The public’s interest in learning more about the low-carb, moderate protein, high-fat, ketogenic diet is gaining momentum and is stronger than ever as evidenced by it being the #5 most Googled diet search term in 2013. Because this nutritional approach has scientific evidence showing it to be a powerful modality against most of the chronic diseases of our time, the curiosity about it comes from a variety of perspectives. From strong evidence for conditions such as diabetes mellitus (Type 2 diabetes) to cardiovascular disease, good evidence for issues like Alzheimer’s Disease to narcolepsy, and emerging evidence for a wide variety of other issues of great research interest including cancer, fibromyalgia, traumatic brain injury and so much more, there are compelling reasons to at the very least give this way of eating a try for yourself just to see how you do in your pursuit of optimizing your health. With the overwhelming flood of support for the new book on this subject written by me and my coauthor Duke internist Dr. Eric Westman called Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (we are already in our fourth printing after just four weeks!), it seems many have already decided to do their own n=1 test of nutritional ketosis doing it in a methodical way making appropriate tweaks and changes along the way.
But I’ve become increasingly concerned by the perpetuation of certain myths that continue to pervade the discussion about very low-carb, high-fat diets that is unfortunately turning some people away from even attempting to get into ketosis because of fear about what they have heard about it on the Internet. A number of these objections to very low-carb, high-fat ketogenic diets have been out there for many years without any scientific basis or support–and yet they’ve been repeated so often without being directly challenged that they’ve become a part of the “things we know” category in the minds of so many people.
Disappointingly, a lot of these seven lingering myths I’m about to share are spread by certain people I know and respect in the Paleo health community and it appears the tactic of making ketosis seem undesirable is being used as a means for discrediting a certain end of the spectrum in the Paleo template that could very likely help a lot more people than they even realize. While they may say on the one hand that eating a low-carb, ketogenic diet can be a very effective therapeutic tool for certain health conditions, what they say out of the other side of their mouth warning of all the calamities that will supposedly happen to various aspects of health is unfortunately turning many people away from even trying it who would otherwise benefit from a ketogenic diet leading to an inadvertent (or is it purposeful?) obfuscation about who should eat this way and who should not.
I’m calling them out in this blog post–THIS IS JUST PLAIN WRONG.
It’s time to set the record straight and put to rest these 7 lingering myths I think everyone should know about low-carb ketogenic diets (interspersed with “Moment of Clarity” quotes and excerpts from Keto Clarity):
#1: Ketosis leads to hypothyroidism and adrenal fatigue.
Why this popular meme continues to find traction in the lack of any evidence that a well-formulated low-carb, moderate protein, high-fat, ketogenic diet with adequate calories is the causal factor in it is beyond me. It’s certainly repeated often enough by some people in the Paleo community that it’s just automatically believed to be undeniably true at face value. But whenever I ask medical practitioners who use ketogenic diets therapeutically with their patients if this is something they see regularly in their practice, not a single one has reported hypothyroidism as the direct response of their patients being in a state of nutritional ketosis.
The excuse given for avoiding ketosis is that the lower level of glucose that happens while on a ketogenic diet leads to a diminished capacity for T4 to be converted into T3, leading to hair loss, cold hands and feet, general malaise, and other symptoms associated with low thyroid function. That’s a very clear sign of too low calories, not a very low-carb, ketogenic diet. Even still, as Dr. Ron Rosedale shared in my Keto Clarity interview with him, a “lower number does not necessarily mean lower function…often it means better function.” When the body is operating optimally, the thyroid levels return to a more desirable state that is lower than what lab values say are the norm. It’s actually a sign of robust health and longevity, not something to be avoided.
That’s not to say you can’t induce a genuine state of hypothyroidism if you fail to consume enough calories on your ketogenic (or any other) diet. But in research studies following people on an adequate calories ketogenic diet, they have not been shown to produce reduced thyroid function. NOT…ONE…STUDY! It just doesn’t happen despite oftentimes being claimed as the gospel truth. Learn more of the truth about this topic by reading naturopathic physician Dr. Chris Decker’s outstanding column “Does Paleo Make Us Hypothyroid?”
