In some recent posts, I’ve mentioned the net carb counts of some foods I like. True Primal soup has 11 net carbs per serving, lentil pasta has 24 net carbs per two ounces, etc. In case you’re wondering, yes, I’m aware that net carbs has become somewhat controversial, and that some low-carb gurus suggest counting all carbs, period. I beg to differ. I still think it makes sense to subtract fiber from the total carb count.
The concept of net carbs got a bad reputation because it was abused by the makers of low-carb junk foods. They’d put 25 grams of sugar alcohol in a dessert bar, then subtract those grams and claim 5 NET CARBS! on the label. Sugar alcohols raise glucose levels in many people, so yeah, I say go ahead and count them as carbs. (Better yet, just skip those food-like products altogether and eat real food.)
But I think it’s a mistake to count fiber as carbohydrate. If you are 1) restricting carbohydrates to VLC or ketogenic levels and 2) counting fiber grams as carbs, you’ll likely end up restricting your fiber intake to little or nothing. Bad idea.
Fiber got a Nyaaaa, who needs it? reputation in the low-carb community because the (ahem) “experts” told us we need to eat our hearthealthywholegrains! to make sure we get enough fiber. I’m pretty sure our Paleolithic ancestors didn’t start their day with bowls of All Bran, and yet the experts insisted we need grain fibers to avoid everything from heart disease to colon cancer. That of course turned out not to be true. Gary Taubes devoted an entire chapter in Good Calories, Bad Calories to the subject.
But grain fibers are the wrong kinds of fibers. As Dr. William Davis explains in this post, the fibers in hearthealthywholegrains! are mostly cellulose, a constituent of wood. Humans have no biological need to eat wood. Yes, those “whole grain” fibers promote regularity, but at a cost:
The poop-bulking effect of cellulose can fool you into thinking that you have achieved bowel health. In the case of wheat and grains, for instance, wheat germ agglutinin and gliadin peptide fragments are highly toxic to the intestinal wall, block gallbladder and pancreatic function, and induce alterations in bowel flora. Cellulose and phytates bind minerals, such as iron and zinc, and make them unavailable to you. But the cellulose provides the appearance of bulky stools despite the toxic damage incurred, causing you to believe that you’ve had a healthy BM.
We certainly don’t need cellulose fibers, which unfortunately led to the belief that we don’t need fiber at all. But we do, because plant fibers feed the good gut bacteria.
When we adopt a low-carb diet, what are our goals? What do we hope to achieve? To lose weight, sure, but also to keep our glucose levels under control and reap the benefits of short-chain fatty acids like butyrate. There’s plenty of research out there suggesting that plant fibers help us achieve both goals, including a study with the rather obvious title of Short-chain fatty acids produced by microbial fermentation of plant fibers improve glucose regulation.
If you’re onboard with the idea that mimicking the diets that kept our ancestors healthy is a good idea, then fibers should be part of your paleo or primal diet. Fossilized stool samples show that Paleo Man ate rather a lot of fiber from plant foods. Here are some quotes from another post by Dr. Davis:
Yes, consuming such fibers is evolutionarily appropriate, as it dates back well over 8000 generations of human existence, predating even the appearance of the Homo species, even predating carnivory, as it was practiced by pre-Homo hominids, Australopithecus (especially “robust” strains). It is therefore deeply instilled into the adaptive physiology of our species.
We evolved on diets that fed our good gut bateria. Here are some quotes from an article by Chris Kresser:
When we eat the soluble fibers found in whole plant foods, the bacteria in our gut ferment these fibers into short-chain fatty acids like butyrate, proprionate, and acetate, and greater amounts of fiber consumed will lead to greater short-chain fatty acid production. In this case, naturally occurring soluble fibers are very important for feeding the friendly bacteria that live in our guts.
One of the risks of long term very low-carbohydrate (VLC) diets, in my view, is the potentially harmful effect they can have on beneficial gut flora. VLC diets starve both bad and good gut bacteria, which means these diets can have therapeutic effects on gut infections in the short term, but may actually contribute to insufficiency of beneficial strains of gut bacteria over the long term. Providing adequate levels of carbohydrate and soluble fiber to feed friendly bacteria is important for optimizing digestive health and maintaining the integrity of the gut lining through the production of short-chain fatty acids.
I don’t count fiber grams as carbs because in my experience, fiber doesn’t raise blood sugar at all. If anything, it seems to blunt the effects of non-fiber carbs. As I’ve mentioned, if I include three ounces of lentil pasta in a meal, I’m getting 36 net carbs. But my blood sugar only rises to 125 or so, probably because of the 10-12 grams of soluble fiber in the pasta.
If you’re not convinced, then I’d suggest conducting a few n=1 experiments. Get out the glucose meter and see how you react to carbs that are high in soluble fibers vs. non-fiber carbs.
Even if you decide to forget the net carb concept entirely and count all carbs, please make sure you get some beneficial fibers into your diet. I know I just posted this video back in August, but it’s worth another look. Here’s Dr. Davis on why you don’t want to skip beneficial fibers on a low-carb or ketogenic diet:
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I’m so glad to see this post! I dearly love Jimmy Moore, but I heard him recently on one of his shows saying that you can’t subtract fiber from carbs. Well, at the time I didn’t agree with that and still go the way of what you’re saying here. And I was particularly glad to hear someone else agreed with me about adding some fiber to keep the gut in proper functioning! I’ve found that occasional (maybe once a week) eating of something like bean soup or beans with tortillas, etc. seems to keep me functioning the way I should be, and does nothing to my blood sugar if I eat in moderation.
And yes, the rest of the time, I subtract fiber from carbs when counting.
Great Post! Thank you!
I’ve yet to hear a convincing argument for counting fiber as carbs.
Our body is such a mess of feedback loops, its easy to miss the second and higher order effects. Paul Jaminet talks a lot about the J curves in nutrition. Its important to remember that there can be too much of a good thing.
It is good that you keep it sane here. Otherwise people tend to go too far with their obsessions.
Yes. I remember a few years ago when some people were eating vegetation by the pound (literally) and wondering why they were having problems.
A transcript for that video is available where it’s posted on the Wheat Belly and Undoctored blogs.
