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How Much Carbohydrate Do You Need to Eat Per Day?



We’ve all grown up equating sugar to energy, but new research suggests our bodies are engineered to run on fat…

I recently attended a fascinating series of meetings in Baltimore, MD accompanied by the top physiology and weight loss specialists in the country. Although I’d long known sugar was dangerous and advised limiting all carbs to 50-100gm per day, going into the meeting I’d assumed we needed some. Specifically, I thought our brain cells required glucose because that’s what I learned from biochemistry books, physiology books, and other medical texts.

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I love your Fatburn Fix!  Has helped me so so much!  I have had the dreaded weight all my life - 20 or so pounds I could never shed.  I have lost that now. I only eat 2 meals a day lunch and dinner with a glass of milk or cappuccino around 4 to hold me over. No snacking and not bad oils.  It has been the key to unlocking my fatburn.  I work out in the am and believe I am burning fat for energy not from food!

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Dr. Cate dismantles the lie that seed oils are healthy, which may the biggest lie about nutrition and health because it’s so insidious.  

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Pull up a chair…

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Dave Asprey
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The key to unlocking my fatburn

I love your Fatburn Fix!  Has helped me so so much!  I have had the dreaded weight all my life - 20 or so pounds I could never shed.  I have lost that now. I only eat 2 meals a day lunch and dinner with a glass of milk or cappuccino around 4 to hold me over. No snacking and not bad oils.  It has been the key to unlocking my fatburn.  

Lauren Smith

Saved my life

I would like to thank you for literally saving my life. Back in February, I had to be hospitalized while on vacation in Phoenix with an A1C of 11% and had to start taking 2 types of insulin and 2 other meds. I read the Fatburn Fix in April, and followed the program to a tee, and I’m down by 15 pounds, 6.8 A1C, and only one once weekly diabetes medicine. 

Leontyne Tompkins

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Penni Wicks

Your body requires ZERO grams of dietary carb. What little glucose your body requires (30gm) you can generate yourself from an ounce of protein

During the meeting, however, I became convinced by the abundance of newer lab and clinical data showing that brain cells, and the vast majority of other cells in the body, actually prefer a product of fat metabolism, called ketone bodies. The power plants of the cell that burn oxygen to produce energy in the form of ATP, called mitochondria, function poorly in the presence of another chemical, called malonyl-coA, which comes from the breakdown of glucose. Forcing mitochondria to deal with malonyl-coA overwhelmes their ability to control the high-energy electrons used in the making of ATP, and the result is a release of free radicals. Free radicals can cause DNA mutations as well as enzymatic destruction.

A minority of cell types actually do require glucose, specifically a few types of cells in the liver and cells without mitochondria (e.g., red blood cells). All other cells work perfectly well burning fat and special kinds of fat-breakdown molecules called ketone bodies. According to world-renowned metabolism expert Dr. Mary Vernon, we need 30 gm (2 Tbsp) of glucose per day to keep those cells that prefer glucose running properly. That small amount can readily be supplied by the conversion of protein to glucose in a metabolic process carried out through a cooperation between the liver and kidney, called gluconeogenesis.

What about Adrenal “Burn-Out”?

Somebody got the idea circulating that low-carb diets might cause adrenal “burn out,” and a few readers have asked about this. I’ve looked everywhere and I can’t find any data supporting the theory. I do find a physiologically plausible mechanism by which carb consumption may cause adrenal gland problems. Take a look at the diagram I’ve adapted here (below) from a lecture presented by Dr. Jeff Volek. It illustrates the mechanism by which high carb diets produce energy swings.

High blood sugar causes excessive insulin release which leads to low blood sugar and a ‘panic’ reaction from the adrenal gland

It’s important to consider that, if you have a metabolism that’s been running on glucose for decades, your metabolism is not in a healthy state and therefore will need some time to realign itself with the input of proper nutrition. You’ll need to give your body some time to adapt to the new fat-burning state. A whole new set of enzymes will need to be re-manufactured, which can take a few weeks to accomplish. For those with metabolisms in serious trouble, I typically advise going low-carb one meal at a time giving each mealime two weeks.

Bottom line: All the latest science contradicts the assertion that we need carbs—any carbs—in our diets. This isn’t to suggest that everyone needs to remove carbohydrates entirely from their diets. Indeed, there may be some as-yet undiscovered benefit to dietary sugar. Today’s article is not meant to suggest that we’d all be better off with zero carbs in our diet. It is, however, meant to point out that very few of our cells need dietary sugars for energy, and therefore the old idea that we need to include carbs in our diets or we’ll feel tired all the time, is running on empty.

ADDENDUM: Thanks to Paul Jaminet, Matt Stone, Cheeseslave and others, there has been a much-needed awareness-raising of the fact that we can overdo every good thing. Since originally posting, I’ve added the following caveat:

I believe that just as we enjoy a change of pace from time to time, so does our metabolism. There may be benefits from consuming enough carb to kick you out of ketosis (50-120 gm per day) on occasion. I suspect our ancestors enjoyed seasonal fruit binges from time to time, for example, and a rare (emphasise RARE) infusion of simple carbohydrate may flood your body with a variety of different sugar molecules in ways that aid fertility, and support tissues that require sugar molecules for structural purposes (like tear and mucuous production by the eyes and digestive system).  Just remember, whatever as-yet unexplained benefit carb-flooding may offer, it may also temporarily stall weight loss .

With over two decades of clinical experience and expertise in genetic and biochemical research, Dr. Cate can help you to reverse metabolic disease and reshape your body.

Please note: Please do not share personal medical information in a comment on our posts. It will be deleted due to HIPAA regulations.

This Post Has 97 Comments

  1. Dr. Cate I’ve used the no Carb Diet before but lost tons of hair for limiting my carbs that much is there anything I can do, But lost lots of weight on the low carb diet.

  2. Dr Cate – I have implemented a low carb diet, for long term health and energy reasons. I have always had an extremely high metabolism and have a hard time not being skin and bones. My BMI was 21 and dropped to 20 after going low carb. I didn’t think I could get any skinnier. My question is, I want to gain weight and muscle so what will that take on my low carb diet with my hummingbird metabolism?

    1. Dr. Cate, you should check out this website:

      @Craig: Don’t do it man! I used to have a BMI of 22; I was 5’10” and weighed ~145 lbs. I was very healthy. I then got totally deluded by the “science” of nutrition and went low carb, high protein/high fat. Guess what??? I lost 20-25 lbs. My family freaked out…I felt tired and weak. I looked emaciated and pale all the time. Worst several months of my life. I almost ended up in the hospital. Please don’t make the same mistake I did. Most of this low carb “science” is a joke. It’s just theory. It’s not been proven either in the lab, or empirically over many decades. Low carb diets will make you lose weight (Atkins). This is why some people who are overweight report shedding pounds and “feeling great” after doing low carb for a while, but for us skinny people with fast metabolisms, nothing could be worse. If you want to gain weight, here’s how to do it: High carb, some fat, not too much animal flesh. Eat a burrito bowl for breakfast every day: rice, beans, salsa, veggies, guacamole, some sour cream…that will make you gain weight. Add some chicken once in a while. Plus it’s much better than trying to ram a whole steak or a stick of butter down your throat.

