The Art and Science of Low Carbohydrate Living

by Jeff S. Volek, Stephen D. Phinney

Carbohydrate restricted diets are commonly practiced but seldom taught. As a result, doctors, dietitians, nutritionists, and nurses may have strong opinions about low carbohydrate dieting, but in many if not most cases, these views are not grounded in science. Now, whether you are a curious healthcare professional or just a connoisseur of diet information, two New York Times best selling authors provide you with the definitive resource for low carbohydrate living. Doctors Volek and Phinney share over 50 years of clinical experience using low carbohydrate diets, and together they have published more than 200 research papers and chapters on the topic. Particularly in the last decade, much has been learned about the risks associated with insulin resistance (including but not limited to metabolic syndrome, hypertension, and type-2 diabetes), and how this condition is far better controlled by carbohydrate restriction than with drugs. In this book, you will learn •Carbohydrate restriction is the proverbial ‘silver bullet’ for managing insulin resistance, metabolic syndrome and type-2 diabetes.•Restricting carbohydrate improves blood glucose and lipids while reducing inflammation, all without drugs.•Dietary saturated fat is not a demon when you are low carb adapted.•Dietary sugars and refined starches are not needed to feed your brain or fuel exercise.•Long-term success involves much more than simply cutting out carbs.•Electrolyte and mineral management are key to avoiding side effects and ensuring success.•Trading up from sugars and starches to a cornucopia of nutrient-rich, satisfying, and healthy foods is empowering.•Studying hunter-gathers’ diets provides clues to how best formulate a low carbohydrate diet.This is a great book for health-minded individuals.It is an excellent book for healthcare professionals.Best of all, it is the perfect gift for health-minded individuals to share with their doctors, dietitians, and nutritionists.

Genres: Health, Nonfiction, Nutrition, Diets, Science, Food, Self Help

316 pages, Paperback

First published May 19, 2011

Reviews

[Cherese Severson · Rating 5 out of 5]

As a medical provider I was really resistant to this type of diet. As a person who struggles with obesity and food addiction I decided to try this anyway. It has changed my life. I appreciate all of the references, I did look up the studies on my own. You can't argue with the science or the results.

[Andy · Rating 5 out of 5]

A fantastic, thorough, dense yet approachable overview to ketosis. It's written by doctors for doctors to tell their patients how to go very low carb, so it can be biomed oriented at times (as in naming many acronyms I haven't heard of), but the information is invaluable.

I have been "paleo" / low carb for five years, but never aimed to go into ketosis. I had many questions - how is athletic performance effected? What are the best fat sources for ketosis? Is all that animal fat *really* what I should be eating? How do specific organs react to running primarily on fat?

This book answers all of those questions and more. I've read "Wheat Belly" and "Why We Get Fat", which were great intros into low carb eating and avoiding grains, but this book is specifically about ketosis. The other books do a better job of explaining why fat is actually good for you, but Art & Science covers the basics. Maybe two chapters in I decided to go full keto as a lifestyle.

The book covers all sorts of topics and cites countless studies along the way. Volek and Phinney have been performing their own patient studies for decades, so they are more than qualified to write about the subject. They also fully admit their shortcomings (and those of nutrition in general) like how inflammation is very complicated and not fully understood and activated by many different things.

There are probably other good keto resources out there, but the combined experience of the authors leaves no keto stone uncovered. I would make it required reading for anyone looking to change their lifestyle to high fat, low carb.

[Thomas Ray · Rating 5 out of 5]

The Art and Science of Low-Carbohydrate Living, Jeff S. Volek and Stephen D. Phinney, 2011, 302 pages, ISBN 9780983490708, Dewey 624.2833 V882a

STARTING

When first thrown wholly upon a diet of reindeer meat, it seems inadequate to properly nourish the system and there is an apparent weakness and inability to perform severe exertive, fatiguing journeys. But this soon passes away in the course of two or three weeks. --Frederick Schwatka, 1880. We feel and function best on sustained, not intermittent, carb restriction. pp. 237-238.

LIFELONG
If a low-carb-adapted diabetic patient "breaks the diet" by eating even transient and/or modest amounts of refined carbs, all the hard-won benefits can disappear, and don't reappear for 3-7 days back on low-carb. pp. 203, 214-215, 244-245.