I’m following a few people on Twitter who are experimenting with zero carb, eating only meat, and they are reporting fantastic gut health. Digestive issues are improving. They are chalking it up to not needing all that microbiome necessary to digest veggies, etc.
Most of these people are currently short term, under a year, so I am interested to see what happens to them at the 1-2 year mark. If Dr. Davis is correct, then there are some issues heading their way.
Personally, I cannot eat just meat. It does bother my stomach. Mainly nausea.
Yeah, I’ve seen people insist it’s okay to starve the gut bacteria because we don’t need them unless we’re eating plants, etc. Since the microbiome does a lot more than just digest plant foods, acting as a “second brain” and all that, starving out the inhabitants strikes me as more than a little risky.
One theory is this: we have gut bacteria, and they want to survive. If they get no fibers to eat, all that’s left to feed on is the mucus in the colon walls. If they weaken that barrier, leaky gut follows, which leads to inflammation, autoimmune conditions, etc.
Dave Asprey got an allergy to eggs after his experiment with Keto and low fiber for a few months. He thinks it was caused also by eating too little glucose, which the mucus is made up of. If the body can’t keep up with GNG, that mucus will be weakened, the body can’t make it without glucose.
Yup, Paul Jaminet wrote about that in the Perfect Health Diet book as well. It’s one of the reasons I believe if you’re going to go very low on carbs, you need to go high on protein. If you’re forcing your body to produce all its biologically necessary glucose from protein, but then restrict protein as well as carbs, something’s going to go out of whack. The Inuits, our poster-boys for a VLC diet, ate a lot of protein … around 240 grams per day for adult males, according to one study.
I was having a horrible and unremitting digestive problem, found an article about a Japanese clinical study in which people with my problem cut out all fiber and it worked, decided I had nothing to lose, and went no-fiber. I was doing fine within a week. After a couple weeks, I added back foods with some fiber in them slowly until I hit a level that made my problem come back.
I would guess the guts of the people you’re following were overworked by a diet far too high in fiber, a la the Saturday Night Live skit Colon Blow. We’ve been told for so long to eat more fiber and more fiber and more fiber, and it messes up our balance. Cutting out fiber for a little while can give the gut time to heal. I don’t think avoiding all plant foods in the long term is the answer, though. Sauerkraut and pickles are soothing to my stomach, and I’m much more sharp and cheerful when I get spinach, potatoes, sweet potatoes, etc. I can’t eat high fiber foods without extreme pain, but even for me, lower fiber plants are definitely beneficial.
There is a difference in eating fiber naturally found in foods and drinking Metamucil, or yogurts with added fiber to it. A friend of mine, a nutritionist, pointed that out. He advised to just eat foods with fiber naturally within the food and the rest will take care of itself.
I’m moving toward zero carb (eating all meat). It seems to help. I’m not there yet, but am close. I can eat certain vegetables, mainly olives and pickles (either fermented or dill/vinegar). Some fermented vegetables give me problems, including (sadly) sauerkraut.
I also tried resistant starch with different probiotics (pills, fermented vegetables and/or yoghurt) for months, and found only detriments.
Also, consider the following two keto diets:
1) primarily red meat with little chicken; fish; vegetables; no dairy
2) primarily chicken with little red meat; not much fish; vegetables; dairy; nuts.
They’re both keto, but people on #1 will do better than people on #2, even though they could both be getting exactly the same fiber each day. #2 will have too much omega 6 intake (chicken is very high in omega 6, as are nuts), which cause insulin resistance at a cellular level.
Unfortunately, the “science” in this area is all over the map. Those advocating high fiber intakes for gut health also could be causing IBS and other problems in those (like me) susceptible to this. Because we’ve been researching low fat diets for so long, and everything is based on people eating high carb, we know very little about what happens with people who don’t eat that way.
For instance, here’s a study (sadly, in mice) where a keto diet appeared to help with autism spectrum disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009541/
How do we know that the biome is actually BAD for certain people, and keto (and/or intermittent fasting) corrects that? And once it’s corrected, can one go back to eating high carbs or will that recreate the original symptoms?
There are no good studies to answer these questions.
I think a stage of cutting out all fiber, or as close as possible, does help people with certain digestive issues. But for most people, I think it should only be the first stage. Adding foods with a little, then medium fiber back gradually is I believe a very good thing for almost everyone. It certainly was for me, in any case. The very high fiber foods — probably not worth it, if you’ve had problems with them previously.
I don’t like “diets.” I’ll incorporate ideas from different ones if the research and rationale are good, but I eat what works for me. Lots of dairy, eggs, some meat, some fruits and veggies, and yes some sweets. This actually turns out to be a lot like the diet my ancestors ate, though no way am I adding lutefisk. Everyone really is different — it’s good to know the research, but the most important thing is seeing what works for you.
I’ve eaten zero/ very near zero carb for more than a year (about 18 months total).
I had no bathroom problems, maintained BMI 17-17.5 without trying and my hair looks gorgeous (haha).
A1C normal despite being type 2. Almost never got sick- just a cold here and there.
Interestingly even at an underweight BMI I continued to have normal periods.
I’ve since added back some spinach, mostly because I got sick of the repetition.
I’m so glad to see this post! I dearly love Jimmy Moore, but I heard him recently on one of his shows saying that you can’t subtract fiber from carbs. Well, at the time I didn’t agree with that and still go the way of what you’re saying here. And I was particularly glad to hear someone else agreed with me about adding some fiber to keep the gut in proper functioning! I’ve found that occasional (maybe once a week) eating of something like bean soup or beans with tortillas, etc. seems to keep me functioning the way I should be, and does nothing to my blood sugar if I eat in moderation.
And yes, the rest of the time, I subtract fiber from carbs when counting.
Great Post! Thank you!
I’ve yet to hear a convincing argument for counting fiber as carbs.
Along the same lines of Jimmy Moore, the only fiber and gut biome support needed according to Jimmy is adding a little spinach. Do you think spinach is enough of a fiber source on VLC diets?
I don’t believe our paleo ancestors (in most areas of the world, anyway) evolved on diets that limited plant fibers to small servings of green leafy vegetables. According to Loren Cordian’s research, a typical hunter-gatherer diet provided 35-50% of calories from plant foods. That’s calories, not volume. Considering how low in calories green leafy vegetables are per ounce, you’d have to eat a helluva lot of spinach to have it account for 35% of your calories.