#2: You’ll destroy your gut health eating a low-carb, high-fat diet.
Much has been made about gut health in recent years and it’s certainly an exciting development in the greater discussion of overall health. There was an outstanding two-part series on this subject on Australian television on ABC’s “Catalyst” in August called “Gut Reaction” that’s a must-see! But if you listen to what some are saying about what happens to gut health on a low-carb, ketogenic diet, you might wonder who would ever go on such a nutritional approach. But yet again, there’s a lot of hype and hysteria that accompanies these bold proclamations that are not backed by any sound scientific data proving it to be 100% accurate.
While much is made about the need for dietary fiber to feed the gut microbiome, the truth is there is a significant lack of research studies looking at how ketosis impacts it. One such study that might give us a clue about this was published in the January 23, 2014 issue of the scientific journal Nature that found low-carb, high-fat ketogenic dieting increased microbes of the genus Bacteroides and decreased Firmicutes. Why is this important? Because when Bacteroides are lower and Firmicutes are higher in a human gut, this is indicative of someone with obesity. But ketosis produced exactly the opposite effect while simultaneously producing a reduction of inflammation levels–a positive overall health marker.
One of my Keto Clarity experts Dr. William Davis said people on a ketogenic diet can get an adequate amount of indigestible fibers to feed their gut flora while maintaining a proper therapeutic level of nutritional ketosis doing the things he shared in that except from my book above. Dr. Rosedale noted in my Keto Clarity podcast interview with him that it’s unnecessary to resort to resistant starch as has become in vogue lately to feed the microbiome. The fiber content of non-starchy vegetables provide a smorgasbord of food to feed the gut bugs without the insulin spike that accompanies such an approach. While it is indeed resistant, upwards of half of the carbohydrate content still impacts the metabolism raising blood sugar and insulin levels–making it less-than-ideal for a ketogenic dieter to be consuming. Instead, opt for the fibrous low-carb veggies to get the benefits of feeding the microbiota without the harmful blood sugar and insulin response.
Because this is far from settled science, we need more genuine research about this topic before making claims that one mode of eating is more harmful to gut health than another. It is possible that consuming certain foods while on a ketogenic diet (as we outlined above) may adequately feed the bacteria in your gut perfectly fine. And we can’t ignore the role genetics may play on this issue much more so than whatever diet we choose to consume. There’s so much more to this issue that we don’t even know about yet that the prudent thing to do is to wait and see before jumping to conclusions that may or may not be valid. There is no reason why gut health should not flourish on a ketogenic diet, so the hysteria about avoiding keto if you want good gut health is imprudent at best.
#3: Proponents of ketogenic diets think EVERYONE should be eating that way as a one-size-fits-all approach.
This one is nothing more than a blatant lie intended to paint people who support ketosis with a broad brush as being overly dogmatic. But as perhaps one of the most vocal proponents of a ketogenic diet today, I cannot help but laugh at how nonsensical this myth really is. Anyone who has heard my many recent appearances on a multitude of podcasts promoting Keto Clarity in the past month, again and again you have heard me state quite clearly that a ketogenic diet is not necessarily for everyone. In fact, in the Introduction of my book, I shared the story about how I gave testimony before the 2010 Dietary Guidelines Advisory Committee where I stated to the panel that “we really need to get away from one set of guidelines for all Americans…(we need) multiple guidelines that people can choose from.” I was referring to the federal promotion of the low-fat, high-carb diet full of whole grains, lean meats and dairy, and very little saturated fat intake which has been an abysmal and utter failure. But those comments can be extended and apply to any nutritional approach that helps people become healthy regardless of what that plan is.
