Directions

Ingredients

Podcast Ep. 13: What Every Parent Needs to Know About Carbs, Protein, and Fat With Franziska Spritzler, RD, CDE

In this episode

Keto? Low-carb? Slow-carb? Low-glycemic? We're getting the science-backed, evidence-based down-low on how cutting back on sugar, refined grains, and processed foods can help our families thrive.

This week, we talk to Franziska Spritzler, who's also known as "the low-carb dietitian." She's a registered dietitian, certified diabetes educator, and author. We talk about swimming against a food environment that's making kids and adults sick, the difference between ketogenic diets verses low-carb, the science behind low-carb eating, and how to incorporate low-carb eating into your family's routine.


Listen here

About our guest

Franziska Spritzler, RD, CDE, known online as the Low Carb Dietitian, is focused on using low-carb nutrition for blood sugar control, healthy weight management and increased vitality.  A former court reporter, Franziska became a dietitian in 2008 in order to “help people improve their health through good nutrition.” Her work promotes low-carb and whole foods to help people manage or beat a number of ailments, including diabetes, hormonal disorders, obesity, and more. Although she no longer consults patients, she continues her work through content creation and research. To read Franziska’s work, head to Diet Doctor or take a look at her book, The Low Carb Dietitian's Guide to Health and Beauty!

Show notes

  • 00:33 - We chat with the founders and hosts of the Metabolic Health Summit, Angela Poff, PhD and Victoria Field in Episode 9!
  • 31:25 - Want to learn more about our review of high-protein, low-carb/low-sugar product reviews? Stay tuned and follow the Give This a Try topic in our Nourish Pathway.
  • 39:00 - Other dietitians that have joined us on The Family Thrive Podcast include Lexi Hall, RDN (Ep. 6), Angela Poff, PhD (Ep. 9), and Tiffani Ghere, RD, CSP, CLEC (Ep. 11).
  • 41:34 - Dr. Richard K. Bernstein is a physician who designed a low-carb diet specifically for those with diabetes.
  • 45:30 - To read more on the Meat-Mixup, click here to see Justin's Pro Perspective on how meat really isn’t as bad as it’s made up to be.
  • 48:52 - Allulose is a low-calorie sweetener that offers the same taste and texture as table sugar. Although it shares a similar chemical structure to a carbohydrate, allulose does not raise blood sugar levels and only contributes a fraction of the calories as regular sugar.
  • 50:35 - At The Family Thrive, we love our cauliflower rice (Seriously, we have so many delicious recipes like this Mexican-Style Cauliflower Rice!). One of our favorite Fierce Foods tips is to swap out white rice for cauliflower rice. This will boost fiber, vitamins, minerals and other micronutrients, and reduce calories and blood-sugar-raising starch. You can also try the 50/50 approach.  
  • 52:00 - Nightbirde is a singer who was featured on America’s Got Talent in 2021. Unfortunately, her health took a turn and she needed to drop out of this season to focus on her battle with cancer. In her social media announcement, she wrote: “Thank you for all your support, it means the world to me. Stay with me, I’ll be better soon. I’m planning my future, not my legacy. Pretty beat up, but I’ve still got dreams.”


Justin: We met Franziska when she had just transitioned from being a clinical dietician with the VA to private practice as “The Low Carb Dietitian.” We were looking for a dietitian who could help childhood cancer families reduce sugars and refined grains and boost healthy proteins and veggies, and she was a perfect fit. Over the years, we have watched as she has become a world-renowned expert on the science behind nutrient-dense, whole food eating. She is the author of The Low Carb Dietitian’s Guide to Health and Beauty, and has been an expert contributor at Healthline.com, and is now at DietDoctor.com. 

In this episode, you’ll learn all about low carb nutrition for families, the difference between keto and low carb, why low carb eating works, the myths surrounding low carb approaches, and how to start incorporating low carb eating into your family’s routine. Without further ado, here is my conversation with the amazing Franziska Spritzler. 

So, Franziska, thank you so much again for taking time out of your day to be here with us on The Family Thrive Podcast. 

Franziska: My pleasure. I'm thrilled to be here.

Justin: Yeah. So we have known each other for a number of years. I actually have lost track. So we first met when we asked you to help out with MaxLove Project. So can you tell us a little bit about your memories of how we kind of first started to work together?