I think how one’s body handles fiber depends on how carb sensitive one is. For me, too much fiber raises my bg, so I count total carbs. Maybe, someday in the future, I’ll be able to eat it without it raising my bg. I really hope so, because I miss certain foods – lentils is one.
How different foods effect one’s bg is always a YMMV thing. Always test.
I agree: test your own reactions to foods. I think the paleo template is a good place to start when choosing a diet, but we also have to account for the fact that many modern humans are dealing with metabolisms damaged by years of sugar and grain consumption. What worked for Paleo Man may not work for them.
Our body is such a mess of feedback loops, its easy to miss the second and higher order effects. Paul Jaminet talks a lot about the J curves in nutrition. Its important to remember that there can be too much of a good thing.
It is good that you keep it sane here. Otherwise people tend to go too far with their obsessions.
Yes. I remember a few years ago when some people were eating vegetation by the pound (literally) and wondering why they were having problems.
http://www.nature.com/nbt/journal/v32/n3/fig_tab/nbt.2845_F1.html?foxtrotcallback=true
It’s behind a paywall. Is it a mouse study?
Doesn’t appear to be, but I couldn’t say for sure without buying the full paper.
shhhhh!
http://sci-hub.io/10.1038/nbt.2845
I promise to whisper.
A transcript for that video is available where it’s posted on the Wheat Belly and Undoctored blogs.
I’m following a few people on Twitter who are experimenting with zero carb, eating only meat, and they are reporting fantastic gut health. Digestive issues are improving. They are chalking it up to not needing all that microbiome necessary to digest veggies, etc.
Most of these people are currently short term, under a year, so I am interested to see what happens to them at the 1-2 year mark. If Dr. Davis is correct, then there are some issues heading their way.
Personally, I cannot eat just meat. It does bother my stomach. Mainly nausea.
Yeah, I’ve seen people insist it’s okay to starve the gut bacteria because we don’t need them unless we’re eating plants, etc. Since the microbiome does a lot more than just digest plant foods, acting as a “second brain” and all that, starving out the inhabitants strikes me as more than a little risky.
One theory is this: we have gut bacteria, and they want to survive. If they get no fibers to eat, all that’s left to feed on is the mucus in the colon walls. If they weaken that barrier, leaky gut follows, which leads to inflammation, autoimmune conditions, etc.
Dave Asprey got an allergy to eggs after his experiment with Keto and low fiber for a few months. He thinks it was caused also by eating too little glucose, which the mucus is made up of. If the body can’t keep up with GNG, that mucus will be weakened, the body can’t make it without glucose.
Yup, Paul Jaminet wrote about that in the Perfect Health Diet book as well. It’s one of the reasons I believe if you’re going to go very low on carbs, you need to go high on protein. If you’re forcing your body to produce all its biologically necessary glucose from protein, but then restrict protein as well as carbs, something’s going to go out of whack. The Inuits, our poster-boys for a VLC diet, ate a lot of protein … around 240 grams per day for adult males, according to one study.
I was having a horrible and unremitting digestive problem, found an article about a Japanese clinical study in which people with my problem cut out all fiber and it worked, decided I had nothing to lose, and went no-fiber. I was doing fine within a week. After a couple weeks, I added back foods with some fiber in them slowly until I hit a level that made my problem come back.
I would guess the guts of the people you’re following were overworked by a diet far too high in fiber, a la the Saturday Night Live skit Colon Blow. We’ve been told for so long to eat more fiber and more fiber and more fiber, and it messes up our balance. Cutting out fiber for a little while can give the gut time to heal. I don’t think avoiding all plant foods in the long term is the answer, though. Sauerkraut and pickles are soothing to my stomach, and I’m much more sharp and cheerful when I get spinach, potatoes, sweet potatoes, etc. I can’t eat high fiber foods without extreme pain, but even for me, lower fiber plants are definitely beneficial.
There is a difference in eating fiber naturally found in foods and drinking Metamucil, or yogurts with added fiber to it. A friend of mine, a nutritionist, pointed that out. He advised to just eat foods with fiber naturally within the food and the rest will take care of itself.
I’m moving toward zero carb (eating all meat). It seems to help. I’m not there yet, but am close. I can eat certain vegetables, mainly olives and pickles (either fermented or dill/vinegar). Some fermented vegetables give me problems, including (sadly) sauerkraut.
I also tried resistant starch with different probiotics (pills, fermented vegetables and/or yoghurt) for months, and found only detriments.
Also, consider the following two keto diets:
1) primarily red meat with little chicken; fish; vegetables; no dairy
2) primarily chicken with little red meat; not much fish; vegetables; dairy; nuts.
They’re both keto, but people on #1 will do better than people on #2, even though they could both be getting exactly the same fiber each day. #2 will have too much omega 6 intake (chicken is very high in omega 6, as are nuts), which cause insulin resistance at a cellular level.
Unfortunately, the “science” in this area is all over the map. Those advocating high fiber intakes for gut health also could be causing IBS and other problems in those (like me) susceptible to this. Because we’ve been researching low fat diets for so long, and everything is based on people eating high carb, we know very little about what happens with people who don’t eat that way.
For instance, here’s a study (sadly, in mice) where a keto diet appeared to help with autism spectrum disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009541/
How do we know that the biome is actually BAD for certain people, and keto (and/or intermittent fasting) corrects that? And once it’s corrected, can one go back to eating high carbs or will that recreate the original symptoms?
There are no good studies to answer these questions.
I think a stage of cutting out all fiber, or as close as possible, does help people with certain digestive issues. But for most people, I think it should only be the first stage. Adding foods with a little, then medium fiber back gradually is I believe a very good thing for almost everyone. It certainly was for me, in any case. The very high fiber foods — probably not worth it, if you’ve had problems with them previously.
I don’t like “diets.” I’ll incorporate ideas from different ones if the research and rationale are good, but I eat what works for me. Lots of dairy, eggs, some meat, some fruits and veggies, and yes some sweets. This actually turns out to be a lot like the diet my ancestors ate, though no way am I adding lutefisk. Everyone really is different — it’s good to know the research, but the most important thing is seeing what works for you.
I’ve eaten zero/ very near zero carb for more than a year (about 18 months total).
