Increasing Protein, or Decreasing Carbohydrate…Which Gives You a Metabolic Advantage?

The claim of a "metabolic advantage" of low-carbohydrate diets has been tossed around by a lot of people.  The idea is that, for a given calorie intake, a diet that gives a metabolic advantage will generate a greater calorie deficit (and hence greater weight loss) than a diet without this advantage.  Since there are studies showing greater short-term weight loss on low-carbohydrate diets versus high-carbohydrate diets for a given calorie intake, it has been suggested that low-carbohydrate diets provide a metabolic advantage over high-carb0hydrate diets.

However, low-carbohydrate diets are also usually high in protein.  It is well established that increasing dietary protein can increase the number of calories you burn for a given calorie intake.  Thus, we know that increasing dietary protein can provide a metabolic advantage.  But what about lowering carbohydrate, independent of protein intake?  I attempted to answer this question with a meta-analysis that I published back in 2006 (although the research was actually performed in 2004).  I concluded that a very low carbohydrate intake (low enough to cause ketosis) provided a metabolic advantage, independent of protein intake.  However, I now consider my study unreliable for answering this question, for reasons that I will address later in this article.

The best way to answer this question is through a carefully controlled study, where you manipulate protein and carbohydrate intake independently, and measure the number of calories burned under various combinations.  When I did my meta-analysis, no such study existed.  Fortunately, we now have a study where this has been done.

The Study Design

Researchers from the Netherlands looked at how the presence or absence of carbohydrate affected energy expenditure on a high protein diet.  The researchers recruited 45 men and women and divided them into 2 groups.  Each group received two different diets, separated by 4 weeks.  One group received a normal diet, and then a high protein diet with carbohydrate.  The other group received a normal diet, and then a high protein diet without carbohydrate.  The subjects were in energy balance, meaning they were eating just enough calories to maintain their body weight.  The diets were as follows:

The subjects ate these diets while staying in a respiration chamber for 36 hours.  The respiration chamber allowed for the continuous measurement of the number of calories burned.  To mimic the glycogen (a chain of carbohydrate stored in your muscles) depletion that exists on low-carbohydrate diets, group 2 did an exhaustive exercise test before each diet to burn up the glycogen stored in muscle tissue.  The researchers also determined the subjects' self-rated feelings of hunger and fullness.

"The Metabolic Advantage"...and The Winner Is...

The results of this study can be seen in this chart:

The researchers found that the high protein, moderate carbohydrate diet increased energy expenditure by about 4%.  This translated into an increase of about 96 calories per day.  This is in agreement with other studies showing a high protein diet to increase energy expenditure by anywhere from 81 calories per day to 90 calories per day.  Thus, we can say that a high protein diet will increase the number of calories you burn by 80 - 100 calories per day when compared to a normal protein diet, and definitely provides a metabolic advantage.

However, the zero-carbohydrate diet did not provide any further advantage over the high protein, moderate carbohydrate diet.  In fact, when the zero-carbohydrate, high protein diet was compared to the normal protein diet, the difference in energy expenditure was only 43 calories per day.  Thus, the high protein, moderate carbohydrate diet did slightly better.  Therefore, a low carbohydrate diet does not provide a metabolic advantage that is independent of the protein intake.

Appetite...and The Winner Is...

The results for hunger and fullness can be seen in this chart:

There was a significant decrease in hunger, and a significant increase in fullness when the subjects were on the high protein, moderate carbohydrate diet as compared to the normal diet.  This has been shown in many other studies.  This study further confirms that protein can help reduce your appetite.  In fact, in one study, a high protein, moderate carbohydrate diet caused a spontaneous reduction in food intake of 1,280 calories per day.

