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The benefits of ketogenic and low-carb diets are irrefutable: gains for medical conditions like epilepsy (source), Alzheimer’s disease, Parkinson’s disease, autism, depression, headaches, brain injury, cancer, PCOS, narcolepsy and metabolic deficiencies (source). There are thousands of cases of weight loss for obese patients who would otherwise have lost hope (see some amazing examples here). The Keto diet also offers benefits for exercise enthusiasts, yielding energy and allowing the body to burn fat and build muscle with great success. And the Keto diet may contribute to clarity of thought. (source)
Regarding cancer, this quote in particular is poignant: “Normal tissue can adapt readily to using ketones (instead of glucose) as a substrate, but malignant cells probably do not have the same degree of metabolic flexibility” (source).
But what about our bodies’ everyday needs? Any extreme diet may have dangers as well as benefits. Our bodies and their dietary requirements are highly individual, based on genetics and epigenetics. While one person may thrive long term on a Keto or low-carb diet, someone else may develop Hashimoto’s.
Having developed Hashimoto’s myself on the low-carb GAPS Diet, I want others to understand the potential risks of long term low-carb diets, and ways around those risks, while still understanding the short term or long term benefits the diets offer.
Below I discuss the many benefits of various low-carb diets, looking at the risks that develop along the way, and how to navigate around them.
First up is the health of the thyroid — the body’s vital hormone control center.
Insulin activates the enzyme that’s involved in the conversion of T4 to T3 (the most active form of thyroid hormone). A low-carb diet provides low levels of insulin. With less insulin, our bodies don’t convert as much T4 into the active form of T3, which means less energy, decreased circulation, hormone imbalance, and many other functions that result from a well-functioning thyroid (source).
Does *Your* Thyroid Need Carbs?
Symptoms of a low-functioning thyroid may include:
- low energy
- cold hands and feet
- poor exercise tolerance/exercise recovery
- tests showing hypothyroid
Symptoms are a good indicator of how your body is doing on the Keto diet. If you don’t feel well, it’s likely the calorie-restricted nature of the Keto diet is putting your body in starvation mode, and your body is producing less T3 as a survival mechanism (source).
Risk #1 — Low functioning thyroid.
Solution — Increase caloric intake. Consider a keto variation (additional fat or carbs) or intermittent ketosis (both discussed more below).
Loss of Minerals
On a low-carb diet, one key to protecting the body’s balance is this: Increase sea salt intake. (Learn here why sea salt assimilates into our bodies better than Himalayan.) When the body produces less insulin, the kidneys excrete more sodium. Other electrolytes are then thrown off balance as well: potassium and magnesium.
Not only do I now use sea salt liberally, I put liquid minerals into every glass of water I drink. Liquid minerals balance the body’s electrolytes. (Find liquid minerals here. Or these are the very best soil minerals, but they are more expensive.) If you’re not already supplementing with magnesium, it is likely you’d benefit from magnesium supplementation as well (with the added benefits to one’s bowels and sleep [learn more here]). It’s estimated that 68% of the population is deficient in magnesium (source). (Here’s a good one.)
Risk #2 — Loss of sodium and minerals.
Solution — Increase sea salt and liquid mineral intake.
Find sea salt here.
My family was among the first to start the GAPS Diet, not too long after the publication of the GAPS book (find it here), and we stayed on the diet for almost 6 years, continuing to look for greater healing. It was when I finally understood the link between my low-functioning thyroid and my low-carb diet that I introduced cassava flour. (Find it here.) Immediately I gained energy and new health. I now integrate gentle, complex carbs into my diet regularly. Yet my diet remains relatively low in overall carb intake.
For me this looks like variety each day — low-carb meals intermittent with complex carbs at other meals. I almost never eat simple carbs like honey or maple syrup or even fruit, unless I have a lot of protein in my belly and it’s just a bit. I’ve experimented with what makes me feel best.
I start the day with high fat, high protein and moderate carbohydrate breakfasts which usually consist of high-protein, high fat cassava flour waffles (like these or these) with a side of sausage or eggs. I put about six tablespoons of Kerrygold butter on my waffle (and no sweetener), which I know seems obscene to some people, but I love it, and my body craves the fat. At lunch I usually eat a Keto-style meal of lettuce, cucumbers and sauerkraut with high-fat meat or triple cream brie, very simple. For dinner, I do best with lots of veggies, including lettuce, a small amount of protein and a small amount of complex carbs. I love cooking big Keto casseroles for dinner (like this one). I also love high fat soup or stew for dinner (like this one). When I add up my carbs at the end of the day, my total carb intake is still pretty low — but it does include valuable and intentional complex carbs.
