Hey Everyone!
You may recall that a while back I released an e-book about Alzheimer’s disease and the potential therapeutic role of a low-carbohydrate, high-fat diet and other lifestyle interventions. Well, I’m happy to announce that the book has been completely rewritten and expanded for release this month as a print book from Chelsea Green Publishing, with a foreword by none other than David Perlmutter, MD, author of the #1 New York Times bestseller, Grain Brain!! 

Chelsea Green is a big deal, folks. They publish the fermentation bible, a.k.a. Wild Fermentation, by Sandor Katz. They are also the U.S. distributor for Dr. Natasha Campbell McBride’s books—Put Your Heart in Your Mouth and Gut and Psychology Syndrome (the original GAPS™ diet book), which are both outstanding. They’re also the U.S. publishers for The Ketogenic Kitchen, by Domini Kemp and Patricia Daly. (Patricia is Ireland and the U.K.’s go-to gal for all things related to keto for cancer.) CG is also publishing the new release of Travis Christofferson’s Tripping Over the Truth (which I reviewed here) – the book that inspired my blog series on the metabolic theory of cancer. So you can see I am in very, very good company among these folks.
My book, The Alzheimer’s Antidote: Using a Low-Carb, High-Fat Diet to Fight Alzheimer’s Disease, Memory Loss, and Cognitive Decline, has been rewritten and expanded with new and even more powerful information, all of which only strengthens my basic premise: Alzheimer’s disease is, at least in part, a systemic metabolic condition, and as such, there are dietary and lifestyle interventions that could potentially stop or slow the progression of this condition, and possibly even reverse some of the damage that has already occurred.
One of the fundamental aspects of Alzheimer’s disease is that neurons in regions of the brain involved in memory processing lose the ability to metabolize glucose efficiently. In fact, in noting that Alzheimer’s patients show as much as a 45% reduction in cerebral glucose utilization, one study’s authors said that this is the predominant abnormality in incipient late onset Alzheimer’s disease…” This is not a matter of debate. There are many things we dont know and dont understand about Alzheimers disease. This isnt one of them.  That metabolic issues involving perturbed glucose and insulin processing in the brain are major factors either directly causing or at least exacerbating Alzheimer’s pathology and progression are so undeniable that the phrases “type 3 diabetes,” “brain insulin resistance,” and “metabolic-cognitive syndrome” are now regularly used in the scientific literature. (Yep, you already knew about plain ol’ metabolic syndrome, but when you throw dementia and cognitive impairment into the mix, you have metabolic-cognitive syndrome.)  The reduction in cerebral glucose metabolism is not controversial. The controversy lies in what causes this and what to do about it.

If you’ve already read the electronic version of the book (and thank you for that!), I would still recommend buying this print version, especially if a loved one is afflicted with cognitive decline or impairment. Not because it’ll fatten my wallet (it won’t; if you think anyone writes a non-fiction book about a topic like this as a moneymaking endeavor, you are wrong), but because it contains a lot of information that is not in the e-book. The chapters on exercise and sleep have been expanded significantly, as have the chapters on the controversial role of beta-amyloid, the role of the ApoE4 genotype, and others. Additionally, the print version contains two entirely new chapters that are not in the e-book at all: one on brain fuel metabolism and one on prevention strategies. In my (admittedly biased) opinion, the chapter on brain fuel metabolism, which includes the whys and wherefores of ketones, is worth the price of the book all by itself, particularlyfor people who are completely new to all of this. (Most of you reading this right now probably know exactly why it is perfectly logical to elevate ketones as a therapeutic strategy for a brain that has lost the ability to metabolize glucose effectively. It could not be more obvious, honestly, and why this is not already the standard of care is beyond me.) Frankly, learning about the concepts of “type 3 diabetes” or “diabetes of the brain” alone is worth it, because I guarantee you millions of people with AD have never heard that before. The chapter on the the importance of cholesterol for healthy cognitive function, and the ever-deepening detrimental effects of statins is also crucial info.
I recently contacted my alma matersto see if they would help spread the word about the book. (One would hope the schools where I got my writing and nutrition degrees would want the world to know that an alumna has authored a book, right?) My grad school did a very nice profile of me, which you can read in its entirety here, but I thought I’d share the responses I provided to two of the questions the media coordinator asked me:

Q: Why is the publisher excited to put this book out?

A: Chelsea Green Publishing is releasing several books related to low-carbohydrate, high-fat and ketogenic diets for a variety of health concerns. The company’s leadership has followed the medical research and recognizes the merit in using dietary means to support health and potentially combat a number of illnesses for which conventional medicine is failing. Alzheimer’s disease certainly fits this description. Some of Chelsea Green’s staff read my e-book and recognized how important it would be to get the information to the people who need it most. Right now there’s really nothing to help individuals with dementia and their families. There are long term care facilities, nursing homes with dementia wards, and financial planners who can assist people with getting their affairs in order in preparation for their decline and debilitation, but there are few to no resources arming people with information and strategies they can implement to potentially halt or at least delay disease progression. Certainly, many unanswered questions remain and there are many decades of research still ahead of us, but that doesn’t mean we are completely without actionable information right now.
Knowing people would be unlikely to stumble upon my book via my little-known blog, Chelsea Green approached me about publishing an expanded and updated print version so that we could bring this stunning data to a much wider audience. It’s a relatively small publishing house that focuses on a few niches, such as organic farming and gardening, homesteading, holistic health, sustainable food production, green building design and architecture, and more. Using scientifically sound dietary strategies to potentially fight some of our most devastating illnesses fits in nicely with their focus on healthy living.
Q: What are you most hoping to accomplishing through this book?

My goal is to educate and empower loved ones and caregivers of individuals with Alzheimer’s disease, mild cognitive impairment, and other forms of dementia and cognitive decline. A large and still growing body of scientific literature points to certain factors that may be contributing to the etiology and progression of cognitive decline, and these individuals are seeking information about how and why these conditions may have developed, and what can be done about them. I am not a physician, nor am I involved in conducting primary laboratory research. As a nutritionist and professional writer, I see my role as being that of an interpreter, translating the scientific findings into plain English in order to empower people to apply the relevant information in their own lives and the lives of the Alzheimer’s, dementia, and cognitive impairment sufferers they care for. The people who need this information the most don’t have time to comb through the medical journals looking for answers. And if they did, not all of them will have the background to make sense of the biochemical jargon.
My book makes the case that we are not powerless in the fight against these dreaded conditions. There is something we can do about them. People have felt helpless for too long, and have resigned themselves to accepting a fate that may be possible to sidestep with the proper interventions. There are strong links between insulin resistance, impaired glucose metabolism in the brain, and Alzheimer’s disease, to the point that researchers now regularly refer to it with the phrases I mentioned earlier: “type 3 diabetes” or “diabetes of the brain.” Based on an understanding of Alzheimer’s as a systemic metabolic problem, rather than some unknowable and completely mysterious illness localized solely to the brain, there are dietary and lifestyle interventions that hold great promise in slowing disease progression and possibly even reversing it to some extent. Considering that the pharmaceutical drugs developed to date for Alzheimer’s have failed time and again to have any appreciable impact on the illness, exploring other strategies is long overdue. I hope that my book contributes to this new landscape and serves as a springboard for those affected by cognitive impairment to conduct their own further research and take control of their health future.
Okay, back on message. As you know, dear readers, as I explained above, I am not a physician, nor am I a researcher who works with mice or humans in a laboratory. What I do think I do well is translate the scientific findings into plain English so people can actually understand it and do something with it. Beta amyloid inhibits the pyruvate dehydrogenase complex? What does that mean, and why does it matter? More ATP and fewer reactive oxygen species are generated from metabolizing ketones than from glucose? Okay, so what?
My book is the so what.
The new and improved, expanded and updated print version of The Alzheimer’s Antidote is available for pre-order on Amazon now. If you’re thinking this book is something you or someone you know would find useful, please consider pre-ordering, rather than purchasing it after it’s released. It will really boost the book’s visibility and cachet if it posts big sales on the first day. (If I understand correctly, all the pre-orders will count as first day sales.) So go ahead and buy a copy for yourself and 400 of your closest friends. (And if you live within a reasonable driving distance of the DC metropolitan area, consider arranging a meet & greet or a low carb pot luck. I’d be happy to come — with a dish! — have a chat, and sign books!)
P.S.  Click hereto see what Dr. Perlmutter, Robb Wolf, Dr. David Brady, and Franziska Spritzler, RD, had to say about the book.

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

New Perspectives on Low Carb Diets for Weight Loss

As I wrote about in a recent post, I’ve finally gotten active in a few Facebook groups dedicated to low carb and ketogenic diets. There’s a world of good being done there, and heaps upon heaps of great information being shared—life-changing and life-saving information people aren’t hearing from their doctors. But there’s also a lot—and I mean a lot—of stuff that makes me want to: a) grab people tightly by the upper arms and shake some sense into them (because that’s more humane than ramming them head-first into a brick wall, which is what I’d really like to do in some cases), or b) wrap them in a long, warm hug, and help them feel better about things. I got all my keto-related anger out in the epic end-of-year rant I posted in December, so today, let’s focus on the kinder, gentler side of things.

I am paraphrasing, but here are a few examples of what I routinely read in various FB groups and blog comments:
  1. “I’ve been following a strict ketogenic diet for two months and have only lost 10 pounds. What am I doing wrong?”   
  2. “I’ve been doing strict keto for three months. I’m off my blood pressure medication and have reduced my insulin dose by half. I feel fantastic and have tons of energy, but I haven’t lost any weight. Why isn’t this working for me?” 
  3. “I’m doing a keto diet and I lost four pounds the first week, three the second week, then only two the third week, and now I’m up a pound. What did I do wrong?” 

Let’s address point number 3 first, since it’s the easiest to knock out of the way. As I wrote about back in this post, weight loss is almost never linear. It just isn’t. To expect it to be is an exercise in frustration and disappointment. If you want to be frustrated and disappointed, then by all means, go ahead and expect that your weight loss will be a straight decline, with absolutely no stalls, plateaus, gains, bumps, or hiccups along the way.  
When you want your weight loss to look like this…
…but it actually looks like this

…well, there’s nothing wrong, mysterious, or surprisingabout it. Not in the slightest. This is how it happens. If your weight loss is linear, especially over a long period of time, with no plateaus and no ups and downs, just downs, downs, downs, please see a doctor ASAP, because you might have some kind of terrible wasting disease and you should get that checked out STAT. Otherwise, ups and downs are normal. They’re angering, yes. They’re frustrating, yes, and disappointing, yes. But They. Are. Normal. Capice?  I could waste lots of time blathering on about why they’re normal, but my posts are already always too long, so if you want to pick my brain about that, feel free to book an appointment.  😉
Let’s look at that second weight loss graph.
As I explained a while back, there are all kinds of hiccups along the way. We’ve got some stalls & plateaus wherein weight stays the same for a while, and we’ve even got some weight gain here and there. But when you look at the entire graph, the progression, over time, is downward.
But what happens when people trying to lose weight step on the scale every day? The small day-to-day fluctuations drive them absolutely crazy. Being “stalled” for a week or two—or a month or two—or gaining a pound or two or four, might even make them quit whatever program they’re following, when they’re actually doing just fine.  According to the good doctors Volek and Phinney, day-to-day fluctuations of as much as four pounds are totally normal. It is not reflective of fat loss or gain. (What could it be, then? Water, glycogen, karma, Saturn rising in Aquarius…) And I can’t find the reference at the moment, but I’m pretty sure I’ve heard Dr. Phinney say he doesn’t consider it a “stall” unless there’s been no change in weight or size (inches/cm) for more than eight weeks. Eight weeks! And most people posting on keto and low carb forums with woeful tales of stalled weight loss are frantic because it’s been one or two weeks. *Facepalm.*
Here’s another fun way to look at how weight loss works in the real world:

I saw this image on Facebook and saved it because it was so awesome. I don’t know who created it, though, so I can’t give credit where it is due. Please know that I am not trying to take credit for work that is not mine. If you happen to know who made this, let me know and I’ll update the source info.

