Why a Low Carb Diet May Not Be Best For You, Kelly Brogan

low microbial diet

Why a Low Carb Diet May Not Be Best For You

Does Low Carb = Low Energy?

I have yet to meet a woman on a long-term, low carb diet who is loving life. I’m here to explain why I think this may be the case.

While we have, collectively, reacted to the low-fat brainwashing of the past half-century, with a defiant, “Fat rules!” attitude, this zeal may be taking us too far astray. I am passionate about the ancestral diet and everything implied by “going back to our roots”, but I also raise a brow at more rigid interpretations, assumptions, and academic flourishes about true replication of a Paleolithic diet. We’ve relinquished Darwin and redeemed Lamarck, so the truth is that we can evolve (or devolve) within one generation. Adaptations to stress and environmental exposures can change our biology and impact our grandchildren.

Thanks to the work of Weston Price, we may not have to go back as far as the Paleolithic to send the body a signal of safety. As recently as the early 1900s, he found traditional cultures flourishing, many with incorporation of agricultural foods like grains and legumes. That said, we also know that the microbiome plays a powerful role in adaptation to these foods, and that some of our guts may not be up for the challenge.

Back in my self-experimentation days, I spent two months on a carb-restricted diet, kicking starchy veggies, fruit, and grains to the curb. I felt great for two weeks, and not a day after. I felt cloudy, tired, and started obsessing about moisturizer and conditioner. Perhaps this is most relevant for those with a history of compromised thyroid function, as the Jaminets have discussed, but I believe it’s relevant to many women.

Many Body Types = Many Right Diets

I look to the Hadza whose women foster gender-distinct microbial profiles, ostensibly related to their consumption of honey and tubers.

I look to the work of my mentor, Dr. Nicholas Gonzalez, who used 10 dietary types, each with dozens of variations, none of which were ketogenic (restrictive of carbs below 100g daily to produce ketones as a source of energy). In case after case of long-term survival with metastatic cancers, none of his patients hopped on this integrative oncology bandwagon.

I look to papers like one by Dr. Karen Hardy, published in Quarterly Review of Biology (seems like we should be re-viewing biology quarterly, in my opinion!), entitled “The Importance of Dietary Carbohydrate in Human Evolution.”

Pass the Potato

In an effort to better understand our perceived leap into the conscious realm, researchers have posed many theories about the pivotal role of fire and of increased meat consumption. Dr. Hardy posits that, based on archaeologic, anthropologic, genetic, and physiologic data, it was actually the coevolution of cultural use of fire, cooked starch, and salivary/pancreatic amylase that afforded the brain the capacity for a quantum leap in evolution. Summarized here, Hardy et al bring the following claims to the table:

(1) The human brain uses up to 25% of the body’s energy budget and up to 60% of blood glucose. While synthesis of glucose from other sources is possible, it is not the most efficient way, and these high glucose demands are unlikely to have been met on a low carbohydrate diet;

(2) Human pregnancy and lactation place additional demands on the body’s glucose budget and low maternal blood glucose levels compromise the health of both the mother and her offspring;

(3) Starches would have been readily available to ancestral human populations in the form of tubers, as well as in seeds and some fruits and nuts;

(4) While raw starches are often only poorly digested in humans, when cooked they lose their crystalline structure and become far more easily digested;

(5) Salivary amylase genes are usually present in many copies (average

6) in humans, but in only 2 copies in other primates. This increases the amount of salivary amylase produced and so increases the ability to digest starch. The exact date when salivary amylase genes multiplied remains uncertain, but genetic evidence suggests it was at some point in the last 1 million years.

Kelly Brogan Diet

For the past eight years, I have used a moderate carb ancestral diet in the treatment of depression with astounding results. This diet focuses on tubers as a source of carbohydrate, and, after one month of slate-clearing (microbial shifting), re-incorporates gluten-free grains, white potatoes, and even beans (soaked). In addition to providing a form of usable energy, these “cellular starches” (as opposed to flour-based starches which are acellular) may play an important gut-rehabilitating role as microbiota accessible carbohydrates or prebiotics.

