Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 Aug

Dear Mark: Does Eating a Low Carb Diet Cause Insulin Resistance?

insulinDespite all the success you might have had with the Primal way of life, doubts can still nag at you. Maybe it’s something you read, or something someone said to you, or a disapproving glance or offhand comment from a person you otherwise respect, but it’s pretty common when you’re doing something, like giving up grains, avoiding processed food, or eating animal fat, that challenges deeply-and-widely held beliefs about health and wellness. It doesn’t really even matter that you’re losing weight or seem to be thriving; you may still have questions. That’s healthy and smart, and it’s totally natural.

A question I’ve been getting of late is the effect of reducing carb intake on insulin sensitivity. It’s often bandied about that going low carb is good for folks with insulin resistance, but it’s also said that low carb can worsen insulin resistance. Are both true and, if so, how do they all jibe together? That’s what the reader was wondering with this week’s question:

Hi Mark,

I’ve been Primal for a few months now and love it. Lowering my carbs and upping my animal fat helped me lose weight and gain tons of energy (not too shabby for a middle-aged guy!). However, I’m a little worried. I’ve heard that low carb diets can increase insulin resistance. Even though I’ve done well and feel great, should I be worried about insulin resistance? Do I need to increase my carb intake? I always thought low carb Primal was supposed to improve insulin function.

Vince

Going Primal usually does improve insulin sensitivity, both directly and in a roundabout way. It improves directly because you lose weight, you reduce your intake of inflammatory foods, you lower systemic inflammation (by getting some sun, smart exercise, omega-3s, and reducing or dealing with stress), and you eat a wide variety of plants, animals, and herbs with anti-inflammatory and/or insulin-sensitizing effects. It improves indirectly because you are removing the thing that exacerbates the condition – large amounts of carbohydrates – and thus avoiding the negative effects. You might still be insulin resistant, but since you aren’t cramming your face with carbs anymore, you don’t notice it.

And sure enough, the weight loss studies indicate that during weight loss, very low carb diets improve insulin sensitivity:

However, going very low carb – to around or below 10% of calories, or full-blown ketogenic – can induce ”physiological” insulin resistance. Physiological insulin resistance is an adaptation, a normal biological reaction to a lack of dietary glucose. As I’ve said in the past, the brain must have glucose. It can use ketones and lactate quite effectively, thus reducing the glucose requirement, but at the end of the day it still requires a portion of glucose. Now, in a low-glucose state, where the body senses that dietary glucose might not be coming anytime soon, peripheral insulin resistance is triggered. This prevents the muscles from taking up “precious” glucose that the brain requires. The brain’s sensitivity to insulin is preserved, allowing it to grab what glucose it needs from the paltry – but sufficient – levels available to it.

It appears that weight loss is the deciding factor, and since low carb diets tend to be more effective at inducing weight loss in subjects, they also tend to be better at reducing insulin resistance in insulin-resistant, overweight people. Once you’re lean and weight stable, though, very low carb diets (less than 10% of calories from carbs) can reduce insulin sensitivity. This is normal and totally necessary in the context of a very low carb diet. If we didn’t become insulin resistant while eating very low carb, our brain wouldn’t be able to get the glucose it needed to keep us alive.

Okay, but what about dietary amino acids? If our tissues are insulin resistant on very low carb, and insulin also promotes muscle protein synthesis, doesn’t that mean the amino acids from the protein we eat have a harder time getting into our muscles? You might think that, but that’s not how it plays out in the real world. In actual clinical trials, low carb diets are consistently linked with preservation of lean mass during weight loss. People on low carb diets lose more fat and less lean mass.

Muscle glycogen stores may be depleted, but if you want to fill those back up, you can do so quite effectively post workout, even when you’re low carb and otherwise physiologically insulin resistant. A bout of weight lifting, sprints, or even just regular walking can improve your ability to tolerate and handle glucose by making you more insulin-sensitive. This holds true even for the otherwise insulin-resistant.

In the end, insulin resistance on very low carb appears to be a physiological adaptation to spare glucose for the brain and prevent your muscles from gobbling it up. I see no reason to think it’s a pathological problem, especially given the droves of success stories on this site and others from people who have lost weight, torn up prescriptions, boggled the minds of doctors, and reclaimed their once-failing health through a low-carb Primal way of eating and living. I could be wrong, and time will tell, I suppose, but I doubt it.

Besides, there are far more pressing potentially negative influences on insulin sensitivity that we can be addressing, like:

  • Sedentary lifestyles. And I’m not just talking about strength training and high-intensity sprints; simple, basic low-level physical activity, like walking on a daily basis, can have a powerful effect on insulin resistance.
  • Unchecked and out-of-control appetites. Weight gain and an excess of energy (that the mitochondria can’t handle for whatever reason) are potent causes of insulin resistance.
  • Environmental pollutants and toxins like BPA and various fungicides can have negative effects on insulin sensitivity.

To sum up, I don’t think you need to worry about insulin resistance as long as you’re still losing weight – which you appear to be doing – since weight loss exerts a powerful effect on insulin sensitivity. However, once you’re lean, or have stalled without changing anything, moving back toward the 100-150 Primal carb gram range will keep your insulin receptors “honest” without causing weight gain (and it may even jumpstart weight loss again). Lifting heavy things, sprinting every once in awhile (in a manner suitable for your physical limitations), and doing lots of slow moving will also keep you insulin-sensitive, particularly after the physical activity.

Thanks for reading, folks, and I hope I cleared this up for you without raising too many more questions. Let me know your experience in the comment section.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. “while a 30% fat low-fat diet reduced it.”

    Typo?

    In my own experience, despite more than a decade on grain-free low-carb, just 4 oz of sweet potato (with lots of Kerrygold & some cinammon, and with some grass-fed steak) will take my BG from its normal 85 to 145 — and keep it over 120 for 6 or 7 hours. So, I conclude that even the alternate-day partial fasting is not improving my insulin sensitivity.

