**Jim Hill:** Welcome to “Weight Loss And…”, where we delve into the world of weight loss. I'm Jim Hill.

**Holly Wyatt:** And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and living your best life while you're doing it.

**Jim Hill:** Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

**Holly Wyatt:** Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

**Jim Hill:** Ready for the “And” factor?

**Holly Wyatt:** Let's dive in.

**Jim Hill:** Here we go. Holly, you and I both feel like there are a lot of different diets out there and there's not one that fits everybody. There are pluses and minuses to the various diets. So what we're going to do is we're going to take some time and do some deep dives into some of these diets.

And the idea is to help you understand the pluses and minuses and maybe what to expect from these diets who might benefit from them. And so we're, we called on some of the best experts in the country to help us do that. And we're going to start today with the low-carb diets. And we have a great expert with us today.

Our colleague here at UAB, Dr. Barbara Gower, Barbara is a professor and chair in the Department of Nutrition Sciences at the University of Alabama at Birmingham. She directs the core of the NORC. We talk about the NORC all the time. This podcast is part of the NORC, the Nutrition Obesity Research Center. So she directs one of our core labs and she directs a core lab for the diabetes research center and also a core lab for the general university. So she really knows what she's doing around metabolic research. Barbara's research focuses on the interplay of diet, endocrinology and metabolism and how those interact to affect risk of chronic metabolic disease. She's an expert in measurement of body composition, body fat distribution, insulin sensitivity and beta cell function. Her two major research areas are nutrition interventions for obesity. We all like that and metabolic health and risk for type two diabetes in African-Americans. Barbara, welcome to Weight Loss And.

**Barbara Gower:** Thank you. It's a pleasure to be here.

**Holly Wyatt:** Yeah. So we've been waiting for this. An expert on low-carb diets. We get questions from our listeners all the time about low-carb diets. So this is a hot topic. So thank you for joining us and spending your time with us. Before we jump into the topic, can you tell us a little bit more about how you got to where you are today? How did you get started studying low-carb diets or ketogenic diets?

**Barbara Gower:** So thinking about that, it was almost 20 years ago, hard to believe I got a grant funded to study intermuscular fat and health. And so your muscle, you think about a muscle as being muscle, but it's shocking to discover when you use sophisticated imaging techniques that there's actually fat in there too. So it's actually adipose tissue. Like it's visible fat.

Like it's the marbling in the state that you see at the grocery store. And we got a grant funded to study that years ago. And one of the aims of this grant was to administer diets that differed in glycemic load. And what we found, much to our surprise, is when we randomized patients to a lower glycemic load diet. So this is more of like a think of a low sugar diet.

It wasn't low-carb per se, but it was low in added sugar and some heavily processed carbs. And we found that their muscle fat just disappeared. So it wasn't just their muscle fat. It was all the fat that you don't want. So, you know, you want some fat in your hips and thighs, but maybe you don't want it in your liver or maybe you don't want your gut or your spare tire. We found that the fat that you don't want went away, but the good fat stayed. And the other thing was in the patients, we had a comparison group that was a low-fat diet and that group lost lean mass. But the group that we put on the low glycemic diet didn't lose lean mass. The study had two arms, a weight maintenance arm and a weight loss arm.

And it was true for both. So basically what we found in a nutshell is that you can selectively remodel yourself just by changing the glycemic load of your diet. And this was true even if you didn't lose weight.

You could keep all the good stuff and get rid of all the bad stuff, which we thought was extremely cool. We tried to pursue it to find out both the effects on not just obesity but on metabolic health and the mechanisms. Like how does this work exactly?

**Holly Wyatt:** So that hooked you. It sounded like that study really got you thinking about this whole area. Is that right?

**Barbara Gower:** That's right. And the feedback we got from the patients was amazing. People would tell us how much they loved one. They like, you know, even if they didn't really know which diet they were on, they would tell you that they loved this diet. I'd like this diet more than the other diet. We did one study that was a crossover and they would tell us which diet they liked. The diets weren't, you couldn't always tell them apart because they weren't that different. The glycemic load is something fairly subtle that you can tweak without the participants realizing it. But they would tell us which diet they liked and they liked the low glycemic diet. We did a study with women with Polycystic Ovary Syndrome and they told us in no uncertain terms that they felt better when they were on the low glycemic diet versus the comparison diet. They could feel the difference.