      If you still don’t believe me, think about what every major ancient civilization has generally eaten for thousands of years. China: Rice is the bedrock of every meal. Same in India, SE Asia and Mexico. In Africa people eat some form of cereals. In Europe, bread has been considered the staff of life for hundreds of years. Roman legionnaires would sometimes refuse to fight if they didn’t have grain. Honestly, what are the chances that all of those people over thousands of years/hundreds of generations were completely deluded about what to eat, and now that we finally have nutrition “science” WE (read a few scientists and doctors in just one generation in the US only) have discovered that “low carb is better?” Come on…seriously…what are the chances? It’s impossible. If low carb were indeed a better choice and led to superior metabolism, growth, and health, we would have discovered this thousands of years ago and left grains in the past. But we haven’t. Every generation of human beings has eaten grains as their staple because they work extraordinarily well for us. Civilization would not have been possible otherwise. I could go on all day long, but I wrote a post about this to Dr. Cate:

      My long post is toward the bottom…Best of luck to you man…I know that was a bit long-winded but I just felt like I had to write something…Hope you feel better…

      1. Greg – I have never felt better. The carbohydrates I was eating were causing huge swings in my blood sugar levels with peaks and valleys, causing fatigue periods followed by quick onsets of shakiness/hunger. Keep in mind that I have never been a sweet tooth. I enjoyed occasional candy/cakes etc., but in very small doses and not every day. I drank no soda or caffeine. I had lots of excess gas(as my wife would attest to). My fatigue caused lots of fogginess and difficulty in concentration.

        I decided to try and go gluten free. I started studying various diets and had a friend who was strict paleo. I settled in with a Paleo + sweet potatoes + rice. I really wouldn’t even consider my diet Paleo as I have swung more towards Dr. Cate’s philosophy.

        The first two weeks sucked from a digestive point of view. Lots of diarrhea. I stuck it out when I learned what a diet heavy in grains does to your digestive enzymes/bacteria. Lots of yoghurt, fermented pickles and lightly rinsed and unpeeled veggies fixed up the digestive tract and soon all the good fats and meat protein where doing exactly what they do best – give me lots of energy without the wild blood sugar swings.

        I am not withering away at all. All my symptoms have disappeared. I have lost 5 lbs switching to my current diet, but that was my floor – I am not losing anymore. I have always been skinny, so my natural psyche wants me to gain weight when I lose 5 lbs. My body actually looks more muscular now and I lost the little belly pouch I had before. I don’t mind the extra 5 lbs off, but I was looking for a way to put some weight on within the diet I have chosen as I do not want to increase my grain intake. Unfortunately, if I want to do that without the negative effects coming back, it means I just have to eat more of my current foods. Its just hard to do with a busy lifestyle so I will probably just be at my current weight, which is fine by me.

        As far as “civilization”, I prefer to look at the survival of our species over 2 million years rather than 10,000. Just because grains became more convenient, doesn’t mean they are superior. Today’s grains are also a far cry from ancient grains and not in a good way(other than yield and profitability). I still love bread with a passion, I am just not going to eat it after my own experience and self-education.

        Thats all opinion of course, which I know you will disagree with and offer your view. That doesn’t really matter, since the way I feel being off grains and on lots of good fats/proteins will dictate how I move forward.

        1. If it works for you, that’s what counts. Personally, I think balance and diversity are key. Today’s grains are not bad for you compared to ancient grains (soil quality has suffered, but the quality of the grain is still good because humans are still around), and mainstream medicine (tens of thousands of peer reviewed articles) is of the consensus that a diet high in animal products, specifically meat and milk, is linked to heart disease. These can form between 10-20% of a diet that is otherwise composed of grain, legumes, veggies, nuts, seeds, and fruit. Olive oil and flax seed oil are also good, but it may be you had wild blood sugar swings because you ate too many carbs at each meal instead of having enough of the other stuff…

          1. The fact that “humans are still around” is very bad reasoning for passing judgement on the effects of grain on the human body. We can eat things that are very convenient but not necessarily good for our health, and still still survive as a species. We can live with disease.

            A recent meta-analysis in the American Journal of Clinical Nutrition pooled together data from 21 unique studies that included almost 350,000 people, about 11,000 of whom developed cardiovascular disease (CVD), tracked for an average of 14 years, and concluded that there is no relationship between the intake of saturated fat and the incidence of heart disease or stroke. In fact, the “risk ratio” for the development of CVD as intake of saturated fat increased was 1.0, meaning that people who ate more saturated fat were no more or less likely to develop CVD.

            The problem is smaller studies are more prone to error and more likely to show an association between saturated fat intake and CVD than larger studies less prone to error. The need to have bold results that are in line with “mainstream medicine” in order to not get swept under the rug. The study suggests that that many small studies went unpublished or otherwise lost down the memory hole if they found no association or a negative association between intake of saturated fat and risk of CVD.

            Low fat, high carb is what is shoved down our throats by the establishment that includes many powerful companies that would be very damaged by a shift in the American diet. The same companies that provide the funding for “mainstream medicine” research.

          2. Craig, eventually you’re going to realize as I did that grains work. They have worked for thousands of years, and if you really want to condemn them as being “not necessarily good for our health” and “survival” food, you’re going to have to explain why some of the longest-lived communities on the planet are grain eaters. I’m sure you’ve heard of the “blue zones.” Everyone in those zones eats grains. None of them have a high intake of saturated fat. Sure, we all know people who have lived to a ripe old age and have eaten plenty of saturated fat, but I think you should stop cherry-picking the studies and just accept mainstream medical research.

            While the USDA food pyramid is certainly influenced by industry, and they include a lot of items on the “acceptable” diet list that are clearly not ideal, the idea that “low-fat, high carb” is a giant conspiracy by the “establishment” (don’t know who you are referring to here) to mainly publish scientific research that benefits large companies is preposterous. I’m not even advocating that people should eat tons of carbs, I’m only pointing out what should be obvious to anyone who looks at the overall body of medical research: Getting the majority of daily calories from fat is not recommended. The research on low carb, high fat is still too young at this point. While saturated fat may not be the evil that everyone thought it was, it should still be consumed in small quantities as part of a balanced diet.

            When I first posted, I was just trying to be helpful. I’ve tried this high fat diet, and it doesn’t work for me. Not even close. The fear of grains is totally unjustified, and if you want to gain weight, eat more rice and beans, not more steak and fat!

  3. Cultures such as the Kitavans and the Okinawans maintain a high carb intake (90% of their calory intake), but they aren’t eating cereals. Almost all of their carb calories come from glucose and maltose in the form of sweet potatoes, yams, cassava, and other tubers. On high carb diets like those, they are free of disease of affluence and have high level of longevity. What do you think about this?

  4. Hello Dr. Cate, it was two years ago today I picked up Deep Nutrition when I visited you in your NH office. I am still thoroughly enjoying the diet eating real food and it’s benefits. Still at my nadir weight, from when I had initially lost 20 pounds of fat.

    I feel like I am 18 again, oh for your readers, I am 53, but feel certain I am in the best physical shape, and the strongest I’ve ever been.

    I have to say, it’s been an ego boost as well. On multiple occasions people have made positive remarks on my physique. I am not super muscle bound by any stretch of the imagination — maybe it’s just that I am not carrying the typical 30 plus pounds of fat of a 50+ year old. One of my wife’s girlfriends impulsively squeezed my arm while remarking “dude you’re buff.”

    As I said, I an not super muscle bound. I have just really latched onto the Mark Sisson philosophy of exercise. Which is to do it in support of your other life goals and have fun with it.