    Howard wrote on August 27th, 2012
    • Howard, try eating a sweet potato with a serving or two of fermented dairy such as kefir or Greek yogurt. The ensuing glucagon reaction may help stabilize your blood glucose and allow you to eat some healthy carbohydrate to slowly acclimate your body into metabolizing carbs again. It’s worth a shot.

      ChocoTaco369 wrote on August 27th, 2012
    • I experienced the same thing when I was on really low-carb diet. I would have one apple and get really sleepy (food coma) from sugar in that apple. I know an apple can contain a lot of sugar, but still. Now I eat more carb from fruits and feel better in general.

      Gift clumsywarrior wrote on August 27th, 2012
      • According to Matt Lalondes nutritional density table, apples are the “losers” in the fruit group. But, in general, having some sweet potatoes is going to be a good idea on a paleo type diet. Obviously, it depends greatly on who you are and what you are trying to do, but in general, our bodies could use some carbs to their advantage. I also get the feeling sometimes that sweet potatoes are actually a better carb source than fruit. Anyone else heard that?

        Max Ungar wrote on August 27th, 2012
        • I’m a lean 40 year old. Sweet potatoes are about the only carb I can consume that make me feel full for a significant period of time without crashing soon afterward.

          Too low carbs (50 or less in a day) and I’m constantly hungry. Sweet potatoes with my meal fix that fast.

          More than 150 grams a day (particularly from non-primal sources) and I crash a few hours after eating.

          100-150 a day–I’m in the Goldilocks zone. Amped all day long. Mark is right on about that, at least for this n=1.

          Fritzy wrote on August 27th, 2012
        • Where can one view this nutritional density table?

          KC wrote on August 28th, 2012
        • i typically stay with heirloom apples which are less sweet then modern varieties. i only eat fruit w/ meal.

          yam is also supposed to not raise BG so much even for those w/ insulin. (so i heard)

          pam wrote on August 31st, 2012
      • I too experienced extreme BG rises after eating something as innocent as a pear and plain full fat yogurt after a year of LC. I am a naturally thin 48kg female but wanted to give low carbing a go for organ health – didn’t need to lose any weight. Now I am really insulin resistant so am def going to eat carbs again! I feel LC eating may benefit a certain sector of the population but not by any means everyone!

        Wilson wrote on February 11th, 2014
  2. Forgot to mention that I still have substantial weight to lose…

    Howard wrote on August 27th, 2012
  3. There are two complications to consider here. The first is that any diet that produces fat loss will improve insulin sensitivity. The second is that there are many ways to measure insulin sensitivity. You can either estimate it using fasting insulin and glucose, as in the studies cited above, or you can directly measure it using a gold-standard approach like the euglycemic-hyperinsulinemic clamp technique.

    When you use the gold standard technique and directly measure insulin sensitivity rather than estimating it, it shows that in the absence of body fat loss, very low-carb diets do cause insulin resistance:

    http://www.ncbi.nlm.nih.gov/pubmed/11237931

    The effects of moderate LC diets on insulin sensitivity are more controversial, with some studies showing decreased insulin sensitivity and others showing no effect:

    http://www.ncbi.nlm.nih.gov/pubmed/9867084
    http://www.ncbi.nlm.nih.gov/pubmed/1846876

    It seems to me that the way to improve insulin sensitivity using a LC diet is to lose fat.

    Stephan Guyenet wrote on August 27th, 2012
    • Does that technique differentiate between which tissues/cells are sensitive or resistant to insulin? Or does it just tell you ‘whole body insulin sensitivity/resistance?

      If the latter, then I don’t see that it tells you anything very instructive because insulin signaling (which is more important than just the degree of general insulin sensitivity) will depend on which tissues/cells are either sensitive or resistant.

      Alex wrote on August 27th, 2012
    • Why the debate, obese, insulin resistant, people will always do better on VLC? I find Rosedale to be correct in that going low carb allows your insulin producing cells to rest. This added to weight loss, will reset your insulin resistance. This might not work in the long term T2D, poisoned with drugs and insulin, but that’s another story. For those who were never considered diabetic or pre diabetic, quit worrying about it, and trust your body.
      It seems to me, that following Mark’s carb curve will satisfy all cases and cures mentioned in this discussion, so what is the Point?

      Greg wrote on September 2nd, 2013
  4. Am I the only one who has to re-read the phrases “insulin resistant” and “insulin sensitive” over again, because I forget which one is good and which is bad?

    Or do I just need to learn to read better?

    Adrian wrote on August 27th, 2012
    • you want to be sensitive not resistant

      Jake wrote on August 27th, 2012
      • …. sounds like good advice for relationships too….. ;-)

        ravi wrote on August 27th, 2012
        • Nice. : )

          Ma Flintstone wrote on August 28th, 2012
    • It’s just that they were so close together, several times. :) I almost had that problem too, heh.

      Aria wrote on August 27th, 2012
    • I’m totally with you there. Glad to know I’m not alone :)

      Susie wrote on August 27th, 2012
  5. I experienced this after the birth of my twins. I lost the baby weight but then carried on losing as I’d gone very, very low carb. I started to develop an out of control appetite and put much of the weight back on very quickly. I’ve had to work hard to manage my appetite over the years and at the same time get my body back to a place where it doesn’t need to respond in such a way and I’ve done that by nourishing it appropriately. I thought it was a mental thing but when I started eating primal/paleo, things settled down.

    Alison Golden wrote on August 27th, 2012
  6. What about just eating more protein instead of carbs?