**Holly Wyatt:** Nice.

**Jim Hill:** So Barbara, when we talk about low-carb diets, that's not one diet. There's a range of diets and people talk about keto diets and low-carb diets and the Atkins diet. Explain a little bit about how you would define these.

**Barbara Gower:** It's interesting. You should ask that, Jim. I actually took part in a round table about a year ago that addressed this question because it just isn't simple. And we did publish some guidelines for how you define a low-carb diet. I mean, basically you could say anything below 100 grams per day is low. But then there's also very low, which might be less than 50.

And there's ketogenic, which is a really tricky one because what it implies is that you achieve a state of what is termed ketosis, which is actually sort of arbitrary. But you're right. It's a continuum. So there is no magic cut point. And a lot of it depends on how an individual responds to the food.

But there is definitely a range. And we could talk all day about that and what those different diets, like the strengths and weaknesses of the different diets that fall in that range.

**Holly Wyatt:** So when you say just for our listeners to make sure 100 grams of carbohydrate, all kind of carbohydrate, when you talk about that, when you say that, right? When if they're looking at a label, I want them to make sure not just sugar, you're talking all carb.

**Barbara Gower:** Well, technically, yes. But not. But I would advise that we really ought to talk about the quality of the carbs also because 100 grams of sugar sweetened beverages is very different than 100 grams of fruits and vegetables and whole grains. So you're right. That's a biggie that is often glossed over, but it's not trivial.

**Holly Wyatt:** OK. So what are some of the outcomes from your research and others' research that you've discovered when people start eating low-carb? Let's just say limiting their carbohydrates. I don't know. What do you say, less than 100 grams? Would that be would you be comfortable with that? Or what would you in that range?

**Barbara Gower:** That's going to make a difference. Yeah. And what’s nice about that is you're still eating carbohydrates. You can be eating bread with less than 100 grams, but you can still experience the benefits.

**Holly Wyatt:** A little bit, a little bit. But that’s 100 grams would be 400 calories worth of carbohydrate. Just to give our listeners a little bit. I don't want to think of they can go out there and just be, you know, eating, eating a loaf of bread. But OK. So moderately low. What are some of the outcomes that you've discovered? I know you've done so much on the metabolic side of things when people cut their carbs or restrict their carbs.

**Barbara Gower:** It’s all over the place. Everything from, you know, I remember a guy once showing me the loops on his belt hole that he was down over, I think at least three notches on the belt hole. All he did was cut out, I think, wheat or something.

It sometimes just trivial changes have really dramatic effects. And in terms of disease, so we have we've administered low-carb diets to patients with type two diabetes, and they can come off all of their medication and basically manage their disease without medication. That I wouldn't say you can reverse diabetes.

I think that's a tricky one. I think if you talk about the early stages of diabetes, you can put it into to remission and you can achieve some degree of improvement in beta cell function. But it depends a lot on the spectrum where you are in terms of your disease. In terms of fatty liver, this one's an easy one. Fatty liver just disappears within weeks of switching a decreasing carbohydrate intake. And I think the response is a dose-response. The more you decrease the carbs, the quicker your fatty liver is going to go away.

That and diabetes are probably the two diseases that are most responsive to carbohydrate restriction. But the interesting thing is pain was an unexpected outcome in patients who have chronic pain, they say their pain goes away or it's alleviated to the point where they no longer interfere with their quality of life. So a lot of surprises that I wouldn't necessarily have expected.

And that's what I think so fascinating about it is to get the feedback from the patients. Blood pressure is another one. We have to tell people to cut back on their blood pressure medication as soon as they cut back on their carbs because their blood pressure drops like a rock and they're suddenly taking too much blood pressure medication and then become lightheaded.

**Jim Hill:** What about long-term adherence? Do people stick with this? I think some of the outcomes are pretty amazing in the short term. But as you know, you have to you have to keep eating it. What do we know about adherence to low-carb diets?

**Barbara Gower:** It's really not difficult. It's first of all, you get the positive feedback. People tend to feel so much better. And then if you're talking low carb, you're still eating some carbs. So it's simply a matter of identifying your diet. You come up with foods that you're happy with, you enjoy eating them. You feel good eating them and you just stick with it. It really isn't that hard. And I have colleagues who adhere to a ketogenic diet, which is ultra-low carb.