I had no bathroom problems, maintained BMI 17-17.5 without trying and my hair looks gorgeous (haha).
A1C normal despite being type 2. Almost never got sick- just a cold here and there.
Interestingly even at an underweight BMI I continued to have normal periods.
I’ve since added back some spinach, mostly because I got sick of the repetition.
That’s one of my problems with the Keto version of low-carb, it removes two of the biggest advantages of low-carb, namely high protein intake and lots of vegetables. When chasing those ketones, every gram of broccoli means extra carbs, and must be reduced to a minimum. Not good for health nor microbiota. Also protein must be cut down to get ketones, thereby reducing the most satiating macronutrient.
When someone switches to low-carb from SAD, two of the biggest benefits he will see is high protein and lots of veggies. Fiber and protein is most correlated to satiety, and he will naturally eat much less. Go Keto and both those advantages are thrown out.
Some people do quite well on ketogenic diets, but I found I had to restrict protein to ridiculously low levels to stay in ketosis. That convinced me that low-carb works for me, but going full ketogenic doesn’t.
Interesting comments. I am trying to keep a keto diet (have heart failure, and hearts apparently like ketones; also insulin resistance is bad for hearts, so trying to cure mine). I’ve also been testing higher levels of protein, as per Ted Naiman. There’s wide range of opinions on how much protein should be eaten. Those who are using keto for cancer need to keep lower protein. There are also those who believe protein causes one or both of an insulin response or a blood sugar response. Jimmy Moore is using a continuous glucose monitor (CGM), and found a high blood sugar spike over two hours after eating a high protein meal. Others (like Ted Naiman) believe we should eat a lot of protein, though he’s also built and not insulin resistant.
I’m trying to get a continuous blood glucose monitor, but the one with which I’m familiar is OTC (over the counter) in Europe but not in the US. I have a friend in Sweden who is sending me one, but it’s back ordered there.
Without sensors such as as a CGM, it’s difficult to get an understanding of what’s happening even in one’s own body. For instance, I believe a higher protein intake for me means lower BOHB levels and possibly higher blood glucose. But both are expensive and difficult to test, even when testing multiple times per day. Get a CGM, though, and you can really begin testing: eat high fat, lower protein but high cals for multiple days in a row, then eat the same amount of protein, normal cals, and see what happens.
And even if I have lower ketones and higher blood sugar with higher protein, is that a bad thing? I haven’t decided yet.
I’m in the high-protein camp, but that’s what works for me. I can eat a big ol’ steak or whatever and my glucose level barely budges. As with everything, you have to see how your own body reacts.
If you’re worried about insulin resistance, here are two things to consider: fibers such as resistant starch can improve insulin sensitivity. Second, more muscle-mass improves insulin sensitivity, and protein is essential to build and preserve muscle-mass.
Also, what constitutes “a high blood sugar spike”? There are blood sugar spikes that are normal, and there are spikes that are in the diabetic range. Only the second category is harmful. There is a tendency among low-carbers to consider normal spikes as harmful. Low-carbing can also cause physiological insulin resistance, and then FBG is elevated. But then the same low-carbers claim that elevated FBG is harmless.
One might also think about where did blood sugar spike come from if no carbs where ingested, only fat+protein? Your body made it via GNG. The body decided it needed glucose (some glucose is needed for survival), and made it. If you hadn’t ingested the protein, the body would perhaps have made the glucose from your muscle tissue instead, which is not a good thing.
Protein will cause an insulin response, less than carbs, but more than fat. But spikes of insulin after a meal is not the same thing as insulin resistance, when insulin levels are high constantly.
Spikes of insulin and blood sugar after a meal: normal
Chronically elevated levels of insulin and blood sugar: not normal
I think how one’s body handles fiber depends on how carb sensitive one is. For me, too much fiber raises my bg, so I count total carbs. Maybe, someday in the future, I’ll be able to eat it without it raising my bg. I really hope so, because I miss certain foods – lentils is one.
How different foods effect one’s bg is always a YMMV thing. Always test.
I agree: test your own reactions to foods. I think the paleo template is a good place to start when choosing a diet, but we also have to account for the fact that many modern humans are dealing with metabolisms damaged by years of sugar and grain consumption. What worked for Paleo Man may not work for them.
I can’t eat high fiber foods any more. Even medium-fiber foods often give me problems. I miss a lot of them terribly (raspberries in particular), but my digestion goes on the blink in ways that no one wants to know about when I eat even a small amount. Years of being prescribed opiates plus a high fiber powder to supposedly control the digestive symptoms (it didn’t) seems to have wrecked my digestion for good. I’d love a way to heal it, but for now I just can’t eat most high fiber stuff.
Lentils are okay for me if they’re thoroughly mashed, and I can eat pickles and sauerkraut. Also spinach, zucchini, and carrots. None in large amounts, though. I have to be careful. I wonder how many people shunning fiber used to eat far too much, wrecked their digestion, and now are simply glad to have a reason to no longer eat things that make their stomachs hurt.
Have you tried repopulating your microbiome with high-dose probiotics? From what I’ve read, if foods with fiber cause you discomfort, it could be that you lack the bacteria to digest them.
Emily, you should take a look to the GAPS Diet.
Thanks, looking into it.
There is a big difference between eating foods with naturally occurring fiber in them and taking a fiber supplement, especially those crappy Fiber One Bars. I’d rather eat a vegetable because I like it and not worry about how much fiber is in it. That will take care of itself naturally.
http://www.nature.com/nbt/journal/v32/n3/fig_tab/nbt.2845_F1.html?foxtrotcallback=true
It’s behind a paywall. Is it a mouse study?
Doesn’t appear to be, but I couldn’t say for sure without buying the full paper.
shhhhh!
http://sci-hub.io/10.1038/nbt.2845
I promise to whisper.
That’s one of my problems with the Keto version of low-carb, it removes two of the biggest advantages of low-carb, namely high protein intake and lots of vegetables. When chasing those ketones, every gram of broccoli means extra carbs, and must be reduced to a minimum. Not good for health nor microbiota. Also protein must be cut down to get ketones, thereby reducing the most satiating macronutrient.