Franziska: Yeah. Well, I met you at a conference in Tampa in 2016, Metabolic Health Conference, and we talked a bit about working with MaxLove. And then I met with Audra and I started working with some of the parents of children with cancer who were in like the MaxLove Support Group on Facebook. And that's how we initially started working together. And it was a wonderful experience for me.

Justin: We loved it. And the feedback we have from families was just amazing. They love you. And this was yeah, this was the beginning of a really wonderful relationship. And at the time, you at least were known to us primarily as the Low Carb Dietitian. So that was….

Franziska: Yeah.

Justin: So that was your handle on, you know, in the web world, the Low Carb Dietitian, and you were able to help our families move in the direction of a diet that would reduce blood sugar or reduce insulin and help as an adjunctive modality as they were going through cancer treatments.

So can you tell us a little bit about what has happened since then for you? So you were the Low Carb Dietitian. You still are. People can find you at lowcarbdietitian.com. But where has life taken you since then?

Franziska: Well, when I was working with you, I was in private practice in California. And I've since moved to Florida and I no longer see people in private practice. I write exclusively for dietdoctor.com, and they are low-carb websites. They provide lots of resources to people, ketogenic diets, low carb diets, and just people who want to get healthier. So that's what I do full time now.

I do miss the consulting that I used to do with your families and other people, but I feel like I can reach a kind of a larger audience with my writing. And we're also planning to do some other helpful things, even a coaching program that we're trying to put together.

Justin: So what drew you to low carb in the first place? So this has been a part of your life for more than a couple of years. What can you take us through that personal evolution?

Franziska: Absolutely. So I actually became a dietitian a little bit later in life. I'd already been a court reporter up until 2008. Then I was a dietitian. I practiced traditional guidelines, kind of lower fat, lots of healthy whole grains. Up until 2011, when I found out that my A1C was 5.6%, and that's not terribly high, but it's just below prediabetes, which is 5.7%.

Justin: Oh, so for the listeners A1C. So what does that mean?

Franziska: OK, so hemoglobin A1C is a measure of long-term blood sugar over about three months. And it's not just your fasting blood sugar, which you'll usually get that on a lab and it'll say glucose. That's your fasting glucose or fasting blood sugar. Mine was always normal. I was around 80, but my A1C was quite high, almost prediabetes range. So that was concerning to me. I started testing my blood sugar and realizing that although I had a very nice fasting blood sugar, it was going up very high after eating what I thought were healthy meals.

So I began doing a little research and discovered that people with prediabetes, which it seemed like I had, could get really good results by cutting back on carbs. And that made sense to me because carbohydrates increase blood sugar more than protein or fat does. But I never thought it was a problem for me. I began cutting back, though, and I noticed when I tested my blood sugar, my levels were much better controlled and the lower I ate, the less it went up and the more well-controlled I was. I also discovered that I wasn't hungry as often and I never, didn't need to snack anymore.

So I found this a huge benefit and realized that maybe I was providing information to people with diabetes and prediabetes that wasn't so helpful because it kept them hungry, snacking all day with blood sugar levels kind of going up and down and needing a lot of medication to manage it.

Justin: What was that information that you were giving to patients before coming to low carb? What was that like?

Franziska: So having a very balanced plate. So you want a portion of some kind of grains or potatoes or starch, a small portion of meat and vegetables and maybe a glass of milk for calcium. So that sounds pretty balanced. And making sure not to add a lot of fat to your food, maybe using Egg Beaters instead of eggs to avoid extra fat. So that's the way that I ate and that's the way that I was recommending that other people eat. And I thought it was a healthy way to eat. And it is for some people. Some people do really well with that.

But people who have any kind of blood sugar or metabolic issues tend to do better with lower carbs. But this isn't what's taught in dietetics programs. It certainly wasn't followed in the hospital that I worked at. I worked at a hospital at that time at the VA hospital in Long Beach, California. So, and it wasn't accepted there, which is why after a couple of years of getting increasingly frustrated of not being able to recommend this to patients that I left to go into private practice.

Justin: So that's where the Low Carb Dietitian was born, you were see…

Franziska: Yeah.

Justin: So you saw it first in yourself and you saw it first in your own lab values that when you started to shift the way that you ate these important numbers began to improve, primarily this A1C.

Franziska: The A1C went down from 5.6% to 5%, and it's been there ever since. That was in 2011, by the way. So it's been 10 years. And my blood sugars have been well controlled that entire time. I've been eating low carb the entire time.