And they have no trouble doing that. It's again, you figure out what it is that you like eating and you define your diet and you just stick with it. Now, you have to want to do this, obviously.

**Holly Wyatt:** Yeah.

**Barbara Gower:** But if you want to, it really isn't hard to do.

**Holly Wyatt:** Well, Barbara, I'm going to push back just a little bit because, you know, me, I've struggled with my weight my whole life. And I also I do believe that there is a lot of good data for low carbohydrate diets in some people. But for me, for instance, it is hard for me to adhere.

I love my carbs. And so I can do it for short periods of time, but for long periods of time, I sometimes struggle. The bag of chips calls my name, I often say. And I want more than one or two pieces of bread. I want, you know, bread and potatoes or something else. And I'm just even making, you know, making this up. But it's sometimes I think it is harder. I wish it was so easy to adhere for everybody. But I agree. There are some people who do really, really well on it.

**Jim Hill:** Holly, for example, has a hard time doing it. Can we identify people that might do really well and might be able to adhere easily?

**Barbara Gower:** I have not seen that addressed and I haven't experienced that. That's a really interesting question. What I can tell you, there was a paper published a few years ago where they looked at cravings and they randomized people to low-fat and low-carb diets. And what they find is that people crave what they're eating. So if they're if they're fed carbs, they crave carbs. If they're fed a really super low-carb, high-fat diet, they start creating fat. They switch what they crave.

And this fits with the concept that it's a learned behavior. In other words, you wouldn't crave sweets. If you would never eat bread, you wouldn't crave bread.

And the more you eat it, the more you want. So what I found, and this is just experienced dealing with the patients in our studies, is that when we switch them over to a low-carb diet, they completely lose interest in eating carbs. They can’t as a matter of fact, what they've told me is they can't believe they ever ate that stuff. And if they go back and they try it again now, it's completely unappealing. My sense is that it's learned behavior and that it's like anything else.

You can learn it. It's an interesting point, Holly, these cravings. And I know people do deal with them. And I don't know how much of that could be reversed just by kind of a behavioral approach. In other words, you shift your snacks to something else for a while and see if you can get over that craving for a specific snack that you had before.

**Holly Wyatt:** Yeah. I will say if I get down into the rage of the ketogenic diet, they go away. So it may be different people, different levels of carbohydrate. They're sensitive to. I mean, you know, you do the precision nutrition grant with us. That, you know, everybody's a little different.

So it may be the level or just a little bit different sensitivity. But I definitely have seen low carbohydrate diets really help with weight loss. I think there's a role for them in weight loss maintenance.

I think they work. People always ask, is it just that you're restricting calories? Or is there something in addition to the restriction of calories? Kind of physiologically, I know this is your area. Let us in on what how you think about how they produce their effect.

**Barbara Gower:** When people shift over, it's interesting, but I think the people who have worse or metabolic health experience more dramatic improvements when they shift to a low-carb or very low-carb diet. You see an amazing diuresis is one of the things that I hear. People are just hanging on to water. And when they stop eating carbs, all of a sudden they just start passing massive amounts of water.

I mean, there's a there's a limit to this. It disappears after a few days. But what that's saying is their body's hanging on to water. And the reason that's occurring is insulin, because what people don't know is insulin, in addition to many other actions that it has, acts to reabsorb water at the kidney tubules. So a lot of times what we see with high blood pressure is when people stop eating carbs, their blood pressure drops. It's not the carbs themselves. It's that their insulin decreases. So when you experience a drop in insulin for it, that's assuming you have higher insulin than, let's say, is normal. You'll experience all sorts of changes in your physiology because insulin is a tremendously powerful hormone. One of the things that insulin does best is deposit fat.

It loves to deposit fat and it also prevents you from burning fat. So let's say you decide you're going to skip lunch and go for a run. You're going to say, well, I can lose a pound by doing this.

Well, guess what? You won't if your insulin stays high. Because your insulin will just keep you from doing that. So your body will find some way to compensate for that. You know, you have an eating and you've gone out and run three miles.

So you burned all these calories. Your body can figure out a workaround for this. It will just drop down its energy expenditure. If you don't eat, it will compensate. And the reason it does this is because if your insulin stays high, you can't mobilize your stored fat. So you just can't will it to happen. Now, you can't sit at your desk and say, you know what? I'm going to lose fat now.