    Kati wrote on August 27th, 2012
    • why put a strain on your liver? if you need the carb then better eat it than convert protein into it. no need to go extremely low carb. i eat my fruit, veggies and white rice every day, in addition to the meat and I am lean, my weight is stable and I feel good. i don’t cheat, i do work out regularly and I lost 16 kilos during the last 8 months. BF probably down to about 10%, never measured it and I don’t care how much is it exactly :-)

      einstein wrote on August 29th, 2012
      • Just a warning, that many carbs will not work for everyone, as far as losing weight. Maintenance maybe. But I have to be pretty strict on my carbs or I will not lose weight. Low carb is like flipping a switch in my body, fat just starts to disappear. But my sugar metabolism is pretty screwy.

        Ashley wrote on December 15th, 2012
  7. You either go Keto or Botelo :)

    Groktimus Primal wrote on August 27th, 2012
  8. Lots of myths about ketosis. But this one tops them: a professor at the university where I teach has decided that ketosis can cause (albeit very infrequently) spontaneous human combustion:

    http://www.cambridge-news.co.uk/Home/Professor-gets-crackling-on-human-combustion-theory-21082012.htm

    Mari wrote on August 27th, 2012
    • WRONG! It’s NOT a fatty diet, but a fat-free diet he mentions.

      He added: “A range of conditions can produce ketosis, in which acetone is formed, including alcoholism, fat-free dieting, diabetes and even teething.

      “So we marinated pork tissue in acetone, rather than ethanol.”

      Betorq wrote on September 1st, 2012
  9. Since being Primal for about 18 months now I have noticed an much better tolerance of carbs. I have only lost 4 lbs total and am able to eat carbs on a daily basis (still less than 200g) and I gain no fat whatsoever.
    Just like everything else it’s different for everybody.

    IcarianVX wrote on August 27th, 2012
  10. Good stuff. My regular diet has lots of hidden sugars but I keep my insulin sensitivity up by walking everywhere possible and weight training.

    J. Delancy wrote on August 27th, 2012
  11. Wait! So and I know you have talked about this, but if my weight loss has stalled maybe it is because I am eating to few carbs? I am usually under 50grams and I have no appetite so my calories are low under 1200 for a 42 year old woman, but my weight has been the same for 4 months. 25% body fat and excess ab fat. Do I just need to eat more carbs?

    Jodie wrote on August 27th, 2012
    • Sounds like it. And perhaps workout a bit if you dont. 25% fat is a bit high for being primal. My BF is around 14%. I eat between 100 and 120g per day of carbs and follow Mark’s general guidelines for exercise (minus the ultimate Frisbee). Try eating an occasional piece of fruit during the day. You will likely find you skin looks much brighter as well as being able to get rid of that belly fat.

      Mindy1986 wrote on August 27th, 2012
      • Just wondering why you would say “25% fat is a bit high for being primal”? Everyone starts somewhere. According to that statement, the minute someone is “primal” they are at 14% bf. Crap, it didn’t work for me :D

        Angie wrote on August 27th, 2012
        • She said her weight loss was stalled there.

          Ashley wrote on December 15th, 2012
    • 25% fat is not high for a woman. Location of fat can have a lot to do with hormones, stress levels, etc. You should evaluate whether or not you could be causing yourself additional stress by eating too little, not sleeping enough, work, overexercising, etc.

      Your weight loss may be stalled b/c you are at a healthy weight. Your calories are way too low. You need to eat at least 1200 calories a day just to get all the vitamins and minerals that you need.

      Amber wrote on August 27th, 2012
      • Thank you everyone, this is my favorite part of this site. Grok on!

        Jodie wrote on August 27th, 2012
    • You need to eat more FOOD in general. I over exercised, ate 1200 cal and am VLC. I get my carbs from green veggies.I felt ‘thick’ in the stomach. I started eating more food, walking instead of chronic cardio and lift weights heavy weights for only about 10 min and my blood sugar went way down, lost 4.5 pounds in 2 weeks and my stomach fat melted off. I have very little body fat, 5’8, 118. I do all this for blood sugar. I was afraid food would raise it but chronic exercise and under eating did. Mark’s the man!

      Kristin wrote on August 28th, 2012
    • If your calories are that low and yet you feel no appetite you’re likely starving yourself in some way or another but for some reason you’re not feeling it. That low calorie, you likely have thyroid hormone issues that could be messing with your weight loss. http://drcate.com/going-low-carb-too-fast-may-trigger-thyroid-troubles-and-hormone-imbalance/

      Whether you have thyroid issues or not though, the treatment is pretty much the same. Add more carbs back in. But be judicious about it – sweet potatoes, potatoes, less-sugary fruits, especially if eaten with fibrous veggies to slow digestion/insulin response would help prevent any potential weight gain from the insulin while the carbs may solve some hormone issues. If you are doing high-intensity exercise (weights, sprints, short runs), eat protein + carb afterwards and that will fix your leptin levels in case they’ve dropped from too much low-carbing (though I’d guess it is more thyroid related, because 25%BF means a relatively high baseline leptin). Also, try intermittent fasting to get the most bang for your carb buck – IF + exercise + protein/carb post-workout meal = great fat loss. Keep the diet the same on non-workout/non-fasting days (low carb). Let us know how it goes :)

      Adam wrote on August 28th, 2012
    • For a woman, 42, 25% BF is very good

      WildGrok wrote on August 28th, 2012
  12. Thank you for clearing this up, Mark.

    Diane wrote on August 27th, 2012
  13. another great article, Mark — an example of why i send the nutritionally-ignorant to your site when i get a chance!

    tess wrote on August 27th, 2012
  14. Speaks to the fact that we all have to figure out what carb load works for our bodies, during weight loss and then after weight loss! Try not to get stuck in a rut. Its an ever changing balance to nourish our bodies they way each individual needs! :)

    Joanne - The Real Food Mama wrote on August 27th, 2012
  15. My personal experience after 2.5 years primal…was probably type II or close to it when I started…great blood sugar control now EXCEPT in the morning where I regularly wake up to readings over 120. Scares me but I’m doing some “n=1″ experiments to see if I can improve the situation. Until I get that down, around mid-day, I am foggy. I have found that the lower my blood sugar the sharper my mind is. All the other benefits of my lifestyle far outweigh this concern. Stress seems to impact my morning readings as well. If I have a big day ahead and it’s weighing on me my numbers are up in the morning. On weekend mornings they are lowest.

