Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (42 page)

– Dr. Jay Wortman

Cardiologist Dr. William Davis also says the claims about very low-carb diets and reduced thyroid function are “simply untrue.” He says that when someone on a ketogenic diet loses weight, levels of thyroid-stimulating hormone (TSH, one of the three key thyroid hormones checked on a thyroid panel) increase and free T3 (another thyroid hormone that’s checked on a more advanced thyroid panel) levels decrease, which some falsely believe indicates hypothyroidism. But Dr. Davis says this is not entirely accurate. “This specific situation does not represent disturbed thyroid function, but rather a physiologic adaptation to limit weight loss by reducing metabolic rate, a survival mechanism that is meant to protect the body from starvation,” he explains. “These hormonal adjustments are transient and correct themselves over several weeks after weight has plateaued. But it does not represent thyroid dysfunction.”

We see a drop in thyroid hormone levels over the short term on a ketogenic diet, but that’s balanced by a more responsive sympathetic nervous system response.

– John Kiefer

As for adrenal fatigue on a ketogenic diet, the thinking has been that a low-carb diet stresses the body, leading to overworked adrenal glands and leaving you feeling tired, fatigued, shaky, unable to recover from workouts, and worse. But what if none of this has anything to do with eating a ketogenic diet? It’s more likely that these are symptoms of an underlying issue that was there long before the shift to a ketogenic diet—if not done properly, the transition could trigger a latent problem.

There are anecdotal reports of people experiencing symptoms of adrenal fatigue or hypothyroidism after being in ketosis for extended periods of time; however, to the best of my knowledge, there are no studies corroborating these reports.

– Franziska Spritzler

Being in a state of ketosis
lowers
the amount of stress on the body through the elimination of such culprit foods as sugar, white flour, grains, legumes, and more. Switching over from the unnatural and stressful state of being a sugar-burner to the more relaxed state of being a fat-burner is arguably far less taxing on your adrenal glands. Getting enough sleep, doing some light exercise, and engaging in stress-lowering activities will do more to help with adrenal fatigue than trying to blame it on a ketogenic diet!

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Any approach to eating that is substantially different metabolically from what most people are doing—like a low-carb, ketogenic diet—may lead to blood values that are outside the “normal range.” This doesn’t always mean that the value is unhealthy, because the “normal range” is defined by what is most commonly seen. The levels of thyroid hormone, for example, may be outside the normal range and yet perfectly healthy if the body needs less thyroid hormone in the blood because it is more sensitive to it. Similarly, most keto-adapted people have so-called abnormally low blood glucose because they are burning ketones so much that they don’t need high glucose levels anymore!

4. LDL and total cholesterol increase to unhealthy levels on a ketogenic diet.

An excess of oxidation-prone LDL particles is, by a long stretch, the most common abnormality in people who develop coronary heart disease and heart attack. People who consume plenty of “healthy whole grains” have astounding excesses of these damaging LDL particles. People who eliminate grains and sugars and enjoy a healthy state of ketosis experience the dramatic reduction, even complete elimination, of these small, dense LDL particles.

– Dr. William Davis

When you consume a low-carb, high-fat diet, HDL cholesterol (the good kind) goes up, triglycerides come way down, and LDL cholesterol particles shift from the dangerous small, dense kind to the much more benign large, fluffy kind. (We talk about all this in much more detail in our book
Cholesterol Clarity.
)

It is true, though, that two numbers on your cholesterol panel—LDL-C and total cholesterol levels—may go up in some people on a ketogenic diet. The question is whether or not that indicates something bad is happening with your health. LDL-C, a calculated measurement, and total cholesterol are actually two of the most uninteresting numbers on your cholesterol panel, and they don’t really matter as much to your overall health as other numbers. What does matter is the LDL particle breakdown, which is presented separately in a more advanced cholesterol panel known as the NMR LipoProfile test.