Sugar and flour-based foods can be particularly problematic for those prone to anxiety and depression because of the simultaneous effects on the hormonal, inflammatory, and gut ecology level. Here is how and why we must distinguish between health-promoting and health-effacing carbs.

Due to being made up of cells, virtually all “ancestral foods” have markedly lower carbohydrate densities than flour- and sugar-containing foods, a property quite independent of glycemic index. Thus the “forgotten organ” of the gastrointestinal microbiota is a prime candidate to be influenced by evolutionarily unprecedented postprandial luminal carbohydrate concentrations. The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, acellular flours, sugars, and processed foods produce an inflammatory microbiota via the upper gastrointestinal tract, with fat able to effect a “double hit” by increasing systemic absorption of lipopolysaccharide.

More than a prescription, this collective body of research raises awareness around the power of inherited epigenetic adaptation as a concert of our environment, physiology, and cultural practice. There cannot be one diet for everyone, beyond the clear benefits of a transition to a whole food diet. Excluding traditional foods such as fruit, root vegetables, and even grains, and beans can serve an important purpose as an acute therapeutic intervention but is unlikely to result in long-term gut-brain optimization and balance.

Featured Image Source: Maciej Szlachta

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Kelly Brogan, MD

Kelly Brogan, M.D. is a Manhattan-based holistic women’s health psychiatrist, author of the New York Times bestselling book, A Mind of Your Own, and co-editor of the landmark textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. View full bio. Want to share this article on your own blog? View our reposting guidelines.

Hi, I’m Laura. NOW you have met a long-time low carber who IS a woman who is loving life! I’m in my mid 50’s and spent my WHOLE life suffering with IBS-like symptoms, and while hospitalized for excruciating stomach pains was told I had Ulcerative Colitis and IBS. I just resigned myself to the fact that I was born with bad stomach genes and this would be my plight through life. Then an amazing thing happened. A year and a half ago, I read, “Wheat Belly” by cardiologist Dr. William Davis, who gives scientific evidence that human stomachs were NOT made to digest grains like ruminant animals. By following his advice, I gave up all grains and educated myself on how to cook for myself and my family in a low-carb way and remain completely grainless. My symptoms disappeared within a week and have remained GONE. The only carbs we get are from occasional potatoes, sweet potatoes, carrots, squash and other starchy vegetables, but NO grains. We have substituted flour with coconut, almond and other flours, even garbanzo bean flour occasionally with no ill effects. My skin is completely clear with no more eczema or face breakouts and I’ve never felt better in my entire life! I suppose there are exceptions to every rule.

Hi Laura! Your story is really wonderful. May I ask you which blood type you are?
I believe that eating gluten- and diary-free according to our blood type and unique immune system is a healthy idea to cure many deseases, including mental disorders -I am a psychologist and this is my favourite subject… ?

Samantha said on

Diets based on blood type have no scientific basis or evidence.

I am an A blood type and I feel there’s more and more evidence to prove that different blood types evolved with different diets. Dr. Atkins stated he had trouble with A blood types being on low carb. I am having trouble myself. I’ve been on it about 2 months and suddenly am experiencing hypoglycemia and anxiety, irritability, things that are usually experienced in the first few weeks. I’m annoyed as I was losing weight and was not hungry.

I too am A positive blood type and I’m having hypoglycemia symptoms on the low carb diet. I was wondering if you found a diet that worked for you because I honestly don’t know what to eat anymore!

Leanne Hardesty said on

All vegetables and fruit are considered carbs. So are you saying that you don’t eat any veg and fruit aside from what you have listed?