    For me it boils down to getting plenty of quality animal fats & protein (I have been under 50 gms carb for almost a year), lots of sunshine, variable exercise as described by Mark, plenty of romance with my wife, enjoying family time, fulfilling work and a couple of hobbys — not necessarily in that order.

    Thank you for creating the foundation of transformation via Deep Nutrition.

  5. There is something that just doesnt seem right about blaming carbs. Frutarians/vegans for example. Those people, if they got any skinnier they would die. No body fat, theiy tend to look old and bony. And those people try to ingest at least 2000 to 3000 calories in fruit and vegetables. A LOAD of carbs. No fat. Can you explain this to me. If its carbs that make you gain weight, why are they so skinny? Maybe its the combination of high fat and high carb toegether with processed and modified food intake. I would love to understand this further.

  6. Dr. Cate,
    I just finished Deep Nutrition and LOVE it. I am a RD who is basically in nutrition rehab 🙂 but progressing nicely I feel.

    I have been LC (50-100g) for about 4 months now and as you noted in comments above, have had constipation. I increased potato, rice and water this week and all is well. However I’m waiting to see if it will affect my wt loss. What do you suggest if incr carbs decrs wt losss but VLC results in constipation? (taking probiotics & eating fresh ferment)

    1. Try Flax, 2tbsp ground, stirred into hot water. More troubleshooting tips on low-carb issues will be coming out in future posts and of course, Page, if you share this post you will be helping other low-carbers find this site and they may add their own tips!

  7. Dr Cate-
    I have been working on going low-carb for a few months. Eliminating processed foods, soy, corn, grains. I read your 100gr/day limit in Deep Nutrition. Do I count carbs from all the veggies I eat? I eat carby veggies (b-nut squash, sweet pototoe) right after exercise. Do these carb grams also count against the 100gr? I do not use dairy (eczema)

    What do you recommend for intestinal upset (indigestion, bloating)? I tried NOW Super Enzymes, but seemed ineffective.


    1. Carbs from every source do count. The solution to intestinal upset depends on the cause! But one thing that may help is to eat something acidic before the meals that bother you–like a (fermented) pickle or q/2 tsp vinegar.

  8. @ANN: you wrote about the china study, well…in the china study as far as i remember the only kind of milk that was taken into account was pastourized milk, do try the raw milk version from a safe place, you will find out that most of the people that you know to have issues with pastourized/boiled milk will probably don’t on a raw milk trial.. 😛

    Catey thanks for the great info on carbs, another nice clear up =)

    Marco – Italy

  9. Experimented with ZC for a few weeks. Very bad results. Heart constantly pounding in chest, felt wired/nervous/anxious/physically stressed out all the time. trouble falling asleep at night/had to drink at least 2-3 liters of water just to not feel dehydrated. Went to see a Traditional Chinese Medicine physician, who told me that eating only meat/fat/dairy/eggs with veggies and fruit had totally imbalanced my internal organs. Went back to eating white rice/veggies/little meat Now feel much better

    1. The experience you describe is common, and of the reasons I wrote up this post:

      While I never advise forcing your body to follow a program that makes you feel bad, nor do I feel Zero Carb is necessary, it’s important to understand why you feel that way. One common observation from my clinic is that people who feel bad from cutting carbs quickly almost all have prediabetes and I use a fasting blood glucose above 90 as a cut off to diagnose this.

      1. My current hypothesis is that while human beings may have evolved to eat a low carb kind of diet aka plenty of fat/moderate protein/minor amounts of fruits and tubers and veggies; modern/civilized human beings probably should not be eating such a diet because our lifestyle and environment is much different from that of the paleolithic. Traditional Chinese Medicine dietetics are tried and true over a large land area with a diverse and varied climate. Plant based with supp protein/fat is the way

  10. im 12 years old and im trying to lose weight im doing more sports but im not sure how much carberhydrates i should have and i just lost
    HELP ME PLEASE !!!!!!!!!

  11. Hello Dr. Cate
    You may remember me as a patient of yours in NH. I am still enjoying the diet, and have reduced my carb intake in stages to my current under 30 per day. I’ll be 53 next week, & I have never felt better, or been in better physical shape. Yesterday I did my first IF, skipped breakfast, and I can’t believe the energy boost. If I had done this before I would’ve had the low blood sugar shakes, but I was better than fine. Does this indicate my FBG has dropped & that I am ketogenic?

      1. Dr. Cate, Unfortunately I didn’t take any before photo, or have anything that would be useful. I started the diet to get my BP under control, and the weight loss was a surprise. I started at 162 lbs with a tight 34 waist jean, today I am at 146 lbs with a loose 30 waist jean. I am 5’11” and consider myself to be small framed. I started the diet Oct 2010 at ~100 gms carbs and was 142 lbs by March 2011. I have seen significant improvements at the gym. Today I am at 30 gms. carbs with IF 3x week

  12. Hi Dr. Cate!!!!

    As you know, I have been very committed to lower-carb paleo-style living in general, but I have been wary of maintaining a low a level of carb intake (or doing any intermittant fasting) during pregnancy and during breastfeeding. The Paleo-sphere has variable advice about carbohydrate intake and breast-feeding: “We reproduced during the Ice Age so low-carb is fine” or “People waited for the right season to reproduce so be moderate (100g).” Love to hear your take on it!

  13. You need a certain amount of glucose for mucous production and immune function, whether directly from starches or converted from protein. If you have a dry mouth or eyes, you have a problem. Cutting carbs can be risky if you don’t know what you’re doing.

    1. Thank you for pointing out that changing diet is something that can have health consequences that a specially trained heatlh provider should help you sort out. It is also important to point out that while dry mouth and eyes CAN be due to problems w/ glucose metabolism they can of course be due to other issues ie inflammation or prior infection/trauma.

  14. I eat marginally carbs. I only eat them from vegetables. I have never had more energy or felt better before in my life. I have not eaten any other source of carbohydrate for the past 10 years. It’s a phenomenal way of life and I recommend it to anyone.

  15. Briefly, I’m 58, T1D, ok A1c (in the 6s), doing low-ish carb for years, recently went VLC Paleo no fruit or grains, everything fresh, insulin under 30u per day. Always had very high cholesterol (~450) and I thought VLC might see a slight improvement. I was completely shocked to find that my cholesterol went up, not down. Thyroid fine. Under what circumstances would cholesterol go up when Paleo and low-carb says it goes down?

    1. TChol is a meaningless number, like knowing weight without height. Your HDL, LDL, and Trig are all important numbers. For instance, if your HDL went up from eating more good fats then your TChol would simply reflect that.

  16. Hi Dr. Cate,

    I just posted a similar comment on Cheeseslave’s blog, and was disappointed in the less-than-nuanced discussion concerning carbs. I would be so grateful to hear your thoughts on the following, not only because I am desperately seeking ways to address my own hormonal health right now…

    I was a lacto-ovo vegetarian (super strict, whole-foods “starchitarian,” with two years of veganism as a teenager) for my entire life, until my oldest son turned six and I turned thirty, and our entire family’s health had pretty much gone down the tubes–it took that long for me to question my “religion.” My hormones in particular were toast, and had been getting worse since adolescence: My basal body temps were two degrees too low, I had horrible cramps and PMS and irregular cycles and “mood swings” (to put it mildly), and my son was sliding into autism and anorexia in a scary way.

