we’re heavy into keto, a very-low-carb, moderate-protein, and high-fat diet. The idea behind the diet is to switch your body from a carb-burning one to a fat-burning one, a state called ketosis or being “keto adapted.” There are many reasons why people go on keto. Though it was originally developed as a diet for children with epilepsy, it has expanded into potentially treating other health conditions, including type 2 diabetes. But when a diet is trendy, it’s usually the potential weight loss benefits that make it popular.

RELATED: Does the Ketogenic Diet Work for Type 2 Diabetes?

If you’ve been following keto (or keto-ish) since committing to it around New Year’s, you may be at the point where you’re thinking it’s not right for you after all. And that’s okay!

Here are eight signs that you should consider giving up on keto (though the advice applies to any diet):

1. Your Doctor Told You That Keto Is Dangerous for Your Health

Let’s just say that if you didn’t talk to your healthcare team before trying a restrictive diet like keto, you may be unnecessarily imperiling your health. That’s because while some doctors may recommend keto as a treatment for certain conditions, there are some people who shouldn’t go on it.

For instance, because the keto diet doesn’t allow many foods that are high in fiber (beans, many fruits, whole grains), Zamarripa does not recommend that someone with a personal or family history of digestive health conditions, including colon cancer, go on this diet. Fiber helps protect against digestive diseases, she says, which is supported by information from the National Institutes of Health.

In addition, if you currently have or have a history of an eating disorder, an extremely restrictive diet may be harmful, she says. Having kidney disease or type 1 diabetes may also make the keto diet dangerous for you.

In sum, if you’re on keto and seeing that your health condition is not improving (or is getting worse), you’d be wise to stop and ask your primary care doctor what eating plan best suits your personal health.

RELATED: The 11 Biggest Keto Diet Dangers You Need to Know About

2. Being on Keto Has Led You to Not Enjoy Food Anymore

Regardless of any underlying health condition you might have, we all have different dietary preferences — and factoring them into your diet decision can help you find one you’ll be successful with. Did you eat many tasty and healthy foods like fruits, whole grains, or sweet potatoes before keto? “Don’t try to ignore that and go against what your body wants. You’ll be able to eat like that for a limited amount of time, but eventually you’ll feel restricted,” says Megan Ware, RDN, who is based in Orlando, Florida. Fat may be filling, but if you’re not eating much because you don’t like pouring it all over your food, it’s not a long-term solution.

3. You’re Sneaking in Cheat Days on the Keto Diet

The need for a cheat day may happen because you feel overly restricted or because you don’t like what you’re eating on keto. Either way, needing a cheat day is a sign that keto isn’t right for you. Not only does a study published in February 2019 in the journal Nutrients suggest that keto cycling could damage blood vessels but it’s also not a healthy mentality to live in. “This is your life, and you get to decide how to live it. If every Monday you’re starting your diet over again, you’re not doing the right thing,” says Ware. The best healthy diet is one that you can follow for the long haul.

RELATED: 10 Healthy Foods You Can’t Eat on the Keto Diet

4. Your Family Just Doesn’t Understand — and That’s Making This Diet Complicated

If you’re on such a restrictive diet that you can’t attend family gatherings or you can’t eat the food that friends or family are serving — and thus have to eat alone before or after — you may feel socially isolated. “Food plays a key role in our culture and social connections, and it should be enjoyed,” says Zamarripa. If keto is taking away your ability to connect with loved ones, reconsider.

5. You Simply Don’t Feel Healthy on the Ketogenic Diet

When you go on keto, everyone will warn you about the keto flu, a time when your body is adjusting to fat burning and you often have symptoms of illness. You should start to feel better after a couple weeks, but if you still feel awful, you may not be properly fueling your body.

It may also be a good idea to work with your doctor and get lab tests taken after being on keto to see how your body is responding. Those can give you a clue that things aren’t going as planned.

Ware has tried keto. She experienced a significant jump in her cholesterol levels, and she had never had high cholesterol before. “There’s a debate on what higher cholesterol numbers on keto mean, but for me, this was another sign that my body didn’t like eating this way,” she says.

RELATED: Can the Keto Diet Help Prevent or Manage Heart Disease?

6. Once You Started Keto, Your Period Became Irregular or Went Away

You expected that keto might be the fix that would make your whole body feel better, but you haven’t had a period for a couple months. (And you’re not pregnant.) It may be your diet. “The ketogenic diet may affect hormonal signaling,” says Zamarripa. Losing your period after beginning a new diet is a sign that it’s too restrictive, she says.

7. The Keto Diet Isn’t Resulting in the Weight Loss You Thought It Would

Your friend has bragged about all the weight they lost effortlessly on keto, while the needle on your scale is barely going down. No matter what diet — keto or not — you follow, know this: It’s not you. “People feel guilty that they can’t lose weight on a diet. It’s not that you’re failing the diet, it’s that the diet is failing you,” says Ware. “The arbitrary set of rules that diets set are not based on you and what’s best for your lifestyle, preferences, and genetics.” The good news is that a registered dietitian can help you figure out another eating approach that has a stronger likelihood of helping you meet your health and weight loss goals, so don’t lose hope. Find an RD at EatRight.org.

RELATED: Keto Made Me Thinner — Here’s Why I Quit the Diet

8. You Feel Like You Can’t Wait to Stop Being on the Keto Diet

Honestly, if you’ve been doing keto since New Year’s, you’re on a longer track than most. “After three months on keto, many people come to me and say, ‘Now I’m looking for something more sustainable,’” says Ware. For any diet you embark on, ask yourself if you’re going to eat like this for the rest of your life. If the answer is no, it’s time to move on.

So You’ve Decided to Stop the Ketogenic Diet — What Now?

If you’ve had enough of keto, you have options — many of which have been researched and proven to be sustainable and healthy. Here are three diets to consider:

The Mediterranean Diet This anti-inflammatory style of eating has a food list that leans heavily on olive oil, legumes, vegetables, and fruits, and includes occasional dairy and meat like poultry and fish. “The Mediterranean diet is one of the most evidence-based and health-promoting eating patterns,” says Zamarripa. Important, though, is the focus beyond food and into social connection at mealtime, she says.

RELATED: 8 Scientific Health Benefits of the Mediterranean Diet

WW (Weight Watchers) This commercial diet is ranked as the No. 1 diet for weight loss in U.S. News & World Report’s 2019 diet rankings. Not only does WW aim to help members eat better (many foods, including fruits and veggies are zero points), it also fosters connection and provides support.

Flexitarian This semivegetarian diet wins accolades because it’s not entirely restrictive (see “flex” in the name), and there’s evidence that it helps followers lose weight and improve their health by reducing the risk of type 2 diabetes and high blood pressure, according to a review published online in January 2017 in Frontiers in Nutrition.

Keto Didn’t Work For Me So What Do I Do Now?

This post may contain affiliate links. Please read my disclaimer for more info.

I decided to write about this topic because I see it come up pretty regularly in a paleo group that I follow. People try keto, claim it doesn’t work, and now they’re switching to paleo. The problem I think is that there’s a lot of keto “information” online but some of it is complete nonsense in my opinion. Scrolling through Pinterest for keto recipes I wonder if people will ever poop again because there’s so much cheese. So much cheese.