While a ketogenic diet has worked very well to improve my own personal health, it has long been my philosophy in my work for people to find the nutritional plan that will work for the individual, follow that plan exactly as prescribed, and continue to do that plan making appropriate tweaks along the way. If that’s a vegan diet and someone can maximize their health doing that, then I’m the first to cheer them on to great success. If that’s a “safe starches” Paleo diet, then Jimmy Moore will applaud their efforts to optimize their health doing that. So why can’t that same respect be given to someone who opts to do a ketogenic diet? The most intense dogma about diet seems to be coming from vegans who think nobody should ever eat animal-based foods and from certain Paleo diet advocates who are scaring people half to death of even attempting a very low-carb, high-fat, ketogenic diet for whatever their reasons. They need to embrace a more inclusive, not exclusive path for people to choose from to optimize their health.
Are there people who promote a ketogenic diet for health that think everyone needs to be eating that way? I’m sure there are amongst the many diehard enthusiasts of this way of eating. But the leading voices of keto are fully aware of and thoroughly understand the individual variability and nutritional needs people have in their pursuit of robust health. It’s rather presumptuous of those who think we’re all unyielding in our promotion of ketosis simply because we share the positive health benefits that come from it. If it works for you, then do it. If it doesn’t, then don’t. Why do some people need to be so smug about it when the choice should be up to the individual to figure out for themselves whether or not it’s the right thing for them to be doing? To think all ketogenic dieters believe in a monolithic nutritional approach for everyone to follow is a purposeful distortion of reality and anyone who would make such statements should be ashamed of themselves for jumping to illogical conclusions that are misleading and divisive. This is helping nobody as they seek out the diet that is right for them.
#4: It’s dangerous for a woman who wants to improve fertility to be in ketosis.
One of the newer arguments being hurled at low-carb, high-fat, ketogenic diets (and it was especially exclaimed in several of the lectures given at last month’s Ancestral Health Symposium in Berkeley, California) targets women of childbearing age and issues stern threats that great harm will come to them and their baby if they even dare get anywhere close to making ketones in their body. To make sure ketosis doesn’t even come into the picture, the remedy is recommended that women who are dealing with infertility problems and wanting to get pregnant need to eat at least 30 percent of their diet as carbohydrates because anything less than that is supposedly not conducive to fertility. In light of all we now know about low-carb diets and the positive impact they can have on pregnancy, that’s a truly oddball claim.
I’ve conducted a few relevant podcast interviews on this very topic:The LLVLC Show #84: Low-Carb And Fertility With Reproductive Endocrinologist Dr. Gil WilshireThe LLVLC Show #454: Dr. Michael Fox On Eating Low-Carb For FertilityThe LLVLC Show #549: ‘The Primal Parent’ Blogger Peggy Emch Beats Infertility With Primal Low-CarbThe LLVLC Show #647: Nat Kringoudis Providing Holistic Fertility Advice In Melbourne, AustraliaAsk The Low-Carb Experts #16: Low-Carb, Pregnancy & Kids | Maria Emmerich and Valerie Berkowitz
The overriding theme of basically all of these fertility experts is that consuming excess carbohydrates is more of a problem in getting pregnant for women dealing with metabolic syndrome, insulin resistance, and polycystic ovary syndrome (PCOS). Thus, for these women dealing with these issues, overcoming infertility and making the process of producing a healthy baby requires carbohydrate-restriction for them. But this runs exactly counter to the position held and suggested by some of the vocal pro-carbohydrate Paleo leaders who implore scaremongering tactics for every single woman of childbearing age. They see ketosis as a “toxic” state for pregnant women and their babies and warn of harm that will come to both if a low-carb, high-fat diet is consumed during the pregnancy. This doesn’t make any sense from a historical perspective of our ancestors where many babies have likely been born while the mother was in a state of ketosis. Do you really think Paleo man made sure to run out to gather as much vegetation as he could to make sure over 30 percent of his pregnant wife’s calories were from carbohydrates? Come on.