    We finally did a 180.

    We have been doing a very low-sugar (probably low-carb, no nuts but with LOTS of veggies), high-animal-fat GAPS diet for two years, and my son has improved steadily, while at first I made great progress: Monthly bleeding shortened from five days to 2-3, was much lighter and less “clumpy,” my cycle shortened from 35-45 to 28-30 days, and my basal body temps became both more even and 1 degree higher overall (even though they were still about 1 degree lower than normal). My anxiety and depression were WAY better. My hypoglycemia, for the first time in my life, disappeared.

    Then…I got pregnant in October 2011, and I am still searching for reasons why I crashed about three weeks later–my mood issues have returned with a vengeance, and they can’t NOT be hormonally-linked, although PTSD also must be part of it (my son’s issues are still pretty intense). I have been severely debilitated by exhaustion, depression, anxiety, and ever increasing panic attacks.

    I have examined Jaminet’s ideas and others, and am not convinced that my hormones crashed due to my diet’s relative absence of carbs. Could it be that, because of a lifetime of high-starch, low-animal-fat eating, my liver just doesn’t work as well as it should?? Could this be why so many women’s hormonal issues are uncovered when they go “low carb”, simply because suddenly the body has lost its compensatory mechanisms for fueling and building itself, not to mention producing hormones? I have no idea, really, but I am fascinated by the discussions concerning glucoengenosis, and I have this feeling that it’s not nearly as simple as I wish it were. Eating more carbs, and even some grains, during this pregnancy has NOT fixed my hormonal “problems” by any means, just like it wasn’t the key to good health during the first 30 years of my life (there are so many variables!). I’m not convinced it’s the missing link to why many people have hormone problems that “start” when they begin eating paleo–were those hormones REALLY just fine before the carbs were taken out? Maybe high-carb is a therapeutic way (of many) to compensate for/deal with a metabolism that has spent a lifetime (and maybe many generations??) eating a high-starch diet…

    These are just some of the thoughts I have, as I ponder how best to heal a family suffering from fairly far-gone degeneration. I’m fascinated by what Jack Kruse writes about hormones, and am doing a modified (no carb restriction) “leptin reset” even while I am getting a lot of blood work done to determine whether I need to take cortisol and/or thyroid in order to continue this pregnancy safely (and with fewer food revulsions and panic attacks!).

    What do you think of these ideas?

    It’s interesting to me because it seems like healthy/already-healed bodies can tolerate (and sometimes thrive) on such a huge variety of diets, and certain healthy people end up advocating these diets for everyone, or at least for most people, or else confusing healthy diets with healing diets. It’s those of us who have been “broken” to some degree that have to do all this searching and trial and error (as one super healthy friend of mine put it, “I actually can’t tell if a certain food is bad for me or not by simple observation, because my body does well in the short term regardless!” We humans are also prone to confusing causation and correlation, not to mention blurring our observations even further with our wishful thinking).

    And it seems like a diet that would most help a person with a certain type of broken-ness might not even be perfect for them later on, as time goes by and they begin healing and their body has different needs.

    I think about this constantly, especially because my family has so many different types of health issues, and we’re all at different “stages” of healing. I’m 20 weeks pregnant and grew up on the aforementioned vegetarian regimen; I never appeared to have any digestive troubles, despite my hormones getting totally wacked! My eight-year-old is extremely fragile still, and cannot handle many carbs at all, for better or for worse, and seems to need tons of fat in addition to lots and lots of meat and protein. My husband has had autoimmune issues since he was three months old, and definitely can’t digest most carbs well at all… My second child is definitely not as robust as he might be, had I known during his pregnancy how deficient I was in animal fats and cholesterol. Sometimes I think that we may NEVER achieve the level of health of which I dream.

    But I’m very interested in continuing to try. Can you recommend any resources for researching hormones in particular? I mentioned Dr. Kruse before because I’m fascinated by his short-term protocols to normalize hormone levels, and because I’m also fascinated by the idea of allowing bodies to improve their digestion and maximize potential. I would love to be convinced that carbs are my key to hormonal health…but I’m not so sure they are. I don’t know. I ate so many properly-prepared, home-fermented whole grains for so many years…and still my son and I have suffered so much, and we didn’t begin to climb out of the abyss until we stopped eating these foods.

    But now my body seems to need more than “just” a super-nutrient-dense, ancestral-style diet. I am struggling so much, and would love some ideas, and I am beginning to think that I will need to take cortisol/thyroid in order to get my bloodwork and moods to a safer level to continue this pregnancy.

    I’m grateful for any thoughts,

    1. Sarabeth
      You are working towards regaining hormone sensitivity and wondering if you ought to take hormones to speed up the process. It so happens that Jimmy Moore is working towards the same goal for the purpose of fertility in his family and I will be discussing this precise topic, regaining hormone sensitivity versus supplementation, with Jimmy More Thurs Feb 23 on his Ask the Low-Carb Expert podcast series here:
      I believe that conversation will help you quite a bit!

  17. Thank you. We eat free range beef, chicken, eggs, raw milk and fish….definitely not vegan. 🙂 I just wanted to make sure this lower carb lifestyle was safe for the long term. Thank you again for the clarification. Even though Cheeseslave recommends natural sweeteners for all her baked goods, I understood from your books that we don’t need sweets at all (except for the occasional fruit and dark chocolate, of course). One more question: what would a portion size be for the 20 % carbs that you suggest? I tell everyone I know about your books. Thanks again!

  18. Ann
    What’s good for you is good for kids, too! Nature wouldn’t have it any other way.

    If you are a vegan, vegetarian, or simply choose to get more than about 20% of your daily total calories from carbs (something I advise against), you do want to think about going through all the processes available to you (see to maximize their benefits. However if your family is low carb and getting plenty of nuts and seeds in your diet, you will be accessing more nutrients than those who are eating high quantities of soaked and sprouted grains.

  19. After all the recent posts at about how we need properly prepared grains to avoid mineral deficiencies, energy loss, thyroid/adrenal stress, etc., I am confused. Properly soaking/sprouting/dehydrating/milling and then baking is a lot of work and I’d prefer to avoid it. However, I want to do what’s best for my three growing girls and myself (they’re ages 12, 9, 7). We eat carrots and squash and some fruit for carbs. We may have some sprouted Ezekiel bread once or twice a month and some soaked oats once or twice a month. I feel your program is healthiest for me (PCOS and some IBS) but want to make sure it’s “safe” for the entire family. Thank you again for helping all of us out here who want to feel well and be well!

  20. Hi Dr Cate
    I am wondering if dietary requirements for carbohydrates would be different for children? Or pregnant or nursing mothers?
    Thanks so much for your work. I love your books.

    1. Aminya
      Children would presumably need fewer carbs, but I can’t say that there is any research to support this. Here’s what I wrote to a woman named Tina about carb intake while breastfeeding. Again we have no research, but it’s an educated guess and I explain my rationale:
      Perhaps, as the recognition that low carb, traditional diets are good for everyone, we will get more specific insights to guide us.

  21. An interesting post, and it calls to mind a post from MDA:

    Some related anecdotal info. My father-in-law has always had a sweet tooth, but until recently has enjoyed very good health, a big strapping man (and not even first-born!). After a couple of bouts with cancer, with better than expected results, he was diagnosed with brain cancer this fall following nausea and dizziness that everything believed to be a viral infection. One tumor, orange-sized, was surgically removed, leaving two that could not be operated on. The doctors offered a grim 3-6 month survival window, but decided to try a combination of radiation and chemo.