Justin: All right. So let's get into the low carb. Like what I really want to get out of this podcast is to give parents an idea of what low carb is like, what it can do with the different scientific rationales for it, because our approach to nutrition, it's focused on whole foods, but there's a component to it where we really want to reduce refined carbohydrates, we want to reduce sugar, and it ends up looking like a low-carb approach.

And so we want to get a handle on this, like what is this and what are the differences between some of the terms that flow around in the low carb world. So can you give us an idea of what the differences between, say, a low-carb approach, other words that parents might know, like ketogenic or paleo or Atkins? So how about we just start with low-carb versus ketogenic? How could we distinguish between those?

Franziska: Ok, so low-carb is a very broad term that kind of encompasses all of those terms that you just brought up, paleo and ketogenic and Atkins. So low carb is just a reduced carbohydrate diet.

So carbs are found in many foods, but primarily things like bread, pasta, potatoes, fruit, and fruit juice. And then in refined carbs, as you talked about, sugars and sweets and potato chips and things like that. So a low carb diet reduces those anywhere from about 20 grams per day, up to 100 grams per day. The average person eats roughly 250 to 350 grams of carbs a day. So a low carb diet can be anywhere in there, but a ketogenic diet is at the very low range of that 20 to 100.

And the purpose of a ketogenic diet is to increase the number of ketones in your blood so they can be used by the brain. Ketones are fat-like compounds that the liver makes. That your brain can use as an alternate energy source. But carbs need to be very low to get the ketones up to that level versus a more moderate low carb diet. Maybe 50 to 100 grams or so would not be producing a lot. You wouldn't, your liver would not be producing a lot of ketones.

Justin: What kind of things could a person eat and still be in, say, the 50 to 100 gram range? So we're not talking about removing all carbs at that point. We can still eat a lot of carb-containing foods. What are some of the things that a person could eat in that range?

Franziska: In that range, probably, you know, small portions of starchy vegetables like sweet potatoes and root vegetables, like carrots and beets, some fruit, perhaps very high sugar fruit. You really want to minimize like bananas and tropical fruits, like pineapple. They've got a lot of sugar. You can have those in very small portions.

But you could have berries. You could also have berries on a ketogenic diet, but maybe some apples and some other less sweet fruits. And beans perhaps, if they agree with your system and even some grains, depending on how sensitive you are to carbs. And that's something that's kind of trial and error. You may not know if you're eating 250 grams of carbs right now and having some symptoms. You may not know how low you need to go to get blood sugar better controlled.

Justin: Oh, yeah. So on a ketogenic diet, we are getting below 20 grams of carbs a day. And the goal of a ketogenic diet, as you said, is to put the body in a state where the liver is now producing ketones.

Franziska: Yes.

Justin: So why would a person want to go that low to be on a ketogenic diet versus just low carb?

Franziska: That's a great question. And for some people, for therapeutic purposes, like people with brain cancer or other neurological issues, epilepsy, those ketones can actually serve as an alternate fuel source for the brain, which may have trouble using glucose. That's glucose or sugar is the usual fuel. Let's say that the fuel that most people use to fuel their brains. People who have neurological issues may get a lot of benefit from a ketogenic diet. It may help to protect the brain, and it can be used as an alternate energy source.

So that's one group that would often benefit from being ketogenic versus low-carb. Many people also find that low carb diets in general, lower hunger, but ketogenic diets being in ketosis, meaning you have a certain level of concentration of ketones in your blood, actually helps to control hunger better. They get a real appetite suppression from that. So that's another reason you might want to do a ketogenic diet as opposed to a low-carb diet.

And some people just find it's really individual, but it's easier to kind of have a more limited food palate than have to worry about how much fruit can I eat. She said a little bit, but how much is a little bit? They find it easier to just, you know what, I'm not going to eat those fruits. I'm just going to eat, stick basically to meat, vegetables, eggs, and those foods instead, and know that I'll always be in ketosis. And it is easier for me than making the judgment call on how many carbs I can have and trying to keep within a certain range.

Justin: For a family that doesn't have any demonstrable health problems. And they're just looking to tighten up their diet and eat a little better, ketogenic diet is not going to be something that they need to worry about.

Franziska: I don't think so. No, no. For the vast majority of people, a low carb diet is, it will be ample to give them the health benefits that they're looking for.

