Top 17 low-carb & keto controversies

Top 17 low-carb & keto controversies

It is not at all uncommon for people to be skeptical of a low-carb diet in the beginning, especially since high-carb, low-fat advice has been so prevalent for decades.1
We don’t want any unsubstantiated fears to get in the way of people reaping the benefits of a low-carb diet. On this page you can learn why many of these controversies are based on misunderstandings or incomplete knowledge – those are nothing to worry about.

However, our goal of making low carb simple also requires us to be be very upfront and honest about potential problems and how to handle them. Some problems can and do occur on low carb, and it can be helpful to know what they are and what can be done about them.

Here are the most common controversies about low carb, and what the currently best available scientific evidence can tell us about them.
 

 


 

1. Will saturated fat clog my arteries and give me a heart attack?

time-saturated-fat-butter-cover-smNo. This is probably one of the biggest nutrition myths of the last few decades.2  
 
During the last ten years or so, many reviews of all available science have come to the conclusion that there’s no connection between saturated fat and heart disease.34 This fact has also been recognized in many high-quality newspapers.5 It’s simply been a mistake.

Fortunately, during the last several years more and more experts and organizations have realized that natural saturated fats – despite their reputation – appear to be neutral from a health perspective.6

It’s natural to eat saturated fats, as they are found in natural foods that we have eaten throughout evolution.7 This includes human breast milk, and the multiple foods that sustained our ancestors as adults.8

Don’t fear fat. Updated experts don’t.
 
A user guide to saturated fat

Watch doctors explain why saturated fat is neutral

Vegetable oils: What we know and what we don’t

Read recent news about saturated fat


 

2. Does a low-carb diet cause high cholesterol?

LDL cholesterolLow-carb diets tend to improve the cholesterol profile by increasing levels of HDL (“good”) cholesterol, and decreasing levels of potentially harmful triglycerides.9 They may also improve the size profile of the LDL.10  
 
These appear to be beneficial changes that are associated with decreased insulin resistance and improved health.

Regarding LDL (“bad”) cholesterol, most people experience no significant changes on low carb.11 However, in some people, LDL levels decrease or (more often) increase somewhat.12

For a small minority of people however, cholesterol may go up abnormally high on a low-carb, high-fat diet.13 In those situations it could be worth adapting the diet to normalize the LDL cholesterol levels. Depending on your overall risk profile, you may want to work closely with your doctor to monitor for any evidence of cardiovascular disease.

Controversy exists about the absolute risk of elevated LDL in all people, as some observational studies show that higher LDL levels in the elderly are associated with living longer.14 While this does not prove cause and effect, it raises the question if LDL is a concern for everyone.

Taken together, studies show that low-carb diets on average improve risk factors for heart disease for the majority of people, including cholesterol.15

The bottom line: Low-carb and high-fat diets on average improve the cholesterol profile and reduce most risk factors for heart disease. The effect of this has been demonstrated in a 2010 study that showed a reduction in atherosclerosis after two years on a low-carb, high-fat diet.16

 
Low carb and cholesterol – the full guide

Learn how to handle elevated cholesterol on low carb

Read recent news about cholesterol

 
 

3. Doesn’t the brain need carbs?

No. On a strict low-carb diet the brain can be primarily fueled by fat – or technically, by ketones. When carb intake is very low, your liver converts body fat or fat from the food you’ve eaten into ketones, which can be used by the brain as fuel.17

brainThis means that fat-burning goes up significantly – a big plus for people who want to lose excess weight.18

Furthermore, your body can produce any glucose it needs through a process called gluconeogenesis, converting other nutrients to glucose – even if you don’t eat any carbs at all.19

There is no need for carbohydrates in the diet, and the brain functions fine without it.

Learn more in our full guide:

Food for thought: Does the brain need carbs?

Watch doctors explain why the brain doesn’t need carbs

Learn more about ketones and ketosis

 
 
 

4. Is low carb bad for the environment?

No. It’s a common misunderstanding that a low-carb diet requires eating a lot of protein, including meat, making it bad for the environment. This is simply not true.

A low-carb diet is supposed to contain more fat, not more protein. This is why it’s often called an LCHF diet (low-carb, high-fat).

The amount of protein should stay moderate – about the same as on other diets.20 So there’s no need to eat more meat just because you’re on a low-carb diet. In fact it’s very possible to even eat a vegetarian low-carb diet, should you want to.

cowFurthermore, the impact of meat production on the environment depends on many factors. Do you buy locally raised, grass fed or pasture raised meat or poultry? If so, these can actually be raised in a manner that is environmentally friendly! They may potentially reduce the pesticide burden and nutrient depletion of soils, as well as allowing for more carbon dioxide to be stored in the ground.21

The environmental benefit of having carb-rich monocultures such as soy, sugar and corn is also overstated. These pesticide-heavy crops reduce biodiversity and contribute to pollution to a much greater extent than, let’s say, a biodynamic cow farm.22

Finally, a low-carb diet often results in people eating less food, as it’s so satiating.23 After significant weight loss people need even less food. Needing less food, and needing to eat less often, is of course good for the environment.

Bottom line: A low-carb diet should only be moderate in protein – e.g. meat – and thus it’s no different for the environment than most diets. If you still choose to eat more meat than usual, the impact on the environment depends a lot on how the animals were raised.
 

Six ways to stay environmentally friendly on a low-carb or keto diet

The green keto meat eater

Watch low-carb experts explain how low carb can be environmentally friendly

TED / Allan Savory: How to fight desertification and reverse climate change

Watch one of the smartest men in the world explain the real problem for the environment (Hint: it’s fossil fuels)

 

 

5. Can you get nutrient deficiencies on low carb?

NutritentsProbably the opposite is more often true. The foods consumed on a low-carb diet are highly nutritious.24 For example, eggs (a staple for many people on low carb) may provide the most complete nutrition of any food on the planet.25

Consider that a complete chicken can be formed from the nutrients inside the egg. There’s no way for the chicken to pop out and get some vitamins and minerals while growing in the egg; everything has to be there. And by eating an egg, we humans get all those nutrients.

