The quest for the perfect diet often feels like a never-ending puzzle in a world bursting with dietary advice and nutrition trends.
We’ve all heard about the wonders of low-carb and ketogenic diets, but amidst the chatter, a crucial question looms: Which one is right for you?
Today, we embark on a journey to unravel the intricacies of these dietary approaches, explore how they can be tailored to suit your unique needs and goals and navigate the common pitfalls that can trip us up along the way.
Join us on this enlightening path towards understanding the science and art of achieving better health, satiety, and nutritional optimization. Whether you’re a seasoned low-carb enthusiast or just beginning to explore the world of keto, this article promises valuable insights that may forever change how you think about food.
So, let’s dive in and discover the keys to unlocking your own path to a healthier, more satisfied you.
Optimised Food Lists & Recipes
While diet trends often revolve around one true diet for everyone, the reality is we are all unique. Choosing the right tool to get the desired results is important.
A high-fat ketogenic diet may be great if you have epilepsy, Parkinson, dementia or mental issues you want to address.
However, if you want to lose some body fat, optimise your blood glucose and improve your metabolic health, dialling back the dietary fat a little can be helpful to increase nutrient density and satiety and empower you to lose some body fat.
The table below shows the macro split of the highest-ranking 300 NutriBooster recipes for a range of different approaches, along with their satiety index score and diet quality score. As you can see, they’re all pretty low-carb.
|Foods||Recipes||net carb||fat||protein||fibre||satiety||diet quality|
|Low carb & fat loss||Sample||8%||48%||40%||5%||68%||80%|
Click on the link in the ‘foods’ column to download our optimised food list for each approach. If you click on ‘sample’ in the recipes column, you can download our free sample of our NutriBooster recipes for that goal.
The infographics below show what each of the variations on a low-carb diet looks like.
The images below show recipes optimised for the keto, low carb and high satiety goals.
If you’re interested in learning more about the benefits of each approach to help you determine which one might be ideal for you, read on.
The low-carb diet has stood the test of time as a valid option to the mainstream grain-focussed high-carb recommendations.
Popular versions of a lower-carb diet have been around in modern times since William Banting’s Letter on Corpulence, published in 1864.
Banting, an English undertaker, wrote up his learnings after he lost 46 pounds (20 kg) on a diet of four meals a day consisting of meat, greens, fruits and dry wine, prescribed by his physician Dr Harvey.
My interest in low carb began because my wife Monica has Type 1 Diabetes. We were fortunate to stumble across the work of Dr Richard Bernstein (pictured below) and the Type 1 Grit Community in 2011.
When we switched to a lower-carb diet, Moni’s total daily insulin requirements halved; we both lost a ton of weight and got healthier, with many other improvements, including her mood and energy levels.
Bernstein, still thriving and practising medicine at 89, developed Type 1 Diabetes when he was 12. Initially trained as an engineer, he’s a numbers man. In 1969 he obtained one of the first portable glucose meters and started testing to understand how different foods impacted his blood glucose and insulin requirements.
Unfortunately, Bernstein’s insights about diabetes management have been largely ignored by the mainstream nutrition community. When our son was diagnosed with Type 1 Diabetes in December 2021, the hospital diabetes educators and dieticians gave us the same carb-centric advice my wife had been given thirty years earlier that we knew would leave him on the carb-insulin rollercoaster.
Fortunately, thanks to Dr B, we know what to do – protein and enough insulin to keep his glucose healthy. Mike is now a thriving 17-year-old who recently set a deadlift world record, lifting 245 kg.
Today, I’m passionate about ‘the little Monis’ and motivated to share my learning. I imagine how my wife’s life could have been if her parents had the information we know now, thanks to Dr B and the many friends I’ve made on this journey in the nutrition space.
For more on Type 1 Diabetes, check out How to Optimise Type-1 Diabetes Management (Without Losing Your Mind).
The popularity of low carb grew to a crescendo after Dr Robert Atkins published Dr Atkins’ Diet Revolution in 1972.
Interest in low-carb waned after Akin died in 2003. Google Trends, which shows data from January 2004, shows interest in ‘low carb’ was still high then. But since then, interest in low carb has bumped along at a lower level, only to be engulfed by the rise in keto around 2014.