Phyllis said on

Hi Laura,
Your comment your comment is a perfect example of the confusion that Dr Brogan is speaking of in her blog post. Giving up grains does not mean giving up carbs. It looks to me as though you have basically given up gluten which many people have problems with. All of the root and starchy vegetables you speak of are carbs as well as the flours made from various different beans. So you may not be as low carb as you think you are. In any case I believe Dr Brogan’s point is that there is not one diet that is good for everyone, except for a diet that consists of whole real food ingredients. What those ingredients consist of is dependent on a number of factors which are unique to the individual.

what can we do? said on

brilliant! I was on a very low card diet for a year and even after adding carbs back in, I have still not fully recovered from the damage VLC did to my metabolism. I now have increased beta adrenergic sensitivity and idiopathic postprandial syndrome as a direct result. My cortisol sky rocketed and my thyroid function decreased. So glad prominent voices in the field like yourself are bringing awareness to the dangers a VLC can have on some.

christina pann said on

Hello! I can’t tell you how excited I am to have just read your comment! I don’t know if you will ever see this but I hope and pray you do and are able to respond with some tips that are helping you battle the negative effects VLC have done to you. I am suffering fro very severe idiopathic postprandial syndrome as a direct result from VLC. It has completely changed my life! I added carbs back in over a year ago but the symptoms have still not abated. I am working with a wonderful ND to address my high cortisol and help get this under control, but so far, although I have improved slightly, there has been no end to this horrible feeling! You are the first person I have ever found to experience idiopathic postprandrial syndrome from VLC. Any advice is much appreciated!! Thank you! christinapann@gmail.com

Has anyone who has had VLC issues had their ammonia levels tested? That can cause serious mental issues.

The trouble I have is that I don’t lose weight unless I am VLC, because unless I am VLC I have uncontrollable hunger, especially in the evening, no matter what I eat for breakfast and lunch.

However, I don’t know if the weight loss causes some mental instability or it is the VLC. Nothing other than VLC works at all for me – I can’t exercise due to a chronic condition (yes, many doctors have told me this).

I just wonder why there isn’t more science behind this. I am Type A blood, and the point isn’t that means that the Type A blood itself is the crux, it is what Type A blood indicates about your genetic background. Diet by blood type is diet by genetic pool.

I know my ancestors rode horses and hunted for a living. I know that they likely had high exercise and high carbs. I can’t do even moderate exercise, and light exercise is an issue for me (all because of back injury when I was young).

I think the only way I could try to eat differently than VLC or no diet at all is if my kids moved out so all temptation is gone from the house, and my spouse went on the same diet as me, and we cleared out everything else and never went out to eat.

I think you may find this talk informative. I don’t believe the Jaminets say this is most relevant to those with compromised thyroid function but for anyone with a compromised/busy immune system for sure. Paul would actually say that vlc (

Vanessa said on

Wow again. I am very susceptible to the triple-hit of hormonal, inflammatory and gut ecology effects of carbs, but have found I love them too. Thanks for the cellular vs. acellular distinction. Very helpful.

I can’t put it any better myself – moderate carbs from whole foods are very effective – speaking both from personal experience and in the work I do with patients suffering from Depression (many of whom are women). I am often disheartened by the debate on ‘carbs’ – we need to recognize the chasm of difference between a-cellular and cellular carbs in terms of what the body does with them and what they do to us. Great article.

I am personally exploring the effectiveness of cyclical consumption also – the potential benefits of having the occasional day that is lower in one of the macros, i.e either carbs, protein or fat. I believe there are benefits to be had from this selective fasting. Any views / articles on this would be appreciated.

ellebelle said on

OH MY! I have just experienced a profound emotional instability and depression after two years on VLC. Just happened to figure out what has been causing this two days prior to finding this blog post. Thank you! I would love to see more biochemical explanations. I have read that you “cannot” make serotonin without carbs. If so, how are there happy people on ketogenic diets? I was under the impression my body would adapt and make serotonin after some time on VLC but obviously it never materialized. A sublingual dose of 5-HTP was life changing. Now I am eating a high carb low fat diet and LOSING weight, and feeling relaxed and centered for the first time in two years. Amazing.

“I have yet to meet a woman on a long-term low-carb diet who is loving life.”

I agree. I have suffered depression and anxiety my entire life. Every time I go low carb my cortisol goes crazy and my anxiety through the roof. I have tried so many times but find I need carbs. I don’t do well with rice and grains but need tubers and fruit for my depression to normalize. I also take 5-hot.