Justin: I get asked this question sometimes, Audra gets asked this, because now when you go into the grocery store, I mean, things have totally changed over the last five-plus years where now we go into places like Target or Walmart and there will be plenty of products now that say keto on them. It didn't use to be like this at all. And so there's a subtle message that, hey, keto. I mean, that has to be better, right?

So an actual ketogenic diet is not necessary for the vast majority of people. A low-carb approach is going to be perfectly adequate. But another thing, what do you think about all of these keto products that are now on the store shelves? I've found that when I actually look at the nutritional facts and I look at the macronutrient profile, that these actually aren't keto. And…

Franziska: A lot of times they’re not.

Justin: Just for any listeners who don't know, Audra and I had Max on a ketogenic diet for many years, and we've been on and off it for his treatment. So we know what it takes to get into ketosis and it's not easy.

Franziska: Exactly. And some of these products have very questionable sweeteners in them that actually can raise blood sugar. IMO's, those can raise blood sugar as much as sugar can.

Justin: So what's an IMO?

Franziska: I said IMO because they're hard to pronounce. Isomaltooligosaccharide.

Justin: Oh, that's a mouthful for ya.

Franziska: Yeah, those are used in syrups, some sweet syrups, and then some low-carb and keto products, mostly keto products, because they can check their will be called a fiber, and then they subtract that fiber from the total carbs and give you a net carb of two or three grams, when in reality, if they're using a lot of IMO's, it could be 10, 15 grams per serving. But someone could think they're only two or three and do a couple of servings and think they're still doing great.

The same thing with sweetener. Now, to tell this, in so many chocolate bars and candies, the thing is, you see them all, only a couple of grams of carb. I can have all I want of these because they're so keto, are so low-carb friendly. And yet again, it's a type of sugar alcohol that can be partially metabolized and raise your blood sugar, therefore decreasing your ketones and you're no longer keto or necessarily even low carb if you're eating a lot of them. So I do think that you need to be very, very careful when you choose keto products. Some of them are just fine. But, you know, it's a craze right now with keto and they're trying to capitalize on that.

Justin: I find many of them to be fine when I look through the ingredients. I don't have a problem with the vast majority of the keto products out there. It's just that they're not keto in the sense that to really get into ketosis, you need a lot of fat and you need to be very moderate with your protein. And many of these keto products have a lot of protein, not necessarily a bad thing. It's just not going to get you into ketosis.

Franziska: Right.

Justin: So we've covered low carb ketogenic. What about Atkins? So if I'm sure there are parents, you've heard of that and they're thinking, what's the difference?

Franziska: Yeah. So Atkins is interesting. It starts off with what's called an induction phase, which is essentially a keto diet. It's less than 20 grams a day. And it actually limits some vegetables depending on how many carbs they have. But it really does allow unlimited amounts of meat and fat. So in that way, it's a little different than a therapeutic keto diet that's meant to increase ketones with the carb levels very low to start.

And the whole idea is to put you in at least mild ketosis and then to keep your hunger down and get you used to eating this way, and then you go through different phases. Phase one, phase two, where you kind of add bad carbs and see how it affects your appetite. See how it affects your weight. Blood sugar. And you kind of find the right carb level for you.

So I actually kind of like that approach for some people. You know, you find what works best for you. And some people may do best, about 20 to 25 grams a carb indefinitely. And others may be able to tolerate between 50 and 100 grams and do really well. But it all almost always or they actually recommend that you do start at the very strict level and then work your way up.

Justin: Paleo. So I'm sure many parents have heard of paleo and they're thinking it might fit into this low-carb world in some way or another. How do you think about Paleo in regard to these other low-carb approaches?

Franziska: Paleo is interesting because it is much lower in carbs than like a standard American diet, but it includes some high-carb foods as well. It's you know, it's basically whole foods, which is great. No dairy, though, or, you know, a primal approach allows some dairy, a paleo, strict paleo approach, though, no dairy, no beans. So no legumes, like even peanuts or anything like that.

And they do technically allow some high-carb fruits and honey even as a sweetener rather than anything artificially sweetened, only natural. So you're going to use a sweetener, use honey. I think they allow stevia leaves, but no stevia processed. So it's basically Hunter-Gatherer, what would people have eaten, you know, millions of years ago? Obviously, we have different food and different animals around different plants. And we had them, but as close to the way that they ate before the invention of modern agriculture as possible.

Justin: So it can be low carb because it doesn't have things like sugar or grains. And yeah, but it can be just as high carb if all we eat is sweet potatoes.