If your version of keto consists of mug cakes made with a “keto sweetener” and bricks of cheese I hate to be the bearer of bad news but that diet isn’t going to work for anyone. A well formulated ketogenic diet is about more than just the macros. For decades we’ve been told that it’s all about calories and little attention has been paid to the quality of those calories. Keto has fallen to the same fate. People believe that as long as it fits the macros then “It’s all good.” That simply isn’t true.

Should You Jump Straight Into Keto?

Some coaches will tell you yes but I’d tell you no. People experience a carb flu when they go from SAD (Standard American Diet) to paleo. Why increase the level of suck by going even lower carb if you don’t have to? I know people who claim that they tried keto for a day but they couldn’t make it. If you want to go keto you have to build the metabolic machinery first. You have to remind your body how to switch from carbs as a primary fuel source to remembering how to burn stored body fat for fuel.

How Do You Get Your Body Into Ketosis?

This is a question that will need some explaining. Sure your body can produce ketones after a night of sleeping without food but is your body using them? There are people who recommend ketone test strips for urine. People pee on the strip and see ketones and they get wildly excited that they’re in ketosis. Not so fast. If you’re peeing out ketones it’s more than likely that your body isn’t using them. It’s good to know that your body is in fact making ketones but urine test strips don’t tell you much about the body’s use of them. With consistent low carbohydrate eating you should see ketones in urine decrease and/or disappear altogether.

When ketones disappear from urine test strips some people are led to believe that they’re doing it wrong. They think that their no longer in ketosis and that keto simply doesn’t work for them. Honestly that’s most likely 100% false. If you want to know what your blood ketone levels are you have to test your blood.

Can You Pass The Fat Burning Test?

Before you align your macros with a ketogenic template make sure your body is using stored body fat for fuel. What are the signs and targets?

  • Has your hunger signal switched from Hangry to a gentle reminder that maybe you should eat?
  • Is your energy level consistent throughout the day?
  • Can you effortlessly get by on 2 or 3 meals a day without snacks or feeling hungry in between meals?
  • Have you completely eliminated sugars and grains from your diet (including honey & maple syrup), eating less than 150 grams of carbohydrates per day or less?
  • You have completely removed vegetable oils from your diet. (corn, soy, canola, cottonseed, sunflower, & safflower oil)
  • You have been comfortably eating a variety of nutrient dense foods in a macro combination of high fat, moderate protein, and low carb intake.
  • You are getting in regular aerobic workouts at a heart rate of 180-age and incorporating lots of general everyday movement.
  • You are conducting brief high intensity workouts with full body functional movements a few times a week along with occasional sprints.
  • You have excellent sleep habits.
  • Are you managing stress well. (Increased daily movement, regular breaks during the day, disciplined use of technology, social time with friends, personal time for you, relaxing bedtime rituals, and consistent bed and wake times.)
  • You handle frequent 12-14 hour overnight fasting periods that can extend to 16 hours (8 pm -> noon the next day) with stable energy and mood.
  • You can skip lunch, or simply have a light snack and carry on productively until dinner without hunger pangs or loss of mental focus.
  • You are free from strong sugar cravings, high-carbohydrate treats, afternoon sleepiness, post-meal sleepiness, or early evening burnout when you come home from work.
  • You rarely notice your mood or concentration levels are affected by food.
  • You rarely experience significant hunger, say 2x/week or less.

If you said no to most of these then I’d definitely say you’re not ready for keto.

A Ketogenic Diet And Blood Sugar

If you’re taking medication to control blood sugar you must work with a physician who will work with you. A gal I helped noticed that her blood sugar levels kept dropping when she went paleo but her doctor told her to keep taking all of her meds. The result was that her kids had to call an ambulance because her blood sugar levels were too low and she passed out. She’s since changed doctors and cut her prescription meds from 8 to 4 but it’s imperative that you find a doctor who is supportive. Many doctors will tell you that you need to keep eating carbs because you’re taking blood sugar lowering meds and in the sense that you’d end up passed out on the floor, that’s true. However, that doesn’t reduce your medication dose and/or eliminate the medication all together.

If you’re going to do keto for a month or just for a special occasion then working with a doctor is going to be a lot of hassle for nothing. My advice is that if you’re going to do it, then plan on doing it indefinitely.

Join The Conversation @Jen’s Primal Discussion

Where can you find a doctor who will work with you? The Paleo Physicians Network is a great place to search for a physician in your area who understands low carbohydrate eating. Most functional medicine docs are also on board with this eating style. The other alternative is to simply ask.

The Non-Obvious Reasons Why Keto Didn’t Work?

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Your Exercise Routine

If you’re exercising at a high heart rate regularly for extended periods of time you’re actually working against your goal to burn body fat for fuel. People have been conditioned to believe that chasing calories will ultimately lead them to their goals but how’s that working out for America? We exercise more than any other country in the world yet we’re one of the heaviest. When you exercise at a high heart rate your body goes anaerobic and relies on glucose for fuel. If you’re trying to get your body to access stored body fat you’re defeating yourself.

Your Sleep & Stress Levels

When the body is stressed it goes into fight or flight mode by activating the sympathetic nervous system. That in turn causes the body to release cortisol. Your body perceives a threat and it still thinks you are a hunter gatherer who needs to outsmart a bear. Cortisol signals the body to release glucose from storage and make it available in the bloodstream, so that you have the necessary energy to beat the bear. When glucose is abundantly available, whether from internal or external sources, it’s going to make getting into ketosis a challenge.

How well do you sleep at night?

Did you know that your quality of sleep and overall health are tightly connected? Did you know that a good night’s sleep is just as important as exercise when it comes to body composition goals?

Study: A restricted-sleep schedule built to resemble an American work week made study participants feel less full after a fatty meal and altered their lipid metabolism. One night of recovery sleep helped, but didn’t completely erase the effects of sleep restriction.

Study: Partial sleep deprivation during only a single night induces insulin resistance in multiple metabolic pathways in healthy subjects.

Study: Losing 30 minutes of sleep per day may promote weight gain and adversely affect blood sugar control

If you don’t sleep well and/or regularly skip sleep for other things you feel are more important you may want to reconsider. For new moms, I completely get it. No one tells you that you’re not going to sleep for the next 2 years all they say is “when are you having a baby?” Unfortunately there’s not much you can do other than to share the evening duties with someone else. I’m married to a paramedic and I will vouch that his sleep schedule is horrible. I’d like to overhaul emergency medicine; if it’s not an actual emergency let the EMS crew rest. He’ll get calls in the middle of the night simply because a physician is too impatient to wait until the morning. Just because they are available around the clock doesn’t mean they should face long term health consequences for it. Right?

If you’re in a profession like this share the science about sleep deprivation and health consequences.

You Ate Too Much Fat

People tend to determine the level of their dietary success based on how much they weigh. Unfortunately that’s a poor indicator of overall health. This is why I don’t own a scale. Some people get carried away with eating fat when they’re following a ketogenic diet. While it’s true that initially eating more fat can help your body become fat adapted there’s a breaking point. How is your body supposed to burn your body fat when you’re constantly eating massive amounts of fat? It’s not. It’s going to burn what you’re eating instead of what’s stored.

