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

1/27/2014

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

33 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.

Franziska Spritzler link

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.

Samantha Scruggs link

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!

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!

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.

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.

Jan link

1/27/2014 06:49:21 am

Hi Franzizska and belated Happy New Year. Both Eddie and I hope the New Year and your new plans are going well..........

As always a very interesting post. I can only speak from personal experience, as we are each unique, we each have our own health issues. Some may be in perfect health others not.

For just over five years I have been living/eating a low carb high fat moderate protein lifestyle. My carb intake is approx 50 carbs per day. I also exercise and do my best to get a good and regular sleep pattern. To use the old saying 'touch wood' my health is good and its been many years since I last saw my Doctor ... in fact he may no longer recognise me! If there are any superstitious readers out there I have 'touched wood' and 'crossed my fingers' etc etc.

I think everyone does need to experiment and see the optimum level and balance of nutrients required for them. If only I knew back then what I know now. I firmly believe that we should all eat real food, stay away from processed foods and as for sugar well that's another story ........ or post ...... I think ?

All the best Jan

1/27/2014 07:47:37 am

Thank you so much, Jan! Happy belated New Year to you and Eddie as well!

I love your insightful comments and gentle sense of humor. Yes, real food is the way, regardless of your carb tolerance. I love the recipes on your website, by the way, and the pictures that accompany them.

Take care,
Franziska

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!

1/28/2014 09:18:37 am

Hi Bonnie,

I'm so sorry to hear that your weight loss has stalled after the initial loss. I know how frustrating that must be when you're doing everything right in terms of food quality and macronutrient composition. Unfortunately, around our age it's very common to have difficulty losing weight, even sticking to a VLC plan. Fluctuating hormones, loss of muscle mass, and other factors can play a role. I'd recommend doing No.1 below first and then experimenting with the others one at a time:
1. Have your thyroid levels and adrenal function checked by your doctor
2. Try lowering fat by 10-15 grams
2. Try calorie cycling: i.e., one day 1300 calories, the next day 1800
3. Try changing up the timing of your meals. If you're eating 3 times a day plus a snack or two, try eating only twice a day a few times a week.
4. Get at least 30 minutes some type of physical activity in every day. Walking is great, and if you like other types of exercise, it's nice to mix it up a bit.

I hope that helps! Best of luck to you!

Franziska

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?

1/28/2014 11:32:58 am

@Bonnie,
Some people reported a tendency to binge on food after IF. We indeed different. The weight-gain in your case suggests for me that you ate more for some reason. Also, the IF is more than eating within a certain window, it is also not snacking between meals. If you decide to experiment more, move evening eating on earlier time, have heavier meal early at the day. You would find how to train yourself not to snack in the link about IF I provided in earlier comment.
I wish I could hep more. Try to follow tips Franziska provided. If you try everything at once, you would never know what worked.

The worst case scenario - your age related hormonal changes prevent your body from loosing weigh. It is possible.

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.
Please, read the article about IF http://gettingstronger.org/2010/11/learning-to-fast/. IF moved me from a weight-loss stall.
Tell us later how you are doing.

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 :)

Brenna Thompson link

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.

http://eating-simple.blogspot.com/2014/02/intermittent-fasting-self.html

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.

1/15/2015 12:28:39 pm

Hi Abraham,

Thanks so much for your question and comments.

A low-carb diet can be just as healthy as a ketogenic diet for most people aside from those using a KD for therapeutic reasons (epilepsy, cancer, neurological issues, etc.) Glucose, ketones, and fat all provide fuel for various tissues of the body regardless of whether 20 grams or 100 grams of carbohydrate is consumed. Your fat intake will still provide at least 50% of calories on a low-carb diet.

Most people who successfully follow the Atkins diet after transitioning from the Induction phase are only in mild and/or intermittent ketosis and have plenty of energy because they can use any of the three fuels, as needed. I've increased my carbs slightly and lowered my fat intake a bit since I wrote this article a year ago, and my energy levels remain very good, and my weight and blood glucose levels remain at goal.

I think it comes down to individual response to the diet, and within low carb, there's a wide range from ketogenic to moderate LC where someone might feel and function their best.

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.

I have followed the traditional diet - 30% fat, 20 % protein, 50% carb diet for years - limiting calories from 1200-1400 kcals per day, along with making sure I get my more than 10k steps per day for about 15 years now only to have my weight continue to increase. I had a terrible pregnancy that required me to be on bed rest for 30 plus weeks about 15 years ago and went from my normal 130 pound self to a much higher weight - and then gradually increasing a few pounds yearly until I hit 210 pounds this last March. Thus, I decided in early May to try the keto diet since nothing else has ever seemed to work for me.