So what should you be paying attention to in your cholesterol tests? Make sure your HDL cholesterol is above 50, ideally higher than 70 (consuming saturated fat helps get you there). Get your triglycerides under 100, ideally under 70 (cutting your carbohydrate intake does this best). Shift your LDL particle size (determined with the NMR LipoProfile test, which any doctor can have run) to mostly the large, fluffy kind (by eating a low-carb, high-fat, ketogenic diet). Additionally, get an hsCRP (high-sensitivity C-reactive protein) blood test to check for signs of inflammation, the
true
culprit in heart disease, and a CT scan of your heart to look for any signs of disease.

And if you are concerned about your cholesterol while on a low-carb, high-fat diet, read
Cholesterol Clarity,
which delves into this topic in great detail.

5. Very low-carb diets induce mucus deficiency, leading to dry eyes and mouth.

The so-called problem of ketogenic diets leading to mucus deficiency is being grossly misinterpreted. First, I have not seen this in decades of using this diet with patients. Second, the claim is that mucus is a glycoprotein that requires glucose, so not eating glucose will diminish its production, resulting in dry eyes and mouth. However, this makes little sense in light of the fact that during starvation, serum glucose is maintained at normal levels almost until death. In other words, there is plenty of glucose available if it is absolutely necessary.

– Dr. Ron Rosedale

This criticism of very low-carb diets simply leaves me crying. Seriously?! The idea is that because our bodies need glucose to make mucus—including saliva, sweat, and tears—if you don’t consume enough carbohydrates, you’ll be reaching for the Visine early and often. Can I just say how utterly ridiculous this is? As someone who has eaten a low-carb, high-fat diet for over a decade, I’ve never had an issue with dry eyes and mouth. And I’ve interacted with tens of thousands of people who eat this way and never once have I ever heard anyone dealing with this issue.

Nutritional consultant and educator Nora Gedgaudas says that “no healthy person adopting a ketogenic diet is going to need to worry about” a mucus deficiency. “I can honestly say I have personally never once encountered a ‘mucus deficiency’ issue when it comes to this way of eating,” she said. Gedgaudas said there is “a lot of fearmongering” that is “absurdly alarmist and completely unrelated to a normal, healthy ketogenic state.”

Mucus production happens normally on a very low-carb diet because our bodies can make enough glucose through gluconeogenesis. Unless there is some underlying metabolic issue regarding amino acids, this criticism is really a red herring. Gedgaudas notes that a study published in the June 2006 issue of the
Journal of Nutrition
found that impaired production of mucin (the molecules that make up mucus) has more to do with amino acid imbalances than a “carbohydrate deficiency.” Consuming bone broth and pasture-raised gelatin will help restore any amino acid imbalances, she explained.

If someone on a very low-carb, high-fat, ketogenic diet is dealing with dry eyes and mouth, it’s more likely that they are simply more prone to this than others. Sensitivities to specific foods or food components could also contribute to these problems. This underscores the importance of tinkering with your own diet to look for things like dairy intolerance, problems with nightshades (tomatoes and peppers, for instance), and more. An autoimmune elimination diet can help you determine if you have a sensitivity to particular foods. To learn more about that diet, check out
The Paleo Approach
by Dr. Sarah Ballantyne.

6. The lack of fiber in a very low-carb diet results in constipation.

Dietary fiber has been given a virtual health halo by nutrition experts as the ideal way to fill you up and keep you regular. So it should come as no surprise that a very low-carb diet would come under fire from these same health gurus. Yes, you do greatly reduce the amount of fiber you consume when you eat a ketogenic diet. However, you can get plenty of fiber from non-starchy and green, leafy vegetables without resort to eating “healthy whole grains.” Furthermore, constipation is easily avoided by simply drinking more water and adding more sea salt and magnesium to your diet.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Just about everyone notices that they tend to have fewer bowel movements after going on a ketogenic diet. This is not a medical problem that needs to be treated. However, if you have hard stools or hard-to-pass stools during the keto-adaptation period, then drinking water, consuming bouillon broth, and using milk of magnesia are all useful remedies.

7. Very low-carb, ketogenic diets contain major nutrient deficiencies.