Is Keto Right For Everyone?

Do I think that people should obsess over their macros daily? No. That borders on another type of diet culture eating disorder. Your ultimate goal should be metabolic flexibility. That is, you should be able to burn whatever fuel source is available.

Dr. Nasha Winters says that everyone gets cancer, it’s just a matter of when. In her book The Metabolic Approach to Cancer she advocates that a ketogenic diet can delay the onset of cancer.

Ultimately I think becoming fat adapted is attainable and I think that we should use it as often as we can. Our hunter gatherer ancestors had no idea what a calorie or a macro was so they didn’t obsess over either. I’m guessing that when they came across a berry patch in the summer they didn’t have any guilt about eating an entire bush of berries. The sugar they consumed help them put on fat for the winter which is when they’d need it the most.

When a person can easily incorporate intermittent fasting into their life and activate autophagy the science definitely supports the health benefits. (Autophagy is when your cells are allowed to clean house and repair themselves.) Then there are various approaches to carb cycling on a ketogenic diet. These of course depend on the person, their level of insulin sensitivity, activity levels, and goals.


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December 8, 2019

  • HFLC
  • Keto
  • Paleo
  • Weight Loss

The Keto Diet Is Super Hard—These 3 Variations Are Much Easier to Follow

The high-fat, very low-carb keto diet lets you enjoy lots of avocado, butter, bacon and cream—but requires cutting way back on added sugars, most processed foods, sweets, grains, and starchy veggies (whew). The eating plan is mega-popular among Hollywood A-listers (including Halle Berry, Megan Fox, and Gwyneth Paltrow); but if you don’t have a private chef who can futz with fats to make delicious meals and snacks, the carb-restricted lifestyle can be extremely challenging to follow.

Thankfully, a few keto variations have been developed that are a little more flexible, and easier to stick with long-term. The traditional or standard ketogenic diet puts your body into ketosis: In this metabolic state, you burn fat (rather than carbs) as your primary fuel source, and that promotes fat loss. On a modified keto diet, your body will go in an out of ketosis, but still shed weight and body fat. Check out the guide below to see how each of the four keto diet types work.

RELATED: 5 Supplements You Should Take If You’re on the Keto Diet

Standard ketogenic diet (SKD)

Macronutrient ratio: 75% fat,15-20% protein, 5-10% carbs

On the standard keto diet, you plan all meals and snacks around fat like avocados, butter, ghee, fatty fish and meats, olives and olive oil. You need to get about 150 grams a day of fat (the amount in nearly ¾ cup of olive oil and three times what you are likely eating now) in order to shift your metabolism so it burns fat as fuel. At the same time, you need to slash your carbs from about 300+ grams per day to no more than 50 (which is about the amount found in just one blueberry muffin). That means sticking to leafy greens, non-starchy veggies, and low-carb fruits like berries and melon. Finally, you’ll eat a moderate about of protein, which is about 90 grams per day or 30 grams at each meal (think 4 ounces of meat, fish, or poultry).

RELATED: 4 Reasons You’re Not Losing Weight on the Keto Diet, According to Nutritionists

Targeted keto diet (TKD)

Macronutrient ratio: 65-70% fat, 20% protein, 10-15% carbs

The targeted keto diet is popular among athletes and active individuals who live a keto lifestyle but need more carbs. It allots an additional 20-30 grams of carbs immediately before and after workouts to allow for higher-intensity exercise and enhanced recovery. (The total carb count comes to 70-80 grams per day.) The best options include fruit, dairy or grain-based foods, or sports nutrition products. Because the additional carbs are readily burned off, they don’t get stored as body fat.

RELATED: 9 Fruits You Can Actually Eat on the Keto Diet

Cyclical keto diet (CKD)

Macronutrient ratio: 75% fat, 15-20% protein, 5-10% carbs on keto days; 25% fat, 25% protein and 50% carbs on off days.

Keto cycling is a way to cycle in and out of ketosis while enjoying a more balanced diet on your “days off.” One keto cycling approach includes five days of traditional keto diet and two non-keto days per week. Some people choose to save their off days for special occasions holidays, birthdays, and vacations. For best results, eat wholesome carbohydrate-rich foods on your off days, including fruits, starchy veggies, dairy products, and whole grains (rather than added sugars or highly-processed fare).

RELATED: Your Ultimate Keto Diet Grocery List

High-Protein Keto Diet (HPKD)

Macronutrient ratio: 60-65% fat, 30% protein, 5-10% carb

This plan entails eating about 120 grams of protein per day (or four 4-ounce servings of meat, fish or poultry) and around 130 grams of fat per day. Carbs are still restricted to less than 10% of daily calories. But many people find this modified keto diet easier to follow, because it allows you to eat more protein and less fat than the standard keto diet. The caveat is that this approach may not result in ketosis, because like carbs, protein can be converted into glucose for fuel. But the high-protein keto diet will generally result in weight loss.

One final note: Keep in mind that the jury is still out on whether or not the traditional keto diet—of any of its popular adaptations—is a preferred way to lose or maintain a healthy weight. Before you decide to give it a go, these are a few of the side effects and complications linked to the diet.

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It’s all the rage. The internet is filled with stories of how everyone from movie stars to ordinary people have shed stubborn pounds with the ketogenic diet. Some suggest that this eating pattern also may be helpful for managing diabetes and warding off Alzheimer’s disease. So, is it a miracle diet or just the latest fad?

How the Keto Diet Works

The ketogenic diet is a high fat, moderate protein, low carbohydrate eating pattern, which differs from general, healthful eating recommendations. Many nutrient-rich foods are sources of carbohydrates, including fruits, vegetables, whole grains, milk and yogurt. On a keto diet, carbs from all sources are severely restricted. With the goal of keeping carbs below 50 grams per day, keto dieters often consume no breads, grains or cereals. And, even fruits and vegetables are limited because they, too, contain carbs. For most people, the keto diet requires making big shifts in how they usually eat.

Why does the Keto diet restrict carbs?

Carbs are the main source of energy for our body. Without enough carbs for energy, the body breaks down fat into ketones. The ketones then become the primary source of fuel for the body. Ketones provide energy for the heart, kidneys and other muscles. The body also uses ketones as an alternative energy source for the brain. Hence, the name for this eating pattern.

For our bodies, a ketogenic diet is actually a partial fast. During a total fast or starvation state, the body has no source of energy. Thus, it breaks down lean muscle mass for fuel. With the keto diet, the ketones provide an alternative source of energy. Unlike a full fast, the keto diet helps to maintain lean muscle mass.

Is the Keto Diet Safe?

This eating pattern is not recommended for individuals with:

  • Pancreatic disease
  • Liver conditions
  • Thyroid problems
  • Eating disorders or a history of eating disorders
  • Gallbladder disease or those who have had their gallbladders removed

Plus, there are both short-term and long-term health risks for all people associated with the keto diet. Short term health risks include flu-like symptoms. For example, upset stomach, headache, fatigue and dizzy spells. This is called the “keto flu.” Some people also report trouble sleeping. Cutting back on high-fiber vegetables, fruits and whole grains also can increase risk for constipation. Often keto dieters must take a fiber supplement to help stay regular, but this should be discussed with a health care provider.

