Problems on a low CHO diet?

If you are reading this then there is a good chance that your diet is proportionately lower in carbohydrate (CHO) than the standard New Zealand diet (or you are considering making the change). More and more people are jumping on the low carb bandwagon and for good reason, particularly if your CHO intake was based predominantly around bread, pasta and other refined products. By default, switching to a whole food diet will naturally lower your CHO without thinking too much about it.

In my clinical experience, most who adopt a low CHO diet feel fantastic. Not only does this remove a lot of the aforementioned processed food, but they are also increasing their intake of natural fats and good sources of protein, and their vegetable intake. Their meals and snacks (if they have them) are balanced and often their nutrient-deprived bodies are finally getting the energy they’ve been seeking. However, in amidst the reports of glowing skin, greater health and bucket loads of energy, there are still people who struggle to find the right balance of nutrients, timing or the low CHO diet is exacerbating other underlying health issues that need to be considered. Depending on the reason for following a low CHO diet, increasing the level of CHO may not be an option for that person. If you fall into this category, then other strategies should be considered to address the problem. While this not intended to be a definitive list, here are some more common problems that people experience, and some possible solutions.

Energy: While it might just be a matter of tweaking the diet to better balance the micronutrients, people can experience a drop in thyroid function due to reducing their CHO intake, especially if this is done without consideration of other nutrients such as fat and protein. Symptoms of this (among others) could be:

  • hair loss
  • weight gain
  • cold hands and feet
  • insomnia
  • thinning outer third of the eyebrow
  • fatigue.

This may be due to two reasons. Acutely, our evolutionary response to low blood sugar is, in the first instance, to recognise it as a threat to our survival, and therefore we must make moves to convert glycogen to glucose to dump into our blood stream. Cortisol, a stress hormone, is responsible for that. Therefore the levels of cortisol can increase. Chronically, if moves aren’t made to correct macronutrient balance, the concommitant effect of this happening repeatedly is to affect pituitary gland function –  exhausting it and reducing the signalling to the thyroid to produce thyroid hormones necessary for function. In addition, insulin is required for conversion of t4 to t3, and one of the byproducts of a low CHO diet (importantly) is to reduce insulin levels in the blood. When increasing CHO isn’t an option, other strategies to help correct this include

  • Ensure adequate selenium, zinc and iodine levels. These minerals are all important in supporting thyroid health. Iodine forms the backbone of t4 and t3, and can be found in seafood, iodised salt and kelp (predominantly) in our diet. A kelp supplement can be a good way to increase iodine and this should be done in the presence of supplementing selenium also – 200 micrograms (ug) per day is recommended, and selenium can be found in brazil nuts and fish. Zinc is found in substantial amounts in oysters, followed by organ meats. If you aren’t much of a fan of either, then 15-30 mg per day of zinc picolonate (taken at night) is recommended.
  • Reduce goitrogenic compounds in the diet. These inhibit the function of the thyroid. Foods containing goitrogens include strawberries, kale and broccoli (a more complete list can be found here)

Another reason why people (and particularly athletes) might struggle is that the diet isn’t high enough in total dietary energy or there is an imbalance of fat and carbohydrate at each meal. Some people (women in particular) are extremely good at cutting things from their diet (in the first instance) and can sometimes find it hard to pick up additional foods (i.e. fat). Their version of a low CHO high fat diet might well just be a low CHO, low fat diet. In addition, not balancing nutrients appropriately at each meal can result in low blood sugar throughout the day, and the feelings of faint and dizziness could be a function of this hypoglycaemia. In my experience, there is no set ‘prescription’ on total calories if lacking in energy, it’s more about increasing the amount of total food at each meal, perhaps adding another serving of fat or increasing your portion of protein until hunger is satisfied and blood sugars are levelled out from meal to meal. For athletes, upping the CHO (particularly after training) can certainly help with replenishing muscle glycogen stores. For others, suggestions to help manage this might include:

  • Increasing protein in the morning meal to minimise blood sugar variation throughout the day.
  • Increasing the amount of fat in each meal by adding avocado, coconut, olive oil dressings, butter to meals (in the context of a low CHO diet, this is ideal).
  • Increase dietary carnitine to increase fat utilisation: if the body isn’t geared towards burning fat as a fuel source, there is a potential that enzymes required for this is downregulated. There will always be some variation here, and certainly the strategy to increase food will help, given that carnitine is found in meat and dairy products. In addition, supplementing with L carnitine could help support this pathway. Carnitine is required for fatty acid transport across the mitochondrial membrane, making it available for energy. While this supplement has been studied extensively in athletic performance (and not found to be beneficial), if you aren’t a regular consumer of foods rich in carnitine (such as dairy and animal products) you may benefit from this to help stimulate the pathway in the first instance.

Adrenal fatigue: If you are experiencing this, supplements to help support the rebalancing of hormones can help. Maca powder (which is quite popular now and fairly widely available) has been found to be useful in a small number of clinical trials, and anecdotally it’s often purported as an adaptogen – something that helps support the adrenal gland. Botanicals aren’t my area of expertise, but supplements such as Good Green Stuff by NuZest contains plenty of these, and here is a list of the common herbal varieties. I’ve talked a little bit about adrenal fatigue in a previous post which provides some other strategies for adrenal health, such as an adequate intake of vitamin b5 and vitamin C. Ideally in this instance you would work with a health practitioner to plan a path back to adrenal health.

Gut health: People lowering their CHO intake can experience a change in gut microbiome. Depending on the level of CHO restriction and the types of CHO in your diet, you gut bacteria may change for the worse as part of a low CHO diet. People often report digestive issues such as constipation, and this may be reduced bulk in the diet, reduced water moving through the small intestine or a lower production of serotonin. Serotonin is produced through CHO in the diet, and is a feel good hormone. Ensure that you have enough CHO from non starchy vegetables. Indeed there is room for a substantial amount of these despite quite severe CHO restriction. These, along with fermented foods, can help form good types of bacteria in your gut that support digestion. Non starchy vegetables contain resistant starch which feeds bacteria in your colon and forms short chain fatty acids (such at butyrate) which is used as an energy source.  Take 5HtP (as a precursor to serotonin, important in gut motility), chamomile tea or chamomile pills to help with constipation, or probiotics. Eat fermented foods such as sauerkraut, kimchi, a full fat yoghurt with beneficial bacteria in it if your CHO restriction allows this. Prebiotics in the form of fructoligosaccharides and inulin can also help (if not following a low FODMAP diet).

Sleep: back ending your CHO intake for the evening can help mitigate sleep problems. CHO produces serontonin – a precursor to melatonin, the hormone important for sleep and including a substantial amount of your CHO in evening meal can help reduce sleep problems. While some people have heard protein aids in sleep, in fact protein increases cortisol production and therefore (as they are competing hormones) melatonin production is reduced. Choosing cuts of meat from the bone that are higher in natural fats and reducing protein portion in the evening could help here. Gelatin (naturally found in these cuts) can also help with promoting the onset of sleep as it’s rich in glycine, not found when you remove fat from meat and just eat the lean protein portion. In addition, the higher protein breakfast option helps reset cortisol production (which ideally would peak in the morning and decrease across the course of the day).

Like I said, not a definitive list of potential issues OR solutions, just a few that you might find useful. I would recommend sitting down with a doctor or health practitioner to delve further into solutions in order to restore your energy if there are underlying issues at play. I will add though that sometimes just increasing your CHO intake will mitigate many of these – particularly if there is no specific health or athletic reason for being as low CHO as you might currently be. If all you have done is cut CHO without much thought to daily amounts, just monitoring it for a week or so could give you an idea if you are restricting more than necessary. CHO isn’t evil that must be avoided at all costs. That’s more the processed, refined food-like substances that fill supermarket trolleys on a weekly basis.

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