When someone switches to low-carb from SAD, two of the biggest benefits he will see is high protein and lots of veggies. Fiber and protein is most correlated to satiety, and he will naturally eat much less. Go Keto and both those advantages are thrown out.
Some people do quite well on ketogenic diets, but I found I had to restrict protein to ridiculously low levels to stay in ketosis. That convinced me that low-carb works for me, but going full ketogenic doesn’t.
Interesting comments. I am trying to keep a keto diet (have heart failure, and hearts apparently like ketones; also insulin resistance is bad for hearts, so trying to cure mine). I’ve also been testing higher levels of protein, as per Ted Naiman. There’s wide range of opinions on how much protein should be eaten. Those who are using keto for cancer need to keep lower protein. There are also those who believe protein causes one or both of an insulin response or a blood sugar response. Jimmy Moore is using a continuous glucose monitor (CGM), and found a high blood sugar spike over two hours after eating a high protein meal. Others (like Ted Naiman) believe we should eat a lot of protein, though he’s also built and not insulin resistant.
I’m trying to get a continuous blood glucose monitor, but the one with which I’m familiar is OTC (over the counter) in Europe but not in the US. I have a friend in Sweden who is sending me one, but it’s back ordered there.
Without sensors such as as a CGM, it’s difficult to get an understanding of what’s happening even in one’s own body. For instance, I believe a higher protein intake for me means lower BOHB levels and possibly higher blood glucose. But both are expensive and difficult to test, even when testing multiple times per day. Get a CGM, though, and you can really begin testing: eat high fat, lower protein but high cals for multiple days in a row, then eat the same amount of protein, normal cals, and see what happens.
And even if I have lower ketones and higher blood sugar with higher protein, is that a bad thing? I haven’t decided yet.
I’m in the high-protein camp, but that’s what works for me. I can eat a big ol’ steak or whatever and my glucose level barely budges. As with everything, you have to see how your own body reacts.
If you’re worried about insulin resistance, here are two things to consider: fibers such as resistant starch can improve insulin sensitivity. Second, more muscle-mass improves insulin sensitivity, and protein is essential to build and preserve muscle-mass.
Also, what constitutes “a high blood sugar spike”? There are blood sugar spikes that are normal, and there are spikes that are in the diabetic range. Only the second category is harmful. There is a tendency among low-carbers to consider normal spikes as harmful. Low-carbing can also cause physiological insulin resistance, and then FBG is elevated. But then the same low-carbers claim that elevated FBG is harmless.
One might also think about where did blood sugar spike come from if no carbs where ingested, only fat+protein? Your body made it via GNG. The body decided it needed glucose (some glucose is needed for survival), and made it. If you hadn’t ingested the protein, the body would perhaps have made the glucose from your muscle tissue instead, which is not a good thing.
Protein will cause an insulin response, less than carbs, but more than fat. But spikes of insulin after a meal is not the same thing as insulin resistance, when insulin levels are high constantly.
Spikes of insulin and blood sugar after a meal: normal
Chronically elevated levels of insulin and blood sugar: not normal
I can’t eat high fiber foods any more. Even medium-fiber foods often give me problems. I miss a lot of them terribly (raspberries in particular), but my digestion goes on the blink in ways that no one wants to know about when I eat even a small amount. Years of being prescribed opiates plus a high fiber powder to supposedly control the digestive symptoms (it didn’t) seems to have wrecked my digestion for good. I’d love a way to heal it, but for now I just can’t eat most high fiber stuff.
Lentils are okay for me if they’re thoroughly mashed, and I can eat pickles and sauerkraut. Also spinach, zucchini, and carrots. None in large amounts, though. I have to be careful. I wonder how many people shunning fiber used to eat far too much, wrecked their digestion, and now are simply glad to have a reason to no longer eat things that make their stomachs hurt.
Have you tried repopulating your microbiome with high-dose probiotics? From what I’ve read, if foods with fiber cause you discomfort, it could be that you lack the bacteria to digest them.
I’m trying to get more foods with probiotics in my diet, but I’m wary of taking a supplement. I’ve had bad experiences with different kinds of supplements in the past, and my body’s always been super sensitive to the negative effects of drugs, supplements, etc., while not gaining much benefit. Even when I don’t know about the side effects, I get them, so it’s not a nocebo effect. I’m ramping up probiotic foods slowly and they are helping. Once I get to the max I’m able to eat of them daily, I’ll look into supplements if I haven’t improved enough to eat my beloved raspberries.
Coffee also actually helps, but I’m so sensitive to caffeine I can’t drink it much. I keep thinking about drinking decaf — but blech. I think I’d rather triple my sauerkraut intake.
re: …if foods with fiber cause you discomfort, it could be that you lack the bacteria to digest them.
People need to zoom in on which fibers, and how quickly. In the particular case of prebiotic fibers (resistant starch, soluble fibers), that aren’t effectively cleaved by human enzymes, but are metabolized by gut flora, one might expect no real metabolic activity until they reach the colon.
But a reaction in the minutes-to-hours range can easily indicate that overgrowths are higher in the intestinal tract than expected and desired. SIBO is the leading, but not sole suspect, and it appears to be a pervasive, possibly growing, problem.
My reaction to insoluble fiber is quick and painful, but my reaction to soluble fiber takes more like 18 hours. I don’t have any of the symptoms listed in the link; I’m particularly fine with fat, since the more of it I eat, the better I do in every way. Especially dairy fat, though olive oil helps as well.
I do have IBS, but since I went off prescription opiates and changed my diet, it only flares up when I’m under a lot of stress or when I do something dumb like thinking just one sandwich won’t hurt. It’s the more uncommon form of IBS (opposite of diarrhea), and I’ve wondered if that has exactly the same causes as the more common type. It didn’t start until opiates I was prescribed did a beatdown on my gut. Off the opiates for well over a year and on a new diet for just a couple months, I’ve got it pretty well under control now. My last flare-up was at a time of great stress when I ate some non-sourdough bread. Not doing that again.
Emily, you should take a look to the GAPS Diet.
Thanks, looking into it.
There is a big difference between eating foods with naturally occurring fiber in them and taking a fiber supplement, especially those crappy Fiber One Bars. I’d rather eat a vegetable because I like it and not worry about how much fiber is in it. That will take care of itself naturally.