    JB wrote on August 27th, 2012
    • I’m experiencing this to some extent as well. I’m trying different things to see if I can lower my morning readings and I’m curious what experiments you have tried or are going to try.

      I’ve lately been tinkering with the makeup and timing of my dinner and activity to see if it makes a difference but so far I’ve only noticed that when my meal or activity before bed contributes to poor sleep my morning levels will be higher.

      Also, have you taken your blood sugar midway through the night to see if your high morning readings are caused by dinner the night before or by some mechanism in your body raising your levels at about the time you normally wake up?

      Anyone else tinkering with this stuff? I’m curious what got you guys good or bad results.

      Tina wrote on August 27th, 2012
      • Yes. I find that sleep quality has alot to do with morning fbs. Late dinners and/or late bedtimes don’t help my sleep.

        Cortisol is the wakeup call and also elevates bs. If I get up when I wake up, my fbs is good. I have a bit of meat asap which seems to keep it from going up any further.

        Always looking for new ideas!

        gibson girl wrote on August 27th, 2012
      • Try a glass of red wine, like a Pinot Noir before bed. Drops my blood sugar from high 90′s to low to mid 80′s.

        Dave, RN wrote on August 27th, 2012
        • Ok, Kristin and Dave vote for a glass of red wine with dinner. You don’t have to twist my arm on that one! I will happily give that a try.

          Tina wrote on August 28th, 2012
      • I’m a (60 yo female Type 2) diabetic and recently started taking digestive enzymes (plus following a lot of Chris Kresser’s digestion advice) so I could drop Nexium from my meds.

        Strangely enough, within a couple of weeks of taking the enzymes, my blood sugar went from a fairly consistent fasting level of 120 to 95 (I’m in Australia so hope I’m doing the conversions to US mg/dl correctly).

        Indy51 wrote on August 27th, 2012
        • That is really interesting because although I haven’t looked deeply into the possible reason behind it, a friend of mine mentioned that her type 1 child experienced much better blood sugar stability when he started adding some papaya with his meals. We were speculating that it was partly caused by the papaya enzymes contributing to better digestion. It definitely was not the expected result based on the GL of papaya and as a result I put it on my list of things to try the night before to see if it changes my morning number.

          I appreciate your comment. I will look into digestive enzyme suppliments too (even though they aren’t as delicious as papaya!)

          Tina wrote on August 28th, 2012
        • That is really interesting because although I haven’t looked deeply into the possible reason behind it, a friend of mine mentioned that her type 1 child experienced much better blood sugar stability when he started adding some papaya with his meals. We were speculating that it was partly caused by the papaya enzymes contributing to better digestion. It definitely was not the expected result based on the GL of papaya and as a result I put it on my list of things to try the night before to see if it changes my morning number.

          I appreciate your comment. I will look into digestive enzyme supplements too (even though they aren’t as delicious as papaya!)

          Tina wrote on August 28th, 2012
    • Might not be the perfect plan or liked by all but one glass of red wine WITH dinner does wonders for morning levels. One glass is enough. Lots of cardio vascular benefits as well

      Kristin wrote on August 28th, 2012
      • The Wine: It works fine as it stops the liver producing glycogen and blood sugar from proteins because it must first clear the ethanol through the liver, a top priority job! (Hope Papaya hasn’t a similar toxicity mechanism..). But 30 minutes hard walk after dinner can have the same effect or even better on a low carb diet: It is enough to deplete muscle and liver glycogen depots: On a standard diet this glucose is replenished within a few hours, but on a low carb high fat diet it could take 48 hours ! That is the time for good BS my DB2 friend (morning BS 7.0) told me and we figured out it is either the depots and/or triggered growth hormones that is/are doing the trick! And then ready to do further testing on this I found first that after every 45 min walk that my blood sugar was always very close to or on 5.0 from sometimes over 6 before, and my morning sugar below 5.5, and then my blood sugar meter just gave up!

        An other thing that has been totally left out from the start is the insulin level of the “physiological insulin resistance”(PIR) . Is the treshold 3 or 13 or individual? Are there any studies apart from mice fed high fat with 10% glucose+10% sucrose to demonstrate PIR ? Coming back to the reason for PIR, preservation of BS: does it normally set in a BS of 5,4 or 3? If higher the preservation argument must be flawed.
        Finally

        sten bj wrote on June 12th, 2013
    • Mine is similarly around 120 in the morning, but goes down by itself in an hour or two whether I eat or exercise or not. My A1c is 5.8–good but not great. I tried Metformin, even worked my way up to a high dose, but it did not help. I do snack (fruit and cream) at bedtime, which is supposed to help but I don’t think does. I think I’m not going to worry about it unless my A1c goes higher. All the other oral diabetes medications are more dangerous than the problem. I would consider a low dose of basal (long acting) insulin, but would that extra insulin in my blood do more harm than the slightly elevated morning bg?

      Pamsc wrote on August 28th, 2012
    • I used to eat right before bed, because I couldn’t sleep otherwise. Consequently my BG levels were always high in the morning. After will-powering to organise myself to eating between 7-8 pm and going to bed around 10 pm, my readings really improved to low end normal. I’ve also switched to preparing lighter (mostly protein) dinners, e.g. Caesar’s salad (just balsamic vinegar for dressing) – you don’t need much energy for sleeping anyway.
      Worth a try…

      pinkmuffin wrote on November 1st, 2013
  16. Thanks for the great post!
    Just a small correction: brain glucose uptake is insulin independent. The brain doesnt need insulin.