    I did some research on the Internet and found that brain tumors feed exclusively on glucose, and that there has been some preliminary research indicating a ketogenic diet can help shrink such tumors. (Ketogenic diets are also successfully used with children suffering from extreme forms of epilepsy, e.g. hundreds of seizures per hour, unresponsive to medication.) Normally I don’t do “diet evangelization,” you run headlong into conventional wisdom resistance or people’s own dietary desires (“but I like my sweets too much!”), and it’s usually a losing battle. But I talked to my father-in-law and told him about what I’d found, bought him a low-carb cookbook, and offered lots of advice on what to eat.

    Barely a month and a half after that 3-6 month prognosis, and albeit with radiation and chemo, and yes an n=1, but one tumor was reduced by 40% and the other by 50%. He’s still going through the chemo, but the doctors were amazed by the test results, and I don’t think they’re limiting him to a month and a half to 4 months to live now. Don’t know how much diet affected the outcome, but it didn’t hurt, that’s for sure.

  22. It would be great if you might consider dedicating a post to the issue of “portion control” on a high(er) fat, low(er) carb diet. I switched to a “Paleo/Perfect Health” diet (I do not like to label my diet) 14 months ago coming from a healthy version of the standard Western diet. I had never had weight problems before and steadily gained 6 pounds on higher fat, lower carb. I re-considered my diet and found that I just overdid the fat (initially, I still bought the “insulin-leading-to fat-storage-hypothesis” which I, along with most low-carbers, do not buy anymore) and ate just too many calories. I lost the weight but I still struggle with portion design. It is easy to eye-measure bread and pasta and lean meat but it is difficult with the added fat, as small additions make a big difference. Also, with fattier cuts of meats it is nearly impossible to guess how much fat is in there especially after cooking…I do not know if I am the only one who struggles with this; maybe it is because the low-carb-blog-sphere is a “mens`world” and men usually need more calories, whatever it might be but maybe you like to adress the topic portion/weight control (especially for women)?

  23. Iris
    In the past 6 months since the comment from Ward I have had the opportunity to meet the Jaminets in person and agree wholeheartedly with your assessment; they are very helpful and tuned-in to the latest in the blog-o-sphere. Also Sou-Ching makes a very tasty Kimchee. If you are truly interested in understanding where we differ, then please consider coming to the AHS symposium’s Safe Starches panel, where Paul Jaminet, Dr Rosedale, Dr Kruse and I will have the opportunity to see if we can’t come to an agreement.

  24. My comment wasn´t meant to be rude – still looking forwars to your books! However, the Jaminets`are some of the most helpful and well-informed people in the blog-sphere so I really felt like defending their position – you should fefinitely check their website!

  25. What about children? Do growing children need carbs, and if so, how much? My 15 year old is a new onset T1D, and his endocrinologist wants him on 360g+ carbs per day, and an A1C of 7 to 7.5 because he is growing. FYI, we have had no real problems with lows, but struggle to keep his BG in the 70-180 range; he goes over 300 BG at least every other day, with wild swings up and down. When I suggested lowering his carbs, his doctor strongly opposed it. I’m confused and just want to do what’s right for him and his younger siblings, but can’t find much literature that speaks to juveniles.

  26. Neil
    Thank you for the nod towards Dr Wahls!

    And those Irish genes are mine. Luke’s Scottish (Yellman) he liked the Irish name though and decided to go with that.

    It would be fantastic if we could simply test for allergies to things like milk and not only that but to know which component of the milk we’re reacting to so that you could avoid it. For example, caseins from goat and cow are slightly different, so some can do one but not the other.

    Until then, we’re left with elimination diets, trial and error, and supportive facebook threads!

  27. Hi Cate – yes I do think that molecular mimicry in celiac is probably pertinent (and also probably where the MS researchers got their inspiration!) . I absolutely agree with you that the reason Saturated fat makes a difference in MS is not clear. However the Swank longitudinal research is pretty persuasive. This is well covered in Dr George Jelinek’s books (website:taking control of MS) and would probably persuade me to be careful with regard to sat fats. There is some evidence that the cell membrane fat profile is different in people with MS (genetic?), that it is more brittle and thus more prone to attack from the auto immune response…. Interestingly Statins are now being used as a treatment! I think gluten is pretty much a no brainer for general health and so Im left with milk! The issue here is the casein I believe. Interestingly the Paleo dieters also avoid milk on the basis the we were unlikely to be milking wild animals! They have shown auto immune responses to casein in the laboratory… Oh and by the way Dr Terry Wahls who has managed to get out of a wheelchair using dietary methods is a big fan of your work and keeps recommending your book on her facebook page! (She is dairy, grain but not Sat fat free). I believe diet is a huge area of interest for a chronic disease that affects so many and am thus grateful for your wonderful work! By the way speaking of genetics; with a name like Shanahan your hubby must have some Irish genes! Neil

  28. Neil
    Very interesting. The molecular mimicry concept makes sense, in fact I have a video I’ve been working on for about 3 years (a cartoon) that animates molecular mimicry as it affects the nervous system.

    As for the idea of brittle membranes, at first blush the issue of saturated fat in the diet ending up in high concentration in cell membranes seems unlikely simply because the concentration of individual fatty acids in membranes is not likely to be tied to the whims of dietary choices, but rather genetically regulated. Of course, there could be genetic-based illnesses, but those would show up early in life I would think. Furthermore, our enzymes can desaturate saturated fat into monounsaturated fats.

    I am putting your suggestions on my do do list because I will look at it as I do further research to support that video I’ve got on my back burner, and put it up as a post about molecular mimicry and inflammation within the immune system. I have just completed another video (cartoon) about molecular mimicry and celiac, which I think you may find pertinent in some ways to your situation.

  29. Hi Cate – to be honest they are pretty clued in to the difference between animal and man made fats etc. Ashton Embry has probably collated the best collection of scientific papers related to the theory that saturated fats and casein (dairy proteins) are problematic in MS. The genesis for the theory with regard to sat fats is generally based on the idea that the cell wall is brittle if you have too much sat fat and not enough omega 3 for pliability. In any case Dr Roy Swank ( a neurologist) conducted a 50 year longitudinal study of MS patients and found that those that had a very very low sat fat diet did best. With regard to the casein protein the suggestion here is that molecular mimicry is the issue ( also applied to gluten by the way). There are articles on gluten causing leaky gut which contributes to the undigested proteins getting into the blood stream and over time setting up the auto immune response. Ashton has a number of these published articles under the science section of his website. I would really appreciate it if you had a look! Intuitively I love the notion of going back to traditional diets – even at 47 I remember my mother and grandmother making Irish stews etc with the bone still in the meat and so on. We are lucky in Ireland in that all our beef is grass fed so Im off to the butcher to get some knuckles! Neil

  30. Hi Dr Cate
    Firstly just wanted to say I loved your book and have been really impressed and excited by your research. This is especially important in my case as I have a chronic inflammatory disease – multiple sclerosis. I believe that your research has given me new insights into how I can vastly improve my health and long term prognosis. HOWEVER there are a couple of problems for me to resolve. Quite a bit of dietary research in MS from some very respected resources (Dr Roy Swank, Dr Terry Wahls, Dr George Jelinek for example) suggest that both gluten AND dairy may be problematic in MS along with a high saturated fat diet. Therefore I am having difficulty reconciling the dairy and saturated fat aspects of your approach with the current MS diets that I currently respect. Can you shed any further light on this as it would be most appreciated! Thanks Neil

    1. Neil:
      I am passably familiar with their work and suspect they are making the same mistake most low-fat proponents make: citing research not on the effects of naturally occurring fats, but on saturated fat manufactured artificially by the hydrogenation of veg. oils. I have yet to hear anyone explain a specific mechanism that is also physiologically plausible for how gluten and dairy both happen to cause the same neurologic symptoms, yet I am open to hearing one if you have a good source for me. I am going to post a piece about food allergies any day now and would like to hear what you think.
      Best of Luck in your Recovery.