Dr Eric Westman, who studied Atkin’s approach while he was still alive, is still active in today’s low-carb community. Many refer to him as the low-carb and keto OG. He has co-authored many of the most influential low-carb books in the low-carb space, including:
- The New Atkins for a New Your (with Jeff Volek and Steve Phinney)
- Cholesterol Clarity (with Jimmy Moore)
- Keto Clarity (with Jimmy Moore), and
- End Your Carb Confusion (with Amy Berger).
Westman has recommended his patients follow his famous ‘page 4’ food list for 20 years. The page 4 food list was ‘borrowed’ from Atkins and Jackie Eberstein, who had used it for 30 years before. The ‘page 4’ food list has become like the Ten Commandments of low carb and keto, passed down through the generations.
Dr Eric Westman explains that the magic of low carb is increased satiety:
“This type of diet program for weight loss is unique in that the hunger goes away. The hunger should go away in a day or two if you’re doing it correctly. On the food list, I say, ‘Hey, you can have an unlimited amount’, but people eat less automatically.”
As a curious engineer, I’ve been trying to understand the key factors that make seemingly opposite dietary approaches that help people be satisfied with less energy and the quantifiable factors that align with eating less vs eating more than we need to.
The chart below shows the relationship between carbohydrate intake and calories using 313,836 days of data from the NHANES nutritional surveys and people using our Nutrient Optimiser app. Coming from a low-carb background, this chart surprised me.
To the left, we can see that a lower-carb diet aligns with significantly reducing calories. But surprisingly, towards the right, we can see that a low-fat, high-carb diet is also hard to overeat. Rather than carbs being bad and fat being good, it seems to be the combination of fat and carbs that aligns with eating a lot more.
While a lower fat or lower carb diet aligns with eating less, the lower carb approach tends to align with a higher protein % and greater nutrient density. Many people eat less on a very low-fat, high-carb diet, but getting enough of all the essential nutrients is harder.
Rather than simply carbs and insulin, thinking about our dopamine response to food can be more helpful.
Professor Dana Small’s 2018 paper Supra-Additive Effects of Combining Fat and Carbohydrate on Food Reward showed that we get a supra-physiological dopamine response to foods that combine fat and carb, which drives us to buy and eat more of them.
The combination of fat and carbs is rare in nature (other than foods like milk and nuts that are only available for a short period that help us grow and store fat for winter), but it is the basic formula for modern ultra-processed foods.
Ultra-processed foods that combine starch, sugar and industrial oils enable us to fill our glucose and fat fuel tanks simultaneously; hence we can eat more. While they may taste great, they also lead to energy toxicity and eventually break our metabolism, leading to type 2 diabetes and the many modern conditions related to storing excess energy.
Ultra-processed foods that combine fat and carbs are intentionally designed to overdrive our dopamine response. So it should be no surprise that many people feel ‘addicted to food’. However, once we move away from the fat+carb danger zone, a lower-carb or a lower-fat diet can provide a healthy dopamine response and enjoyment of food.
While ultra-processed foods are engineered to taste unnaturally good and elevate dopamine like an addictive drug, you also get a dopamine hit when you get the energy and nutrients you need from nutritious whole foods.
But this doesn’t mean your food shouldn’t taste great. The food you should eat should taste good because it contains the nutrients you need to thrive.
Energy Intake at Macro Extremes
To help us understand which dietary approach can help us achieve greater satiety and reverse this epidemic of energy toxicity, the chart below shows the macro split of the top 100,000 days of data when we sort by:
- High protein (%),
- Low carb,
- High fat,
- Low fat, and
- Low protein.
At the bottom, we can see that the highest energy intake aligns with the lowest protein intake, which also has the highest carb intake.
Intriguingly, the low-fat and high-fat extremes have the same overall calorie intake.
Meanwhile, at the top of the chart, we see that the lowest carb intake and the highest protein are fairly similar. People consuming a high protein diet are still pretty low carb; they consume a little less fat and hence a lower overall energy intake.
Another major benefit of a lower-carb diet is the glucose stability it provides. If you’re managing diabetes, dialling back your intake of fast-acting carbs is an important first step.
