The Idiot’s Guide to low-carb, healthy-fat eating

By Marika Sboros

Some doctors and dietitians still believe that low-carb, high-healthy-fat (LCHF) diets are dangerous. That’s despite compelling evidence to show safety and efficacy of LCHF for weight loss, diabetes, heart disease, cancer and even dementia.

LCHF is a global phenomenon. In South Africa, there are more than three million “Banters”, as fans of LCHF regimens are known in that country. Banting pioneer is University of Cape Town emeritus professor Tim Noakes, a world-renowned scientist and medical doctor. Here, in a Q&A, Noakes gives an Idiot’s Guide to getting started on the LCHF path.

Is LCHF a diet?

No, it’s a lifestyle.

Is LCHF a one-size-fits-all way of eating?

There’s no such thing. No diet is right for everyone. LCHF is best for people with insulin resistance (the inability to tolerate carbohydrate).

Is it correct to call your diet ‘Banting’?

It’s probably more correct to call it Ebstein – after German physician Dr Wilhelm Ebstein who first made it high-fat. That was the diet Sir William Osler promoted in his monumental textbook: The Principles and Practices of Medicine, published  in 1892.

Is LCHF a fad?

Anyone who claims Banting or Ebstein diets are fads knows nothing about medical nutrition history. Nutrition did not begin in 1977 as our students seem to be taught.

Is it the same as Paleo?

The Paleo diet is slightly different. It promotes consumption of only those foods that would have been available to Paleolithic man from about 2.5 million years ago to the Agricultural Revolution starting about 12 000 years ago.  Foods allowed on Banting but excluded on Paleo are dairy. Paleo allows fruits but Banting excludes many.

What about Atkins?

The Atkins diet is similar to Banting  but the differences are trivial. To find the ideal low-carb diet you need to experiment to see how you respond.

Is LCHF extreme?

It depends what you mean by extreme. Moderation is a smug, puritanical word. No mammal eats in moderation. In nature all diets are extreme: lions eat only meat, polar bears mainly fat, panda bears only bamboo shoots, giraffes only acacia leaves.

Is LCHF balanced eating?

Balance is what has worked for each of these species for millions of years. LCHF can be extremely low in carbohydrate. It’s the one nutrient for which humans have absolutely no essential requirement but that depends on how sick you are.

Your recommended carb range is <200g to <25g? What are the indications?

It depends how insulin resistant you are and how much exercise you do. If you are insulin sensitive  tolerate carbohydrates well, have low fasting blood glucose, insulin and triglyceride concentrations, low small LDL particle numbers; low HbA1c; high HDL-cholesterol concentrations; and no fatty liver) and exercise regularly a few hours a week, then it can be safe to ingest up to 200g carb per day.

What carb-fat-protein ratio is best?

It depends on how sick you are. If you’re diabetic, we say 20% to 30% protein, 60% to 70% fat, 5% carbs. The sicker you are, the more fat you need because fat is insulin-neutral and good for blood sugar control.

Any weighing of food on your diet?

No. That’s a joke. You can’t predict accurately the absolute calorie content of foods when eaten by humans. You also don’t know how many calories each person needs.

Is Banting (LCHF) dangerous for babies?

No. It’s common in many traditional societies such as the Inuit in Canada, the Maasai in Kenya. The choice between health and ill health begins with infants as soon as they’re weaned. The science  is in our book, Raising Superheroes.

What does LCHF mean for infants?

Meat, fish, chicken, eggs and veg because these foods optimise brain development. The infant brain grows fast for the first two years of life.

Is Banting for babies low-carb?

No, only compared to traditional high-carb, high-sugar, low-fat guidelines.

What’s all the fuss around ketosis?

Ketosis is a perfectly natural condition in which the liver increases its production of ketone bodies (from circulating fats). Consequently, ketones can substitute for glucose as a fuel for the muscles, heart and brain. Ketosis from intermittent fasting is probably the natural human state. Indeed in the 1500s, Europeans typically ate once a day, not three to six or even more times as we now do.

Are there different forms of ketosis?

Yes, nutritional ketosis and diabetic ketoacidosis. They are polar opposites. Nutritional ketosis is one of the most important adaptations in the human body. It allows humans to survive periods of starvation without destroying their brains (from a lack of blood glucose supply). It is very different from diabetic ketoacidosis. Ketoacidosis occurs in persons with insulin-deficient type 1 diabetes and who are unable to produce even a trace of insulin. It is a life-threatening condition.

How can people get into nutritional ketosis?