Franziska: Yes. Potatoes and fruit. All right. Yes, sweet potatoes and fruit for almost every meal, then you're certainly going to be getting a lot more carbs than when you get on a low-carb diet.

Justin: Awesome. Ok, so the fourth low carb approach that I wanted to ask about, and then I threw Paleo and there's the fifth is something that I've seen at Diet Doctor over the past several months is a more high-protein approach. I know there are different names for this approach, but can you tell us about this more high protein approach that the Diet Doctor has started to focus on?

Franziska: Yeah, so it's high protein. And what does that mean? Believe it or not, we're still trying to figure out exactly what it means. Diet Doctor...exactly how much protein it is. But it's basically trying to get the most protein per calorie for people who want to lose weight.

Justin: Can I just pause there? So we want to increase protein per calorie?

Franziska: Right.

Justin: All right. So for every calorie we eat, we want the percentage of the protein to be in what range? So if we're eating like 1,000 calories, how much of that should be a protein?

Franziska: So on a high-protein approach, over 30%.

Justin: So 300 calories of that one thousand calories would be protein.

Franziska: 300 as a minimum. And sometimes a little higher.

Justin: Ok.

Franziska: So that's what we're saying for now. And what that means in absolute grams per day is going to depend on the calorie amount that you eat. So a very small woman would have a lower, even if she's eating a high protein diet for her, would be a lot lower in protein than someone like my boss at Diet Doctor who is 6’7”. So, high protein diet looks very different. But they're for the amount of protein per calorie that you're eating, it's similar amounts. So it's just, it's really, yes, focusing on high protein, but not low fat and it's still low carb.

You can even do it, I don't want to say ketogenic exactly because it's not high fat, but at a very low carb level, less than 20 grams of carbs per day, if you want. But we are really recommending that most people do a more moderate, low carb, maybe 30 to 60 grams of net carbs.

And I'll just briefly recommend, mention what net carbs are; that's total carbs, minus all fiber that naturally occurs in food, avocados actually are pretty high in total carbs, but most of them, most of it’s fiber. So when you subtract that out, it becomes a very low-carb friendly food.

Justin: And we subtract out this naturally occurring fiber because it doesn't get turned into blood sugar.

Franziska: Exactly. It either passes right through your system or is converted into fatty acids by gut bacteria. But it does not increase your blood sugar. It does not have any effect on your insulin.

Justin: So with this high protein approach, is it that the concern is less about the carb amount and more of a focus on the protein and that it's really carbs and fat are seen as just together, as just a source of energy?

Franziska: It is.

Justin: Can you explain that part a little bit?

Franziska: Yes. On a high protein diet, or at least the way we're viewing it. We want to maximize calories from protein and not get too much energy from nonprotein sources like carbohydrates and fat. Now, protein is not there to provide energy so much. It's there for muscle building, for preventing bone loss. And protein also can, just like being in ketosis, getting more protein can have an effect on satiety. There are studies that show this.

So for those reasons, we say prioritize protein. You're still, though, if you're getting 30, 35, or even 40% of calories from protein, that's still not more than the fat and carbs put together. So you're still percentage-wise, not getting as much. You probably will be getting more calories from fat than protein if you're following a low carb approach, but just not as many calories from fat as you would on a ketogenic diet or even a low carb approach that has lower protein.

Justin: Awesome. And then one word you used from the science world, satiety. So that's just feeling full.

Franziska: Feeling full and satisfied. So that you eat less. Yes.

Justin: So, ok, so we've covered these different approaches in the low-carb world. So what do you personally prefer for just you, for yourself?

Franziska: So I follow a pretty high protein, low carb diet. I eat probably between 110 to 125 grams of protein per day. I'm five foot eight. It's not terribly high, but it's higher than a lot of people would eat. I eat about 30 to 50 grams of net carbs per day. Total carbs, that's with the fiber of usually 70 or so, because I eat a lot of fiber, a lot of vegetables. And that's what works best for me. Other people I've seen do better with a little less protein, a little more fat. Some people do better with fewer carbs, others with a little more carbs. But that's my personal approach that's worked for me for many years.

Justin: Awesome. Now, this is a tough question, and I totally accept if you just want to say pass, but if you had to recommend an approach just for the average family out there, no major health problems, they just want to do a little better. In what direction would you point them in this low carb world?