CARBOHYDRATE INTOLERANCE
Insulin resistance is carbohydrate intolerance. Just say no to carbs. pp. 174, 186-203. Also known as metabolic syndrome, defined as 3 or more of:
* Waist circumference ≥ 40 inches (men) or ≥ 35 inches (women)
* Fasting triglycerides ≥ 150 mg/dl
* HDL-C, High-density-lipoprotein cholesterol, < 40 mg/dl (men) or < 50 mg/dl (women)
* Blood pressure ≥ 130/85 mm Hg or on meds for it
* Fasting glucose ≥ 100 mg/dl or on meds for it. pp. 175, 192-193.

SODIUM, POTASSIUM, MAGNESIUM
All carbohydrate-restricted diets make the kidneys dump sodium. p. 149. Absent sufficient sodium, your body jettisons potassium too. You get irregular heartbeats and muscle cramps. So get plenty of salt and potassium. Add 2-3 grams of sodium per day, such as 2 bouillon cubes. p. 241. Broth is good. One teaspoon salt per quart. p. 150. When you boil meat, 45% of its potassium comes out in the broth. Leafy greens and broth are good magnesium sources. p. 153. If you have muscle cramps, take 3 slow-release magnesium tablets daily for 20 days. Do not take magnesium if you have kidney problems. p. 244.

PUMP YOU UP
Resistance training (such as weightlifting) is necessary to maintain lean body mass on a calorie-restricted diet. pp. 125-128.

Sedentary people lost 69% as fat, 31% as lean.
Those on endurance training 50 min. 3x/wk lost 78% as fat, 22% as lean.
Those on endurance training as above plus resistance training 40 min. 3x/wk lost 97% as fat, 3% as lean.


EXERCISE
Exercise is a wellness tool. Exercise is not a weight-loss tool. A fat person should first reduce carbs. Long runs or long bike rides can wait until weight has been lost. When fat people exercise regularly, their resting metabolism SLOWS. So instead of losing 10 pounds per 350 miles run or 1000 miles cycled, they lose only 2 to 7 pounds. And risk joint damage. pp. 242-243.

CARBS
Carbs increase insulin; insulin sequesters fat in fat cells, and stimulates hunger. pp. ii, 78, 107, 143, 195.

INSULIN RESISTANCE
Glucose can't enter (nonbrain) cells without insulin and cells' sensitivity to it. p. 75. Hundreds of millions of people are insulin-resistant, including about 25% p. 76 or 34% p. 173 of U.S. adults.

Most people whose muscle cells are insulin-resistant are fat, as the pancreas floods the blood with insulin, which fat cells stay sensitive to and imprison the fat. p. 80. If fat cells become insulin-resistant, they release fats that then deposit in the muscles and liver. A hot mess. pp. 181-189.

LOW-CARB
Ketogenic 75-to-85%-fat, zero-to-10%-carbohydrate, 15-to-20%-protein diets improve insulin sensitivity. pp. 33, 76-79, 86-87, 123-126, 148, 156, 163, 186-203, 207-210, meals 231-235, 238-239. These percentages are by calories, not grams--BUT, what's important is limiting daily carb grams, to less than about 50. p. 109. Peanut butter that's 16 g fat, 7 g carbs, 8 g protein per 32 g is (16*9, 7*4, 8*4)/(144 + 28 + 32) = 70.6% fat, 13.6% carb, 15.7% protein.
https://www.smuckers.com/peanut-butte...
https://www.wolframalpha.com/input?i=....


KETOGENESIS
On 50 grams (200 calories) or less of carbs per day, the liver makes ketones, that in a few weeks rise to 1 to 3 millimolar concentration in the blood: most of the brain's fuel is these ketones. p. 33, 199-201.

SATIETY
An inpatient study of fat type-2 diabetics: one week of eating a balanced diet to satiety, followed by the same foods but limiting carbs to 20 grams (80 calories) per day. Energy intake dropped from 3100 to 2100 calories per day, all due to the missing carbs. Hunger, satisfaction, and energy level did not change. p. 163.

INFLAMMATION
Insulin resistance increases inflammation. And conversely, in a vicious circle. Inflammation is an immune response to carbohydrate, in carbohydrate-intolerant people. pp. 185-191.

FATS
Avoid soybean, corn, sunflower and cottonseed oils. p. 240.

KETOACIDOSIS
Type-1 diabetics need insulin injections to control blood-fat levels: overproduction of ketones in type-1 diabetics is life-threatening ketoacidosis. This is a danger only if the pancreas can't make the tiny amount of insulin needed to limit fatty-acid release from fat cells. p. 80.

CONVENTIONAL WISDOM
Conventional wisdom changes with the deaths of the experts who touted the wrong idea. pp. 177-179.

