9
Individualizing Carbohydrate Intake Level
▶ The effective carbohydrate intake level can vary considerably from patient to patient,
as can strategies for determining that level.
▶ The level depends on several factors including age, gender, metabolic rate, insulin
sensitivity, activity level, and quality of carbohydrate (glycemic index/load).
▶ One effective strateg y is to start at a level that is effective for most everyone, typically
~20 g of total carbohydrate per day. This level achieves weight loss and ketogenesis in
most individuals.
▶ Then, small amounts of carbohydrate (~5 g ) can be added to the daily amount each
week in the following situations:
▶ As the patient reaches the goal for weight or another goal such as blood glucose
control
▶ If cravings for carbohydrate might lead the patient to abandon the eating plan
▶ If side effects of the eating pattern (e.g., constipation) cannot be managed
otherwise and threaten continued adherence.
▶ Ideally, 5 g of carbohydrate from one type of food (e.g., ½ cup berries, 1 cup of non-
starchy vegetable or 1 oz of nuts) is added daily for 1 week.
▶ If weight loss (or weight stability, if that is the goal) continues, then another 5 g of
carbohydrate from the same or another type of food can be added.
▶ In this manner, the patient can identify a level of carbohydrate intake below which
weight loss can be achieved and a higher level at which weight stability can be
achieved.
Figure 1. Reading a Nutrition Facts Label (cont'd)
General Eating Principles to Communicate with Patients
• A low-carbohydrate nutritional approach has a natural appetite reduction
effect to ease you comfortably into the consumption of smaller and smaller
quantities. Therefore, counting calories is not required.
• Eat when you are hungry and stop when you are comfortably full.
• You do not have to eat if you are not hungry. Skipping meals is acceptable
as long as you do not overeat or eat high carbohydrate foods later due to
delayed hunger.
• You do not have to eat everything on your plate "just because it's there."