You can't do it. There's all sorts of physiological changes that have to occur in order for that fat to get mobilized and for you to burn it as a fuel. And that's the magic of low-carb diets. It hits the big ticket item, which is insulin.

If you can get your insulin down, it's like unlocking the fat in the fat stores. It's just been locked up and you haven't been able to get at it. If you get your insulin to drop, the lock is gone. And now if you skip lunch and go for a run, that fat's just going to pour out. You're going to burn that 300 calories from your run in stored fat, but that won't happen unless your insulin drops. So I think the whole key, the magic of low-carb is getting that insulin down. And that's true in both obesity and chronic disease.

All chronic diseases ultimately at the end of the day are due to insulin excess.

**Jim Hill:** I'm glad you brought up running. So exercise, I think exercise is terribly important. And carbohydrates are often a fuel for exercise. People on low-carb diets, does it affect their energy for exercise? How does that work?

**Barbara Gower:** It will, and it depends on how low you go. I think you can still eat a low-carb diet and exercise if it's low. Now, if it's keto, that's a different matter. I think keto is tricky for two reasons. One is because it's so low in carbohydrate, it will affect your energy level.

But more importantly, if you do high-intensity exercise, that burns a lot of carb. And if you're not eating them, where are you going to get them? Your body will get them. Where it gets them is by mobilizing muscle and burning muscle, converting that to sugar and burning that, which you don't want to do. So what we advise patients, if they're going to go keto, is don't exercise.

Not at least nothing more than a little walk around the block at a very moderate pace. So if you're going to do keto, I would say don't exercise, you're shitting yourself in the foot. If you're going to do low carb, if you're eating 50 grams a day, you're fine. You can still exercise.

And there's probably an individual threshold for exactly how low you can go and still be able to exercise. But I think, you know, if you're going to exercise, I would eat some carbs. I would just eat helpful ones. I would not be drinking Gatorade. The whole sports field is a nightmare.

**Jim Hill:** That's a marketing ploy, isn't it?

**Barbara Gower:** Oh, yeah. Don't do it. Just don't do it.

**Holly Wyatt:** So that is a perfect kind of segue to the question. Are all carbs the same when eating a low carb diet? You know, should you target certain carbs or just count total carbs?

What I believe, and this is just because I believe in eating healthfully, is that you should eat good quality food. So I would say they're not all the same, and you should choose your carbs carefully, especially if you don't have that many of them. You know, be careful what you choose. I would say it's a bad idea to say, well, I can only eat 100 grams, so I'm going to eat, you know, ice cream, cookies and chips.

Probably not. First of all, you're not doing yourself any favors. You know, you're reinforcing those cravings for the foods that you're trying to get away from. But they're also not healthy foods for your body. You know, what your body needs is fuel and vitamins and minerals and helpful components from the foods. So get rid of the junk food.

The biggest favor you can do yourself is getting rid of junk food. So yeah, I think especially sugar. Sugar is bad for many reasons.

If you go on a low-carb diet and cut out all your sugar, the first person who's going to notice is your dental hygienist, who's going to say, hey, I don't have to clean your teeth today. There's no problem with them. And the second thing is that you may notice that you don't have cataracts. What I found is that people who get a certain age get cataracts. And what that's been shown to be due to, loosely speaking, is what cataracts are is basically sugar crystals in your eyes.

I'm sure there's a genetic predisposition to it, but it's excess sugar. So there's lots of good reasons why you don't ever need to eat a lot of added sugar. That's probably the single biggest thing you can do if you're going to go low carb is cut out the sugar.

**Jim Hill:** So I think we've got a lot of good data now to suggest people can lose a lot of weight on low-carb diets. Once people lose the weight and probably the calories go back up, if you're lowering carb, what do you eat? Do you eat more fat, more protein? What's the, for maintenance, if you were following a low-carb diet for maintenance, what, how would you make up for those calories?

**Barbara Gower:** Protein is usually fixed. Humans don't vary that much on the amount of protein that we eat. It's going to be 15% energy on average, or maybe a little more.

I think you can go a little bit higher, depending on personal preference. But mostly you make up the excess with fat, which is tough for us, because we've been trained our whole life not to eat fat. So it's really hard to figure out how you put it back.