If you want to see a real world example of the impact of a low-carb, high-fat diet on the development of a healthy baby, then read about Canadian ketogenic physician Dr. Jay Wortman’s n=1 baby experiment here, here, here, and here featuring the beautiful and vibrant little Isabelle (who I got to meet on the 2013 Low-Carb Cruise) and she is now thriving as a growing little girl thanks to her mom and dad’s decision to conceive her while eating a low-carb, high-fat diet. Yes, I realize this is only an anecdotal experience, but the fact there was not only no harm that took place to that little baby girl, but the fact that she is now well ahead of the pace of development expected cannot be ignored or discounted.
My Keto Clarity expert neonatologist Dr. Mary Newport says that babies are in a mildly ketotic state within 12 hours of birth and that it’s no accident breast milk contains a very high amount of fat, even saturated fat. Ketones help a baby’s brain to develop and it’s a natural state for them to be in as they continue to grow. For more information, read an outstanding column about this topic on the “Ketogenic Diet For Health” blog called “Babies thrive under a ketogenic metabolism.” Despite the dire warnings about ketosis during pregnancy and the “need” for carbohydrates for these women, none of it seems to be founded in scientific truth.
#5: There is no harm to health produced by consuming real, whole foods that are starchy or sugary.
Just eat real food (aka JERF as my fellow health podcasting bud Sean Croxton from “Underground Wellness” would say). It’s a simple message and one I fully embrace as a great starting point for so many people interested is improving the quality of their diet. Let’s face it, too many people still think that Dorito’s, honey buns, pancakes, and Coca-Cola are all foods–but they’re not even close. I like to refer to them as cheap food-like products with very high margins that the food companies market the heck of in order to promote them to us as “food.” But once people recognize and make the genuine shift to real, whole foods, does that mean anything and everything classified as such is fair game for consumption without any consequences to your health? Good question.
The argument has been made that if you opt for whole food sources of carbohydrates such as white rice, white potatoes, sweet potatoes, fruits and honey, for example, they are perfectly fine to make you into the healthy, fit, physical specimen you desire to be. If only it were true. While I’m sure the Kitavans and other traditional people groups (the ones most frequently cited by pro-carb Paleo enthusiasts as their evidence) undoubtedly did perfectly fine eating upwards of 40 percent of their diet from these carbohydrate-based real, whole foods, the fact is they didn’t live in a world chock full of abundant processed, highly-refined sugary and grainy food-like products that can wreak havoc and lead to great challenges on the weight and health of the people who consume them. And if that description of the modern-day diet looks familiar, it should–that is the very Standard American Diet (SAD) that has plagued so many of us before we finally discovered the superiority of a real foods-based Paleo and/or ketogenic lifestyle.
As a result of the persistently high blood sugar and insulin levels (as well as increased inflammation and other metabolic health markers) that came from eating that way, it alters the way your body responds to even whole food carbohydrates now. That’s just a reality from consuming these truly bad carbohydrates over the years that led many of us on the road to morbid obesity, diabetes, and chronic disease that these promoters of “safe starches” just don’t completely grasp and understand. If you’re healthy and never had to experience the negative metabolic impact of consuming processed carbohydrates that now make you very sensitive to the blood sugar and insulin impact of even the “good” carbohydrates, then consider yourself lucky and continue to eat up on those foods. Nobody is stopping you from doing that.
But there should be an acknowledgement from these same people that there are consequences for previous dietary choices that may make it detrimental to their health to even consume real food carbs now. That doesn’t take away anything from their point that these traditional groups survived and thrived consuming these same carbohydrates because they absolutely did and still do. It just means all bets are off now for those of us with significant insulin resistance or metabolic damage where a low-carb, high-fat, ketogenic diet becomes a necessary therapy for warding off the ill effects of our old eating habits. And that’s totally okay. It would be great if a better understanding of this were articulated by the people who push carbohydrates on everyone like they are a necessary macronutrient. They are not.