Long term health risks of the keto diet include kidney stones, liver disease and deficiencies of vitamins and minerals. To limit carbs, many nutrient-rich vegetables and fruits are cut out. Thus, intakes of vitamin A, C, K and folate usually are low.

The high fat nature of the keto diet is very controversial. A considerable body of research has shown that diets high in saturated fat may increase the risk for heart disease and other chronic health problems. The risk that keto dieters might be taking with regards to their long-term cardiovascular health has not been fully studied.

What the Science Tell Us About the Keto Diet

The keto diet has been used to help manage epilepsy, a disorder characterized by seizures, for more than 100 years. More recent studies are evaluating the keto diet as an alternative dietary treatment for obesity and diabetes. Research findings on the benefits of the keto diet for these health conditions are extremely limited. Studies on effectiveness of the keto diet were conducted with small groups of people. And, most of the research about Alzheimer’s disease relies on research done on lab animals. To fully assess the safety of this eating pattern, more research is needed. Plus, studies must be done on the long-term health effects of the keto diet.

Body mass index and individual metabolic rates impact how quickly different individuals produce ketones. This means that on the keto diet, some people lose weight more slowly than others — even if they are following the same exact keto diet plan. For this group of people, the keto diet can be frustrating and may impact their motivation for making healthy dietary changes. Plus, many people are not able to stick with the keto diet and gain back the weight after returning to their previous pattern of eating.

The Bottom Line

The ketogenic diet is quite restrictive. Research supports this eating pattern for epilepsy when managed along with a health care team, since its treatment can be very complex. However, with regards to the keto diet as a tool for weight loss and other health benefits, the jury is still out.

For a personalized weight management plan that meets your individual needs, consult a registered dietitian nutritionist. An RDN can create a personalized weight loss program based on your unique health and nutrition needs and goals. To find a dietitian in your area, search the Academy’s Find an Expert database.

The low carb, high fat diet (LCHF diet) has developed a strong following in Scandinavia, having originated in Sweden.

The story goes that Swedish GP Dr Annika Dahlqvist was subject to an investigation after being reported for recommending a low carb, high fat diet to her patients.

The investigation though cleared Dr Dahlqvist of wrong doing based on their findings that her methods were scientifically sound.

What is the low carb, high fat diet?

As the name suggests, the diet suggests eating high fat and low carbohydrate foods.

Who is the diet for?

The diet, because of its low requirement for insulin, has been recognised by the Swedish government as being suitable for people with type 2 diabetes and as helpful to individuals looking to lose weight or maintain a healthy weight.

Which foods can I eat on the LCHF diet? – Green light foods

The following foods are compliant with the diet:

  • Dairy : natural yoghurt, cheese, cream, butter
  • Meat
  • Fish
  • Eggs
  • Vegetables
  • Olive oil and canola oil (organically grown and cold-pressed)
  • Home made sauces

The recommendation of the low carb, high fat diet is that people eat full fat versions of dairy food in preference to low fat options.

The diet does not rule out fatty meats and instead encourages people to leave the fat on rather than removing it.

Organic versions of foods are suggested where possible.

What food can I have up to moderate amounts? – Amber light foods

The following foods can be eaten in moderate amounts:

  • Bean and lentils
  • Nuts, almonds and sunflower seeds
  • Fruit (not including dried fruit)
  • Chocolate with a high cocoa quantity (65 to 90%)

Sausages can be eaten occasionally but can include undesirable additives.

Alcohol can be included with the note that it is fattening and can lead to imbalances in blood sugar.

What should be avoided on the diet? – Red light foods

The diet suggests that only a minimal amount of the following should be eaten:

  • Potato, rice, bread, flour and corn based products
  • Other cereal-based products – such as pasta, pastry, biscuits and breakfast cereals.
  • Dried fruit
  • Sweets and cakes
  • Sugary drinks
  • Margarines
  • Omega-6 based oils – such as corn, sunflower, safflower, soybean and peanut oil

How can I find more information about the LCHF diet?

A great introduction is the book, ‘Diabetes, No thanks’.

The book is an English language description of one man’s journey from his diagnosis of diabetes, through to controlling his diabetes with the diet alone.

Why High Fat?

The most important take-home message is to only increase your fat intake once you lower your carbs. And remember it is healthy fat we want to increase such as avocado, butter, olive oil and coconut oil, not ‘fatty foods’, there is a difference.

If you increase your fat and don’t lower your carbs, all you are doing is ending up on the Standard American Diet (SAD) which is high-fat high carb, and the cause of all the modern health problems such as obesity, T2 diabetes, heart disease, stroke and cancer.

If you increase your fat but don’t cut back on the bread, cakes and biscuits, you are going to end up with weight gain, poor appetite and poor biomarkers, pretty much where you probably started off. This is the most critical step to get right.

Do not to go for low-fat products. When fat is removed, so is much of the nutrition and it is generally replaced with some form of carbohydrate. For example, low-fat cream cheese has 15% carbs whereas regular spreadable cream cheese has only 4%. You will go through a period of reading every label, but you will soon recognise the brands and the foods to buy.

Buy the least processed, freshest, closest to nature foods as you can. If it has a long expiry date, ask yourself why? Food shouldn’t last months or years, buy food that rots, buy food that your grandmother would recognise and buy ingredients, not products. Simple rules, simple food.

The fear of fat and cholesterol are the foundation of our dietary guidelines for the past 2 generations. It is wrong and there is no scientific basis (see links in the navigation bar for more articles). I encourage you to read these and learn how research regarding cholesterol has changed over the past decade.

This is a great low-carb lesson on all things cholesterol. It explains how cholesterol is essential to all humans and really it is not cholesterol which is the problem but the proteins that carry cholesterol around the body. The great visuals show LDL, LDL size, LDL particle count and the bottom line is that cholesterol is NOT the enemy.

I have embedded a clip at the bottom of this page for those who want to delve deeper, but here is a brilliant presentation by Dr Andreas Eenfeldt which brilliantly summarises the science behind LCHF and why we have got it wrong about reducing fat.

Another article by Professor Grant Schofield talks about how hard it is to challenge the establishment. My favourite quote in the article,

“science isn’t a democracy. We don’t have a vote and the most popular hypothesis wins. We deal with evidence”

For a full in-depth explanation of the relationship between carbs, lipoproteins and inflammatory factors HDL, LDL, triglycerides… read “The Art and Science of Low Carbohydrate Living” by Volek and Phinney. It explains the complex picture and relationship between carbs, fat, LDL, HDL, TG.

For decades we have been told to reduce our fat intake, especially saturated fats to reduce cholesterol and our risk of cardiovascular disease (CVD). Yes reducing saturated fats and butter etc from our diet reduces your cholesterol, but it mainly reduces HDL which is your good cholesterol and makes smaller LDL (bad cholesterol) which is more damaging.

The majority of cholesterol circulating in our bloodstream is low-density lipoprotein cholesterol (LDL). The proposed link between LDL and heart disease is the basis behind restricting cholesterol and saturated fat intake, and the use of statin medication. Studies have now shown you can indeed reduce LDL by dietary restrictions, or by the use of statins, but the reduction does not actually reduce the incidence of heart disease or reduce mortality rates.