On to points 1 and 2:

Here is my combined response to people who post similar tearful tales:
“You’ve lost 10 pounds in 2 months? You should be proud of yourself and celebrating, and instead youre beating yourself up and feeling like a failure. Please stop! Please think about it this way: if you had gained 10 pounds in 2 months, that would seem like a very, VERY BIG DEAL, right? So why is it not an equally big deal that you’ve lostthat much? You said it yourself: you’ve already experienced a huge improvement medically and you feel fantastic. That says it all. Please, give yourself credit!”
Let’s focus on the sentence in bold. I emphasized it because I wish I could say this to everyone out there who’s fretting and feeling disappointed at what they perceive as a slow weight loss. Any loss — any loss at all — is proof that at least something you’re doing is effective. What if you’ve only lost eight pounds, instead of ten? Or you’ve lost six or just four pounds? You’ll beat yourself up for your perceived failure, when if you had gained four, six, or eight pounds in the same timeframe, you would … well, you would beat yourself up for your perceived failure. (Why? Because eight, six, or even four pounds ARE a big deal! Got it? Good!)
About the second part—experiencing wonderful improvements in medical conditions, even when weight loss is slow or perhaps not even occurring at all: fat loss is a nice goal, but if you are living with metabolic syndrome, T2 diabetes, heart disease, PCOS, kidney dysfunction, hypertension, or any other condition currently believed to be intimately linked to insulin resistance, then your time and dietary efforts are better spent focusing on improving your health, rather than your weight. Low carbohydrate and ketogenic diets have many, many benefits beyond weight loss. In fact, some of the therapeutic effects are observed in people who don’t lose weight. So rest assured that in following a nutrient-dense low carb diet, your health is likely improving even when the dastardly scale would have you feel like a failure.
And remember—always, always remember—being “thin” is not indicative of being healthy. Body mass index and other metrics that take only body weight into account say absolutely nothing about someone’s metabolic health. I use the acronym “TOFI” pretty casually (thin outside, fat inside), but it’s actually a pretty big deal. To the extent that excess adiposity is reflective of insulin resistance and harmful metabolic dysregulation, then yes, losing some of that excess fat is probably a sign that you’re correcting some of that dysregulation. But in that case, the goal—the prize to keep your eyes on—is better health, not smaller pants.     
Easier said than done, I know. (Believe me, I know. I haven’t learned all this by serendipity, y’know.) But just something to keep in mind, because it makes me sad when I see people feeling like low carb isn’t working for them when they’re actually doing beautifully.

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Low Carb Cooking Class! (LC3) — Roasted Vegetables

Time for another installment of Low Carb Cooking Class!
Today’s lesson is for people who claim they don’t like vegetables.
Let’s get one thing out of the way: despite what has been pounded into your head for pretty much your entire life, vegetables are not actually requiredin the human diet. They’re just not. I’m sure that is quite shocking to some of you. (What about fiber?! What about feeding your gut bacteria? What about the phytochemicals?! Don’t we need quercetin, resveratrol, curcumin, sulphorophane, and other goodies we get from plants? Well, sure, they might be helpful in certain circumstances, but required? Nope.) There are no essential nutrients—none—that you get from plant foods that you can’t get from animal products. You can, indeed, live on a “zero carb” or animal-only diet. (Kind of like the opposite of veganism.) You don’t even need the fiber. In fact, lots of people with IBS and other issues related to impaired digestion of plant material seem to do better on diets low in indigestible fiber. I’m not saying I recommend a zero-carb diet; only that it is, technically, possible. (And not only is it possible, but many people are absolutely thriving on this way of eating, when just about everything else—including regular ol’ low carb and ketogenic diets—did not give them the results they were looking for.) According to the Food and Nutrition Board of the Institute of Medicine of the U.S. National Academy of Sciences, “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed.” And since fiber is a carbohydrate, zero dietary carbohydrate means zero dietary fiber. But again, I’m not saying a zero carb diet is recommended or optimal; I’m simply noting that you don’t need to force down copious amounts of indigestible plant material if you really, really don’t like it.
But for those of you out there who do want to include vegetables in your diet, but maybe aren’t the biggest fan of them, why is this? My guess would be that you grew up in a home where your only exposure to vegetables was via frozen or canned vegetables heated up in a microwave, or fresh vegetables boiled beyond all recognition, with flavor and texture both rendered completely unappetizing. If you don’t like vegetables because you’re accustomed to being served veg that are mushy, soggy, bland, and just plain lifeless, that ends now!

Now that you’re low carbing, you can enjoy your vegetables drizzled with olive oil, topped with melted cheese, dipped in ranch dressing, used as a pasta substitute, or even used as a pizza crust. (Another good recipe for this here.) Vegetables can be boiled, steamed, grilled, stir-fried, deep fried, or…
Yes! I have converted more than one veggie hater into a veggie lover by serving them roasted vegetables. I have a good friend who had never liked brussels sprouts until he tried them roasted. This technique is dynamite. It transforms pretty much any and all vegetables into bits of extreme deliciousness.  
Here’s how it works:
Preheat your oven to 425°F/220°C. Chop the vegetables into similar-sized pieces, toss with olive or avocado oil (melted bacon fat or ghee might be even tastier), and season liberally with salt and freshly ground pepper. (To save washing an extra bowl, you can lay the vegetables out on a baking sheet and do the seasoning right there. For even faster cleanup, line the baking sheet with aluminum foil – your cleanup will consist of “remove foil from pan, roll up in ball, throw away.” You won’t even have to wash the baking tray. Score! [Am I concerned about aluminum foil touching my food? No. I wrote a book about Alzheimer’s disease, and I don’t think aluminum has anything to do with it.]) Spread the vegetables out in a single layer. A little overlap here and there is fine, but if you leave them in a big pile, they’ll steam, rather than roast, so give them room to do their thing.
Roast for anywhere from 10-25 minutes, depending on how well done you like your veg and how large the pieces are. What happens is, the outsides start to get brown and, in some cases, crispy, while the insides gets soft and tender.
The list of vegetables that become amazingly delicious when cooked this way includes:  brussels sprouts, broccoli, cauliflower, fennel, radishes, asparagus, zucchini, yellow squash, eggplant, green beans, carrots, beets, bell peppers, and onions—red, yellow, white—all of ‘em!  Roasting vegetables this way brings out their natural sweetness. What, you didn’t know broccoli had some sweetness to it? Or fennel? They do.
Roasted vegetables are pretty much the easiest side dish ever, except for eating vegetables raw. They require nothing more than salt, pepper, oil, and a baking tray.
Here’s a list of things you can serve this alongside:
  • Everything

No, seriously. This is the king of all side dishes. It works with meat loaf, steak, roast chicken, canned tuna, salmon, or sardines, pork chops, grilled or baked fish, and even cold cuts or hard boiled eggs if you’re reallyin a pinch for animal protein. There’s basically nothing you can’t serve these with. They’re great hot, cold, or room temperature, so they’re perfect for making a large batch to ensure you have a bunch of leftovers. To use the leftovers, eat them as-is, or use them in a frittata or chop them into smaller pieces to use in egg muffins.
Pro tip: toss the vegetables with balsamic vinegar after roasting, just before serving. (Even better if you reduce the vinegar into a thicker syrup consistency. Higher in carbs? Yes. Suitable for everyone? Maybe not. But still, we’re talking vinegar, not Twinkies, and with a concentrated balsamic vinegar reduction, a little goes a long way. And we’re concentrating the natural sweetness of the vinegar, but not addingany sugar or corn syrup to it, like you might see in bottled vinegar glazes.)
Another pro tip: instead of salt & pepper, toss with a spice blend you like. (McCormick’s Montreal Chicken works really well with this stuff, but there are plenty of others that would do just fine.)
Check out how one my very favorite low carb-friendly doctors, Ted Naiman, MD, puts this into practice. (The whole page is worth reading, but this roasting technique, specifically, is about 2/3 of the way down.) Cranking the oven up to 500° might be a little high, but hey, whatever works! That would probably just accomplish the task that much faster. In fact, you can go the other way and use a lower temperature – like 300°F or so – and it still works, but it takes longer. (Some people say the result is better, but that probably depends on whether you like the crispy & browned aspect, or prefer your veg cooked until soft and sweet but without the charring.)
Here are some pictures of this in action. Everything looks very plain, but looks can be deceiving. I assure you, with the right seasoning — really, just salt & pepper — roasted vegetables are wickedly delicious. As always, please excuse my lack of photography skills.
Everybody getting ready in the bowl, coated in olive oil, salt & pepper: yellow & orange carrots, 
fennel, red onion. (Quick, someone call the keto police! She’s eating carrots and red onions!)

Brussels sprouts, yellow and orange carrots
(Carrots? Quick, call the keto cops!)
Radishes and zucchini

Brussels sprouts getting nice and crispy-brown on the outside

I’ll leave you with some mouthwatering recipes for roasted vegetables from the cooking geeks experts at Serious Eats. I get hungry just reading the titles. Here are some other great ones. Except for the first one, which is from my beloved Ina Garten, a.k.a. the Barefoot Contessa, these are all from Michelle Tam at Nom Nom Paleo (whose food photography is outstanding):

P.S. If you do Brussels sprouts this way, you will see that the individual leaves that fall off get crispy and charred and they basically taste like popcorn. Yes, I eat charred food sometimes. Am I worried about consuming the AGEs? No. (Check out Nom Nom Paleo’s recipe for Brussels sprouts chips.)
Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Low Carb Cooking Class! — Roasted Chicken & Veg

Just when you thought my blog was becoming nothing but rants about ketogenic diets…
It’s time for another installment of Low Carb Cooking Class!
We’ve covered lots of ground so far in this series on very simple and easy cooking for low carbers like myself, who want to eat delicious, homemade low carb foods, but who are not about to spend a fortune on almond or coconut flour, erythritol, coconut aminos, and all sorts of other esoteric ingredients that are absolutely not required in order to put a nutritious and yummy low carb meal together. Here’s the territory we’ve visited so far

To be honest, I feel kind of silly writing blog posts that boil down to, “brown ground meat in a skillet with some onions and zucchini, and add some salt.” I mean, really? There are people who don’t know how to cook low carb like this? But maybe there are. And that’s what this series is all about—low carb cooking that is simple, easy, and above all, practical—the kind of cooking you’ll do all throughout the week, on busy nights when your kids have six different activities going on, or you get home from work and you’re ravenous, and you “don’t know what to make for dinner.
I have a nice collection of low carb, ketogenic, and Paleo cookbooks, and I love flipping through them for the food porn (and for ideas…food ideas, not porn ideas, haha), but to be honest, I rarely make any of the dishes in them. I have no kids and no boyfriend, so in preparing food for myself, sometimes dinner is as boring simple as a can of salmon and a raw green pepper. I think we somehow got this idea that every meal has to be the stuff of legends and worthy of being posted on Instagram. (I do not post pictures to Instagram, mostly because I’m a terrible photographer, but also because no one wants to see pictures of a can of salmon and a green pepper.)
So, in the interest of keeping things simple yet delicious, today we’re going to cover something that should be a staple of basic cooking for just about everybody, whether they eat low carb or not. It’s time for roasted chicken!

I’m going to expose myself to laughter and ridicule here, but here’s a confession: I was in my early thirties the first time I ever roasted a whole chicken. Oh, sure, drumsticks and thighs? No problem. Boneless breasts on the Foreman grill back in the day, with nary a molecule of added oil in sight? Yep, been there, done that. But it wasn’t until my third decade of life that I did a whole bird at once, and perhaps some of you out there have yet to take the plunge. A roasted chicken atop a colorful nest of vegetables is nutritious, delicious, and looks impressive as heck. And the good news is, it couldn’t be easier.
Happy chickens make delicious meat.
If you have the means, do your soul some good and start with a pasture-raised chicken from a local farm. You will pay a lot more for it than for a bird from a big supermarket, but you will know that your chicken enjoyed a life in the fresh air and sunlight, possibly eating some corn and soybeans in its feed, but also doing what chickens do best: foraging and pecking in the grass for bugs, worms, and other creepy-crawly grubs. (Note to people who are new to “real food” – chickens are not vegetarians! That is not a selling point on egg cartons nor on chicken packages. Ask any farmer—chickens are not only omnivores, they are cannibals! They will descend like…well, like vultures, if one of their own succumbs in the field. They happily and mercilessly eat just about anything, including their own.) Chickens raised on small, local farms will also not be plumped up with dextrose solutions and who-knows-what-else. They’ll be smaller, but very likely more flavorful. (As always, though, if super-special hoity-toity farm foods are not within your budget at this time, all hell won’t break loose if you buy a regular ol’ chicken from the regular ol’ store. I’ll still love ya. But keep in mind that food from local farms might not be as expensive as you think.)
Roasted chicken and vegetables is another great one pan meal, except this one requires a baking dish or roasting pan large and deep enough to hold the bird and the veg. (Something like this.) It’s helpful if it comes with a rack, but the rack is not absolutely necessary. You don’t need the rack; you can simply set the chicken directly on top of the vegetables.
Here’s how it works:
Preheat your oven to 350°F/180°C.
Rub the outside of the chicken with olive oil or melted or softened butter. Sprinkle salt and freshly ground pepper all over. (Yes, the freshly ground really does make a difference.) I like to use paprika, too, for the color and flavor, but you can use just about anything you like. Honestly, salt and pepper are all you need, but if you want to bump the flavor up a notch, sage and thyme work wonderfully, as does rosemary. You could also give your chicken a southwestern flair and use chili powder and cumin if you like. You can even loosen the chicken skin and sprinkle some of the seasoning directly into the meat, which will allow the flavor to permeate the meat a little better. If you’re using fresh rosemary or thyme, you can insert a few sprigs here and there between the skin and the meat. Depending on what kind of flavor you’re going for, something else that works is cutting a lemon either in half or into wedges and inserting them into the cavity. This is also great to do with a whole head of garlic – simply cut it in half horizontally (no need to peel it, although you might want to remove some of the outer skin if there’s a lot of it) and put that in the cavity along with the lemon. You’ll be able to eat sweet, roasted, soft garlic cloves with your chicken…YUM! (And yes, I feel kind of skeevy writing the phrase, “insert it into the cavity…” Indeed, you will be putting lemons and garlic into a chicken’s hoo-ha.)  To keep things really easy, just use poultry seasoning, or one of my all-time faves — McCormick’s Montreal Chicken blend.
That’s about it for the bird. It’s ready to go into the oven! But what about the vegetables? What kind of vegetables go well with a roast chicken?
Um, just about everything, actually. There are few vegetables that don’t lend themselves to roasting while being basted in the savory chicken juices. Carrots, celery, onions, zucchini, yellow squash, brussels sprouts, radishes, green beans, and fennel all work great. (For fennel, use the bulb and the stalks—yes, you can eat the stalks, just like celery. They’re good raw or cooked). Add some more lemon wedges to the vegetables—roasted lemons are delicious; they lose most of their pucker factor when cooked this way and become savory and just plain yummy.
If you’re on the higher end of low carb and occasionally enjoy sweeter and starchier vegetables, ones that would be dynamite here are parsnips, wedges of sweet or white potatoes, beets, or butternut squash. Whatever vegetables you use, try to cut them into similar sized pieces so they cook evenly. To be honest, though, it’s really hard to screw this up. Some pieces might be less well done, and others will be brown and tender and insanely delicious, and that’s totally fine.
To save yourself from having to wash an extra bowl, after cutting the vegetables, prepare them right in the roasting pan. Drizzle with a bit of olive or avocado oil and sprinkle generously with the same seasonings you’re using on the bird. You don’t need all that much oil, though; the vegetables are going to get plenty of yummy fat and savory goodness just by way of being under the chicken as it cooks.
Final step: set the rack in the pan, and the chicken on the rack. Or if not using a rack, simply set the chicken directly on top of the vegetables. Let the whole shebang bake for about an hour, and it’s done!
Here’s how it looks before it goes in the oven. I don’t have an “after” pic, which would obviously be way more appealing. (Sorry…I took this picture a while ago, long before I was blogging about low carb cooking, and it honestly didn’t even occur to me to capture the final product.) 

