Low carb living

What do you need to know to successfully eat low carb for life?

Dr Stephen Phinney, MD, PhD, knows more about this than almost anybody. He has researched adaptation to very low carb diets (and exercise) for a long time. Here he shares this knowledge, as well as insights from traditional cultures who never ever ate a lot of carbs. Do you for example know what pemmican is?

Dr Phinney’s book: The Art and Science of Low Carbohydrate Living (2011).

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  1. Peggy Holloway
    My partner and I (70 and 59, respectively) are Steve Phinney fans. I've been low-carb for 12 years, but my partner (a retired physician) wasn't convinced it was for him until he read Dr. Phinney's book and decided that his stubborn excess 40 pounds might come off on a low-carb lifestyle. He then found out that even though he's been an experienced cyclist for years, he had much more strength and stamina on a ketogenic diet. (and lost the weight in 4 months) We biked all over the state of Nebraska (US) for thousands of miles this summer on steak and eggs and loved telling people about our low-carb lifestyles and recommending "The Art and Science of Low-carb Living."
  2. moreporkplease
    What a fantastic video, Andreas! Here he clarifies important points, but I still have 1 question.

    Clarified point 1: Cheating with a bagel even once sets you back weeks, not just a couple of days. This is key because a lot of people cheat, and many low-carb forums will tell them that it takes a few days to get back to keto-adaptation. But now we know the truth - that bagel and even that indulgent steak will cost you, big time. Don't cheat and keep your protein moderate.

    Clarified point 2: Ignore what Phinney wrote in his new Atkins book. Don't increase your carb level as you go along or as you add more exercise. Stick at 50 or less to stay keto-adapted.

    Question about point 2: does Phinney mean 50 *total* carbs, or does he mean 50 *net* carbs - that is, subtracting fiber. This is the point that confuses many otherwise dedicated low-carb folks. It's easy to eat 50 *net* carbs - that can be as many as 75-80 *total* carbs. So please Andreas, can you just quickly clarify for us whether Phinney means total or net here?

    I've personally been eating 30% protein, 60% fat, and 10% carbs - since I'm still trying to lose weight. But after listening to this, I think I'll drop my protein to 25% and increase my fat to 65%. Or should we all just head to Phinney's maintenance level from the start - should we all just say from the beginning, "20-25% protein, 70% fat, 5-10% carbs?"

    This would certainly make the diet much easier from the very start, since just about every online or mobile phone app diet calculator keeps track of these ratios for you.

  3. George
    I'm having trouble trying to figure out what kinds of fats he recommends on this 80%-ish fat diet. I mean, is he just spooning lard straight into his mouth? Drinking olive oil by the pint? If carbs are supposed to be essentially non-existant, and protein is supposed to be a moderate levels as well... where is the fat coming from? If I, for instance, ate three eggs and two strips of bacon for breakfast, a grass-fed burger patty cooked in coconut oil for lunch, and a pork chop in another healthy oil for dinner... would that be adequate, or would that be too much protein? I get the carb part, it's just the protein vs. fat part that isn't quite sinking in. Any help would rule!
  4. Greg

    EAT: Chuck, 70/30 ground beef, pork belly, pork shoulder, etc.

    DO NOT EAT: skinless chicken breast, pork loin, top round roasts, etc.

  5. Janknitz
    George, I'm with you, it's actually a challenge to get that much fat in! I'm cooking liberally with it, adding a spoonful of coconut oil to my coffee, enjoying heavy whipping cream, butter, etc. but still fall short of that 70%! And I don't really eat that many calories, because I'm not hungry. Still, something to work toward, I suppose.

    Great interview Andreas.

    So Spencer, is Dr. Phinney fit enough for you????? ;o)

  6. George

    Is there any handy resource where one could find the most ideal high-fat meats and such? And alternatively, a list of more lean meats to put on the back burner?

  7. Rachel
    Great video, very informative. Would it be too rude to make a gentle suggestion that the interviewer interjects and interrupts his subjects less? It makes it difficult to listen to.
  8. Rachel
    I have trouble keeping protein in check whilst getting fat up. Firstly it's very hard to find fatty cuts of meat for sale, and even if I can, I just don't like the taste of animal fat. Unless it's browned and crispy, and I've a nagging suspicion that brown crispy fat isn't as good.

