I received the following question from a site visitor that makes a great topic for discussion on how many carbohydrates we should consume. This is an area that is quite confusing for many people, so let’s try and clear things up.
Here’s what Paul had to say.
I completely agree with you about the Paleo diet and its many benefits. I am recovering from 5 years of vegetarianism (ages 15 to 20, I’m now 21) and going Paleo has reversed all my chronic health problems. But I do have an issue with your low-carb position. When I first went paleo I did a ketogenic diet to treat my candida infection. I felt much better for the first month but after awhile I lost too much weight, couldn’t think properly, had dry eyes and dry mouth even though I was eating plenty of fat and drinking plenty of water.
One day I was on paleohacks.com and saw some people talking about the book “Perfect Health Diet” by Paul Jaminet and Shou-Ching Jaminet. I ended up ordering the book and was amazed by the wealth of knowledge it contained. It was very scientific and the information they presented was backed by many studies. They believe that the body does work best when there is a steady supply of starch in the diet, paleo starch but starch none the less.
I’ve found this to be true and I now eat some starch at every meal. Taro, Cassava, plantains, sweet potatoes just to name a few. I feel fantastic, much better than when I was low carb. I make sure to eat them with some fat, some protein and greens so they don’t mess up my blood sugar levels.
I don’t mean to attack your school of thought on diet, and I thoroughly enjoy reading your website. I’ve learned so much coming here and agree with you on so many things. I’ve just been there done that with low-carb and it was not a good experience. What is your opinion on my reaction to a low carb diet? ~ Paul
Congratulations for seeing the light and becoming a recovering vegetarian.
I have not read the book Perfect Health Diet, but I did go to their website and review their philosophy and read their dietary guidelines. Since they are basically promoting a version of an evolutionary diet, I am in agreement with some of their philosophy and they appear to be contributing some valuable information to the field.
However, in my opinion, their daily recommendation for starches is just too high for most people and their recommendations for protein may be too low for many. There is a wealth of scientific and anthropological research that would dispute their position on starches and protein.
As I see it, the plate should consist primarily of animal protein and fat and little carbohydrate. Furthermore, any carbs you do consume are best if not acquired through rice or potatoes on a frequent basis. A medium size potato is the equivalent of a half a cup of sugar and rice is a very high glucose load as well. I would also say that alcohol, chocolate, and non-fructose sweeteners do not belong anywhere on the plate.
The first point you want to be aware of is that the population that I serve consists of people who have severe sugar and carb addiction, caffeine addiction, drug and alcohol addiction, compulsive overeating, adrenal fatigue, depression, anxiety and other mental health issues, excess sympathetic nervous system activity, insulin resistance, weight issues, Candida overgrowth, SIBO, or other microbial invasions. The dietary needs of this group of people are much different than the dietary needs of the general population.
All the people I work with have a severe problem handling glucose. They have some degree of carbohydrate intolerance. Their brain chemistry and endocrine system are significantly impaired. As I’m sure you know, starches of any kind are broken down into glucose, which results in an insulin response and a surge in neurotransmitter levels in the brain. In people who are trying to repair their brain chemistry and endocrine system, the two primary goals are to prevent a spike in insulin and a surge of neurotransmitters, because when either of these situations occurs it triggers their symptoms and leads to cravings for sugar and carbohydrates and abandonment of their diet completely.
Therefore, this group of people typically does best on a low-carb (LC) or very-low-carb (VLC or ketogenic) diet. However, the keyword here is “typically.” Nowhere on my site do you see me say that everyone should eat the same amount of carbohydrates. The primary lesson that I teach is that your carbohydrate consumption should be gauged by how many symptoms that it creates or alleviates and whether it triggers cravings for sugar and carbs. If you get depressed, anxious, irritable, hyper, tired or moody when you eat a certain amount of carbohydrates, then you shouldn’t be eating that many carbohydrates. If cravings for sugar and carbs develop in response to a particular level of carbohydrate consumption, then neurotransmitters and insulin have been spiked too much and the level needs to be adjusted. Some people can eat more carbohydrates than others and some people may require more than others.
The level of carbohydrates that triggers the spike in insulin and surge in neurotransmitters or that one should consume will vary from person to person to some degree depending on a wide variety of factors like genetics, age, heritage, their level of impairment, how long they have been sick, what phase of life they’re in, activity levels, stress levels, where they are on the healing journey, and other health issues they may be facing.