/THE/ CAUSE?
Why did your bath overflow? Was it because you forgot to turn off the faucet, or was the drain clogged? p. 178. Metabolic disease results from a collection of simultaneous problems. p. 189.


This book is better even than Gary Taubes'.

Has good recipes.

[Brian]

The most complete, cogent, assessment of the medical literature regarding low-carbohydrate diets I have ever read. Drs. Phinney and Volek are two of the world experts on the topic having done a vast majority of the research to date. The book not only explains the physiology and value of low carb diets, but also clearly shows the flaws in research that have led to the misconception that fat is bad for you and high carb diets are not.

I have known Dr. Phinney personally for many years and always turn to him when I need help understanding what to do to help my patients.

If you want to know why we have an obesity epidemic in the United States and what to do about, this book is a must read.

[Peter Jonsson · Rating 5 out of 5]

just found this book after trying a two week period on the keto diet. after reading half the book i realize that some of the suffering with regards to keto-adaptation does have natural causes and straightforward remedies. will try again when i get home from a current trip. this is really exciting the stuff which is happening in the body. also i love the tone and the language in the book. if you are trying keto right now make sure to read chapter 18...

***Now I've been on the diet for 3 months and Im rereading the book and taking notes. Have been looking around for information but this book in combination with some podcasts from/with Dominic D'Dagostino have been the most helpful. Thanks to the book and the tips in it Im now enjoying a much more stable metabolic life. Im still learning about foods and timing but as they say in the book: Each individual is different and has to find what works for them. That is the "Art" of low carb living. For a reader who has the discipline and interest and patience to move beyond the ordinary way of eating - this is a gold mine. Im grateful to have found among all the "noise" out there.

Best of luck from Sweden :-)

[Ci · Rating 5 out of 5]

This book turned my years' learning at HSPH upside-down, along with the cherished Food Pyramid. It is well-written in a semi-scholarly semi-self-help fashion but without the usual nauseating advocacy through anecdotes. The main points are made through peer-reviewed published research. I can't judge its scientific merits (not being an expert in this field) nor know how its principle would apply to my individual situation, but I applaud its clear and concise education on various metabolic issues. I am still digesting its diametrically different conclusion from the governmental sponsored main-stream dietary guideline. This book needs to be reviewed next year. Notes May 2014.

[Heidi Garrett · Rating 4 out of 5]

This is the third (and probably the last) book I will read on keto adaptation. When I learned that research is pointing to chronic high glucose as the source of things like dementia, alzheimers, cancer, diabetes, heart disease, etc. I became very interested in the ketogenic way of life, i.e., converting your brain from being a "sugar burner" to being a "fat burner." The authors of this book have done studies on the keto way of life and are very knowledgable about its implementation. The first part of the book was the best for me.

[Connie · Rating 5 out of 5]

Next to my Bible, the most important book I have. Refer back to it several times a week. If you're trying to be healthy, you MUST have this book!

[Jake · Rating 3 out of 5]

This book is a starting point for most people, but I found some of what Volek focused on to be a bit out of line with some of the academic literature I read concurrently. Take, for instance, these two studies in Nature.

The first says the carbohydrate-insulin model as too simplistic, and the second says there is no evidence of increased metabolic activity on the ketogenic diet.

https://www.nature.com/articles/ejcn2...

https://www.nature.com/articles/ejcn2...

It's quite clear to me the main benefits of the ketogenic diet are that, like most diets, it encourages a caloric deficit. That's the most crucial step and the step that all dieting plans when you look at dieting as a cross-cut, work most of the time.

Keto accomplishes this by drastically limiting your options of what you can eat, and it encourages the consumption of protein-rich foods which are more satiating.

When people say this book is "scientific" I don't really understand what they're talking about. Volek has a hypothesis and a theory which he presents to you. He gets a lot of it right but I'll stress this is not magic.

[Robbie · Rating 5 out of 5]

Excellent read

I've chosen to give this book 5 solid stars because of the quality and amount of information presented. Fair warning, there is a lot of medical and scientific terms. It's easily decipherable with a basic understanding of medical terminology.

That said, I learned a lot more about biological markers and feel my understanding of nutritional ketosis has improved, even after countless hours of research I've done on my own.

I'd recommend this book to people who are interested in the science behind low carb diets and understand the differences between nutritional ketosis and ketoacidosis. This isn't a book aimed at sharing recipes; if that's what you're after, I strongly suggest looking elsewhere.

[Thalarctos · Rating 5 out of 5]

Reading this book may literally save your life. It explains why low carb diets are good for general health, not just weight loss.

