How low carb is keto?

On a keto diet, how many carbs do you need to cut? How many carbs can you eat? The answer varies a bit depending on you as an individual and your goals.

In general: the fewer the carbs the bigger the impact might be on weight loss and reduction of cravings and hunger.1 If you have type 2 diabetes, the fewer carbs you eat, the faster your blood glucose and insulin resistance might improve.2 Some, however, find a very low carb diet too restrictive and challenging.

Here are three examples of how a low-carb dinner can look, depending on how many carbs you eat per day.

 

Ketogenic

Under 20 grams per dayStrict low carb

Moderate

20-50 grams per daymoderate low carb

Liberal

50-100 grams per dayLiberal low carb

 

The plate on the left would be ketogenic for most people. The other two, while very healthy, would not likely be ketogenic, but could still contribute to gradual weight loss and improved blood glucose and insulin sensitivity.3

We define low carb as anything under 100 grams per day. Note that a Western diet often has 250 grams of carbs per day, or even more.4

 
 

How we define low carb and keto

At Diet Doctor, we define the different levels of carbs this way:

  • Keto low carb: less than 20 grams of carbs per day. This level will be ketogenic for most people.5 In our keto recipes, less than 4 percent of total energy comes from carbs, and the rest will come from protein and fat.6 In keto recipes we also keep the protein level moderate. Some may find that protein above this range is converted into glucose enough to raise blood sugar levels.7 However, there appears to be a disconnect between potential mechanism and clinical effect seen in published research.8
  • Moderate low carb: between 20 and 50 grams per day. In our moderate low carb recipes, energy derived from carbs will be between 4 to 10 percent. The rest will come from protein and fat.
  • Liberal low carb: between 50 and 100 grams per day. In our liberal low carb recipes, energy derived from carbs will be 10 to 20 energy percent. The rest will come from protein and fat.

Note: Although our recipes are arranged by percent calories of carbs, protein and fat, we do not feel you need to calculate these on your own. We provide them as a reference, but practically we recommend you limit your carbs, ensure adequate protein, and adjust fat as needed for satiety and taste. that eliminates the need to constantly calculate “percent macros.”

Fiber and net carbs

Our listed carb counts are the amount of digestible carbs, also called net carbs. This simply means we do not count the fiber.9 For example, you can eat nearly all the fiber you want from keto vegetables without seeing a significant sugar or insulin impact.10

However, be very careful of of the term “net carbs” on labels of low-carb products, processed foods, protein bars and energy/chocolate bars. Manufacturers often use “net carbs” as a way to disguise sugar alcohols that may slow weight loss and impact blood sugar.11 In fact, try to avoid any processed product that list “net carbs” on a label. Learn more about keto sweeteners

The most effective keto diet — and the healthiest — is likely based on natural, whole foods.12 Learn more

 

What carb level to choose?

Do you need to stick to a keto diet, consuming under 20 grams of carbs a day? Or would you have good results with a moderate low carb diet, consuming 20 to 50 grams of carbs a day?

People with a lot of weight to lose, type 2 diabetes, insulin resistance, metabolic syndrome or sugar and/or food addiction, may find that they get their best results on a keto diet, keeping carbs very low.13 When starting out, however, they may experience keto side effects, like the keto flu, until they are adapted to burning more fat.

People who want to lose pounds but still have good insulin sensitivity, have less weight to lose, or still have good blood sugar levels can often do very well on a moderate or even liberal low carb diet.14 They are less likely to experience significant side effects. Lean, active, and healthy individuals can also do very well on liberal low carb.

We believe many people may do best starting out on a strict keto diet.15 This will give you the best idea of whether you like how you feel, how it impacts you and what sort of results you get.16 Then, as you hopefully achieve your health and weight goals, you can decide whether to add more carbs back into your diet to a level where you feel your best and can maintain your health goals.

Here’s a two-week get-started guide to a keto diet

However, if you feel that avoiding most carbs is too hard, it’s also possible to get some health benefits by just avoiding the worst carbs.17 Perhaps this can be the right start for you? In that case, feel free to use the guide below:

Eating better: Six steps down the carb mountain

Meal plans

Get lots of weekly keto meal plans, complete with shopping lists and more, with our premium meal planner tool (free trial).
 

