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There are a lot of opinions regarding low-carbohydrate diets in terms of what level of carb restriction is optimal, should you jump or ease into carb restriction, and are occasional carb loads helpful or harmful?  Here's my take on these issues.

Defining Low Carb
There remains a lot of confusion around this question because there are no agreed-upon definitions for "low-carbohydrate" or "carbohydrate restricted" diets.  Although specific values have been proposed for low carbohydrate diets (e.g., less than 130 grams/day) and very low carbohydrate ketogenic diets (e.g., less than 50 grams per day), these absolute thresholds do not account for the principle of individuality, that is, the level of carbohydrate tolerance will vary from person to person, and even within a person over time.  Because of inter-individual variability, it is more helpful to define a low carbohydrate diet a little differently.  From the clinical perspective, a low-carbohydrate diet might be defined as the level of carbohydrate intake below which signs and symptoms of carbohydrate intolerance occur.  From the metabolic perspective, one would operationally seek carbohydrate levels that allow nutritional ketosis (blood ketone bodies > 0.5 mM) or optimal fat burning to be achieved.   

At one end of this range, someone with early signs of metabolic syndrome or pre-diabetes might permanently get rid of their metabolic problems by holding total dietary carbohydrate intake in the range of 100-125 grams per day.  At the other end of this spectrum might be a type-2 diabetic who, on a "balanced diet" providing 300 grams per day of carbohydrate, requires multiple medications to keep fasting glucose values even marginally controlled under 150 mg/dl.  For this person to achieve an optimum initial response that allows reduction (and hopefully withdrawal) of diabetic medications, clinical experience has shown that holding dietary carbohydrate at 20-to-25 grams per day is often necessary.  For many type-2 diabetics, a few weeks at this level allows them to reduce or stop both insulin and oral medication while at the same time achieving better overall glucose control.  A few months later, following substantial weight loss, some individuals might be able to increase daily carbohydrate intake above 50 grams per day and still maintain excellent glucose control, whereas others might need to remain below the 50 gram level to keep their type-2 diabetes in complete remission.

A more practical and effective way to determine how low in carbs to go is by measuring blood (not urine) ketones.  Inducing a state of nutritional ketosis and maintaining it long enough to fully adapt requires a conscientious effort to restrict carbohydrates for two or more weeks.  The level of carbohydrate restriction required to optimize fat burning and fat loss varies from person to person, but the most consistent effects will be achieved at levels of carbohydrate below 50 grams per day. But some highly insulin sensitive individuals may be able to achieve this threshold consuming 70 grams or more per day, whereas others may need to keep carbs between 25 and 40 grams per day.  You can measure blood ketones from a finger stick and see quantitative results in a matter of seconds using handheld glucometers like Precision Xtra.

In summary, how much you choose to limit your dietary carbohydrate intake should be driven by your personal experience.  As a result, the amount of carbohydrate that you decide to eat might vary considerably depending on your individual metabolic condition and the level of benefit you wish to derive.  

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How Fast to Cut Back?
This is a great question, but the answer is not as clearly spelled out by objective research as we would like.  Some people advocate easing into carbohydrate restriction slowly by cutting back by one food category at a time (e.g., first sugars and juices, then refined carbs, then starchy vegetables, etc).  Others take the plunge all at once.  To date, no one has done a study with a large group of subjects to see which strategy yields a higher proportion making an effective transition into nutritional ketosis.  

What we do know is that it takes a couple of weeks to keto-adapt, and you don't accomplish much towards that goal until you are making substantial amounts of ketones.  The other concern with easing into a low carb diet is that once you are eating less than the 150 grams of carb needed to feed your brain with glucose, but still more than the 50 gram threshold below which ketosis is dependably operating, your brain's fuel supply becomes pretty tenuous.  If there's not enough glucose to meet the brain's 600 Calorie daily energy habit, and blood ketones remain below the 0.5 millimolar threshold where they can begin to pitch in, your body's only two options are to burn up protein or binge on carbs.  In my experience, taking the plunge is better.  That does not mean that this transition will be easy, but perhaps easier that trying to slowly slide your metabolism between two distinctly different fueling strategies.     

As to what happens when you are faithfully restricting carbs and then indulge in a high carb meal or a whole weekend of insulin-stimulating carbs, that's a topic for another article.  The take home message here is that restricting carbs needs to be more than a casual endeavor and it needs to be tailored to the individual, rather than following arbitrary guidelines designed to hit the average person, after all no one wants to be average.

Have you ever tried a serious carb-reduced diet for a significant period of time? What were your results with it? Let us know in the comments field below!

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