Meat, fish and vegetables are also highly nutritious foods. And many people eating low carb tend to replace nutrient-poor pasta, rice and potatoes with more nutrient-rich vegetables.

Studies show that a low-carb diet can be nutritionally complete.26

Compared to the more complete nutrition of a low-carb diet, refined flour is more or less devoid of any nutrition whatsoever apart from pure starch. Usually it’s legally required to add vitamins to flour, so that people who eat a lot of it do not get vitamin deficiencies.

On top of that problem, grains like wheat are high in phytic acid that can reduce absorption of many minerals.27

Another concern with low carb diets is the lack of fruit, often thought to be necessary for proper nutrition. This is a sad misunderstanding. Apart from vitamin C, there are very few nutrients in most modern fruit.28 These days, they are modified to be large and very sweet. Fruit is basically candy from nature, and should probably be eaten in moderation. Juice is even worse, given the concentrated sugar and lack of fiber to help slow the absorption.29

Modern fast food and junk food also contain a lot of calories and not much nutrition.30 And low-fat products are low in essential fat-soluble vitamins, which are found in full-fat versions of yogurt, cheese and other whole foods.

Bottom line: Switching from a standard Western diet to a low-carb diet based on real foods is likely to significantly increase the amount of vitamins and minerals you get from your diet.

 
 

 

6. Can low carb damage your thyroid?

thyroid2Not likely. If you eat a well-formulated low-carb diet, meaning you replace carbs by eating more healthy fat, it’s very unlikely it will affect your thyroid negatively.

Long-term starvation or calorie restriction diets can lead to hypothyroidism (an underactive thyroid). But you won’t be starving on low carb as long as you eat enough fat to feel satisfied.31

In fact, some people who lose significant amounts of weight on low carb may end up needing less thyroid medication, and a few individuals may even be able to stop taking it completely.32 This may just be an effect of a smaller body needing less thyroid hormone. There isn’t any research showing that restricting carbs itself can improve thyroid function.

This means that if you have hypothyroidism and supplement with thyroid hormone you can start a low-carb diet like anybody, and continue to do regular checkups as usual. If you lose a lot of weight it may be wise to do an extra check of your thyroid hormones once in a while, e.g. every time you’ve lost 30 pounds (15 kilos). It’s not impossible that your dose may need to be adjusted.

Bottom line: Eat enough to feel satisfied, and your thyroid will be fine.

 
Watch doctors explain why low carb is fine for the thyroid

Learn how to eat more fat

 
 

 

7. Can low carb damage your kidneys?

Highly unlikely.33 Many people still believe that a low-carb diet necessarily is very high in protein, that could put a strain on the kidneys. This is a myth based on two misunderstandings.

kidneysFirst, a well-formulated low-carb diet is high in fat, not protein. The amount of protein – like meat – should be moderate, just like in most diets.34 There’s no benefit of eating excessive amounts of protein. It can even be detrimental on a low-carb diet, as excess protein can be converted to glucose, just like most dietary carbohydrates.35

As a low-carb diet shouldn’t be very high in protein, the whole “problem” behind this controversy simply does not exist.

Secondly, people with normal kidney function can handle high amounts of protein without any problem for the kidneys.36

Even if people choose to eat excessive protein, this will only be a problem if the kidneys are already severely damaged. An example of this would be end-stage kidney disease that is close to requiring dialysis. Basically, if you have severe kidney disease and you’ve been told to limit protein, you should of course do so.37 But that would still make it possible for you to successfully eat a low-carb, high-fat diet.

To summarize: For people without kidney disease there’s no reason to worry about the effect of excessive protein on your kidney health. And, most importantly, there’s no need for anyone to eat excessive protein on a low-carb diet in the first place.

Bottom line: A low-carb diet is fine for your kidneys.

In fact, by lowering elevated blood sugars a low-carb diet may actually protect the kidneys from one of the most common causes of damage. Especially for people with diabetes, low carb might help protect their kidneys, by helping control their blood sugar levels.38

 

Watch doctors explain how low carb affects your kidneys

How to reverse your type 2 diabetes

 
 
 

8. Can low carb make you depressed?

depressionNot likely. But during the first week, or two, of a low-carb diet, it’s common to experience symptoms similar to those of depression (such as lethargy, tiredness, irritability, brain fog).

These problems usually disappear within a few days or a week. They can often be avoided for the most part by getting enough fluid and salt – for example a cup of bouillon 1-2 times a day.

Long term, a low-carb diet often has the opposite effect. Getting into ketosis can make some people feel very energetic and might increase mental performance and endurance.39 People sometimes mention the “mental clarity” they feel.

Studies of the mental state on low-carb diets generally, and on average, show either no clear change or a slight improvement, compared to before starting the diet.40 Note that studies show the average result for a group of people. A few individuals may feel worse, while others feel better.

One reason that some people may feel depressed is if they have an addiction to reward from high-carb, sweet foods.41 Removing such foods when people are addicted to them may result in temporary feelings of loss and sadness, similar to symptoms of a depression. It may be similar to the effect of withdrawing from nicotine or alcohol when addicted to these substances.

Fortunately, after early withdrawal symptoms have passed, getting free of an addiction is incredibly liberating and enables people to lead fuller and happier lives. So it can definitely be worth the struggle.

Finally, to make a low-carb diet feel great long term requires tasty food and a simple and enjoyable lifestyle. Feel free to use our resources to speed up the process.

 

Watch doctors explain why low carb often have positive results on the mood

Watch our video course about sugar and food addiction

Check out awesome low-carb recipes

Make low carb simpler using our low-carb living guides

 
 
 
 

9. Is low carb bad for exercise?

Exercise and low carbLow carb can be good, bad, neutral or even fantastic for exercise. It depends.

During the first couple of weeks when you’re switching from a diet rich in carbs to a low-carb diet, your capacity in the gym will most likely go down.42 This is due to the low-carb flu, but it will likely mostly pass within one or two weeks.43

After a few weeks of adaptation, people often report feeling at least as good as before when exercising, especially if they make sure to get enough fluids and salt.