Most people who thrive using the Keto diet to obtain weight loss, athletic or medical goals, need to closely monitor the duration of the diet with their unique body, considering supplements and symptoms. The GAPS diet for me ended up being a high protein Keto diet, which has its own downfalls, which I’ll discuss more below. The GAPS diet doesn’t need to be ketogenic or low-carb; but it should be intentional based on one’s health.
There are definite reasons to embrace low-carb diets. These include having SIBO, wherein the overgrowth of bacteria in the small intestine is feeding off of starches causing fermentation and bloating, or pathogen overgrowth, where invasive bacteria need to be starved and eradicated.
At one point I intentionally observed a high protein Keto diet for one full year to overcome pathogen overgrowth and food sensitivities. I felt happy and content during that period (yet not energetic!), thankful that finally something was helping me to get well. I ate only fat, pastured pork, eggs and zucchini.
In the case of many GAPS patients, the gut lining is taxed by breaking down the sugars found in grains and starchy foods. Enterocyte cells that line the gut need a break from starchy foods in order to regenerate. That break might last from 6 months to 2 years. Unlike our family 8 years ago, most GAPS adherents now know not to be on the GAPS diet for 6 years. (We were sort of guinea pigs, starting it so early; and there just wasn’t as much information or networking back then.)
Unless directly combating issues like pathogen overgrowth, SIBO etc., GAPS dieters can be intentional to include generous servings of winter squash, carrots and beets, while being mindful of what their unique bodies need in their current stage of healing.
The GAPS Diet’s high fat, high protein profile can become confusing. High fat, low-carb diets like the diet first developed by Dr. Ron Rosedale, and the Keto diet, specifically put the body into a state of ketosis wherein it burns ketones from fat for energy. If you add a lot of protein to this diet, and only consume a moderate amount of fat, like GAPS dieters oftentimes do, there is less fuel for energy. Protein isn’t used by the body for energy like carbs or fat are.
We can be mindful that GAPS is a high fat, high protein, low-carb diet and therefore, used long term, may limit the body’s energy systems. Or, as mentioned above, if you’re on the GAPS diet and don’t intend to be in a state of ketosis, consider being very intentional to add in plenty of GAPS-legal carbs.
Risk #3 — Too much protein, not enough fat or carbs = low energy.
Solution — Increase fat intake if ketosis is desired. Increase carbs to match energy output if ketosis is not desired. In some cases, also reduce protein intake.
Too much protein on low-carb diets can lead to other problems too: namely kidney stones, gout and acidosis. These conditions develop when excess protein is eaten, manifesting in high calcium and uric acid levels in the urine. Acidified urine creates sharp, painful crystals (source).
Risk #4 — Kidney stones, gout and acidosis.
Solution — Decrease protein and increase fat intake. Drink lemon water, because citrate prevents the crystals from sticking togther. Increase mineral water intake.
If a long term low-carb or Keto diet is used, it’s also recommended to increase one’s antioxidant intake to offset these dangers. Antioxidant sources include one of my favorite supplements with multi-fold benefits (including liver detox and healing of leaky gut): NAC (find it here); also selenium (which occurs naturally in soil minerals), alpha lipoic acid, which is also great for hormone balancing, (find it here) and eating lots of colorful produce items (source).
Continuing on why to embrace low-carb diets, some patients might be working on getting their blood sugar levels under control, so carbs may cause an unsteady spike. The Keto diet removes this problem by replacing carbs with fat. If we’re in ketosis our bodies use fat as fuel.
Alternately, because I don’t practice a state of ketosis but my diet is relatively low in carbs, I utilize carbs and correspond their intake to how active I am that day. I must have protein and fat when I eat carbs; and I think that’s something we all need to remember: having the right balance of macronutrients.
Exercise uses glucose as fuel (when the body is not in a state of ketosis). If we have too much insulin in our blood and we’re not active, that insulin gets stored as fat and eventually, if the cycle of eating too many carbs in contrast to one’s activity level continues, diabetes will occur.
