At the beginning of 2018, there were basically three types of low carb diets; the popularized low carb, high fat diet of Dr. Jason Fung and Diet Doctor, the low carb, higher protein, moderate fat diet of Dr. Stephen Phinney and Dr. Jeff Volek, and the (then) new low carb, high protein diet of Dr. Ted Naiman.
In 2018, Dr. Ted Naiman was promoting a diet which aimed to “target protein, limit carbs and balance fat” and was recommending ~120 gm of protein (based on 1 g protein per pound of ideal body weight), <50 gm of net carbs, and ~120 gm of whole food fats’ (fat found naturally in food) and ~30 gm of added fat (such as on top of vegetables, salads and cooking), but last year (2020), he came out with his “P:E Diet” associated with his P:E ratio Macro Calculator (bottom of www.p2eq.com) which is a very high protein (40%), moderate carbohydrate (>100g carbohydrate / day) and low fat diet.
The low carb high protein diet was abandoned* by Dr. Naiman in favour of a high protein low fat approach — but since his audience is primarily those who are seeking to build and sculpt their muscles, a high Protein to Energy (P:E) ratio does make sense, provided amounts do not exceed the urea excretion capacity of the kidney. As I outlined in this previous article, it can come close to exceeding that safe level in some cases.
* [UPDATE – May 17, 2021] – I misspoke myself above and am adding a correction.
Dr. Naiman has not “abandoned” a low carb high protein approach. As indicated below, for some weights and heights Dr. Naiman’s P:E Macro Calculator (p2eq.com) does generate carbohydrate recommendations that are below the low carb cut-off of <130g carbs per day [1], but for the most part a P:E diet is moderate carbohydrate (130-225g), based on the definition of Feinman et al (Nutrition. 2015;31(1):1—13) and is low fat, based on the USDA definition of less than or equal to 30% of daily energy as fat.
Low Carb High Fat Moderate Protein
In 2018, both Dr. Jason Fung and the Diet Doctor website were promoting a low carb high fat (LCHF) diet of ~75% fat, 15% protein and 10% carbohydrate, but since that time, Dr. Fung has increasingly focussed on the role of regular intermittent- and long term fasting for weight loss and diabetes remission, while continuing to encourage the same distribution of macros.
From High Fat to High Fat and Low Fat
To many people’s shock and surprise, recently the Diet Doctor website announced that they would not only be supporting the popular low carb high fat diet but also the high protein approach of Dr. Naiman — even bringing him on staff to head it up. The backlash on social media was so strong that it resulted in a clarifying post this week from Dr. Bret Scher.
“Some feel we have gone too far and are now ”fat bashing” or promoting ”fat-phobia.” We regret that our message hasn’t been clear on this subject. But that is not our intent. someone may lose weight and feel great on a 20% protein, 5% carb, and 75% fat diet. Someone else may do the same with a 30% protein, 10% carb, and 60% fat diet. The latter is a low-carb, higher protein diet, but by no means is it a low-fat diet.”
Based on the macros generated by the p2eq.com calculator (see macros above), Dr. Naiman’s current approach is 40% protein, 30% carb and 30% fat — and not a 30% protein, 10% carb and 60% fat diet. Whether the Diet Doctor website will choose a middle ground has yet to be seen.
The Role for Low Carb High Protein
It has been my clinical experience since 2018 that a low carb higher protein diet is an excellent option for those seeking weight loss and remission of type 2 diabetes — especially those who do not do well on a very high fat diet, or for whom regular intermittent or extended fasting is not optimal due to the increased risk of sarcopenia (muscle loss).
This approach is safe, provided an individual is able to handle intakes of 1.5 – 2.5 grams protein per kg ideal body weight. This enables carbohydrate content of the diet to be kept low — which it is very effective for lowering blood sugar levels for those who have pre-diabetes or diabetes, or at risk of those and provides room for a wide range of healthy fats — from fish and meat, dairy foods, as well as nuts and seeds.
Those following most low carb or ketogenic diets choose the number of grams of carbs they want to limit the diet to, then they establish the amount of protein, then the rest is fat. A low carb high protein diet prioritizes protein based on individual. need*, then sets the upper limit of carbohydrate based on blood glucose control, then the remainder is added fat, based on weight goals.
*But how much protein is best? That depends for whom.
As outlined in an earlier article, different people have a different protein needs. A healthy man or woman seeking to build muscle has a different protein need than an older adult wanting to reduce the risk of sarcopenia (muscle loss) or someone simply wanting to prevent deficiency. The amount of protein someone needs depends on many factors, including whether a person is growing, pregnant or lactating (breastfeeding), or has been sick or just had surgery. Even for those who aren’t in these special circumstances, protein needs may be calculated to prevent deficiency, to sustain exercise or to preserve muscle mass in older adults, and each of these calculations are different.
Dr. Naiman’s P:E database of foods has made it very easy to choose foods with the highest amount of protein for energy*. Setting carbohydrate levels low and adding a bit of fat for taste works incredibly well for those whose goals are blood sugar control and weight loss. This is the basis of a low carb high protein approach.
*An oversimplification of Dr. Naiman’s P:E ratio is used in the above graphic for illustrative purposes.
Final Thoughts…
The P:E Diet was supposed to “end diet wars” but when one increases protein, by necessity one has to either decrease carbohydrate or fat, and the P:E diet chooses to decrease fat. Again, this makes perfect sense for those who are seeking to build muscle, but not so much for those with pre-diabetes and diabetes who don’t tolerate even moderate amounts of carbohydrate, regardless of glycemic index. Different people have different nutritional needs.
I truly believe there is “no one-sized-fits-all low carb or keto diet” and that there is a room for a low carb higher protein diet among the options.
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To your good health!
Joy
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Resources
- Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ,Westman EC, et al. Dietary Carbohydrate Restriction as the First Approach in Diabetes Management: critical review and evidence base. Nutrition. 2015;31(1):1—13.
- Institute of Medicine (US) Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols; Wartella EA, Lichtenstein AH, Boon CS, editors. Front-of-Package Nutrition Rating Systems and Symbols: Phase I Report. Washington (DC): National Academies Press (US); 2010. Appendix B, FDA Regulatory Requirements for Nutrient Content Claims. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209851/
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