Furthermore, for endurance athletes, there are many benefits to being fat-adapted and eating LCHF.44 For instance, this is demonstrated by the fact that the two top performers in Tour de France 2016 were on some form of low-carb diet.

Similar benefits have been seen for powerlifting and weightlifting athletes.45 Additionally, following a ketogenic diet might improve body composition when combined with resistance training.46

However, more carbs are probably needed for non-endurance sports such as sprinting etc.47 In these cases, it might be a good idea to take in some more carbs on the day when you need to perform, such as during a game day.

 

Watch doctors explain how low carb can be good for exercise

Learn more about how to increase physical performance on low carb

 

 

10. Is low carb bad for your gut bacteria?

Gut bacteriaProbably not. There is currently a lot of research being conducted on gut bacteria. The main problem with much of the reporting on gut bacteria and diet is confusing statistical correlations with causality, i.e. taking weak clues and mistakenly calling it proof.48

Not much, if anything, can yet be said about the health effects of changes to the microbiome49 on a low-carb diet, only that it changes.50 However, many people report that they have less gastrointestinal stress and bloating after starting a low-carb diet. Additionally, the ketogenic diet may lead to beneficial changes in the microbiome in people with certain health conditions, such as multiple sclerosis and epilepsy.51

The number one thing to do for your gut bacteria is to never use antibiotics unless you have to.52 And even then less is often better.

 
Watch a presentation on the possible benefits of slow carbs to feed the microbiome

 

 

11. Can you get constipated on low carb?

Yes. Constipation is a possible side effect that can occur, especially during the first time on a low-carb diet, as your digestive system may need time to adapt.53

It can usually be alleviated by either drinking more water and increasing salt intake, taking in more fiber or, if necessary, adding Milk of Magnesia.54

Note that just because some people have a bowel movement less often does not mean they are constipated. Many people report decreased stool frequency on low carb, but as long as they don’t feel bloated or abdominal pain, there is no concern with this.55

If you suffer problems with constipation when starting low carb, it is usually temporary.

 
Learn more about preventing or curing constipation on low carb

 
 

 

12. Can you get osteoporosis on low carb?

osteoporosisNo. There is a lingering idea that eating low carb could result in osteoporosis, due to making the blood “acidic” and leaching minerals from the bones. But this theory has been disproven in several ways.

For example, under normal circumstances the pH of the blood does not change depending on what you eat.56 Blood pH is tightly controlled within a very narrow range – otherwise, we’d die.

This theory is usually based on the idea that a diet rich in protein would make the blood acidic, making it bad for the bones. This is the opposite of what studies show – people who eat more protein tend to have stronger bones.57 Looking at all available science, higher protein intake hasn’t been shown to harm bone health and may potentially even help protect against bone loss in the lower spine.58

Finally, repeated studies show no effect on bone density in people eating low carb, even after several years.59

Low carb does not affect the bones.

 
Learn more about low carb, blood pH and bone strength

 
 

13. Does low carb cause hair loss?

hairOccasionally. Temporary hair thinning can occur for many different reasons, including any big dietary change. This is especially common when severely restricting calories (e.g. starvation diets, meal replacements) but it can also occasionally happen on a low-carb diet.60

This kind of temporary thinning of the hair61 typically occurs 3-6 months after a big dietary change or any other kind of stressful experience for the body. After a period of losing more hair than usual, the lost hairs then grow out again, so that the hair ends up as thick as before.

It’s safe to say that the large majority of people who try a low-carb diet never experience this. Furthermore, it’s likely possible to minimize the risk by not doing a low-carb and low-fat diet at the same time, i.e. by avoiding starvation. Make sure to eat enough fat to feel satisfied, and a moderate amount of protein.62  

Learn more about low carb & temporary hair loss

Learn how to eat more fat

 

 
 

14. Does low carb cause ketoacidosis?

KetoacidosisNo. Many people mix up ketoacidosis with ketosis.

Ketoacidosis (also known as diabetic ketoacidosis, or DKA) is a rare and dangerous medical condition that mainly occurs in people with type 1 diabetes if they don’t take insulin, especially if they are ill.

People with type 2 diabetes who take certain medications (eg SGLT2 inhibitors) can also develop DKA, although this is relatively rare.63 However, eating a ketogenic diet while taking these medications might potentially increase the risk of DKA.64

Ketosis (sometimes referred to as nutritional ketosis), on the other hand, is a 100% natural and safe state for most people, under full control by the body.65

It can be caused by a low-carb diet or by a brief period of fasting.66

Under normal circumstances, a strict low-carb diet never results in ketoacidosis. It results in ketosis, a natural and safe state that enables the body to quickly burn large amounts of fat.67

 
Learn more about ketosis and ketoacidosis

 

 
 

15. Do you get a shortage of whole grains on low carb?

Do you need to eat whole grains – like bread or pasta – to stay healthy? While the fiber in whole grains may slow down the absorption of glucose and lower the glycemic index (possibly a good thing), it’s less clear what the benefit is on a low-carb diet.68 There’s likely much less benefit of slowing down the absorption of carbs if you don’t eat many carbs.

Furthermore, there no high-quality science proving a need to eat whole grains to prevent disease or prolong life. The most recent Cochrane review of high-quality nutrition science found no evidence for that idea.69

There’s a widely-held belief that people need to eat grains to get specific nutrients. However, other foods that are lower in carbs are often more nutritious.

Finally, there’s an idea that the microbiome in our guts may benefit from the fiber in whole grains. This is still a controversial topic with a lack of high-quality science. However, there are many other sources of fiber that are far lower in carbs than whole grains.

Learn more about whole grains and health

 

 

16. Is salt dangerous for your health?

A low-carb diet is not necessarily higher in salt than other diets. But it’s often recommended to increase salt intake when starting, to reduce the risk of side effects. So is salt dangerous?

Actually, the science for this common piece of health advice is quite weak:

Salt restriction lacks credible evidence

 

17. Is red meat dangerous?

A low-carb diet is not necessarily higher in red meat than other diets. It’s even possible to eat a vegetarian low-carb diet. However, many people eat a low-carb diet with red meat. Here’s our guide to what the scientific evidence tells us about it:

Guide to red meat – is it healthy?