Franziska: Yeah, that's a good question. I would say a low carb approach that's moderate, maybe net carbs anywhere from 40 to 60 to start or a little bit more. It depends on the family, I would say. And I again, when we're talking about moderate, I don't think the counting is so important. Like 40 to 60, it could be 30 to 80. You know, it could be a wider range. It could be up to 100 for very active families, really active kids.

You know, the kids, I think up around 100 grams is just fine, maybe more. For moms wanting to lose weight, maybe a little less. So maybe you give them a little more sweet potato and yourself a little less and fill up more on broccoli and some lower-carb vegetables.

Justin: Yeah. Yeah. It strikes me that the counting would be counterproductive.

Franziska: Yes.

Justin: Yeah. That is just too much work. But focusing on food types would be a little more useful. Yeah.

Franziska: Yeah. Yeah. So a good protein source at every meal and no fear of fat. That's something that I mentioned, you know, the way that I used to eat with the Egg Beaters and really being very careful with fat. On a low-carb diet, you have permission to eat more fat. If you're not doing ketogenic diet, you don't have to worry about really dousing everything in butter. But you don't fear fat that can actually make food taste quite a bit better. And the combination of protein and fat is very filling. And then you're getting fiber from vegetables, which is also filling. So it can be a very satisfying diet for everyone.

Justin: Ok, so now I want to get a little bit into the science for parents who want to know, like, why does a low carb diet actually work? Is there some magic sauce in here? The way that I understand it, there are two ways that we can think about this and maybe more that. The first one is that there's some special fattening properties in carbs that because carbohydrate they raise blood sugar, which raises insulin, and this can have knock-on effects with hunger and fat burning.

So there's in the science world, I understand that as the insulin, the carbohydrate-insulin model. And then there's this other approach that it's really focused on hunger and that if we just increase protein and reduce carbs, that we're just not going to be as hungry, and then we're just going to eat less. Are there any other parts of this puzzle that I'm missing?

Franziska: No, I think you summed it up very well. The thing is, we don't have great evidence for either of them. It's hard to say. That's why there's arguments, because we know that low-carb diets work. When you give them to people and you have somebody follow a low-carb diet and a low-fat diet or another type of diet. People end up eating less on a low-carb diet naturally. You tell them they can eat whatever they want and they eat less.

Is that because of insulin or is it because the protein helps them to feel fuller or having more stable blood sugar levels throughout the day without blood sugar and insulin rising and falling? I think it's a combination of both.

But again, we don't have great evidence for either one. We just know that they worked for almost every, almost everyone I know that followed a low carb diet. Whether they have stayed on it long term or not, said “I just wasn't as hungry. I ended up losing weight and I wasn't even that hungry.” And I could go, you know, “I could skip a meal because I wasn't hungry. And why is that?”

Well, we're still trying to figure that out, truly. But I think that blood sugar and insulin are part of it. But I also think that the protein, most people, when they start a low-carb diet, tend to increase the amount of protein when they cut back on carbs, so that can also have an effect.

Justin: Oh yeah. In your professional experience, what are the main reasons that people have a hard time staying on a low-carb diet?

Franziska: Well, it really does come down to personal food preferences, even though there are so many amazing substitutes. For some people, it's just impossible for them to stay on the diet because they either love potatoes or sweets or something so much. I actually find that that's rare, though, for someone who really is interested in health and willing to kind of stick it out.

Beginning can be tough. I find that having a lot of substitutes on hand, being well prepared before you start can make all the difference. One of the big things is at home it may be fairly easy to stay on plan, but then once you go out to eat or you're invited to someone's home, especially in the early stages, it can be really tough. Nobody really wants to impose on their guests or even make a big deal at a restaurant. I can't eat this, what do you have? It gets easier over time. And what's great is that now there's a lot of different options.

But I think those things are hard for a lot of people. And then people have ideas in their head that low-carb just isn't that healthy, that it isn't a way that they can eat forever. And that can be hard to get around too, and especially if they're receiving messages from other people in their lives who aren't supportive. So there's a lot of reasons that low carb can be hard. But I think kind of preparing before you do it and learning about these things and having foods on hand and kind of knowing what to expect can make a huge difference in whether you're successful and able to stick to it.

Justin: Yeah, for us, it was a slow transition when Max was diagnosed in 2011. We just slowly learned about nutrition or the way that nutrition can support him during his treatment. So we moved closer and closer to a ketogenic diet. And when we finally went full in, I mean, it was probably a year and a half of just transitioning slowly, and then we're like, “Ok, let's just take the plunge.”

