Yonatan Genauer

Phone: 0477-459-615

Email: [email protected]

A Low Carbohydrate Diet

Introduction - Low Carbohydrate diets have many health benefits

Low carbohydrate diets are well researched and have many proven benefits such as weight loss and
improved blood sugar control. However more research is coming out every year showing a huge
potential for treating many other conditions including improving insulin resistance, some types of
cancer, fatty liver, PCOS, epilepsy, neurodegenerative disorders, and mental illness to name a few. This
resource will help you understand the mechanism and give you an idea of what foods to eat to kickstart
your low carbohydrate journey.

Let’s start with the basics: The three macronutrients

What we need out of food is energy and nutrients. Our foods are made up of three macronutrients:
Carbohydrates, fats, and proteins. Energy can be extracted from each of these macronutrients however,
each of these macronutrients has a different effect on our body and our health.

Carbohydrates

The word carbohydrate, often shortened to carb, refers to a type of molecule. In the context of food,
carbohydrates are better known as sugars and starches. Sugars are the simple version of these
molecules. Starches are made of long chains of simple sugars linked together. This can get confusing at
times as sugar in the form of starch is often found in foods which we think of as “savoury” such as
potatoes.

Examples of different sugars

Sucrose – the official name for table sugar

Fructose - the sugar most often found in fruit or honey

Lactose - the type of sugar found in milk

Glucose - a basic sugar unit in many foods and the main sugar in our blood stream

Starches - made up of long chains of glucose such as in potatoes, bread, rice and corn

1
 Figure: Long chains of glucose
attached together are called starch
and can be found in foods such as
bread, rice, corn, and potatoes. In
the gut they are all broken down
and absorbed as glucose

Which foods are rich in carbohydrates?

Foods with high levels of carbohydrates include:

 Foods and beverages which have added sugars such as cakes, biscuits, donuts, soft drinks,
juices, and cordials. Many packaged foods have added sugar even if they are savory foods.
 Foods made from grain such as bread, rice, pasta, oats and breakfast cereals
 Starchy vegetables such as potatoes, corn, sweet potatoes, and most root vegetables, even
ones which we think of as healthy such as carrot, beetroot and pumpkin.
 Foods with naturally occurring sugar such as fruit, honey, and maple syrup.

The physiological response to carbohydrates

When we eat any form of carbohydrate – regardless of whether it comes from a simple sugar or starch,
and regardless of whether it is from a natural source or not - it is broken down in our digestive system
and absorbed into the blood stream as sugar. The glucose component of the carbohydrate is absorbed
directly into our blood stream which raises our blood sugar levels. Other simple sugars are converted
into glucose by the liver or stored as fat.

High blood sugar levels are dangerous, and the body makes a big effort to keep the blood sugar within a
tightly controlled range. Therefore, when blood glucose rises after a meal, the body releases a hormone
named insulin which directs each part of the body what to do with the incoming glucose. The first task
of insulin is to get the sugar out of the blood stream and into the cells. The more carbohydrates in a
meal, the greater the amount of insulin released.

2
Figure: This image shows how carbohydrates spike the highest insulin response in the body. Insulin in turn is the
major fat storage hormone in our body. More on this can be found on the Virta Health website, a company that is
working to help people lose weight and reverse diabetes with a ketogenic diet.
https://www.virtahealth.com/faq/what-causes-high-blood-sugar

Many people know that sugar and sweet foods are bad for their health. However, it is important to
understand that also many savory foods such as rice, potatoes and spaghetti, as well as fruit have a large
effect on blood sugar levels.

Figure: Tools such as Dr David Unwin’s sugar infographics can help understand how different foods raise
our blood sugar (for this tool and more: https://phcuk.org/sugar/)

3
Insulin and weight gain

So, what is the problem with elevated levels of insulin? One problem is that insulin is the main hormone
that drives fat storage. To the fat tissue (also known as adipose tissue) insulin signals to uptake the
glucose and store it as fat and prevents the breakdown of fat for usage. If this happens often, it can lead
to weight gain. It also keeps you from feeling full for long, which is done through prioritising storage of
incoming energy rather than using it upfront. Have you ever wondered why two hours after receiving a
large amount of energy from a big sugary dessert, you don’t feel energised but rather sluggish instead?
Where did all that incoming energy go to? Fat storage and weight gain.

Insulin resistance and how a low carbohydrate diet can help with weight and blood sugar control

Over time, high levels of insulin can lead to insulin resistance which, simply put, is a decrease in the
efficiency of insulin signalling. To compensate for the reduced efficiency, higher levels of insulin are
released. This can result in a vicious cycle of increasing insulin levels and reduced efficiency. This often
causes weight gain but can also lead gradually towards diabetes and several other health problems. The
shared cause for these diseases is called metabolic syndrome. Avoiding this is often as simple as not
having too many carbohydrates since this is what triggers the insulin response. If you already have
severe insulin resistance, it might take some time for the body to heal, but avoiding carbohydrates will
have an immediate effect by bringing down your blood sugar and insulin levels.