“People have been recommending low-fat diets for 30 years, and then it turns out to be completely wrong! There is no proven correlation between saturated fats and CVD”. Fredrik Nyström, Professor of Internal Medicine, Linköping.

“It’s time to face the facts. There is no connection between saturated fats and CVD”. Peter Nilsson, Professor of Cardiovascular Research, Lund.

“Two generations of Swedes have been given bad dietary advice and have avoided fat for no reason. It’s time to rewrite the dietary guidelines and base them on modern science”. Göran Berglund, Professor of Internal Medicine, Lund.

When fat is removed from our diet, it is usually replaced with carbohydrates. Eating fat allows you to feel full, fat is full of Vitamins A, D, E and K, cholesterol is the basis of our hormones.

LDL/HDL ratio

LDL (bad) carries cholesterol and other lipids from the liver to the body and the organs.

HDL (good) carries cholesterol and lipids from the body back to the liver for disposal.

So too much LDL can lead to an accumulation in circulation, arterial walls, plaque formation and arterial disease – or is it? New studies have shown that reducing LDL by a low-fat diet or a high-fat diet, the high-fat diet does a better job at reducing the real incidence of heart disease. So much so, the Lyon Diet Heart Study was terminated early due to the dramatic decrease in mortality with the group that ate the 40% fat Mediterranean type diet vs. the American Heart Assoc Healthy Diet. Another study of postmenopausal women showed reducing dietary fat intake reduced LDL but had no effect on cardiovascular disease (stroke, heart attack, and overall mortality) after 8 years.

LDL quality vs quantity

It is also known that LDL is only part of the picture of lipid profiles. Smaller LDL particles are more atherogenic (dangerous) than larger ones. And yes LDL concentrations increase as a result of a low carb diet, BUT low carb diets significantly increase the LDL particle size and the compelling new data associates small LDL particles with increased rick of CVD.

Furthermore, you should not be concerned if on a low carb diet your LDL remains the same or slightly increases. IF other lipid and inflammatory markers dramatically improve, generally your small particle LDL decreases, serum triglycerides reduce and HDL increases. All potent factors which reduce your overall CVD risk.

Statins and low carb diets

If your LDL is raised, the standard protocol is to decrease dietary cholesterol and saturated fats and possibly begin taking a statin. There is no question that statins reduce LDL but new studies are indicating their effect to reduce CVD is due to their anti-inflammatory effect rather than reducing LDL.

It is a difficult decision to start using a statin drug. The benefit of the anti-inflammatory effect, against the major side effects of dementia, fatigue, muscle pain and increased risk of diabetes. New figures show that up to 87% of the patients taking statins may be unnecessary. This is something that needs to be discussed and researched further.

Volek and Phinney state that if lowering your LDL is your main goal, then a low-fat diet and a prescribed statin make sense BUT should just lowering your LDL be the correct aim?

A low carb diet, however, improves LDL particle size, raises HDL (good), reduces triglycerides, lowers insulin resistance, lowers inflammatory markers and lowers blood pressure.


Raised fasting triglycerides (TG) are a clear risk factor for heart disease, they also are an early sign of insulin resistance and your bodies inability to metabolize carbohydrates.

The body generally has 5g of glucose circulating, but an average meal may contain 100g carbs. Anyone who is insulin resistant will convert these excess carbs into fat (via de novo lipogenesis) rather than converting the excess glucose into glycogen (which is self-limiting). These are turned into triglycerides which if they are not released from the liver, will build up and cause fatty liver disease (hepatic stenosis).

TG containing saturated fats are associated with insulin resistance more than those TG containing essential fatty acids. It is simplistic to think the saturated fats we eat are to blame for insulin resistance and CVD. However, with insulin resistance, the liver readily converts carbs to fat and the main product is saturated fat!! When excess carbs are eaten, saturate fat VLDL particles are produced by the liver, which in circulation are converted to small particle LDL (remember the dangerous, reactive ones). Therefore a high saturated fat content in your TG is directly related to your carb intake!! and how well your body processes it.

Raising HDL

This is the lipoprotein that takes the lipids from the body back to the liver for disposal. It is one of our best indicators for long-term cardiovascular health. HDL is the lipid scavenger.

HDL also increase the bioavailability of nitric oxide (important regulator of vascular function and blood pressure), is an antioxidant, anti-inflammatory, antithrombotic, all contributing to its anti-atherogenic properties.


The basic understanding that dietary intake of saturated fat and LDL levels, predict CVD is to say the least, questionable. The current model of reducing fat intake (and increased carbs) has a marked negative effect on TG and HDL.

The TG/HDL ratio is a broader assessment of risk and its relationship with insulin resistance, making it superior and more accurate than focussing on LDL.

How do we improve the TG/HDL ratio? By reducing carbs we improve all CVD risk factors

  • decrease TG
  • increase HDL
  • increase LDL particle size

“low carbohydrate diets are unparalleled by any other lifestyle intervention or even drug treatment, and therefore represents the most powerful method to improve this ratio”.

The Cochrane Collaboration (a review of all studies published) came to the conclusion “… no significant evidence for concluding that dietary saturated fats are associated with an increased risk of CHD or CVD”.

One final video to watch for those who want to know the nuts and bolts of cholesterol, here is Dr Peter Attia. For more videos, take a look at my YouTube Channel.

“atherosclerosis is NOT a lipid mediated disease, atherosclerosis is a lipoprotein mediated disease”

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A Low Carb, High Fat (LCHF) Diet is a way of eating that restricts the amount of carbohydrates and increases the amount of healthy fats that you eat to optimise your health and nutrition.

We define a Low Carb Diet as less than 30% of your daily calories coming from carbohydrates (the average Australian is currently consuming about 50%). For those of us with weight to lose or other health issues to address a much lower intake of 5 to 10% of calories coming from carbohydrates may be required.

We do this by eating real, whole foods that are not processed – the type of foods our bodies were designed to eat.

In practice this means removing sugar, bread, pasta, rice, beans, starchy vegetables (i.e. potatoes) and processed foods from your diet. There is no nutritional need for any of these foods that cannot be found from other sources and carbohydrates are simply not an essential nutrient. This also means eating plenty of non-starchy vegetables, meat, eggs, butter, cream, olive oil and nuts.

While this way of eating may initially appear restrictive and unsustainable, this approach to nutrition allows you to eat a delicious and varied diet that leaves you feeling satisfied. It allows you to eat when you are hungry and still lose weight while improving your health and controlling your blood sugar.

Is a low-carb or keto diet right for you?

Where to start: For more information on treating epilepsy with a keto diet, watch this video:


11. Cognitive decline, Alzheimer’s disease, and other neurological conditions

In treating existing cognitive decline, whether it is Alzheimer’s disease or other forms of dementia, switching your brain’s fuel from glucose to ketones appears to have a positive effect.45 Alzheimer’s disease is sometimes referred to as “Type 3 Diabetes” as it appears to include insulin resistance of the brain and a reduced ability for brain cells to take up glucose.46 So switching fuel sources may be beneficial.

