Water Weight: Does It Change When Changing Diets? Does It Matter?

We’re now up to the final topic in the series reviewing experiences on the diet. Our final topic is the issue of weight gain and loss. This will take a few posts to explore. Next week will be “fat loss week.” This week, let’s look at the question of water weight.

Overweight people who come to the Perfect Health Diet from a high-carb diet seem to lose weight from the beginning. Here is a recent comment from Robert:

I started PHD a few weeks ago, after finding the blog, and then reading the book. I have only positive experiences to report…. I had been overweight in the past, and lost weight by low-calorie dieting on processed foods, along with strength training. After a while I would revert to some degree of overeating, and have to diet again. I’m mildly overweight now but I have been losing 2 lbs. per week on the PHD. Keep in mind this is before any calorie counting. I keep telling myself I will plug things in to Fitday, but so far my hunger is autoregulating itself and the weight is coming off.

However, some of our readers who came from very low-carb diets experienced immediate weight gains. One commenter on Amazon seemed to think this experience would be universal:

[I]f you are coming to the diet from a zero-carb or very-low-carb regimen, you can count on an immediate and substantial weight gain if you suddenly adopt the recommended intake of “400 carb calories [100 grams] per day of starchy tubers, rice, fruit, and berries.” (K. Hix)

Commenter Maggy reported a gain of 5 pounds in her first week:

Following your advice, I added back a bit of “safe starch” last week, and decreased protein intake, keeping sat fat and MCF pretty high. Well, I got on the scale today and have managed to put on 5 pounds! I’m trying to figure out what is going on and what I need to tweak. I do need to lose a good 20-30 lbs, and while I don’t want to compromise health, I also don’t want to put back on what I managed to lose doing a VLC diet.

Is this an adjustment period I need to get through? Maybe I’m one of those broken metabolism folks who has to stick with VLC?

Commenter Bill also experienced a quick gain of a few pounds, and wondered if it could be due to water weight:

After experimenting with adding modest amounts of “safe starches” to my much lower-carb routine, I have noticed a modest weight gain of 3-5 lbs. I wonder if it’s merely glycogen and water repletion.

Beth Mazur of WeightMaven.org agreed:

I also wouldn’t be surprised about weight gain. Presumably these folks are normally running on fairly low glycogen stores. Add some starchy carbs back, and the resulting water weight gain could be a handful of pounds presumably.

That’s an interesting question, so I thought I’d look into the matter.

Background: Glycogen, Glycoproteins, and Water Weight

Sugars are hydrophilic. If you put some water next to some sugar, the sugar will soak it up. As a result, a person’s water weight depends in part on the weight of sugars in the body. More sugars, more water, more weight.

It’s commonly stated that each gram of glycogen is associated with four grams of water; let’s take that as a general ratio for organic sugars.

A typical adult has around 500 grams of glycogen, roughly one-third in the liver and two-thirds in muscle. With associated water, this would add about 2.5 kg or 5 pounds to body weight.

But there are also several pounds of glucose in glycoproteins throughout the body:

  • Mucus in the digestive tract and airways may be as much as 80% sugar by dry weight.
  • The glycocalyx, a protective polysaccharide coat around cells, is primarily composed of sugars.
  • Hyaluronan, glucosamine, and other compounds that enable joints to move freely have much of their weight as sugar-water associations.

These sugar-containing molecules with their associated water add a lot of weight to the body. Glycogen we’ve said accounts for as much as 5 pounds; mucus probably accounts for several pounds at least; and other glycoproteins must add at least a few pounds more.

Are Glycogen and Glycoproteins Lost on a Low-Carb Diet?

It’s commonly asserted that much of these sugar-containing molecules, and their associated water, are lost on a low-carb diet. From a review of Gary Taubes’ Why We Get Fat, linked today by CarbSane:

[B]etween 5-10lbs of weight are lost on a low-carb diet due to the mobilization of the water stored with glycogen …

I argued in my “zero-carb dangers” series that a danger of zero-carb dieting was that the body would downregulate production of glycoproteins; and that reduced production of these might be quite dangerous.

For instance, reduced production of mucus in the digestive tract might increase the risk of gastrointestinal cancers, bowel diseases, and entry of infectious pathogens through the gut.

If it’s true that low-carb diets reduce water weight by 5 to 10 pounds, there must be a substantial loss of sugar-containing molecules. This is hardly likely to be healthy. Glycoproteins are essential for good health. Indeed, the evolution of glycoproteins was a prerequisite for the evolution of multicellular life!

So I would find this kind of water-weight loss quite alarming.

Let’s look for some data to see if it actually happens.

From High-Carb Diet to Fasting

In our earlier post on fasting for migraines, commenter js290 linked to a very nice post by Ned Kock, in which he talked about the components of weight loss during starvation. Ned posted this picture, taken from a textbook [1]:

Over 30 days of fasting, almost half the weight lost is from fat and almost half from water; small amounts of protein and sugar are lost.

In the first few days, water loss dominates. In the first 48 hours, 3.4 kg are lost, of which roughly 0.35 kg are glycogen, 0.1 kg protein, 0.3 kg fat, and 2.65 kg water.

So in the first two days of fasting, fully 5.8 pounds of water are lost. That’s remarkable.

Presumably, if this person had been returned to his normal diet, that weight would have been regained in a few days.

If the water loss was triggered by a loss of carbohydrate (in glycogen and glycoproteins), then a very low-carb diet might have had the same effect as the fast.