If you look closely, you’ll see that some of the carrots are yellow or purple. I used the “carrots of many colors” from Trader Joe’s. These things are a trip. They actually do have slightly different flavors, with the yellow ones being the most different from the others. (The yellow ones have a pleasant earthy flavor, reminiscent of parsnips and beets.) And get this…the purple ones are actually orange or yellow on the inside. It’s wild — check it out! Purple carrots also have a higher antioxidant content than the other colors do.

You are not going straight to low carb hell if you eat carrots.

As for making a sauce or gravy, they’re really not necessary. The chicken will be so moist and the vegetables will have basted themselves in the delicious chicken juices, so you won’t need anything extra at all.
And what to do when you’re finished with the chicken? Use the carcass for homemade stock! They don’t call this Jewish penicillin for nothin’. If you’re going to make stock, get a couple extra pairs of chicken feet from your farmer, or see if a local butcher will sell you backs & necks–the pieces with lots of bones and cartilage. It’s not absolutely necessary to add these to a batch of stock, but it does lend just a little more gelatin goodness. (The farm I work at sells chicken feet in bags of 4 for just two dollars. It’s one of the best bargains there is, except for $5 for a quart of lard from the happiest, woods-foraging pigs there are. We also sell chicken heads, at 4 for just one dollar. Yes, the really hardcore traditional cooks use the headsin stock…)
Well, that’s about it for this one. Like I said: couldn’t be simpler. Chicken and vegetables, seasoning, one pan, roast for an hour, and serve your happy, hungry family or your happy, hungry self. Bon appétit!

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

My Top 10 Favorite Posts

I missed my four year blogversary!
My blog has existed since August 2012. I would have celebrated sooner, but August 2016 blew right past me. (Probably because I was mired in a deep and longstanding depression, which I thought I was starting to come out of, but which is actually back in full force and only lifted temporarily.)  As of this writing, there are 242 posts. I don’t think I hit my stride until sometime mid-2013, but there are a couple of gems going back as far as September 2012.
For those of you who found me a few years into my blathering blogging, and since new people stumble upon my blog every week, I thought it would be nice to start the new year by sharing a selection of my personal favorite posts for those of you who have only recently tuned in, as well as for any of you who are wondering what the “must read” posts are. (In my opinion, anyway.) I tried to purge all my low carb and keto-related anger in a few posts prior to the close of 2016 so that I could start 2017 on a more positive note. I can’t promise I won’t post any more rants in the future (I think we can all agree I’m not physically capable of holding it in), but I am going to try to stick to things that are a little more scientific, as well as posting tips and insights that are helpful for following these types of diets in the real world.
With no further ado, here are my top ten favorites, in no particular order, except that the first one is probably nearest and dearest to my heart and resonates with me, personally, the most deeply:

A takedown of the idea that obesity causes the myriad other conditions it’s “associated with” (such as type 2 diabetes, heart disease, infertility, etc.), rather than it being yet another effect or symptom of underlying metabolic or hormonal dysfunction that is the true cause of health problems, and which occurs in people of all shapes and sizes, including those who are underweight or at a “normal” or “healthy” BMI (whatever the heck that even is, anyway). If, like me, you are tired of everything from cancer to a broken arm to a hangnail being blamed on somebody’s body weight, and you’re tired of people thinking they can make assumptions about someone’s dietary and exercise habits based on nothing but the size of their body, this one’s for you!
An 8-part series (so far…there will be more) that explores the underappreciated role of insulin in driving chronic illness in the industrialized world, and why a myopic focus solely on blood glucose has blinded us to a much more insidious and widespread problem. (Click here for an editorial I co-authored with Dr. Jason Fung on the topic.)
Within the insulin series, I honestly love all the posts, but if I had to pick favorites, I’d say they are part 6 (in which I wrote about the concept of “TOFI” – thin outside, fat inside, and how being “thin” does not mean someone is immune to the horrible consequences of chronically elevated insulin); part 3 (in which I wrote about the underappreciated role of glucagon in problems with blood sugar regulation, inspired by this video, which is absolutely worth your time to watch when you have 45 minutes to spare); and part 2 (in which I wrote about associations causal relationships between chronic hyperinsulinemia and/or hyperglycemia and a whole slew of health issues: hypertension, heart disease, PCOS, erectile dysfunction, kidney disease, gout, poor eyesight, and inner-ear and balance disorders (e.g., vertigo, tinnitus, Ménière’s disease), which are  typically deemed “idiopathic,” meaning no one knows what causes them. (Um, I think we do now.) Really, though all 8 parts are worth reading, if I do say so myself.
An eye-opening look at the not-at-all surprising link between statin drugs and increased risk for type 2 diabetes. (Sneak peek: in addition to lowering cholesterol [which is problematic in itself], statins interfere with synthesis of special proteins required for proper pancreatic beta-cell function. Nice, huh?) I will probably write a scathing post covering new and even more terrible things I’ve learned about statins since writing this one, but if you want to go straight to the source on the new stuff, this paper will make you furious. (Email me if you’d like the full text.)
A science-heavy (sort of) series covering exactly what it says – the metabolic theory of cancer. (That is, the idea that cancer is not caused by genetic mutations, but rather, by metabolic aberrations stemming from rampant mitochondrial dysfunction.) This series contains lots of explanations of biochemical processes. If you prefer my rants, this is not for you. On the other hand, if you are looking for plain-English explanations of some semi-high-level biochemical “stuff,” this is guaranteed to blow your mind a bit.
Within the cancer series, my favorite posts are Aerobic Fermentation (a.k.a. “The Warburg Effect”),  Glycolysis Run Amok & Mutant Hexokinase, Mutations Vs, Mitochondria (my personal #1), and Cancer as a Protective Mechanism. Unfortunately, if you don’t have at least a little steeping in the biology of cancer cells, you’ll have to start at the beginning and progress through the series in order. But it’s totally worth the price of admission, I promise! (And considering admission is free, you are actually making out like a bandit on this deal!)
My speculation on why some people coast through life never having to give a thought to body weight regulation, while others (like me!) seem to accumulate second chins and extra-large saddlebags just looking at a cupcake. Why are there people who seemingly don’t gain body fat no matter what or how much they eat, while others seemingly can’t not gain body fat, even when they “eat less and move more?” Why, oh WHY, is getting to and maintaining a lean physique completely effortless for some, and so, so damn hard for others? (But I’m not bitter or anything…)  ;D
The phrase “calories out” is too often used to encompass only the calories that are “burned” during deliberate exercise or low-level physical activity, rather than the myriad biochemical processes over which we have no conscious control, and which are responsible for expending the vast majority of calories we burn energy our bodies use. When we put body weight regulation down to eating less and exercising more – that is, taking in less energy than we expend through deliberate physical activity – we completely ignore the massive amount of energy our bodies expend just to keep us alive, whether we’re running a marathon or lying on the sofa. Why do some people’s bodies seem to use so much more energy for the unconscious processes than others’? That is, why are some people’s basal metabolic rates so much higher than others’? It’s not only about having more skeletal muscle mass. Something elseis at work, and until we acknowledge this and find ways to address it, many attempts at forcing fat loss in the short term (by eating less and moving more) will fail in the long term.
A deep-dive (a.k.a. extra-long post) into the concept of vitamin J. (Spoiler alert: it’s joy.) You can have the most pristine diet, the most hardcore workout program, a stockpile of fancy-schmancy super-expensive supplements, walk barefoot on the grass, wear special light-blocking goggles at night to help entrain your circadian rhythm better, and guess what? None of that matters if you hate your life. I could say more, but, well…just read the post if you have been trying—and failing—to “fix” your life solely by addressing your health and physique. Contrary to what we hear via social media, there’s more to life than avoiding carbs and vegetable oils.
As I reiterated in my epic year-end rant about strict ketogenic diets, some folks use these terms interchangeably, and they’re not interchangeable. There are important distinctions, and while some people might argue this is merely semantics, in my estimation, lumping these two approaches together as if they’re the same is leading to problems when people try to follow these diets over the long term, or when particular circumstances necessitate tweaks and changes in application.
A shorter and much lighter version of the aforementioned keto rant. Contrary to what some might believe, there are, in fact, human beings who can consume potatoes, fruit, legumes, and grains without becoming diabetic, obese, infertile, depressed, or keel over immediately from a heart attack. Really, there are.
My thoughts on why the backlash against low carb high fat diets is not based in science, but rather, in the prudish and puritanical attitudes we have in the U.S. toward rich, fatty, succulent animal foods. Can you imagine an Italian turning his nose up at prosciutto? A Spaniard saying no to a sizzling chorizo, with a chunk of manchego cheese on the side? Or a Greek man passing up a nice, juicy piece of roasted lamb leg in favor of fat-free feta? Please. Some of the backlash against low carb diets comes from people who are still brainwashed by the low fat, healthywholegrains “thing,” and who avoid fatty animal foods for ostensible health reasons, but in my opinion, it’s much more a product of people simply not being able to wrap their heads around the idea that it’s neither sinful nor downright deadly to indulge in the delicious flesh of a dead animal.
Honorable Mentions:
Why do so many medical professionals either ignore the stunning efficacy of low-carb diets, or worse, actively warn patients againstimplementing this potentially lifesaving nutritional strategy? Do they ever feel like failures when patient after patient only continues to get worse, and requires ever-increasing doses of medications with dangerous side-effects? Do they ever stop to wonder why their patients’ health deteriorates? Do they assume patients don’t follow their advice, rather than stopping to question if maybe the advice, itself, is the problem? (There was a follow-up post as well, in which I pointed out that many of the physicians who use low carb and ketogenic diets in their practices have come to do so after trying to get healthy or lose weight with the conventional advice themselves, and failing.)
An exploration of the structure and function of the entire digestive tract, north-to-south, from the brain to the bunghole. (No, the brain is not technically part of the digestive tract, but it’s definitely a player in what, when, and how much we eat, and how well we do or do not digest what we eat.) Ever wonder just what the heck your gallbladder is for, or what your pancreas does aside from helping to regulate blood sugar? This is your chance to find out. I cover it all: leaky gut(and the connection to autoimmune conditions), hypochlorhydria (low stomach acid, and why antacids are a terrible idea, because stomach acid is good for you), constipation (and its connections to depression), and more!
Some of my very first posts, from back in 2012!
Saturated, monounsaturated, polyunsaturated. What do these terms mean, and what are the implications for the different fats we should favor for hot applications versus cold applications, and which oils we might want to avoid ever eating. (Sneak peek: there’s a reason you never see recipes calling for deep-frying anything in flaxseed oil, and you don’t make salad dressings with beef tallow.) Also: what, exactly, are trans fats, and why are they so undesirable in the food supply? And omega-6 & omega-3s – where do these terms come from? What do those numbers mean? I go through all of that and more! (Gets a little technical, especially in the post about transfats, but if you’d like a good layman’s intro to the chemistry of this stuff [or need help falling asleep], this will be up your alley.)
Happy Reading!
P.S. Did I miss anything? Do you have a favorite post I didn’t mention? Are you a fan of the food label posts? Did you like the explanation of being in ketosis versus being fat-adapted

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Stop Following a Medically Therapeutic Diet "Just ‘Cuz" (a.k.a. The Keto Train to CrazyTown)

This is a very long post (even for me). Take it or leave it. You have been warned. Comments have been disabled for this one. Love this post or hate it, agree with some of it, disagree with some of it. Whatever your feelings, you are free to express them elsewhere.  

