In Defense of High-Protein, Low-Carbohydrate Diets
If you don’t have time to watch the excellent video above, here are some key points made by Dr. Layman:
- The Institute of Medicine’s range for protein intake is very broad: 0.8-2.5 grams per kilogram of body weight per day, or 56-200 grams per day
- Always use absolute protein (grams) instead of percentage of calories from protein (15% of calories from protein would be only 45 grams on a 1200-calorie diet but 113 grams on a 3000-calorie diet)
- Study results don’t all agree due to varying levels of compliance (Measures of compliance are often not reported)
- Distribution of protein throughout the day in at least 3 feedings is important. Less than 20 grams of protein per meal has no effect on protein synthesis, and 60 grams of protein in one sitting is more than your body can effectively use
- When oxidized, essential amino acids act as signaling molecules for metabolism, including tryptophan as a precursor for the synthesis of serotonin, phenylalanine’s release of the satiety-promoting gut hormone CCK; and leucine for muscle protein synthesis (MPS).
There’s plenty of research in favor of moderately high protein consumption, including a study Dr. Layman published earlier this year expanding on many of the concepts above, such as the amount and type of protein required at mealtimes to optimize leucine’s effects on MPS: 3 grams of leucine per meal, or a minimum of ~25 grams of protein per meal (1).
Also, while insulin is viewed by many in the low-carb community as a “storage” hormone, it’s actually also an anabolic hormone that promotes growth in children and increased muscle mass in adults. Chronically high levels of fasting and postmeal insulin are indeed unhealthy, but along with leucine, a small rise in this hormone after meals is vital for MPS. Also, research suggests that much like insulin resistance, aging may produce “leucine resistance,” which requires additional amino acids in order to promote MPS signaling (1).
Muscle protein breakdown (MPD) and MPS occur in everyone and should be in balance in order to maintain muscle mass. If your goal is to increase muscle size, the ratio of MPS to MPD must be increased through strength training as well as sufficient protein intake. Loss of lean muscle due to inadequate amino acid intake is one of the major drawbacks of fasting, which results in an extended period of MPD, and “fat fasts,” where a 1000-calorie, 90% fat diet is consumed for several days to break out of a weight loss plateau.
Weight loss: There’s been much talk lately about striving for nutritional ketosis in order to lose weight. I’ve seen people encouraged to keep protein “moderate” (i.e., 1 gram per kilogram lean body mass) and increase fat intake in order to drive up serum ketone levels. But all the studies on low-carbohydrate diets supporting weight loss have used high protein intakes, whether ad libitum or prescribed (2-6), including the ones described as “very-low-carbohydrate ketogenic diets,” whether urinary ketone levels were measured and reported or not. And for the record, I don’t believe that ketogenic diets always promote weight loss more effectively than low-carbohydrate diets do and can in fact be counterproductive for weight loss at low protein and energy intakes.
Protein has the highest thermic effect of food (TEF) of the three macronutrients, meaning its digestion and absorption cause metabolic rate to increase significantly more than with carbohydrates or fat. An older study linked this effect to protein’s high satiety value (7), and many studies have confirmed that with higher protein intake, people end up eating less as a result of feeling full and satisfied (8-10).
Retention of muscle mass: During weight loss, there’s a risk of losing lean muscle tissue in addition to fat. However, research has shown that increasing protein intake can protect against muscle loss during the process of losing weight (11). Higher protein intake can also decrease sarcopenia, or the loss of lean mass that occurs as a natural part of the aging process, estimated at 3-8% per decade after the age of 30 (12), and it’s particularly effective when combined with resistance exercise. Dr. Bill Lagakos of Calories Proper wrote a great blog post demonstrating that nutritional ketosis in the absence of adequate protein (~100 grams per day for most) does not prevent a decline in muscle mass during weight loss. Bill has written many other excellent articles on protein and other topics, so please check out his blog if you haven’t already.