From High-Carb to Low-Carb Diets

There are some metabolic ward studies looking at what happens when people adopt low-carb diets. Here’s one that looked at an Atkins-style diet. [2]

The subjects entered the metabolic ward but continued to eat their normal diet on days 1 through 7, to provide a baseline. Then they adopted an Atkins-style diet for 2 weeks. Carbohydrate was reduced to 21 g (80 calories) per day, and they could eat as much fat and protein as they wished.

The results:

During the low-carbohydrate diet, mean body weight decreased by 2.02 kg from 114.43 kg (last day of the usual diet) to 112.41 kg (last day of the low-carbohydrate diet) …

During the low-carbohydrate diet, mean body water decreased from 46.30 kg to 45.94 kg. Body water decreased in 6 patients, increased in 3 patients, and did not change in 1 patient. After subtraction of body water, mean body weight decreased from 68.13 kg to 66.48 kg. [2]

In other words, water weight hardly changed. The weight loss was accounted for by fat loss, which was understandable because the subjects reduced their calorie intake by 946 calories per day. [2]

So in this study, water weight loss averaged only 360 g (0.8 lb), and some patients actually gained water weight on the low-carb diet!

So it looks like going from a high-carb diet to a low-carb diet needn’t lead to much loss of water weight.

From Low-Carb Diet to Fasting

I looked for some papers on what happens when a low-carb dieter starts a fast. I found this:

In her book ‘Living on Light’, Jasmuheen tries to animate people worldwide to follow her drastic nutrition rules in order to boost their quality of life. Several deaths have been reported as a fatal consequence. A doctor of chemistry who believably claimed to have been ‘living on light’ for 2 years, except for the daily intake of up to 1.5 l of fluid containing no or almost no calories was interested in a scientific study on this phenomenon.

The 54-year-old man was subjected to a rigorous 10-day isolation study with complete absence of nutrition. During the study he obtained an unlimited amount of tea and mineral water but had no caloric intake….

[The man experienced] a mean weight loss of 0.26 kg/d … [3]

If his weight loss of 260 g/day consisted of 130 g protein and 130 g fat – a plausible mix – then he was expending about 1700 calories per day. This is very plausible, and leaves little room for water weight loss.

So when a low-carb dieter starts a fast, he may lose hardly any water weight at all!

Summary and My Own Experience

These studies are inconsistent. If going from a high-carb diet to a low-carb diet doesn’t produce water weight loss, and going from a low-carb diet to fasting doesn’t, then why would going from a high-carb diet to fasting?

I confess I was surprised by the level of water loss reported by Ned’s source. I fast moderately often, and I lose typically around 1 pound during a 36 hour fast. Shou-Ching’s experience is similar. That doesn’t leave much room for water weight loss.

But clearly, some people do experience large losses of water weight when they adopt a low-carb diet or a fast, and then regain it upon carb re-feeding.

I think we have to conclude that the phenomenon of water weight loss on low-carb diets, and water weight gain on carb re-feeding, is variable across persons. In some persons it happens, and in others it doesn’t.


I think those sugars serve important functional purposes. Glycoproteins are essential for health. Glycogen is a desirable reserve that helps the liver manage blood glucose and muscles exert force.

Maggy asked if she was metabolically broken because she gained 5 pounds in a week by adding carbs back in. Now, a lot can happen in a week, including significant changes in fat and protein mass, and water weight changes due to changes in sodium levels. Low-carb diets tend to lead to salt loss, so that may have been a factor.

But if the weight gain was entirely due to restoration of sugar and water levels, then I’m reluctantly led to the conclusion that Maggy may indeed be “metabolically broken.” The brokenness is not in the gain of bodily sugars when she eats the carbs; it’s in the loss of these important sugars on her very low-carb diet!

If it’s unhealthy to lose those sugars, and if a metabolically healthy person can sustain the body’s sugar and water levels through a fast, then the loss of sugars on either a low-carb diet or fast suggests a damaged metabolism.

As much as Maggy wishes to lose weight, it is important to lose weight from adipose cells, not from water and glycoproteins. Her rapid ~5 lb weight gain upon shifting from a very low-carb diet to the Perfect Health Diet might have been a very good thing.


CarbSane has begun a series on water weight, and has interesting numbers on water weight in adipose tissue and lean tissue, and how water weight varies between obese and lean persons. This post introduced several papers, and a follow-up contributes an interesting analysis and suggests that movement of fatty acids between adipose and lean tissue may be involved in water weight changes.

I didn’t know that extracellular water weight in tissues was so variable. Thank you CarbSane! 


[1] Wilmore, J.H., Costill, D.L., & Kenney, W.L. (2007). Physiology of sport and exercise. Champaign, IL: Human Kinetics. Cited by Ned Kock, “The amounts of water, carbohydrates, fat, and protein lost during a 30-day fast,” http://healthcorrelator.blogspot.com/2010/10/amounts-of-water-carbohydrates-fat-and.html.

[2] Boden G et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005 Mar 15;142(6):403-11. http://pmid.us/15767618. Full text: http://www.annals.org/content/142/6/403.full.pdf.

[3] Heusser P et al. Nutrition with ‘light and water’? In strict isolation for 10 days without food – a critical case study. Forsch Komplementmed. 2008 Aug;15(4):203-9. http://pmid.us/18787329.

Leave a comment ?


  1. I too have gained weight since first reading the Perfect Health Diet and adding more carbs to my diet. My clothes are tighter and I can see and feel more fat around my waist, so it is unlikely to be all water weight.