The biggest potential for using a ketogenic diet as a therapy may be in mild cognitive decline, but the lack of alternative treatments for severe cognitive decline make dietary changes attractive, although improvement has been difficult to demonstrate.47 This may also be an area where ketone supplementation could be beneficial, but again the level of evidence about consuming extra ketones over and above dietary changes is still low.48

Ketones appear to have a protective effect on the brain in general, and therefore we can speculate that a ketogenic diet may possibly benefit various neurological conditions such as traumatic brain injury, stroke, and other causes of nerve cell damage.49 This remains a hot topic of research.

How low to go for cognitive issues?

Early, limited data suggest a keto diet, which switches the brain’s fuel from glucose to ketones, may be beneficial in improving symptoms of Alzheimer’s dementia. While still highly exploratory, some individuals may want to try a ketogenic diet to see if their cognitive function improves when they remain in ketosis. To achieve this, most people would need to routinely stay under 20 grams of carbohydrate a day.

In theory, shifting the brain’s metabolism from glucose to ketones could offer protective effects for other neurological conditions. While ketogenic diets for posttraumatic brain injury, spinal cord injury, and Parkinson’s disease are now being actively researched, the data is so far very early and not yet conclusive to indicate it as a therapy.

Where to start: Diet Doctor has written some articles about the burgeoning, but still controversial, area and we have also published a video presentation about insulin and the brain by psychiatrist Georgia Ede below:

The ketogenic diet for Alzheimer’s prevention and treatment: can it help?

GuideAlzheimer’s disease and other related neurodegenerative conditions, which impact memory, behavior and decision-making, are now an epidemic hitting all Western societies.


12. Cancer adjunctive therapy

Ketogenic diets have the potential to assist in the treatment of certain cancers. Some cancer cells have an abnormal metabolism such that they depend completely on glucose for their fuel and are unable to oxidize fatty acids.50 Theoretically, switching the body’s metabolism from glucose to fatty acids, as happens in a ketogenic diet, could potentially help treat some types of cancer.51

Based on the need for an altered metabolism, low-carb diets likely would not be as effective as keto diets. In addition, a ketogenic diet may help sensitize cancer cells to make radiation and chemotherapy more effective. Although the ultimate effect is speculative, this could help reduce the required dose to allow for adequate treatment with fewer toxic side effects. 52

Animal research and limited human data suggest that a ketogenic diet may be beneficial when combined with traditional therapies for treating brain, prostate, colon, pancreatic and lung cancer.53 However, we should recognize that forms of cancer may differ greatly, and for some cancers, a ketogenic diet may not be the best approach to use, even in conjunction with medical treatment.54

Importantly, the amount of human evidence supporting a ketogenic diet for cancer treatment is limited, and this evidence supports a ketogenic diet combined with traditional treatment such as surgery, radiation and chemotherapy. No convincing data exists yet to support that a ketogenic diet is superior to traditional therapy, or that it should be used as a solitary treatment.

This should be considered a scientific field in its infancy, with more information to come.

How low to go?

It is too early to conclusively say keto diets help treat cancer, but preliminary evidence points to potential benefits when combined with traditional cancer therapies.

Furthermore, although no studies of this have been done, for an individual who is controlling type 2 diabetes or other conditions with a keto or low-carb diet, continuing this diet while undergoing cancer treatment might help to maintain overall health.

Where to start: For more information about how diet and cancer may be related, see Diet Doctor’s introductory discussion about the Warburg effect and cancer and the Diet Doctor article discussing existing science and debate around using the ketogenic diet as an addition to standard therapy for the brain cancer, glioblastoma.

13. Lifestyle concerns

Athletic performance

Athletic performance on a keto diet remains a controversial subject with conflicting data.55 Issues of adaptation time, type of exercise, differences of training and racing diets, and baseline fitness all play a role in measuring response. Some studies that found a negative response investigated the effect of a keto diet on performance over as little as four days.56 That is a woefully inadequate time to allow for adaptation to a keto diet.

Fully adapting to a keto diet may take a lot of time, something many athletes may not have in preparation for an event. Yet to see maximal benefit, there needs to be a shift in fuel metabolism to ketosis and adequate adaptation to this state.57 It is estimated that this adaptation period typically lasts four to six weeks, but in some cases may take much longer.58

The leading book on the keto diet and athletic performance is The Art and Science of Low Carbohydrate Performance by Jeff Volek PhD, RD and Dr. Stephen Phinney, MD, PhD.59 The authors note on the book’s website: “The key fact underlying this book is that you can train your body to burn fat by simply changing your diet over a period of a few weeks, thereby turning blood sugar and glycogen into secondary fuels. Once you make this transition, you can then train harder, perform longer, and recover faster.“

Based on anecdotal reports, it appears there are subsets of endurance athletes who thrive on a ketogenic diet, just as there are subsets who do worse.60 As of now, the science does not adequately define a way to predetermine who will do well and who will not. If one is willing to do a self-experiment for a minimum of six months, then a trial of a ketogenic diet seems reasonable.

For those who struggle, transitioning to a non-ketogenic low carb diet, such as 150 grams of carbs per day, might allow athletic performance to improve, especially for the more glycolytic (glucose burning) activities such as sprinting or interval demands (for example, jiu jitsu). We don’t have solid evidence to compare a non-ketogenic low-carb diet to a high-carb diet, so again self-experimentation is likely the key to finding the best individualized approach.

Verdict: In theory, endurance exercise performance could improve with a keto diet after a prolonged adaptation period, but the data are inconclusive.

Mental health, performance, and attention

This is an area full of anecdotal reports but with a shortage of scientific evidence. In theory, shifting the brain’s metabolism from glucose to ketones could be beneficial for cognitive function in general. Therefore, a ketogenic diet of under 20 grams is required. Even then, however, there is no consensus as to improved cognition. This is an era best left to self-experimenters to see if they happen to see improved mental clarity and less brain fog.

Verdict — No clear evidence. Self-experimentation with a keto diet is reasonable, as carbohydrate is a non-essential nutrient. Diet Doctor has written a few articles that explore the nature of the evidence so far for both mental health conditions and for attention deficit disorder.

There’s a good chance you know someone who swears off bread with the same rigor that vegetarians steer clear of steak. It seems that low-carbohydrate diets are the only way people lose weight these days, and the high-fat ketogenic plan is the most popular carb cutting method.

In fact, keto was the most researched diet in 2018, according to Google.

But it’s not the only way to reduce carbs–it’s just the most restrictive since it eliminates many nutritious foods, like bananas, sweet potatoes, and oatmeal.

What’s the deal with keto vs. low carb?

Keto enthusiasts may swear off bread to lose weight, but you can enjoy pasta, bananas, and even bagels, on a low-carb diet.

That’s because maintaining ketosis, a metabolic state where you burn fat instead of carbohydrates for energy, is the backbone of keto. Sure, this sounds ideal, but making the switch is difficult. You’ll have to consume roughly 65 to 85 percent of your calories from fat. The specific number varies by person, but it generally means eating fewer than 30 grams of carbs per day.

Then, another 20 percent of your calories come from protein, while carbs are restricted to 10 percent of your total daily food consumption. Nailing this ratio is challenging, because most foods include a mix of these three macronutrients. Avocados and nuts are rich sources of fat, but they also contain carbs.

Many foods are out. What foods are OK on a keto diet?