Over the past few years, I’ve seen a disturbing trend in people who are trying to lose weight limiting protein to 50-60 grams per day in an attempt to achieve beta-hydroxybutyrate values over 1.5 mmol/L. (Fasting, of course, limits protein to zero grams for the duration of the fast). For therapeutic purposes such as epilepsy, brain cancer, neurological or mood disorders, this may be warranted. But I strongly disagree with this tactic for weight loss or diabetes management, the population group I primarily work with.
Protein is a satiating, self-limiting nutrient that increases metabolic rate, increases satiety, and helps maintain muscle health. So my question is why would we want to intentionally limit it if the goal is fat loss?
What about kidney health, bone health, and blood glucose levels?
There’s a misconception that high protein intake is bad for the kidneys, but this seems to be based on the results of an older study on individuals who already had renal disease (13). Subsequent studies have demonstrated that high protein consumption (more than 1.5 grams per kg body weight) doesn’t adversely affect the health of kidneys in people without preexisting renal disease (14). In fact, recent research suggests that even individuals with renal disease may not need to limit protein as previously believed, depending on the stage of disease. In 2013, researchers looked at the effect of a “moderate” protein diet (90-120 grams) vs. a “standard” protein diet (55-70 grams) in overweight and obese men with type 2 diabetes and impaired kidney function (15). This was a long-term study lasting two years, and in addition to weight loss and better blood glucose control, both groups saw an improvement in renal function.
I’ve written about the effects of high protein diets on bone health recently. It’s a very long blog post, but if you skip to the “Protein” section at about the halfway point, you’ll see that high-protein intake is actually beneficial rather than harmful for bone density, provided intake of minerals such as calcium are optimized and alkaline foods like vegetables are included in the diet.
And what about the effect of high protein intake on blood glucose levels in people with diabetes and prediabetes? Like the studies on weight loss discussed above, all of the carbohydrate-restricted research verifying its benefits on glycemic control have been high in protein (often ad libitum amounts of meat, poultry, and eggs) (16-19), including one coauthored by Dr. Eric Westman in which 17 out of 21 subjects were able to eliminate or reduce dosage of insulin and/or oral diabetes medications over the course of the 16-week study(20). Although the amounts of food consumed weren’t listed, most if not all of these participants were likely eating at least 100 grams of protein daily, given that their carbohydrate intake was less than 20 grams and portion sizes of protein foods weren’t limited.
When the term “very-low-carbohydrate, ketogenic diet is used” in weight loss and diabetes research, it’s referring to carbohydrate restriction — not extremely high fat intake and definitely not protein restriction.
In 2004, Mary Gannon and Frank Nuttall studied 8 men with type 2 diabetes who followed a moderately low-carbohydrate (~100 grams net carbohydrate), high-fiber (~36 grams), very-high-protein (~200 grams) diet. After 5 weeks, fasting and postprandial blood glucose levels, insulin levels, and HbA1c had significantly improved (21). Of course, this was a very small study, but the results are pretty encouraging, given that dietary protein intake was roughly twice the amount consumed by most people.
Going with Science
When I say I’m in favor of high-protein, low-carbohydrate diets, I’m not recommending that most people eat anywhere close to the amount of protein consumed in the Gannon study. In fact, I don’t think most of us could eat that much and feel well. Protein needs vary from person to person based on size, age, activity, and certain medical conditions. But I think we need to base low-carbohydrate recommendations on what the science shows, which is moderately high protein intake — particularly during weight loss and aging — on an ad libitum basis for most people.