 
 

More

A ketogenic diet for beginners
14-day keto diet meal plan with recipes and shopping lists
Ketogenic diet foods – what to eat and what to avoid

 

Visual guide

 

  1. The idea that fewer carbs is always more effective is mainly based on the consistent experience of experienced practitioners, and stories from people trying different levels of carb restriction [weak evidence]

    The only intervention study – to our knowledge – that compared different levels of carb restriction was a small trial that found trends towards greater weight loss and greater improvements in cardiometabolic risk factors as carb intake went lower.

    PeerJ 2019: Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial [moderate evidence]

    Ketogenic diets have been found to reduce appetite:

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

    Obesity (Silver Spring) 2011: Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet. [moderate evidence]

  2. Glycemic control appears to improve more the lower carb intake is:

    Journal of the American Dietetic Association 2008: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis [moderate evidence, downgraded as it’s comparing effects between different low-carb trials. There is no RCT comparing low carb to lower carb.]

    This is also based on the consistent experience of experienced practitioners, and stories from people trying different levels of carb restriction [weak evidence].

    Low-carb diets has been shown to help reduce or even normalize blood sugar, and thus potentially reverse type 2 diabetes:

    Diabetes Research and Clinical Practice 2018: Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis [strong evidence]

    BMJ Open Diabetes Research and Care 2017: Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes [strong evidence]

    A non-randomized trial with risk of financial bias shows remarkable effectiveness at reversing type 2 diabetes:

    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]

    Full list of studies on low carb for diabetes

  3. Diabetes Research and Clinical Practice 2018: Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis [strong evidence]

    Annals of Internal Medicine 2014: Effects of low-carbohydrate and low-fat diets: a randomized trial [moderate evidence]

  4. Adults in the US consume about 50% of their calories from carbohydrates, or about 250 grams of carbs per day if eating 2000 calories:

    Centers for Disease Control and Prevention

  5. A diet under 20-50 grams of carbohydrates “typically leads to the presence of measurable ketones in the urine”:

    The American Journal of Clinical Nutrition 2007: Low-carbohydrate nutrition and metabolism [overview article]

    Note that higher levels of carb intake also can be ketogenic in some people, depending on their metabolism and activity level (increased activity can contribute).

  6. Carbs, fats and protein are sometimes called your “macros” — the percentage of the three macro nutrients.

    The limit of 4 per cent of energy coming from carbs in a ketogenic recipe means that if you are eating 3 meals a day, at a range of about 2,000 calories a day, you will stay below 20 grams of carbs. Many of our keto recipes will have you eating significantly less than the 20 grams of carbs each day

    Our keto recipes also include a moderate amount of protein. That means in recipes with a maximum 4 percent of energy derived from carbs, protein is capped at 30 percent of energy — and the rest, 71 percent or more, is energy from fat.

    If a keto recipe has lower carb percentages, then recipes allow slightly more protein, keeping fat at a range of at about 70 percent or more.

    Here are the exact protein limits we use to classify recipes as keto:

    4 % carbs = max 30 % protein
    3 % carbs = max 32 % protein
    2 % carbs = max 34 % protein
    1 % carbs = max 36 % protein
    0 % carbs = max 38 % protein

    If a recipe has too much protein, it will be classified as moderate low carb rather than keto, although that does not mean you cannot maintain ketosis by eating it.

  7. The process of converting excess protein to glucose is called gluconeogenesis (literally “making new glucose”). During digestion, protein is broken down into individual amino acids, which your body can use to make glucose.

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

    Excess protein can also potentially raise insulin levels.

    Diabetes Care 1991: Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects [overview article]

  8. The trials included in this review of RCTs did not restrict protein intake and showed significant improvement in blood glucose levels and metabolic health.

    BMJ Open Diabetes Research and Care: Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes [strong evidence]

    In addition, two studies showed that a diet with 30% of calories from protein improved glycemic control.