Glad to hear some sense. It’s why I haven’t ever bothered to go into full ketosis. There are so many healthy foods that would be restricted. It seems we have evolved a similar rationale and diet Tom. It’s good to read your blogs. LLVLC used to be something I never missed but all it seems to be now is keto topics.
I consider a ketogenic diet to be a tool in the toolbox. It’s the right tool in some situations, but I don’t believe it should be the default diet for everyone.
Glad to hear some sense. It’s why I haven’t ever bothered to go into full ketosis. There are so many healthy foods that would be restricted. It seems we have evolved a similar rationale and diet Tom. It’s good to read your blogs. LLVLC used to be something I never missed but all it seems to be now is keto topics.
I consider a ketogenic diet to be a tool in the toolbox. It’s the right tool in some situations, but I don’t believe it should be the default diet for everyone.
Excellent, Tom.
If an ingested substance is not significantly causing an insulin response leading to adiposity, then it’s reasonably safe to say it’s ok to discount it from your daily net carbs? That’s oversimplifying, but still true at its core.
Personally, I’ve found the cooked/cooled/reheated resistant starch in potatoes to be very beneficial to my personal satiety, digestion, large intestine health, and dietary variety.
I am not diabetic, I am a bit overweight, suffer from anxiety/depression, and IBS-C. I have a high-veggie diet, including starches, and animal protein, to manage this. I can immediately tell when I’m “off” because all of my issues flare up. This is usually a response to eating dairy, grains, or more than a taste of straight sugar in a given time frame. Tl;dr:the more highly processed, the worse I am.
So, eat food in its natural state or as close as possible. Not too much. Lots of plants, because HGs weren’t exactly swimming in flank steak and pounds of ground day after day. I recognize that there are many legitimate pathologies that require different interventions, but for the everyday person trying to be in better health and shed a few lbs and just not feel so bum crappy all the time, this is as simple as it gets.
I would also say one missing ingredient is patience. You don’t adapt to anything, Be it keto or WFPB or paleo/primal or PHD or resistant starch overnight. This rollercoaster of debate is incurred by everyone wanting a quick, permanent fix. “Why isn’t this woooorrrrkkkkiiinnngggg?” Well, it’s hasnt been long enough!
That’s how I’d put it, yes. I don’t think we need to worry about or restrict every substance officially categorized as a carbohydrate. I also don’t worry about my glucose rising to the 125-130 range after a meal. That’s expected and normal.
Oh, I needed to hear that. I’ve been getting a little obsessive about the BG readings after having to buy a new meter because they don’t make the strips for my old one anymore. New meter readings are consistently higher and freaking me out. (I’m not diabetic, at least not diagnosed.) I’ve ordered another new meter – different brand – for comparison. No more new meters, no more chasing a better reading. Yours is the one site I can always count on to bring me back to sanity. Thanks.
Different meters can vary by 15-20 points. In fact, you can get that much variation using the same meter, depending on the brand. So yes, I wouldn’t freak out over a 15-point swing now and then.
I also wouldn’t freak out over transient rises in glucose after meals, like I said before. Your body needs some glucose — not the 300+ grams per day we were all told to consume by the ding-dongs at the USDA, but some. When you eat foods that provide that biologically necessary glucose, it has to travel through the bloodstream to get where it’s needed. So of course your blood glucose level will rise after you eat a meal that includes, say, a sweet potato. Perfectly normal and expected, as long as your blood sugar returns to normal by the 90-120 minute mark.
Excellent, Tom.
If an ingested substance is not significantly causing an insulin response leading to adiposity, then it’s reasonably safe to say it’s ok to discount it from your daily net carbs? That’s oversimplifying, but still true at its core.
Personally, I’ve found the cooked/cooled/reheated resistant starch in potatoes to be very beneficial to my personal satiety, digestion, large intestine health, and dietary variety.
I am not diabetic, I am a bit overweight, suffer from anxiety/depression, and IBS-C. I have a high-veggie diet, including starches, and animal protein, to manage this. I can immediately tell when I’m “off” because all of my issues flare up. This is usually a response to eating dairy, grains, or more than a taste of straight sugar in a given time frame. Tl;dr:the more highly processed, the worse I am.
So, eat food in its natural state or as close as possible. Not too much. Lots of plants, because HGs weren’t exactly swimming in flank steak and pounds of ground day after day. I recognize that there are many legitimate pathologies that require different interventions, but for the everyday person trying to be in better health and shed a few lbs and just not feel so bum crappy all the time, this is as simple as it gets.
I would also say one missing ingredient is patience. You don’t adapt to anything, Be it keto or WFPB or paleo/primal or PHD or resistant starch overnight. This rollercoaster of debate is incurred by everyone wanting a quick, permanent fix. “Why isn’t this woooorrrrkkkkiiinnngggg?” Well, it’s hasnt been long enough!
That’s how I’d put it, yes. I don’t think we need to worry about or restrict every substance officially categorized as a carbohydrate. I also don’t worry about my glucose rising to the 125-130 range after a meal. That’s expected and normal.
Oh, I needed to hear that. I’ve been getting a little obsessive about the BG readings after having to buy a new meter because they don’t make the strips for my old one anymore. New meter readings are consistently higher and freaking me out. (I’m not diabetic, at least not diagnosed.) I’ve ordered another new meter – different brand – for comparison. No more new meters, no more chasing a better reading. Yours is the one site I can always count on to bring me back to sanity. Thanks.
Different meters can vary by 15-20 points. In fact, you can get that much variation using the same meter, depending on the brand. So yes, I wouldn’t freak out over a 15-point swing now and then.
I also wouldn’t freak out over transient rises in glucose after meals, like I said before. Your body needs some glucose — not the 300+ grams per day we were all told to consume by the ding-dongs at the USDA, but some. When you eat foods that provide that biologically necessary glucose, it has to travel through the bloodstream to get where it’s needed. So of course your blood glucose level will rise after you eat a meal that includes, say, a sweet potato. Perfectly normal and expected, as long as your blood sugar returns to normal by the 90-120 minute mark.
Tom, what do you think about Dr. Mario Di Pasquale anabolic diet where you eat all the carbs you want from one meal to two days a week and the rest of the week low carb, no more than 30 grams of carbs per day combined with a strength training regime?
