(Recipe for this loaf featured at end of article)
Carbohydrates and the role they play in a healthy diet, are one of the most hotly contested nutritional debates in the world, particularly in light of the latest trend towards a high fat/ low carbohydrate approach.
Is it any surprise that this is one of the top questions I get asked by clients and friends alike?
Now, I want to first reiterate I am not totally against a low carbohydrate or ketogenic diet, I believe there are many instances in which this nutritional tool can be used therapeutically to achieve excellent results, particularly in cases of epilepsy¹, obesity, type two diabetes², Alzheimer’s disease, metabolic syndrome³ and in some instances PCOS4 as well as various forms of cancer. There have been amazing success stories for people on this style of eating plan.
However, here at Vitalise Health we do not believe in a one size fits all approach and I wanted to address the instances in which a ketogenic diet could do you more harm than good.
Adrenal Fatigue and HPA dysfunction:
In situations of adrenal fatigue, cortisol gets dysregulated and in some studies has been shown to increase on a low carbohydrate plan. The ramifications of this is that potentially following a low carb diet, could add extra stress to the body in some individuals, if we couple this with 21 st century stressors such as job worries, not enough sleep and over-exercising, then bingo a recipe for adrenal burnout.5 Furthermore, another study found that carbohydrate improves cortisol response6 in very stressed people, it can also help with mood and sleep with evidence emerging that carbohydrates increases tryptophan uptake and serotonin7
Interestingly, one study found that too much protein reduces GABA8. Now, GABA is a relaxing neurotransmitter which we could benefit from having more of. Human gut flora are also impacts on GABA, with intestinal bacteria liking to feed off some starch, particularly resistant starch.
So, the take home message is if you’re suffering from adrenal fatigue or high stress, then there could be benefits to eating a moderate carbohydrate diet, particularly if elevated cortisol is an issue for you.
One of the less discussed downsides of a very low carbohydrate diet over the long run is the potential for alteration of the gut flora.There is now emerging observational evidence that a very low carb diet can lead to gut dysbiosis and a reduction in the diversity of the gut flora, it is believed this could be due to reduction in carbohydrates results in less prebiotics foods (i.e. food for your gut flora) such as soluble fibre and resistant starch.
These prebiotics are essential for promoting the growth of beneficial gut flora 9 Without them, your beneficial flora can’t produce as much gut-healing substances, like butyrate and other short chain fatty acids, and your microbiome composition may even shift in an undesirable direction. Therefore, if you do follow a low carb or ketogenic diet it could be of benefit to supplement with prebiotics such as resistant starch, or unmodified potato starch, these products must be incorporated slowly, as you can experience severe gas and bloating if too many prebiotics are taken all at once, or if there is existing gut dysbiosis or bacterial overgrowth.
With the increasing use of a ketogenic diet, particularly for women of child bearing age I thought it was important to look at some studies showing the detrimental effect of ketosis during gestation. One study found that a ketogenic diet during gestation resulted in altered embryo growth, which could be implicated with organ dysfunction and possible behavioural changes after birth.10
Additionally, a ketogenic diet appears to affects maternal fertility and increases vulnerability to ketoacidosis during lactation. Another study showed prenatal and early postnatal exposure to a ketogenic diet showed modifications to neonatal brain structure, and results in retarded physiological growth. These alterations could be accompanied by functional and behavioural changes in later postnatal life.11
Hypothyroidism is one of the most commonly cited medical reasons for needing to eat a moderate carb diet. The main reason why carbs affect thyroid function so directly is because insulin is needed for the conversion of the inactive T4 hormone into the active T3 hormone, and insulin is generally quite low on very low carbohydrate diets.
So if you’ve suddenly started developing hypothyroid symptoms on your low carb diet, then perhaps you would be better off upping the carbs. Now, I am not suggesting going crazy on the mac n’cheese or curly fries but reaching for some gentle carbohydrates as discussed below.
What carbohydrates should be eaten?
Firstly, I think everybody needs to determine their own individual carbohydrate tolerance and to experiment at what level they feel best. People who are doing anaerobic exercise, such as high intensity interval training will require greater levels than sedentary people working an office job, otherwise performance and energy may well suffer. That’s also not to say there aren’t athletes that don’t thrive on a ketogenic diet, this takes adaptation and may not work for everyone.
I personally notice I need to have a moderate amount of carbohydrates in my diet for optimal thyroid function, healthy hormones and mood. Even after following a very carefully balanced ketogenic plan with sufficient calories, I started developing hypothyroid symptoms and gained a substantial amount of weight. Now, I am in no way suggesting you go crazy and follow the grain heavy recommendations set out in the traditional food pyramid model (which suggests 6-8 servings a day), but opt for complex carbohydrates with minimal human intervention, think sweet potato, beetroots, pumpkin, artichokes, organic corn, potatoes, low fructose fruit or some of the gluten free pseudo grains such as quinoa, buckwheat and amaranth, even brown rice and gluten free oats can serve some people well.