Eating a high-fat diet is harder than it seems, given that protein and carbs are restricted. People often confuse keto as a high-protein diet, but that’s not the case, says Melanie Boehmer, MS, RD, CDN, CISSN, and outpatient dietitian at Lenox Hill Hospital.

“If you eat too much protein that can kick you out of ketosis,” she says. “It’s not just a matter of paying attention to your carbohydrates.”

Oils are a staple on the high-fat diet. Fattier cuts of meat, such as bacon, avocados, cheese, and steak are often found in keto meals. However, you’ll want to watch portions to limit protein and carbs.

Many beneficial foods– fruits, starchy vegetables and beans–need to be avoided, which may lead to vitamin and fiber deficiencies. Be sure to incorporate as many leafy greens, broccoli and cauliflower, as possible to ensure you’re getting enough nutrients.

In comparison, there isn’t a “right way” to go low-carb.

“There’s not an official definition,” Liz Weinandy, M.P.H. and R.D. at Ohio State University, explains to Men’s Health. Eating 150 grams of carbs per day is considered low-carb for people who were previously eating double that amount

No food is off-limits, meaning you can eat bread, pasta, and starchy vegetables. Nearly any dietary preference including Mediterranean or vegetarian diets can be made low-carb.

In the absence of rules, here’s the healthy way to try a low-carb diet:

Before overhauling that weekly grocery list, stop and consider your goals, advises Boehmer.

100+ Amazing Low-Carb, High-Fat Recipes & 21-Day Meal Plan amazon.com $24.95

Eating fewer carbs can be helpful with weight loss, but active adults preparing for a 10k or trying to build muscle should reconsider this approach.

“If you’re a high performing athlete, there’s no way you should be cutting carbohydrates,” Boehmer explains to Men’s Health.

Thinking about your motivation is also helpful. Does a particular diet fit your lifestyle (and palate) or are you enticed because everyone else is doing it?

Once you’ve decided on low-carb, study your current eating habits, Boehmer recommends.

A food journal, or apps like MyFitnessPal that track overall calories as well as macronutrients, can offer a more detailed assessment of your diet. Check out the 2015–2020 Dietary Guidelines, which offers recommended daily servings of each macronutrient–carbohydrates, protein, and fat. For example, the average 30-50 year guy eating 2200 calories is advised to get roughly 45-65 percent of his daily calories from carbohydrates. That’s about 150 grams, but many Americans consume well over 200 grams of carbs per day, says Boehmer.

“The standard American diet has definitely become carbohydrate dominant,” she says. “We’re sedentary. The reality of that is we don’t need a lot of carbohydrates.”

Of course, everyone’s needs are different. You can determine what’s right for you by using the Body Weight Planner from the National Institute of Health.

Westend61Getty Images

Avoid drastic changes. Instead, gradually decrease the number of carbs you eat by 15 grams per day.

If your eat bagels and pasta daily, then changing to a drastic diet like keto will be brutal. Boehmer recommends starting slowly by eliminating 15 grams of carbs at a time, about one serving.

Look for ways to scale back that don’t feel restrictive: eat one piece of toast at breakfast instead of two. If that’s manageable, cut back by another 15 grams and ditch half the bun on your burger at lunch. Ideally, you’ll want to get about 30-40 percent of your calories from carbs, says Weinandy. Don’t overlook total calories, protein, and fat: all are important to maintain a balanced diet.

Low-carb diets offer a wealth of benefits, including weight loss and stable blood sugars.

However, the effectiveness of a diet depends on execution. A plate filled with fruits, vegetables, protein, and healthy fats will keep you regular, satiated and energized. Meals that omit food groups could leave you with vitamin deficiencies.

In fact, consuming higher quality low-carb foods–like salmon, leafy greens, and nuts–may add 12 years to your life, according to research published last year by Harvard University. And numerous studies show that ultra-processed foods like sugary cereal, generally high in carbs, are linked to an increased risk of cardiovascular disease.

What’s more, low-carb diets are particularly helpful at regulating blood sugar, according to a study published last year in the journal Pediatrics.

Low-carb vs. keto: which is better?

Ultimately, this question is best answered by assessing your goals and preferences. That said, many people find keto too difficult to maintain.

“Not having that rigidity is a little bit more of a relief for some people,” says Boehmer. “It gives you more flexibility to find what works for you.”

Melissa Matthews Health Writer Melissa Matthews is the Health Writer at Men’s Health, covering the latest in food, nutrition, and health.

Bulletproof vs. Paleo vs. Low-Carb and Ketogenic Diets: What’s The Difference?

  • On the Bulletproof Diet, you eat lots of healthy fat, high-quality protein, and minimal carbohydrates.
  • It’s designed to melt body fat, improve focus, and boost your overall performance by limiting your exposure to anti-nutrients, toxins, hormones, and other junk that makes you weak.
  • The Paleo diet is a primal or ancestral diet based on the types of foods presumed to have been eaten by early humans — meat, fish, vegetables, and fruit.
  • The ketogenic diet places you in a fat-burning state called ketosis. To get there, you eat lots of fat, moderate protein, and very few carbs.
  • There is quite a bit of overlap in what foods you eat on Paleo vs. keto vs. Bulletproof. Read on to understand the key differences, and what makes Bulletproof stand out.

Choosing the right diet makes all the difference in how you feel every day. I was in my 20s when I started suffering from severe fatigue and cognitive dysfunction. I was 300 pounds, sick constantly, and almost had to drop out of grad school because I couldn’t concentrate.

Back then, I thought my inability to think clearly and perform at high levels was some sort of moral failing. I would beat myself up. I would work harder and stay up later, trying to catch up with my peers.

I tried every diet imaginable, including raw vegan, keto, and Paleo, and spent years falling off the low-fat bandwagon. I hit the treadmill for hours every day. Nothing worked. So I took matters into my own hands.

“The Bulletproof Diet” was born after a decade of working with some of the world’s top health and nutrition researchers. Over a span of about 15 years, I devoured thousands of research papers and books on human nutrition. I used my body as a testing ground to determine what worked best for my biology.

The result is a diet that has helped thousands of people lose fat and gain the energy and clarity they thought they’d lost forever. So, what differentiates the Bulletproof Diet from other low-carb diets? Read on to find out.

Related: Take the guesswork out of keto with this 7-Day Cyclical Keto Meal Plan, plus Keto Recipes Cookbook

Bulletproof vs. keto vs. Paleo: The big picture

If you were to map out the most popular diets, you’d see a vast spectrum of practices and plans ranging from low-fat vegan to high-fat, low-carb (HFLC). This deliciously fatty end of the spectrum is where the Bulletproof Diet and the keto, Paleo, and Atkins diets would lie.


The ketogenic diet is a style of eating that places you in ketosis — a state in which your body burns fat for fuel, instead of carbs. To achieve this state, you eat lots of high-quality fat, moderate protein, and very few carbs. This diet doesn’t specify how you hit your macros, and it doesn’t restrict full-fat dairy. Learn more about keto with this detailed beginner’s guide.


The Paleo diet eliminates processed foods and focuses on what our Paleolithic ancestors ate — mostly meat, plants, nuts, and seeds. It excludes dairy, grain products, and sugary processed foods. The Paleo diet uses proteins and healthy fats to support strong muscles, healthy bones, and optimal immune function.

