![]() 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
38 Comments
Galina L.
1/27/2014 12:27:25 am
We all different when it come to the carbohydrates tolerance. I have a friend who achieved the same result as me using IF alone - eating two meals a day within 6 hours, she started to do it 10 years ago. Her mother lost 50 lbs. Ironically, it was suggested to them by my friend's husband (a biochemist) who thought they would reduce their basal insulin levels and the area under a blood sugar curve. He never heard about insulin-based theory of obesity before.In Russia it was not popular at all. I tried such methology before doing LCarbing - it didn't work for me, I was too hungry between meals without carbs limitation.
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1/27/2014 12:53:28 am
Thanks so much for sharing your experience and that of your friend and her mother, Galina! Glad you found what works best for you.
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1/27/2014 01:18:37 am
It is interesting how people are quick to judge each other for their dietary choices, as can be seen by that first testimony. I agree that there is a lot of research to support LCD and VLCKD, but any diet plan has to be individualized, and is nobody's business but the person eating and their health care providers who are prescribing the plans. I am glad to see there are other dietitians that are on board with the idea, though! I just prescribed a ketogenic diet to a lady with cancer & diabetes, and she just about did a double take! It's not so common right now!
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1/27/2014 03:40:42 am
Thanks so much for your comments, Samantha! I love hearing from other open-minded dietitians who appreciate the benefits of carb restriction. My best wishes for your patient with cancer and diabetes, along with all your other patients!
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Galina L.
1/27/2014 04:33:47 am
I think we often forget about the reduce carbohydrate tolerance after the adaptation to a VLC diet. There is also a rise in a fasting BS for some, especially middle-aged LCarbers due to a physiological insulin resistance. Some people report really high numbers. I guess, having carbohydrates intake not close to zero is better to prevent extremes.
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1/27/2014 07:44:15 am
Great points, Galina. I haven't experienced a rise in fasting BG at this point; it's still in the mid-80s, fortunately. But I know it's a common occurrence with women our age.
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Hi Franzizska and belated Happy New Year. Both Eddie and I hope the New Year and your new plans are going well..........
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1/27/2014 07:47:37 am
Thank you so much, Jan! Happy belated New Year to you and Eddie as well!
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Bonnie
1/28/2014 08:28:27 am
I am 45 years old, weigh 180 and would like to be 145-150. I gave up sugar and grains Dec. 1 and have been eating LCHF since then. I have been experimenting with different levels of carbs, usually around 20/day, sometimes up to 40-50. I have had no weight loss in 2 months, after the initial water loss. Nor have Iost inches. I am eating very healthfully and track my macros, usually around 1600 cal, 125g fat, 70g protein, 20-50 carbs (depending on my experimentation at a given time). What is a better way to determine what my body needs, because nothing seems to be working. I am eating all whole foods at good fats. Nothing from a box or any "low carb" foods. Thanks so much for your article!
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1/28/2014 09:18:37 am
Hi Bonnie,
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Bonnie
1/28/2014 10:41:33 am
Thank you. I actually tried Intermittent Fasting (eating between 11 and 7) for 2 days and gained 2 pounds. I felt like it was clear that wasn't working for me. Should I stick with that a little longer, or can it work negatively for some?
Galina L.
1/28/2014 11:32:58 am
@Bonnie,
Galina L
1/28/2014 09:42:10 am
Some people have a weight-loss stall when they have dairy in their diet, nuts also routinely put dieters (especially middle-aged females) into trouble. Try to eliminate all dairy except butter and small amount of heavy cream in your coffee.
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1/28/2014 10:11:46 am
Thanks, Galina. Nice to hear from someone who found something that worked to move the scale in the right direction! It often takes experimentation because, as I said in various ways above, we are all different. 1/28/2014 10:52:25 am
Sorry to reply down here, Bonnie, but this website doesn't allow someone to reply to a reply. Two pounds may very well have been a normal fluctuation rather than a true gain from IF. Galina and others have had success with it, but it's not for everyone. I'd definitely give it more than just a couple of days, though. See how you do on it, and if you're hungry or just not enjoying it, go back to three meals a day. I like the calorie cycling idea as well, but not everyone does well on it while others swear by it. Good luck, and let us know how you do :)
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1/31/2014 08:24:30 pm
I eat fairly low carb, and recently did a week of IF and wrote a blog post about it.
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1/31/2014 10:44:36 pm
Thanks so much for sharing your experiment, Brenna! Great to hear that IF is working well for you and you plan to continue it. It's so interesting to see how everyone responds to meal timing and composition differently. I'm personally a three-meal-a-day woman although I occasionally skip lunch or dinner, but I definitely feel best eating breakfast, so I'd never skip that meal.
Abraham Choi
1/15/2015 12:10:33 pm
Here's my question: Is a low carb diet as healthy as a ketogenic diet? I ask this because a low carb diet means that glucose will still remain as the primary fuel source and since it's "low carb", one would think that you have low levels of fuel. Whereas in a ketogenic diet ketones are the primary fuel source, and since the fat intake is high, it can be assumed that you have high levels of fuel. I've been awfully curious about this and I hope someone with facts can shed some light.
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1/15/2015 12:28:39 pm
Hi Abraham,
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Abraham Choi
1/15/2015 01:12:56 pm
Oh. Good to know. :)
Angel the dietitian
6/24/2015 07:32:55 am
I was so glad to come across this post. I have done keto for two months - started it because I am obese (and a dietitian - something that bothers me immensely), my fasting blood sugar was creeping up in the high 90's, and my HA1C was 5.4, and I was looking for a way to bring it down so I figured I would give keto a try.