[Angelea · Rating 1 out of 5]

I'm not convinced that following a very low carb diet is safe and healthy as a long-term dietary pattern. The research the author cites is interesting, but not necessarily convincing that it will have the health benefits it claims over the long run. I think healthy eating and a healthy relationship with food is to be found somewhere in the middle of the SAD and the LCHF extremes. Just look to the longest living populations around the world and you'll find people who eat pretty high carb diets (and do lots of other things that probably have just as much, if not more, to do with their longevity and health as their diets do). So the theories backing LCHF and actual practice of higher carb, mod protein, low-ish fat diets don't seem to jive here.

[Tom · Rating 5 out of 5]

This book was a bit of an eye opener for me. It makes a convincing case that the common recommendation for a low fat diet is not well supported by the science. This pretty much flips the traditional food pyramid on its head. For people, like me, who have developed an insulin resistance and type II diabetes, the low carbohydrate (higher fat) diet may be the better option.

[David · Rating 2 out of 5]

this book was write as if he was writing to his colleague. difficult to follow but very good information inside

[Carol Bakker · Rating 5 out of 5]

In addition to Dr. Atkin's Diet Revolution, this book by Volek and Phinney is one of the foundational sources of information on the low carb diet. It isn't the book I would put in a newbie's hand, but I felt I had to read it myself.

This is a very science-y (I heard that word on a podcast) book written for medical providers. It took me 16 weeks to get through it, because I needed to read each page three times in a rested state before comprehending it.

What I Loved:
:: Chapter 18, Ten Clinical Pearls gives the essence of the book in layman's language
:: Learning more about insulin resistance (which is basically carbohydrate intolerance)
:: Recognition that no one diet fits every person.
:: Acknowledgement that the genome is incredibly complex, and little understood

Sober Reality
:: Underlying carbohydrate intolerance means a person will need to maintain a tight level of carbohydrate restriction for decades (not just a few months) to remain healthy and nondiabetic

There is almost nothing in this book about the role of fasting to keep insulin low. I am undecided between low carb/keto and intermittent fasting or some combination of both.

[Sher · Rating 4 out of 5]

This book was recommended to me by my internist, because she put me on a ketogenic diet for three months. Clearly written and a balanced amount of science and narrative. Explains how low carb high fat diets work, and why you don't need to be frightened of eating higher fat and along low carbs. It's also relevant in explaining what poor studies look like, so helps you get better at identifying bad science. Helpful. but even more helpful is the very up to date Diet Doctor. com, which is the international website for low carb and Keto diets with hundreds of interviews, videos, and articles produced by doctors all over the world.

[Albert · Rating 3 out of 5]

I periodically like to read a book on nutrition. It is a subject that in general interests me, and I enjoy the science of nutrition. I find these books not only educational but motivating. They help me refocus on my personal goals. It helped that I began a low carb diet in March, so six months in I was ready for some more education. This book is supposedly more directed towards providing professionals, doctors and nutritionists, with what they need to guide their patients through a low carb diet. I can’t speak to how effective it is as a source for that audience. For me, there were times when the science or at least the terms were a bit much, but for the most part I was able to grasp the information presented. Overall, I found this book both educational and enjoyable. It has motivated me to want to learn more, and it has led me to some additional resources as next steps.

[Susan Hawthorne · Rating 5 out of 5]

Terrific info that everyone should know! Simply adore this book. It explains all you need to know about low carb - do read it!!! Important info for your health!

[Msjodi777 · Rating 3 out of 5]

Can be a bit technical but has some really good information.

[Mai Moanes · Rating 4 out of 5]

A heavily researched book by physicians who seem to actually know what they're talking about..Really valuable if u r planning to stick to low-carb eating as a lifestyle....

[Rene Axel · Rating 5 out of 5]

Excellent scientific explanation of exactly what's in the title.

[Harold King · Rating 5 out of 5]

Very amazing and useful book! I do my weight-reduction diet based on this book, and it makes me extremely good results. The low-carb diet (the "keto") is incredible effective!

[Penney · Rating 4 out of 5]

My bet is that sometime soon, low carb / high fat diets will be accepted as mainstream healthy eating advice and that this is not a 'fad'. This book was pretty scientifically dense at times and was also very focused on the low carb diet impact on pretty severe pathogenic states such as people with diabetes type-2 and metabolic syndrome so at times I had to ask myself - how is this relevant to me?