 

Expert Q&A

For more answers to common low-carb fears from some of the leading low-carb doctors70 in the world, then check out our Q&A video series:

  • Is low carb bad for exercise?
  • Everything in moderation?
  • Is low carb bad for the kidneys?
  • Is low carb an extreme diet?
  • What is the main benefit of low carb?
  • Does the brain need carbohydrates?
  • Are there potential dangers with a low-carb diet?
  • Is there a link between low carb and eating disorders?
  • Can fasting be problematic for women?
  • Women's questions introduction
  • Is low carb bad for the environment?
  • Isn't weight loss all about counting calories?
  • Why is low carb important to you?
  • Can you get depressed on low carb?
  • Can low carb make menopause easier?
  • Is low carb bad for the thyroid?
  • Is low carb bad for gut bacteria?
  • Is saturated fat bad?
  • How do you maximize your health?
  • Can exercise be problematic for women?
  • Can low carb and keto help with PMS?
  • Do you need more carbs when breastfeeding?

More questions & answers about low carb
 
 

 
  1. This advice may have contributed to the obesity epidemic first seen in the US, which is now a global health issue.

    Nutrition 2015: Statistical review of US macronutrient consumption data, 1965-2011: Americans have been following dietary guidelines, coincident with the rise in obesity [overview article]

  2. Current Nutrition Reports 2018: Saturated fat: part of a healthy diet [overview article]

  3. Here are five meta-analyses showing no connection between saturated fats and heart disease:

     
    Learn more about the science of saturated fat

  4. Beyond studies on saturated fats, there’s no good support for natural foods containing plenty of saturated fats being a concern. For example, butter, meat, coconut oil, etc. In studies, these foods have not been proven to increase heart disease risk:

    American Journal of Clinical Nutrition 2017: Total red meat intake of ≥0.5 servings/d does not negatively influence cardiovascular disease risk factors: a systemically searched meta-analysis of randomized controlled trials [strong evidence]

    PloS One 2016: Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality [very weak evidence]

    Indian Heart Journal 2016: A randomized study of coconut oil versus sunflower oil on cardiovascular risk factors in patients with stable coronary heart disease [moderate evidence]

  5. Here are a few examples.

    TIME: Eat butter. Scientists labeled fat the enemy. Why they were wrong.

    WSJ: The dubious science behind the anti-fat crusade

    The Washington Post: ‘Carbohydrates are killing us’

  6. These include cardiologists like Dr. Bret Scher, Dr. Aseem Malhotra, Dr. Scott Murray and Dr. Blair O’Neill and organizations like The International Network of Cholesterol Skeptics. Furthermore, The Academy of Nutrition and Dietetics has publicly stated that saturated fat should no longer be considered a nutrient of concern, given the lack of evidence connecting it to heart disease.

  7. Humans and our ancestors have been eating natural saturated fats for millions of years:

    Nature Education Knowledge: Evidence for meat-eating by early humans [overview article]

  8. About 50% of all the fat in breast milk is saturated fat.

    Lipids 2010: Saturated fats: a perspective from lactation and milk composition [overview article]

  9. Nutrition Reviews 2018: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis [strong evidence]

    Annals of Internal Medicine 2010: Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial [moderate evidence]

  10. Lipids 2009: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet [moderate evidence]

  11. A recent study in people with type 2 diabetes found that LDL cholesterol increased by just 9%, on average, after one year on a very-low-carb diet.

    Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study [weak evidence]

  12. This can vary quite a bit from person to person. For instance, in a 3-week study of healthy people who followed a low-carb diet, LDL cholesterol levels increased by as little as 5% in some and as much as 107% in others.

    Atherosclerosis 2018: Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: A randomized controlled study [moderate evidence]

  13. These individuals are often referred to as “hyper-responders,” which Dave Feldman of Cholesterol Code has written about extensively: Hyper-Responder FAQ

  14. BMJ Open 2016: Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review [weak evidence]

  15. British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. [strong evidence for improved risk factors]

    Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study [weak evidence]

    Progress in Lipid Research 2008: Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome [overview article]

    Learn more about this and other studies on low carb and risk factors

  16. All three diets induced weight loss and resulted in signs of reduced atherosclerosis, compared to baseline.

    The low-carb, high-fat diet – defying expectations – did not do worse. Instead the non-significant trend was towards a stronger positive effect on low carb:

    Circulation 2010: Dietary intervention to reverse carotid atherosclerosis [moderate evidence]

  17. Although the brain always requires some glucose, a portion of its energy needs can be met by ketones.

    Critical Care 2011: Clinical review: ketones and brain injury [overview article]

    Journal of Cerebral Blood Flow & Metabolism 2017: Inverse relationship between brain glucose and ketone metabolism in adults during short-term moderate dietary ketosis: a dual tracer quantitative positron emission tomography study [weak evidence]

  18. Research has shown that people who consume ketogenic diets often experience an increase in fat burning and fat loss.

    Diabetes and Metabolic Syndrome 2017: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies [moderate evidence]

    BMC Proceedings 2012: Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio [moderate evidence]

    Military Medicine 2019: Extended ketogenic diet and physical training intervention in military personnel [weak evidence]

  19. American Journal of Clinical Nutrition 2009: Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet [moderate evidence]

  20. In many LCHF studies showing health benefits, people are advised to eat a moderate amount of protein and as much fat as needed to feel satisfied.

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

    Applied Physiology, Nutrition and Metabolism 2017: A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel [moderate evidence]

  21. Environmental Health 2017: Human health implications of organic food and organic agriculture: a comprehensive review [overview article]

    Nature Communications 2015: Emerging land use practices rapidly increase soil organic matter [weak evidence]

    Agricultural Systems 2017: Impacts of soil carbon sequestration on life cycle greenhouse gas emissions in Midwestern USA beef finishing system [weak evidence]

  22. Science of the Total Environment 2018: Environmental and health effects of the herbicide glyphosate [overview article]

    Global Food Security 2017: Livestock: on our plates or eating at our table? A new analysis of the feed/food debate [overview article]

  23. Many studies have shown that when people eat low-carb high-fat diets, their appetite decreases. As a result, they naturally eat end up eating less without consciously restricting how much they eat.