This will be the last of my emotionally charged posts for a little while. I have to get it out of my system, but once it’s out and the new year gets underway, I’ll focus on posting things that are more educational and helpful (or intended to be, anyway).

It’s funny. Considering I advertise myself as a low carb and keto-friendly nutritionist, I often find myself recommending that clients eat morecarbs. More protein. And that they abandon weighing and measuring every morsel of food and pouring olive oil and melted butter on everything in an effort to arrive at some magical, no-fail, automatic-fat-loss-inducing macronutrient ratio somewhere upward of 75% fat.
I have been threateningpromising on social media for a while now that I was going to post an epic rant about some problematic things I see when healthy, fit, active people follow a medically therapeutic diet because they have come to believe they should. (Or worse, have come to believe that they have to, because it’s the only way to be healthy and prevent metabolic illness. 
Now, before I get into things, we’ve got to establish some ground rules:

  • This post is not an attack on ketogenic diets. If you think I don’t understand the therapeutic benefits of ketogenic diets, then you obviously have not been reading my blog for very long. (Shame on you. Ha! No, just kidding. If you’re new, welcome!) I have extolled the virtues of ketogenic diets in podcast interviews, in my e-book about Alzheimer’s disease (which has been completely rewritten and expanded for release by a big name publisher in March 2017, so please, don’t bother buying the e-book; wait until the new one comes out. It’s much better [and available for pre-order now!]), and I’m leading up to addressing the benefits of ketogenic diets in the series I’m writing on the metabolic theory of cancer. I think ketogenic diets have tremendous potentialwhen they are applied intelligently and rationally. Unfortunately, as is true for fasting, with so many (sooo many!) people jumping onto the keto wagon these days, the words “intelligent” and “rational” aren’t applying as much as we might hope.  
  • This post is not a personal attack on anyone. As always, if what you’re doing is working, then keep doing it! If you eat a certain way, and you feel well, have enough energy to do the things you enjoy doing, and you’re happy with your moods, cognition, body composition, emotional well-being, and whatever biomarkers you like to keep track of, then by all means, keep eating that way! If you enjoyfollowing a strict ketogenic diet, then keep following it.

So if this post is not about those things, then what is it about, and why am I writing it?

It is not my goal to preach, proselytize, or “convert” anybody into following or not following any particular diet. The funny thing is, despite being a low carb, Paleo, and keto-friendly nutritionist, the truth is, I don’t give one flyin’ hang what you eat. The reason I’m writing this is because it needs to be written. (And either no one else is as riled up about these issues as I am, or no one else has the courage to call people out on their nonsense, so if I want this message to get out, then it’s up to me to do it.)
I am writing this because even though strict ketogenic diets can be great—GREAT—for many people for many reasons, they might not be appropriate for everyone, all the time.
I see this time and again in clients.  Much like what I said about fasting, the reason I have to tell both sides of the story is because I see the effects of what happens when people don’t fare so well on super-strict ketogenic diets. Just because something works like magic for one person doesn’t mean it’s going to work equally well for everyone else at all times. I receive inquiries from people following very high fat, very low carb diets, and they feel fatigued, anxious, weak, depressed, their athletic performance is regressing, and maybe they’re even gaining body fat. (Yes, even when insulin levels are low, they’re gaining fat.) So, like my fasting post, if you feel fine following a super-strict ketogenic diet, then keep following it. This post is about people who don’t feel fine.
Allow me to reiterate, because past experience has shown me that no matter how clearly I explain myself, someone will always get their panties in a bunch by trying to apply what I say to their unique snowflake situation. SO: if you have been following a long-term super-strict ketogenic diet and feel that you are at your physical, mental, emotional, and cognitive best, carry on! This post is not for you. This post is for people who do notfit that description. I am daring to suggest that maybe—just maybethis one, single approach might not be the best way for everyone, everywhere, no matter their circumstances—to eat.
Here’s where things get a bit gnarly, and I have to muster up the courage to just say what needs to be said: it is noteworthy how much any way of eating with a particular label affixed to it—be it Paleo, low carb, ketogenic, vegan, vegetarian, or something else—seems to attract individuals with borderline or full-blown eating disorders or obsessive/neurotic tendencies.
I am not a psychiatrist. I can’t help these people with their food “issues.” If they’re scared to eat altogether, or scared to eat certain foods, there’s not a whole lot I can do about that. All I can do is bring their attention to it, and make them aware that I didn’t just fall off the turnip truck and they ain’t hidin’ anything from me. I do it as kindly and as gently as I can, but I do try to point out that they do not have a healthy relationship with food, and that the level of restriction and regimentation they are imposing on themselves is likely a direct cause of the things they have contacted me for help with: fatigue, anxiety, depression, amenorrhea, lethargy, weight gain, and more. 
Just as with fasting, it seems that the majority of people who experience these issues from a ketogenic diet are women. (I guess it would be pretty strange if a man wrote to me asking for help with his amenorrhea…) They’re almost always women. Women who usually, but not always, have a history of anorexia, vegetarianism, veganism, or raw foodism. They use keto as another way to restrict food while pretending they have healed their relationship with food and with their bodies. There is a lot of orthorexiaand anorexia in KetoLand™. A lot.These individuals use keto to pretend like they’re eating normally, but the degree to which they restrict and the degree to which they are straight up afraid of perfectly benign foods is still massively disordered behavior around food. (They are still essentially starving themselves for total calories as well as micronutrients; they just happen to be doing so while eating a small amount of food that sticks to rigorously imposed ketogenic percentages.)
To be clear, it’s not always women who run into trouble on long-term uber-strict keto. There are plenty of men who get themselves into these messes too. I see them on social media all the time. When I work with clients like this, in trying to get them to even think about expanding their diet, I point out that even though they’re afraid to start eating certain foods again, they can acknowledge that what they’re doing now isn’t working. They don’t feel their best. If they did feel well, and if they had no physical or psychological ailments bothering them, they wouldn’t have contacted me for help. They might need some time to get used to the idea of eating more food, and eating a wider variety of food—especially carbohydrates—but they can at least see that something has to change, because they’re not getting anywhere by doing what they’ve been doing.
With that in mind:
Dear healthy, young, fit, lean, athletic people who DO NOT FEEL WELL: Please stop following a medically therapeutic ketogenic diet.
In my blog and with my clients, I try to differentiate between ketogenicdiets and low carbohydrate diets. They are not the same. I think semantics is starting to get us in trouble. These terms are not interchangeable, but many people are using them as if they were. And as I have written about before, a great number of people who would do just beautifully on a low carb diet have somehow convinced themselves that they must be strictly ketogenic, and stay strictly ketogenic at all times, forever and ever, even when they don’t feel well anymore. So before I go on, I should probably define some terms, or, if not define them, then at least share my thoughts:
Low carb diet (LCD):  This is very hard to define, because, well, it’s not defined. For my purposes, I’ll say it’s a diet under 100 grams of carbs per day. Obviously, compared to a ketogenic diet, 100g of carbs is high, but compared to a standard American or modern Western diet, it’s low. For reasons I’ll explain in a minute, I dislike going by percentages and I think percentages are quite problematic, but since many other people seem to be so hung up on that: for someone eating 2000 calories per day, 100g of carbs (400 calories) would be a mere 20% of total calories. Compared to the 40-60% of total cals from carbs that millions of people consume daily, 20% is plenty low. On plain ol’ low carb diets, protein is not restricted, and while fat is also not restricted, people are not encouraged to add unlimited amounts of extra fat in order to arrive at some pre-determined ratio. (Notice I have called this low carb, but not “low carb, high fat.” Just low carb.)
Medically therapeutic ketogenic diet (MTKD):  A diet formulated to have a ratio of approximately 3:1 or 4:1 of fat to combined protein and carbs. (That is, 3 or 4 times as much fat as protein and carbs combined.) This typically means that in addition to restricting carbohydrate, protein must also be restricted, and the major emphasis is on fat. Some people like to give percentages instead, for example: 77% of total calories from fat, 13% from protein, and 10% from carbohydrate. As I said, I’m not a big fan of the percentage model. Percentages don’t tell us much, because depending on someone’s total caloric intake, the absolute grams of any of these things could vary significantly. (For example: on a diet of 1800 calories per day, 10% of carbs is 180 calories, or 45 grams, but on a diet of 8000 calories per day, 10% would be 800 calories, or 200 grams of carbs, which would pretty much prevent ketosis regardless of how much fat was being consumed. I realize this is an extreme example, and it’s unlikely that anyone aiming to be in ketosis would be eating 8000 calories per day, but it’s just to show the point: percentages don’t mean much. Someone eating 77% of calories from fat and 10% from carbohydrates will not be in ketosis if their total caloric intake is massive. The ketogenic state has more to do with what is lacking in the diet [carbohydrate] than what is present in large quantities [fat]. More on this in a bit.) For a MTKD, whatever parameters are used regarding ratios or percentages, carbohydrate intake is usually limited to 20-30g per day or less.
Ketogenic diet (KD):  I’m not sure how to differentiate this from a MTKD, except that the people who follow a “ketogenic diet” and use the term relatively loosely tend to focus on the carbohydrate restriction angle. These more “casual keto” diets — not super-strict ones being used as medical therapy — are usually less than 30g of carbohydrate per day (with some insisting this be total carbs, and others insisting it’s net carbs [total carbs minus fiber]). Beyond that, protein is not restricted, and fat is more variable: eat more fat, eat less fat, depending on your goals. But gobs and gobs of extra fat arent required in order to achieve a specific ratio or percentage. The main difference between “casual keto” and low carb is that even though low carb is still … well, low carb, it might be higher than 30g of CHO per day. But they’re similar in that protein and fat are modulated based on someone’s goals (changing body composition, in particular), and not pre-determined by a set ratio.
What these three approaches have in common is carbohydrate restriction, albeit to varying degrees. Where they mostly differ is in protein and fat.
In a nutshell:
MTKD:  Very low carb, very high fat, reduced protein
KD:  Very low carb, moderate fat & protein, or “adequate” protein, adjustable fat
LCD:  Lower carb than standard diet, but not always as low as ketogenic; adequate protein, no particular emphasis on fat loading. (Emphasis on low carb, rather than high fat.)
I think where people run into trouble is in following a MTKD when they would fare just fine—if not better—on a low carb diet or ketogenic diet unrestricted in protein and without following orders from on high to add gobs of extra fat to everything. And in this case, when I say “MTKD,” I mean that people are aiming for what they have internalized to be some kind of “magical ketogenic percentages”—so, not necessarily the 3:1 or 4:1 math. Basically, they’re aiming for very high fat, very little carbohydrate, and just enough protein to not die. (Usually going for 70% or more of total calories from fat.) It seems to me that most of the problems that arise on ketogenic diets are the result of people chasing these magical percentages without much of a pressing reason for doing so.
Before that, though, let me address an even more important issue than low protein, ultra-high fat, and ultra-low carbs…
Electrolyte imbalance/insufficiency is probably the single most common and easily correctableculprit behind people feeling like poop on these dietsparticularlyif they work out hard and sweat a lot. Y’know why sweat tastes salty? Because you lose sodium when you sweat!!Owing to the effects of insulin on the kidneys, ketogenic diets (by way of lowering insulin levels) have dramatic effects on how the kidneys reabsorb—or, as the case is, don’t reabsorb—and hang onto electrolytes, especially sodium, potassium, and magnesium. Signs & symptoms pointing to a need for more of these include fatigue, headaches, lethargy, leg cramps, edema or swelling/fluid retention (especially in the lower legs), and maybe even nausea and lightheadedness.
Bottom line: even if you’re eating plenty of green leafy vegetables (which are good sources of Mg and K), you probably still need to supplement with extra, and you definitely need to salt your food (or drink broth made with bouillon cubes). Very low carb diets are not compatible with low sodium intake, PERIOD. If your physician has prescribed a low sodium diet for you due to elevated blood pressure, please know that insulin affects blood pressure far morethan sodium does, and the number 1 best thing you can do to reverse hypertension is adopt a low carb diet, or at the very least, quit sugar.
Okay, now back to magical percentages. There are four main reasons people aim for a high percentage of fat on a ketogenic diet:

  1. Disease management or prevention
  2. They believe that more fat = higher ketones and higher ketones = better results
  3. Weight loss
  4. Optimizing health

Let’s address each of these in turn.
Disease Management
or Prevention
In case you forgot from when I mentioned it way back at the beginning of this post, I am well aware of the therapeutic potential of ketogenic diets. People are using them for cancer, neurological health, mood disorders, and more. But just because ketogenic diets help people manage or reverse medical conditions doesn’t mean ketogenic diets are required to prevent those conditions from developing in the first place. I wrote about this in a guest post on Robb Wolf’s site a while back:  Calling an exterminator and having him fumigate your house will kill an insect infestation in your home, but that doesn’t mean setting off bug bombs in your house is required to prevent the infestation from occurring in the first place. You can use other, less drastic measures to ensure you don’t need the more extreme solution later on. (Better insulation on doors & windows, not leaving food out, etc.)
Has every octogenarian and nonagenarian who’s reached old age free of dementia, Parkinson’s disease, cancer, and type 2 diabetes followed a ketogenic diet? Of course not. So can we please inject some sanity into these discussions? Again, if you want to use a ketogenic diet as a potential—potential—prevention strategy, go right ahead. (I think they can work for prevention; I just don’t think they’re required.) But don’t scare other people on the interwebz into thinking that they also must do so, lest they damn themselves to a fate of metabolic and mitochondrial disaster because they enjoy eating a baked potato every now and then.
Yes, ketogenic diets might—might—prevent any number of chronic diseases, but the long-lived octogenarians and nonagenarians in the “blue zones” don’t follow strict ketogenic diets. Many of them have consumed bread, beans, and fruit throughout their entire lives. So even if KDs and MTKDs have a role in prolonging lifespan and healthspan, they are clearly not the only effective strategy. For many people, I would argue that adequate physical activity, maintenance of muscle mass, sufficient quantity and quality of sleep, a sense of purpose in life, a sense of humor, and a generally low carb diet would do just great. As I specified in that guest post for RW, a super-strict KD probably isn’t required to ensure lifelong health, but good glucoregulation and generally low-ish insulin levels probably are. And here’s a news flash: there are people who maintain insulin sensitivity and normal blood glucose levels on diets that include fruit, beans, and starches. (If that doesn’t describe you, then yes, perhaps you need to be on the very low end of low carb, but that doesn’t mean that everybody, everywhere, needs to be there with you.)