Carbohydrate intolerance is similar to gluten intolerance or lactose intolerance. As Drs. Volek and Phinney explain in The Art and Science of Low Carbohydrate Living, when one is intolerant of carbohydrates, the logical course of action is to reduce one’s intake of the problematic substance below the threshold that produces symptoms in the same way that one would eliminate gluten or lactose if they were intolerant of these substances.
Although Phinney and Volek are discussing carb reduction to address conditions such as type 2 diabetes and heart disease, the same principle applies here. People with candida are addicted to sugar and carbs, and the root of the addiction is impairment of the endocrine system and disrupted brain chemistry, both of which are addressed by minimizing intake of carbohydrates.
However, there is a wide variance in individuals’ severity of intolerance to carbohydrate. Some people may be completely intolerant, and others may be mildly or moderately so. Determine your degree of intolerance by assessing the symptoms and cravings produced when you consume carbs, and find the carb intake (or carb threshold) that resolves the most symptoms for you and eliminates your cravings. I don’t typically advocate a zero-carb diet, which would provide no food for your healthy bacteria and would require you to avoid vegetables altogether, possibly making the body too acidic and eliminating nutrients from the diet that could be health enhancing, but some people (e.g, those with SIBO) feel they have no choice but to eliminate the carbs completely to find some relief.
In regard to Candida overgrowth, there are many factors that will determine how many carbohydrates the individual can consume comfortably, which include the following: what species and strain of Candida they carry, the level of overgrowth that is present, how long they have had overgrowth, whether it is systemic or local, the overall health of their gut, whether they are insulin resistant, and what other health conditions they have in addition to Candida.
What I have found to be true for myself (someone who has dealt personally with most of the conditions I mention above) and most people that I work with who have the conditions I mentioned above is that anything above 60 or 70 grams of carbs per day typically results in a wide variety of symptoms like depression, anxiety, irritability, insomnia, and cravings for sugar and carbohydrates, as well as a flare in Candida overgrowth. For some people, even that is too high and they do better in the ketogenic range of less than 50. If one is dealing with SIBO, then carb level will definitely need to be below 50 to achieve significant improvements.
Therefore, I educate that this is the range that will probably work the best if you are dealing with the conditions I have already mentioned. However, one person may function optimally at 25 grams of carbs per day, while another may function most optimally at 70 grams per day. And, we are speaking of total carbs, not net carbs.
I encourage each person to experiment to find what works best for them. There is not a one-size fit all even within the Paleo diet. It must be individualized for each person’s needs as discussed in great detail on this page.
It is not uncommon for me to work with someone who can’t even touch a piece of fruit or starch in any form what-so-ever without it triggering a binge on sugar or carbohydrates and/or unbearable mental health symptoms, despite heavy supplementation to support neurotransmitters. Doesn’t matter whether they are Paleo approved starches or not. Starches they still are.
In my own life, the taro, cassava, sweet potatoes, winter squashes, etc., (as well as any other carbohydrates) all produce depression, anxiety, weight gain, irritability, fatigue, chronic widespread pain, a sore throat, intense gastrointestinal distress and pain, foul gas, bloating, and cravings for sugar and carbs if eaten with any frequency (and they are always consumed with animal protein and fat, but that doesn’t change the negative impact they have on my blood sugar.) I can have a sweet potato once in a great while for a holiday as a treat, without too much complication, but I still pay a little price. It has always been this way for me and I’ve been at this for more than 25 years. I even have to be careful with carrots, as they will make me feel horrible as well if I eat too many. Carrots can only be consumed in small amounts combined with other greens.
I simply could not get out of bed if I consumed 100 to 150 grams of starches per day as the Perfect Health Diet suggests. This is the case for many of my clients as well. Not only that, I just have no need or desire for that many carbohydrates; I prefer and function most optimally on animal protein and fat. However, it is entirely possible that at some point of my life I may need to make some adjustments and go slightly above ketosis once again on a daily basis. Additionally, I must have a minimum of 8 ounces of animal protein with “every” meal in order to keep my blood sugar stable and function optimally.