References
1. Layman, DK. Defining meal requirements for protein to optimize metabolic roles of amino aids. Am J Clin Nutr. 2015 Appr 29. poi:ajcn084053. [epub ahead of print]
2. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003 Apr; 88(4):1617-23
3. Foster GD, et al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate vs. Low-Fat Diet: A Randomized Trial. Ann Intern Med. 2010;153(3):147-157
4. Brinkworth GD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months. Am J Clin Nutr. 2009 Jul;90(1):23-32
5. Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009 Apr;44(4):297-309
6. Ebbeling CB et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. 2012;307(24):2627l-2634
7. Crovetti R, et al. The influence of thermic effect of food on satiety. Eur J Clin Nutr. 1998 Jul;52(7):482-8
8. Anderson GA, et al. Dietary proteins in the regulation of food intake and body weight in humans. J Nutr. 134:974S-979S
9. Rolls BJ, et al. The specificity of satiety: the influence of foods of different macronutrient content on the development of satiety. Physiol Behav. 1988;43(2):145-53
10. Halton TL, et al. The effects of high protein diets on thermogenesis, satiety, and weight loss: a critical review. J Am Coll Nutr. 2004 Oct;23(5):373-85
11. Soenen S, et al. Normal protein intake is required for body weight loss and weight maintenance, and elevated protein intake for additional preservation of resting energy expenditure and fat free mass. J Nutr. 2013 May;143(5):591-6
12. Arentson-Lantz E, et al. Protein: a nutrient in focus. Appl Physiol Nutr Metab.
2015 Aug;40(8):755-61
13. Brenner BM, et al. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med. 1982; 307:652-659
14. Martin WF, et al. Dietary protein intake and renal function. Nutr Metab (Lond). 2005;2:25
15. Jesudason DR, et al. Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts. Am J Clin Nutr. 2013 Aug;98(2):494-501
16. Nielsen JV, et al. Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up. Nutr Metab. 2006 Jun 14;3:22
17. Yamada Y, et al. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 2014;53(1):13-9
18. Unwin D, Unwin J. Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice. Practical Diabetes 2014, 31: 76–79
19. Tay J, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015 Jul 29pii: ajcn112581.[epub ahead of print]
20. Yancy WS, Westman EC, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab. 2005 2:34
21. Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004 53:2375–2382
Interesting stuff. At 100g of P and 50g of C I calculate 600 cals, giving a total intake of 1200 cals if fat is 50% ? Perhaps the 70% fat people are just at higher calories eg 2000 calories total fits the same carb and protein as above.
Hi Phil,
The numbers and percentages are a bit tricky because they’re based on total carbs, but I only count digestible carbs. Given that my daily fiber intake ranges from 30-40 grams, this definitely skews things a bit.
This is a rough average for me:
Calories: 1500
Protein: 110 grams (440 calories) 29%
Total Carbohydrates: 75 grams (300 calories) 20%
Fiber: 35 grams
Fat: 85 grams (765 calories) 51%
Great, Thanks for the info,
At 29% protein I wouldn’t say you were especially high, though as with all relative statements it depends on the context. I tend to think of over 35% as high (if not excessive).
Perhaps we need some kind of lexicon where over 50 is high, 20-50 is moderate and under 20 is low. That at least fits LCHF but probably makes the SAD “low protein”. Hmm. I’ll get my coat.
Yes, I don’t think it’s very high either, but I’ve seen many recommend no more than 1 g/kg, which for me would be only 57 grams. I feel much better with 90-110 grams.
I like your idea! However, 50% protein would be extremely high at a normal caloric intake of 2000 calories (250 grams) and moderately high at 1200 calories (150 grams), which is why I don’t really like using percentages. I think absolute values work much better.
I understood that carbs are not easily converted to carbohydrates, but the fat ingested with the carbs is rapidly stored which is why there is fat storage with a high carb and fat diet http://fatnews.com/index.php/weblog/comments/carbohydrates-are-not-easily-converted-into-body-fat
Hi Julianne,
I think you had a typo there and meant to say that carbs aren’t easily converted to fat, correct? It’s true that carb intake must surpass needs in order to be stored as fat, yes.
A high-fat, high-carb diet does result in fat storage as a result of excessive calories and high insulin levels, certainly.
oops yes – I meant fat. I think the amount is quite high before it starts converting to glucose, yet people think it is quite low. Some interpret carbs have to be very low for fat loss, but in my experience it is individual. I’ve seen some clients get fat better fat loss results by maintaining protein, (30 – 50 g per meal) eating more starch (root veg rather than grains) and reducing fat when fat loss is stalled on a low carb diet.