    I also find that chicken- the lean, skin-free, protein-rich cuts that I can buy- fills me up and keeps me satisfied for longer than most other foods, including other, fattier meats.

    At the moment my calculations put my fat intake at around 60%, protein between 25-35% and carbs between 5-15%. Short of eating pats of butter (which I'm quite happy to do!) I can't think of a way of easily changing the ratios, and eating butter doesn't fill me up like protein would.

    I am currently debating whether I want to be ketogenic longterm. At the moment it's for weight loss, but since my father and grandmother both developed type 2 diabetes and were both obese, I wonder whether my genes would simply prefer me to carry on eating this way indefinitely.

  9. Rachel
    PS This Rachel is different from the Rachel who commented on Dr Eenfeldt interrupting.

    PPS I see I'm late in commenting on the fat issue! :)

  10. Jaime
    I watched this video a few days ago; it was posted by you in Youtube. I was wondering why you didn't included it here, because it is very interesting, although I share with others the logistic difficulties of achieving 80% fat without spooning. Some typical daily meals as an example would have been very helpful.

    By the way, isn't his name spelled Stephen?

  11. moreporkplease
    "protein between 25-35%"

    I think you really have to keep your protein below 30%, This-Rachel-is-different! :) Protein over that may be turned into glucose via a body process called gluconeogenesis. But again, this is something for Andreas to comment on, I'm not a doctor.

    As for how to eat more fat, that's easy: bacon bacon bacon. :) Fresh Italian sausage from a good butcher, so it doesn't have all the additives, etc. Duck breast with skin! Pork belly! If you can find a German-style butcher in your area, ask for neck roasts that still have the lard and skin on - these cuts are very cheap and cook up very yummy and crispy. Add some hollandaise to your chuck steak.

    Try to get a meat share from a local farmer - search for one near you that offers Mangalitsa pork, an extra-fat and super-tasty breed. Notice also that Dr. Phinney mentions the ever-delicious high-fat cheese!

    And I know he often enjoys half an avocado. Also, when in doubt, cabbage or spinach in cream sauce. Asparagus with hollandaise. Ok, hollandaise with everything! :)

  12. JAUS
    Excellent interview again. I absolutely agree 100% with what Dr Stephen Phinney said in the clip.

    I have right now pemmican in my fridge ready for when I travel and want to be sure to have real food to eat every day. Correctly made and stored pemmican can last a decade (only fat and dried meat, salt is optional). If I could eat only one thing for the rest of my life it would be pemmican.

    For anyone who is interested in making pemmican, google "pemmican manual" and the first link will download a free pdf with instructions.

  13. JAUS
    #3 Just eat more fat in weight than carbs and protein together, then you automatically will eat more than 70% fat. If you eat a piece of meat that has 20% fat content then you are already getting more than 70% energy from fat since fat is more than twice as energy-dense than carbs and protein are.
  14. Galina L.
    When somebody is very keto-adapted (like me), his or her blood sugar level is never too low, and fasting BS can be on a high side. I am on a ketogenic diet for my migraine control. I feel much better than before overall, stop having flues, don’t need asthma medication, no urinary tract infections, my stamina has increased significantly, but blood sugar is higher than before , eapecially fasting BS. I am eating VlC for 4 years, and I think, what if FBS will get higher than now? When a person in my situation should start to worry?
  15. moreporkplease
    Hi Galina:

    You might try cutting back some carbs - maybe instead of a whole apple, try a half apple, for example, or even eliminate fruit for 2 weeks - I've read about some people who had to cut back 5-10 carbs a day in situations like yours.

    Best wishes.

  16. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    Rachel #7,
    That's not rude. I'll try to stop doing it so much.

    Jaime #10,

  17. #2
    On the net carb or total carb issue:
    The relevant thing is digestible or availible carbs. Fibers are only carbs in a strict biochemical sense. In humans about 90 % or more of the fibers will just pass right through. A few % of fibers will be turned into (saturated) short chain fatty acids (SCFA:s) by bacteria in your colon. So in real life, fibers are fats rather than carbs.