As you can see in the chart, while increased protein reduced appetite, the combination of high protein and no carbohydrate reduced appetite even further.  This means that a low-carbohydrate diet can provide an advantage in regards to reducing appetite that is independent of the protein intake.  Another study found similar results; in fact, that study found a spontaneous reduction in calorie intake of 294 calories per day over a high protein, moderate carbohydrate diet.  Thus, while low carbohydrate diets don't provide a "metabolic advantage" that is independent of protein intake, they do provide an "appetite advantage" that is independent of protein intake.  This appetite advantage is likely due to ketosis; one study showed that injection of ketones into the brain of rats caused a reduction in food intake.

Thus, the primary reason why low-carbohydrate diets tend to show superior weight loss in the short-term has nothing to do with a metabolic advantage, or an effect on insulin, or some other magical unknown effect.  It all has to do with appetite control.  When people consume a low-carbohydrate, high-protein diet, they are getting a "double-whammy" in regards to appetite regulation.  They're getting the dramatic benefit of increasing protein, and an additional (although smaller) benefit of a ketogenic diet.  The bottom line is that the people on these diets spontaneously eat less....A LOT less.

The Need for an Individualized Approach

One thing about studies in this area is that individual responses tend to vary dramatically.  For example, in one study I mentioned earlier, the responses between the low carbohydrate and moderate carbohydrate diets were highly variable, and there was considerable overlap.  Thus, while ketosis decreased appetite on average, it didn't help in every individual.  This is not surprising, as the control of appetite is a highly complicated, and is influenced by both your physiology, genetics, and psychology.  Thus, an effective dietary approach for one individual may not be effective for another; for example, one person may have outstanding results on a low-carbohydrate diet, while another person may do better with a more moderate approach, due to a variety of reasons.  This is why there is no "one-size-fits-all" dietary approach for everyone.  This is also evident when you peruse various internet message boards regarding various dietary philosophies.  You will find success stories and struggles with every approach.  Finally, it is evident when you look at the long-term clinical trials of various dietary approaches (including low-carbohydrate approaches), as the amount of weight regained and the failure rates tend to be high with all approaches.  Thus, there are no simple solutions to the problem of weight gain and obesity, as there are hundreds of variables all simultaneously interacting to produce the problem in the first place. 

A Note About Scientific Integrity

I mentioned earlier about how I now consider my 2006 meta-analysis conclusions to be unreliable.  The paper was a good paper for my knowledge level and the available data at the time.  However, science is always changing, as newer and more reliable data is collected, and as the knowledge base grows.  Any scientist with integrity should be willing to change his mind about an idea, if new information indicates that the old information may have been wrong.  I have learned much since the publication of that paper, and my new knowledge now tells me that the paper's conclusions were likely wrong.  Among the reasons why I now consider that paper unreliable:

  • I treated protein and carbohydrate as independent variables in my analysis.  However, because low carbohydrate diets are usually high in protein, the two are not truly independent.  This confounds the results of my analysis; regression analysis assumes that your predictor variables are independent of each other.  My analysis violates this assumption.
  • I incorporated many studies that involved self-report of food intake.  It is known that self-report of food intake is unreliable for determining calorie intakes in overweight people.  To try to reduce the effect of this problem, I only incorporated self-report studies that had an objective, biological marker that indicated diet compliance (such as urinary nitrogen excretion to estimate compliance with a high protein intake).  However, the problem with this is that none of these markers are objective markers of actual calorie intake.  Thus, calorie intake estimates could still be considerably off, even if there was evidence of compliance based on another marker.  This is a big problem if you're trying to determine if there's a metabolic advantage.  If a low-carbohydrate diet offers an additional advantage in regards to satiety, then there would be systematic underreporting among individuals on high carbohydrate diets.  This systematic underreporting would show up as a "metabolic advantage" in a meta-analysis.
  • I looked at body composition in this paper; however, if you've read my series on body fat testing, you now know that fat-free mass hydration and changes in body water can introduce significant error into measurements.  Because low carbohydrate diets have strong effects on body water, this would introduce systematic error when comparing body fat measurements between a low carbohydrate and high carbohydrate diet.

These flaws in my analysis, coupled with the new data from the well-controlled studies I discussed in this article, indicate that my conclusions were wrong.