I agree that it’s highly individual! I follow a low-carb diet for blood glucose issues rather than weight control, and I’ve found from experience that I do need to keep carbs pretty low at meals, regardless of fat and protein intake. But others can certainly tolerate more, and that’s true for some of my clients as well. Thanks for sharing 🙂
Would these high amounts of protein simply mess up a diabetic worse than the ADA diet?
No, not at all. Please read the section on blood glucose levels, and you’ll see that in every low-carb study, people were allowed to eat as much protein as they wanted, and their diabetes control improved.
I’m looking at this too, I agree that studies are generally higher in protein which isn’t a surprise given the long shadow of fat phobia. I’m not sure there is a 5C / 15-20P / 75-80F study out there to compare, so while accepting that diabetes measures improved this also happens in the low fat arm so we don’t really know what the optimum protein for minimum HbA1c is, do we ?? I’m mindful of several diabetics who report elevated BG on increased protein intake from their meters.
I still think there’s a wide range of acceptable protein intake and people need to see where they do best for BG control. I have several clients who had worse BG control with very high fat intake as you describe. They did much better after increasing protein and lowering fat to 50-60% daily. It’s the eat-to-your meter approach that I think everyone should be doing.
I agree. Great post, Franziska! I, too, now eat a higher protein slightly lower fat low carb diet. I was introduced to the work of Dr. Layman not that long ago and find his points compelling.
Thank you so much, Margaret! I appreciate your comments and am glad we agree on Dr. Layman.
The most useful thing I took from Layman was the “anabolic threshold” concept of 20 – 30 grams per meal. I tend to look at this as 60 – 90 grams of protein per day at three meals and a few incidental grams on top.
Fascinating post. Great job distilling the salient points–thanks! I need to up protein intake. I’m woefully low according to this research. A T1 eating LC, protein effect s my BG.
Appreciate your insights into trendy protein-restricted ketogenic diets. Its promoters are jumping on the latest weight loss bandwagon without doing the research.
Thanks so much, Gerri! Ideal protein intake does vary quite a bit from person to person based on size and muscle mass. A petite woman who’s 5’0 and 100 lbs may not need more than 60 grams of protein, which would be 1.3 g/kg body weight.
Thank you again for your kind words and comments.
Where does gluconeogenisis fit in or begin here? That has always been my concern with bringing my protein too high. I was trying to keep my input at about 70g/d, although realistically I’ve been more like 90 g/d. I’m a 5’8″ middle-aged female who has wanted to lose weight, but hasn’t (nor gained). Would you say that gluconeogenesis is not a concern at the levels you are talking about? Thanks!
Hi Mimi. Gluconeogenesis is a demand-driven rather than substrate-driven process, meaning it occurs when your body needs glucose rather than making more because of high levels of protein in your diet. You and I are the same height,and 90 grams per day is definitely not excessive for you, particularly if you’re trying to lose weight.
Hope that helps! Best of luck to you.
So is there some point in low-carbing (which I’ve been doing for about 4 years, although not to the point of ketosis), where the body or brain says, hey, forget about that muscle building, make me some glucose, liver? What would trigger the demand for more glucose and ramp up gluconeogenesis? Thanks again.
Hi Mimi,
I’m not quite clear on your question. Are you experiencing elevated blood glucose levels when fasting, or does this occur after eating? Elevated blood glucose levels aren’t generally due to gluconeogenesis.
Franziska,
I’m actually thinking purely theoretically here. I’ve always wondered what triggered gluconeogenesis. I’m sure it may be more complicated than someone without a bioscience background like me could understand. I haven’t been monitoring my own BG for a while, but did see some high 90s readings first thing in the morning when I did.
Mimi, Gluconeogenesis occurs when you don’t have enough glucose to meet your needs. On a very low carbohydrate diet it can occur, but it has nothing to do with the level of protein you eat. If you need to make glucose, your liver will make it, either from amino acids in protein that you consume as food, or from breaking down muscles into amino acids.