Do we need carbohydrates?

Current guidelines recommend that 45%-65% of our energy intake should come from carbohydrates.
This recommendation started originally with the American dietary guidelines in 1980 and spread to most
countries’ nutritional guidelines. Graphically this was represented by the food pyramid where grains
formed the base of the pyramid. Unfortunately, these recommendations were based on weak evidence
and did not lead to good outcomes. It is important to note that from a physiological perspective,
carbohydrates are not essential in the human diet. That is right, the required amount is zero, none.

Figure: An early version of the food pyramid. Today the same idea is represented in the Australian Dietary
Guideline with different graphic representation.

Is a low carbohydrate diet safe?

4
Yes! Low carbohydrate diets are very common, well researched, and are very safe for a vast majority of
people. However, if you are taking certain medication such as diabetes medication or medications for
lowering blood pressure, then it is necessary to consult your doctor before starting on a low
carbohydrate diet, and preferably one who is well informed about this lifestyle. It is likely that your
medication will need to be adjusted downward, which is a positive thing overall. In addition, pregnant
women and children should always consult with their doctor before starting on any dietary changes. We
say this for caution not because any difference is actually expected.

What about protein and fat?

A low carb lifestyle is not only about restricting the carbs but also about getting in plenty of the right
food choices. It is especially important to get enough protein. A simple way to think of protein intake is
that high protein foods should be the foundation of every meal. Some vegetables can then be added
and some healthy fats. Protein has the highest satiety effect from all macronutrients per calorie. This
means that for the amount of energy you get from the food, you will feel fuller, which in turn will help
with any weight loss goals. It is important to understand that if you only adopt the restriction side of the
diet it is likely you will feel weak and hungry which is not sustainable and might even lead to reduced
muscle mass. Eating low carb is not about having salad all day.

Low carbohydrate foods and a meal plan example

Foods which are very low in carbohydrates can be consumed quite liberally based on hunger and energy
needs. These include meat, poultry, fish, seafood, eggs, hard cheeses, and a variety of above-ground
vegetables. Fats such as cream, butter and olive oil can be added as needed. Some foods are quite
healthy but contain some carbohydrates. These foods are recommended, but only in moderation. This
includes things like avocado, nuts, seeds, and yoghurt.

Example of a daily meal plan:

Breakfast: Large omelette with roasted tomato, and spinach.

Lunch: Large green salad with walnuts, hardboiled eggs, tuna/roasted chicken, and olive oil.

Dinner: Grilled meat/Chicken/Fish + 2 cups of above-ground vegetables (broccoli, zucchini, brussels

sprouts etc) dressed with olive oil.

Snacks: Handful of nuts, small bowl of yoghurt and berries, hard cheese, coffee/tea with cream

What about the traditional weight loss advice?

The traditional advice for weight loss is to eat less and move more. This has various forms and
accompanying phrases such as portion control, reduced calories, low fat, counting steps, and other
methods to negate sedentary lifestyle. However, often this advice is insufficient to make real, long-
lasting changes, and the problem with it is that it ignores many basic factors and is based on over
simplified ideas.

It is true that our weight is determined by a balance between how much energy comes in through food,
and how much energy is lost or spent. However, the traditional advice which is derived from this truth is

5
based on the assumptions that we know exactly what drives us to eat too much and that it can be
controlled by decision alone accompanied by will power, and that our energy expenditure will increase
directly with physical activity, and this too is only a matter of determination. Mind over matter. But is it
really that simple?

Figure: The energy balance module. A basic truth founded on the laws of thermodynamics, leading to over
simplified and non-useful weight-loss advice by ignoring many important components.

Additional factors – a complex picture

The advice to eat less and move more does not address factors such as hunger and satiety. It does not
address the required effort when it comes to exercise or the fact that exercising also increases hunger. It
does not address emotional, social or environmental considerations. Another issue which is often
ignored is that most of the energy expenditure of the body goes to fuel our basic metabolic
requirements, over which we have little direct control. Whilst physical activity is important for health,
from the perspective of weight management alone, adding a few sessions of exercise per week makes
only a small difference to overall energy expenditure. It is also well established that when we reduce our
energy consumption over a period, the basic metabolic rate tends to slow down, making it much harder
to keep losing weight. In addition, the advice ignores the mechanistic control pathways of energy
regulation in the body which are hormonal. Hormonal regulation determines not only our hunger and
satiety signals but also, at least to some extent, how the energy is utilised in the body and if it would be
burnt as fuel or stored as fat. Hormonal regulation is affected by how much we eat but more
importantly the food composition as well as the timing, the food combinations, as well as stress, sleep,
age and other factors.

In short, we now know that it is not only about how much you eat and exercise but also about what you
eat, when you eat, how much sleep you get, how much stress you have in your life and many other
factors that affect weight and need to be addressed in any serious weight loss plan. In short, advice to
eat less and go to the gym is rarely sufficient to make a difference.