    Obesity Reviews 2014: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  24. These include natural fats, meat, poultry, sea food, eggs, vegetables and berries.

    Learn more about low-carb foods

  25. Nutrients 2015: Egg and egg-derived foods: effects on human health and use as functional foods [overview article]

  26. For example this one:

    BMJ Open 2018: Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design [weak evidence]

  27. Phytic acid binds to important minerals like calcium, iron, potassium and magnesium, which impairs your body’s ability to absorb and use them.

    Journal of Zhejiang University. Science. B 2008: Phytate: impact on environment and human nutrition. A challenge for molecular breeding [overview article]

  28. Here are the nutrition profiles for commonly consumed modern fruits. Fruits are also high in sugar, with the exception of avocado: nutrition in fruits

  29. Studies have shown that consuming fruit juice results in greater weight gain than consuming fresh fruit.

    Obesity (Silver Spring) 2012: Beverage vs. solid fruits and vegetables: effects on energy intake and body weight [moderate evidence]

    The Lancet Diabetes and Endocrinology 2014: Fruit juice: just another sugary drink? [overview article]

  30. The Journal of Clinical Lipidology 2015: JCL roundtable: fast food and the American diet [overview article]

  31. There aren’t any studies showing that a low-carb or ketogenic diet with adequate calories can cause hypothyroidism, a condition reflected by elevated levels of thyroid stimulating hormone (TSH).

    In a study of overweight diabetic men without hypothyroidism who consumed less than 20 grams of carbs per day for 16 weeks, TSH levels remained the same or decreased slightly by the end of the study.

    Nutrition & Metabolism 2005: A low-carbohydrate, ketogenic diet to treat type 2 diabetes [weak evidence]

  32. Anecdotal stories, i.e. very weak evidence.

  33. A 2018 review of 12 randomized controlled trials in people with type 2 diabetes concluded that low-carbohydrate diets do not jeopardize kidney function.

    Diabetes Metabolism Research and Reviews 2018: Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: a meta-analysis [strong evidence]

  34. Keeping protein intake moderate and eating enough fat to feel satisfied are the hallmarks of a LCHF diet.

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

    Applied Physiology, Nutrition and Metabolism 2017: A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel [moderate evidence]

  35. In gluconeogenesis (literally “making new glucose”), your body converts amino acids from dietary protein into glucose. Although gluconeogenesis is an important process that occurs on a regular basis, it may increase if protein intake is excessive.

    International Journal for Vitamin and Nutrition Research 2011: Protein turnover, ureagenesis and gluconeogenesis [overview article]

  36. Medicine (Baltimore) 2015: Long-term effects of a very low carbohydrate compared with a high carbohydrate diet on renal function in individuals with type 2 diabetes: a randomized trial [moderate evidence]

    Nutrition & Metabolism 2005: Dietary protein intake and renal function [overview article]

  37. There’s some evidence that this can slow progression of the disease:

    American Journal of Kidney Disease 1996: Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study [moderate evidence]

  38. A 2018 comprehensive review of 12 RCTs found no evidence that low-carbohydrate diets are harmful for kidney health in people with type 2 diabetes.

    Diabetes Metabolism Research and Reviews 2018: Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: a meta-analysis [strong evidence]

    Furthermore, clinicians have reported improvements in renal function in their diabetic patients who follow carb-restricted diets, as documented in this case report:

    Nutrition & Metabolism 2006: A low-carbohydrate diet may prevent end-stage renal failure in type 2 diabetes. A case report [very weak evidence]

  39. This is mainly based on anecdotal evidence from people in nutritional ketosis. [very weak evidence]

  40. Here’s a recent example, showing similar improvements on two different diets, including a very low-carb diet.

    Both diets showed improvements that may at least partially be due to a simultaneous exercise program. The point is, though, that there is no obvious difference between the diets:

    Journal of Internal Medicine 2016: Long-term effects of very low-carbohydrate and high-carbohydrate weight-loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial [moderate evidence]

    In an earlier study comparing a ketogenic diet to a low-fat diet without an exercise component, the ketogenic diet group reported a greater reduction in depression and fatigue than the low-fat diet group, although both groups experienced overall improvement in these and other symptoms.

    Obesity (Silver Spring) 2007: The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms [moderate evidence]

  41. Frontiers in Psychiatry 2018: Sugar addiction: from evolution to revolution [overview article]

  42. In a two-week study, overweight adults who consumed a ketogenic diet reported greater fatigue during exercise than those who ate a moderate-carb diet.

    Journal of the American Dietetic Society 2007: Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study [moderate evidence]

    However, such studies have been criticized for not allowing enough time for proper keto-adaptation prior to testing exercise capacity.

  43. According to ketogenic researcher Steve Phinney, although it takes only a few days to get into nutritional ketosis, it can take 3 to 4 weeks to become fully keto-adapted, regardless of body weight, composition, or fitness.

    Nutrition & Metabolism 2004: Ketogenic diets and physical performance [overview article]

    Virta Health Blog: Keto-Adaptation

  44. Metabolism 2016: Metabolic characteristics of keto-adapted ultra-endurance runners [weak evidence]

  45. Journal of Strength and Conditioning Research 2018: A low-carbohydrate ketogenic diet reduces body mass without compromising performance in powerlifting and Olympic weightlifting athletes [moderate evidence]

  46. Journal of the International Society of Sports Nutrition 2018: Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial [moderate evidence]

    Journal of Strength and Conditioning Research 2017: The effects of ketogenic dieting on body composition, strength, power, and hormonal profiles in resistance training males [weak evidence]

  47. At this time, it’s unclear how performing high-intensity sports like soccer and basketball would be affected in people who’ve been eating LCHF long term, for example, six months or more.

    Journal of Human Kinetics 2017: Low-carbohydrate-high-fat diet: can it help exercise performance? [overview article]

  48. For instance, in a 2018 review of studies looking at the effects different types and amounts of fat on gut health, results from most observational studies found weak associations between self-reported high fat intake, gut bacteria imbalances, and metabolic dysfunction (e.g. insulin resistance).