However, the upshot is that there are a lot of pre-markers to these states, which are health indicators in themselves, such as high triglyceride levels in the blood, low good cholesterol (HDL-C), high bad cholesterol (LDL-C), small LDL-C particle size and inflammation markers which have all been clinically proven to be reduced when carbs are reduced. Lots of carbs simply aren't good for you, no matter if you're 'healthy'.

I haven't succeeded in getting into a ketogenic state yet as I won't go two weeks without sucumbing to a mini-magnum but I believe the changes I've made so far are all positive. I'm gonna keep pursuing this one.

[Erika · Rating 4 out of 5]

This book is dense. Some parts were nothing new to me, just reiterating what I'd already learned from other low carb books or online reading, and some parts were way more detailed and technical than I would ever care to go, but there was a fair amount of good middle ground, where I learned something new and useful or found an explanation that really clarified something I'd before understood only incompletely, and for those bits it was definitely worth reading.

I wouldn't recommend this as a first foray into the why and how of low carb, I think Gary Taubes' Why We Get Fat & What to Do About It is still the best I've found for accessibility by and persuasion of the general public or a low carb newbie, but this book is a very solid extra layer for medical professionals or someone particularly interested in the mechanics and impact of carbohydrates on weight, diabetes, heart health, and other medical conditions.

[Nargiz · Rating 5 out of 5]

I have started Keto diet about 2 months ago. Since then I have listened to a number of podcasts, read articles, watched YouTube videos and visited Reddit Keto community every single day. While they have provided a great insight, I wanted more detailed science background and this book is perfect for that.

It is easy to read but contains all information you need to know on how your body works and the science behind the Ketogenic diet. I found there are popular opinions on the web regarding the diet,that are not always supported by science.For example, reddit community tends to quote a hard under 20g rule. But the book explains that depending on your insulin sensitivity under 50g would work, and after you reached your goal and looking to maintain, under 100g and higher fat intake is okay. It is up to you/your doctor to figure out the limits.

Knowing the science gives me confidence to continue this as a lifestyle and to experiment on what works best for me. Highly recommend.

[Tamahome · Rating 3 out of 5]

I would never go this extreme. But has some nice tidbits, like:

"...not as long as the gallbladder gets regular signals to contract, coming in the form of cholecystokinin released by the upper small bowel in response to dietary fat. However, if the dietary fat intake is low, (under 30 grams per day) during rapid weight loss, the gallbladder doesn't get the signal to empty itself, and this cholesterol can build up and increase the risk of gallstone formation."

And don't forget how dehydrating insufficient salt is...

"High carbohydrate diets make the kidneys retain salt, whereas a low carbohydrate intake increases sodium excretion by the kidney (called 'the natriuresis of fasting')."

[Karen-Leigh · Rating 3 out of 5]

Quite technical but readable. Added some information to my Atkins data collection and reinforced my resolve to diet. It also made me feel chuffed that I knew the news was skewed for the past 40 years by big business and mass media. Talk about fake news...no wonder people believe Trump when he yells 'fake news' because we have all learned that money manipulates the media and we do get fake news. I remember the beating Dr. Atkins took in the 70's and I remember everyone telling me I was a fool to follow his diet even when it was working better than any diet I had ever been on in my life till then. People are still spouting that stuff but the scientific community has finally got on board and is being heard and Atkins is redeemed. I wish he could have lived to see it.

[Royce · Rating 5 out of 5]

This book lays out a sustainable plan of how to enjoy long term success on a low carb diet. They get into the emotional and religious connotations we associate with carbs and bread especially. They cite 140 studies to back up their claims and seem to do a fair job of pointing out possible flaws in the studies that deserve it, even if they agree with the authors point of view. This is a wonderful book, written as if it is talking to a fellow doctor, but very easy to follow for the uneducated folk like me.

[Arturo Mijangos · Rating 4 out of 5]

I really enjoyed reading this book. I believe I enjoyed it because I was looking for this type of information. I was able to understand insulin resistance and the different metabolic pathways. There were only a few sections that I only skimmed, and other readers might find parts like that.
I gave it four stars not for content, but there were at least four sections in the book where the authors go into defending their work and putting other research down. I was not reading the book to understand academic squabbles, and the book is not a place to take them up.

[Denny Wanlass · Rating 5 out of 5]

Absolutely the best low-carb book on the market. Despite the fact that it is written for doctors it is easily accessible and very readable. I think it was written in such a way that even doctors steeped in the orthodoxy of calories in vs. calories out can understand it. The science is presented in a way that clearly illustrates how the human body works (yes, every human body, yours is no different) and how to fuel it for maximum performance and health.