The Bulletproof Diet

The Bulletproof Diet is similar to these diets, but it upgrades your life by taking your food a step further. The Bulletproof Diet is designed to maximize your willpower by reducing cravings and minimize aging by focusing on how food works in your body on a biochemical level. Cavemen didn’t have mass spectrometers and microscopes and modern science. They weren’t biohackers and lacked the control of their environment that we take for granted today.

New to the Bulletproof Diet? Here’s the overview:

  • The Bulletproof Diet tells you what type of food to eat, when to eat it, and how to cook it.
  • It features high amounts of healthy fats, moderate amounts of high-quality protein, and tons of organic vegetables. You eat within certain timeframes in order to create unbelievable levels of energy and mental clarity throughout the day.
  • It identifies the exact foods that provide the most energy and contain the least performance-robbing, inflammation-causing anti-nutrients and toxins.
  • It hacks the root of food cravings, allowing you to lose weight with zero hunger or a battle of willpower.

While the Paleo and Bulletproof diets agree that sugar and grains aren’t really food, Bulletproof came about through anti-aging, cognitive performance, and fertility research, not by focusing on ancestral health. The Bulletproof Diet is different than Paleo and similar diets because it takes into account the factors outlined below.

The Bulletproof approach to fats, meat, and carbs

The Bulletproof Diet focuses on both quality and quantity: the quality of your food is super important, but you should also play around with the ratios of fat, protein, and carbs you consume. We encourage a bit more fat than most Paleo authors (50-70% or more), including butter (a food that’s been debated in the Paleo community for a while), and moderate protein consumption.

This is opposed to most Paleo meal plans, which offer a bit more protein, and moderate fat and carb consumption.

One of Bulletproof’s most distinguishing, most effective features in making you feel your best is that it encourages you to eat more fat than most low-carb diet plans and includes one day per week of protein fasting. Pretty unheard of in the Paleo scene.

And of course, there’s Bulletproof Coffee, which isn’t technically Paleo, because cavemen didn’t have butter, lab-tested mold- and toxin-free coffee, or the ability to concentrate the most useful 6% of coconut oil in a non-oxygen atmosphere (i.e. Brain Octane Oil). Or blenders. Cavemen didn’t have those either. But Bulletproof Coffee totally rocks when you add it to the Paleo template!

A focus on food quality

Think about how vegans, particularly raw vegans, pay attention to food quality. They’re obsessive for a reason — because it matters! On the Bulletproof Diet, you eat grass-fed, wild-caught, and organic foods because they have more nutritional value and fewer hormones, pesticides, and other toxins that can mess with your mojo. Check out my two-part series on why grass-fed beef is healthier than grain-fed.

Bulletproof food quality principles agree with veganism on food quality more so than, say, Atkins diet followers. Many people who follow an Atkins or general low-carb diet will eat non-organic produce and grain-fed meat out of a sense of convenience — or maybe they just don’t know any better. But these foods contain hormones, pesticides, and other toxins that can harm your performance and make you slow, tired, and unfocused. A Bulletproof Diet includes nutrient-dense, high-quality foods that feed your body at a cellular level and minimize your body’s exposure to harmful chemicals and mold. Learn more about how mold affects your performance.

A focus on food processing

You likely know that processing your food is bad. But cooking food is processing food, even if you do it yourself. The Bulletproof approach to nutrition focuses on how your food is prepared or cooked. That means cooking your food gently and avoiding overcooking or charring your meat.

Cavemen stuck their meat on a stick over a fire and they created heterocyclic amines and polycyclic aromatic hydrocarbons (a.k.a. HCAs and PAFs, capable of damaging DNA after they are metabolized), a topic ”The Bulletproof Diet” specifically addresses and teaches you how to avoid. The bottom line is that better prep = better food.

Some Paleo authors might recommend crispy bacon or charred, heavily cooked meats — Bulletproof does not. Gently cook your foods, or they will lose some of their most important nutrients.

Pitfalls of Paleo and keto: Why you should customize your diet

If you strictly follow the Paleo diet, you don’t eat any dairy at all — but then you’d miss out on all the benefits of grass-fed butter or raw dairy, if you tolerate it. On the ketogenic diet, severely restricting carbs for extended periods of time can lead to impaired sleep quality and thyroid problems. That’s why the Bulletproof Diet advocates carb cycling, also known as keto cycling.

Meanwhile, no two Bulletproof Diet followers eat the exact same way or take the exact same supplements.

We like to think of it as “this is more Bulletproof or less Bulletproof.” Everybody is different, but the Bulletproof Diet Roadmap makes it easy to identify potentially performance-robbing, brain-fog inducing Kryptonite foods that make it hard to reach your peak mental and physical performance.

Maybe you should eat nightshades, maybe you shouldn’t. The best way to find out is to try both for yourself and see what kind of difference you feel. But if you don’t have a spectrum to tell you that these are suspect, then you have no way of telling how the foods you put in your body are affecting your everyday performance.

The only way to really figure out which foods may be giving you problems is to use your body as a testing ground. This means eliminating suspect foods, then methodically adding them back in. There are some guidelines on how to do this in “The Bulletproof Diet.”

Food, technology, and timing

It’s OK to improve food through the use of technology. The Bulletproof Diet doesn’t reject improvement of food using technology, like xylitol. Birch sugar is totally acceptable on this diet, even if it is made in a lab, because the biochemistry works. It’s also OK to use supplements to help you digest your food or promote better energy or sleep.

The Bulletproof Diet also incorporates some meal timing elements that various versions of Paleo have yet to adopt. For example, Bulletproof Intermittent Fasting is not the Paleo-approved plain intermittent fasting because you’re drinking Bulletproof Coffee, but it works very well, giving you energy and clarity throughout your day. Bulletproof also encourages you to time your carb consumption to improve sleep quality.

Is Bulletproof a ketogenic diet?

Yes … and no. It does emphasize a diet high in high-quality fats, and it utilizes intermittent, cyclical ketosis to melt fat and promote high energy. However, the Bulletproof Diet discourages long-term ketosis for everyone. Some people struggle with thyroid or hormone problems, adrenal fatigue, poor sleep quality, and extremely dry eyes when they severely limit their carb intake. On the Bulletproof Diet, you moderately increase your carbs (and go out of keto) once per week to support your body’s systems.

The Bulletproof Diet also places more importance on food quality. On the ketogenic diet, it’s possible to achieve ketosis by eating a high-fat diet filled with grain-fed meat, but you won’t feel your best. When you eat grass-fed meat, wild-caught seafood, and organic vegetables, you limit your exposure to anti-nutrients, toxins, antibiotics, and hormones that make you feel sluggish and weak.

The bottom line

Paleo is committed to the ancestral modality, and I’m a fan of it. Meanwhile, the Bulletproof Diet focuses on the research behind ways to improve performance and mental clarity by providing ample amounts of resources for your body’s building blocks.

But we’re all friends. We’re all working toward higher food quality, more grass-fed meat from healthy animals, better vegetables, and higher-performance humans.

Have you tried both the Paleo and Bulletproof Diets? Noticed a difference? I’d love to hear about it in the comments below!

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