    Ivars wrote on August 27th, 2012
    • Well actually: http://www.diabetes.co.uk/type3-diabetes.html
      “Studies carried out by the US Brown Medical School research team identified the possibility of a new form of diabetes after finding that insulin is produced by the brain as well as the pancreas”.

      Robyn wrote on April 10th, 2013
  17. Man, people are really divided on this whole carb and starch debate – undoubtedly gives weight to personal exploration of literature and nutritional experimentation on oneself. But, the first paragraph couldn’t be more true for college kids: everyone wants to know why you don’t touch grains and processed foods, and if you don’t have a concise answer prepared, they’ll dismiss the legitimacy of your diet in a second.

    Peter wrote on August 27th, 2012
    • Easy enough, just send them here, tell them about gluten, gliadin, antinutrients in beans, the evils of industrial seed oils, how cholesterol is harmless and you’re good. Or just tell them to go mind their own business, or that you’re celiac. :)

      As for carbs, eat the smallest amount that your body needs based on workouts, etc. The less glycation/insulin, the better for longevity.

      raydawg wrote on August 28th, 2012
    • my concise answer is: “Look at me and look at you. And you still need to ask who’s right?? Now get out of here, you’re interrupting my intermittent fast!”

      JPizzay wrote on August 28th, 2012
  18. Thank you for this, Mark.

    There seems to be a growing animosity against those of us who are both paleo/primal AND low carb–with claims that we will experience increased insulin resistance and hypothyroidism from very low carb diets.

    I’m glad you’re putting the insulin resistance myth to rest.

    Janknitz wrote on August 27th, 2012
    • The insulin resistance is a protective mechanism so that red blood cells and very long nerves don’t starve. The rest of the body can happily run on ketones.

      It’s not harmful, though if you take a glucose test where you have to fast, then drink a nasty orange flavored glucose bomb drink, you’ll fail that test. But the test itself is meaningless since it doesn’t account for this mechanism.

      Get enough carbs to run your body, and no more.

      raydawg wrote on August 28th, 2012
    • I went paleo/primal AND low carb and kept up my intense workouts and now I have PCOS. It’s a seres of symptoms all related to glucose resistance.
      I’ve always eaten extremely clean food, so this is a real shock that this could happen to me.
      I wish I had been better informed about this before. Because I gained 50 pounds this last year…. it’s impossible to get off of me now.
      I am eating more carbs and trying to reverse the insulin resistance now.
      My macros are now 40P – 30C – 30F.

      Laura wrote on September 9th, 2012
      • Hey, I am new to this site but I saw your comment and the exact same thing happened to me I think. I have gained almost 40lbs in the last 5 months and counting since I started to eat “normally” again and I don’t know what to do. I know this post is a year old. Have you had any luck?

        Kristen wrote on November 7th, 2013
  19. Great article Mark. You always cover the best topics at the perfect time. I suggest there is room for more information on type 1 diabetes and paleo eating. Specifically and relating to this topic, when I eat very low carb (carbs coming from only my protein, nuts/seeds, eggs and vegetable sources, which are non starchy) my insulin needs can go up almost 1 1/2 to 2 fold. This is most evident after a high carb (75 grams) day and then going low carb for the next day on. While it’s suggested there is “no reason to think it’s a pathological problem,” people stepping up to this diet with diabetes may need extra support and certainly needs to test their blood sugar 10-15x a day until their body is adapted. I am looking forward to more information on paleo and type 1 diabetes. This diet is paramount for long-term diabetic health, in my opinion and walks of life.

    Kelly O'Connell Schmidt wrote on August 27th, 2012
  20. So my question then is where to get the carbs from? I absolutely refuse to eat grains again, I don’t even like them anymore and do not miss them at all.

    I’d have a tough time ever getting back up to 100 grams of crabs a day as I come nowhere near that currently. I really don’t want them either, I have more energy now than I ever have and I feel fantastic. I would hate to do anything that would change that.

    Aaron wrote on August 27th, 2012
    • Mmmmm . . . crabs.

      Flossie wrote on August 27th, 2012
      • LOL.

        Garde wrote on August 28th, 2012
    • I get my carbs from fruit and vegetables. My green smoothie (organic whole milk plain yogurt – though I am going back to Greek yogurt once I finish these containers — spinach, coconut milk, almond butter, a single square of dark chocolate) has 20 carbs without adding berries.

      Nicole wrote on August 27th, 2012
    • Aaron;
      Sweet potato baked/roasted in ghee or straight butter, or kale cooked in broth /garlic and sprinkled with nori and gomasio with maybe a couple of egg-yolks on top are two frikkin divinely tasty carb. go-tos. The latter being super-quick when hungry. Eight minutes from decision to consumption. (Provided you have prepared stock on hand in fridge/stove).

      Ma Flintstone wrote on August 28th, 2012
    • I manage to get 50-100 grams just eating nonstarchy vegetables and small servings of low-sugar fruit.

      For me, it’s not low-carb, but good carb, and I measure “good” by the nutrition I get for the carbs. E.g. carrots, onions, squash and blueberries are in.

      I make this distinction cause I did “low carb” for decades and ate a LOT of crap. Getting the vast majority of carbs from fresh produce is different than just eating “low carb”.

      jpatti wrote on October 5th, 2012
  21. This gets so confusing…

    I thought that going low carb, high protein was a good way to healthfully lose weight or at least get excess fat off my body. It simply isn’t working.

    How do you know if you’re eating too much protein? My diet is mainly spinach/kale/tomatos/carrots, 300 grams of lean protein, olive oil, 1 apple a day and some vega one protein powder.

    That’s pretty dang low carb but certainly no NO carb,

    Even with this diet my blood sugar level is not low enough to satify my dr. I’m not happy as I can NOT seem to lean out.

    Advice?

    Belinda wrote on August 27th, 2012
    • No saturated fat, liver, egg yolks? Those are important.