When I regained my health, I was also able to exercise again. For low-carb, non-Keto diets, how much energy is going out dictates about many carbs we need to consume. If we’re highly active we may need more carbs.
On Keto? High fat, low-carb diets can help patients get blood sugar levels under control. So can exercise. Extra active on the Keto diet or need more energy? Increase your fat intake to increase your energy levels. Add in MCT oil (find it here) or exogenous ketones (find them here) for more immediate exercise energy (both are discussed more below.)
Paleo & Keto Sweets
Trying to get blood sugar levels under control leads many dieters to low-carb sweeteners. Whether Keto, Low-Carb or Paleo, this is a common trend among those trying to get healthier: reach for “healthier” treats.
By nature and definition the Paleo diet is not low-carb; but the low-carb label may be a misconception some people have about the Paleo diet. With plantains, cassava, taro, parsnips, beets, sweet potatoes, winter squash and many other nutrient-dense complex carbs, the Paleo diet is rich in opportunities to balance one’s macronutrients.
The bigger challenge for Paleo dieters is remembering what our ancestors really ate: fat, meats and roots, broth, herbs, greens, some veggies, in-season fruit only and scant nuts. Many Paleo dieters load up on nuts, seeds and fruit, trying to satiate their love for snacking and sweets. Rather, the best route to health gets back to common food themes, themes we see in all of the Traditional wellness diets: high fat soups and stews, wild seafood, fermented foods and the ancestral foods listed above.
Keto dieters, too, fall into this trap. Old sweet tooths die hard. Many Keto dieters load up on sweets made with erythritol or other low-carb sweeteners, instead of eating nutrient-dense foods. The emphasis on the Keto diet should be nourishing, high-fat foods.
Risk #5 — Eating too many low-carb sweeteners and desserts.
Solution — Reduce sweets. Increase fats and savory foods.
The Keto diet can be used intermittently for most. There are several medical conditions where it’s advisable to use the Keto diet long term, two years or longer, and certainly a doctor’s guidance is necessary in any case where a long term low-carb diet is being used to achieve health goals. Otherwise, if the goals associated with ketosis are more in regard to weight loss or exercise performance, it may be wise to use the diet for short periods of time.
Ketogenic diets can be risky if the patients are left malnourished. One could argue effectively that every cell in the body requires glucosylation of proteins to communicate, a process that requires glucose. One approach is to use MCT oil to flood the liver (source). The liver then pours out ketones, but the patient can still consume some glucose (and protein) so the body is fully nourished. While this approach has merits, it is best used under the guidance of a doctor.
Risk #6 — Malnourishment. Watch for dry eyes or dry mouth that may indicate not enough mucus.
Solution — Consider larger doses of MCT oil. Ask your doctor about this method used by Dr. Paul Jaminet.
Another and easier approach is to drink exogenous ketones. Most people don’t yet know that drinkable ketones exist. (Find ketones here.) What a cool and easy way to give the body energy or get into ketosis quickly. (By the way, my husband especially loves this product. When he gets home from work tired, but needs to keep working on home projects [we’ve got a deadline coming up!], he drinks his ketones and LOVES the energy he gets from them. The first time I gave ketones to him, I mixed a scoop with raw milk. He came back a few hours later and asked me, “What was that you gave me?” I told him. “Well, they worked!” he said. Yeah, ketones are awesome for delivering energy, and they’re safe to use later in the day. My husband stays away from caffeine, so ketones have been a great supplement for him. This Salted Caramel one is a yummy flavor!)
The other main benefit to drinking exogenous ketones is they allow the body to skip the sometimes difficult transition into ketosis. Called “keto-induction” or now more commonly the “keto-flu” this stage is marked by flu-like symptoms that reflect the body’s reduction in blood glucose levels, increased minerals in the urine and possibly a decrease in overall food volume (source). Multiple medical studies show the safety of using ketones to skip the “keto-flu” (source and source).
I consider exogenous ketones to be one of the best supplements for maintaining a healthy diet with some carbs, while also burning fat for energy and clarity of thought.
Exogenous ketones are also excellent for medical patients who don’t want one more challenge with their healthcare. The transition into ketosis is easy through this delicious (although a bit too sweet!!) supplement (mixed into coffee, water, milk, smoothie or other beverage of choice). (Find several flavors of ketones here.)