    One possibility is like the discussion between Gary Taubes and Tom Naughton (linked to by CarbSane), where they speculate that people damaged by excessive sugar intake need to avoid carbs from then on. For many years I guzzled non-diet soda, so this could be me.


    Another possibility is the view of Matt Stone, who thinks low carb diets are similar in effect to a combination of undernourishment and excessive exercise. After a low carb diet is over, one might gain fat back as your body overcompensates for the previous undernourishment. Stone says this happened to him from excessive exercise. If Stone is right, carbs are a necessary to be in a healthy state, but going off carbs will cause trouble when you add them back to your diet.


    My decision point is whether to stick with the carbs (I ate a lot of sweet potatoes) or to go back to a lower starch diet. This has been going on for several months.

  2. Wow, my response got referenced. 🙂 I had forgotten about that.

    When talking about weight loss, it’s important to figure out with some level of certainty that it’s fat that’s being lost and not lean. In this interview with John Little, co-author of Body by Science, he shares a story of measuring a client using his facility’s BodPod. The client lost 15 lbs of lean mass while on an Atkins diet. I don’t know the details of the client and his diet, but my speculation was he had not converted to fat metabolism yet. I think the general idea of good health is to gain lean mass, not lose it. So when people talk about weight gain and loss, it’s important to specify what’s being gained and lost.

    Also, when talking about carbs, it seems like it’s important to distinguish what kind of carbs, whether it’s high or low glycemic, fibrous or non-fibrous. Obviously, not all carbs are the same.

    People seem to get caught up in the weight part of it when perhaps what they should be concentrating on is whether they’ve effectively changed the metabolism of their body to burn fat instead of sugar. Weight on its own doesn’t tell you whether you’re burning fat or not.

  3. Interesting for sure.

    I know that often competitive body builders manipulate their hydration level shortly before they compete by going really low carb. They get dangerously dehydrated so they can look as ripped as possible, but they also restrict fluids too.

    Does the information below add to the discussion? Carb Sane posted this recently:

    Insulin Weight Loss and Water Weight


  4. Hi Lillea,

    Just saw that too. I’ll look tomorrow when I’m not tired. It’s interesting that the amount of water in adipose tissue is variable … opens up one more variable … but at least in the papers CarbSane cites, it doesn’t appear that the adipose tissue water levels change quickly enough.

    The reason glucose works for quick water loss is that the ratio of water weight to glucose weight is 4:1, and there is only 4 calories per gram in glucose.

    In CarbSane’s papers, in adipose tissue the ratio of water weight to fat weight is 14:86 and there are 9 calories per gram in fat, so you don’t have the same leverage.

    So this water weight can affect body composition over long periods of time, but not in a few days.

    At least that’s how it looks at first glance …

    Best, Paul

  5. Hi Paul
    Thanks for another interesting perspective. My experience with weight stability is a bit baffling. I was lean before adopting the PHD (6 months ago) and my weight has not changed since, although I may carry slightly less fat. I lose weight (`5lbs) unintentionally if expending a little more energy than normal, say daily moderate hikes over a 2 week hiking trip, and keep calorie intake about the same. Combined with the added hiking exercise my patella’s begin to ache. Independently of hiking trips, my joints “feel” worse, but nothing serious, if my weight drops from normal even slightly. This suggests under nutrition but here is the anomaly. My calorie intake is ~500Cal higher than it was before PHD, yet I am not gaining weight. Calories from carbohydrate average 500/day counting vegetables. I feel very energetic and have no serious infections per blood panels and from “self” tests such as your suggested VitC loading to diarrehea and VitD loading (off-scale after 4weeks of 10,000IU intake). As an experiment (now 7 weeks), I have reduced fibre intake to 11-13gm/day (by measurement from a previous 40gm by estimate) with the intention of reducing inventory of feces. I estimate that I have reduced that inventory by at least 2lbs. Without going into the gory details of stool morphology it seems to me that the IG mucosa may be growing and stools shrinking in a cyclical way. Is it possible to grow and excrete 65gm of mucosa/day? The 65gms correlates roughly with 500Calories at the average caloric value of food intake per gm. How crazy is that? The more plausible reason is that the excess calories are not being absorbed. However I see no obvious evidence of that in stools and there are no IG distress symptoms.

  6. You’re absolutely right that ‘it is important to lose weight from adipose cells, not from water and glycoproteins’. It’s even more important not to lose muscle. Many athletic clubs and some medical facilities offer tests of body fat %, and resting and exercise metabolic rate. You can pretty much directly observe the additional calories you burn even at rest by adding muscle. I’d be interested in seeing research reporting the quantitative relationship.

  7. Hi Jeremy,

    Interesting questions and it seems there is a lot of interpersonal variability. I also drank a lot of sodas for years, but I didn’t eat many polyunsaturated fats and I guess that saved me from obesity issues.

    For me I’ve noticed only slight changes in body composition. When I became inactive in the fall I noticed I needed fewer calories and I began skipping morning food every day and eating less overall. But I doubt my weight fluctuated more than a pound or two.

    Hi js,

    I fully agree that body composition is the key, and that weight can be misleading.

    Still, it tells us something. Here we have a very basic question: Is more water weight desirable or undesirable? There seems to be a belief in the low-carb community that losing water weight is a good thing but I’m doubtful. Of course we don’t want excessive glycation and that may be behind the additional extracellular water that obese people carry according to CarbSane’s post. But in slender people, water weight loss may be a worrying sign.