      (If you’re still scared of fat, see: http://www.youtube.com/watch?v=exi7O1li_wA
      http://www.youtube.com/watch?v=flLwKQGm43A)

      Sofie wrote on August 27th, 2012
    • How much fat are you eating? It doesn’t look like you are eating near enough unless you are drinking quite a bit of olive oil. Also, you’re eating too much protein, which is probably being converted to glucose once you have used all your body requires.

      matt wrote on August 27th, 2012
    • Belinda,
      Matt is right, 300 grams is a lot of protein. Aim for 1-1.5gr of protein per body weight kilo as a guide. Dump the protein powders if you are getting enough protein from food. Lack of good fats (grass fed beef, butter, etc)in the diet may not be helping your hormones which are critical to fat loss – especially in women. Kill the apple for occassional berries.

      Anthony wrote on August 27th, 2012
      • Not sure about this one, i’m sure 300g of protein was a typo. But protein intake is dependent on your lean body mass (muscles, tendons, bones, organs etc.) not necessarily bodyweight. Of course it’s all dependent on your goals.

        JPizzay wrote on August 28th, 2012
    • 300 grams of protein?! Are you a 300lb football player?

      “Low-carb” is a misnomer. It’s “low-carb, adequate protein, and the rest is fat”. Some people have trouble stomaching even the minimum of protein, 60g.

      Or, do you mean you eat 300g (2/3 lb) of meat?

      Moshen wrote on August 27th, 2012
      • Whoa..hold the phone.

        300 grams is 100 grams per serving which is just a few oz. It’s really NOT allot of meat. Adding in the protein powder does increase my protein level, something I haven’t really thought about.

        I’m 5’9 and 153 lbs, about 18/19% BF.

        I’m pretty liberal with EVOO..I mean REALLY. I used to eat Coconut oil but I found my waistline growing hence I cut it out. I’ll also eat a few almonds and by a few I mean 6-8 a day.

        I do have to consider that my HCL level may not be high enough to handle 300 grams of protein. I’m just SO hungry a mere 2-3 hours after I eat.

        Thanks for the advice.

        Belinda wrote on August 27th, 2012
        • So you are talking about 300g of a protein food, about 10 ounces, of which the macro nutrient called protein is about 90g. That might be adequate – you may need more fat – saturated fat – to stop being so hungry.

          Kare wrote on August 27th, 2012
        • One delicious and extremely simple recipe using a liberal amount of EVOO is as follows..basically a fat and protein soup, good for breaking fasts.
          All ingredient amounts are your choice.
          EVOO in pot (I used to use about 1000 calories worth after caloric restriction days for dinner), on low to medium heat.
          Melt in cheese.
          Add whatever seasoning you want.
          Add meat, probably best ground. I normally used canned fish that was salted. It mixed easily and tasted really good.
          Add eggs if desired.
          Once it’s all warm, it’s ready.
          And that was basically it. Sometimes I’d cook onions for it beforehand or just add a small amount of chopped raw onion and/or garlic. I usually ate some other raw vegetables with it but I bet they’d be good cooked and mixed in.
          I don’t like the taste of plain olive oil but found that recipe enjoyable.

          Animanarchy wrote on August 30th, 2012
        • 300 grams of protein is much different than a 300 gram serving of protein.
          To get 300 grams of protein you would need to eat approximately 1300 grams of chicken breast.

          Laura wrote on September 9th, 2012
    • Listen to the interview that Jimmy Moore did with Dr. Steve Phinney. This will address your concerns:
      http://www.askthelowcarbexperts.com/2012/08/23-long-term-stalls-weight-gain-even-on-a-well-formulated-low-carb-diet-dr-stephen-phinney/

      Lezlee wrote on August 28th, 2012
    • How is a female with 18-19% bf not pretty leaned out-already?

      DarcieG wrote on August 28th, 2012
      • the grass is always greener… ;)

        JPizzay wrote on August 28th, 2012
  22. Thanks for addressing this issue, Mark. I have seen family members and, anecdotally, others report high-normal fasting blood glucose levels (say, 95-105) on very low-carb primal diets. Some digging led me to physiological insulin resistance, such as you discuss here, as a likely explanation for these results. Understanding that high fasting blood glucose levels could represent a consequence of a “normal” physiological response to low carb intake, I still wonder whether elevated blood glucose levels could nonetheless be problematic, perhaps by increasing causing production of harmful (inflammatory) AGEs through the process of glycation. Interestingly, second-hand reports of Chris Masterjohn’s talk at AHS 2012 indicated that Chris believes high blood glucose levels per se may not be the key factor in the production of AGEs. If that is correct, it would seem to allay at least one possible concern regarding the effects of physiological insulin resistance on a very low-carb primal diet. In any case, I would appreciate hearing your perspective on this issue whenever you have an opportunity to address it.

    Brian wrote on August 27th, 2012
    • did you ever get anywhere with your question regarding complications of low carb induced insulin resistance? i’m in that group- 101 but lean-ish (6′, 175), healthy, active, no food cravings, no family history of diabetes and eating F60%; P30%; C10%. wondering what implications might be long term, especially when i occasionally stray (pizza/beer or pasta once a week)! if it is just a bit of weight gain, no worries, but if it is heart or kidney problems…

      alan wrote on March 10th, 2013
  23. Interesting article Mark…

    Ed wrote on August 27th, 2012
  24. Nobody seems to be talking about fat as a replacement for grain-based carbs (except a few lonely commentators). I don’t believe there is a need to consume these carbs anymore when they are replaced with fat – butter, coconut oil, and other animal fats.

    I broke my body fat plateau with a dramatic increase in saturated fats which fuel the body and the brain.

    As another commentator said: low carb, adequate protein and the rest is fat.

    Just drop the grain-based carbs altogether and if you are tempted, get carbs from veges and sweet potato.