Addressing other components of the picture in a very short manner

6
A low carbohydrate diet is a good start, but it is not a magic solution for weight or health. Many other
components are important, and it is worth keeping a holistic view of your life. The following points are
just a few we thought are worth addressing beyond the topic of carbohydrates.

Frequency of eating and snacking: By snacking often and especially on foods that contain
sugars/carbohydrates, you will keep your insulin levels up which will hinder weight-loss goals. Our
advice is to eat to satiety during meals and refrain from frequent snacking.

Timing of eating: Some people find it helpful to eat an early dinner and a late breakfast. This gives the
body more hours with low insulin levels during the night. Eating late at night contributes to poor sleep
and usually contributes to weight gain. Try to stop eating a few hours before bedtime.

Some people call this approach digestive rest, time restricted eating or intermittent fasting. It can be
described as reducing the window of eating to 8-10 hours per day for better weight loss and improved
health. For example, 8Am-6pm=10 hour eating window.

Sleep: Poor sleep can cause weight gain through disrupting hormonal and appetite regulation. It can
lead to an increase in stress hormones, impaired glucose metabolism, and encourage excess eating.

Environment: Your attempts to eat healthily are within a modern environment which is full of unhealthy
options. Take active steps to counter this. For example, keep a home environment that is clear of junk
food, plan eating events in advance, and have strategies in place for what to order when going out.

Awareness and emotional eating: Many of us eat for various reasons besides hunger. These can be just
bad habits, food addictions or emotional eating. Bringing awareness to your eating habits can help
identify and address some of these patterns.

Family members and friends: Many people do not eat alone. If you are part of a family unit, it is
important to discuss and create partnerships with the other people regarding your needs. Make sure to
get everyone on board and find your support group.

Shopping: The shopping event is an important one since it is likely to determine what you will eat in the
following days. Think ahead and plan your shopping. Find strategies that are useful. Some like to work
with shopping lists, others with food categories. Whatever works for you is good as long as you come
back with healthy foods which are the ones you want to eat.

Cooking and convenience: Find what is most convenient for you in terms of cooking and food
preparation. Some people like to cook large batches and freeze. Try to get organized in a way that
supports your eating intentions. Being organized can help with eating real foods and reduce reliance on
processed foods, takeaways and less healthy options.

Test and monitor: How are you feeling? How are your energy levels? Is your weight stable? How are
your blood test results? Monitoring and following your progress are important components for long
term success. This keeps you on track and can show you if you are headed in the right direction.
Sometimes adjustments are required. Our top recommendations would be to monitor blood pressure,

7
waist circumference and wearing a continuous glucose monitor. This would give you valuable feedback
on how you are tracking. If you go off the right track, do not give up, just get back on track!

Physical activity: Yes, physical activity contributes to good health. This is not necessarily about burning
calories. Rather it is part of a healthy lifestyle, maintaining good physical function and preserving muscle
mass for old age. The key is to find a routine that you can maintain and enjoy. Ideally this would support
maintenance of cardiovascular fitness, strength, flexibility, and balance. And above all, try to find
activities you actually enjoy.

Alcohol: This would probably not come as a surprise but drinking alcohol is not healthy. Frequency and
quantity matter so if you cannot give it up, try to minimize it to the best of your ability. Unfortunately,
the damage goes beyond the empty calories and the weight gain.

Addressing nutrient deficiencies: Many people these days are deficient in essential nutrients. Some that
come up often are magnesium, iron, and B12. However, being deficient in these often indicates that
other nutrients are low as well. It is worth checking this out when you see your doctor to make sure you
are getting what you need.

Sun exposure: Too much sun exposure during the middle hours of the day can be dangerous. However,
there is increasing evidence that not enough sun exposure is also quite bad for your health. The best
solution is to get sun exposure early in the morning and in the late afternoon/evening. A walk outside at
these times of day can give you both some physical movement and some healthy sun exposure. Walking
after a meal also helps curve the spike in blood sugar.

Relational domain: Mental health is so important and many times it is closely tied to the relationships
that we have with others such as family, friends, or our partners. Sometimes making sure that your
relationships are good is key to managing everything else in life. Seek help if you need.

Be kind to yourself: Easy to say and equally easy to dismiss as a worn-out phrase but remember that
thoughts are powerful and have a real impact on your physical body. Whilst we encourage you to take
responsibility for your health, this does not mean criticizing yourself and feeling guilty about everything
you do. Make steady steps towards your health goals and keep a positive mindset.

Learn to recive help: Booking a few sessions with a good dietitian, a doctor or health coach might be
useful. It might seem like a high price now but if this is the difference between success or failure in
achieving ideal weight and good health, it is a small amount to pay in the long run.

Finally, this list is not an individual or complete plan. For a personalised approach, expanded details and
help with your weight lose journey, please talk to us or book a session with our dietitian.