Most people who have elevated fasting blood sugar aren’t experiencing gluconeogenesis but rather glycogenolysis, where your liver is releasing its stored sugar into the bloodstream due to its cells being insulin resistance. This happens to many people as we get older, regardless of diet.
People on low-carb diets sometimes (definitely not always) see higher blood glucose levels that may be due to something called physiological insulin resistance. Mark Sisson wrote a blog post about this some time ago: http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/#axzz3nAumnfNG
At any rate, protein intake of ~100 grams per day wouldn’t be the cause of elevated fasting or post meal blood glucose.
Best,
– Franziska
Great article. I am a big fan of getting enough protein. My understanding from various sources is that your body can utilize a certain amount of protein from a meal, but that extra protein will induce Gluconeogenesis (GNG). Authorities like Bernstein even recommend partial carb counting of dietary protein. My personal experience is that a high protein meal (whether zero carb or not) will induce a blood sugar rise over 3-5 hours indicating that dietary protein is causing GNG despite my blood sugars not being low. For someone with a normal insulin response this might not cause elevated numbers after a meal but for my insulin challenged body the effect is quite visible. This article (http://www.nutritionandmetabolism.com/content/11/1/53) suggests that dietary protein does induce GNG and describes the mechanism.
Thank you so much! This was very helpful and informative. It’s answered a question that has been bouncing around in my brain for a while.
Hi Mimi,
I’m not sure if you were thanking me or Brian or both of us (it’s impossible to reply directly to a reply on this blog, as I’m sure you’ve noticed!), but I’m glad you were happy with one or both of our responses 🙂
Hi Brian,
Thanks for your kind words and comments.
I was trying to address Mimi’s concerns about high protein intake causing issues with weight loss and/or fasting blood glucose levels without going into what occurs with people who have diabetes. For her, eating 70 vs. 100 grams of protein daily should make no difference in her blood glucose levels and will certainly not stall her weight loss efforts.
Here’s a great article discussing why high protein intake does not increase blood glucose levels in people without diabetes: http://www.ketotic.org/2012/08/if-you-eat-excess-protein-does-it-turn.html
Eating protein causes the alpha cells of the pancreas to release glucagon, which does increase glucose production from the liver via gluconeogenesis. However, in people without diabetes, the small simultaneous release of insulin from the pancreatic beta cells results counters this. For people with insulin-dependent diabetes, the protein will certainly raise blood glucose, hence the need to inject insulin for coverage.
In my blog post, I almost included a section about Dr. Bernstein’s recommendations that his patients eat as much protein as they need to feel satisfied and then take an appropriate insulin bolus for coverage, but the article was already far longer than I’d intended it to be!
Thanks again for your comments and insight!
Another well-researched and informative post, Franziska. Your blog is always helpful.
I’m curious about which proteins I should include in my daily count. I’ve been doing LCHF for about 7 years and count primary/complete protein–meat, eggs, cheese for ex, but not yogurt. Am I cheating?
Thanks so much, Jkim!
Yes, yogurt counts as a complete protein, as all animal products do. So you’ll definitely want to count the grams of protein from all types of dairy. I count protein grams from all sources, whether complete or incomplete, because the essential amino acids in nuts, vegetables, seeds, etc., combine with complementary amino acids in both plant and animal foods to make complete protein.
Hope that helps!
Hi Franziska –
Thanks for the nicely written and logical blog post.
Your case for boosting postprandial blood insulin and leucine levels is currently accepted in the mainstream nutrition community, and is indeed quite true with the exception of when one is in nutritional ketosis.
Way back in 1983 when I published my infamous bike racer study in Metabolism (vol 32, pp 757-68), we reported that holding protein intake constant at 1.6 g/kg body weight when they made the transition to the eucaloric ketogenic diet resulted in no loss of lean body mass or physical performance. This despite consuming less than 10 g/d of total carbs and a sharp decline in blood insulin levels.