The Bottom Line

The bottom line is that there is no metabolic advantage to a low carbohydrate intake that is independent of a high protein intake.  There is a metabolic advantage to a high protein diet, which will increase the calories you burn by 80-100 calories per day.  There is also a dramatic satiety advantage to a high protein intake.  A low carbohydrate intake (low enough to cause ketosis) can increase this satiety advantage, but individual responses will vary.  The best dietary approach for you will depend upon a variety of factors.

REFERENCE:  Veldhorst, M.A., et al.  Presence or absence of carbohydrates and the proportion of fat in a high-protein diet affect appetite suppression but not energy expenditure in normal-weight human subjects fed in energy balance.  Br. J. Nutr.  (Epub Ahead of Print)

89 Responses to “Increasing Protein, or Decreasing Carbohydrate…Which Gives You a Metabolic Advantage?

  • James,

    Great post! While reading the last section, it reminded me of one of my “intellectual” heroes: W.E.B DuBois, who lived long enough to write three autobiographies. In each one, except the first of course, he critiques all of his previously held philosophies, explains why he was wrong, and why he has changed positions. This is called intellectual honesty; the acquisition of knowledge is a constant process of reflecting on what you’ve previous learned or believed …

    • Thanks, Muata. It’s amazing how egos can get in the way; a lot of people refuse to acknowledge new evidence when it’s placed before them.

  • “individual responses tend to vary dramatically”

    Biological individuality. It could well be the most overlooked and most relevant thing in nutrition science. Next only to scientific Integrity…

    Excellent work! Thanks.

  • James,

    Just curious: What if you add a high-fiber diet to your winner?

    Ken Leebow

    • Ken,

      I don’t think fiber would change things much from an energy expenditure standpoint. If anything, you might see a miniscule decrease in energy expenditure as you would have a decrease in metabolizable carbohydrate because you are replacing it with non-metabolizable carbohydrate. However, the effect would be so small that it would likely be irrelevant.

      Fiber would add the advantage of increased satiety, and a decreased amount of metabolizable energy for a given energy intake. In that sense, it would be beneficial.

  • James,

    Thank you so much for this site, and your critique of the low carb/high protein diets. I have long been a strong advocate of high protein diets and have embarked on my own weightloss journeys into the low carb/high protein land with both success and failure. I’ve tried South Beach, Atkins, and Nutri-System with some unfortunate side effects that made continuation impossible. I’ve have spent many years figthing the weight loss battle and losing, until recently. Surprisingly, Weight Watchers has been the path that works really well for me. I lost 5% of body weight in 3 weeks and I am nearly 20 lbs of total weight loss in less than 3 months without significant life-style changes or a rigorous exercise plan.

    I am also one of those over weight individuals who honestly thought I was not consuming THAT much food and WW has really opened my eyes to what I am putting in my mouth and what value it has nutritionally and calorically. I am learning ways to eat all the things I like – pizza, pasta, cake, cookies, etc. while losing weight and not the low fat/artificial sugar/highly processed crap either. I finally found something that works for my body and for my lifestyle. I feel good and I am steadily losing weight while enjoying my life and knowing I can stick with this long-term.

    Reading your blog has also been a huge benefit. The idea of “calories in/calories out” should be common sense, but like me, most people don’t have any idea how many calories they are consuming. It’s easier to blame it on something “else.” I know many people who have dramatically benefited from a high protein/low carb diet and have been able to maintain that diet for many years. I am just not one of them, and perhaps that is partially my “biologial individuality, psychology” and a number of other factors unique to me alone. I appreciate your honesty, integrity and research!

    • Angela,

      Congratulations on finding an approach that works for you! I really wish more people would understand that weight loss is a very individualized approach. There are so many factors to consider. Thank you for sharing your experience.

  • From the discussion:

    “It is impossible to determine whether the observed effects of the HP-0C diet are due to a lack of carbohydrates or to elevated fat levels. Because the maximal protein content in a high-protein diet in energy balance is limited(21), the proportion of fat in a high-protein, low-carbohydrate diet always will be relatively high. The observed effects may be due to the low carbohydrate content as well as the high fat content, promoting together with a relatively high protein content a high fat oxidation and elevated b-hydroxybutyrate concentration.”