It is not only my opinion that a low-carb or very low-carb (ketogenic) diet is beneficial for many people. There are numerous studies that have found it to be exceptional for helping people with insulin resistance, insomnia, obesity, cardiovascular disease, diabetes, PCOS, cancer, autism, obsessive compulsive disorder, addiction, depression, schizophrenia, Parkinson’s, Alzheimer’s, seizures, migraines, and many other neurological disorders. You should take a look at my ketogenic diet page for more information on this and the books Grain Brain by Dr. David Perlmutter and Primal Body Primal Mind by Nora Gedgaudas and The Art & Science of Low Carbohydrate Living by Dr. Stephen D. Phinney and Dr. Jeff S. Volek and End Your Addiction Now by Dr. Charles Gant. You should also take a look at this page as well.
The science demonstrates that carbohydrates are non-essential in the diet considering the fact that the body can make glucose from amino acids in protein, lactic acid, or glycerol ( a derivative of fat), anytime it needs to do so. Furthermore, our ancestors went for long periods of time without access to carbohydrates, therefore they were running on a ketogenic diet a large portion of the time. Yes, our ancestors did consume a few tubers, but it did not make up a very large percentage of the diet, and these were much lower in starch content than the starches we have available to us today and they were only eaten seasonally. Additionally, our ancestors did not have metabolic damage that most people in society today have.
Mark Sisson recently wrote a series of posts indicating that there may be a case to be made that we do need a little bit of “resistant” starch in our diet to feed the healthy bacteria in our gut and that it helps improve insulin sensitivity. However, in order to consume “resistant” starch you’re going to be consuming non-resistant starch which is going to be problematic for the people I work with and resistant starch is a big problem for people with SIBO. But, do keep in mind that like everyone else in this field I am always in the learning process.
The whole “safe starches” concept provoked a lot of discussion in the Paleo blogosphere and you can read a really great debate on the issue at Jimmy Moore’s site. Here’s a quote from that discussion provided by the Atkins program, that I think hits the nail on the head. “In fact, ketone experts say the body functions more efficiently on ketones especially when glucose metabolism is broken. Moreover, glucose is tightly regulated and there is never a deficiency of glucose on Atkins because glucose is formed from substrates such as gluconeogenesis.” Although I am not promoting the Atkin’s diet, we are both pro low-carb and what they say applies to the ketogenic diet as well.
In my own body and the majority of people that I work with that have the conditions I mentioned previously, glucose metabolism is broken, and that is why an LC or VLC diet is usually most beneficial. On the other hand, in my opinion, there are very few people left in the world who are not damaged in their ability to handle glucose to at least some degree, so the pool of people that could consume as many starches as the Perfect Health Diet suggests is not very big.
However, there are other factors that must be considered and your needs may (and most likely do) change over time. For example, the level of carbohydrates that you function most optimally within your teens and 20s is likely to be different than the level you function most optimally on in your 40s and 50s and 60s. As we age, the way our bodies handle insulin changes; most of us become less tolerant of carbohydrates.
If someone is overweight, they may benefit the most from a ketogenic diet until they lose the desired weight and then they may feel better later by increasing their carbs to somewhere between 50 and 100 or they may find they feel best staying on a ketogenic diet. While someone with no weight issues, no endocrine system issues, no brain chemistry issues, and no microbial overgrowth may do just fine with 100 grams per day.
Women who are pregnant, wanting to get pregnant, or breastfeeding will most likely have a greater need for carbohydrates than women who are not and so will people who are athletes or who have a very active lifestyle.
A young woman or a woman who is pre-menopausal or a man of any age can eat a lot more carbohydrates than most women who are post-menopausal, because the loss of estrogen affects the management of insulin. For example, in my own life, although I had been nice and thin all my life, I started gaining weight at an alarming rate after menopause despite eating no more than 60 or 70 grams of carbs per day, getting regular exercise, proper sleep, stress management, etc. I gained like 16 pounds in two years and the only way I was able to lose that weight was to lower my carb intake to below 50 grams per day for 4 days out of the week, and slightly above that for the other 3 days out of the week. I hear this from post-menopausal women all the time; they must significantly lower their carb intake in order to lose weight.
Adrenal fatigue has a significant impact on one’s ability to handle glucose since the adrenals are called upon anytime glucose goes up or down and insulin is released. Too much glucose in the diet puts an excess demand on the adrenal glands, but so does low blood sugar. Therefore, people with adrenal fatigue almost always do better on a low-carb diet, because it keeps blood sugar levels stable. However, there is a spectrum with adrenal fatigue. Some people may be at the low end with mild impairment and other people may be at the extreme other end with severe exhaustion. People with severe exhaustion will tolerate fewer carbohydrates than people with mild impairment. Furthermore, the adrenal glands need lots of animal fat because cholesterol is needed to make cortisol, so their needs for animal protein and fat may be higher than others.
