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Is a very low-carb diet suitable for you? What are the pros and cons and what you should expect from it? These and other questions are answered by Franziska Spritzler from Low Carb Dietitian. Franziska is a certified dietitian and has personal experience with very low-carb ketogenic diets!

Very-low-carbohydrate ketogenic diets (VLCKDs) have been around for hundreds of years and were the standard form of treatment for diabetes prior to the discovery of insulin in 1922. William Banting, a British undertaker, deserves credit for developing the first VLCKD for weight loss in the mid 1800s.

Cardiologist Dr. Atkins popularized it again in the early 1970s after reviewing decades-old nutrition research in his attempt to discover a plan that would allow people to lose weight without going hungry – his own Achilles' heel when it came to sticking to a diet. Over the years, the very-low-carbohydrate ketogenic diet has been criticized for being too restrictive, difficult to maintain long term, and unhealthy. However, many people find that this way of eating is the only one that allows them to lose weight and effectively control diabetes.

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How is a Very Low Carbohydrate Ketogenic Diet Defined? Although at this time there isn't universal agreement on the term, a few years ago leading researchers in the field of carbohydrate restriction proposed the definition of very-low-carbohydrate ketogenic diets as those containing less than 50 grams of total carbohydrate per day. However, the degree to which carbohydrates need to be restricted to induce ketosis varies from person to person. Some may achieve elevated ketone levels consuming 60 grams of carbohydrate or more, while others may need to restrict carbs to less than 30 grams or even less than 20 grams to experience the same effect. A VLCKD is defined as any diet with less than 50 grams of total carbohydrates as defined by Phinney and Volek (or 20-25 g net carbs). There isn't a universal definition of a VLCKD.

Net Carbohydrates or Total Carbohydrates? Many people count net carbohydrates by subtracting fiber from total carbohydrates, but there are differences of opinion regarding whether fiber should be counted. Soluble fiber may be absorbed and therefore could affect ketosis and blood glucose levels, while insoluble fiber simply passes through the GI tract unabsorbed. Most foods contain both types of fiber, as shown in this comprehensive chart. In their excellent book The Art and Science of Low Carbohydrate Living, Dr. Steve Phinney and Dr. Jeff Volek recommend 50 or fewer grams of total carbohydrates per day on a LCKD and do not mention fiber or net carbs in this regard. However, it stands to reason that consuming 50 grams of total carbohydrate where half or more of the carbs come from fiber will lead to higher ketone levels than if the same person consumes a 50-gram total carbohydrate diet containing only a few grams of fiber.

Why Follow a VLCKD? I'm a registered dietitian who eats a diet containing less than 50 grams of total carbs daily and recommends carbohydrate restriction for people who want to lose weight, control diabetes, improve symptoms of PCOS (polycystic ovary syndrome), or experience better overall health. However, there's a lot of controversy around this way of eating. As with any dietary approach, there are advantages and disadvantages to limiting carbs to very low levels.

Potential Side Effects of Very-Low-Carbohydrate Ketogenic Diets Your LDL Cholesterol Might Go Up Will a very-low-carbohydrate diet raise your LDL cholesterol? Maybe. LDL cholesterol response to carbohydrate restriction is variable; it's believed that roughly 50% of people experience a rise while the other half either see a decrease or experience no change. However, even if your LDL does go up, it will in all likelihood result in the more favorable Pattern A mentioned above. There is also a temporary increase in LDL following significant weight loss, so keep this in mind. Finally, the LDL-C in most lab reports may not be accurate. It's calculated using total cholesterol, HDL-C, and triglycerides in what's known as the Friedewald equation, and if triglycerides are less than 100, it will overestimate your true LDL level. Your Food Choices Will be Somewhat Limited This is one of the biggest criticisms of low-carbohydrate diets, and there's some validity to it. On a VLCKD, there are several off-limits foods that may include some of your favorites: pasta, rice, bread, most fruit, and sweets. Although there are acceptable substitutes for many of these items, even the most enthusiastic low-carber will admit that there are some foods that simply can't be successfully replaced by a low-carb version, such as bread or baked potatoes. The #1 Keto Diet App App Store Google Play You'll Likely Develop a Decreased Tolerance for High-carb Foods Although people respond to carbohydrate restriction differently, generally speaking, tolerance for carbohydrates usually goes down after becoming keto-adapted. In other words, your blood sugar will rise higher after consuming a high-carb item than it would if you followed a regular diet comprised of at least 150 grams of carbohydrate daily. This is sometimes referred to as physiological insulin resistance in order to distinguish it from the pathological insulin resistance that occurs in Type 2 diabetes, obesity, and metabolic syndrome. Because of this, you're instructed to eat at least 150 grams of carbohydrate for three days prior to taking an oral glucose tolerance test (OGTT), which allows you to regain carb tolerance. If you took the OGTT (which involves consuming 75 grams of straight glucose) without modifying your very-low-carbohydrate diet, your blood sugar might potentially rise to the level where diabetes could be diagnosed (200 mg/dL) even if you don't have diabetes. You might get constipated Not everyone who follows a VLCKD develops constipation, but enough do to mention it here. Fortunately, it's often temporary and can be remedied by drinking enough fluid, getting sufficient magnesium, and consuming additional salt – at least 1-3 extra grams per day.

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Franziska Spritzler, RD, CDE Registered dietitian, certified diabetes educator and creator of LowCarbDietitian.com Franziska Spritzler, a registered dietitian and certified diabetes educator, is a strong proponent of carbohydrate restriction for people struggling with diabetes, insulin resistance, obesity, and PCOS. She follows a very-low-carbohydrate, ketogenic diet for blood sugar control and has experienced many improvements in her health as a result of making this change. More posts by Franziska Spritzler, RD, CDE Franziska Spritzler, RD, CDE Expert Article This article was written by Franziska Spritzler, RD, CDE who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page. Evidence Based Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.