And you can put it back via helpful sources. So you can add olive oil, you know, you can cook your meals in olive oil, put olive oil in your salads, go back to eating high-fat dairy, eat, incorporate nuts in your diet, have avocado with your lunch. There's ways that you can get healthy fat sources. And that's usually where the carb deficit gets made up.

**Holly Wyatt:** So people always ask me this, so I'm going to ask you this. Should they measure ketones? Is there any, you know, we, a long time ago, when you went on the Adkins diet, for instance, you measured ketones in your urine, and that's how you knew you were in ketosis. And is there any, you know, any reason that we should be measuring ketones? Would that be helpful?

**Barbara Gower:** So this is just my personal opinion. But the short answer is no. And the reason is why is that ketones, they're used very quickly. So your liver produces them. And as soon as they are in the circulation, they get taken up by various tissues and burned as a fuel.

The tissue that does this, the most is probably the brain. The heart also loves ketones. It loves ketones. It's, it's actually, it's therapeutic to cardiac function is exposure to ketones.

The same is true with brain. It's been, there's some experimentation being done in terms of cognition and brain function by providing people with exogenous ketones. You can now buy them in a bottle or a drink mix and take them.

And it's, and so far everything we're hearing is that they have a beneficial effect. So our tissues love ketones, all that to say they soak them up like a sponge. So as soon as your body gets the hang of doing this, they disappear from the circulation very quickly and you stop excreting them in urine.

So what you'll find, even if you initially measure your ketones in your blood or your urine on day one of your ketogenic diet, that's going to go away after a while. And it isn't that you aren't producing them and you're doing something wrong. It's just that your body is utilizing them. Your body gets really good at utilizing these things and they disappear instantly. So I think it can be frustrating if you're measuring ketones and you're seeing that the levels are low.

You keep thinking, gee, I'm not doing it right, but you probably are. And so I wouldn't do it personally.

**Jim Hill:** It's not worth it.

**Barbara Gower:** That's not worth it. That's right.

**Jim Hill:** So we hear a lot about low-carb diets. What, if anything, do you think people get wrong about or misunderstand about low-carbohydrate diets?

**Barbara Gower:** It's that people all think it's high protein. I don't know. Atkins has been blamed for this. I'm not sure if that blame is justified. I think, oh, I need to get a lot of bacon. I'm just competing on this meat. You don't really have to. You can even do a vegetarian version of a low-carb if you want too bad enough. I think it's a little trickier to do. But that's probably the biggest thing, is how to increase the fat content of the diet well. And you do want to do that because fat has incredible satisfying properties. If you increase the fat content of your meal, you aren't going to be hungry for a long time. So that's the trickiest part, is learning how to eat fat.

**Holly Wyatt:** Wow. I can see that. So where do you think that—what's the new research questions? Where's the field going? What are we going to get excited about that you think is coming for us?

**Barbara Gower:** The trickiest part with low-carb and keto is that when you put people on a low-carb or keto diet, they instantly lose weight. So we all know that weight loss is beneficial. If you can lose weight, everything gets better. Your high blood pressure goes away, your diabetes goes away, your fatty liver goes away.

Everything the doctor nags you about is now fixed. So people think, oh, well, keto, all it does is cause you to lose weight. That's all it does.

I think the big question, the big interesting question, is it doing more than that? And I am fairly sure that it is. I think it's very difficult to tease it apart, though, because when you put someone on a keto diet, they're going to lose weight. And it isn't because there's nothing to eat. Keto's really boring.

What are you going to do? Sit around and eat fat? There's lots of good keto foods to eat, lots of highly palatable foods that people really enjoy. But I will say this, you're not going to eat the whole bag of chips ahoy because you aren't eating any chips ahoy. With ketogenic diets, usually it's self-limiting.

You might snack on macadamia nuts, which are good, and you like them, but you're not going to eat the whole bag of a few handfuls and you're good. So it's tricky because you do eat less. But partly it's because you're not as hungry. The foods are more satisfying, and your brain gets turned off. That hunger, that nagging hunger that people can't get past, it finally gets turned off. So people voluntarily eat less and they lose weight. The other thing from the endocrine perspective is that the endocrinology of your body shifts so that you're no longer programmed to store. When you're eating a high-carb diet, you're basically programming yourself to store fat.