Keto Girl said on

I am a long term ketogenic diet user who feels fantastic on a VLC, fatty meat heavy diet. Tubers and legumes make me violently ill and spike the daylights out of my blood sugar. My body can’t handle that stuff. The ketogenic diet has reversed my type 2 diabetes and thyroid disfunction as well. I now ovulate again where I did not before. Don’t unilaterally poo poo a diet that is healing many women. A lot of us, especially those of us with a high percentage of Neanderthal DNA, can’t tolerate these sugary vegetables. And they are still sugar.

Anonymous said on

What diet do would suggest for bi-polar disorder? I seem to experience mania with carbs.

michelle said on

Very interesting article, thank you.
I’m curious as to non-wheat flour, such as corn flour in tortillas I would guess, and the garbanzo bean flour… are they cellular and allowed when one is benefiting from no wheat flour and sugar.

Ketogenic Groove said on

Here I am, you’ve met another. I have been in ketosis for over 8 years and it has literally saved my life. Over my lifetime of 60 years I developed systemic candida from a 50’s hospital birth whereby I was fed canned evaporated milk sweetened with table sugar as the formula du jour by many pediatricians of the time. This was my first and only food for my first five months of life. It is a testament to my good genetics (even with a few MTHFR SNPs) that I am still alive. However I was overweight and sub-clinically depressed with Binge Eating Disorder most of my life. In my 50’s I developed a superbug from a cascade of bladder infections for which I regretfully took the antibiotic Cipro each repeated infection, until I finally killed the superbug with a course of Uva Ursi herb. But the damage was done and my Candida became fungal and systemic. My only hope was starting the strictest Candida diet which allows carbs in the form of all above-ground vegetables (except winter squashes) and avocadoes, but no grains, fruits (except lemon/lime), no nuts or root vegetables. The health benefits of this diet for my particular health issues, are astounding. Besides all the organic above ground vegetables and avocadoes, I eat grass-fed meats, wild-caught fish, pastured eggs and coconut oil daily that not only keep the candida and its symptoms at a minimum, but my mood is rock steady: calm, clear, focused and I breezed through menopause. More benefits: my skin literally glows, is never dry even in winter, hair and nails are shiny and strong, I sleep like a (happy!) baby, no post-menopausal symptoms at all, I lost all extra fat and I stay lean and fit with no joint pain EFFORTLESSLY. I am NOT making this up!! I am 60 years old and a certified Mental Health Nutritionist and veteran yoga and meditation instructor. I started taking hip-hop dance classes recently, keeping up, energy wise, with the 20 year olds in the class. All this being said, do I think everyone should eat the way I do? Absolutely NOT! We contemporary humans are so genetically diverse and bio-unique now that it wouldn’t make sense. What DOES make sense is to eat for your own best health. So PLEASE, Dr. Kelly, do not mock ketogenic diets. Some of us not only need ketosis to survive, we have found that ketosis makes us thrive. And I am not alone. Just go to, for example, Marksdailyapple.com and meet hundreds and hundreds more, young and old, male and female, who have similar stories to mine. Thank you, otherwise, for your dedication to mental health through natural therapies and nutrition. You are an inspiration. Regards, Layla Masant