Risk #7 — Malnourishment, low energy, dry eyes, dry mouth, keto flu.
Solution — Use exogenous ketones, and for some maintain higher than 5% carbs in the diet (up to 20%).
Although the Keto and low-carb diets seemingly discourage the intake of starches, some starches do more good than harm. In fact, the body needs them to thrive.
Don’t forget to ingest prebiotics or resistant starch while on low-carb diets. These indigestible starches are needed for colon health, immune regulation and microbiome balance (source). Here’s a great prebiotic supplement that helps ensure a well-balanced microbiome and healthy colon ecosystem.
Risk #8 — Imbalanced microbiome, poor colon health.
Solution — Increase intake of resistant starch through diet or supplement.
Other Dangers of Keto
One other danger of the ketogenic diet comes to mind. And that’s the deluge of unnatural foods that have become popular on Keto blogs and called for in “Keto” recipes. Mozzarella cheese: I’m talking to you. We’re talking about how animals are raised. If we drink the milk of animals housed in feed lots who are fed on grains and antibiotics, that milk, long term and short term, is inflammatory and disease causing (source). Conversely, grass-fed animals’ meat and fat are more nutritious (source). Many Keto recipes call for cheap cream cheese, cheap mozzarella cheese, cheap heavy cream, cheap eggs and lots of almond flour (there’s a drought in California where those almonds are grown, and almonds are high in the undesirable omega-6s). What matters isn’t just high fat. It’s the quality of fat.
If we’re going to eat a lot of bacon and beef and butter, it needs to be well-sourced (source). We need to budget for pasture-raised meat and eggs, pasture-raised, A2 dairy, and we need to try low-carb nuts beyond almonds, like pecans, hazelnuts, Brazil nuts and macadamia nuts (source).
Otherwise, if used over time, the Keto diet sabotages wellness goals by creating a new set of health problems. And the Keto diet, when tapping into feedlot ingredients, plus California-grown almonds, has to be one of the least sustainable diets on the planet.
Risk #9 — Disease from low quality food.
Solution — Budget for better quality meats, fats, dairy, eggs and produce.
In the midst of this conversation I want to reiterate the importance of fat intake and its role in nourishing the body, allowing the body to absorb additional nutrients and balancing blood sugar levels. Although the primary topic of this post doesn’t seem to be fat intake at first glance, I want to emphasize this necessary aspect of low-carb diets, because it really is at the foundation of doing diet well. Well-sourced animal fats, from pasture-raised animals, (and this can be from high-fat beef, it can mean butter, it can mean cooking with a lot of lard), are health giving and essential. When carbs are taken away, they must be replaced by fat. Fat is fuel with no drawbacks. Fat is what makes low-carb diets productive and safe. This gets back to Risk #3 above; make sure you’re getting enough fat on low-carb diets. Fat is your energy source.
Regarding non-animal fats, yes, extra virgin olive oil is healthy, in moderation. As mentioned earlier, MCT oil is great. Avocado oil is good. These liquid fats are convenient. Another favorite source for easy fast fat is cocoa butter wafers. (Find Fair Trade cocoa butter wafers here.) We love these in our home — like candy, but not sweet, very satisfying.
But above all others, for most people, well-sourced animal fat, including butter or ghee, is best utilized by our bodies (source). Animal fat should be the main focus, with MCT oil and the others coming in next for added benefits.
Carbohydrates are either fiber-based or they’re not. If they’re not fiber-based, they’ll turn to glucose and raise insulin levels, which can be disease causing. What strikes me as I study these topics is this: We are each unique. For one person glucose is fine and has some nutritional value. For someone else, it should be avoided for purposes of health and longevity. Carbs have become a controversial topic.
Most bodies can tolerate about a 20-30% calorie intake from carbs. If we don’t eat carbs, our bodies can manufacture glucose from protein. If we eat more than 30% carbs our bodies convert carbs into fat.
Some clinicians argue that humans function best with some glucose which is used by the body to create the mucosal lining that protects the GI tract, among other things, thus preventing disease (source). Not including those with medical conditions who thrive best on a Keto diet, this level of glucose is best enjoyed through complex carbs, not simple carbs. Carbs may be best enjoyed intermittently, which means having some Keto/low-carb meals.