I’m planning a post for sometime in the new year going into a bit more detail on the following point, but here’s the nutshell version: carbohydrates, per se—from real, whole, unprocessed foods—are not poisonous. It’s almost ridiculous to even suggest this. (Yes, many plant foods contain anti-nutrients, but this is not something unique to grains and legumes. Broccoli, cauliflower, blueberries, avocado, and many other plant foods beloved to low carbers and keto adherents contain anti-nutrients as well. I’m not referring to the anti-nutrient issue here. I’m referring primarily to the effects on insulin and blood glucose.) There are many long lived and HEALTHY people who eat beans, potatoes, rice, fruit, and even … *gasp!* … bread. We could talk about the Okinawans, or the Kitavans, the traditional Greeks, Italians, and more. The difference is they weren’t combining those starchier foods with corn and soybean oil, refined sugar, HFCS, etc. (To say nothing of not having sedentary automobile-based existences or desk/cubicle-based jobs, and not having completely screwed up circadian rhythms.) If you can’t acknowledge the difference between parsnips and Lucky Charms cereal, then I’m not sure we’re even inhabiting the same plane of existence. I don’t know why it’s so hard for people to understand that a small bowl of rice consumed with kimchi, a fried egg, some fish, and a bit of seaweed, is not the metabolic equivalent of unlimited breadsticks and a bottomless bowl of fettuccini alfredo. Once someone is already metabolically damaged from years of ingesting the pure pile of toxic sh*t that is the “standard American diet,” then yes, perhaps they are best advised to avoid even the foods that we might otherwise deem wholesome (for example, beets, parsnips, and butternut squash). But that doesn’t mean that those foods were what caused the metabolic problems in the first place. 

That ketogenic diets seem pretty close to a darn near miraculous therapy for a wide range of conditions doesn’t mean that healthy people mustfollow this medically therapeutic nutritional strategy in order to remain healthy. If you are a healthy, fit, strong, active individual who exercises intensely several times a week, why are you eating like a child with intractable epilepsy? What has convinced you that the percentages of fat and protein suitable for an epileptic child are suitable for you?    
Don’t apply to yourself what applies to someone else’s situation, which might have absolutely no relevance to you. Just because someone else’s child has a life-threateningly severe peanut allergy doesn’t mean you need to carry an epi pen and never shake hands with someone whose third cousin might have eaten a peanut butter and jelly sandwich two years ago if you do not have a peanut allergy, capice?
Stop following a medically therapeutic diet “just ‘cuz.”
More fat = higher ketones;
higher ketones = better results
This reminds me of the diet-heart/lipid hypothesis which, sadly, most family physicians and cardiologists still subscribe to. It’s the idea that eating cholesterol raises blood cholesterol, and high cholesterol clogs arteries and causes heart attacks. Both of these are incorrect. (That is, dietary cholesterol does not automatically become cholesterol in the blood, and high cholesterol in the blood does not “clog” the arteries or cause heart disease.) 
Similar fallacies abound with keto: more fat doesn’t always translate to higher ketones, and higher ketones don’t necessarily mean better results. Whatresults? Well, whatever results someone is after: greater weight loss, better athletic performance, and more. I do think higher ketones can offer therapeutic benefit for cancer, mood disorders (such as anxiety or depression), traumatic brain injury, and neurological disorders. But higher ketones do notautomatically and unfailingly ensure quick fat loss or setting new PRs in the gym. (“PR” stands for “personal record,” for you non-gym dwellers.)
The first thing to know here is that prominent low carb researchers Jeff Volek, PhD, RD, and Stephen Phinney, MD, PhD, consider the range of nutritional ketosis to be blood levels of βOHB at 0.5—5.0 mmol/L. So if you think you have to swill down cups of olive oil and add half a stick of butter to your morning coffee in order to reach blood ketones of 2.0 mmol/L or higher in order to be a “fat-fueled” or “keto-adapted” beast, you are misguided. If your ketones are “only” at 0.5, guess what? You’re in ketosis. Congratulations. And you know what else? People notfollowing a ketogenic diet might wake up with βOHB at 0.1—0.3 mmol/L, so even if you’re “only” seeing ketones around 0.3 or 0.4, that could still be three or four times higher than for people consuming a typical amount of carbohydrate.
For the purpose of fat loss, having relatively low ketones doesn’t mean you’re “doing it wrong,” and you don’t need to glug down ungodly amounts of fat in order to artificially force your body to make more ketones. Again, ask yourself why you want higher ketones. Are you trying to protect healthy cells for an upcoming radiation or hyperbaric oxygen treatment for cancer? Are you an Alzheimer’s patient trying to feed starving neurons? Or have anonymous participants on an online forum convinced you that you won’t reap the benefits of carbohydrate restriction unless your ketones are above some arbitrary threshold that they can’t even explain to you?
The fact is, some people’s bodies produce higher ketones more readily than others’. It’s just the way it is. More fat might facilitate greater ketone production, in some people. (Please know I’m talking about fat in general, and not specifically coconut, palm kernel, or MCT oils, which will result in higher ketones in just about everybody, even with a concurrent high carbohydrate intake. [As Chris Masterjohn, PhD, said: “…adding MCT oil to your pasta is more ketogenic than restricting your carbohydrates to ten percent of calories.”])  Those of you who obsess over ketone levels, please, please, consult with someone who truly understands the biochemistry of this stuff, because when I see that phrase — the dreaded one that makes me cringe … I got kicked out of ketosis — I know that that person has no appreciation for the complex feedback loops and regulatory processes that govern ketone production. (Not to mention gluconeogenesis and fatty acid oxidation.) There’s so much more to it than most people realize. 
There are reasons to aim for high ketones, and to take deliberate measures above and beyond carbohydrate restriction to do so. But it’s all about #context. Do you need to aim for high ketones? Depends on what you’re trying to achieve. What are you wanting those ketones to do for you?
Many people seem to be going for high ketones because they think the higher their ketones, the more body fat they’ll lose, and the more quickly they’ll lose it. NOT ALWAYS
Weight Loss
Most important fact here: Ketones are the result, not the cause, of using fat for fuel. Ketones do not drive the process of “burning fat”; they are the byproductof it.
Second most important fact: most of the people who contact me for help when their super-strict ketogenic diet has them feeling like poop do not even need to lose weight. Again, they have somehow come to believe that they need to follow a MTKD “just ‘cuz.”
Stop it.
Stop it, stop it, STOP IT!
On second thought, let me rephrase: if you feel great eating a high percentage of your calories from fat, eating just enough protein to eek out a sort-of existence, and severely limiting carbs from everything but the specific vegetables and nuts whose carb content is the lowest of the low, then keep going. Absolutely no trouble there.
But if you don’t feel so great—and I know some of you don’t—then perhaps it’s time to rethink things. This is especially true if you have implemented a ketogenic diet for the specific purpose of fat loss, and you’re not getting anywhere with that goal. (Assuming, of course, that you actually have weight to lose and you aren’t following a fat loss diet as a result of raging body dysmorphia. I’ve had clients who struggle to lose weight because they’re already at a healthy body weight, or sometimes even underweight.)
Let’s talk about stubborn fat loss first, because it’s the more common issue.
If you’re struggling to lose body fat, does it make sense to add a lot of extra fat to your food? The more fat coming into your body from food, the less your body needs to tap into its own stored fat for fuel. But that’s what you want, right—for your body to have to use its own adipose tissue for energy. That’s how we lose that fat, after all.
So here’s the deal: carbohydrate restriction prompts the body to start running on fat. It’s not the presence of large amounts of dietary fat that makes us burn fat; it’s the absence of carbohydrates.
Stated another way:
Ketosis is achieved by what is not in the diet, not by what is. It is the absence of appreciable amounts of carbohydrate that results in ketosis, not the presence of copious amounts of fat.
(Again, not talking about consuming a high amount of MCT-rich oils, which will elevate ketones even in the presence of significant dietary carbohydrate. I’m talking about what I would call “normal dietary means.”)
If lots and lots of dietary fat resulted in ketosis, then you could load up a large bagel with several tablespoons of butter or cream cheese and be in ketosis, but again, it’s not the presence of all the butter that would do it; it’s the absence of the bagel. With this in mind, burning fat in generalwill happen when you cut back on carbs, but burning your stored body fat, in particular, will happen when you cut back on dietary fat. In this sense, those of us using ketogenic diets for the specific purpose of fat loss (me included!) have been misled by the abbreviation “LCHF,” or low carb, high fat. As Ted Naiman, MD has explained so beautifully, if your body is already “high fat,” then all you need is the low carb:

Various sources here and there have led people to think that as long as they keep insulin levels low (by eating very little carbohydrate and also limiting protein), they’ll lose weight. It doesn’t matter how much fat they eat, as long as insulin levels are low.
It is possible to gainbody fat while in ketosis.
I know this to be true because I’ve experienced it. (There’s a reason I am prohibited from keeping mayonnaise and peanut butter in my house, if you must know.) As I’ve written before: “Even if you’re in ketosis, if you’re eating several hundred (or thousand!) extra calories of pure fat, all that food energy still has to go somewhere. With or without insulin, in or out of ketosis, it’s not just going to disappear.” You can be dark purple on your ketostix or high on your blood meter all you want, and it doesn’t automatically translate to body fat loss.
So please, if you are struggling with stubborn body fat loss—and particularly if you are still quite a ways from your goal weight—stop listening to people who encourage you add fat to foods in order to make them “MOAR KETO. Remember, there is no magical ketogenic ratio, and as Dr. Naiman so simply put it, if your body is already high fat, then all you need is the low carb. Now, that doesn’t mean you will follow a low carb, low fat diet. No-sir-ee. It just means that you can eat foods that are already high in fat (ribeye steak, avocado, pork chops), but not need to add more fat in order to arrive at some mythical percentage that will result in automatic fat loss. (If only it were that simple!) Even if you doeat a relatively low amount of fat, though, if you have a significant amount of body fat to lose, guess what? You’re stilleating a high fat diet, except the fat is coming from your body, rather than your plate. As a percentage of the fuel your body is using, fat is still high, even if there’s not a whole lot of it in your food. (You are “eating” your own body fat.)
This is why people you might know on Twitter and Facebook who are alreadylean and jacked post photos of pats of butter on top of steaks, or plates literally piled high with bacon, eggs, and avocado, and some of them also drink coffee or tea with multiple tablespoons of butter and coconut oil in them. They have “wiggle room” for increased fat intake, because they do not have as much body fat to draw on as do people with much higher body fat percentages. (They also usually do fairly hardcore workouts and need the refueling in order to perform well at the next effort.)
When you are brand new to this way of eating—be it keto or just regular ol’ low carb—the dramatic reduction in carbohydrate intake will be such a shock to your body that at first you’ll be able to “get away with” a higher fat intake for a while and it won’t interfere with fat loss. But eventually, things will settle down, and you might find that in order to mobilize the fat on your fanny, you’ll have to put a little less fat on your plate. It doesn’t mean you have to live on skinless chicken breasts, dry tuna, and fat-free cottage cheese, but it might mean that you have to lay off the fat bombs, bulletproof coffees, heavy whipping cream, and nuts & cheese (unless you’re really good about portion control with those last two, and let’s face it: most of us aren’t).   
Optimizing Health
What about people who don’t need to lose weight but are following this diet anyway, likely either because they think they need to lose weight, or because they think it will prevent weight gain, or because they’re simply trying to optimize overall health? Again, I’m not talking about cancer patients, diabetics, or those with insulin resistance, PCOS, or related conditions. I am talking about supremely healthy human specimens. As I have been emphasizing throughout this post so no one gets the wrong idea about what I’m saying here (even though some inevitably still will), if you are a supremely healthy human specimen following a super-strict KD and you feel like dynamite, great!Keep following it. But if you don’tfeel so hot, perhaps it’s time for a change. If you’re following a particular diet for a particular reason—doesn’t even have to be keto; it could be anything—but success eludes you, then why continue to follow that diet? If a super-strict ketogenic diet is not getting you the results you want, then stop doing it.
You wanted to have more energy, not less, right? And you wanted to feel happier, not more depressed, right? And you wanted to feel more calm and stable, and less anxious, right? You wanted a better sex drive. In short, you wanted to feel good. But you don’t feel good. You feel lousy.
If you tell someone (or multiple someones in your forum of choice) that you don’t feel good on a very strict ketogenic diet, and they tell you you’re either doing it wrong, or you need to do it harder, please think about this same logic coming out of the v*gan community. Example: You have no energy, your hair is falling out, you haven’t had a menstrual period in 14 months, your joints hurt, you’re anxious, and your skin looks sallow? There’s nothing wrong with you; you’re just still detoxing from all your previous years of sinful and disgusting animal flesh consumption. You need MOAR KALE and MOAR CHIA SEEDS, and maybe a lemon juice & cayenne cleanse for your liver.
(This poor hypothetical anemic person needs a very large, very rare steak, STAT.)
Why stick with something that isn’t working for you, just because it’s working for someone else? As is true for disease prevention, following a super-strict ketogenic diet is not the only path to health, fitness, vitality, robust cognitive function, and a physique that others envy.
Robb Wolf doesn’t follow a strict ketogenic diet, and let me tell you, the dude is jacked.  Franziska Spritzler (“the low carb RD”) follows a low carb diet but not one that is strictly ketogenic, she does not fast, and she is slim, fit, and looks easily fifteen years younger than her real age (which I will not divulge out of respect for my friend!).  
All of this is to say that a ketogenic diet is not required in order to be slender, muscular, fit, strong, and healthy. You can keep blood sugar and insulin levels within healthy ranges without living exclusively on butter, coconut oil, kale, avocados, cream cheese, salmon, and mustard greens. I promise. You can be fat-adapted and be a “fat burner” without being in deep ketosis.