If you inject insulin, it’s impossible to match your insulin dosing with your carb intake. There are always errors. Large inputs of carbohydrates lead to large errors that are hard to correct. Per Dr Bernstein’s Law of Small Numbers, reducing carbohydrates leads to smaller errors that are easier to correct.
People with insulin resistance can also experience reactive hypoglycaemia when they overconsume refined carbohydrate foods. The large insulin response to high-carb meals causes their glucose to come crashing down, which leads to increased hunger and eating more sooner to raise your glucose back to normal levels.
In our Data-Driven Fasting Challenges and Macros Masterclass, we guide people to test their glucose after they eat. If they see a rise of more than 30 mg/dL or 1.6 mmol/L, it’s a sign that they overfilled their glucose fuel tank and should reduce their carb intake in the future.
Some variation in glucose is a normal part of your body’s hunger and satiety signalling. There’s no need to dial back carbs even further once your glucose is in this normal, healthy range.
As noted above, a high satiety, higher protein % diet is already low carb. Simply swapping carbs for fat will cause a smaller but longer rise in glucose and insulin, which is not optimal either.
After watching my wife and son’s closed-loop insulin pump system for years, I’ve noticed that higher-fat meals keep their glucose and insulin elevated for longer. We also see a similar thing in our Data-Driven Fasting Challenges, where people find their glucose comes back below their personalised trigger sooner when they dial back the fat a little.
A high-fat ketogenic diet may keep your glucose stable, but it won’t necessarily reduce your average glucose or insulin if it doesn’t address the root cause – energy toxicity.
High Protein %
One of the beneficial side effects of reducing carbohydrates is that, for most people, they increase their protein %. As shown above, people who consume the least carbs consume 34% protein, while those who consume the most carbs consume only 12% protein.
The chart below shows the relationship between protein % and calorie intake, showing that we eat the most when our food contains about 12.5% protein.
To the far left, a very low protein intake can align with eating less (e.g. fruitarian or high-fat therapeutic keto). However, for most people, the magic of a low-carb diet is increased satiety due to increased protein. In addition, a higher protein diet tends to be more nutritious and provides a healthy dopamine hit that satisfies our cravings with less energy.
Summary – Low Carb
For most people interested in improving their body composition, losing weight and stabilising their blood sugars, a low-carb diet can be an amazing approach because it provides greater satiety and effortless weight loss. By changing what you eat, a lower-carb diet increases nutrient density and satiety, which leads to effortless weight loss.
Like low carb, the ketogenic diet also has a long history of benefits.
The ketogenic diet first became popular in the 1920s to mimic fasting for people with epilepsy but waned in popularity once anti-epileptic drugs became available. However, in 2014, keto exploded in popularity, engulfing low carb.
What is a Ketogenic Diet?
Due to the rise in popularity of keto, much of the low-carb movement got swept up into ‘keto’.
Because they’re both lower-carb approaches, the line between keto and low-carb became blurred. “Keto” now means a lot of things to a lot of people.
But, by definition, a keto-genic diet generates ketones.
But given that we can create ketones, particularly if we’re in an energy deficit, my definition of a keto diet is one where generating ketones is the priority.
Benefits of a therapeutic ketogenic diet
While online searches for a “keto” and “keto diet” have decreased since January 2019, research interest in the therapeutic ketogenic diet has been ramping up.
As mentioned above, ketogenic diets have been used for decades as a non-pharmacological treatment for epilepsy, particularly in children with drug-resistant epilepsy.
Besides epilepsy, the ketogenic diet is being studied for its potential benefits in neurological disorders like Alzheimer’s disease, Parkinson’s disease, and traumatic brain injury. Some studies suggest that ketones produced during ketosis may provide alternative energy sources for the brain and potentially have neuroprotective effects.
Ketones can cross the blood-brain barrier and help nourish our brains when our brains have become insulin resistant and no longer accept fuel from glucose effectively. Amy Berger’s Alzheimer’s Antidote is a great reference if you or your loved one is facing Alzheimer’s.
Some studies suggest that a ketogenic diet may benefit cancer treatment by exploiting the metabolic differences between cancer cells and normal cells. The idea is that cancer cells rely heavily on glucose for energy, and restricting glucose through a ketogenic diet; it may help slow tumour growth or improve the effectiveness of other treatments.