Given the well-known ‘need’ for insulin to drive muscle protein synthesis, this observation has confounded many of my academic colleagues, and more than a few of them have probably hypothesized that I made those data up. However the answer to this conumdrum is ‘hidden in plain sight’ in that paper. Despite no increase in protein (or leucine) intake when the subjects transitioned from the high carb control diet to the ketogenic diet, all three serum BCAA levels increased by 25-30% after the first week in nutritional ketosis and they stayed up for the 4 week duration of that study.
It took us a while to figure out why this dramatic increase in leucine, isoleucine, and valine levels occurred. The answer is quite elegant — beta-hydroxybutyrate competes with the BCAA’s for catabolism in muscle mitochondria, so the state of nutritional ketosis has a potent leucine sparing effect. This sharp and sustained rise in blood leucine (much more than can be achieved by taking expensive leucine supplements) explains how lean body mass and physical performance can be sustained when most dietary carbs are removed and protein intake remains moderate.
So yes, if one chooses to eat enough ‘healthy carbs’ to not be in nutritional ketosis, then you would need more protein per the arguments of Don Layman and Mary Gannon to build or sustain lean body mass. But nutritional ketosis is turning out to be a physiological sweet spot. Getting nutritional ketosis right (20-50 g/d of total carbs, protein at 1.5 g/kg reference wt) takes a bit of guidance and practice, but I liken the process to flying on a plane from California to Hawaii. It is a fairly small target with a lot of deep water in between, but it is a neat place to be once you are there. Particularly since we now know that 1 mM beta-hydroxybutyrate also unleashes the body’s endogenous defenses against oxidative stress (Shimazu et al, Science vol 339, pp 211-4, 2013), it may be a bit premature to discount the therapeutic benefits of nutritional ketosis.
Be well,
Steve
Hi Steve,
Always great to hear from you! Thanks so much for taking the time to read and comment on my blog post. I appreciate you sharing your expertise and insight with me and my readers.
Very interesting point on the branch-chain amino acids increasing on a ketogenic diet when protein intake was unchanged! I actually agree with everything you’ve said, and it certainly wasn’t my intention to discount therapeutic applications for nutritional ketosis. Your books The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance are the best ones on the subject I’ve seen.
My concern is that people are restricting protein to unnecessarily low levels (ie, 50 g/day for an overweight woman of average height) in an attempt to increase serum ketone levels. I agree that protein at 1.5 g/kg reference weight is adequate, certainly, in the contact of nutritional ketosis.
Thank you so much again for your response and for all the work you’ve done and continue to do to advance the acceptance of very-low-carbohydrate ketogenic diets. You’ve helped countless people better understand carbohydrate restriction and its many benefits.
Best,
Franziska
As an admirer of both of you it seems you’re talking past each other a little bit. Franziska is concerned that people are restraining protein to achieve nutritional ketosis and Steve is saying if you’re in nutritional ketosis then the protein sparing may mean Franziska’s concerns are unfounded ? Bill Lagakos doesn’t really make a clear case that protein sparing doesn’t happen in ketosis in the linked item and Steve contradicts it above.
So, for clarification, what is the minimum protein intake for an overweight woman of average height in a) nutritional ketosis with B-OHB >0.5 mmol/l or b) low carbing at <100g CHO
In Europe EFSA ruled that 75 grams was sufficient protein intake for VLCD dieting overweight / obese patients. Is 50 grams a problem if you're en-route to Steve's Hawaii (0.8 - 2.5 g/kg RBW) but not quite there, and certainly not once you are there ?
Given the "buzz" of elevated ketones and the demonstrated increased flux of ketones into the brain and muscles at elevated levels I certainly have sympathy for striving to increase them - I just wish my liver would read the memo.
Hi Phil,
I’m not sure Steve elected to receive notifications on responses to his comments, but I really think he is the one who should address your questions, since he and Jeff Volek are undoubtedly the leading experts in nutritional ketosis.
However, I think it’s safe to say that he’d agree 50 grams or 0.8 g/kg RBW is too low for an overweight woman of average height.