    Also, note that the RQ was lower in the HP-0C group (obviously). It would have been interesting to see the bodyweight and fat mass fluctuations between groups because you can burn the same amount of calories but from different sources (considering the glucose-fatty acid cycle proposed by Randle).

  • Satiety is an interesting factor. If someone has a raging appetite, I can only assume that that would make it very difficult to adhere to a calorie deficit. Maybe that’s why I’ve been successful with a low-cal approach, with no focus on reducing carbs- or increasing protein, for that matter. I just haven’t had any issues with appetite/ hunger. My stomach will grumble a little bit here and there, but it’s minor and very manageable. So, for me, a high protein/ low carb diet (or should I say a specifically ketogenic diet?) to increase satiety hasn’t been necessary. So why should I do it? Other than to conform to some dogma, of course.

    • Exactly, Jordan. There is no “one size fits all” approach. It amazes me when some people try to force one particular approach on everyone.

  • Yeah, what’s up with that? I have zero interest in telling people what to do and how to live their lives. Of course, I’ll mention that a calorie deficit is necessary, but I’ve never, ever told someone to specifically follow *my* diet! I know that there are other ways to do it, and I’m not going to try to impose my way on anybody else. If someone wants to do LC, Paleo, vegetarian, vegan, or whatever, that’s their business. Ultimately, one needs a calorie deficit to lose weight, but there are many, many, many different ways of doing that.

    Moreover, there are factors other than weight loss that one may have to consider, and that can add another layer of complexity to it. There are issues like allergies, celiac disease, digestive issues, ethical concerns (like someone not wanting to eat meat because they don’t want to kill or mistreat animals,) financial concerns, etc. Those issues have nothing to do with weight loss, but they can still be crucial factors for certain people. So certain diets may not be feasible, or even possible, for a particular person because of one or more of those factors.

    • “Moreover, there are factors other than weight loss that one may have to consider, and that can add another layer of complexity to it. There are issues like allergies, celiac disease, digestive issues, ethical concerns (like someone not wanting to eat meat because they don’t want to kill or mistreat animals,) financial concerns, etc. Those issues have nothing to do with weight loss, but they can still be crucial factors for certain people. So certain diets may not be feasible, or even possible, for a particular person because of one or more of those factors.”

      Thank you for mentioning this Jordan D.! Some of these things have a great impact upon my own diet journey. I have some pretty severe food allergies that preclude eating certain processed foods, as does my daughter and therefore many high-protein foods are off limits. Most processed foods are a no-no as well as they are highly allergenic, like many of the high-protein/low carb/artificial sugar options on most plans.

      I am having great success, and although I most certainly consume protein, I am not consuming large amounts and instead my focus is on lots of fruits and veggies, some whole grains and some protein for healthy sources. I can still eat pasta, but now I add about 2 cups of cooked veggies, some olive oil and a bit of parmesan cheese. I still eat pizza, but I simply add veggies – red onion, bell pepper, mushrooms and zucchini.

      I track my hunger and have found two breakfasts that leave me feeling very satisfied and lead to a very successful day – 1 cup of Goji Berry Cereal, 1/2 cup of fresh berries, 3/4 cup of almond milk and a cup of coffee sweetened with a tsp of pure maple syrup. (that is about 6 gs of protein.) OR 1/2 cup of scrambled eggs, 1/2 a sprouted grain english muffin, 1 -2 cups cooked veggies and 1/2 – 1 cup of fresh berries or other fruit plus my obligatory cup of coffee.

      I am wearing clothes I have not worn in years. I have more energy, and I am able to STICK with this program even at family events. I can go to my favorite restaurants. I don’t have to ask family members to have something I can eat, or bring something separate. I can partake in my baking (which I started because of my daughters severe food allergies, and my own allergies). I just make “mini” portions, or eat 1/4 of what I would have eaten in the past. I do not feel deprived. I don’t feel guilty after eating something “illegal” in other diets.