Dr Chris Palmer has also been making waves with his excellent book Brain Energy, which explores the role of diet and mental health. Metabolic Mind, funded by the Baszucki family, who started Roblox, is spearheading research in the emerging field of metabolic psychology after seeing the benefits of a high-fat ketogenic diet for their son.
A recent study by Nick Norwitz et al. demonstrated that a high-fat ketogenic diet could help people with anorexia regain a healthy weight.
Who is a high-fat ketogenic diet suitable for?
A high-fat ketogenic diet that produces elevated ketones appears helpful for a range of mental health and metabolic conditions. It’s still early days, but as the research progresses, I hope we will understand the mechanisms and refine the treatment protocols for the many people who could benefit from this approach.
If you’re already lean and metabolically healthy, fuelling with more fat is also an awesome option.
Who is a high-fat ketogenic not helpful for?
However, I don’t believe that a high-fat keto diet is optimal for most people primarily interested in weight loss, diabetes management and improving their body composition.
If you’re part of the growing majority of people who need to lose some excess weight, a lower carb, nutrient-dense, higher satiety diet, with a little less dietary fat, maybe a better option for you.
What I’ve Learned
After seeing the results of a lower-carb diet for Monica to help her manage her Type 1 Diabetes in 2011, I became fascinated with nutrition and was eager to learn more.
At the time, everyone was chugging Dave Asprey’s Bulletproof Coffee.
While the ketogenic diet has been around for a century, keto launched into popular consciousness after Jimmy Moore did his n=1 year-long keto experiment (May 2012 – 2013), lost weight, and then published Keto Clarity with Dr Westman in August 2014.
Jimmy’s Livin’ La Vida Low Carb podcast was a major force, with over a thousand episodes, hosting all the low-carb and emerging keto gurus.
As with any large movement, there were many versions of keto and beliefs about how and why it worked.
Over the years, I’ve had to unlearn a few things I once believed.
Keto Clarity laid out the formula for getting into ketosis:
- Chapter 5 – Find your Carbohydrate Tolerance
- Chapter 6 – Determine Your Personal Protein Threshold
- Chapter 7 – Consume Fat, Especially Saturated Fat, to Satiety.
Jimmy’s goal was to reduce carbs, moderate protein, and prioritise fat to achieve ‘optimal ketosis’ per Phinney’s nutritional ketosis chart (shown in the Art and Science of Low Carb Living).
In many podcasts and talks, Jimmy educated his followers to do the same.
Unfortunately, the optimal ketone chart (shown below) was based on two studies from the 1980s where people had recently transitioned to a ketogenic diet.
But as more people started testing their ketones and chasing ‘optimal ketosis’, most people found that blood ketones decreased after an initial adaption period which lasted a few weeks or months.
The chart below shows the blood ketone values over a year from Virta’s one-year results. When people initially switch to a ketogenic diet, their ketone jumps to 0.7 mmol/L (i.e. just into nutritional ketosis), decreasing with time.
Virta’s two-year follow-up study showed that ketones settled at 0.27 mmol/L. So, despite the fact that they were on a ketogenic diet supervised by Dr Steve Phinney, these people did not maintain nutritional ketosis (i.e. ketones greater than 0.5 mmol/L), let alone optimal ketosis (i.e. ketones between 1.5 and 3.0 mmol/L)!
At a conference in October 2022, I asked Dr. Phinney if they had any long-term data on the ketone levels, and he said that they don’t encourage people to keep testing ketones, so they don’t have the long-term data. Steve also confirmed that people with more muscle and metabolically healthy tend to have more efficient monocarboxylate transporters, clearing lactate and ketones from the blood.
This aligns with my compilation of glucose and ketone values shown below. It appears that people with lower glucose tend to have lower ketones. However, your ketones will be higher if you have more fat on your body (i.e. energy toxicity) or are forcing more dietary fat.
So, faced with decreasing ketones, despite a high-fat ketogenic diet, what do you do if you believe that you need to achieve ketones above 1.5 mmol/L to lose weight and be metabolically healthy?