Low carb versus ketogenic:
When did “low carb” 
become passé?
I have had clients that were terrified—yes, terrified—to eat bell peppers. BELL PEPPERS. Because of the carbs! Can we please, please stop this madness? There is a world of vegetables and fruits that many people can consume and keep their blood glucose and insulin well within perfectly safe ranges. Not everyone is as metabolically damaged as others. Some aren’t much damaged at all. Maybe some people doneed to avoid carrots, red and yellow peppers, red onions, beets, peaches, cantaloupe, parsnips, butternut squash, and tangerines—but that doesn’t mean everybody does. (If you think the “diabesity” epidemic was caused by people eating too many orange peppers or overdoing it on acorn squash or plums, you are [probably] WRONG.)
When it comes to carbohydrates, there is a continuum. Brightly colored bell peppers and yellow squash have more carbs than dandelion greens, but for the love of all that’s holy, they’re not exactly jellybeans! Am I making sense here? Any sense at all?
Before anybody gets the wrong idea here, allow me to explain myself.
When I tell people I think they might feel better eating more carbohydrate, I make it clear that I’m not suggesting those carbohydrates come from bread, bagels, pasta, fruit juice, granola, sugary corn or wheat cereal, or toaster pastries. (Not even organic, GMO-free toaster pastries.) They can come from larger amounts of the non-starchy veg these people are already eating, as well as a greater variety of vegetables. Things that had previously been completely forbidden, banished, and verboten. (Yes, I understand there are people who doneed to limit their intake of carrots, yellow peppers, and the like, for the purpose of blood glucose control. I AM NOT TALKING ABOUT THOSE PEOPLE.)
This is why I continue to emphasize the distinction between low carbohydrate diets and ketogenic diets. As I’ve written about before, people use the terms interchangeably, but they are not interchangeable. Many people might feel (and look!) their best on a low carb, but not ketogenic, diet. As I have written about before, there’s a difference between being “in ketosis” and being fat-adapted. For the purpose of weight management (that is, maintaining a fat loss and warding off body fat gain), being fat-adapted is probably sufficient for most people. Maybe not all, but most. As is proven by billions of people around the world, strict ketosis is not required to keep blood glucose and insulin levels within healthy ranges, either. Some people need to maintain ketosis in order to achieve this, but that doesn’t mean everybodydoes. Many factors contribute to glucoregulation and insulin sensitivity, and individuals vary—like, really vary—in their carbohydrate tolerance. I don’t think anyone is necessarily suited to thrive on 300+ grams of carbs a day in the form of bread, cereal, muffins, cake, soda, and things like that, but there are plenty of people on planet Earth who can thrive on, say, 100-150g, maybe even 200g (remember, that’s still only 800 calories, which is not all that much for, say, a lumberjack, or someone else with a physically demanding job), coming from things like potatoes, parsnips, turban squash, beets, honeydew, taro, cassava, and grapefruit.  
First, just as people differ in their carbohydrate tolerance, people differ in what I’ll call their ketogenic threshold—that is, the amount of carbohydrate they can consume and still be “in ketosis.” (If that even matters!) The reason most of the popular low carb and ketogenic diet programs recommend starting off with 20–30g of carbs or less per day is because that’s the amount at which just about everyone will enter ketosis within a couple of days. But plenty of people can eat as much as 60g of carbs (if not more) and still stay in ketosis. That’s probably not the majority of people, but it’s some. (Again, I’m talking about inducing nutritional ketosis through normal dietary means, not exogenous ketones or extra-large servings of coconut or MCT oils.)
But what does it matter, anyway? What is the goal? Is it to be in ketosis, or to feel well? Is it to be in ketosis, or to lose weight? These are not synonymous. If you’ve been following a strict ketogenic diet with the intention of staying in ketosis at all times, ask yourself why. Why are you aiming to be in ketosis all the time, and are you achievingwhatever goal you’re seeking? If perpetual ketosis isn’t getting you to where you want to go, why are you still doing it?
The great people at KetoGains have a saying: “Chase results, not ketones.” And if you join the Facebook group, you will quickly see that they get results.
Even the late, great Dr. Atkins, himself, never intended for people to stay in ketosis forever. The first two weeks is the induction phase, and that is 20g of carbs or fewer per day—for two weeks. He had what he called a “carb ladder” during the ongoing weight loss phase, or OWL. (OWL is the phase after the two-week induction period, but before someone reaches their goal weight and transitions into maintenance. It’s exactly what it says it is: ongoing weight loss, and while some people need to stay in ketosis in order to accomplish this, many don’t.) The carb ladder means that each week, carbohydrate intake is increased by about 5g per week until someone finds their individual carbohydrate limit for losing weight. This is the part many people don’t do. They stay in induction permanently, which is fine, if you’re happy there, you feel good, and you’re continuing to get results.
But if you don’tfeel good, and you’re not getting the results you’re after, then for goodness’ sake, change your diet! Eat more carbs! Can I just say that already? For the love of all that’s holy, EAT MORE CARBS. You do not need to be in deep ketosis at all times in order to be lean, healthy, fit, and control your blood sugar and insulin. For healthy, lean, fit, athletic people, somewhere around 50-75 grams of carbs a day from hubbard squash, raspberries, tomatoes, yucca, or parsnips (plus your usual go-to greens and other very low carb vegetables) are not going to mean the difference between being a metabolic ninja or triggering a total health meltdown.
I’m sorry. I’m sorry I sound so angry. I’m just tired of getting emails from people who feel like garbage and are afraid to eat red peppers, but think it’s completely normal to put half a stick of butter in a cup of coffee. It gets old after a while, folks. I’m not the biggest fan of the Whole30 approach, but they do have some good stuff. This is what they call “the carrot train to crazytown,” and it’s worth reading.
If you think the presence of red onion and red, yellow, and orange peppers here means this gorgeous pile of delicious food could not possibly be acceptable on a ketogenic diet, please think again.

Back to my man, Dr. A. Just like I recommend for some clients, Atkins didn’t suggest people go up the carb ladder by reintroducing pasta, bagels, muffins, and biscuits. It was supposed to be larger portions of the low-carb vegetables they were already eating in induction, and/or reintroducing small amounts of the slightly sweeter items that were not permitted on induction, such as those carrots or red peppers. Induction is just that: an induction. An initiation. Maybe that’s what they should call it, in fact. An initiation. Because when you are initiated into something, there’s the initiation, and then it’s over. You’re part of it, and you don’t have to go through it again. It’s like fraternity and sorority hazing at a college, or basic training or plebe year in the military: the strictest, most regimented phase is temporary.
(I will acknowledge, though, that in the case of low carb diets, sometimes people do need to experience the induction phase a second time…or third or fourth, depending on how many times and how far someone has strayed from actually following low carb. Sometimes we do need to go back to the beginning. But most of us don’t need to stay there for all time. In this sense, we can think of induction as inducing the metabolic shift from a glucose-centric to a fat-centric metabolism.)
To sum up (for anyone who has actually made it this far):
Like I said in the fasting post: different goals might require different strategies. What are you looking to accomplish? Do you have cancer? Do you have Alzheimer’s? Have you suffered a traumatic brain injury? Do you have multiple sclerosis? Do you have PCOS? Are you trying to lose body fat? Are you an endurance athlete? Are you a powerlifter? Are you underweight and looking to gain mass? What is YOUR #context? The exact same dietary approach might not be suitable for all of these circumstances.
Again, this is absolutely nothing against keto. I love keto. Love it, love it, love it! When it is applied intelligently and rationally.
So, keep calm and keto on.
Or not.
I’ll leave you with the following gem from Bill Lagakos, PhD, who runs the excellent Calories Proper blog:
Myths: carbs cause insulin resistance (IR), diabetes, and metabolic syndrome.  Carbs are intrinsically pathogenic.  If a healthy person eats carbs, eventually they’ll get sick.

And the only prescription is more keto.”

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

9 Ketogenic Diet Myths

Let me burst your bubble right here at the beginning. This list is for people who are already following a ketogenic diet or are considering beginning one specifically for the purpose of losing body fat. If you’re looking for a nice, solid debunking of other myths about this way of eating (e.g., “All that saturated fat will clog your arteries,” “All that protein is bad for the kidneys,” “You need carbs for energy,” “I learned in medical school four hundred years ago that ketosis is fatal,” and other such nonsense), here are two excellent debunkings: one from Authority Nutrition, and one from my dear friend Ellen Davis, creator of Ketogenic Diet Resource, which is the single best one-stop-shop, gateway entry I’m aware of for all things ketogenic-diet related. (And I’m not just saying that because Ellen’s a friend. I’m saying it because it’s true. The reason we became friends is because I came across her site a few years ago, and … well, the rest is history.)
Why do these ideas need to be called out for the myths that they are?
Well, now that I’m participating more in social media related to low-carb and keto, I’m noticing—and I could be wrong, but I don’t think this is only my imagination—that there are a few falsehoods that have become quite pervasive in our community. So pervasive, in fact, that they persist despite being flat-out incorrect. And because they persist, we continue to see post after post after post on Facebook, Instagram, Twitter, and wherever else, from people at their wit’s end because they aren’t losing fat, are gaining fat, or have not had every single longstanding malady resolve immediately upon ditching bread and loading up a cup of coffee with butter and coconut oil, or drowning everything in cheese, as others may have promised them would happen.  
If these individuals are lucky, they stumble upon a group where logic, sanity, science, long-term experience, and the attainment of actual results rule (rather than chasing ketones for the sake of high ketones). If they’re not lucky, they fall head-first into groups where the same-old not-helpful advice is parroted ad nauseum.

With this in mind, here is my own personal list of the top 9 biggest falsehoods regarding ketogenic diets for fat loss, along with “alternate versions,” intended to help us see things from a different perspective. There are probably many more out there; these are just the ones that came to me first. If you have some favorites that I’ve missed here, share them in the comments so we can all collectively cringe! 