I’m not familiar with that specific program, but I think carb cycling makes sense. “All the carbs you want” might be going overboard, but if he’s talking about doing it on days when you engage in heavy lifting, that would also make sense.
That’s an old program that’s been around for decades in the bodybuilding and powerlifting community. I don’t recall the part about eating all the carbs you want. His program was more in line with Rob Faigin’s Natural Hormone Enhancement…low to zero carb for three days, then have a higher carb intake on the 4th day. A lot of that stems from Vince Gironda Meat/Egg diet where you zero carb for three days and have ONE high carb meal (usually a potato or plate of pasta), then go back to zero carb.
It was meant to be a pre-contest diet, not meant to be long term.
Faigin’s book spells out slightly different plans for bodybuilders in training vs. a long-term plan for normal folks. For normal folks, it’s 3 days of low-carb, then a carb-load day, then 4 days of low-carb, then a carb-load day. He doesn’t specify a limit on carbs for carb-loads, but emphasizes that 1) the carb-load should only be for the last meal of the day, and 2) should not also be a high-fat/high-protein meal.
It’s been about 15 years since I read that and I don’t recall him giving any kind of carb numbers to eat. That was something for the reader to figure out for themselves. Even bodybuilders vs. everyday people weren’t really advised to go from 50 gms/day during the low carb days all the way up to 500 gms. There’s some sensibility to it. I don’t think I could even do 200 gms/day on a carb load.
But the regular folk are using that carb load day as an excuse to over consume. Vince Gironda was more sensible and would have fired a client (many of whom were actors as well as bodybuilders) if he caught them pigging out on junk foods.
Faigin doesn’t prescribe a limit, but does say the carb-load meal isn’t an excuse to pig out on sugar, which he does limit.
I suppose if you follow his advice exactly and eat a high-carb meal that’s 1) low in fat and 2) based on starches instead of sugars, it would be difficult to go overboard or eat junk foods. I doubt many of us would want to eat a dozen potatoes with very little added fat.
Tom, what do you think about Dr. Mario Di Pasquale anabolic diet where you eat all the carbs you want from one meal to two days a week and the rest of the week low carb, no more than 30 grams of carbs per day combined with a strength training regime?
I’m not familiar with that specific program, but I think carb cycling makes sense. “All the carbs you want” might be going overboard, but if he’s talking about doing it on days when you engage in heavy lifting, that would also make sense.
That’s an old program that’s been around for decades in the bodybuilding and powerlifting community. I don’t recall the part about eating all the carbs you want. His program was more in line with Rob Faigin’s Natural Hormone Enhancement…low to zero carb for three days, then have a higher carb intake on the 4th day. A lot of that stems from Vince Gironda Meat/Egg diet where you zero carb for three days and have ONE high carb meal (usually a potato or plate of pasta), then go back to zero carb.
It was meant to be a pre-contest diet, not meant to be long term.
Faigin’s book spells out slightly different plans for bodybuilders in training vs. a long-term plan for normal folks. For normal folks, it’s 3 days of low-carb, then a carb-load day, then 4 days of low-carb, then a carb-load day. He doesn’t specify a limit on carbs for carb-loads, but emphasizes that 1) the carb-load should only be for the last meal of the day, and 2) should not also be a high-fat/high-protein meal.
It’s been about 15 years since I read that and I don’t recall him giving any kind of carb numbers to eat. That was something for the reader to figure out for themselves. Even bodybuilders vs. everyday people weren’t really advised to go from 50 gms/day during the low carb days all the way up to 500 gms. There’s some sensibility to it. I don’t think I could even do 200 gms/day on a carb load.
But the regular folk are using that carb load day as an excuse to over consume. Vince Gironda was more sensible and would have fired a client (many of whom were actors as well as bodybuilders) if he caught them pigging out on junk foods.
Faigin doesn’t prescribe a limit, but does say the carb-load meal isn’t an excuse to pig out on sugar, which he does limit.
I suppose if you follow his advice exactly and eat a high-carb meal that’s 1) low in fat and 2) based on starches instead of sugars, it would be difficult to go overboard or eat junk foods. I doubt many of us would want to eat a dozen potatoes with very little added fat.
In those days, prior to seeing Fat Head, a “cheat day” would have been a Tastykake or a pint of Haagen-Daz.
I’ve never heard of Tastykake, but it sounds awful. My cheat meal (if you can call it that) is usually a Mexican dinner. Even for that meal, I skip the rice because rice sends my glucose into the stratosphere.
Tastykake is a Philly institution. Back in the day it was a whole food product. Now it’s all chemical. I still get one pumpkin pie every year at Thanksgiving. Betty White was their spokesperson when I was a kid. https://www.youtube.com/watch?v=wSWB_nWDG_Q
Here in the UK we’re lucky (for once!) and probably in Europe too, I don’t remember – on labels and in texts and recipes fibre is broken out from the carbs, thus carb count = digestible carbs.
Gosh our spelling is also quaint!
Way back when, I did a lot of testing, and one thing I discovered was that they put a LOT of sugar in the likes of “All Bran”. Another thing I discovered was that “wheat bran” still contained whatever it was in wheat (probably wheat germ agglutinin) that spikes my BG to hell and back.
While most of my symptoms disappeared like a switch being turned from low carb, some of my digestive symptoms, mainly GERD and intestinal grumbling and worse, remained until I dropped wheat entirely.
Now my bowels are as regular as an atomic clock, with possibly three days out of a year when they aren’t, which is close enough for jazz.
I routinely eat from two to six oatcakes a day (5 – 6g carbs each) because I need something to hold up the grass-fed butter, cheese, smoked salmon etc. and I occasionally eat the likes of basmati rice or quinoa in small quantities when I need something to soak up all the healthy fats running out of a sauce, but apart from that I almost completely avoid grains.
OTOH I eat quite a few veggies to dilute my meat, poultry, fish and game, principally leafy and seasonal greens, and non-seasonal things like peppers, chillies, mushrooms, garlic, olives, avocados, nuts etc. Putting two and two together, since this has worked for over twelve years now I think I’m on to something – for ME! Obviously there’s enough of the right kind of fibre without too many digestible carbs. I aim at around 50g carbs which about matches my insulin output sans IR.