  8. Hi Paul, Funny how I had this post in the hopper when I read yours: http://carbsanity.blogspot.com/2011/01/insulin-weight-loss-water-weight.html

    One of those references deals with water weight partitioning in lean and adipose tissue while the other deals with insulin’s role in the water content of adipose tissue. I’ve got a follow-up to this already in the works.

    Just some anecdotal observations from low carb forums and my own experiences, it seems some have a lesser ability than others to replenish their glycogen somewhat from protein. Also some follow a relatively high fat/low protein version of low carb so presumably would replenish less glycogen as well. So if one or both of these is the case, I would expect to gain water weight transitioning to your diet. It is not uncommon for low carbers to report 5 and even 10 lb gains (depending on their weights) overnight after a carb “binge”. In my case I generally ate a lowER (not low!) fat higher protein version of VLC and did not binge on carb “cheat” days. Therefore I didn’t see much of a weight change on the scale. More importantly, my tight clothing fit just fine so even if I weighed more I couldn’t care less.

    In the past 6 months I’ve eased myself into eating more carbs on a regular basis. I’m probably at around 300 cals most days. My weight did not bounce. One of the issues I think some have when they try to up their carb intake is that they tend to micromanage things a bit too much. If someone’s been VLC for a long time, it will take their bodies a while to ramp up enzyme/hormonal production to adapt to a dietary change just a it did when they converted the other way. So, if I were to offer advice to anyone concerned over a slight gain at first, it would be to be patient and DON’T panic!

  9. Hi Morris,

    It’s interesting that you lose weight fairly rapidly when you increase activity. That suggests you’re very lean – so a lot of the energy has to come from protein rather than stored fat.

    Joint issues – be sure to take your vitamin K2! That sometimes fixes them. Earlier you said that your joint aches diminished as you added carbs (http://perfecthealthdiet.com/?p=1032#comment-6764). Is that still the case?

    I think it’s good to be producing plenty of mucus in the GI tract. I found your numbers a little hard to follow. From what I’ve read, in 100 g of stool there might be 75 g water, 8 g undigested food, 10 g bacteria, and 7 g mucin. So, 2 lb stool per day might contain 70 g mucin or 50 g glucose for a loss of 200 calories. So you could be saving yourself a significant amount of glucose.

    I’m not sure why you’re needing more calories. Are you taking vitamin C etc.? Are you more active than you were?

    I am glad you are feeling good overall!

    Best, Paul

  10. Oops! Should have read the updated comments before posting. I tend to think that my papers are more relevant to the “unexplained” rapid initial losses of LC vs. LF diets that exceed that which can be explained by glycogen/associated water depletion which will be the thoughts summarized in a follow-up. Going the other way, however, it seems that IF weight increases it’s probably due to glycogen etc. and associated water rather.

    Tis interesting, however, that water content of fat increases with insulin sensitivity. Could a minor rebound after weight loss due to improved IS actually be a good thing?

  11. Hi CarbSane,

    I saw your post last night just before bed, what a coincidence!

    I hadn’t known that adipose and lean tissue were variable storers of water. It sounds like the obese have more glycoproteins / carbohydrate modifications of membrane proteins than the lean, and so more extracellular water.

    Thanks so much for sharing data and experiences. I couldn’t agree more with “don’t panic!” The body has so many different parts and some of them are good to have more of, as Paul P points out. It’s risky to just focus on losing weight without focusing first on health, and without understanding why the body responds to diet as it does.

    I’m looking forward to learning more about weight issues. Your blog is a tremendous resource.

    Best, Paul

  12. Hello Paul
    Thanks for your reply. I did not explain clearly. My guestimates are that the stable inventory of feces in the colon has been reduced by about 2lbs (900gm) to an unknown value and that the daily stool mass is about 150-200gm, about 2/3 of pre fibre restriction weight ie still very large. I estimate that the average caloric value of my food intake is about 7.5Cal/gm based on the CPF ratios. So an excess of 500Cal /(7.5Cal/gm) is equivalent to about 65gm of mucin turnover if it is correct (which I very much doubt) to assume that the extra energy is all going into mucin production. Further for that balance to work the mucin must be produced and consumed on a daily basis! Competion between production and consumption by bacteria? Very bizzare.
    Re your question, I supplement with K2 and my level of exercice has not changed significantly. If this makes any sence or is of interest I can elaborate the (gory) details behind my estimates.

  13. Hi CarbSane,

    Looks like my last comment crossed with yours.

    Your papers do raise the interesting issue of the importance of glycoproteins and carbohydrate modifications of membrane proteins throughout the body in determining water weight. This can be a substantial mass.

    I think that IF they vary substantially then that is definitely a health hazard. There is an optimal level of carbohydrate modifications, and either too much or too little is pathological.

    So that raises a bunch of questions: Is the higher level of extracellular water in the obese pathological, or optimal in the obese state? Higher insulin sensitivity leads to more glycoprotein manufacture and more water weight – that correlation makes a bit of sense – but then why do lean people have less water weight? There must be a pathological change in there somewhere.

    Your last question I think is a great one. It didn’t occur to me before writing this post that water weight might be important (because glycoproteins are important) and loss of water weight might indicate poor health. We can live with low glycogen, albeit with reduced athletic performance and ability to sustain a fast, but low glycoproteins can be positively dangerous.

    Best, Paul

  14. Hi Morris,

    Thank you, now I understand.

    I would guess that your mucin loss from 200 g stool could have increased by no more than 20 g/day or 80 calories. So it can’t account for the 500 calories. But there are lots of other ways that extra calories might be lost.