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6/25/2015 02:00:53 am
Hello Angel,
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Ari
9/2/2015 09:57:07 am
I have been doing a LC diet for about 2.5 months now and i have only been able to loose 6 lbs, I have tried cutting back on fat, cutting back on protein and I am just sitting on this plateau .. Can you please suggest something .?? 9/2/2015 11:03:21 am
Hello Ari,
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justme
9/9/2015 01:18:49 pm
I'm on Atkins Diet .....I understand how it works and on it for 2 weeks .
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9/9/2015 02:03:56 pm
Thanks for your comments. The Atkins Diet is great and often ketogenic in the initial stages. Congrats on losing 20 lbs so far! After the initial loss, plateaus are common with all diets, but they will pass provided you stay on plan. Keep up the good work, and best of luck to you!
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Galina L.
9/10/2015 05:14:54 am
I want to report an update of my situation. I was feeling less optimal due to the development of menopause, and requested more blood tests 3 - 4 months ago. It was found that my B12 was not sufficient, vitamin D was low, progesteron very, very low, but estrogen was ok. Also, TSH was 3.4, while usually it was 2.5.
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9/10/2015 06:20:28 am
Thanks so much for the update on your progress, Galina. Very happy to hear that the adjustment in thyroid medication had such a profound affect on your health and ability to lose weight. Appreciate you sharing your experience.
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AIC
1/30/2017 12:48:14 pm
I have done low carb and and I have done keto LCHF. On keto I ended up in the hospital with tachycardia and prolonged QT. At first they thought it was an electrolyte imbalance, but my levels were normal. My HDL went down and my LDL went up a lot. My globulin levels were up and so were my liver enzymes, but they couldn't tell why I was having tachycardia and prolonged QT. I strongly believe that not one size fits all and no one will tell me otherwise. Once I got off keto, my body went back to normal. My sinus rhythm is normal again and so are all my levels except I am working on lowering my bad cholesterol and raising up my good again.. I wish I could have stuck to keto as I initially had a ton of energy and was so mentally alert. My mental recall was getting better too, but for some reason my body just couldn't handle it.
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1/31/2017 03:02:45 pm
Thanks for sharing your story. I'm sorry you had a bad experience with keto. Adverse reactions such as yours are rare but not unheard of. I'm glad you've recovered and are doing well overall. Best, Franziska
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Grace
4/8/2017 11:12:58 am
Thank you, for telling it how it is... everyone is different this program is not one size fits all ! I did very little research and had twelve pounds to lose so I wanted the fastest weight loss. I decided on Dr Dukan's program, did the attack phase first which is zero carbs first week then low carbs the next. I knew about the keto flu Day 1- exhausted 2 -totally wiped Day 3- dizzy, absolute exhaustion, forgetful ,Day 4 exhaustion ,migraine, forgetful, pain around eyes sockets felt like the flu thought about calling my doctor Day 5 - same as day 4 for, but worse Day 6 - migraine , nausea, and dizzy totally thinking there is no way in hell I can do this diet Day 7- headache and exhausted did more research drank two teaspoons of sea salt and potassium in water some symptoms went away Day eight all symptoms when away
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Galina Lebedev
4/8/2017 04:30:07 pm
A typical low-carb diet as Atkins or a protein Power diet will not cause you such issues. Dukan diet is not a normal low-carbs diet which includes mostly fat, moderate protein and very low carbohydrates. What you experienced on a Dukan diet may be due to a protein poisoning or so-called "rabbit starvation". Here is the citation from Wiki "Protein poisoning (also referred to colloquially as rabbit starvation, mal de caribou, or fat starvation) is a rare form of acute malnutrition thought to be caused by a complete absence of fat.
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This is how I took midlife, I was tired, overweight and stressed to the point of being unhealthy. Very unhealthy; so much so that that I couldn’t really function. My anger and bitterness was a whole new level. I discovered bio-hacking, and it was life changing. Then I also started my keto journey. As soon as I had a handle on myself physically and had hacked myself into an energized state, my mind followed. I learned that I didn’t need to accept that my memory was failing in midlife. There was something I could do about it. I did, and as I did, people started take notice. My attitude improved greatly.
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Jillian
4/29/2018 03:53:38 pm
I have been VLC since 2/25/18. I started at 177. I lost 4 pounds in my first week, but then slowly lost 6 pounds over the next two months. I seem to yo-yo every now and then , where I lose a pound and then go back up two. I haven’t eaten more than 23 carbs per day since I started. I generally am around 1450 cal per day. I also am trying to stick to 70% fat, 25% protein and 5% carbs. Why does my weight loss go so slow? I haven’t cheated since I started, and even have been trying to go to the gym 2-3 nights per week. Any recommendations would be great!
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Hi Jillian,
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Louise
6/10/2018 03:12:14 pm
Thank you, this was very helpful. I have been eating 1200 calories and less than 20 carbs per day for the past 3 months. I never got that “clarity” I was told about, and while my energy was steady, I was physically weaker than I’d ever been. Climbing steps was challenging, even in my own house where I’m accustomed to running up stairs! Weight loss was rapid at first then slowed to nothing. I got blood work done this week and got scared by my high LDL numbers, so switched my macros to 50 carbs per day, a plan I had been on before without cholesterol issues. BOOM! The energy came flooding back! I feel like a million bucks after just a week with a few more carbs each day. As far as weight loss goes, I’ve all but given up, but being 15 pounds heavier than I’d like while feeling great is much better than being 15 pounds up and feeling crappy!
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