      Just as different people react differently to medication that “should” work for their condition I do strongly believe that there is no “one size fits all” diet plan. I am living proof and I don’t need a double-blind-placebo-controlled study to know what works and doesn’t work for me! I am just glad to FINALLY have someone ELSE with FAR greater knowledge than I beating that drum and doing so with carefully researched evidence.

  • nadfubach
    9 years ago

    I see in the study that percentages were used and at maintenance calorie levels. What would constitute as “high protein” when eating in a deficit?

    • Hi, Nadfubach,

      The problem with using percentages is that 30% protein on low calorie diet is not the same as a eucaloric diet. Thus, I don’t like to use percentages to define what constitutes “high protein”. In general, it is better to look at protein on a per kilogram of body weight basis. There’s no standard definition as to what constitutes “high protein”; typically I personally consider anything around the 1.5 gram per kilogram range to be high protein.

  • Hi James, forgive me if I missed you linking/referencing to this study, but it really smacked me n the head when I came across it, and I think the Metabolic Advantage and LC Superiority zealots should be humbled by these results. I think it also ties in with your post here:
    A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight

    Of particular interest is that the participants in this study were not aware they were in a weight loss study and even told not to expect to lose weight!

    • Hi, Carbsane,

      Even though I haven’t linked to that paper in any of my articles, I have referenced that paper in some of my lectures to show the spontaneous reduction in energy intake when you feed people a high protein intake.

  • Hi, James. Have you considered writing a letter to the AJCN about your second thoughts about your meta-analysis?

    • Erik,

      I have thought about it, but given that the paper is over 4 years old now, I wonder if it’s even worth bothering. I still might think about it.

  • “However, science is always changing, as newer and more reliable data is collected, and as the knowledge base grows. Any scientist with integrity should be willing to change his mind about an idea, if new information indicates that the old information may have been wrong.” Very well said. The tentative nature of science being one of it’s strongest qualities. It is important to recognize there are no absolutes (thus the need for the Bead Model of Truth) and what we know depends on the preponderance of evidence.

  • Josh Dale
    9 years ago

    Hi James,

    Great article! Using the same reasoning regarding that you critiqued your first paper with: how do we know that the increase in satiety wasn’t due to the 70% fat vs. low cho/ketones?

    Thanks in advance!


    • Josh,

      You are definitely correct. That is one of the challenges of nutrition research…when you change one macronutrient, another must change as well. Since they are not independent, it is difficult to ascertain which change is responsible for the effect you see. So it is possible that the higher fat intake was responsible. The research on fat intake and satiety is equivocal, as it shows both improved satiety (mainly due to delayed gastric emptying), as well as the possibility of passive overconsumption (due to its energy density). So that makes it even more challenging to determine the cause of the improved satiety in this particular study. It may also be a combination of factors.

  • Krieger,

    I like your article, but you are forgetting to mention the greatest metabolic advantage to protein, which is protein retention/ storage (building of muscle). Say a persons maximum protein retention is at 20% protein, at energy balance. If that person only eats 10% protein, he/she will lose the benefits of increased protein retention and will (???) lose out on higher fat oxidation due to the 10% protein being replaced by carbs, fat or both (more carbs will decrease fat oxidation and more fat will only leave more fat to burn). (left out a “w” so it wouldn’t be detected as spam)
    Strangely enough, this study show two groups with different protein intake, where the high protein group lost less weight than the low protein group, but lost just as much fat as the low protein group. Obviosly, the low protein group lost more lean mass, but i would expect the high protein group to slightly lose more fat. What do you think is the case here Krieger?

    • I think it’s simply a case of a very short study duration (only 2 weeks) combined with the insensitivity of techniques for estimating body composition. It’s simply too difficult to have good precision with those parameters.