I seldom bother to test my BG now, unless I’m eating out and suspect I’m going to eat something ungood. My rules of thumb have become – can I smell ketones in my early morning pee but not so much during the rest of the day – which suggests I am using them at about the same rate I am generating them – and can I go most of the day without feeling hungry or needing to eat – which suggests I am principally running off stored energy from the previous day’s meal(s). Horrifying dieticians and clueless doctors is an added bonus, as is the fact that my regular doctor has gradually come around to realising that since I haven’t killed myself yet, as predicted, perhaps there’s something she ought to know that she hasn’t been told.
You’ve done what we all need to do: experiment and figure out what works for each of us.
I had a LOT of help, especially at first. This was invaluable
http://loraldiabetes.blogspot.co.uk/2009/04/test-test-test.html
first written FIFTEEN years ago and still never subjected to an RCT, despite that on the ADA’s own forum it has consistently shown results which blow their official advice into the weeds – which taught me the value of feedback, and taking manual control of systems which should be automatic but no longer are, and the likes of Michael Eades with his peerless explanations of the technology behind metabolism.
I also learned a lot from Mark Sisson 1.0, and even Stephan Guyenet 1.0, before he started deleting his best posts and all the invaluable comments, and many others since.
Now I’d especially recommend you and Amy Berger for your ability to simplify things to where anyone with an IQ above that of dietician would find them understandable.
Currently I read the likes of Malcolm Kendrick and Dave Feldman
http://cholesterolcode.com/
plus a whole bunch of researchers and Real Doctors on Twitter who routinely post far too many papers to be able to read them all, and recipes which I seldom use but sometimes find things to try (like Halloumi).
I tend to apply the old Engineers’ Maxim – why fix something that isn’t broken? My biggest regret is that I was never told how to fix things that WERE broken for most of my life, and although there are more clueful doctors now, and even some clueful dieticians, they are still a small minority in the face of a tsunami of unnecessary disease and suffering.
Here in the UK we’re lucky (for once!) and probably in Europe too, I don’t remember – on labels and in texts and recipes fibre is broken out from the carbs, thus carb count = digestible carbs.
Gosh our spelling is also quaint!
Way back when, I did a lot of testing, and one thing I discovered was that they put a LOT of sugar in the likes of “All Bran”. Another thing I discovered was that “wheat bran” still contained whatever it was in wheat (probably wheat germ agglutinin) that spikes my BG to hell and back.
While most of my symptoms disappeared like a switch being turned from low carb, some of my digestive symptoms, mainly GERD and intestinal grumbling and worse, remained until I dropped wheat entirely.
Now my bowels are as regular as an atomic clock, with possibly three days out of a year when they aren’t, which is close enough for jazz.
I routinely eat from two to six oatcakes a day (5 – 6g carbs each) because I need something to hold up the grass-fed butter, cheese, smoked salmon etc. and I occasionally eat the likes of basmati rice or quinoa in small quantities when I need something to soak up all the healthy fats running out of a sauce, but apart from that I almost completely avoid grains.
OTOH I eat quite a few veggies to dilute my meat, poultry, fish and game, principally leafy and seasonal greens, and non-seasonal things like peppers, chillies, mushrooms, garlic, olives, avocados, nuts etc. Putting two and two together, since this has worked for over twelve years now I think I’m on to something – for ME! Obviously there’s enough of the right kind of fibre without too many digestible carbs. I aim at around 50g carbs which about matches my insulin output sans IR.
I seldom bother to test my BG now, unless I’m eating out and suspect I’m going to eat something ungood. My rules of thumb have become – can I smell ketones in my early morning pee but not so much during the rest of the day – which suggests I am using them at about the same rate I am generating them – and can I go most of the day without feeling hungry or needing to eat – which suggests I am principally running off stored energy from the previous day’s meal(s). Horrifying dieticians and clueless doctors is an added bonus, as is the fact that my regular doctor has gradually come around to realising that since I haven’t killed myself yet, as predicted, perhaps there’s something she ought to know that she hasn’t been told.
You’ve done what we all need to do: experiment and figure out what works for each of us.
I had a LOT of help, especially at first. This was invaluable
http://loraldiabetes.blogspot.co.uk/2009/04/test-test-test.html
first written FIFTEEN years ago and still never subjected to an RCT, despite that on the ADA’s own forum it has consistently shown results which blow their official advice into the weeds – which taught me the value of feedback, and taking manual control of systems which should be automatic but no longer are, and the likes of Michael Eades with his peerless explanations of the technology behind metabolism.
I also learned a lot from Mark Sisson 1.0, and even Stephan Guyenet 1.0, before he started deleting his best posts and all the invaluable comments, and many others since.
Now I’d especially recommend you and Amy Berger for your ability to simplify things to where anyone with an IQ above that of dietician would find them understandable.
Currently I read the likes of Malcolm Kendrick and Dave Feldman
http://cholesterolcode.com/
plus a whole bunch of researchers and Real Doctors on Twitter who routinely post far too many papers to be able to read them all, and recipes which I seldom use but sometimes find things to try (like Halloumi).
I tend to apply the old Engineers’ Maxim – why fix something that isn’t broken? My biggest regret is that I was never told how to fix things that WERE broken for most of my life, and although there are more clueful doctors now, and even some clueful dieticians, they are still a small minority in the face of a tsunami of unnecessary disease and suffering.
I tried the lentil pasta and it was quite good. Tasted like the real thing. I don’t test glucose but I know insulin spikes when I feel them and I didn’t get anything. But, as I suspected, where I thought I’d get 5 meals spread out over 5 days, the leftovers didn’t make it past my 7 PM snack (which is usually some meat).
Which is why I don’t keep pasta or rice around anymore, even the gluten free alternatives…just too easy for me to over consume.
If you know that’s going to be a problem, then yeah, I’d avoid the temptation.
I tried the lentil pasta and it was quite good. Tasted like the real thing. I don’t test glucose but I know insulin spikes when I feel them and I didn’t get anything. But, as I suspected, where I thought I’d get 5 meals spread out over 5 days, the leftovers didn’t make it past my 7 PM snack (which is usually some meat).
Which is why I don’t keep pasta or rice around anymore, even the gluten free alternatives…just too easy for me to over consume.
If you know that’s going to be a problem, then yeah, I’d avoid the temptation.