    Craig Pendergast wrote on August 27th, 2012
    • A good in a nutshell explanation. Love it.

      JPizzay wrote on August 28th, 2012
    • Agreed! Good point craig. However, i prefer to go with low carb, above average protein and rest fat. Don’t want to lose any muscle mass just because of keto.

      Darren@KetoDietPlans wrote on November 23rd, 2012
  25. I’m wondering if i fall within the category of prolonged ketosis even though i have carb refeeds on the weekends…I’m at the point where all i crave is animal fat, meat, and veggies.

    JPizzay wrote on August 27th, 2012
    • I find a half of pound of whale blubber satisfies any cravings I have.

      Paleo Bon Rurgundy wrote on August 28th, 2012
  26. Craig, I second that motion!

    Nocona wrote on August 27th, 2012
  27. as a vegetarian with out of control blood sugar, I stumbled into Marks web site….which dove tailed with Dr. Richard Bernstein’s book “Diabetes Solution” ,which I was reading, encouraging no carb eating and I went Paleo. Well..46 lbs lighter, with incredible blood work numbers, and my diabetes blood sugar plunged until its almost under control (one drug)… only)..Paleo is the way to go.

    rik wrote on August 27th, 2012
    • Do you mean the real deal Paleo or Primal. I see it interchanged and used the same a lot. Paleo to me is more lean meats less sat. fat. No dairy!

      msfish wrote on August 27th, 2012
  28. http://drrosedale.com/blog/2012/08/18/a-conclusion-to-the-safe-starch-debate-by-answering-four-questions/#comments

    Read this article and check out the comments. Quite a bit of good information.

    Jonathan Swaringen wrote on August 27th, 2012
  29. I do a very low-carb and high fat diet on a regular basis and I have been leaning out and continuing to lose fat rapidly.

    My one caveat is that once every week or two I do a carb refeeding day to keep me from going crazy and from letting my metabolism stagnate. I think this has kept the insulin resistance from becoming an issue.

    Drumroll wrote on August 27th, 2012
  30. Guys,

    Could you please provide your opinion on this. I’ve gone primal a couple of months ago, and things are chugging clong quite nicely. I lose weight, gain some of it back on heavy carb weeks, generally my body seems to be responding how i want it to.

    I lift weights three times a week, and i’ve recently moved from lifting heavy for very short set to doing 75% of my bodyweight for sets of twenty. It damn near kills me- My question is, could this be accurately considered a sprint?

    My aim is both to trim down my 17% body fat, and to balance strength along with it.

    Your advice would be much appreciated.

    Mark Issac wrote on August 27th, 2012
    • Sounds like those sets could give you some benefits of a sprint.
      A sprint can be anything you do at maximum effort and speed.
      But if you do anything that makes you burn, strain, and have to catch your breath, it’s basically the same as a sprint, in my opinion.

      Animanarchy wrote on August 30th, 2012
  31. ****My question is, could this be accurately considered a sprint, and would it help me lose wight?

    Mark Issac wrote on August 27th, 2012
    • Work out fasted, and don’t eat after the workout for about 1-2hrs (you could if you want to bulk up, but not if you want to lean out.) You can also ingest some black coffee with Yohimbine to help the process (but yohimbine should be on an empty stomach, or else it won’t work.)

      No, those aren’t sprints, sprints are running at top speed for a short while (until you’re winded). You could do sprints in an HIIT form, that is, run in bursts until you’re winded and feel the burn, rest for a few minutes and do it again 4x-5x.

      See the leangains site for more info about that.

      raydawg wrote on August 28th, 2012
  32. I eat 1-2 kilograms of sweet potato everyday, along with chicken breast. Do you think that is too much?

    will wrote on August 28th, 2012
    • that’s about 150kcals per kg of raw sweet potato in carbs right there, it is a lot, but if you’re not trying to lose fat, it’s ok — as long as you don’t ingest other carbs. But you probably want to stay under 1kg.

      And wouldn’t you want to eat a big salad as well? So why limit yourself to such huge portions of sweet potato, and why eat the same thing every day? That’s not healthy, you’re hitting the same metabolic pathways day in and day out.

      Also, why just the chicken breast? You do know there’s fish, shellfish, grassfed beef/bison/lamb, and especially their livers out there.

      Eat different stuff every day, and even do IFs once in a while.

      raydawg wrote on August 28th, 2012
      • I’m trying to gain weight, around 10 kilograms. I eat tuna as well and steak 3 times a week.

        I was wondering what are some alternatives to gaining weight following paleo principles. I need something relatively cheap and calorie dense-like sweet potato (although that makes me somewhat tired following large portions

        will wrote on August 28th, 2012
    • chicken breast?! Gross ;) 1-2 kilos of sweet potato sounds like a lot unless you’re training competitively or building houses by hand from scratch. But if you’re thriving off it and feeling great, see how far it’ll take you!

      JPizzay wrote on August 28th, 2012
  33. Those omega-3s taste uber after not having them for a while.
    I wish stores sold salmon juice by the bottle.
    And remember, they’re good for your brain, so eat fish and you’ll acquire sardine wit. ;)

    Animanarchy wrote on August 28th, 2012
  34. I don’t think an extremely low-carb (ketogenic) diet over a long period of time is a good idea. Eliminating sweets and grain products is an excellent idea. But eliminating fresh vegetables and small amounts of fruit (also considered carbohyrates) in favor of nothing but protein and fat is like throwing the baby out with the bath water. It eliminates many of the vitamins and nutrients the body needs for healthy functioning.

    Incidentally, according to my very experienced homeopath, low-carb is the best thing out there for normalizing blood pressure. This means protein, healthy fats, AND vegetables, along with small amounts of whole fresh fruit.

    Shary wrote on August 28th, 2012
    • Who said you can’t have fresh fruit and veggies? If you search for the shopping list on this site you will see that there is a wide range of fruits and veggies you can have. The fruits listed have a low-glycemic index that is important for this new way of eating.