When it comes to macronutrients, quality is most certainly a part of the equation, but we should never neglect the critical role that quantity plays in the large population of people dealing with obesity and chronic disease brought on by poor nutritional choices in the past.
#6: Ketosis is not a normal state our hunter-gatherer ancestors would have been in on a regular basis.
How you define what “normal” is will determine whether this myth is valid or not. If you mean it’s a metabolic state our hunter-gatherer ancestors were in 100% of the time throughout their lifetime, then I don’t think that is true about a state of ketosis. But if by normal you are referring to it being a natural part of the ebb and flow of how they lived their lives between big animal kills, then ABSOLUTELY!
Another one of my Keto Clarity experts is family physician Dr. Bill Wilson who explained in my interview with him for the book that “throughout most of our evolutionary history, humans used both glucose and ketone bodies for energy production” and that our Paleolithic ancestors used glucose as their body’s preferred fuel when non-animal food was available. But during periods of food shortage or when animal-based foods were their primary source of calories, want to take a wild guess at what was sustaining them? You got it—it was ketones! “Thus, our ancestors spent most of their time in a state of ketosis,” Dr. Wilson concluded. He added, “If our early ancestors hadn’t developed a way to use ketones for energy, our species would have ended up on Darwin’s short list eons ago!”
It’s foolish for anyone to state that our Paleo ancestors didn’t need to rely on ketosis at least some of the time to sustain their energy levels and mental clarity when they were between hunting expeditions. The result of the big kill itself was a low-carb, high-fat buffet of deliciousness that was augmented with a few bits of wild vegetation gathered by our Paleo ancestors. But once that animal was completely consumed and they engaged in periods of fasting, ketones had to step in the place of the lack of food to sustain them. This was the normal process that took place over and over again in hunter-gatherers.
Nobody knows with absolute certainty what our hunter-gatherer ancestors went through in their diet and lifestyle because we didn’t live in that time and place in human history. Nevertheless, simply because ketosis perhaps wasn’t necessarily “normal” in hunter-gatherer times doesn’t mean that it can’t be used as a powerful therapeutic approach for humans in modern times. We have evolved (and not in a good way) because of the external stimuli in our food supply and environment that makes a state of nutritional ketosis perhaps necessary for a certain segment of the population to engage in. It’s the new normal for so many of attempting to optimize our health after years, even decades, of being exposed to the ravages of modern-day living.
#7: If you’re an athlete, don’t you dare eat a low-carb, high-fat diet or your performance will tank.
And finally, we come to the myth that is becoming increasingly laughable with all the growing number of especially endurance athletes who are embracing a low-carb, high-fat, ketogenic diet to ENHANCE their athletic training and performance. The claim is an athlete should not consume less than 20 percent and more likely closer to 40-50 percent of their calories from carbohydrate sources. That’s all well and good if you are desiring to fuel your body on sugar with a maximum of 2,000 calories worth of energy at your disposal before having to refuel. But why not tap into a better, longer-lasting fuel source with upwards of 40,000+ calories worth of energy available? That would be the advantage you get from running fat and ketones as your fuel source!
