Low Carbohydrate Diets

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Examples: Atkins®, Protein Power, LCHF, Ketogenic Diet, Rosedale Diet.  This strategy was made popular by Dr. Atkins but has been used by physicians for over a century to treat obesity, diabetes, and other health problems. Find out how it works and whether it is safe.

EXAMPLES: Atkins, Protein Power, LCHF, Ketogenic Diet, The Rosedale Diet

STRATEGY:
Very low carbohydrate (0 to 50 grams/day)

FOODS: All sweet and starchy foods are essentially forbidden.

POTENTIAL BENEFITS:

Most effective diet for weight loss
Often eliminates cravings and food obsession
Energy may improve
Mood may improve
Reduces risk for numerous chronic diseases
Encourages fatty foods, which some people enjoy
May not need to count calories
Best diet for carbohydrate-sensitive people

POTENTIAL PROBLEMS:

Initiation can be difficult (carbohydrate withdrawal)
Socially challenging (can be hard to eat out)
There may be side effects, depending on food choices
Cheating once can set you back a few days or more
Some versions allow processed/artificial foods
Some people need to also limit calories to lose weight

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Low-carbohydrate diets were made popular in recent decades by Dr. Atkins, but the concept has been around for more than a century.  It has long been known by scientists that very low-carbohydrate diets are effective not only as a weight loss strategy, but also as a way to treat and/or prevent diabetes, epilepsy, and other common chronic diseases.

Are low-carbohydrate diets safe?

There is plenty of strong scientific evidence now that low-carbohydrate diets are safe. How could the Inuit Eskimos have thrived for centuries eating an essentially carbohydrate-free diet if low-carbohydrate diets weren’t safe? The body requires zero grams of carbohydrate, so removing carbohydrate from your diet will not harm you.

However, if you take medication for any chronic health problem, especially if you use medications to control diabetes, high blood pressure, or heart disease, it is very important that you work with your health care provider in the early stages of this diet to monitor your medication dosages. This diet can have powerful (positive) effects on your chemistry, often very quickly. Blood pressure and blood sugar can naturally fall towards more normal values even within a few days, so medication dosages may need to be reduced accordingly to avoid potentially serious medication side effects.

Are low-carbohydrate diets effective?

Yes, they are in fact uniquely effective. Most people lose more body fat, faster, and more comfortably on low-carbohydrate diets than on any other diet tested. Low-carbohydrate diets are usually healthier than other diets, because they improve cholesterol profiles and blood sugar/insulin profiles much more than other diets do. This is because carbohydrates are the driving force behind cholesterol and blood sugar problems. These diets are absolutely the best diets for people with pre-diabetes and diabetes (type I and II), and for carbohydrate-sensitive people in general. These diets have the potential to completely reverse type II diabetes.

Ketogenic Diets

The ketogenic diet (as written about in books such as The Rosedale Diet, New Atkins for a New You, and The Art and Science of Low Carbohydrate Living) is unique in that it is not only very low in carbohydrate, but also limited in protein, so that the body has no choice but to burn fat for energy.  These specially-formulated low-carbohydrate diets have been successfully used to treat epilepsy for decades, and are more effective than anti-seizure medications in some cases. Researchers are even investigating the potential of low-carbohydrate diets in the treatment of cancer.  To read my blog posts about ketogenic diets and cancer, click HERE. To read about my own experience with a ketogenic diet, click HERE.  To read about my friend Anne’s experience with a ketogenic diet as compared to Weight Watchers, click HERE

I frequently recommend very low carbohydrate diets to my patients who wish to treat mental health problems such as depression, anxiety, bipolar disorder, and eating disorders, without medications. To read my blog post about ketogenic diets in the treatment of epilepsy, bipolar disorder, and other brain disorders, click HERE.

Low-carbohydrate induction phase

The first 24-72 hours on a very low-carbohydrate diet can be tough, as your body has to adjust to living without dietary sugars and starches. You may feel irritable, hungry, moody, and tired. You may have trouble sleeping. However, once you get through that initial withdrawal period, your body will be off the dreaded invisible insulin roller coaster and you should feel much better. It takes several weeks for your body to completely transition from decades of being a carb-burning machine to being what it was designed to be—a fat-burning machine—so if you try one of these diets, be sure to give it at least a month if you can, before you decide what you think of it.