    However, the controlled trials (higher-quality evidence) found that fat intake didn’t have a significant effect on gut bacteria or metabolic health:

    Clinical Nutrition 2018: Dietary fat, the gut microbiota, and metabolic health: a systematic review conducted within the MyNewGut project [moderate evidence]

  49. The gut microbiome is the entire collection of bacteria and other organisms living in your digestive tract.

  50. Nutrients 2019: The impact of low-FODMAPs, gluten-free, and ketogenic diets on gut microbiota modulation in pathological conditions [overview article]

  51. Frontiers in Microbiology 2017: Reduced mass and diversity of the colonic microbiome in patients with multiple sclerosis and their improvement with ketogenic diet [weak evidence]

    World Journal of Gastroenterology 2017: Ketogenic diet poses a significant effect on imbalanced gut microbiota in infants with refractory epilepsy [weak evidence]

  52. Science 2016: Antibiotic use and its consequences for the normal microbiome [overview article]

  53. This can be somewhat individual, though. For instance, in a 6-month study where people with type 2 diabetes ate fewer than 25 grams of total carbs per day, 68% of the study participants reported that they became constipated at some point during the study.

    American Journal of Medicine 2002: Effect of 6-month adherence to a very low carbohydrate diet program [weak evidence]

  54. This is mainly based on the consistent experience of experienced clinicians. [weak evidence]

  55. Between three times a day to three times a week is considered a very normal range for bowel movements.

    Cleveland Clinic: Frequent bowel movements

  56. This includes diets in which very few carbs are consumed, e.g. ketogenic diets.

    Endocrine 2017: Acid–base safety during the course of a very low-calorie-ketogenic diet [weak evidence]

    Nutrients 2018: Chronic ketogenic low carbohydrate high fat diet has minimal effects on acid-base status in elite athletes [weak evidence]

  57. Current Opinion in Lipidology 2011: Dietary protein and skeletal health: a review of recent human research [overview article]

  58. The American Journal of Clinical Nutrition 2017: Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation [strong evidence]

  59. Here are three examples:

  60. Journal of the American Medical Association 1976: Alopecia in crash dieters [weak evidence]

    This is based on reports from people who’ve experienced hair loss after beginning a low-carb or ketogenic diet, rather than published research. [very weak evidence]

  61. In medical terms it’s called telogen effluvium.

  62. This is the safe, effective and sustainable way to follow a low-carb diet.

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

    Applied Physiology, Nutrition and Metabolism 2017: A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel [moderate evidence]

  63. Diabetes Research and Clinical Practice 2017: Effects of SGLT-2 inhibitors on diabetic ketoacidosis: a meta-analysis of randomised controlled trials [strong evidence]

  64. Lakartidningen 2018: Life-threatening ketoacidosis in patients with type 2 diabetes on LCHF diet [very weak evidence]

  65. In rare cases, being in ketosis can be dangerous for certain people; for instance, those who are deficient in certain enzymes needed to use ketones effectively. Although disorders like this are typically diagnosed in childhood, one condition (porphyria, a blood disorder) can happen at any time. Other conditions require consulting with a doctor to ensure that being in ketosis is safe.

    Who should not follow a ketogenic diet?

  66. Journal of Nutrition and Metabolism 2018: Nutritional ketosis and mitohormesis: potential implications for mitochondrial function and human health [overview article]

  67. Several studies have shown that diets that cause nutritional ketosis often accelerate fat loss, among other benefits.

    British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials [strong evidence]

    Diabetes and Metabolic Syndrome 2017: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies [moderate evidence]

    Journal of the International Society of Sports Nutrition 2014: The effects of ketogenic dieting on skeletal muscle and fat mass [weak evidence]

  68. For instance, a grain-free, very-low-carb diet was shown to be much more effective for weight loss and decreasing blood sugar in overweight people with type 2 diabetes compared to a low-glycemic-index (low-GI) diet that included whole grains:

    Nutrition & Metabolism 2008: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus [moderate evidence]

  69. Cochrane Reviews 2017: Whole grain cereals for the primary or secondary prevention of cardiovascular disease [strong evidence for lack of any proven effect]

  70. Dr. Sarah Hallberg, Dr. Ted Naiman, Dr. Jason Fung, Dr. Peter Brukner, Dr. Eric Westman, Dr. Cate Shanahan, Dr. Rangan Chatterjee

