Ketogenic Diet vs. Low-Carb Diet: A Personal Choice

Fruit with whipped cream: too many carbs?

Ketogenic diets (aka keto diets, nutritional ketosis or NK) are currently all the rage, and for good reason. As I wrote in a previous post a few weeks ago, very-low-carbohydrate, ketogenic diets (VLCKDs) are extremely effective for weight loss and diabetes, among other things. There's also emerging evidence suggesting they may be beneficial for certain cancers and neurological conditions like Parkinson's disease and ALS (also known as Lou Gehrig's disease). Having previously worked in a clinical setting with several patients who had the misfortune of contracting these diseases, I find it very encouraging that following a ketogenic might offer some improvement for them, as well as others in the same boat.

I follow a VLCKD and receive a lot of great feedback from others who have also experienced overwhelmingly positive results with this way of eating. I love hearing these success stories, so please keep them coming. However, one reader named Michelle had this to say in the comments section of my recent article: 

"I don't do well on a very low carb diet; I have to have around 50-70 g's of carbs a day to feel well and function. I guess this is still low carb when compared to the standard diet, but find so much prejudice against me because people say 'If you just stuck to eating VLC you would eventually lose weight and feel better'. This just is not the case with me. I've adapted the LC diet for me and I feel great and I am losing weight steadily. Please folks, stop thinking that one size fits all, it does not!
Great site. Thank you for all your efforts."

I was disappointed to hear that this woman -- who is most definitely following a low-carb diet and having success doing so -- feels that others are judging her for not restricting carbs to ketogenic levels (generally defined as <50 grams/day, although some require <30 grams/day to enter and remain in ketosis). She clearly is losing weight and feeling well, so if I were her nutritionist, I'd recommend she keep going with what she's doing now. This is exactly what I do with my clients: find the level of carbohydrate intake that works best for them, whether or not that means NK.  In my own case, I started restricting carbs for blood glucose management and ate around 100 grams total carbs (70-80 grams net carbs) for over a year before discovering that limiting carbs to <40 grams net carb was the only way I could achieve truly normal postprandial blood sugar.

While there's a lot of compelling research supporting ketogenic diets for weight loss and diabetes, there are also studies that have demonstrated benefits at carbohydrate intakes between 60-100 grams per day. In fact, many studies that initially provide <20 grams of carb daily gradually increase the amount over the course of the trial, based on individual tolerance. This was Dr. Atkins's approach as well, and many people have maintained large losses using the Atkins "Carb Ladder."  In addition, it's very possible to be in ketosis yet not lose weight if calories are too high.

For diabetes control, I believe everyone can achieve good control using Dr. Bernstein's plan: very-low-carbohydrate intake consisting of 6 grams at breakfast and 12 grams at lunch and dinner. Many Type 1's and Type 2's have written to me about their success with Dr. Bernstein's approach, and I have a very good Type 1 friend who maintains fantastic control by following his plan to the letter. But some people may find this too restrictive and instead find success at higher -- although still fairly low -- carb intakes. Two long-term studies from Sweden found significant improvements in blood glucose control (including a substantial decrease in hypoglycemic episodes) when total carbohydrates were restricted to 70-90 grams per day.

As someone who lost 30 pounds and maintained that loss for over 25 years on around 150 grams of carbs a day (an estimate, as I never counted them), I know that being in ketosis isn't always necessary to induce weight loss. There are people with experiences similar to mine, many others who find that a VLCKD is the only way that works for them, and still others like Michelle and my husband who do best somewhere in between. We're all so unique in our responses to carbs, calories, protein, and food in general. In my own experience, I honestly never felt pressure from anyone to lower my carb intake when I was eating around 80 grams net per day, but perhaps things are a little different now given the popularity of NK. As passionate as I am about ketogenic diets and their potential benefits beyond weight loss, I really want people who follow any level of carb restriction to feel supported by the low-carb community. Remember n=1, YMMV, etc., so do what works best for you. And to all my readers -- from the zero carbers to the 100-plus-grams folks --  thanks for your continued support of my work.

References

1.  Foster  GD, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 2010 Aug 3;153(3):147-57
2. Boden G, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with Type 2 diabetes. Ann Intern Med. 2005 142:403-411
3. Nielsen JV, et al: A low carbohydrate diet in type 1 diabetes: clinical experience: a brief report. Upsala J Med Sci 2005 110:267–273, 2005
4. Nielsen JV, et al:  Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: a clinical audit. Diabetol Metab Syndr 2012; 4:23 

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