1.  I can eat unlimited fat and lose body fat.
2.  It’s not possible to gain body fat while in ketosis.
(Alternate version of numbers 1 and 2: insulin is the only thing that matters when it comes to the gain or loss of body fat, so as long as insulin levels are low, I will not and can not gain fat, regardless of anything and everything else going on in my life and my body.)
3.  I must be in ketosis in order to lose body fat. It is the only way.
(Alternate version of number 3: every single person on the planet who has ever lost body fat has done so via a ketogenic diet.)
4.  There is a direct relationship between ketone levels and fat loss: the higher my ketones, the more fat I will lose, and the more quickly I will lose it. Higher ketones mean more fat loss, because higher ketones cause greater fat loss. Fat loss is the result of high ketones.
(I don’t have an alternate version of this to illustrate how wrong it is. Frankly, it doesn’t need one. It’s just wrong. *Think, think, think…*  I guess I can give the example of an uncontrolled type 1 diabetic: they’re not losing fat because their ketones are [pathologically] high; their ketones are [pathologically] high because they’re hemorrhaging fatty acids out of their adipose tissue. High ketones are the result, not the cause, of breaking down large amounts of fat.)
5.  I must eat at least 70% of my calories from fat, or I’m not eating at “ketogenic ratios.”
6.  Going by macronutrient ratios (percentages of total calories from fat, protein, and carbohydrates, rather than absolute grams) is the best way to formulate a ketogenic diet for fat loss.
(Alternate version of numbers 5 and 6: ketogenic diets are defined by the macronutrient ratios. In other words, a diet consisting of 10,000 calories with 80% of total energy coming from fat, 12% from protein and just a teeny, tiny 8% from carbohydrate will be ketogenic simply because fat is 80% and carbs are a paltry 8%, even though 8% of 10,000 calories is 800 calories, or 200 grams of carbohydrate. Anyone out there think you can achieve nutritional ketosis eating 200 grams of carbohydrate? [Assuming you are not mainlining MCT oil and are not a T1 diabetic.]  There: “ratio” myth officially debunked. And no, I don’t think anyone trying to lose body fat — or for pretty much any other reason [except perhaps being an Olympic-caliber swimmer] is eating 10,000 calories a day. I’m just trying to illustrate the point is all.)
7.  If my blood ketone level is not above 1.0 mmol/L, I am not in ketosis, it is not high enough, or I am “doing it wrong.”
(Alternate version: Jeff Volek, PhD, RD, and Stephen Phinney, MD, PhD, are wrong when they say nutritional ketosis begins at blood β-OHB levels around 0.5 mmol/L. Dr. Phinney, who has been doing low carb research almost as long as Amy Berger has been alive, doesn’t know what he’s talking about, so you should listen to the “bros” in your Facebook group instead. Also: looking back at the debunking of number 4: WHO CARES WHAT YOUR KETONE LEVELS ARE?!  Since higher ketones do not cause greater fat loss, stop chasing ketones. Let me say that again: Since higher ketones do not cause greater fat loss, stop chasing ketones. For the specific goal of fat loss, it is more important to be fat-adapted and generally using fat for fuel than to be “in ketosis” at all times. Does this mean it’s never a good idea to aim for high ketones and take specific measures to produce them [e.g. fasting, exogenous ketones, MCT oil]? No, of course not. There are #contexts in which it very well could be appropriate to deliberately modulate specific factors in order to generate higher ketones. What contexts? Maybe cancer treatment, traumatic brain injury, Alzheimer’s disease, or other neurological issues. My point is, these #contexts are NOT FAT LOSS.)
8.  Carrots, red/orange/yellow bell peppers, beets, and other “sweet-ish” vegetables are outright prohibited on a ketogenic diet.
(Alternate version of number 8: it is not physiologically possible to consume one carrot, or half a red pepper and remain in ketosis. If I want to lose fat on a ketogenic diet, I can never, ever have a salad with shredded carrots or julienned pepper. If someone tries to serve me carrots at Christmas dinner, I will disown them because they don’t understand my diet, they are trying to poison me with their carby garbage, and I will never, ever attend another holiday at their house again, because if they’re gonna serve carrots, they might as well just tie me up and force-feed me white bread slathered with grape jam.) I’m not the biggest fan of the Whole30® program, but I agree with the creators when they called this “the carrot train to crazytown.” (More on this in the upcoming mega-epic keto rant I warned you about last time.)
9.  A ketogenic diet is pure magic, and it will fix all aspects of my life and my health. If I hate my job, keto will make me happy. If I no longer love (or even like) my spouse or significant other, keto will magically repair my relationship. If I’m drowning under heaps of financial debt, keto will help me win the lottery. People don’t like me because I’m an *sshole; keto will turn me into a kind, compassionate person.* Keto is good for everything in life – Every. Single. Thing. – and if my life is not perfect after “going keto,” then I’m doing it wrong.
*I actually think this is not all that far-fetched, IF someone’s *sshole-ness stems from anger and irritability resulting mostly from hypoglycemia. In cases where mood swings and general un-likability stem from wacky hormones and the brain going crazy on sugar (or lack thereof), then I can totally see keto making someone less of a d*ck. (Keto does have mood stabilizing effects, and it’s even been known to help bipolar!)
(Alternate version of number 9: any diet, whether ketogenic or not, is the secret to happiness. For a good debunking, see this post on Vitamin J. [Warning: it’s one of my longest ever, so save it for some night when you have trouble sleeping.])
I realize that my alternate versions of these ideas are a bit extreme. Normally I actually kinda hate when people make arguments using extreme examples that typically don’t occur in the real world, but I think this approach can be helpful sometimes—like now. I only used the extremes to point out how laughable—and misguided—some of this stuff is. We tend to be blinded by our own biases and beliefs, and when this stuff starts stinking of religious zealotry and closed-mindedness, well, I refuse to participate. I don’t think low-carb and ketogenic diets are the only way people can lose weight and be healthy. And I think sometimes we do get a little too enamored with our own principles. And sometimes we just need a little reality check.
For another good reality check regarding some potential falsehoods we allow ourselves to believe about low-carb and keto diets, here’s another post from Authority Nutrition. (What can I say? Kris Gunnars and the people who write for him do great work.)

More rants coming soon!  😉

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

A Word About Upcoming Posts

I try to be a voice of sensibility in the vast and overwhelming sea of information regarding low carbohydrate and ketogenic ways of eating. It even says so at the top of my homepage: “A source of sanity in the sea of nutritional madness.” What I know compared to what there is left to learn is like a thimble of water compared to the Pacific Ocean. There’s a lot more—a lot more—I don’t know than what I do know, but I try to share with you the small bits of knowledge I gain as I hang on for dear life while traversing these tumultuous waters. I’ve done it about digestion, cancer, insulin, fuel partitioning, and more. (My Alzheimer’s book has been completely rewritten and updated for a March 2017 release as a print book from a big name publisher, so I’ll continue do it about Alzheimer’s, too.)   
However, I am starting to worry that, due to my penchant for ranting about things that bother me about the low carb and ketogenic communities, I’m developing a reputation for being an angry, hateful, vicious, and vindictive person. I assure you, I am neither angry, nor hateful, nor vicious, nor vindictive. In fact, “in real life,” I am quiet, shy, and, I’d like to think, gentle and kind. Nevertheless, there’s no denying the fact that I do rant a lot. But what can I say? The utter madness being masqueraded as fact in certain spaces provides no shortage of material to rant about. Being a gentle and kind person, I assume the spreading of misinformation occurs as a result of plain ol’ ignorance, rather than deliberate malice and ill intent. Whatever the intent, the end result is that misinformation is being spread, and because of it, people are experiencing setbacks along their roads to better health, fat loss, better blood sugar control, and more.
Why do I care? Well, like I mentioned in my rant post about fasting, as a nutritionist working with clients, I deal with the consequences of what happens when people follow advice that is either straight-up false, or advice that is perfectly appropriate for a certain context, but which is not applicable to their context.
It’s getting old, folks. I’m tired of trying to respond politely to emails from people who are afraid to eat two ounces of carrots in a serving of mixed vegetables, but who think it’s completely normal to put five tablespoons of butter and coconut oil in a cup of coffee. (Or better yet, to drink that 500-calorie coffee in the morning and say they’re “fasting.”) I’m tired of trying to respond politely to emails from grown adults who are restricting themselves to 45 grams of protein a day because they’re afraid that if they eat more than that, they’ll be at less than 80% fat and they’ll mess up their “keto ratios,” and also because the excess protein will be turned immediately into glucose and cause a huge spike in their blood sugar. (No, it won’t. Really, it won’t. Seriously now, it won’t.) I’m tired of trying to respond politely to emails from people who are disappointed and frustrated because they’re not losing weight or are maybe even gaining weight, even though they’re listening to their trusted experts online and are eating more fat – adding lots of extra butter to things, eating fat bombs, and shunning anything that even hints at being lean or low in fat. They’re as afraid of skinless chicken breasts as they are of 64-ounce troughs of Mountain Dew. And I’m tired of trying to respond politely to emails from people who, for whatever reasons—and there are many—are convinced that they must, must be in ketosis at all times. I swear, if I read or hear “I got kicked out of ketosis” one more time…
I am frustrated, and good-hearted people out there trying to follow low carb or ketogenic diets are frustrated, too.
In this spirit, I have a few more rants planned (already written, in fact) about the problematic things I see in the carbohydrate restriction community. But I don’t want to be a one-trick pony. I don’t want to have a reputation as an angry person who only ever posts electronic versions of hissy fits. Nevertheless, now that I’m more active in a few Facebook groups, I am confronted with these problematic things every day, and I feel compelled to address them. Since I don’t want to address them over and over and over again, I am going to post these few rants and then be done with them. (For now. Heaven knows there will always be something else that gets a rise out of me, but I’ll try to keep the ranting to a minimum once these next few posts are out of my system.) And get them out of my system I must. I don’t have children. What I have instead are ideas to write about, and they nag me, metaphorically pulling on my pant leg, until I finally give them they attention they require and see to their care and feeding.
I have three such posts in the hopper. You will know them when you see them. One of them—the last one I’ll post—is a candidate for a spot in my top three longest posts ever (alongside the one about my mother and the one about vitamin J). I thought about breaking it up into three or four separate posts, but I’d rather just get it all out at once and be done with it. Plus, that way, if I ever need to respond to someone on social media, or someone who emails me directly, in regard to some of what that post includes, I can just send them a link and it will all be centrally located.
As for what I’m going to write about after that, I’ll continue with more Low Carb Cooking Class (LC3), and I have not forgotten about the series on the metabolic theory of cancer. I do plan to pick it up again, as we have finally, finally gotten to the point where we can talk about the ketogenic diet and have it make sense. And I have been saying for ages now that I’d like to write something about sodium, and how salt is not something to fear, but that’s going to take a while. Before that, I’m going to post a couple of things that I see a need for, if questions on Twitter and Facebook are any indication: a guide to dining out on a low carb or ketogenic diet, and breakfast ideas for people who either don’t like bacon and eggs, or who are “tired of them.” (Yes, apparently such a thing is possible, though I have yet to witness this rare phenomenon in person.) I’m also contemplating sharing my thoughts on “zero carb” diets, as well as my growing suspicion that a plethora of modern chronic illnesses are driven not just by hyperinsulinemiaand hyperglycemia, which are both, of course, huge issues, but by chronic nutrient insufficiency. The more I learn about the nuances of certain biochemical processes and the modern food supply, the more I appreciate just how robust the human body is, because frankly, I’m actually surprised there aren’t even more very ill people in our midst. That there aren’t is a testament to the ability of the human body to adapt and overcome and keep on truckin’ even when all indicators suggest someone is about to keel over and die at any moment.  
That’s all. Just wanted to warn you let you know what’s in store for the next few posts. After that, I’ll get back to writing things that might be more helpful for people, and I’ll try to keep my anger out of things. (Although I have to say, while I don’t want a reputation for being angry, my sarcasm and snark seem to go over pretty well, and I’m totally okay with being known for that.)  😉 

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Low Carb Retreat

Calling all introverted low carbers!
Are you intimidated by the mere thought of attending one of the huge, flashy, noisy, low-carb, Paleo, and ketogenic conferences and festivals that are all the rage these days? I remember several years ago, when Jimmy Moore’s Low Carb Cruise was the only event where like-minded low carbers could meet in person, do fun stuff together, and best of all, chow down on low-carb food (and not-so-low-carb food…it is a cruise, after all). Now, however, you can’t shake a stick without hitting an event having something to do with low carb, Paleo, Primal, ketogenic, or ancestral eating.
Just off the top of my head, we have: 

Some of these events are somewhat subdued and more academically focused, while others are basically kombuchakeg parties disguised as events about health & fitness. (Not that there’s anything wrong with a good keg party!) Each has its place, and its ideal audience/attendees.
For those of you who prefer something quieter, smaller, and maybe aren’t totally into the Bulletproof-barefoot-orange goggles-six-pack abs-being terrified of Splenda and omega-6-do-you-even-lift-bro, and you wonder if you even really belong to any of the communities where these things reign supreme, I have good news for you!
If that sort of stuff isn’t your speed (lord knows it ain’t mine), but you’d still like to mingle with like-minded people (at least where food is concerned), and do it in a peaceful and beautiful place, where nothing is asked of you but to enjoy nature, take a nap, go hiking or fishing, and eat yummy low carb foods, I’m putting some feelers out for Wendy, a long-time blog reader who has generously offered to organize a low carb weekend retreat near her home in Kemptville, Ontario, just a little south of Ottawa. I’ve haven’t been there, myself (yet), but she assures me it is quite beautiful, and is a great setting for those of you who would enjoy nature walks, kayaking, cycling, or just simply “getting away from it all.”
We would schedule a few sessions throughout the weekend—maybe a couple of talks from yours truly, some group discussions, and a class or two on low-carb cooking and meal planning. (We’re open to other ideas if anyone has any.) Mostly, it would be pretty low-key, with people free to come and go as they please, attend everything or nothing. If all you want to do is take naps in the grass and have someone wake you when it’s time to eat, that can be arranged! (Thinking about doing that, myself, to be honest…)
Anyway, this is all very nebulous right now. This is in the early, early planning stages and at this point we’re just trying to gauge if there’s even an interest for something like this. So if this is something that appeals to you—and if you have ideas for specific things you would like and would notlike to be part of the weekend, please contact Wendy directly at (I told her I’ll be happy to attend but am not a good planner and organizer. As I said to her, I make a great Indian but a terrible chief. A bad leader, but a great follower.)  😉

Thanks, everyone, and maybe I’ll see you in Canada sometime!