In my own life, when I was going through menopause, I had a severe adrenal crash and one of the things that helped me the most was staying in that 60 to 70 grams of carbs per day and eating lots of fat. It was at this time that I become even more intolerant of carbohydrates than I had ever been. As a matter of fact, according to my cortisol saliva test. I was not producing cortisol or DHEA at any time throughout the day. I was flat lined. After a variety of supplements, lifestyle changes and a low-carb diet, I was able to bring my cortisol levels back to normal at all time frames throughout the day.
How many carbs you consume will also depend on what goal you are trying to achieve. If you’re trying to lose weight, reverse insulin resistance, overcome an addiction or compulsive overeating, then your carb intake should be much lower than someone who is trying to gain weight and has no addictions. If you’re trying to address Candida or SIBO, then carb intake must be low. People trying to overcome compulsive overeating or sugar and carb addiction must be under 50 grams a day. When you lower your carb intake to this level and consume adequate amounts of animal protein and fat, your desire for sugar and carbohydrates and binging behaviors simply disappear.
The phase of recovery that you are in for one of these particular conditions will also impact your carb intake. For example, in the early stages of overcoming food and carb addiction, insulin resistance or adrenal fatigue, then you may not be able to consume any carbohydrates at all, but in the later stages of recovery after you’ve made some improvements in brain chemistry and the endocrine system, then you may be fine at 60 or 70 grams per day or 100 or some other particular number. The same is true for Candida, in the early phases of recovery, carbohydrate consumption is usually more restricted than it is in later stages of recovery.
Not only that, your need and tolerance for carbohydrates can vary from day to day to some extent, depending on what’s going in your life. One may find they have a higher need on a particularly stressful or active day or vice versa. Even I occasionally have days when I feel like I need to increase carbs for that day, which is always done with Paleo-approved carbs. More frequently though, I feel the need to increase my fat rather than my carbs.
One may also find that they do best by really emulating our ancestors and that means eating a little higher carbohydrate level during the summertime and less or ketogenic during the winter months, like they did.
On the Perfect Health Diet website, at the bottom of their dietary guidelines page, they state that some health conditions respond best to low-carb diets and that neurological disorders benefit from a ketogenic diet. It also states that they discuss this in their book. So, clearly, the authors of the book, Paul and Shou-Ching Jaminet, are aware that many people will not benefit from the level of starch that they are recommending for the general population, which doesn’t really contradict what I am saying. Maybe you missed that section in their book.
I am in the process of working on a new book called Diet for Sobriety that will demonstrate how the Paleo diet is effective for overcoming addictions of all kinds and improving mental health, that will go into a lot more detail about the things I have discussed here today. It should be available by the end of the year, so keep an eye out for that.
So, my answer to your question about what are my thoughts about your reaction to a low-carb diet would be this — I would say that you are the exception rather than the rule with Candida. Most people with Candida do not do well with that many starches in the diet. However, you have found what works for “your” body “at this time” in your life (as a 21-year-old male with your own particular set of circumstances). If this is what makes you function most optimally, then this is “your” perfect diet. But, you may find that this changes at some point in your life.
However, that does not mean that everybody should follow the same guidelines you are following or that it would be “perfect” for them. It doesn’t mean that many other people don’t benefit from a low-carb or a very low-carb (ketogenic) diet. It doesn’t mean that I am right and you are wrong or vice versa. It means that we are all unique and it demonstrates the very point that I often stress in my teachings, that the Paleo diet must be fine tuned to meet your unique biochemical needs.
Furthermore, you are only 21 years old, so you have not had as many years available to you to mess up your brain chemistry and endocrine system as severely as many other people. You apparently are not broken in your ability to handle glucose. People who have been eating a high-carb diet or dealing with Candida overgrowth or adrenal fatigue for decades have much more damage and will have more problems with starches. Additionally, most likely your Candida problem was not severe or systemic, because severe systemic Candida does not get completely eradicated with diet alone, if ever at all, and it certainly won’t happen if one is eating a lot of starches.
I can’t say with certainty why you had the symptoms you had in response to the low-carb diet, but it sounds to me like you felt better initially because it immediately reduced the food source for your Candida, which meant fewer toxins and fewer symptoms. However, then you began to go through the inevitable detox and adjustment phase, which commonly produces the type of symptoms you experienced. It takes time for the body and brain to run efficiently on fat and ketones and the adjustment process is uncomfortable, so you may not have given it enough time. You may have needed to alkalize a little more as well.