    It’s often hard to figure out where calories go. A little change in metabolic rate can have a big difference. When I had scurvy, I was ravenous and probably ate >5000 calories per day, but still lost weight. My body temperature was very high. That’s why I asked about vitamin C.

    Best, Paul

  15. Paul,

    Just to emphasize, my weight gain was on the order of 10 pounds although I have been strength training some and so maybe a 1-3 pounds of that could be lean tissue. Luckily, I weigh 40 pounds less than Gary Taubes, who has given up on weight loss at his 220 pounds. I wonder if Taubes struggle with weight loss is influencing his writing?


  16. Hi Jeremy,

    I didn’t know Taubes was up to 220 pounds! In some videos he looked to me like he was aging a bit, but he didn’t seem obviously overweight.

    It would be interesting if he were gaining weight on a low-carb diet. You’d think that would cause him to change some of his opinions.

    Like you, I weigh 180 pounds. At 6′, I’m pretty happy with my weight. I used to be too skinny I think. I wore a 30″ waist in college, now 32″.

  17. I’m six feet and have a stock of 34 waist pants, but they are feeling tight with my weight gain. I was chubbier in college, maybe 36 inch pants. I am worried I am heading back in that direction with the extra carbs.

  18. Hi Jeremy,

    I had to reduce my calorie intake when I reduced activity this fall; I just adopted intermittent fasting every day instead of occasionally, didn’t change my other meals or ate a bit less, and it seeemed to work fine. My pants might have gotten a slight bit tighter for a few weeks, but after starting intermittent fasting they returned to normal in a few weeks. I’ve continued the intermittent fasting because I think it’s beneficial immunity-wise. But I find it’s no trial, I’m not hungry at all. Judging by my stable weight and strength, the reduced calories are not an issue.

    Do you feel hungry? If you try to reduce calories, is it hard?

  19. Yeah, I haven’t so big at reducing calories, but a little more discipline would be better. I have been skipping some meals but eating more to compensate at other ones. I’m not particularly hungry, so that’s good. We’ll see how this approach to eating goes for a while. I am wary of the declining metabolism that Matt Stone worries about if I reduce calories intentionally.

  20. Hi Jeremy,

    I don’t think you need to worry about declining metabolism as long as you’re well nourished. I think nutrient deficiencies, not reduced calorie intake, are the problem in starvation. I’ll blog about that later.

  21. Well, that sounds like an interesting blog post!

  22. Hi Paul.

    I want to thank you for this blog, it’s being of great help. I’ve been on a ZC diet with no plant foods for 1.5 years. Just recently (2 months ago) I added carbs back to my diet, after I found out your blog. Before my 1.5y of ZC diet, when I was on the SAD, I had lots of energy. Though I was addicted to sweet stuff and I guess I was eating about 2000kcal of carbs a day (from sugar and starch). The point of switching to a ZC diet was to help my acne and not to loose weight. I’m very lean and in fact need to gain weight. The diet didn’t help much though. During the first 5 or 6 months I felt very tired all day and did no have enough energy to even think much. After the 5th month up until the end of my zc diet, I started feeling better and had energy to think and do what I had to do, but still not enough to exercice. So I didn’t do much exercice at all during this 1.5y. I though that adding carbs would also give back my previous energy level, which didn’t happen. Maybe I have to eat those 2000kcal, because now I feel the same re energy, eating 500kcal of carbs, or just eating protein + fat. I’m not sure if something has broken during my ZC diet, or if I needed lots of carbs all along, since I haven’t tried a low carb diet before going ZC. I suspect I might have got a fungal infection or something. Maybe my thyroid or adrenal gland is not working properly. Or it’s copper deficiency, since I supplemented lots of zinc(50 to 100mg), molybdenum(1000mcg), vitamin C(2g) and other copper antagonists. I was very convinced I had copper toxicity, and also copper deficiency, called “biounavailable copper”. I read lots about it and it matched (I have ADD and problems with comunicating). So liver is something I just recently added to my diet. It didn’t do much of a difference though. So, I’m kinda lost. I’m not sure whether all I read about copper is true, or if it’s my case anyway.

    You write a lot about autophagy and it’s benefits, so I decided I’ll implement a special 1 week diet. If I have a fungal infection, it’ll probably help. I’m planning on restricting 100% protein and just stick to white rice (or maybe dextrose) and coconut oil. I’m not sure about vegetables. I’m currently eating lots of cucumbers, tomatoes, letucce and some carrots. They digest fine. So I may include these aswell. I have many questions though. For instance, the little amout of vegetable protein I would get is in anyway going to be a problem re autophagy? Also I’m planning to eat 200g of coconut oil a day, is that too much (I have no weight problems) ? Also, I’m not sure if the insulin spike from the rice (or dextrose) will afect autophagy and also ketone production from coconut oil. If so, I guess I meal a day would be better. Or maybe ditch the carbs and stick to just coconul oil and vegies. Any insight?

    Sorry to bother you with this long text. I know it’s offtopic, but I wasn’t sure you still respond to comments in old posts. As you probably realized, english is not my native language (I’m Brazilian), also I tend to write confusing texts , so I hope you coud understand it all.

  23. Hi Cristiano,


    Autophagy is not helpful against fungal infections — only against intracellular bacteria and viruses. So it could help you, but not against fungal infections.