  31. Murray
    Thanks to requests like yours I am currently working on a detailed post about food allergies along the lines of celiac, which should be done by this weekend or shortly after.

    Lactose intolerance is not, strictly speaking, an allergy. It’s a result of an enzyme that functions in babies and if we stop drinking milk as we get older, the gene regulating the enzyme shuts down production. Like other genes, this one can potentially be turned back on again. I suppose I should also do a piece with more detail. Please do subscribe to email updates to stay tuned!

  32. Hi, Cate –
    I loved your books and am implementing your program as much as possible while living in rural Kentucky where some of your suggested food items are not available. Fortunately, I have located a local source for raw milk and fresh farm eggs. There is some local produce available in season, but most of the farmers around here grow Tobacco, corn and soy beans!
    I have ordered a copy of “Deep Nutrition” for my daughter who lives and works on a ranch on Maui.
    Now, my question: Have you responded anywhere on the issue of food alergies and lactose intolelance? This was asked above by Mary Levy on June 26, and was also the focus of a review on Amazon. I am new to this blog, so if you have already addressed this issue please direct me to your reply.
    Thanks for providing us with such valuable information, I am immensly impressed by the depth of your research!
    Murray Crow

  33. I have IBS and experience a lot of bloating which makes me look pregnant. I also have been having week muscles, and having a sickness feeling. My weight fluctuates and I have a very poor diet. Can you recommend where I can get a diet plan that would help me? I have 2 children so I don’t have much time to be organising and planing meals, something easy? I would like to cut out carbs from my diet as potatoes and bread seem to bloat me more, and my sugar intake is very high, I like x3 sugar in tea/coffee and eat a lot of junk food.

  34. I wonder if it’s just that some people do better with some amount of carbohydrate in their diet. I grew up in Hawaii and can’t imagine all my Japanese and Chinese friends going without rice or noodles. They (when living on their traditional diet) do not get fat at all, even from the massive amounts of carbs they consume, mainly from rice/noodles. I have tried and tried to follow a low carb diet but once I hit around 60 grams, I start shaking. I can’t turn the page the page of a book because I am shaking too much! I feel OK, just hungry; I can’t seem to get full and worse, I can’t sleep without waking up in the middle of the night with muscle twitches and acid reflux from hunger. Maybe some of us need even just a little bit of grains. Just wondering. Thanks!

  35. If you’re going to eat grains, they’re better for you sprouted. Why? Fewer empty calories (carbs) and more nutrients, thanks to the germination process in which plant enzymes convert stored starch to all sorts of stuff, the stuff a plant needs to grow: amino acids, fiber, vitamins, and more. Depending on how long the sprouting process continued (2 days, 5 days) you’ll get more conversion. Generally somewhere around 10-30% of the carbs are converted to better stuff.

  36. In reading your Deep Nutrition I see you advocate sprouted grains. I also read on this blog that your mind has changed on the carb need for our bodies. Are you still in favor of grains? Thank you Karen

  37. I think maybe my comment on August 5 has slipped through the cracks, since it still says “awaiting moderation”.

    By the way, I just made my first beef bone broth after watching your video with Sean. It came out great! I did notice that the written directions say to add the veggies to the pot later on, but the video shows the veggies going in the pot right at the beginning. Which is the best method, nutrient-wise?



    1. Rebecca
      Your comment actually is going to get answered in a blog post as soon as possible, since I can see this being a popular issue. Thanks for your patience.
      Both methods of making broth offer different benefits. Veggies going in earlier will, thanks to their lower pH, assist in dissolving minerals out of the bone. Going in later will preserve the vitamins and antioxidants.

  38. Hi Maria
    I’m glad you are considering making diet changes. If you’ve been stuck with the medical system unfortunately the nutrition advice is really almost exactly the opposite of what works, which is why I wrote my books and developed T.R.I.M. The information in Chapters 8 and 9 of Deep Nutrition will help explain why there may be food-related inflammation disrupting your liver, and what foods cause it. (Of course you must con’t to work with your PCP until he’s exhausted other potentially more serious causes.) And the rules in Food Rules will get you started in the right direction diet wize. After you’ve read chapters 8,9 and food rules you can read the rest of Deep Nutrition to get a more in-depth understanding of the role of food in your body’s functioning.
    You are just starting in the right direction, congratulate yourself and DO NOT give up until you’ve reached your goals.

  39. Dear Dr.

    I found your books on today and ordered both of them. I just turned 45 and have struggled with my weight for most of my life. I am barely five feet tall and weight 170 pounds. My biggest health problems are: moderate persistent asthma (diagnosed right before I turned 30), endometriosis stage four (diagnosed at age 41, married for almost a year, and struggling to concieve! I’ve had two endometriosis surgeries so far.), acne, slightly high blood pressure, and my primary physician is concerned because blood tests show my liver enzymes are high (but nobody can tell me why they are high or what I can do to improve this condition. I had a liver, gall bladder, ect. scan and my liver was shown to be perfectly normal. But still I have high liver enzymes!). Also my Mom has Diabetes 2.

    I am very concerned because I have the worst time being able to breath. Also growing up, I never learned how to eat right. I am very confused over all the mixed messages out there. Also we have a family history of colon cancer (I had my first colonectomy at age 44 and they found three polyps including a large one! How can I prevent these things? And from growing into cancer?). Growing up I always ate sugar cereal or pop tarts for breakfast. I also eat a lot of fast food. I’m also addicted to sugar especially pepsi. I’ve drank it all my life.

    I am very interested in your T.R.I.M. program and was thrilled to learn you are in NH. I live in New Bedford, MA. Do you think an anti-inflammatory diet could help me? Could it really improve the asthma? the endometriosis? the infertility? acne? sebborheic dermatitis? At times when I’m walking home from work and struggling to breath, it makes me feel so frustrated and want to cry. If you could give me some basic info and some encouragement (maybe point me in the right direction), It would be very helpful. I’d really appreciate it so much! Thank you for your time and consideration! I just feel so helpless and lost with this awful asthma and my general health condition. I’m only forty five years old and feel like I’m 90 sometimes! I realize now that I’m mostly to blame for my poor health due to my bad food choices all my life.

    Hope to hear from you!

    I can’t wait to receive your books from and learn more!

    Does your books talk more about this anti-flammatory diet? I want to learn more! Can it really help me with all my conditions?


    Maria N.

  40. Thanks, Caty! What I meant by “thyroid function going down” is that I had a full thyroid panel done, including TSH, Free T3, Free4 and Reverse T3, and my results show that my thyroid function is worse than it was before, with Reverse T3 going up considerably.

    Are you saying that it is your opinion that long-term low carbing does not cause thyroid problems?