Reduce your carbohydrate intake to 25g/day, eat less protein and lots of fat.  The easiest way to reverse nutritional ketosis within 15-30 minutes is simply to eat some carbohydrate or protein.

You’re a fan of intermittent fasting?

Yes!  Carbohydrate foods produce an insulin response that is exaggerated in those with insulin resistance. Intermittent fasting reduces the frequency with which you secrete insulin, intermittent fasting. It reduces the probability that you will develop worsening insulin resistance leading to type 2 diabetes.

Is saturated fat ever a health threat?

It can be, in the presence of a high-carbohydrate/sugar diet that causes elevated insulin concentrations due to the excessive carb intake.

What’s the key here?

To eat a diet that keeps blood insulin and glucose concentrations low. We say: eat what your appetite directs you to. Once you cut the carbs we think your brain will tell you if you need more fat or protein. It’s about finding the balance that works for you.

On LCHF fundamentals: what to cut out?

Bread, potatoes, rice, pasta, pizza, sugar, all grains, cereals, processed, packaged, boxed, adulterated foods, cakes, sweets, biscuits, fizzy drinks, all the addictive things. Anything sweet, starchy has to go,  and low-fat foods.

What stays in?

Fat and protein. You can eat fat in relatively unlimited amounts but only moderate protein. A healthy high-protein diet for humans doesn’t exist. If your diet was 100% protein, you’d get sick and die. You can’t easily overdose on fat; it reduces appetite and helps to beat sugar addiction.

What are good protein sources?

Eggs, full-fat dairy, cheese, yoghurt, fish, chicken – with the skin, not battery fed –  and some meat, preferably organic, or at least pasture-raised, not from animals raised in feed lots and fed grains because that destroys the meat’s quality. Meat’s not a main focus, but we like lamb because it’s fatty and pasture fed. Boerewors is fine but without cereal in it, and bacon, preferably not smoked.

And good fat sources?

Butter, cream – ladle meat and veg with butter; put cream in tea or coffee. Coconut oil is very healthy, everyone should have two tablespoons daily. Avocados, nuts – almonds, walnuts, pecan nuts, especially macadamia nuts, they are like drops of fat.

What about vegetables?

We recommend those with lowest-carb, highest-nutrient content: leafy greens such as kale, it’s one of the most nutritious vegetables; cauliflower, broccoli, they’re on our green list – (in The Real Meal Revolution).

Is it possible to be an LCHF vegetarian?

Yes, by eating a high-fat version –  including nuts, avocados, dairy and other safe oils, like olive oil. But, please, no “vegetable” (seed) oils as these are highly toxic.

And vegan?

Well, I know a vegan athlete, a former professional cyclist who eats 80% fat in his diet. He ate lots of coconut oil and avos. It’s an extreme diet that works for him. I don’t recommend it for everyone. Clearly, his gut flora can handle it.

Some people won’t lose weight on LCHF. Why?

The key to obesity control is to understand the role of the human brain homeostat (appestat) that controls energy intake and energy expenditure. For millions of years, the appestat worked perfectly, exactly matching how much we ate to how much energy we expended each day. The controls are so exquisite they must be accurate to within a few calories per day. If not, no human would ever be weight-stable for any length of time.

So what’s the real magic of ‘Banting’?

Banting quietens the appestat so that calorie consumption drops without hunger and weight is lost effortlessly. It is important to move progressively to eating less frequently so that at most, you eat one full meal a day with much smaller snack-type meals in between large meals.

How much weight is safe to lose quickly?

Most of those who try Banting respond positively and lose sometimes unimaginable amounts of weight, as much as 150kg!  Billy Tosh in Cape Town set another record by losing 83kg in 28 weeks.  These people do it by increasing their fat intakes, cutting sugar to zero grams per day and limiting carbs to less than 25 g/day.

What about alcohol?

It’s a toxin and significantly slows weight loss on LCHF regimens. We say: first lose weight, and  reintroduce alcohol in small amounts if you must.

No sweet “cheat” treats at all?

A small piece of dark chocolate is fine but many people can’t eat just one small piece  – like smokers who can’t have one cigarette. The key is to get sugar out the diet. People don’t understand how addictive sugar is or what it actually is – not just sucrose, the white stuff.

And best snacks?

Nuts, biltong, cheese, coconut – I love coconut chips best of all – and full-cream yoghurt.

Is LCHF only for the rich?

No. Our Eat Better South Africa campaign shows it’s possible to “bant” by eating foods that are as cheap as the cheap high-carbohydrate, highly-processed foods that are currently the sole option for many of the poorer South African communities.

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