    I think since eating extreme diets hasn’t worked too well, it might be a good idea to just try eating a normal diet for a while, with middling amounts of carbs, protein, and fats. We recommend something like 20% carbs, 15% protein, 65% fat. Add in our supplement regimen, which should be safe for you as long as you’re not getting copper from building pipes or some such source. Fasting/autophagy can come later after you have gotten used to the diet. That way, you’ll have a better idea whether it’s helping (viral infections) or hurting (fungal infections).

    If you can see a doctor, some simple tests like TSH (for thyroid problems) might help you understand what’s going on.

    Let me know how things go.

    Best, Paul

  24. Wow this is what I call a fast reply.

    Paul, I’m not sure I made it clear, but I’m already following the PHD (2 months already), averaging 600cals from protein + safe starches. To that I add lots of beef back fat. The problem is that my energy level is not good enough, it’s the same as when I’m on ZC. Also I’m under the impression ketones give me more of a clear thinking whereas carbs make me more anxious. So it may indicate an infection of some kind. Hence the idea of this weekly experiment. OK, so autophagy helps figh viruses, but what about lauric acid, insn’t it a good antifungal? That’s why I’m planning to eat 200g of it a day for this 1 week.

    So my doubt is whether I’m not absorbing the carbs (doubtfull, as I dont have digestion problems, with the exeption of sweet potato, if I eat too much and don’t chew properly. maybe I developed fructose intolerance after this 1.5y zc diet), or the carbs are being absorbed but are not getting to the brain and muscles.

    As for thyroid lab test and all I just don’t have the money, it’s expensive here in Brazil, I’m just 23yo and I’m a college student (so my money is going down the sink). But to be honest I doubt I have thyroid problems. I’m more convinced my problem infectious in origin. I know it’s not ideal to treat a problem with guesses and no lab work, guesses are all I have atm. I wanna thank you again for your time.

  25. Hi Cristiano,

    Ah, thank you.

    If ketones are helping you and carbs make you anxious, you’re right, that could be a sign of a bacterial infection. Autophagy should be helpful. But it’s a long-term aid, it just gives a slight help to the immune system. For brain infections, ketogenic diets are most helpful. Coconut oil does more than fasting to help the brain.

    Lauric acid does have antifungal (and antimicrobial) properties, especially in the partially digested monoglyceride form. However, the antimicrobial effect is fairly mild. It’s more something you hope will make a little difference each day that compounds over time.

    I completely understand the money issue. One thing you might consider is a week or two of doxycycline. If you do have a brain infection this may make you feel better while you take it. That would be another piece of evidence.

    Best, Paul

  26. I’ll do this experiment and see what happens. If indeed I feel good with coconut oil, I’ll try the antibiotic later on. My only problem is that now the drugstores require prescription in order to buy it. Well, overall I’m feeling more confortable with my approach now. You are being very helpful.

    One quick question if it’s not asking too much. What’s your take on balsamic vinegar. Last week I was eating lots of thin sliced raw onions soaked with 50 to 100ml of balsamic vinegar.

  27. Hi Cristiano,

    I avoid vinegar which is acidifying and take lemon juice which is alkalinizing. Art Ayers has said that vinegar solubilizes biofilms, but there’s not much in the literature on that and I think lemon juice has a lot more going for it.

  28. Hi Cristiano.

    If you don’t have enough money to test your thyroid you can try this:


  29. Hi Kratos, thank you. I’m definitely going to try it.

    Paul, is it because of the citric acid in lemon? Do you think that potassium citrate or magnesium citrate could be good in that regard too?

  30. Hi Cristiano,

    Yes, it’s the citric acid I’m recommending.

    Potassium citrate and magnesium citrate are very nutritious, so I recommend them. If the goal is solubilizing biofilm metals, then perhaps the acid form rather than a salt might work better.

  31. Kratos, this is really weird because I noticed just a couple of weeks ago that the outer edges of my eyebrows seem to be receding!!!

    From your link to Dr Bate’s Thyroid Page

    … if the outher 1/3 of your eyebrows doesn’t grow, hypothyroidism is probable. (sic)

    I’m up to half an Iodoral tablet now and don’t know if that means I’m taking too much or not not enough iodine?

  32. Hi erp,

    Have you noticed any other symptoms? Is your thyroid gland enlarged?

    It would be really good to get a TSH test from your doctor.

    You don’t want to be hypothyroid while you’re trying to lose weight. And it’s important to go slow. It took me 4 months to get up to a half Iodoral.

    Best, Paul

  33. Paul, I’ve followed your suggestions taking Kelp first then 1/4 tablet in the 3rd month and now in the 4th month, I started half an Iodoral yesterday.

    I’ll be having blood tests prior to my knee replacement next month and I’ll request the TSH test as well, although I’ve had thyroid tests in the past and they’ve always been normal.

  34. I remember very clearly the first time I went low carb, after having eaten very high carb my entire life, dropping 8 lbs in 2 days (Sunday to Tuesday, 163 -> 155). I was peeing like crazy over the course of these first couple of days, and my caloric intake was upwards of 2500 calories (6 eggs for breakfast, a whole two pound chicken with skin and about 4 tbsp of butter for lunch, 16 oz grass fed rib eye from US Wellness for dinner). It’s only an n=1 result, but for me it’s enough evidence to suggest that low carb diets do in fact cause an initial loss of water. An alternative position would require ample proof.

  35. I should hope I would lose water on a low-carb regimen. I tend to retain far too much water usually. It’s been a problem off and on since I was eighteen, and since I became obese it’s far worse. (And no, I am not exaggerating. When your drill sergeant sends you to sick call in basic training because your left foot is significantly bigger than your right and it’s obvious you’ve got edema and you weren’t injured, something is wrong. They never did find out what it was, but then, they never went farther than an X-ray, which was negative. I’ve had issues with the other foot and both my hands since then.)