I have been doing it for about 7 weeks now - and have lost 15 pounds. I am elated to have lost this weight. I feel full, have plenty of energy, find that my mind is clear most of the time. The first four weeks on keto were amazing, these last three weeks though have been rough, thus I was thinking of liberalizing my diet some (not back up to where I was though). I am having some pretty significant GI issues including gastritis, and when the gastritis has flared up I find I don't tolerate meat well. I was feeling very guilty at the thought of liberalizing my diet, but after reading this I am feeling a little better.

On a side note - as a dietitian I found that when I mentioned I was doing the keto diet to my fellow dietitians I just got lectured on how horrible this diet was. Lectured that I should never do something like this to my body. Bothers me immensely. I have been a dietitian for 16 years and one thing I have learned is that what works for one person may not work for the other, and vice versa. Just because they can remain thin eating the more typical "healthy" diet doesn't mean I can. Every body's body is different. Conversely, I them discussing obese individuals and it makes me sick. Many of the dietitians I work with have super high metabolisms and never stop eating. For the most part they do eat a lot of low fat, high fiber foods, but every night the need their ice cream or cake after dinner. At least half of them never exercise, yet I hear them talking about how obese people must lie on 24 hour recalls and about their exercise routines. Frustrates me. . . . Sorry - just wanted to rant a little :)

6/25/2015 02:00:53 am

Hello Angel,

Thank you so much for sharing your story here. Congratulations on losing 15 pounds within the past two months on a keto diet! I'm so sorry to hear that other dietitians aren't supportive of your very-low-carb way of eating, but that's a pretty typical response, sadly. It's so true that there's no one-size-fits all diet.

I'm so glad you've experienced wonderful benefits, and please feel free to contact me with any questions or concerns anytime.

Keep up the great work!

- Franziska

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,

Congratulations on the 6 pounds you have lost. I'm sorry you've hit a stall. For some people, weight loss is very, very slow. There are many reasons for a plateau, and they're not always food-related: stress, lack of sleep, age, hormone imbalances. Making sure your diet is well balanced is important. Also, if you're not in caloric deficit, you can't lose weight, so it's a good idea to track to get an idea of how many calories you're consuming. Hang in there -- I wish you the best of luck!

justme

9/9/2015 01:18:49 pm

I'm on Atkins Diet .....I understand how it works and on it for 2 weeks .
I keep reading about Ketogenic and it sounds complicated compared to Atkins Diet . I lost 20 pounds in 7 weeks , stopped drinking soda ( cold turkey June 14 2015 ) , I count calories daily
"my fitness pal 1400 calories". I workout at home and at the gym daily . I am determined to lose as much weight as possible .
I've a long road a head of me . Just wished I could figure out the Ketogenic Diet ......As far as plateau , I went through that and had to change everything ,....Monday ...lift free weights , Tuesday ...Cardio ..........Wednesdays....swimming .....Thursdays..
Lift weights ...Fridays ...Taking Yoga ..........I plateau for 11 days and It upset me , so I figure I'm going to mix each day up ......
Drink between 64 - 80 ounces of water daily ..........

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!

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.
My GP first corrected the dose of my thyroid medicine, and my TSH is 0.2 now. It alone stopped hot flashes at night which used to bother me then. Later I started the supplementation of D,B12 and progesteron. What is also very important, I am loosing weight steadily while eating more. Somehow my appetite didn't increase, but I stopped controlling my food intake very strictly, which was necessary before. To the day I lost at least 10 lb, may be close to 15.
My message to others - it is almost impossible to override your hormonal situation with a diet and exercise. It may help, but your body is extremely important factor on your weight.

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.

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.

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

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
All this time I was in ketosis because I had fasted on green veg juice for two days before I did the Dukan program . My point is that these programs should suggest some people need to go very slowly . I went cold turkey , what I did this was wrong! Going low carbs should not make you feel like your going to have to go to the " Emergency Department" or on the verge of dying. Listen to your own inner wisdom and choose what is right for you. I have now picked a program that works for me since, I'm vegetarian fits my lifestyle and I love it

Franziska link

4/8/2017 12:45:55 pm

Thanks so much for sharing your experience, Grace. I'm glad you've found a program that works well for you. I wish you the very best of luck and good health.

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.

Excess protein is sometimes cited as the cause of this issue; when meat and fat are consumed in the correct ratio, such as that found in pemmican (which is 50% fat by volume), the diet is considered nutritionally complete and can support humans for months or more. Other stressors, such as severe cold or a dry environment, may intensify symptoms or decrease time to onset. Symptoms include diarrhea, headache, fatigue, low blood pressure, slow heart rate, and a vague discomfort and hunger (very similar to a food craving) that can be satisfied only by the consumption of fat.

Protein poisoning was first noted as a consequence of eating rabbit meat exclusively, hence the term, "rabbit starvation". Rabbit meat is very lean, commercial rabbit meat has 50–100 g dissectable fat per 2 kg (live weight). Based on a carcass yield of 60%, rabbit meat is around 8.3% fat.[1] For comparison, in terms of carcass composition, beef and pork are 32% fat and lamb 28%."

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