Like many others, I initially tried to eat more butter and MCT oil, reducing protein and eating fat to satiety to get my ketones higher. Eventually, I realised I was just getting fatter. The photo shows my work profile photo at the height of my ketone chasing. There had to be another way.
Fear of Insulin
Along with ketones, insulin has been a leading character in the keto story.
It all made sense at the time. If insulin is the fat-storage hormone, and carbs rise the most, reducing carbs would effectively stop your pancreas from producing insulin. Thus, I would lose weight like an uncontrolled Type 1 Diabetic. Oh, and protein raises insulin, too, so I should limit that, especially if I want to achieve ‘optimal ketosis’.
Unfortunately, it didn’t seem to work that way in practice.
A T1D friend Allison (one of the founders of Type 1 Grit), found that her daily insulin requirements doubled when she was chasing elevated ketones with a 90% fat diet. She became insulin resistant, and ‘injecting insulin was like injecting water’. Her weight increased, and her HbA1c went from 4.8% to 8.0%! Fortunately, she was able to lose weight and get her HbA1c back down with the high-satiety recipes in one of our early Macros Masterclasses.
Recent studies have shown that fat also has an insulin response, just over a longer period:
- Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes showed that for T1Ds on a closed-loop insulin pump system, adding fat to carbs required more insulin.
- A 2021 study showed that blood glucose rises over the longer term in response to fat when insulin is not given.
- And an intriguing preprint study found that 8% of people appear to have a larger insulin response to fat than carbs?!?!
After watching my wife and son’s insulin data, I realised that the insulin response to food (bolus insulin) is only a fraction of the insulin your pancreas produces. In people on a standard higher-carb diet, basal insulin is about 50% of their daily insulin demand. But for people on a lower carb or keto diet, basal insulin makes up 70-90% of their daily insulin.
Rather than merely an anabolic hormone, I now see insulin as primarily an anti-catabolic hormone that stops your body from falling apart.
Insulin holds back your energy in storage while you have energy coming in via your mouth. So the more energy you have in storage, the more insulin is required to hold that energy. Hence, to reduce your insulin, you need to find a way of eating to achieve a healthy weight, ideally one that doesn’t require unsustainable levels of willpower.
Avoiding protein & Eat Fat to Satiety
If your carbs are low, it’s natural that most of your non-protein energy will come from fat. But if improving your body composition is a priority, it’s smart to prioritise protein rather than fat. But if you try to limit protein, you’ll be hungrier and overeat fat to achieve satiety.
I used to think “eat fat to satiety” meant that fat was the most satiating macro. But after diving into the data, I now understand that fat is the least satiating macronutrient per calorie.
The chart below shows the relationship between fat % and energy intake from one hundred and fifty-six thousand days of data from our Optimisers, who generally consume a lower-carb diet.
A higher fat % aligns with consuming more energy. If you’re already on a low-carb diet, getting most of your energy from fat is fine. But if you have some body fat you want to lose, dialling back the dietary fat can help.
Body Composition Matters
Thanks to Professor Roy Taylor’s Personal Fat Threshold concept, I now understand that diabetes management and improving metabolic health is about optimising your body composition, not merely avoiding carbohydrates.
Trying to limit how much we eat by simply counting calories usually ends badly. But we can change WHAT we eat to increase satiety, which influences how much we eat. In time this reverse energy toxicity and all the fuel in our body can be stored safely without overflowing into our bloodstream.
What is the Future of Low Carb and Keto?
Whether your focus is therapeutic ketosis, managing blood sugars or weight loss, a lower-carb diet will help.
Therapeutic keto, lower carb, satiety and nutrient density and all variations on a lower carb diet can be more useful, depending on your goal.
I’m excited about the future of lower-carb dietary approaches. As science progresses and we better understand how they work, we can give people an escape hatch from the forever diet wars and empower them to achieve their desired results efficiently.
Rather than one officially sanctioned monolithic low-carb or ketogenic diet with approved foods for all, we can optimise your food choices to better align with your context and goals to help you get the results you want more efficiently.
Which Approach is Right for You?
So before you go, we’d love you to download a printable food list to inspire your next shopping trip using the links below. I hope they help you on your journey of Nutritional Optimisation.