35 comments

  1. Cindy
    Jessica Fithen from facebook wrote: Diet Doctor's views on protein are out dated but the rest of their information is usually pretty solid.
    Reply: #3
  2. Martha
    What about the gallbladder? I started the LCHF diet two weeks ago, but yesterday was in the hospital with a case of biliary colic, which is triggered by having gallstones and the digestive system's demand for bile after a fatty meal. If I have my gallbladder removed (recommended by my doctor), can I continue on the LCHF diet? What are the risks?
  3. Marianne G
    Cindy, in what way are DD's views on protein outdated?... Facebook is a big place with lots of misinformation. I prefer to stay away from it. thanks!
  4. Jon Otte
    I am glad to read all this information. Folks remember the american food industry as well pharma industry will never give up till they see us people die of diabetics or heart attacks. Having said that I am so glad that I am LCHF. I am trying hard to get rid of Glipizide and simvastatin. I am sure I will be able to live without diabetic medications. Keep up the good work.
  5. Tom M
    Can the LCHF diet lead to increased production of gallstones?
  6. Lisa
    What about people with IBS? Fat is a problem for them. I know from experience. Also, what about people with dairy and egg intolerance.
  7. Thadeu
    I think that may be that a low carb high fat diets are highly inflammatory for the intestines.
  8. chris
    what about if you have had a kidney transplant
    Reply: #9
  9. mike
    I had a kidney transplant 5 years ago been on lchf 2 years almost healthiest ice ever been email me if u want shinesthroughtherain@gmail.com
  10. San
    Lisa, Thadeau, I had the opposite experience - High Carb makes my IBS-C a lot worse and gives me joint pains, but high fat (avocado, coconut all, coconut milk) brings both things into remission (by cutting the carbs and sugar) < the sugar is the killer for me as well as grains in my case.
  11. mila
    Since I started the diet(1week ago) I do have night sweats every night.
    Is that the symptom of a keto flue and how long that will be an issue?
    BTW I am 67 years old and night sweats is not a natural thing for me any more.
    Reply: #12
  12. Sabrina
    Hi Mila, I have just seen your mesage and wanted to let you know that I had the same side effect for a few nights (about a week) after I started. lots of night sweats. I don't have them anymore. Have yours stopped too?
  13. Wanda
    I've been on low carb since August and now for about a month I haven't lost anything. My weight just moves back and forth between a few pounds. How do I kick-start it to start losing again?
  14. Michael
    Being relatively new to low carb eating ( with great results so far) the carb count of many food labels seems to not agree with some listed here or on other low carb web sites I have seen. I know enough to compare the serving sizes listed and they are compatible. For instance on this site whole cashews were shown as having 27 net carbs per serving. In the store today saw a package of planters cashews and the label showed maybe 8 net carbs for a serving. I have seen this on other food items also. Which is correct?
  15. Tash
    Its all so very interesting but i can increase my fat levels with high cholesterol
  16. Bet
    I have just finished day 8 of the LCHC plan (eating according to the plan) and since day 4, I felt the sensation of a 'tight necklace' around my neck.. I have never experienced anything like this before - it feels really weird as I want to remove 'the necklace' but, of course, there is nothing there... this sensation is at the base of the throat where the thyroid is, so my question is, is there any relationship to the diet to some kind of weird activity going on with the thyroid? otherwise, the plan has been easy to follow but I am concerned about this sensation...
    any feedback would be appreciated.. thanks..
    Reply: #19
  17. George
    Hi, I've been on keto for three months now, and i'm getting frustrated.
    I'm losing weight, and that part is great, but I'm not getting any of these supposed other benefits.
    My memory is as horrible as it was when I was carb burner. I still have very low energy.
    I still rarely exercise, because I'm miserable, every second i spend doing it.
    I get horrendous brain fog. I can't stay focused.

    I also hear people claim it reduces inflammation. Yet, every time i go for a walk, longer than a fourth of a mile, i get plantar fasciitis, and pain in my right ankle.

    I hear people claim it will reduce skin issues. My facial psoriasis is worse than ever.

    I don't understand. I'm super low carb (20 total carbs or less), i get plenty of micronutrients (through a combination of food, supplements and - when possible - Vitamin D from the sun), most of my calories come from fat, I eat to satiety (one to two meals a day). I stick with grass-fed meats. My only dairy intake, is sharp cheddar made from the raw milk of grass-fed cows. 3 months, no cheat days. Plenty of electrolytes. Plenty of water. Intermittent fasting. Sometimes 44-72 hour fasts.

    I'm going to stick with the diet, as long as I continue to lose weight. But I'm just sick of hearing everyone talking about the "the endless, magical benefits of keto", and experiencing absolutely none of them.

    Am I doing something wrong? Or is there just something wrong with me?

    I hope someone can help.
    Thanks in advance.

    Reply: #23
  18. Sandi Stutz
    I'm in the two-week trail phase and just realized in the last two days that I feel great and more energetic and have been plowing through paperwork drudgery with a breeze. No sure if it is the diet or new meds I started taking but I do feel better. My question is if the daily diet of eggs continues after the initial two weeks. I still have cholesterol fears even though I have not had a problem with it and eggs are getting boring. What are the other breakfast options?
  19. KetoAna
    Bet, I am having this exact same thing happen to me, in the exact same place. It started a few days ago, after 3 weeks on the keto diet. I could barely swallow anything for most of the day; today it is happening again. It feels like there's a massive lump in my throat, hence how I found this article - through a Google search on the topic.

    I haven't read anything elsewhere about this symptom.

    I wonder if it's a symptom of low potassium?

  20. Mina
    I wonder if anybody has any experience/knowledge about the negative effective of low carb diet on the immune system and white blood cell counts?
    I was on strict low carb diet for 4 months and I lost 5 kg. After that I started to have 2-3 high carb meals per week. in 7th month I started to have weird feelings of weakness in my legs and headaches. Complete blood test reveled white blood cell count lower than normal (3, where the minimum of normal range is 4). My doctor did not show a big concern about that but recommended me to eat everything in balance which I am doing.
    Not having a reference blood test before starting the diet I can't tell that the diet affected it, but definitely it didn't boost my immune system. Probably LCHF is not the best diet for everybody!
    Reply: #22
  21. carl
    Low carb completely cured my IBS issues, I had endless doctors put me on all kinds of medication for years but in the end a change of eating habits fixed me plus I lost80lbs in weight :)
  22. Jm- Dietitan
    Probably because you deprived yourself from micro nutrients which is abundant in complex carbohydrates. They contain phytochemicals, vitamins and minerals which strengthen and improves immune system.
  23. Jm
    It might be because the Keto Diet is not the best diet for you.
    There are no conclusive studies yet regarding the relationship of psoriasis and diet but people with this condition reported that they feel much better when they ate foods rich in complex carbohydrates (fruits and veggies) and choose leaner types of meat.

    Glucose which is the primary source of energy of the brain is limited with that kind of diet.
    You can try to consult a dietitian to determine which diet is good for you.

    Reply: #26
  24. Robin
    KetoAna & Bet,

    I too have had this sensation - when I was on the Atkins Diet. I don't know about either of you, but I was diagnosed with hypothyroidism many years ago. Anyhow, I found that once I started increasing my carb intake, that sensation went away. I'm in my fourth week if this plan (no more than 20 carbs a day) and felt the sensation for the first time last night. I grabbed a strawberry and the feeling went away. That leaves me to wonder if this sensation comes with too strict of a carb intake? I didn't go over twenty with that strawberry, but it definitely helped.