    I eat all whole foods, no added sugar of any kind, no processed foods, no grains and no legumes. I basically eat meat, fish, fowl, eggs, healthy fats and low-carb veggies. No starches of any kind (potatoes, etc.) and no fruit.

    You mentioned mayonnaise. I do use a moderate amount of may0, but I make my own out of coconut oil, MCT oil, olive oil, eggs, mustard, sea salt and lemon juice. Would this also be a problem, based on my ingredients, or is the only problem with the Atkins thing is that it is commercial mayo made of bad oil and other ingredients?

    By the way, I just made my first beef bone broth after watching your video with Sean. It came out great! I did notice that the written directions say to add the veggies to the pot later on, but the video shows the veggies going in the pot right at the beginning. Which is the best method, nutrient-wise?

    You talk about inflammation. I gain weight by looking at food, and whatever combo of macros and calories I have tried never works more than a few weeks, and then I gain back any weight that that I have lost very quickly. Would reading the book (which I have not yet, but plan to) help me figure out what the heck is wrong with me, or do I have to get on a plane and meet with you personally? Is there a way to get help on a limited budget (no funds available for air fare)?



  41. I have a question about eating low carb and its affect on thyroid function. In the past few days, I have been reading a lot of things on the internet about decreasing thyroid function when eating very low carb for an extended length of time.

    Since starting low carb over two years ago, and being 95% paleo for over a year now, my thyroid function has gone down, and now I have high Reverse T3. I have had to start taking bio-identical thyroid replacement for this.

    One of the things I read is that Dr. Atkins found that thyroid function decreased if carbs were kept too low for too long, and that is why he developed the \Carb Ladder\ to try to encourage people from staying too low carb.

    Over the past two years, I have eaten between 40 and 20 grams of total carbs (not net), and I still have 36% body fat and now low thyroid, too.

    Just so you know, I don’t have an axe to grind – I would rather stay pretty low carb, but now I am wondering if it may have damaged my thyroid function, and I wonder if I should be increasing my carbs, which is not that easy to do when you refuse to eat grains and legumes!


    1. Hi Rebecca
      I’m not sure what you mean by “thyroid function has gone down?” If you rT3 went up and no other changes, that may represent an increase in thyroid function. If TSH (the hormone that prods the thyroid to produce more thyroxine) dropped that means you thyroid activity has actually increased. Dr. Atkins may have made his observations on thyroid hormones because may of his recipes include things like mayonaise that are loaded with what I call Megatrans fats (discussed in chapter 8), which can damage all glands and organs of the body.

      It may be useful to you to to understand that my rationale for lowering carbs is based on the fact that sugar is sticky and potentially damages all your glands and organs, with the result being all kinds of mixed up hormone functions. If you have not already done so, I recommend you re-read chapter 9 in Deep Nutrition to get a fuller picture.

  42. Marcus

    Marcus: THANK YOU FOR THIS VERY IMPORTANT QUESTION! Whenever you make major diet changes, you may experience side effects.

    Most of the changes in your body are welcome: More energy, effortless weight loss, fewer headaches, better digestion, better sleep, increased libido, better glucose and cholesterol numbers, mental clarity, resistance to colds, resolution of allergies, and the list goes on!

    Since we’re cutting out the cereal, whole grains, beans, and other fiber sources, make sure to replace the bulking agents with a steady stream of fiber rich fresh veggies or you’ll probably notice some constipation.

    I’ve noticed most people don’t drink enough water, and this diet can put undue strain on the kidneys if you’re dehydrated. Drinking at least 12-16 ounces with every meal keeps your kidneys happy, and, in fact most people with high blood pressure and renal damage see big improvements in kidney function.

    That water with meals is also important to aid solublization of all that nutrient in the GI system.

    And women … be ready for some hormonal changes including slightly more painful periods and even some heavier bleed because you will be more sensitive to the hormones your body is making. This should be temporary.

    The transition can be rough for people with diabetes treated with medications, because blood sugars will drop — sometimes dangerously low — unless they’re working closely with a doctor to reduce dosages. This is why, during TRIM, we monitor this closely.

    We’re working on a book, The TRIM Solution, that provides an entire program for adapting a healthier diet including what to expect in terms of benefits and what to do to prevent unwanted side effects.

  43. Hi Dr. Cate I’m currently reading Deep Nutrition & I truly appreciate the work you & Luke have done to put this type of info on traditional nutrition out there. What type of effect will switching from sugar burning to fat burning have on ones body & mind during the transition of from eating a diet full of carbs & sugar to one with plenty of good fats & protein. Thanx in advance

  44. Dr. Cate, I think I have a girl crush on you. 😉 Seriously, it’s so refreshing to have data to back up nutrition information. I have greatly reduced my carb intake, and am attempting to drag the family along (kicking and screaming). It’s not easy, but I believe it does heal.

  45. Hi Dr. Cate,

    My husband was recently put on low dose medication for HBP. Even though it’s becoming more common to see that, we am not happy with him being on it at only 46. We are attempting to help lower it through reflexology and low carb eating. I know that high carbs make the arteries “gunky” and stiff. Will a low carb lifestyle change actually reverse the damage or just hold it at where it is?

    1. Good question, Carol, because not all low-carb programs are the same. A diet that can reverse hypertension, not just hold it steady, will need to consider multiple dietary factors that generate inflammation, as well as sleep and exercise. Check out the Ten Steps to a Healthier Body link ( for an outline and some more information on what to expect from following a truly healthy, anti-inflammatory diet.

  46. Hi Howard
    Thanks for sharing your success on zero carb. I notice a lot of folks lately seem to be down on aerobic exercise, as you are. I am not sure where that’s coming from but if, as you indicate, there is the assertion out there that aerobic exercise requires glucose or affects the cortisol levels in a bad way that is not correct–at least not when we’re talking about moderate amounts of aerobic exercise. I will blog in more detail on exercise and food and how your body responds to both in a future post. Stay tuned.

  47. Textbooks reflect the long held, but incorrect assumption that since carbohydrates are burned before fat, they must be the preferable fuel. But plenty of zero-carbers, including myself, can attest to the fact that their brains and bodies function far better on fat. Carbohydrates are the jet fuel used for that quick burst of fight-or-flight, and that comes from stored glycogen in the liver. And, as with any necessary glucose as you stated, that is replenished via gluconeogenesis.

    What is important to realize, however, is that that same glucose, if continuously replenished and reused as in aerobic exercise can result in the same problems caused by ingested glucose, not to mention the exacerbation from the associated high cortisol levels.

  48. Hi Cate,
    Does low carbing raise TSH? Low carbing has improved every aspect of my health. However I noticed one thing. Lowering my carbs appears to have raised my TSH values. Is this worth worrying about?

    May 2010
    A1c: 5.7
    TSH: 3.0
    Eating about 120g carb/day

    Apr 2011
    TSH: 5.0 (Free T3: 3.3, Free T4: 1.52)
    Eating about 20g carb/day

    July 2011
    A1c: 5.3
    TSH: 4.77
    Eating about 50g carb/day


    1. HI Pasca

      Interesting data, very organized, you are!
      Typically, I see people’s TSH drop a little bit when they follow my TRIMProgram (see for details).
      Are you also aware of “secret” trans fat? If not, that could possibly be affecting your health. As far as should you worry about those numbers, I’d have to defer to your doctor …. Lab results must always be interpreted in the context of in-depth knowledge of your history and even physical exam findings.