    I’m getting a little irritable with all the Taubes-bashing. Let me be clear that I don’t think he is God or anything, and it’s entirely possible he’s wrong about some things in his books. But as long as he gets people into the proper range of behaviors that lets them improve their health, that’s fine with me. I’m also getting irritable with the way so much discussion of healthy eating and healthful behavior takes on the characteristics of obsessive-compulsive disorder, and I’m starting to wonder if this is what was originally meant when whoever-it-was invented the mental disorder called orthorexia.

    I cannot find any information on Taubes’s height but he looks tall to me in photos, and if he’s even six feet tall, 220 is not obesity for him. Unless his bones are half an inch thick.

    Seriously, people. What about the Inuit? I don’t mean the ones eating white-man food and their bones are falling apart, I mean the traditional ones. They’re not a different species from us. The body makes glucose from protein so I’m not sure how it is that all these important glucose-related compounds are going to be lacking on zero-carb. Probably you don’t know either.

    I like carbs, and in reasonable amounts some of them seem to not hate me. But I’m not going to pretend there’s a dietary requirement for them. They help in certain high-energy situations and they help us avoid starvation and that’s about the best I can say for them. Any nutrient actually needed for human survival and that you can find in a plant food, including grains, is also found in some animal food somewhere, in the organ meats if not in the muscle or fat. And if you’re eating mostly animal, your dietary needs change–for instance, you don’t need as much vitamin C because you’re not constantly bombarding your system with glucose which competes for the same cell receptors. You use up less B vitamins and you use up less vitamin A, as well, since processing carbohydrates draws on both those stores, so you need to eat less of them and lo and behold, they’re plentiful in critters in the first place.

    People don’t give up on most or all carbs because they’re stupid. They do it because it helps them.

  36. Hi Dana,

    I think Taubes has done a lot of good. He’s helped put nails in the coffin of the lipid hypothesis, and he’s helpfully shifted the conversation about obesity toward the hormonal-molecular dysfunctions that promote fat growth and inhibit fat loss.

    But the best tribute one can pay to a scientist (and I credit Taubes with being more than a journalist, but an active participant in the scientific discussion) is to go beyond him.

    Low-carb diets are very helpful against obesity. Our diet is a low-to-moderate-carb diet, so we are allies of Taubes in the main fight he has chosen.

    But he has been incautious in some of his speculations, and it does him no dishonor to refine his prescriptions even as we acknowledge the good he has done.

    As for some of your other assertions:
    (1) The body has a requirement for glucose, and this is best met by a combination of carbs and protein, not solely by protein.
    (2) The body seeks to conserve protein, so there is a risk of glucose deficiency if insufficient protein is eaten (possibly even if abundant protein is eaten, depending on hormonal balances).
    (3) The reduced need for vitamin C on animal diets is not a sure thing. The need for vitamin C is highly variable and depends on, for instance, the state of your infections and other sources of stress. You will get adequate C from an animal diet only if everything goes well.
    (4) See my scurvy post, http://perfecthealthdiet.com/?p=1139, for why insulin is needed for vitamin C transport through the glucose receptors and for vitamin C recycling. Vitamin C status isn’t optimized on a very low-carb diet, but on a moderate-carb diet that promotes vitamin C recycling and cell entry while maintaining low insulin most of the day.

    As I said, we’re advocates of a low-carb Paleo diet. But many low-carb Paleo diets could be improved with a few changes, including addition of some safe starches.

    Best, Paul

  37. Hi Paul,
    You have written a lot on the dangers of very low carb diets. However, I think the key is not really the total carb intake, but rather the resulting blood glucose levels. In other words the danger appears to be more closely related to A1c values than to total carb intake. While a 20g /day carb intake could be dangerously low for a person who is not insulin resistant, it might be quite OK for a person who is a Type 2 diabetic. The way to compare these two people would be their A1c values. While a non insulin resistant person might reach an A1c < 4.8, a type 2 diabetic might reach an A1c = 5.3 which would place him/her at a perfectly reasonable blood glucose level.

    In summary, while I think your advice regarding very low carb diet is reasonable, I believe you should really talk about this not in terms of total carb intake but rather in terms of A1c values. This will allow your recommendations to factor in varying degrees of insulin resistance. Perhaps a reasonable recommendation would be to ensure that your A1c stays above 5.0.

  38. Hi Pascal,

    I don’t believe that blood glucose is the key.

    Blood glucose is regulated for the benefit of the brain. Zero-carb diets induce systemic glucose conservation by mechanisms other than reduced blood glucose levels. In fact, blood glucose levels are often higher on zero-carb diets; my fasting blood glucose reached 105 mg/dl on zero-carb once I got my infections down. My A1c was 5.4 on very-low-carb.

    It’s quite possible that the carb intake that minimizes A1c is also optimal. I believe that the A1c minimizing carb intake is probably around 600 calories/day. However, as you say A1c’s of 5.3 or less are good, and it’s not clear that reducing it to 4.8 would further improve health. My belief is that there are benefits to reducing carb intake a bit, say to 400 calories/day, even if it raises A1c a little.

    The zero-carb dangers I speak of, such as reduced mucus generation, are not induced by hypoglycemia but rather (most likely) by a hormonal program similar to the starvation response. Insulin probably doesn’t figure into this in a big way, though the mechanisms remain to be determined.