      • Thank you for answering. I’m no pro low-carb, but this study have been bugging me;,f1000m,isrctn

        As you can see this is a study with healthy normal weight men on a low-carb diet (30g carbs) eating ad libitum and still losing 3.4kg of fatmass and gaining 1.1kg of lean mass in 12 weeks.

        I have been googling looking for some debunking or discussion of this study, but can’t find any. If the subjects were obese that would easily explain it, but these were healthy normal weight subjects. Maybe there is some flaws in measuring methods?

  • The advantage comes from inefficiency if fat – ketone production and acetone loss. The second issue is Atwater factors for people vary. Carbs vary the most, somewhere between 2 and 5, average 4. The advantage shows up for people who fully digest carbs. Which are you?

    At best the Caloric Density can only be measured to about +- 10%. Without careful weighing of food and calculating the calories, people will always underestimate calories, in some studdies by 30%.

    Your sited study does not address this.

    It would require a captive feeding of people for about a month. To demonstrate for yourself, weight your food and compute the calories using caloric density. Try two diets, one high fat, 1gm/kg of protein, and 25 gms of carbohydrate per day, and the other 30% fat, 1gm/kg protein, and the remainder carbs. You need to do each diet for a month or so to see where you are at.

    I am weight stable on 1550 C/day on high carb diet, and loose at 1800C/day of high fat diet.

    but what do I know. Don’t confuse a good story with facts.

  • Kalle Tolonen
    8 years ago

    So a 2 d study rests the case?? Hardly. How about metabolic adaptations..?

    • This is not the only study showing the lack of a metabolic advantage for a low carbohydrate intake in humans. And why would metabolic adaptations be relevant here?

  • There seems to be one thought that has been neglected here.Some of the many things that signal the end of a couuntry/nation/civilisation are:-1. Moral standards (biblical) vanish2. Law fails and corruption reigns supreme3. Personal responsibility, honour and integrity becomes scarce and trust goes out the window (who me? paranoid? never!)4. Life revolves around I instead of us

  • Hi James Kreiger,

    I read the article and its very helpful. But I am confused because of my bad outcomes.I am 25 yr old, 65 kgs and pure vegetarian. On a diet of 4 brown.bran bread a day+ 2 glass low fat milk+ 1 cup low fat probiotic curd(occasionally) and vegetables (salad with no sugar or salt) since 2 months. i need to reduce 7-8 kgs. Will start on whey protein isolate in the morning next week. Will such a schedule help me reach my target? Till now since 2 months i have reduced only 1 kg with a workout of 20-30 minutes elliptical training and ab excercises a day.

  • I was referred to this article as proof that the carbohydrate hypothesis is wrong. Anyways I sort of already believed that there is no metabolic advantage to low-carb diets from other readings. However the question I have now is whether this study disproves the idea that carb reduction can both decrease ad lib caloric intake (which we know it can) AND increase ad lib exercise (or the motivation to exercise) by freeing the person from “internal starvation” brought upon by excess insulin? So it wouldn’t be a *resting* metabolic advantage, but could simply make somebody more physically active?

  • Armi Legge
    7 years ago

    Great job James,

    Do you think the reduction in food intake seen on low carb diets could also be because of a reduction in food reward? Stephan Guyenet has written about this a lot, and, if true, it explains a lot of problems.


  • Jan sundatesan
    7 years ago

    Thank you so much for the most educative article on insulin and diabetics. I am a type 2 diabetic. My morning fasting sugar used to be 130+ before. But after going on vegetarian version of South beach diet with eggs I lost 27 pounds in 7 months. My fasting sugar went down to 99 and a1c went to 5.8 from 6.8. Now I understand why my morning sugar was high even if I missed my night meal. Is my improvement in blood sugar because of weight loss or the diet which is moderate carb and high protein? After reading your article I am relieved that I can consume Dairy products. I was confused by reading Mark human and Joel furman on dairy products.

  • WOW. Really great article. My biggest takeaway was that carbs up your appetite something I was totally oblivious to.

    I’m a high protein/low carb advocate simply because my focus is on strength building and increasing lean muscle, but this is a new angle.