  25. SM
    Hi all,
    Three weeks ago I was put on my second metmorfin tablet and I also started to get terrible neuropathy pains in my hands and feet. I started LCHF soon after that and am glad to say that my sugars are doing wonderful. I am down to half a pill and feeling fantastic. The neuropathy has almost disappeared too..
  26. Ashley
    This is inaccurate. The brain does not require glucose for fuel. It works perfectly great on ketones. I would suggest you look at current research in regards to all the benefits of LCHF eating r/t neurodegenerative diseases. Did you say you are a dietitian?

    Carb eating is inflammatory not LCHF. Gut issues are more often than not associated with inflammation.

    I am a Registered Dietitian that wishes others in my field would do their research rather than continuing to regurgitate academia! Please read up on what that fructose in all those healthy fruits you push actually does to the body. And let's not mention the epidemic of obesity et diabetes running rampant with dietitians et doctors still telling these diabetics to consume carbs consistently through the day while shooting up insulin. I guess we should just tell that patiet with nut allergy to consume nuts throughout the day et shoot yourself up with an epi-pen.......pathetic!

  27. SMoseley
    This information is very helpful, as I get asked many of these questions all the time, since I started going Keto. I am experiencing the sudden hair fall now, and that is what led me to this article. It is reassuring to know it is normal after the change in diet, and will grow back. It has been about 3 months since I switched to this way of eating, so that falls in line with the estimated time for this to happen. I have examined the nutrition in my present diet and can't see where I have any nutrient deficiency that would cause hair loss. I have gotten Toppik for now to fill in the thinness and have splurged on some hair vitamins anyway just in case my follicles need some nudging to regrow new hair.
  28. Anthony
    Scary news about "low carb"... This article just broke today about ATKINS and HEART FAILURE. Can you please deconstruct this and provide your thoughts? Looking for reassurance on the differences of your keto prescription and what may have happened here. Thank you. https://www.telegraph.co.uk/science/2018/05/29/atkins-diet-may-cause-...
  29. Ariënne
    Hello, thank you dietdoctor for this fantastic site and the good work you do!

    Just want to ask a question. Since living lchf (half a year now) I have to urinate very often and I crave salt. Should I take more salt during the day? Could that solve it completely? Or should I have it checked?

    And something else: I had this bad breath problem. Since I stopped taking Psyllium husk it vanished. Coincidence or not?

  30. Neil
    In regards to the kidney topic, you have focused on the protein issue, but my concerns are about the ketones, which are present in the blood during ketosis. My mother has a solitary kidney and has recently started a low to no carb diet and I wanted to know whether a single kidney is sufficient for filtering out the excess ketones adequately, or not. Will they all get used by the body? Will the excess be expelled without going through the kidneys . It seems that in a person with two normal working kidneys, ketone levels should be fine, maybe with increased risk of stones, but I haven't yet found any information on people with only one kidney.

    Will a low carb diet, with a body that has reduced filtering capabilities due to a solitary kidney, cause a build up of ketone bodies, such as acetoacetate, beta-hydroxybutyrate, and acetone, in the blood stream to concentration levels above what is safe?

  31. Drea
    I have been on a LCHF for about 4 weeks now. It seems like it is taking some time for me to transition into fat burning. I still get headaches, but now from low blood sugar (as opposed to electrolytes), as I started adding trace minerals to my water and more salt. (So at first it seemed more of an issue with electrolyte balance). My gums have been more sensitive, and my teeth as well. In fact the second day when I started, I actually almost fainted, and my teeth were killing me. I get the feeling it may be related to the process of fat adaption for me. I think it may be related to minerals. I got a multi vitamin, and am now taking a cal.mg.zinc. trace mineral supplement... and I think i am going to get more vitamin c. I also wonder if the process of ketosis, which causes bad breath is making my teeth sensitive?

    I am planning to add more carbs soon. I am able to handle some sweet potato really well at night. If I eat blackberries, which I used to eat everyday in the morning, my body flips out. I seem really sensitive to fructose right now.

    I would appreciate if anyone had any ideas.
    thanks

  32. kira
    hi. i have a kidney disease, with gross proteinuria (creatinine is ok). following, i had recently 2 gout attacks. i'm 10 days on your challange, and had to do blood work - cholesterol, urea and uric acid sky rocketed. do i need to stop the diet? if not, where can i find a plan with reduced protein?
    thank you
    love your site!! and sibscribed :-)
    kira
  33. Remy
    I have to take photon pump inhibitors for esophagus problems. I cannot find anything relating to low carb diet and PPI interactions. Do you have any studies in this regard? I am very tempted to try but not until I clear that potential risk.
    Reply: #34
  34. Cheryl
    Hi Remy u are likely to benefit from LCHF and a smaller meal diet. I was suffering from gerd for over 10 years and the issues is gone after taking less carbs and reducing meal sizes. I stopped all stomach medications.
  35. Greg Hill
    I often read/hear discussions of the pros and cons of LCHF and HCLF diets, and both sides talk about eating moderate protein. What I have never seen, however, is any discussion of a moderate protein, moderate fat and moderate carb (MPMFMC?) diet. That's what I eat, and it seems to be working pretty well for me.

    I find it useful to distinguish between "diets" and "nutritional regimens." Although I don't assume that the point of a "diet" is necessarily weight loss, I do assume that all "diets" are intended to help correct some unhealthy condition, and are followed only for so long as it takes to make that correction. I think of LCHF and HCLF as true "diets" in that sense. But for perfectly healthy people what is needed is a highly personalized "nutritional regimen" that is basically "moderate everything." It is fine tuned to keep a given individual in tip-top condition by, for example, consuming fewer nightshades than most people can easily tolerate, or increasing consumption of fatty fish for getting a bit more DHA omega-3 fatty acid than most people need. There can never be any such thing as a one-size-fits-all nutritional regimen, but for those of us who are currently in pretty good shape, I believe moderate amounts of all three macronutrients (fat, unrefined carbs like sweet potatoes, and proteins) are just fine. Our bodies are clearly designed to be very flexible. Instead of obsessing over counting grams of this or calories of that, a healthy person's focus should be on keeping it all as unprocessed and toxin-free as possible, getting a lot of variety ("eat the rainbow"), and maintaining a healthy gut microbiome with the regular consumption of probiotics and prebiotics.

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