I have interviewed several ketogenic athletes on my podcast:Ask The Low-Carb Experts #37: Ben Greenfield | Ketogenic Diets And Exercise PerformanceThe LLVLC Show #836: Christopher Kelly Busting The Myths About Low-Carb Diets & AthletesThe LLVLC Show #827: Terry Shanahan Shares Real Food Paleo Principles With Professional AthletesThe LLVLC Show #826: Ben Greenfield Helps Athletes Of All Types Go ‘Beyond Training’The LLVLC Show #759: Dr. Peter Brukner: 2013 Low-Carb Down Under Seminar SeriesThe LLVLC Show #642: Ultramarathon Runner Timothy Olson Thrives On A Low-Carb DietThe LLVLC Show #593: Nephrologist Dr. Keith Runyan Finds Low-Carb Ketogenic Diet Through Type 1 DiabetesThe LLVLC Show #262: Swedish Low-Carb Triathlete Jonas Colting
Just like the rest of us mere mortals who are not training for an intense bout of elite athleticism, these athletes also need to customize their own nutritional plan to fit their specific needs. In my Keto Clarity interview with Ironman triathlete Ben Greenfield, he stated that after experimenting with a full-on ketogenic approach during his training and tinkering around with various other methods to fuel his body, he now realizes that a cyclical ketogenic diet seems to work best for him. He would never be able to thrive in his athletic performance eating the upwards of half of his calories from carbohydrates on a regular basis because his body would never be able to tap into his fat stores for energy.
There is certainly a period of adaptation (perhaps upwards of 2-4 weeks) that athletes need to go through in order to shift their bodies from being primarily a sugar-burner to mostly a fat-burner using ketone bodies as an alternate fuel. Greenfield states that once you get into this metabolic state of ketosis, there are three primary benefits an athlete will experience doing this: 1) the metabolic superiority of using fat for fuel; 2) the mental enhancement that takes place with adequate ketone levels; and 3) the greater health and longevity that come from controlling blood sugar levels naturally in the presence of higher ketones. In fact, ketones are the preferred fuel source for the muscles, heart, liver, and brain because none of these vital organs handle carbohydrates very well and can in fact become damaged when we consume too many carbs. Sounds like an athlete has much more to GAIN from being in ketosis than the pro-carb crowd is letting on.
The Final Word
I hope this helps to clarify some of the lingering myths that you’ve been hearing about ketogenic diets from people who think they are well-meaning and helping others with their advice. Based on the inordinate number of repeated e-mails I receive from people desiring to try nutritional ketosis but are concerned about one of these seven lingering myths, they’re actually causing more harm than good in the grand scheme of things. The fact of the matter is a low-carb, moderate protein, high-fat diet is an outstanding way to augment your healthy lifestyle choices. A growing list of practitioners are using it with great success in their patients dealing with a wide variety of weight and chronic health issues. That said, the only way you can know if nutritional ketosis is right for you or not is to give it a try and see how you do. Don’t prejudge the diet based on what you’ve “heard” about it in the blogosphere. Grab your own copy of Keto Clarity and learn more about the what, how, and why of this way of eating that is helping multitudes of individuals who have been frustrated by the failure of virtually every other dietary approach. In the case of these people, ketosis has been a miracle in their life and nobody should ever take that away from them. Honor their choice and respect them for finding something that finally works at last. Isn’t that the goal we should all be striving for? You bet it is.
Sadly, it doesn’t seem to matter how much you try to combat the lies, distortions, and mischaracterizations of nutritional ketosis to those who seem to have a hellbent agenda against it, they just keep banging the steady drumbeat against it. I don’t know what to say about the kind of persistent dogmatic position against having people even try ketosis that is promoted by people who claim to have the best health interests of their followers in mind. In the face of 185+ scientific studies we included in the back of Keto Clarity, plenty of clinical experience by medical doctors putting their patients on a low-carb, high-fat diet, and just plain common sense is brought to bear on this question: those who incessantly preach against low-carb, ketogenic diets as somehow being dangerous, nutritionally deficient, and unnatural will not be swayed in their beliefs about this incredible way of eating. Oh well, I guess you can’t fight such unmitigated ignorance like this with the truth.
What do YOU think? What has been YOUR experience with being on a well-formulated low-carb, moderate protein, high-fat, ketogenic diet? Have you seen the kind of success with it over the long-term as so many others have? Or has this way of eating been less-than-optimal for you? If so, what were your blood ketone readings and why do you think it wasn’t as effective for you? Let me know in the comments section.