    The human gastrointestinal tract is rather poor at this - ruminants and gorillas can convert a lot more fibers to fat and get aboou 60 % of more of their energy from SCFA. (click my name above and you'll find a post about gorillas)

    I do not however like the term "net carbs" because it has been missused in the low carb community, claiming that sugar arcohols should not count as net carbs, while in fact some sugar alcohols, like maltithol easely turns to sugar.

    My favorite food database is Fineli (a finnish datatbase with swedish and english as optinal language). They use the term "aviable carbohydrates":

  18. moreporkplease
    Ty, Per! I notice however Dr. Phinney never says "fiber" or "net carbs" - altho' he wrote a book about them - or "available carbs." He just says "carbs."

    Quite a few of us are really seeking clarity on this particular point. Many of my pals on FB are women over 40 who struggle - the difference could be crucial for them.

    I do wish we could get a clearer answer on this, either from Andreas or from Dr. Phinney himself.

  19. Nads
    This was a great interview Andreas, as have been the last couple. It's great to see someone who has been on a vlc diet for so long. Your lecture at the Ancestral conference is what started me on this, after going sugar-free a few months earlier. In particular the graph of the blood sugar levels after the steak and bernaise sauce compared with the sandwich, apple and chocolate was what convinced me.

    I no longer count my carbs nor track my food after doing this for a couple of months and usually getting between 50-80g per day. I only need to maintain my 57kg (125 pounds), not lose any more. I don't have ketostix so I don't even know if I'm in ketosis. The foods I eat are meat and chicken (with fat on), fish, eggs, butter, cheese, greek yoghurt natural, cream, nuts, flax bread that I make, salads and veges (without potato, sweet potato or corn), berries (one punnet a day maximum), milk (do I really need to give up a cup of milk per day??), I cook in coconut oil or butter or lard, I sometimes make things with almond meal, coconut etc. Is this ok to continue this way? I feel it's doing everything I need for my appetite (previously I was a hungry low-fat calorie-counting bingeing "maintainer" or yo-yoer). I'd like to maintain without effort and be healthy, as I'm almost 50 years old. There is one problem though. I'm pretty flat with my energy!!!

    Anyone who cares to answer any of this, feel free!

    PS Is there a low carb forum that is in English and not too busy and confusing? I'm from Australia so if anyone knows an Ozzie one even better.

    X Nadine

  20. JAUS
    #17 All fibers are not carbs, lignin is not a carbohydrate. Only soluble fibers are converted to short chained fatty acids. Unsoluble fiber is completely meaningless from a nutritional standpoint and can in fact damage your colon.
  21. JAUS
    #17 BTW erytriol is a sugar alcohol that doesn't raise blood sugar at all. Eat a tablespoon of pure erythriol and measure you BS and see for yourself.
  22. #20 and #21
    I agree! Unsoluble fibers are meaningless and harmful and I eat as few of them as possible. Still fibers are not something you should count as a carb in a low carb diet.

    Yes, I am familliar with erythritol, that's the only sugar alcohol I use when ocassionaly making something sweet. But sugar alcohols are not created equally and malthitol is something totally different.

  23. JAUS
    #22 Well then we agree that erythriol shouldn't count as a net carb. Avoid generalizations as much as possible, use the word maltitol instead of sugar alcohols because some sugar alcohols are in fact perfectly acceptable.
  24. FrankG
    It seem to be hard to dispel the idea that an high fat diet means spooning it straight from a tub of lard ;-)

    Perhaps it helps to remember that the percentages quoted above are in terms of percentage of energy(calories) not percentage of volume -- fat has over twice the calories of carbohydrate or protein, so replacing 100g of carbohydrate with around 43g of fat is the same in terms of calories, but could be enough to change a diet from being defined as high-carb to high-fat, and (as above) might be as easy as eating chicken with the skin on and simply no longer avoiding natural fats by eating "low-fat" versions of food.

    Although I rush to add that we don't just eat for energy and just to speak of calories is grossly over-simplistic -- we need to nourish our bodies with more than just energy and yet again it seems that natural fat is essential in that regard.