  49. Dr. Cate-
    I was wondering about your recommendation to consume cow’s milk dairy in the face of indisputable evidence, such as in the landmark China Study, of the connection between casein in dairy (the protein, so nothing do with fat levels, or pasteurization) and disease.

    Hundreds of studies have showed that consuming dairy in children and infants leads to allergies and other issues. In countries where dairy is not consumed, such as in China, there is no osteoporosis, since dairy is among the most acid-forming of all foods and leaches alkaline minerals, such as calcium, out of the body.

    I have stopped consuming dairy, and have never felt better. My bone densities have improved as well.

    Ann Levy

    1. I am curious about that as well. There is a lot of info out there demonizing dairy and after my son developed allergies to milk we have stopped its consumption as well. At that point my husband noticed some of his chronic symptoms cleared.

      1. Some people develop a celiac-like syndrom to casein and should avoid anything containing casein.

        Others can tolerante raw milk, or milk from other animals ie goats.

    2. For Ann and Curious

      I do not make blanket recommendations against any natural food unless it causes you problems.

      As far as I am concerned, all evidence is disputable. And many people have disputed the China Study, most recently and entertainingly in my opinion is Denise Minger:

      I have addressed the acid-balance theory in response to others over on my dairy posts, which you can start reading here:

  50. Hi Ward
    I’m not familiar with those authors, however I would think that they ought to have offered support for their own claim in their book. Since they apparently did not, I think you have your answer! 🙂

    Regarding the 50 g, our bodies do need about 2 Tbsp of glucose per day (about 30 g) to run cells lacking mitochondria. That amount is easily supplied by the process of gluconeogenesis which converts amino acids into glucose. This is the process by which all carnivores manufacture the needed glucose for red blood cells and a few other cell types that lack mitochondria and therefore can’t burn fatty acids or ketones.

    I hope that helps!

  51. I would like to see some discussion on the Jaminet’s (authors of the Perfect Health Diet) claim that very low carb diets may lead to “glucose deficiency” that results in “insufficient production of mucus in the digestive tract” and the resulting digestive difficulties (p. 254 PHD).

    They claim that good health requires at least 50 g of “safe starches: taro, yam, potato…) on top of any carbs that may be present in vegetables. These same “safe starches” are the ones most likely to produce the energy swings you discuss in your post. Part of their argument is that glucose is needed not just as an energy source but also as a molecular building block.

    Do you know of any science that would support their claim?

  52. Thanks for another great post. With regards to the adrenal fatigue/low carb diet connection, Dr. Diana Schwarzbein (endocrinologist/author) strongly supports this theory and, apparently, has seen this condition occur in many of her patients. Her books document this in more detail. However, I too have been unable to find any studies which shed much light on this concept either way.

  53. Hey Cate 🙂 it’s me again…

    There must be a relation between the high levels of glucose (or insulin) and the enzyme…

    I have a gut feeling thou (didn’t research on this yet). The malonyl-CoA being involved in the synthesis of fatty acids must be more related to a deficiency of the fat in the diet. And a low fat diet is most likely a high carb one. Maybe that’s the relation… but I’m not sure. My above theory is just a speculation at this point.

    I’m gonna study this for a while and if I can’t come to a conclusion I will email in shame my Biochemistry professor 🙂

    1. Dr. Mary Vernon, a bariatric specialist, is the one who opened my eyes to the mitochondrial effects of the metabolic differences between high and low carb diets. You can do a youtube search under her name, you’ll probably find her lectures very interesting. She’s kinda fun to listen to–very spunky.

  54. HI MIke,
    Nice to hear from my favorite Villager!

    Yes, Malonyl-CoA doesn’t know whether it came from carb or fat breakdown. The issue is a little more complicated than I made it but since you are inviting me to transform into superGeek mode here’s a few missing details that I found VERY interesting. This comes from my favorite biochem book but probably any biochem book will have the same kind of info [Textbook of Biochemistry, by Devlin 5th ed. p 715]

    “[u]nder conditions of carbohydrate abundance (high insulin levels), tissue levels of Malonyl ClA, the product of the aceytyl-CoA, the product of acetyl-CoA carboxylase reaction, are elevated, causing suppression of mitochondrial CPT1 activity.”

    CPT1 activity suppression over the long haul causes an effective deficiency of carnitine and…

    “The very low carnitine level in heart and skeletal muscle seriously compromises long-chain [over 16C] fatty acid oxidation.”

    and by seriously compromises they mean the process goes all pear shaped to include inability to control the highly volatile electron transport chain that leads to the production of ATP.

    So in my estimation, a chronically high carb diet gives you a temporary and very mild version of CPT1 deficiency. True (genetic) CPT1 deficiency leads to muscle cramping, weakness, and eventually death.

  55. Hey Dr. Cate, I’m very intrigued by the information that the Malonyl-CoA comes from the breakdown of glucose. That’s not exactly true.

    Malonyl-CoA comes from the Acetyl-CoA and bicarbonate in the presence of the acetyl-CoA carboxylase. My point is that Malonyl-CoA has as much with glucose as it has with the beta-hydroxi butiric acid…

  56. When I tried low carb for about 2 months, my morning cortisol levels went above the normal range (I’m also hypothyroid and had cortisol in the upper range prior to low carb). What would I have to do to prevent this rise next time? Thanks

    1. Jon: I recommend you check out the Nutrition and Metabolism website (see logo on my right sidebar) for your local low-carb literate MD

      HIgh cortisol likely resulted because your body is not accustomed to burning fat and it takes a larger jolt of adrenaline to kick start your AM metabolism. They could advise you about what to do next time.

  57. HI Charlie

    You are right; carbs ONLY serve to replenish glycogen and they are not at all necessary to gain muscle mass. Glucose cannot be used to build muscle. Protein can be used to build muscle or replenish glycogen. I’ll do a more detailed post on the protein versus carb debate for muscle form and function in the future.

  58. Finally, an issue that I am passionate about. I have looked for information of this caliber for the last several hours. Your site is greatly appreciated.

  59. I can personally attest to this: since drastically reducing my carb intake during the past six months, I’ve lost 24% body fat (while working out too, of course). My personal trainer asked me the other day after reviewing my progress log if I had been taking any fat loss pills. I asked her, “Why? Your body can do it naturally if you cut the carbs.”

    A related question I had on this topic is on muscle building. A coworker of mine who is trying to gain muscle mass mentioned that he was trying to increase his daily carb intake to help build muscles, which seemed odd to me. The only connection I could make between sugar and muscles is that perhaps one could maybe do some more exercising during a sugar spike. Or maybe the extra glucose would refill glycogen stores to do more exercising. But in any case, do you know to what extent carbs, whether directly or indirectly, are necessary when trying to gain muscle mass?

    I’ve gained about 10 pounds of muscle mass while cutting carbs, but I’ve seen others who love to drink sugary protein shakes gain muscles just the same. Is one method more advantageous than the other?

    1. Hi well it always depands what kind of carbs u eat. Im on all fruit and green leafy veggies ,3 organic eggs a day 80grams nuts or seeds per day and i maintained a sicks pack at a body weight of 195 pounds.Alos my wife and 34 month daugther eat the same way.its the fat in the diet at the same time as carbs that is the problem.Check out this book
      “Neal Barnard’s program for reversing diabetes” on amazon i bought it and saved my life.

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