    Best, Paul

  39. Paul,
    Thanks for your response regarding carb intake and A1c values.

    I was wondering what are your views on insulin resistance and its increase or decrease based on diet. I have seen lots of websites where individuals mention that they reversed diabetes. However, what they really did was to normalize blood glucose levels by lowering carb intake. They did not reverse their insulin resistance. It is not clear if these folks have even slowed down the rate of increase in their insulin resistance (i.e. if R = insulin resistance, has dR/dt decreased). Do you know of any studies that have measured the effects of both different macronutrient ratios and the intake of micronutrients on insulin resistance and its rate of change.

  40. Hi Pascal,

    That is a really important topic.

    Actually, two topics. In addition to insulin sensitivity vs resistance, there is the issue of “insulin sensitivity dynamism”. Healthy people can quickly adjust their degree of insulin sensitivity to changes in diet. Metabolically damaged people can’t, and remain stuck in insulin resistant states inappropriately.

    My sense is that people do sometimes restore normal insulin dynamism, but it probably takes months of healthy living.

    Diabetes is probably much tougher to recover from than metabolic syndrome.

    I don’t know offhand of studies, but it would make a good blog post or series.

    Best, Paul

  41. Hi Paul,

    I was looking over old Fitday data from a few years back when I lost a good amount of weight and a lot of it fat. I realized that most days I was eating 55% carbs, 25% fat and 20% protein, on a fairly low calorie diet, ie 1200 calories. this really surprised me as contrary to a lot of people, I dont lose weight on either high protein or high fat, in fact, when I changed to either of those I have gained weight and I suffer badly from lethargy on a high fat diet. I just wondered if you had any comments on that. I am thinking of doing it again since it worked really well for me.

    Thanks 🙂

  42. Hi SB,

    Interesting data!

    That works out to 660 carb calories and 240 protein calories per day, or 900 carb+protein which is square in the middle of our recommended 600 to 1200 calories/day range. We happen to like fatty foods so would have eaten more calories and a slightly lower carb higher fat mix, but as long as your diet was nourishing this is in line with our recommendations for weight loss. See http://perfecthealthdiet.com/?p=2145.

    1200 calories/day total is really low so if you’re going that low you almost have to eat lower in fat for a sustainable long-term diet.

    I would just counsel you to be sure to get adequate fat-soluble vitamins and choline when eating that way. So egg yolks, beef liver, and vitamin K2 are advisable.

    I would suspect your high-fat low-calorie diet was malnourishing in carbs+protein and/or some other nutrients (potassium?), thus the lethargy.

    Good for you keeping Fitday data! That really helps.

    Best, Paul

  43. Hi Paul, thanks so much for your insight. your comments about potassium are really ringing some alarm bells. And I am putting some pieces together on that. Especially, frequent night time urination, puffy under eyes, hypothyroidism, carrying water weight, cant lose weight, and since I am an athlete, having lost copious amounts of sweat and not ever really replaced my electrolytes then its likely potassium is an issue. Do you have any recommendations for dosage, apart from eating K rich foods? RDA says 4700mg, so my guess is that the amount we need is way higher than that.

  44. Hi SB,

    4.7 g is a lot – 10 pounds of cooked rice; 7 pounds of spinach; or 11 bananas – few low-carbers get that much. I don’t think you need that much, but I’d say it’s desirable to get at least 2 g/day.

    Foods are the best source. I’d say include some K-rich foods every day.

  45. One could simply estimate their daily BMR caloric intake, consume a consistent amount less than the BMR, and weigh in each morning. The daily weight should quickly decrease if most of the lost weight is water. When it plateaus, as in your figure, you can then assume that to be your baseline weight. Any loss from the plateaued weight (providing you don’t change your calorie intake) is from protein or fat loss.

  46. Hi Paul,

    I’ve read in several places that if insulin is spiked by consumption of a high glycemic meal, then the high levels of insulin make it difficult for the kidneys to excrete sodium from the body, which in turn causes subcutaneous water retention throughout the body in order to dilute the concentration of sodium.

    My own personal experience is that I hold onto water when I choose white rice as my safe starch, but not when I choose sweet potatoes. This is purely an aesthetic concern of mine. The one time when water retention doesn’t seem to be an issue with white rice is when I consume it post-workout after a session of heavy weight lifting.

    Could it be possible that white rice causes an insulin spike which causes the kidneys to hold onto sodium and thus subcutaneous water throughout the body, except post-workout when the body is better primed to ‘handle’ insulin?

    Thank you!

  47. Oops, I forgot to add one last thing. As I mentioned this purely being an aesthetic concern, I’m wondering if there are other ways I can deal with the water retention other than limiting my white rice intake to post-workout.

    Do you believe dandelion root or dandelion root tea is safe to consume in order to help the body get rid of extra subcutaneous water? Dandelion has been touted in many books and on many websites as being a ‘safe herbal diuretic,’ but I am suspicious of the long-term safety of any strong diuretic, no matter how ‘natural.’

  48. Why the Metabolically Broken Can’t Eat Carbs | Paleo Parents - pingback on January 20, 2013 at 4:40 pm
  49. So, some people gain water weight on the PHD. What I want to know is, what to do? Should I stay the course, or is there some adjusting that needs to happen. After all the reports in the book about weight loss and health improvement, I was a bit surprised at my water weight gain. But I’ve known for a long time that when I eat carbs I swell up. So, what to do now. Should I reduce carbs, reduce calories over all, or change some balance. What do others think about this. and Paul, what is your advice?

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