      Trishie wrote on August 28th, 2012
      • I realize that. I’m going by the number of comments I’ve read (on this and other web sites) from people who seem to think that if less is good then none is better. Actually, all fruit and veggies have something to offer nutritionally. For more rapid weight loss, sticking with low glycemic is best.

        Shary wrote on August 28th, 2012
    • I disagree completely. I’m fairly sure you can get all the vitamins and minerals you need out of a well formulated VLCKD.

      If you eat offal, bone broth and such. I haven’t run any numbers but that’s my gut. For those that like vegetables/fruits it may not be ideal but I think its possible.

      At this point since I don’t have numbers I can’t prove you wrong but my gut says you are.

      From eating fish, bone broth, and different kinds of pastured meat that covers at least all the amino acids. That I’m fairly sure of.

      Jonathan Swaringen wrote on August 29th, 2012
      • To get some of the vitamins that are destroyed by cooking (e.g. Vitamin C), you have to eat at least some of your animal products raw, or at least very rare. (which I do)

        That claim does coincide with what I have read. It does appear to be possible to get 100% of your nutritional requirements from animal sources. In fact, I think that a combination of pastured eggs and large insects (grasshoppers, roaches, waterbugs, etc.) eaten raw would do it. Personally, I’m not much for eating insects or raw eggs, so I choose to supplement with dark green and purple veggies, and occasional fruit. And some modern-day supplements.

        It is also possible to get 100% of your requirements from a vegetarian diet — with a great deal of effort. I don’t think it’s possible to do so with a vegan diet (which I regard as an extreme eating disorder) without supplementation with synthetic vitamins.

        Howard wrote on August 29th, 2012
        • Why insects at all though? Were you just saying that you’ve read its possible with insects? I’m fairly certain it would be possible with just beef, pork, chicken with some organ meat included.

          Add in fish and bone broth. While eating some raw or close to raw…should get everything. Whats in insects that you couldn’t find in one of the others?

          Jonathan Swaringen wrote on August 29th, 2012
        • It would be great to see Mark post about the possibility of getting everything you need as far as vitamins, minerals, aminos, etc. from animal products (including delicious organs)…and just eating veggies for fiber’s sake.

          JPizzay wrote on August 29th, 2012
        • I am curious about Antioxidants as well. I know vegetables and fruits are touted for their antioxidants.

          Can you get plenty of them from animal products? I think so but I don’t know very much about that. A properly formulated VLCKD would be anti-inflammatory for sure though.

          Hey Mark do a post please thanks :)

          Jonathan Swaringen wrote on August 29th, 2012
  35. I’ve been primal since end of Nov 2011–about 9 months. After years of highish triglycerides of 150 and above, I just got my trig results today: 74!

    Down over 10 pounds from last year, too. (Now 112 lb, but I’m very small-framed. I can do pull-ups and everything, quite muscular now. The nurse commented this morning, “Nice muscles!”)

    That’s after a cruise last week where I drank plenty o’ wine, rum, tequila… and even had some brioche and desserts and whatnot.

    Since triglycerides levels correspond to the body’s handling of blood sugars, I’d say this lifestyle has done wonders for me. My family history features high trigs.

    I eat fruit each day with my daughter, along with ample veg and meats. I do take an omega-3 once a day, too. The main thing I changed was to drop grains from my daily diet.

    Last year, I was all about the rice and beans and avoiding animal fats. Not this year, and the HDL went up from 50 to 77, too. I’m very surprised and pleased today, so I’ll not be sweating insulin resistance any time soon.

    Joy Beer wrote on August 28th, 2012
  36. About the protein, this is how I do it…

    I generally eat approx 75% of my lean body weight with up to 30gm of carbs in the form of fruit/veggies per meal. The rest come from plenty of fat.

    If I eat 40gm or more carbs per meal I get sleepy and tired.

    The only time I eat 1 – 1.5gm of protein per pound of lean body weight is after heavy training like weight lifting, sprint etc for the last 24 hours. Then, it is back to 75% of my lean body weight. Works well every time.

    Karl Roberts wrote on August 28th, 2012
  37. Need help and advice:

    About 5 months into a very low carb and high fat diet, my usually low BS of 80-95 shooted to 174, then 190 and then 204… I was wondering if its due to the increased protein or something else.

    I eat natural foods and no packaged or processed food… no fruit, no hidden sugars in anything I eat…

    My weight is 118lbs, 5ft 3ins and normal blood pressure.

    Comments please

    Fergie wrote on August 29th, 2012
  38. If I eat around 50g of Carbs a day am I allowed one or two beers a day? Please? :-)

    Chris wrote on September 6th, 2012
  39. Interesting article… starting to make sense. I went primal about a year ago. I went really low carb. Didn’t lose ANY weight. Then, as soon as I added carbs back in, I gained 50 pounds just as quick as anything. I’ve been going to the Doc. Tests say my glucose is spot on, but I have all the symptoms of PCOS. The symptoms all stem from glucose resistance.
    This article explains what has happened to me. I was really confused how I could become glucose resistant after eating such a low carb diet.

    Laura wrote on September 9th, 2012
  40. I do Leangains and carb cycle. The 100-150 grams of carbs on the curve is ridiculous and has no scientific basis. I do 35 grams of carbs on rest days and 270-ish on training days and I’m lean. Eating too much fat, too much carbs or too much protein will make you fat, not good carbs for active people.

    No, I’m not a sugar burner. I burn fat and glucose like all people.

    Kate wrote on September 14th, 2012
    • This will greatly depend on what you do on your training days. Do you do crossfit type workouts that burn glycogen/glucose? Then yes, carbs are necessary. I’m assuming at 270g of carbs on training days means you’re doing some intense stuff. Whatever the case, it’s working for you so keep doing it! ;)

      JPizzay wrote on September 14th, 2012

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