This pattern more closely resembles the hunter-gatherer lifestyle in contrast to the modern American diet which assumes feasting all of the time is our entitlement. Just as a bear does not store up for winter year round, we may thrive best when we emulate seasons of scarcity and seasons of abundance, even mimicking this variation within a given day. Or in the case of many, ketosis can be maintained for a period of days, weeks or months, and then a Traditional or Paleo diet can be assumed for another segment of time.
Personally, I’ve made incredible strides with my Hashimoto’s (I was just taken down to half a grain of thyroid supplement from a full grain) by using the daily intermittent approach. Despite being fit and active, my body doesn’t need carbs at every meal. Others will benefit from week or month(s) long variations.
Ancestral Nutrition and Our Modern World
Ancestral nutrition says that our ethnic heritage plays a significant role in the foods that help us thrive. There are remote people groups who subsist largely off of starches and thrive, free of heart disease, obesity or premature death. There are also distinct people groups who live mostly off of fat. And we see people groups who decline in health when, in recent history, they change their diets to include more simple carbs (I am speaking here of Pacific Islanders and African Americans, both of whom now lead the world in diabetes after increasing their intake of sugar, carbs and vegetable fats, whereas historically their diets were free of refined sugars and rich in animal proteins, fats, roots and fruits and void of processed fats and sugar.)
Ultimately no people group is going to benefit from processed vegetable fats or refined sugar. But it can be helpful to look back a century or more to where our ethnic heritage leads. If we are not a mix of several races, we may do best eating foods from our ancestral origins: more fats or more meat or more carbs.
Humans have more amylase, a digestive enzyme, than other creatures. This means we’re designed to be able to digest starches and digest them well. However, in our modern world, because many of our bodies have been thrown off balance, this innate ability may be offset by the fact that blood sugar regulation is more challenged today than it was by our ancestors. If someone is predisposed to insulin resistance, starchy foods aren’t going to benefit their bodies; but fat is.
In this case, ancestral nutrition is overthrown by the imbalances created by a modern world.
Therefore, one final benefit to low-carb diets? Low-carb diets have helped us wean ourselves from heavily processed, sugar-laden diets. If practiced sustainably, they’ve brought us back to Traditional fats and in so doing, have helped us to anchor our blood sugar levels, given dieters a few paths for how to find our way back from cultural diseases like diabetes, mental illness and even heart disease.
Many holistic doctors agree that lower carb diets (20-50 grams per day, 30% or less of diet) contribute to longevity (source). Processed foods and higher carb diets lead to disease and weight gain. Carb intake must correspond to energy output and activity level; otherwise weight gain occurs (source). The Keto diet utilizes fat for fuel, circumventing the body’s usual use of glucose from carbs. The Keto diet recommends consuming only 5% carbohydrates. Ultimately, neither ketosis itself nor maintaining a low-carb diet are end goals. Both diets are dramatic tools toward wellness. If robbing your body of the nutrients provided by carbohydrates is your concern, but you still desire the benefits that ketones provide, consider MCT oil in large doses under the supervision of your doctor, or the use of ketones. Or, conversely, consider correlating your carbohydrate intake to your energy/activity level output if a state of ketosis is not desired.
- Include plenty of sea salt if you employ a low-carb diet. Liquid minerals and bone broth are also beneficial options.
- Consider using the Keto diet intermittently, for measured periods of time. If used long term, consult a practitioner to protect mucus levels in the body as well as thyroid and mental health.
- If needed, increase fat intake. Don’t overdo protein. Consider lemon water.
- Increase antioxidants.
- Incorporate resistant starch for immune regulation and microbiome balance. (It’s easy to exclude prebiotic foods when we eat low-starch; but resistant starch is beneficial to all diets and necessary for optimum health.)
- Budget for pasture-raised meats and fats, to protect one’s health, optimize nutrition and protect the planet’s resources.
- To get into a Keto state quickly and accomplish one’s goals directly, ketones can be used with or without the Keto diet. This approach allows patients to skip the keto flu and/or allows some carb intake to protect the body’s other processes. (Find ketones here. Ketones can be stirred into coffee, smoothies etc.)
Interested in burning fat for fuel? Need more energy? Try ketones HERE to get lasting, safe energy alongside your healthy diet!