  25. DoragonMama
    @moreporkplease I have found in my own experience that women have more comlpex isues than men do while living VLC, men do not have the hormone and thyroid problems that plague women and getting those issues treated will help many women to continue to lose weight.
    Along the same lines I have problems controling my diabetes even though I eat <20g of carbs per day and live on a very high fat diet, but the men I know with diabetes do not have problems once they control their carb intake.
  26. #23
    That was exectly the reason why I wrote in my first post: "while in fact some sugar alcohols, like maltithol easely turns to sugar"
    That is NOT a generalization!
  27. Dianne
    As a post-menopausal woman, I find that I have gall bladder issues when I try to add more fat to my diet. I eat vegetables, animal protein with fat, a little cheese, coconut oil and a LOT of nuts. I don't like to eat that many nuts, but I get so hungry otherwise.

    When I eat more fat, I don't have to eat as many nuts, but then my gall bladder acts up. My weight is where I want it, my fasting blood sugar is in the low 80s (it was over 100 when I ate a high carb, low fat diet). Any suggestions on the GB issue?

  28. Diane
    So then how do you calculate the ratios? I have been adding up the grams for protein, fat and carbs to get the total grams, then calculating the percentages from there. Is this the right way? Or do I need to take the grams for the individual macros and multiply them by whatever it is to get the calorie values and then calculate the percentages off the calorie values?
  29. FrankG
    @Diana #28 I'm assuming your question about ratios was aimed at my #24 "...the percentages quoted above are in terms of percentage of energy(calories) not percentage of volume -- fat has over twice the calories of carbohydrate or protein, so replacing 100g of carbohydrate with around 43g of fat is the same in terms of calories..."

    I realised after that should read "weight" rather than "volume" but I hope the meaning was clear anyway ;-)

    My point was really to dispel the idea that an "high fat" diet means eating the same amount of food but substituting fat for carbohydrate... gram for gram. I'll admit that after years of "brainwashing" by the media, government agencies and health establishment, it can be hard to shake the idea of "arterycloggingsaturatedfats" and the term "high fat" does seem to give many the impression of sitting on the couch with a large tub of lard and a spoon ;-)

    I guess it might help at first to count these things in order to get a feel for where we are, but I'm now at the stage where there is no need to count anything but instead: when presented with real whole food, I trust my body to let me know when I have had enough of everything it needs -- much like every other animal on the planet.

    To these ends I tend not to focus on numbers but my understanding is that: yes you need to multiple the grams of each macronutrient by its respective calories* per grams and use that to estimate the percentage of energy from each macronutrient... so for example: with carbs and protein at 4 calories per gram and fat at 9 calories per gram, and aiming for around 2,500 calories per day; with ratios of 20% protein (500 calories), 70% fat (1,750 calories), 10% carbs (250 calories) that comes to 125g Protein (500/4), 195g Fat (1,750/9) and 63g Carbohydrate (250/4) -- so by weight, the fat i pretty much the same as the protein + carbs

    My son in the math-major, not me, so I hope I have those figures correct!

    BUT please remember that we don't just eat for energy, nor do we eat "macronutrients" -- I prefer to eat real whole food and basing (as it seems does Dr Phinney) my diet on what humans have eaten for much of our evolution, I find that we are well adapted to eat food as packaged by nature in pretty much the ideal ratios for our needs.

    *please note that I am using the common-usage of calories, and perhaps I should be more precisely writing kcalories or something else. http://en.wikipedia.org/wiki/Calorie

  30. FrankG
    @Rachel #7 -- I beg to respectfully disagree... if Dr Andreas asked fewer questions it would not be an interview ;-)

    I get the impression that he already knows Dr Phinney's answers to many of these questions but is asking them on behalf of the general audience -- heading off questions or objections that others might raise.