Well done Franziska, this is another fantastic post, I totally agree with you! Ketogenic diets are not any better for weight loss than low-carb diets and adequate protein intake is crucial for successful weight loss.
Thank you so much for your kind words, Martina! Truly appreciated 🙂
What do you think of Jason Fung’s new posting?
https://intensivedietarymanagement.com/fasting-and-muscle-mass-fasting-part-14/
Your posting was fantastically informative. Thanks.
Hi Carole,
Thanks so much for your kind words about my post.
While I respect Dr. Jason Fung and agree with him on several nutrition-related issues, fasting isn’t one of them. I read all of the comments, and Valerie made some excellent points, culminating with last line: “The problem is that there is zero protein intake to balance that breakdown.” Bingo!
The 2nd variable in the protein formula of g/kg is body weight. In your blog post and subsequent readers’ comments, it is variously described as ‘total body weight,’ ‘lean body weight,’ and ‘reference body weight’ (RBW).
If a person is seriously overweight, which weight is used to determine the grams of protein within the range of 0.8g to 2.5g adds a weight variable as large as the range of protein itself. And while the range of protein is defined by several variables (age, gender, level of activity, etc.), the weight factor is not.
Without clarification, the result is that one person’s calculation of the ideal amount of protein for a particular person can be distorted and quite arbitrary.
I now use ‘lean body weight’ and determine ‘kg’ from the middle weight on the BMI chart for ‘normal’ or ‘ideal’ weight for my height. My understanding is that this weight is one in which the body composition is lean but contains a ‘healthy’ amount of fat. Is ‘lean body weight’ the same as ‘reference body weight’?
In any case, for the overweight or obese, total body weight, it seems to me, would not be correct as protein in the diet is not required to sustain body fat.
Thanks for your comments, Dan. I should have clarified that for the overweight or obese, lean body weight or ideal body weight rather than actual body weight should be used in calculating protein needs. Using “reference body weight” requires that you know your own percentage of lean and fat mass, while IBW can be calculated without this information:
Men: 106 lbs plus 6 lbs for every inch over 5 feet (add or subtract 10% for large and small frames, respectively)
Women: 100 lbs plus 5 lbs for every inch over 5 feet (add or subtract 10% for large and small frames, respectively)
Thanks, Franziska. That’s really helpful.
Thank you for curating these study findings into a very easy-to-read post! I appreciate that your site is both credible and approachable.
I’m seeking conclusions of any randomized trials (2+ years in duration) of people with type 2 diabetes and their longer-term experience with LCHF way of eating.
I will keep researching; if you know of 1 or 2, would you kindly point me to the URLs, Franziska? Thank you very much. Best, Ed
Hi Ed,
Thanks for the nice feedback! The only 2-year+ study on low carb for T2D that I’m aware of was done in Sweden several years ago: https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-14. There may be more out there, but at this point I don’t know of any.
Best of luck to you! – Franziska
What would you recommend for someone with a history of gout? I agree with your post and all but I recently had my first gout attack and am concerned about eating this way. I was eating a low carb diet when I had the attack. Protein was averaging 115-120 grams a day. Carbs at 20-30 a day. I’m 170 pound 53 year old male. 6 ft tall.
Hi Rob,
Thanks for your question. I’m sorry to hear about your gout attack.
Although high meat and seafood intake are linked to increased incidence of gout, eggs aren’t, and high dairy consumption appears protective: http://www.nejm.org/doi/full/10.1056/NEJMoa035700#t=article. You could also increase carbs a bit (even doubling what you’re doing now would still be considered low carb) by adding some legumes, which are also inversely associated with gout.
I wish you the best of luck and good health!
– Franziska
Thank you for your response. Are eggs safe in high amounts ie 4-6 a day?
Yes, definitely safe for most people, although perhaps not for those with certain genetic issues (APOE4 mutation, etc.). For protein, I’d do a combination of dairy, eggs, nuts/seeds/legumes, and smaller amounts of meat and seafood.