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Obesity is (mostly) a Hormonal Issue: Let’s Stop Pretending it’s Solely About Calories

When doctors or nutritionists see someone with gigantismor acromegaly, is their first thought, “Clearly, that person just needs to grow less and shrink more”? No. Obviously not. Because it is clear—like, crystal clear, beyond-the-shadow-of-a-doubt, smack-you-upside-the-head clear that these conditions result from hormonal irregularities. You can no more control what results from the hormonal effects of a pituitary tumor hemorrhaging human growth hormone than you can control what results from the hormonal effects of a fourteen year old boy who found a special magazine hidden away in his dad’s nightstand. (Do kids still do that these days, or do they just find it on the interwebz instead?)
People with gigantism or acromegaly aren’t abnormally tall or large because they wantto be, or because they somehow willedthemselves to be. They are at the mercy of hormones. Like I said, to anyone with half a brain, this is obvious. No one questions this. No one blames these individuals for needing custom-made clothing or other accommodations. No one says, “Well, if they had just not grown so much…if only they hadn’t let themselves get so tall, they wouldn’t be in this situation.” “They’d be fine if they were just less tall and more short. No one says idiotic things like this because people understand that this is not within someone’s control.
So why, then, when it comes to the outward, rather than upward, expansion of the human body, does it all of a sudden become about willpower, discipline, and “calories?” Why is not more widely recognized that the horizontal growth of the body results from hormonal irregularities just as the vertical expansion does?
Why do so few people get this?

Someone who does get this (besides me, and probably you, dear readers) is the very brilliant registered nurse who goes by the pseudonym “Woo” (whom I introduced you to here).  She rants writes about this frequently. (Here are two of my favorites that are relevant to this topic, both with supremely awesome titles: CICO: why do we even entertain this idea? It’s obviously wrong; and Semi-weekly reminder: CICOtards = myopic. If one rejects the neuroendocrine basis of adiposity, you will always be WRONG.) Quick warning if you happen to give those a read: Woo has truly unique and fascinating insights into all this, but her style takes some getting used to if you’re new to it.  😉
Someone else who gets it is Dr. Jason Fung. In fact, he has a fantastic blog series called The Hormonal Theory of Obesity. (It’s up to over 20 parts now, each of which is both educational and hilarious, and fortunately Dr. Fung is much more succinct, so reading all of that series would take you about as long as reading two or three of my posts, haha!)
Dr. Fung has pointed out on podcasts that certain medications are known to cause weight gain. Prednisone, for example, which is a synthetic steroid/synthetic cortisol. Why does it cause weight gain? It has no calories. If weight gain is the result of eating more calories than are expended, why does a pill with no calories cause weight gain? Why does natural cortisol cause weight gain? People with Cushing’s syndrome(or Cushing’s disease, resulting from a pituitary tumor that results in the adrenals pumping out high levels of cortisol) tend to be overweight. Why should high cortisol cause weight gain? Cortisol has no calories. Why does chronic sleep debt contribute to weight gain? Insufficient sleep has no calories. Talk to someone whose thyroid is on the fritz and can’t lose weight no matter how hard they exercise and how tightly they manage their diet. Why should this be? Low thyroid hormones have no calories. What all of these things have in common is they change the hormonal milieu of the body.
This has nothing to do with willpower and discipline (W&D). I have written about this overand overand over again. (Okay, yes, it does have to do with W&D in the sense that in order to change the hormonal milieu, you have to avoid foods and behaviors that contribute to out-of-whack hormones, and that definitely requires some W&D. More on this in a bit.)
I mentioned cortisol and thyroid hormone. We could add testosterone, growth hormone, DHEA, estrogen, and progesterone into the mix, as well as other hormones that affect what the body does energetically. (That is, what it does with the energy it gets from food. I’m not talking “energetically” like balancing your chakras and all that…) So there are multiple hormones at work here, but let’s focus on the one—the one—over which we have the most control. It’s pretty difficult for us to have direct influence over our level of DHEA or progesterone. I’m not saying these aren’t important, but in terms of having the biggest influence over fuel partitioning in the body, and being one that we, ourselves, can exert the biggest influence over, there’s really only one game in town.
You’ve probably figured out by now that I’m talking about insulin. (Remember: It’s the insulin, stupid.) Insulin helps orchestrate the partitioning of nutrients either toward oxidation (“burning calories”), or toward storage, and if toward storage, then favoring storage as triglycerides in adipose tissue. (Insulin is also necessary for “storing” amino acids in the form of skeletal muscle, but that’s not really storage in the same sense as adipose, and it’s not really what we’re focusing on here anyway, so forget I even mentioned it. I only wanted to point out that insulin does some good things and some very necessary things [e.g., building muscle], since I tend to only focus on its detrimental effects.)
High insulin levels result in the accumulation of body fat. We know this. Doctors know this. (At least, high insulin levels result in the accumulation of body fat in some people. There are, indeed, some special snowflakes who, for whatever reason, don’t gain body fat in the presence of chronically elevated insulin, but remember, as I’ve ranted written about, this does not mean they don’t experience other poor health outcomes stemming from chronic hyperinsulinemia.)
Why do insulin injections cause type 1 diabetics to stop breaking down their own adipose tissue and losing fat uncontrollably? (That is, it helps them maintain and even add totheir fat stores.) Why should insulin do this? Insulin has no calories.
So can we please stop pretending that the maintenance and accumulation of body fat stores is driven solely by calories, and if we can just get people to ingest fewer calories, all will be well?
Okay, so, insulin. We know insulin causes (many) people to gain body fat, and acts as a big obstacle to them losing that body fat. Therefore, gaining body fat is (for many people) a hormonal issue.
So what?
The big “so what” here is that, unlike individuals with gigantism and acromegaly, who cannot control their levels of growth hormone, we cancontrol our insulin levels. Some people’s bodies do this better than others naturally, while others among us have to work at it. (And we’ll have to continue to work at it for the rest of our lives.) Regardless of how easy or difficult it is, barring the rare case of an insulinoma (insulin-secreting tumor), we can control it. By hook or by crook, with low-carb or ketogenic diets, with fasting, with exercise, and/or with medication, we can get our insulin levels down to a level at which adipose tissue lets go of stored fat (fancy science word for this: lipolysis), so that other cells can use it for fuel.
Yes, folks, insulin isn’t just for regulating blood sugar. Another of insulin’s starring roles is inhibition of lipolysis. Doctors know this. Endocrinologists know this. Heck, I’m “just” a nutritionist, and I know it. And if insulin inhibits the breakdown of stored fat, and someone has a goal of losing some of their stored fat, then perhaps I’m a simpleton and things are much more complicated than I think they are, but it seems like reducing insulin levels should be a primary strategy for fat loss, no?
The part I can’t figure out is how someone can reduce their insulin levels when medical and nutrition professionals insist that they consume several servings of grains and other starchy foods each day — you know, precisely the foods that raise insulin the most. Sure, exercise and medication can help, but again, unless I’m oversimplifying things to the point of inaccuracy, it seems like the easiest, most convenient, and most effective strategy would be to simply stop consuming the foods that raise insulin the most. I mean, call me crazy, but…
Aaaaanyway, this is where willpower and discipline come into the picture. (I said we’d come back to them, and look, it only took me 10 paragraphs!) Reducing one’s insulin levels does require a bit of W&D, but not in the traditional sense. That is, it’s not like: “Hey, fatty, you need to exercise some willpower to not eat so goddamn much. Lay off the bacon cheeseburgers and order a salad, you greedy pig. And while you’re at it, have the disciplineto go to the gym and run a few miles on the treadmill before you eat that salad, lardass. Better yet, make it several miles. You’ve gotta earn that lettuce, Humpty-Dumpty!”
Yeah, NO. 

It’s more like, “Right now, your body is a ‘sugar-burner.’ This means your body is dependent on frequent infusions of carbohydrates in order to give you energy. But since all those carbohydrates are wreaking havoc on your insulin levels, and high insulin levels directly inhibit the breakdown of your stored body fat, we need to find a way to keep those insulin levels lower. But because you’re dependent on frequent carbohydrate infusions, in order to break this dependence, you’re going to have to be strong and say no to what are probably some of your favorite foods: bread, cookies, pasta, bagels, sugary sodas and coffee drinks, mac & cheese, peanut butter & jelly sandwiches, donuts, and more. I know, it sucks, but the cool thing is, if you can muster that bit of W&D for a few days (or a few weeks, for some people), you’ll find that you crave those thing less and less, and once your insulin levels get lower, you’ll be feeding off of your own body fat, so you’ll actually have a lot more energy than you ever had when you were chained to the carbs and your blood sugar was all over the map. Oh, and did I mention that while you muster up all this willpower and discipline, you can eat bacon, ribeye steaks with melted butter or blue cheese on top, ham & cheese omelets, prosciutto, roasted vegetables with garlic and olive oil, lamb sausages, and extra-dark chocolate?”
Oh, the deprivation! Oh, gosh, the willpoweryou’ll have to muster! How ever will you survive?

So yeah, people do need some W&D – at first. But once the “low carb flu” has passed, the worst of the withdrawal is over, and the physical addiction to sugar is (mostly) broken, they won’t need to white-knuckle everything so strongly.

So, the thing is, this is about calories, but only in the sense that the type of calories we consume can have a massive impact on how many of those calories we consume. (Think about gummy bears versus steak: which one will have you feeling hungrier sooner? [And wanting sugar?]) Robb Wolf has a new book about this coming out in spring 2017.
So when the “experts” tell us to eat more of the very things that are drivingthis vicious cycle in the first place (in case anyone’s confused, I am referring to sugar- and starch-dense foods, especially refined grains [and especially grains doused in sugar, and even more sugar]), well, what do we expect?
What do we do when people follow officially sanctioned advice but don’t get the promised results? What then? Should we “blame the victim?” When people follow the advice and don’t get the promised results, should they follow that advice harder—that is, eat even less and move even more in order to have even fewer calories in and even more calories out—or should they ask themselves if maybe the advice is flawed? If you follow shitty adviceand get shitty results, there’s actually nothing wrong with YOU.  
If this is about “calories,” then it’s (mostly) about the calories that raise insulin the most. Or, rather, the foodsthat raise insulin the most. (The reason I say “mostly” is because, no, you cannot actually consume unlimited amounts of fat and expect to lose weight, even if your insulin levels stay low. Take my word for it; I learned the hard way. [Thanks a lot, mayonnaise!])
Even if the magical formula is calories in fat loss, low carb still wins. In fact, people who don’t like to admit that low carb has approximately eight hundred benefits that happen even in the absence of weight loss, usually argue that low carbing offers no “metabolic advantage,” as the late, great Dr. Atkins called it. They say the real reason low carb is effective for weight loss is that by way of regulating appetite and satiety signaling, people naturally reduce their total food intake. Umm, yeah: people naturally reduce their total food intake. Isn’t that what the CICO people want us to do? And if it’s much easier to do it by reducing carbohydrates (rather than reducing fat), then this should still be the first-line recommendation for losing fat. (Again, I could be wrong. I nearly failed my mathematical reasoning class in college, so I’m not exactly a logic whiz or anything, but I think I might be on to something here…)
So what, exactly, the hell?
Low carb works. We can debate into the next century (and no doubt we will) about why it works, but when “diabesity” and related disorders are threatening to bankrupt individual families and entire nations, and so, so much quality of life is lost to the resulting physical, psychological, and cognitive degeneration and debilitation, then we need to do something about it now, and that “something” is telling people that one of their best hopes for reversing their illnesses and regaining their vitality is a low-carb diet. It might not be the only effective solution, but when patients are routinely presented with other options, including veganism, a vegetarian diet, a low-fat diet and lots of exercise, not to mention invasive and dangerous surgery—it’s long past time for medical and nutrition professionals to quit their prudish and politically correct backlash against low-carb, and for this way of eating to be recommended just as highly—if not more highly—than any other.
And it’s time to stop blaming people for eating too many “calories,” and start informing them that their excess weight is hormonally driven, and then educating them about how to reverse this hormonal situation by changing the type of calories they consume.
With this in mind, I’ll leave you with an image from the ever-talented Ted Naiman, MD

Just one nuance I would add: changing what we eat can have a profound influence on how much we eat. They are not necessarily independent variables. I guarantee you have experienced this yourself: you could easily polish off an entire (large) package of cookies in one sitting and then still be looking for more, but after a big steak, you’re pretty well stuffed for quite some time, and the total calories in a family-sized bag of cookies are probably higher than those from a steak. (So yes, owing to its effects on appetite and satiety hormones, low carb does, indeed, still win.)
Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.