  31. FrankG
    Here is an account by Stefansson, as discussed by Dr Phinney


  32. moreporkplease
    Hi Diane:

    Don't freak out over the math. Just check out any common website like fatsecret.com or fitday.com - whatever - all of these food tracking websites do the same thing - enter in a full day's exact menu - you will see what your current ratio of protein-fat-carbs is and then you can easily adjust from there. If you do it every day, after about 3 weeks you'll begin to instinctively recognize what you need to do. Then you don't need to track anymore, you'll have taught yourself what you need to know. :) :)

    For example, the first time I did this, I realized I was eating about 32% protein, because I would eat an 8 oz steak at dinner. Now I just have 4 oz of protein food for lunch and breakfast, then have 6 oz at dinner. This keeps my protein at about 28%.

    But after watching this video again, I may take that down to 4 oz at dinner as well and just have an extra spoon of cream in my coffee! :)

  33. Diane
    That's the thing. I wasn't counting at all. Then I tried one of these calculators and had to do the math myself. I was shocked by the numbers. It was like 11% carbs, 53% protein, 35% fat. Wow, way too much protein. So this morning I put in my breakfast, which was a piece of bacon, two eggs, one avocado and a tablespoon of cold butter plus two cups of coffee with cream and it was only up to 60% fat. I'm like, what the heck? Do I need to eat a stick of butter? So I guess I'm calculating it wrong.
  34. Galina L.
    @ moreporkplease,
    In order to be in ketosis, I am on very LC diet already there is nothing to cut away, I don't regularly eat fruits. I wonder, which FBS readings for person on VLC are a problem.
  35. JAUS
    Why even care about calories at all, there is no good reason for counting them. Animals don't need to know how to count calories so why should we? If you are hungry, eat; if you're not, don't; it's as easy as that. Meat is about 20% (one fifth) protein and fat content varies depending on what you buy. Let's say you buy an piece of meat with 20% fat then you have 80% fatless meat left, 80/5=16% of protein. It's really simple math.
  36. moreporkplease
    Hi JAUS:

    "Why even care about calories at all, there is no good reason for counting them. Animals don't need to know how to count calories so why should we?"

    Um, because if you read the anguished blogs of over-40 low-carb women, they are suffering. There are many in the category who can't lose weight unless they count calories, add weight- lifting, limit total carbs to 40, give up all processed/artificial foods - and still it's a long haul. Peri-menopause/menopause is a different, different thing. And I wish the overall low-carb community would admit not only that women over 40 exist, but that they may be the majority of low-carb dieters.

    But what can we do, the only big-name female low-carb expert is Dr. Mary Vernon. And she never addresses women's health as a specific topic. So who else is there? The men certainly aren't going to do it, to be frank. :)

  37. Milton
    @Diane: "So then how do you calculate the ratios?"

    I use the calories when calculating the ratios, which is what I assume is the usual approach.

  38. JAUS
    I forgot to link these two excellent Youtube-clips that show how to make pemmican:

    Part 1: http://youtu.be/ywBwUiq5v4o

    Part 2: http://youtu.be/JZi5thqBjQA

  39. Diane
    I recalculated using calories instead of weight and voila! Proper ratios. I hate math. I think I will write a computer program to calculate these for me next time.
  40. Garry
    It is known that many environmental toxins end up deposited in fat tissue. Is there any concern that eating more animal fat will increase exposure to these toxins? I understand that eating 'organic' grass-fed meats eliminates these concerns to some degree, but these cuts of meat may not always be available and when they are they can be expensive.
  41. moreporkplease
    As I said, Diane, fatsecret.com does all the calculations for you and shows you the pie chart automagically. That would certainly be easier! :)

    What was your result? Many women over 40 whose blogs I read have first tried becoming more ketogenic - upping fat from 60 to 70-75% of calories, then limiting calories to between 1500-1800 while keeping that fat percentage, then adding some weight lifting twice a week.

    If those don't work, they then move on back to the doctor for tests to see if they need to add metformin, Januvia, thyroid, or other hormones. So don't give up! There are still many options to get you on track and improve your health! :)

  42. I really enjoyed this interview! The most helpful piece for me was that if your goal is to be a fat burner it's especially important to not have cheat days or binges since it can take several weeks to get back on track as an efficient fat burner. My partner has been of the mindset that it's no big deal, but clearly it sets a person back more than just getting back into ketosis.
  43. Galina L.
    @ Dianne # 27
    I had my gallbladder removed 7 years ago, at the beginning I had diarrhea after fat consumption, but in time it got less and less, and now I can eat fat without any unpleasant side effects. Let your body to get adjust. The more you avoid fat, the more sensitive your body will be to it . It is easier to increase amount of butter, cream and coconut oil, beef and lamb fats are more challenging, however, I am eating it now as well.
  44. Dianne
    @ Galina #43

    Thanks for the encouragement. I'll follow your suggestions.