    Diabetes 2004: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes [randomized trial; moderate evidence]

    American Jopurnal of Clinical Nutrition 2003: An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes [randomized trial; moderate evidence]

    In another study, patients with type 2 diabetes who ate a meal with 50 grams of protein didn’t experience a significant increase in blood sugar.

    Journal of Clinical Endocrinology and Metabolism 2001: Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes [randomized trial; moderate evidence]

  9. Although some low-carb experts disagree, it’s generally accepted that humans lack the enzymes needed to break down fiber and absorb it into the bloodstream. Therefore, the fiber portion of carbs does not raise blood sugar and insulin levels.

    Nutrients 2010: Effects of dietary fiber and its components on metabolic health [overview article]

  10. Fiber does not directly affect blood sugar levels, though it can indirectly slow down the absorption of digestible carbohydrates that you eat.

    Fiber can have both beneficial and some potential negative effects on gut health, but it usually has no major impact on the effects of a low-carb diet.

  11. For instance, maltitol – a very common sweetener in low-carb products – has the highest glycemic (35) and insulinemic (27) indexes of all sugar alcohols.

    Nutrition Research Reviews 2003: Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties [overview article]

    About 60% of maltitol is digested and absorbed in the small intestine, like other carbs.

    Gastroenterology 1990: Digestion and absorption in the human intestine of three sugar alcohols [moderate evidence]

    Gastroentérologie Clinique et Biologique 1991: Clinical tolerance, intestinal absorption, and energy value of four sugar alcohols taken on an empty stomach [moderate evidence]

  12. This is mainly based on evolutionary theories and clinical experience. [weak evidence]

    Focus on eating good quality, minimally processed whole foods. Ideally the food you buy shouldn’t even have a list of ingredients (or it should be very short).

    Unprocessed or minimally processed whole food is what our ancestors have been eating for millions of years, and what the human animal is evolutionarily adapted to. By introducing processing, e.g. refining carbohydrates in a way that increases the speed of absorption and reduces the amount of nutrients and fiber, we change the food into something our bodies may not be adapted to, i.e. we introduce an unknown risk of side effects.

    Learn more: What are you designed to eat?

  13. This is mainly based on the consistent experience of experienced practitioners, and stories from people trying different levels of carb restriction [weak evidence]

    The only small intervention study – to our knowledge – that compare different levels of carb restriction found trends towards a larger effects with fewer carbs, for weight loss and cardiometabolic risk factors. However, these trends did not reach statistical significance:

    PeerJ 2019: Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial [moderate evidence]

    Regarding sugar/food addiction, this is likely mostly caused by avoiding the foods that can cause a food addiction, most of which are processed foods full of sugar and/or other refined carbohydrates.

    Just like with any other addiction, avoiding the cause is a necessary part of slowly reducing the addiction. A person who is addicted to alcohol normally can’t consume alcohol “in moderation” and be successful. The same thing is likely true for any addiction. [clinical experience, weak evidence]

    In the case of the keto diet, it may also be that the hunger-reducing effect can be helpful:

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

    Frontiers in Psychology 2015: Ketosis, ketogenic diet and food intake control: a complex relationship [overview article]

  14. PeerJ 2019: Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial [moderate evidence]

  15. Unless there’s a specific reason for you not to do this.

    Who should NOT do a ketogenic diet?

  16. It can also be helpful to experience it, as it’s a good way to shed a few pounds if weight ever creeps up or weight loss stalls.

  17. Whether people go on a low-carb or a low-fat diet, they tend to lose weight as long as they minimize sugar and refined flours in their diet:

    JAMA 2018: Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion [moderate evidence] (analysis)

    Here are more studies and overview articles showing a connection between sugar, excess weight and disease:

    JAMA Internal Medicine 2014: Added sugar intake and cardiovascular diseases mortality among US adults [weak evidence]

    Nutrition & Metabolism 2005: Fructose, insulin resistance, and metabolic dyslipidemia [overview article]

    The American Journal of Clinical Nutrition 2007: Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease [overview article]