Additionally, you may have made the transition into a ketogenic diet too quickly or you may not have been consuming enough calories, fat, salt, or water. All of which can result in a wide variety of negative symptoms in some people that may drive one back to the carbohydrates. This can be resolved by moving into the ketogenic diet more slowly, increasing calorie intake, salt, fat, and water.
However, there is some research that suggests Candida can feed on ketones after a period of adaptation. I have not had this experience and haven’t had any clients with this experience. As I mentioned, I get the most relief with a ketogenic diet and so do many Candida sufferers. But, this is something to consider. If one feels that their Candida is feeding on ketones, then the ideal carbohydrate range would be 60 to 70 grams per day. This would prevent an elevation in glucose or ketones.
So, had you been my client, I would have educated you about all the things I have discussed on this page and suggested you consider the possibility of not giving up, but going at it a little slower, before deciding it wasn’t right for you. But, perhaps you would still find that you are just one of those people who do better with more carbs than others.
On the other hand, do keep in mind that just because someone can get away with eating a significant amount of carbohydrates at a particular time, does not mean that consequences you cannot see are not occurring. It takes time for consequences to present. They may be revealed to you at a later date.
Some people do report negative symptoms they believe are related to a long-term low-carb diet, but not the majority. When that is the case, then some practitioners like Chris Kresser have found that increasing the carb intake slightly with the “safer” Paleo approved starches has been helpful. However, other respected experts on the topic of low-carb feel these problems stem from an insufficient caloric intake, not the reduced carbohydrate intake.
In the Art & Science of Low Carbohydrate Living Drs. Phinney & Volek explain that it is important that the low-carb diet is formulated properly. When carbohydrate intake is decreased, then fat needs to increase. So does water and salt, because we excrete them more efficiently when are eating fewer carbs. Additionally, one must be sure to consume enough calories. If these steps are not taken, then there can be a wide variety of negative effects like lightheadedness upon standing up quickly, feeling faint, weakness, fatigue (worse after exercise), headaches, and constipation.
There is a belief in some people that a very low carb diet may contribute to hypothyroidism or adrenal fatigue. I disagree. Most people have an adrenal and thyroid problem prior to eating the low-carbohydrate diet, and it gets worse from other factors as time goes on, not the lowering of carbs. However, if there is not sufficient intake of calories when going low-carb this could contribute. Research shows that when you are “on a well formulated low-carb, moderate protein, high-fat diet with adequate calories there has been no occurrence of low thyroid.”
Additionally, a lowered thyroid level on a thyroid test for someone who is eating ketogenic may be a sign of “improved efficiency of metabolic functions and a desirable longevity marker.” There may be a lowered conversion of T4 to T3, but that doesn’t mean there is a problem. “When we are burning ketones from fat as our primary fuel source, our thyroid just doesn’t have to work as hard as it does when it’s got to manage bodily metabolism on a less preferred fuel (glucose).”
Furthermore, I would assert that carbohydrates are much more stressful and harder on the adrenal glands than eating ketogenic. “Being in a state of ketosis lowers the amount of stress on the body through the elimination of such culprit foods as sugar, white flour, grains, legumes and more.” “Switching over from the unnatural and stressful state of being a sugar-burner to the more relaxed state of being a fat-burner is arguably far less taxing on your adrenal glands.”
I would also like to note that even though you say you are eating a little Paleo approved starch with each diet, that I would venture to say that you are still in the low-carb category in comparison to most standards. So, I don’t really think we are on opposite sides of the fence here. There is a wide variance of what might be an acceptable level of carbohydrates within the Paleo structure.
If you are above the 150 grams a day, then I would be concerned that you are eventually going to develop the many health conditions that are associated with excess glucose and then move into the category of people who have metabolic damage.
The same is true for animal protein and fat; some people may need more or less animal protein and fat than others, some may need more fat than protein or vice versa all depending on the same factors we have already discussed. So, the bottom line is that each person should use the Paleo diet as a guideline and then adjust their consumption of each of the macronutrients (protein, fat, and carbohydrates) accordingly based on their own specific needs at any given time. Keeping in mind that our dietary needs are dynamic as we go through our life cycle, not stationary.