  45. Dana
    I disagree with the commenter who said not all fiber is carbs. Fiber is most certainly carbohydrate, no matter which kind it is. What makes some fibers less soluble than others is how easily the bacteria in our gut break them down. But they're all long chains of complex sugars.

    By the way, we turn glucose into fatty acids so that doesn't really mean anything.

    I use the work of the doctors Eades to determine what my protein intake should be, set a goal for carb intake and then make up the rest of it in fat. Seems the most sensible route because I don't want to go so high on protein that I'm making sugar out of it. If I were to increase daily carb intake from a starting point of 20g (and I wouldn't want to stay at 20g because that's *too* limiting--you can be in ketosis at 50g) I'd swap some fat calories for carb calories. It's not much of a change and I'd still be eating more fat than anything else.

  46. Margaretrc
    @Dana, true, all fiber is carbohydrate, chemically, but I think what the commenter meant is that some (all) fiber doesn't raise blood glucose because it is either not digested at all (insoluble) or is converted in the lower gut to short chain fatty acids (soluble.) Thus a carb counter does not have to count fiber as carbs when figuring carb intake. However, to also get technical, the difference between soluble and insoluble fiber isn't about how the gut bacteria handle it, but how well it absorbs/is absorbed by water. Technically all fiber molecules are too large to dissolve in water, but "soluble" fiber does soak up a relatively large amount of water compared to insoluble.
  47. Diane
    moreporkplease , I forget what the totals ended up being when I redid them right, but it was close to 70% fat, 20% protein and 10% carbs. All my carbs are from chard, onions, mushrooms, avocados and tomatos. I was using a web application over on the USDA website. They recommend I only consume ~1800 calories for someone my size. I don't measure most of the time because it's hard sometimes to know what I've eaten if a meal contains many ingredients, but on the days where my food is simple enough to put in the calculator, I end up between 900 calories and 1500 so far, with one exception being the company Christmas party where I estimated 2700 calories (I hiked 18 miles that day though so I think it was okay). Right now the only exercise I do is hiking in the mountains on weekends or just walking. The only weight lifting is hauling my sorry butt to the top of some mountain.
  48. Galina L
    Guys, stop counting on exercise to cover overeating. I am not criticizing anyone, but often people feel on subconsciousness level that they are entitled to more food when they move more. If you are not in the Toure de France team, it is mostly not the case. Sure, parties happens, holidays, celebrations, and it you eat more, it is a good thing to move more. I found, however, that fasting around overeating is more effective. Compensate food excess with the relative lack of food. Our body it very creative with the energy use when we exercise. During the weekend and couple days at the beginning of the week me and my husband were engaged in very intense cardio activity for couple hours every day for 4 days (for entertainment) in local national park. I was with a pulse monitor out of curiosity. Average pulse rate was between 148-152. I didn't lay down the rest of the day, moved the same amount, eat the same amount of food, however, got much hungrier. I lost absolutely no weight, and clothes didn't get looser.
  49. Tom Hepplewhite
    Ok but how does a veggie consume that much fat?
  50. Ray
    @Galina #14
    When somebody is very keto-adapted (like me), his or her blood sugar level is never too low, and fasting BS can be on a high side.

    @Galina #34
    I wonder, which FBS readings for person on VLC are a problem.

    I was not aware that it is common to have high fasting blood glucose levels if you were keto-adapted. Do you (or anyone) have any links to more information about this?

    Wouldn't no/low carbohydrate intake allow the liver to run its gluconeogenesis 'program' at its optimum target value? It seems that this would be a fairly low fasting blood glucose. For what its worth, my fbs is about 90 when things are going well (no cheating). I should be fairly well keto adapted after a year of intermittent fasting (5 to 6 hour eating window) & low carb (usually <100g).

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