    I’ll have to re-read the article and check out the links to get a full appreciation of the research.

    Thanks again for posting James …

  • Barbara Lutz
    6 years ago

    Hello Mr.Krieger!

    Your article has helped me with my research paper about calories. My sci. fair project is measuring calories using a calorimeter. Your articles was one of the few that actually answered my question! like your article!

  • Chris Jack
    5 years ago

    OK – let’s say I accept that protein makes you feel fuller for longer. But are you then suggesting that it is a sensible, healthy diet?

    I’m thinking about the relative pros and cons discussed in articles like

    • Hi, Chris,

      The problem with that WebMD article is that it is confusing very low-carb diets (like Atkins) with high protein diets. A high protein diet does not need to be very low in carbs.

  • A great article.I have always believed in moderate carbohydrates or small quantities to lose weight. Carbohydrates serves has a fuel source to give us the added energy to burn fat whilst exercising. This ensures greater fat burning effect, wouldn’t you agree ?

    • Hi, Mitchell,

      I would agree that someone who engages in intense exercise needs to consume adequate carbohydrate to help sustain exercise intensity. This, in turn, would help to create higher daily energy expenditures, which would help lead to more fat loss.

  • Excellent article and very helpful. My question is concerning exercise, specifically long distance. I am preparing for another half marathon. I wonder what the implications of a reduced carbohydrate, high protein diet would have on my performance. I speculate that the increased protein would help my recovery.

    • Increased protein may help reduce muscle damage from running. However, the reduced carbohydrate may impair endurance performance.

  • Robert Sivewright
    5 years ago

    Hi James,

    It’s really great to see such a long running article, with good, solid advice.

    I am a recently diagnosed (less than 2 months) type 2 diabetic with high cholesterol (6.9 total HDL 1.47) and high blood pressure (medicated for the last 8 years) and very over weight (120 kg at diagnosis, down to 111kg over the last six weeks) and 5’8″.
    I’m not sure if you know of Prof. Tim Nokes, a very highly regarded South African sport scientist, who has fairly recently come out as very pro high fat low carb diets, which started my research into various high fat diet options.

    The most frustrating thing I have found in researching different diets, is the massive amount of information available, both pro and con high fat very low carb diets, with no real conclusions and factual, well researched recommendations, I realize that the true scientific community very rarely, if ever draw conclusions from the study data but rather present findings in a neutral manner.

    If I may, I would like to pose the question: are there any serious, potential side effects that you know of for someone as over weight as myself going on a high fat low carb diet and attempting to maintain ketosys for a prolonged period (6 months or more).

    Unfortunately I have a very narrow logical approach to the dieting and diabetes question and I’ve convinced myself that if blood glucose levels are my problem, and carbohydrates are the reason for glucose in the blood then it’s logical to me to remove the carbohydrates from my diet.

    After diagnosis I started a high carb, low-GI, low fat diet on the advice of my dietitian (I followed the diet for 4 weeks losing 6.5 kg and lowering my post meal sugar spikes from 16-21 mmol/dl to 10-13 mmol/dl) which I found was very difficult to maintain. I stated a high fat, low carb diet (<40g carbs daily) 7 days ago after a lot of very unscientific research. I enjoy the food, I've never really been one for veggies and fruit or sweets and cakes although I have upped my veg and salad intake as well as mixed nuts (currently my only source of carbs is carrots, tomatoes, nuts and very limited baked beans). For the last 2 days my 1-2 hour post meal blood sugar peaks after 7 days of high fat low carbs have not risen above 7.9 mmol/dl, while my fasting levels have been bouncing around between 5.4 and 6.7 (I test my blood sugar 8-12 times a day, possibly due to my newness to diabetes, but I also want to know what effect, what foods have on my blood sugar)

    Unfortunately, my doctor and dietitian are both unwilling to discuss the issue of high fat diets as to them it is obvious that high fat diets are unhealthy, no discussion.

    Your time and willingness to answer random questions from total strangers is greatly appreciated.


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