The key is listen to YOUR body and what leaves you feeling energised, alive and at optimal health.
A little note….
The purpose of this post was not to vilify LCHF/Ketogenic diets, as mentioned there are many people out there who get fantastic results with this type of plan but I wanted to highlight that everyone is different and encourage you not stick to a dogma or rules, we need to be flexible with our health and know that our needs are constantly changing.
I also wanted to incorporate a recipe with some good carbs. This loaf is a perfect breakfast loaf that won’t cause your blood sugar levels to sky rocket, it isn’t overly sweet so you can add your own toppings, I like coconut yoghurt and cinnamon, or a slather of nut butter, if you’re the dairy eating type try organic ricotta and orange zest.
Spiced sweet potato breakfast loaf:
- 1 large orange kumara (600-700g)
- 3 tbsp of almond butter
- 3 tbsp of coconut oil (Or macadamia)
- 1 tsp mixed spice, 2 tsp cinnamon, 1 tsp Chinese five spice, 1 tsp of ginger
- 4 eggs
- ½ c of rice malt syrup (may need to go up to ¾ c if you like it a little sweeter)
- ½ c of coconut flour
- Pinch of salt
- 1 tbsp of lemon juice
- ½ tsp of baking soda, ½ tsp of baking powder
- ½ c of coconut threads
- ½ c of chopped walnuts (or any other nuts)
- ½ c of 70% cacao dark chocolate
- 1 banana sliced in half and baked on top (minimal fructose per serve)
- Chopped granny smith apple
Cut the sweet potato lengthways in half, place on an oven tray and bake. Once cooked, scoop out, discard the skins, mash and let it cool.
In a separate bowl, whisk the eggs, coconut oil, almond butter, spices, salt, rice malt syrup, baking soda and baking powder, walnuts (and any other goodies). Add cooled sweet potato, mix well and then add coconut flour. Stir until fully combined.
Line a loaf tin with baking paper, grease with extra coconut oil, add mixture and sprinkle coconut threads. Bake for 30 mins at 180 c.
1. Henderson, C. & Filloux, F. (2006). Efficacy of the Ketogenic Diet as a Treatment Option for Epilepsy: Meta-analysis. Journal of Child Neurology, vol 21:193-198. doi: 10.2310/7010.2006.00044
2. Westman, E. C., Yancy, W. S., Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5, 36. doi:10.1186/1743-7075-5-36
3. Volek, J, Phinney, S, Forsythe, C et al. (2009). Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids, 4, 44: 297-309. http://link.springer.com/article/10.1007%2Fs11745-008-3274-2
4. Mavropoulos, J. C., Yancy, W. S., Hepburn, J., & Westman, E. C. (2005). The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition & Metabolism, 2, 35. doi:10.1186/1743-7075-2-35
5. Ebbeling C.B, Swain J.F, Feldman H.A, et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607.
6. Markus, R, Panhuysen. G, Tuiten. A, Koppeschaar. H (2000). Effects of food on cortisol and mood in vulnerable subjects under controllable and uncontrollable stress. Physiology and Behaviour, 70(3-4):333-42.
7.Herrera C.P, Smith, K, Atkinson F, Ruell P, Chow C.M et al. (2011). High-glycaemic index and -glycaemic load meals increase the availability of tryptophan in healthy volunteers.British Journal Of Nutrition, 105(11):1601-6. doi:10.1017/S0007114510005192. http://www.ncbi.nlm.nih.gov/pubmed/?term=21349213
8.Poddar, M.K, Bandyopadhyay B.C, Chakrabarti L et al. (2000). Dietary protein alters age-induced change in hypothalamic GABA and immune response. Neuroscience. 97(2):405-409. http://www.ncbi.nlm.nih.gov/pubmed/?term=10799772
9. Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients, 5(4): 1417–1435, doi:10.3390/nu5041417
10. Sussman. D, Van Eede. M, Wong, M.D, Adamson, S.L, Henkelman, M. (2013). Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth, 8;13:109. doi: 10.1186/1471-2393-13-109.
11. Sussman. D, Ellegood, J, Henkelman, M. (2013). A gestational ketogenic diet alters maternal metabolic status as well as offspring physiological growth and brain structure in the neonatal mouse. BMC Pregnancy Childbirth, 29;13:198. doi: 10.1186/1471-2393-13-198.