EVan Eberhardt said on

I wouldn’t even necessarily throw all grains under the bus either. The biggest obstacle with grains is preparing them properly to inactivate all the anti-nutrients (phytic acid is one everyone should familiarize themselves with and make sure they keep the consumption of it down). Native cultures went to epic lengths to get their grains in as friendly a manner as they could come up with. This may have meant months of preparation (drying, aging, sprouting, fermenting, and perhaps all of these). OR, the much easier shortcut, is simply to refine grains by extracting their hulls, bran, and germ, and then from there, use fermentation if possible. Organic unbleached refined sourdough bread is a good example of an ‘okay’ carb source, IMO (assuming glutens are tolerated), as long as it’s consumed with other nutrient dense foods like meat and dairy (when was bread a problem for Europe before the industrial revolution? I don’t recall any history of obesity and auto-immunity widespread). The same with rice. FORGET brown rice unless you happen to have some ancient recipe that probably takes a long time to prepare. It’s far easier to just eat white rice AND include fish, seaweed, pork, beef, spices, bone broths, organs, and whatever else is nutrient rich that all of Asia has consumed for millennia (white rice is probably 5,000 years old at least, and again, how widespread was obesity and other diseases?). White potatoes also have phytic acid (not much, about as much as white rice), but again, if consumed with butter, sour cream, bacon, cheese, chives, and of course a meat dish, the anti-nutrients can’t win the battle, so to speak, and start causing nutritional deficiency diseases. So, the best advice is to see how YOU respond to each type of food and go from there. Feel great eating white rice and sourdough bread? Then have at it. If issues start cropping up (especially dental decay, which is an early indicator that your diet is not in alignment with your needs), then it would be wise to start finding out which foods work best for your system. For the sake of life enjoyment (which food is tied to each and every day), I don’t think we need to eliminate grains from the entire planet if some people tolerate them just fine.

Michelle said on

I’d love to hear more about the sourdough. I bake this regularly for my Dutch husband, who doesn’t much care for American bread. I almost never eat it. I have tried everything I can think of, from Whole30 to vegetarian (which my husband is) and nothing works. I am eating lots of veggies, a bit of fruit and nuts, some beans, occasional brown rice. No sugar or white flour. I don’t feel better. I feel like shit. I cannot lose weight, and I am quite overweight. Supposedly, just cutting all sugar will result in incredible weight loss but it has not done that for me. Nor do I feel any better. I’m willing to follow any diet, from vegan to keto if it will make me lose some weight but neither approach has done anything for me.

Allison Bell Bern said on

Sorry, Michelle…that sucks! Maybe the answers to what ail us aren’t in our diets at all…but if they’re really in finding more community to which we can connect…it seems we might all be screwed 🙁

DowntoEarthThinking.com said on

Great story Layla. I too have learned about the benefits of Ketosis. We get all manner of bad information from many of the so-called professionals as they run to jump on a fad bus like Paleo and others ! As you mention it is all about balance and also about your energy needs depending on how much you are asking your body to perform physically also. I have actually gotten to a point that I can go in and out of Ketosis as I need and able to keep my metabolism and endocrine system in great balance all the while, simply by understanding my nutritional needs and realizing what works, not what many others say ? I have used my physical workouts as part of my tools to determine such and I write about all of it in rather great detail at my site as well. You healed yourself ! and that is exactly what I am teaching many others to do as well. Mostly by going inside and starting their own Inner Journey and realizing their own “Inner Powers”. I imagine you can relate to these dynamics now and you will likely appreciate the site as well. http://www.downtoearththinking.com I am 67 and have the body of a fit 25 year old and was in fact crippled for over 5 years from a serious motorcycle accident and healed myself. Very similar to what you describe as your own experience. Good on Ya and enjoy. Kelly Brogan is one of the exceptions to the rule and doing some excellent work to inform people as she speaks many truths of health matters ! She is also helping many other professionals realize there is much more to the story than what we have been told and we can in fact heal ourselves ! I am very encouraged to see so many professionals taking a more honest view of what we call health care here in this country and standing up against the status quo.

The problem is not the lowcarb diet, but how people apply it, in my opinion. Also, it takes the body time to adapt to using fats for fuel instead of glucose. Upto three months initially, but even then the body is still adapting. A well formulated Ketogenic diet can be great for balancing hormones, mood, stress levels and so on when followed correctly.

Another issue is that many people start relying on allergenic foods following a Ketogenic diet…eggs, nuts, dairy etc. And they often do not go low carb enou to start utilising fat for fuel instead of glucose, or they eat too much protein.

If you want an example of a woman thriving on a Ketogenic diet then watch the videos of ” Stephanie person skater” on YouTube, she looks extremely healthy for a woman of her age and is thriving on a Ketogenic diet 🙂

I believe it will just take time for the stories of people who are doing well on this way of eating and living to make their presence known 🙂 There are definitely a lot of people who failed at it, and with good reasons because it’s difficult and doesn’t fit with the modern world, but that doesn’t mean it doesn’t work and isn’t profoundly healing for people.