So your body's trying to do that. It's constantly storing everything you eat. So you're still hungry because you've just stored everything you just ate. When you do keto, it's like flipping a switch.

Now the floodgates are going in the other direction. Now you're mobilizing everything you ate. So your brain is seeing tons of fuel.

You're not hungry anymore. So if you try to get someone to maintain their body weight on a ketogenic diet, it's almost impossible because their body doesn't want to do it. Basically, you're force-feeding them, and it's unnatural. They don't want to eat that much food.

Their body has nowhere to put it, essentially, because it's no longer programmed to store. And this is from a research perspective, this becomes very tricky because we're trying to tease apart the independent effects of the diet itself away from weight loss. But yet we can't keep the weight on people, which I think is ironic and sort of humorous.

But it's a problem in a sense, as we can't get people to maintain their body weight when you restrict the carbs. But the answer to your question, I think, is it's all at the liver. What I'm interested in is studying hepatic metabolism, which is the liver metabolism. I think when you take the carbs away from the diet, the endocrinology changes, your insulin goes down, your glucagon shifts up, and the signal's going to the liver change. Remember, the liver is sort of the master organ when it comes from running your metabolism. And I think what the liver does with fuel changes completely when you're eating a low-carb or ketogenic diet. What the liver can do when you're eating a high-carb diet is it can take those carbs, it can turn them into fat, and it can store them. People think the reason they have fatty liver is because they're eating too much fat.

It's actually not true. The fat that's stored in the liver comes from carbs. Those carbs elevate secretion of the hormone insulin, which then takes those carbs and builds fat out of them and then stores that fat in the liver. But you turn that whole process off when you no longer eat carbs. Your insulin drops, you don't convert the carbs to fat, and you don't have fatty liver. And this applies to other chronic diseases as well.

So I think understanding what the liver is doing with fuel and how those processes are regulated is the interesting question on the horizon.

**Holly Wyatt:** I can tell. She likes the liver. Can you tell that? How excited she got when she started talking about liver physiology, liver metabolism. Love it. So, Jim, I think it's time for listener questions. You asked the first one. There's two listener questions we have to ask.

**Jim Hill:** All right. Sarah asks us, I lose weight quickly when I eat a low-carb diet, but the minute I eat any carbohydrates, I gain it back really quickly. Any advice? How can I sustain a low-carb diet?

**Barbara Gower:** I would ask her what the carbohydrates she eats back. So when she starts to refeed on carbs, what is she eating? If she's going back to sugar, sweetened beverages, I think that could be a problem. It's highly individual. So what works for someone may not work for something else. We'd have to play around with what carbs she's eating and see what we can do there.

**Holly Wyatt:** All right. The next one is, I like this question. It's a little complex. This came from Paul. He's been reading the labels and he's looking at total carbs. He's confused. Should he be looking at total carbs or net carbs when trying to stay on a low-carb diet, when he's counting carbs, right? Trying to stay under 50 or whatever that number is. For example, on his meal replacement bar, it has 23 grams of carbohydrate, but 12 grams of fiber, 1 gram of sugar, 0 added sugar, and 7 grams of sugar alcohols, which just muddy the water even more. And then on the box, it says 4 grams of net carb. Is that low carb? Should he count 4? Should he count 23? Help him out here.

**Barbara Gower:** So the short answer to the question is use total carbs and not net carbs. Here's my second short answer is don't eat that bar. Holly, with everything that you just read, do you want to eat that bar?

**Holly Wyatt:** The sugar alcohols, is that the real thing? The fiber, the fiber is okay. And zero added sugar, 12 grams of fiber, but you're talking about the 7 grams of sugar alcohol?

**Barbara Gower:** Well, I have issue with a lot of it, but those sugar alcohols can be tricky. Erythritol is actually okay. Maltitol is not, and the others fall somewhere in between. What I can tell you is I just completed a study with individuals with type 2 diabetes and we tried. We experimented with using, I won't mention any brand names, let's say commercial low-carb products, and the bars were a huge problem. Remember, these are people with diabetes. Their sugar shot up every time they ate one.

They couldn't eat them. We had to change the study protocol. So what I can tell you is those bars are not, they don't do what they say. It's a huge marketing thing.

It's all engineered to sell bars, but they aren't doing the patients any good. And I would really recommend not eating them.