Some low carbohydrate diet plans suggest that you gradually increase your carbohydrate intake after a certain period of time, or once you have achieved your weight loss goals, but this is not necessary, and is likely to backfire.

Can you gain weight on a low-carbohydrate diet?

YES. Some years ago, my mother lost 90 pounds effortlessly on the Atkins diet, whereas I myself gained 5 pounds. Everyone is different. No diet works perfectly for everyone straight out of the box. I have since learned how to tailor low-carbohydrate diets to suit my own chemistry. While many (lucky) people can eat anything they want on a low-carb diet and never have to count calories, protein grams, or fat grams, others of us are less fortunate. Some people DO need to count calories, although in most cases, you can get away with significantly more calories on a low-carbohydrate diet than you can on a standard low-calorie diet, because your metabolism is higher.

Can you eat sugar-free treats on low-carb diets?

Some people are capable of generating blood glucose and insulin spikes after eating sugar-free products, such as candies and cookies sweetened with sugar alcohols. After having seen Dr. Andreas Eenfeldt’s excellent video presentation about his LCHF (“Low Carb High Fat”) diet (to see the video, click here), I was inspired to test my own blood glucose response to sugar-free chocolate and found that my blood sugar rose from 83 to 126 within less than an hour (and I am not diabetic). Therefore, you may need to avoid these kinds of treats in order to be successful.

Another important fact: whey protein is often recommended as a low-carbohydrate, low-glycemic index supplement on some versions of these diets, and Atkins even markets shakes made with whey protein. However, even though whey proteins don’t raise blood sugar, they do raise insulin levels substantially (see my dairy page), so you may need to be careful with these, because insulin spikes tell your body to make fat, not burn it.

Are low carbohydrate diets healthy?

Removing carbohydrate from your diet is very healthy. However, like any diet plan, the overall health of this diet depends on your food choices. Healthy eating is not just about what you are not eating. It is also about what you are eating. I have known people who have found some very unhealthy ways of approaching a low-carbohydrate diet. There are plenty of low-carbohydrate junk foods on the market that are not good for your body.

Some low-carbohydrate plans allow you to include a variety of unhealthy foods, such as low-carbohydrate snack bars full of highly processed ingredients, ready-made sauces loaded with chemicals, and dessert substitutes made with artificial sweeteners. You can choose not to use them if you want to create a healthier version of this diet.  It is always best to choose whole foods whenever possible. 

Can vegetarians and vegans eat a low-carbohydrate diet?

Yes, absolutely, but it is more challenging. The reason for this is that many popular plant protein sources are quite high in starch—hummus (and beans of all types), tempeh, grains, nuts, and seeds contain significant amounts of carbohydrate. It’s not that you can’t eat these things at all, but you need to count their carbohydrates and make sure you’re not eating more than about 10-15 grams per meal.

Vegetarians can enjoy eggs and hard cheeses, but would need to limit quantities of certain dairy products, such as milk and yogurt, as they contain lactose, a naturally-occurring milk sugar.

Vegans are more limited still, as eggs and dairy products are off the menu, however, it is still possible if you are motivated, and you will reap all of the same health rewards that meat-eating low-carb dieters enjoy.

There are numerous vegetarian and vegan protein powders on the market. Options include casein, soy, pea, rice, and hemp protein powders.

Low-carbohydrate diet side effects

The most common side effects reported include constipation, fatigue, bad breath, and insomnia. These are typically not due to the lack of carbohydrate, but to the types of foods chosen and how those foods affect certain individuals. All of these can usually be corrected with special adaptations. I will be writing more in future articles and in my blog about special changes you can make to these diets if you are having trouble tolerating them.

BOTTOM LINE ABOUT LOW-CARB DIETS:

Very low-carbohydrate diets are the best overall diet plans for weight loss, especially for those who are carbohydrate-sensitive. These diets are also very effective in the management of type I and type II diabetes.

Low carbohydrate diets stabilize insulin levels, and therefore I believe that these diets can also be used to successfully manage all kinds of other chronic health problems which are associated with hyperinsulinemia (high insulin levels).