Thankyou for all your excellent work and article Dr Brogan you are brilliant, I do hope you will look more into the cases of those who thrive on a Ketogenic diet though.

Dr. Schwarzbein did not go into any detail as to how to eat, etc to heal insulin resistance. She just said eat complex carbs with ur protein, use healthy sat fats (guess fats change from healthy to unhealthy sometimes??) and it takes 7 yrs, in her client population anyway.
What a letdown, to learn the biochemistry and then not the application. My brain fog is so bad, just following her analysis makes me proud. Further thinking is beyond me…
I have all her bks, from about 8 yrs ago when I first discovered her. Perhaps the answer’s in there? Her thinking didnt seemed to have changed in those utube vids.

I am also someone who does MUCH better in ketosis. In fact, whenever I try to eat starches, etc., I get horribly constipated and my brain goes south in a big way. (I am open to the possibility that my gut has evolved to not having the appropriate probiotics to handle the carbs. Though, in fact, I do eat some starchy or non-gluten grainy carbs intermittently. But, as soon as I do, I start to crave sugar like mad.)

Thanks, as always, for your thoughtful analysis. Yours is such a welcome blog.

Dr. Brogan, as one who recently entered the pre diabetes camp, I have noticed that even eating complex carbs like oatmeal spikes my blood sugar big time according to the glucometer. I suspect the same would happen with a sweet potato although I haven’t yet tested this food.

I will look at your website for more information on how you deal with metabolic issues but I would be curious what you would say to patients in my situation.

DonnaJH said on

I have been happily Ketogenic for 6 years. Starting 6 mos ago I have been upping my probiotics slowly and gently and adding small amounts of nutritiously dense carbs to most meals. I found my A1c was slightly elevated and my brain was a bit foggy, so I have backed off the carbs a bit and will have another blood test at the end of this month.
I’m 55 and thriving with Hashimotos. I think the probiotics are helping a great deal. I’m going slowly with them because my Hashi system is very sensitive and easily annoyed. I’ve learned not expect quick results with diet/exercise changes.

I find all of these comments very interesting and it supports the flexibility of mind that comes from our observation of bio-individuality. I have noticed that cutting out grains made psoriasis go away because I added a very balanced diet of carbos through mostly vegetables, smart fats like avocado, olive oil, nuts, etc, and clean proteins like eggs, fish, poultry, etc. I eat about 30% of each of these three groups and I suspect eliminating carbs via grains would only be a problem for me if I didn’t replace the carbs with vegetables and a bit of fruit. My skin told me the answer.

Hello,
I am low carb at the moment and in ketosis. I have been for 6months trying to heal my gut. I have also been trying to get rid of pathogens and candida. I’m worried that if I eat starches I will feed what’s there. I don’t know if it’s the low carb not making me feel great or all the other stuff going on. Would you see adding starches in as a problem is dealing with dysbosis and pathogens?

Susie Q said on

Hi there
I am following a Leptin Diet which seems very similar to the Keto diet. I am on day 10 and every day for the past three days I have experienced depression and despair like never before. Today I broke down and cried because I feel so blue. I am usually a very social person but I have no desire to call anyone or be around friends. I don’t know what to do because I am pre-diabetic and my inflammation is high so I know I need to change my eating habits and lose the 20 pounds I gained in menopause. Any ideas?

The question is whether it is VLC or the food choices.

I tried the diabetes diet when I had gestational diabetes, and it drove me nuts trying to follow it, and I was always hungry. I feel like my son ended up underweight and as an adult is not his full possible height because he was deprived in the name of the diabetes diet.

I think I have issues when I am too high protein, so I add fat in when I can.

Susie, are you familiar with Dr. Jason Fung? He is a diabetes specialist who promotes Intermittent Fasting in his practice. Dr. Eric Berg is a clean Keto expert and is also a strong supporter of IF for insulin resistence.

I highly recommend checking out their YouTube videos thoroughly, being sure to read the comments, as well for possible clarifications.

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