**Holly Wyatt:** So he should count 23 grams, you think. What about fiber though? Does he count? Should you count fiber when you're counting carbs?

**Barbara Gower:** Probably not.

**Holly Wyatt:** So he can take those out, but then everything else stays. And don't eat the bar, you're saying.

**Jim Hill:** Don't eat the bar is the short answer. Holly. Now it's time.

**Holly Wyatt:** All right.

**Jim Hill:** It's time for the vulnerability question. I'm going to ask Barbara. I know you like to exercise. You and I have in common, we like to go on bicycle trips and so forth. What kind of diet do you follow?

**Barbara Gower:** I would say I follow a low-carb diet. I don't follow a keto. And low is, it was definitely below 100. It could be lower than that. But I think importantly, I don't eat any grains, and I don't eat any, or I try to minimize added sugar. There's going to be a few grams in there somewhere. I minimize added sugar. I don't intentionally eat it, and I don't eat any grains.

So what I do eat is a little bit of something like a potato, you know, like a tuber kind of a root would be okay. And that's the diet I follow. I will tell you this, I've done many, many years of ketogenic diet. I know how to do it. I think it's important to actually know how to administer a well-formulated ketogenic diet because we do it clinically.

And so I constantly experiment in that realm. And I once did a really demanding bike tour eating keto, and it wasn't hard at all. As long as I ate enough calories, I was fine. So I just, I did, I ate a lot and I was completely, okay, I never needed the carb.

**Holly Wyatt:** Wow. All right, I've got one. Do you ever crave something sweet? What do you do? Or do you ever want chips or french fries or cookies or desserts? Or does that just not ever pop into your head? And if it does, what do you do?

**Barbara Gower:** I don't. I do know about sweet cravings because I like everybody else in America. I grew up eating junk food. But as soon as I cut them out, I stopped craving them.

I now have absolutely no interest in them. Until recently, I could honestly say I can't remember the last time I ate ice cream. But I was recently experimenting with ketogenic. I shouldn't say ketogenic ice cream, but ice cream that adheres to ketogenic diet.

Because we have, we do practice a clinic where we administer keto diets. And you can now make ice cream with them. There's the flavored syrups. You buy a flavored syrup and you make your ice cream out of heavy whipping cream and some source of a low-fat milk or plant-based milk. And you use these artificially flavored syrups.

They're sweetened with Splenda. And you can add a few scoops of protein powder. And you can make ice cream out of this. That's absolutely delicious. It's really good.

And I also noticed in the grocery store, there's a brand, I'll forget what it is, of keto ice cream. They do a very good job. I looked at the label and the ingredients are completely acceptable. And the quality of the product is excellent. I would recommend eating keto ice cream if I wanted something.

**Holly Wyatt:** All right.

**Jim Hill:** So Holly, let's sum up. We've heard a lot about low-carb diets. And there's some pretty compelling research about the health benefits, the weight benefits of low-carb diets. And I think Barbara, what you're saying is this is a way of eating that you can do permanently. It's not just a, you know, temporary thing to get the weight off. It's a way you can learn to live your life.

And then as long as you don't go too low, you can add the exercise to that, which I think is important for weight loss maintenance.

**Barbara Gower:** That's right.

**Holly Wyatt:** Yeah.

**Jim Hill:** Holly, anything to add?

**Holly Wyatt:** I think that's about it. I think it sounds like that for some people, especially, it really does turn off the cravings. I think maybe looking into kind of have to kind of individualize that a little bit, but it sounds especially for Barbara, like you've really found something that works really well for you and for a lot of other people that you study and deliver. We should be watching. There's going to be some studies coming out. I think it sounds like you're going to be studying how the liver plays a role in that fatty liver. So that is yet to come out, but we will be watching for that.

**Jim Hill:** Barbara, thank you so much. This was really, really helpful. We will hit some other diets in later episodes, but this was a great deep dive into low-carb diets. Thanks, Barbara, and we'll see you next time.

**Holly Wyatt:** Yeah. Thank you.

**Barbara Gower:** Bye-bye.

**Jim Hill:** And that's a wrap for today's episode of Weight Loss And… we hope you enjoy diving into the world of weight loss with us.

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**Jim Hill:** We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

**Holly Wyatt:** And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.