Excellent resources and support for low-carbohydrate diets include:

Jimmy Moore’s Livin’ La Vida Low-Carb Blog and Podcast

Dr. Andreas Eenfeldt’s LCHF diet:  www.dietdoctor.com

Dr.s Michael and Mary Eades’ Protein Power plan:  www.proteinpower.com

The Rosedale Diet:  www.drrosedale.com

The best book about the science behind ketogenic diets is “The Art and Science of Low Carbohydrate Living” by Dr. Stephen Phinney and Dr. Jeff Volek.  It is superb–thorough, authoritative, well-referenced, and readable.  Dr.s Phinney and Volek also co-authored “The New Atkins for a New You”, along with Dr. Eric Westman.  This book is a true diet book, with practical advice, menu plans, etc.

  • http://www.facebook.com/snooptaco Elaine Shields

    Hi Dr. Ede, do you have any recommendations for the constipation side effect of eating low-carb? Should I take magnesium? Thanks for your time!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Elaine

    Constipation is not caused by a lack of carbohydrates but by the presence of specific foods that are causing constipation. I don’t know if you have already read my blog post on the topic, so if not, take a look at that. Two additions I would make to that list are raw and/or tough/fibrous vegetables, and gelatin. You can add seeds and grains to the culprit list, too, since they are in the same family as legumes and nuts. You may not need to eliminate all of these culprits; it may be that there is only one that is bothering you. Everyone is different.

    • http://www.facebook.com/snooptaco Elaine Shields

      Okay. So perhaps people eating low carb end up complaining about constipation because they are suddenly now eating an increased amount of (say) tough veggies with the new diet? There is gelatin in my fish oil supplement, so maybe I will see if that is the culprit, since I am hardly eating any vegetables. Thanks!

  • Sarah

    I was on a low carb mostly ketogenic diet for about a year and a half. I did lose weight, and at first some allergy type symptoms improved. My blood sugars were mostly reasonable. mostly below 140 if not 120. However, then things went downhill. I started to get more allergy sorts of symptoms. My insomnia became worse. My depressed moods which had never really improved, got worse. It was very distressing to put it mildly. Finally, I decided to try some starches which I had pretty much dropped from my diet. Things got maybe a little better. At least my constipation went away. I will have to say at that same time I eliminated most dairy, because I had determined that I must have histamine intolerance. I still think that or it’s a good imitation of histamine intolerance. I eliminated or reduced other histamine containing foods as well. My blood sugars were more erratic during this dietary experiment. I still was having a lot of trouble. Of course depression is the worst. Finally, After reading articles by Dr. Ray Peat, I decided to mostly or completely eliminate starch and try fruit instead as well as doing some other things he suggests in his articles. Well, one thing I have found out is that my blood sugar pretty much stays completely normal with low fasting blood sugars on a high carb but no starch diet. I am still dealing with mood issues, but slowly figuring out how to get better. From being on forums, I know many other people have had this kind of problem with low carb. I ate very little processed food on my low carb diet. I tried to eat the healthiest low carb food I could. I read lots of information about low carb diets, such as Dr. Bernstein’s book on diabetes, and “Life Without Bread.” As I said, there are many people who have had this same experience. You seem very open to more information about food and diet, so I thought I would post this here. If you have any thoughts on this, I would be interested.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Sarah

      Thank you for sharing your experience here. Each of us is different so I would never discount your personal experience. What I would say is that the side effects of any given diet, including a ketogenic diet, are almost always due to the types of foods eaten by a particular individual as opposed to the macronutrient ratio of the diet. For example, I felt lousy on a ketogenic diet that contained processed meats but feel wonderful on a ketogenic diet that contains only fresh/frozen meats. My blood sugar, as you can see from my posts, is incredibly stable and normal on a ketogenic diet with almost no carbohydrate. But without knowing the nitty gritty details of your various diets, it’s hard to say what may have been going on. It can be tough to figure out, for sure.

  • Fiona

    Hi Dr Ede, I’ve been on a LCHF diet for two weeks now. All was going well and I was really enjoying it but now insomnia has hit big time and I don’t know what to do? Should I increase my carbs in the evening to get the tryptophan ? I’m not keen on taking any taking pills. Thanks for your advice.
    Fiona

Last Modified: May 3, 2013 at 8:48pm