Active Low-Carber Forums - Dr Cate: Fatigue & Low Carb

It's an old post, but it's something we discuss a lot:

Low Carb Fatigue

Quote:

1) Lack of fat burning enzymes.
Years of carb consumption in excess of 100 gm per day means your body almost always had plenty of carb around and has shut down most of the enzymes for burning fat. There are different solutions for getting past this. One solution is to simply grin and bear it and in a week or two you’ll be running on ketones. Another solution is heavy exercising, which bypasses the insulin resistance most people have. Still another is prescription medication use, including metformin (Glucophage) and eventide (Byetta). (If you take diabetes medications you should not attempt this on your own.)

In these first few days and weeks after cutting carbs your insulin levels decline. Insulin helps us to retain salt and Dr. Erik Westman, co-author of The New Atkins for a New You, explains some people develop headaches and fatigue from the lost bodily salts:

In those who don’t have salt-sensitive conditions like heart failure or uncontrolled hypertension and to minimize fatigue/headaches during the first few weeks, we advise salt supplementation, and bouillon is an easy way to do this. Bullion ameliorates fluid shifts that may be a cause of fatigue for some people.

2) Thyroid problems.
Most of people who have been following a SAD for decades have some degree of insulin resistance and are also resistant to other hormones, including thyroid hormone. This is probably why so many on the SAD develop thyroid disease. While cutting carbs is a necessary step towards resolving insulin resistance, the change in energy source requires a response from the thyroid gland and your thyroid may not be up for the challenge. The solutions for getting past this are less clear but in my clinic I advise those with insulin resistance to cut carbs one meal at a time starting with breakfast and give each change a two week interval for your body to adapt.

3) Inadequate carb consumption.
We know most Americans eat way too many carbs but we don’t know if some people need more carbs than others for the long term. I have advised my patients to make their daily carb intake goals range from 30-70 grams per day and so far have not had anyone running into trouble even after many months.

Still, some do. Dr Westman’s believes that adding back carbs may improve symptoms because of the salt-retaining effects of insulin, not the carbs per se:

In those who experience improvement from adding more carbs, the energy return may have nothing to do with the carb itself! It may rather be the volume increase from renal sodium retention from the rise in insulin after eating the carbs.

Much food for thought here.