But I remember when we finally did, going to the grocery stores, I remember going to Trader Joe's in particular, and all of the frozen foods that I used to buy, like I started to look at the nutrition facts and the ingredients. And there were so many I mean, I would probably say 80, 90% of them I just had to put back. It was like, we can't do that anymore. Even though we were making a slow transition when we finally took the leap. Is that all right? We are going to get Max into ketosis and we're going to eat this way.

Oh, there was so much that we had to change. But then learning how to tweak meals, learning how to make the same thing. Oh, we can do spaghetti, but now in a totally different way. We can do mac and cheese, but in a totally different way. And so it was learning about all the different strategies. And then today, of course, it's a lot easier because there are so many products on the market.

Franziska: Absolutely.

Justin: We'll be featuring in The Family Thrive App, a review of high protein, low carb cereals that are now on the market. There were none of these when we started in 2013 when we actually went more stringent toward a ketogenic diet. No cereals like this. No, I don't think there were any breads. There might have been one bread brand. But yeah. So we'll be reviewing cereals. We'll be reviewing low-carb, high-protein pastas. We'll be reviewing low-carb, high-protein breads. All this stuff is now easily available. But we found a wonderful hot dog bun now. So it is a lot easier now.

Franziska: It's much easier now. And I'm glad you have all of those. That sounds great. That’s awesome.

Justin: So, Franziska, what are the biggest misunderstandings around low-carb nutrition that you come across?

Franziska: I just think that a lot of people think that low-carb diets are fad diets, that they're unsustainable, that you can't do them long term, and that they are you know, they basically all you're eating on a low carb diet is butter and bacon. And you don't have a lot of variety. And this just isn't true.

You're only cutting out the very high-carb foods like pasta, bread, potatoes, cereal, and fruits, and sweets, and starches. But you can have everything else. You can still have so many other things. And it really can be a very well-balanced diet.

There was a dietitian from New Zealand who did a study years ago to show that a low-carb diet provides ample amounts of vitamins, minerals, everything you need to be healthy. I think that's another misconception that a low-carb diet lacks some healthy foods like whole grains.

Well, whole grains are great if you tolerate them, but there's nothing magical. There's nothing in whole grains that's unique to them that you can't find in other foods, like vegetables and nuts and seeds. So I think those are the misconceptions. If it's just a very fad-like diet that can't be maintained.

Justin: Oh, yeah. We've been, you know, almost 10, 10 years on a low carb approach in one way and it's just the way we eat now. And the one thing that we found right away was, oh, our plate is mostly vegetables. Like if we do, you know, chicken and broccoli or a steak, you know, it's like half the plate is broccoli. And it didn't use to be like that.

So for a typical meal beforehand, there might be a protein, but then there are definitely be a starch that would be filling up most of the plate and then maybe a little bit of the vegetables on the side. And so now with a low carb approach, it's a lot of veggies. We’ve removed the starch and then keep the protein. I have no doubt that we eat way more veggies today than we did before.

Franziska: I feel the same here and same with all the people that I've ever worked with. And many people have reported to me on what they eat. I eat vegetables at breakfast now, which I never did before. So, you know, I eat vegetables three times a day. And yeah, so it can be extremely healthy and sustainable.

That's the misconception that low carb is a fad diet, it's unbalanced because you're getting lots of nutrition with a low carb diet. If you're doing it in a healthy way, of course, you can just eat, you know, just bacon and eggs for every meal. That's, you know, you get to eat bacon and eggs on a low-carb diet. That's wonderful. But for a really well-balanced diet, you want to include vegetables and some other fruits as well, and lots of different protein sources.

That's what makes the diet healthy, is having a lot of variety. And you can still get lots of variety on the low-carb diet.

Justin: Awesome. So if a family is thinking, you know, we want to move in this direction, we don't need to, you know, drastically reduce carbs or go keto, but we would like to move in this direction. What are a few things they can start to think about changing in from the standard American approach to move in this direction?

Franziska: Well, I would say to start with, get rid of the white starches and sugars in your house, get rid of them, donate to a food bank if you don't want to throw things out. I understand not wanting to throw them out. But if you want to get started on this, that's the first place to start.

If you're already doing whole grains and you've gotten rid of most of the sugar in your life, then I would just start to slowly cut back on those things.

Maybe one at a time. Like, you know, some people love cereal. If whole-grain cereal is the hardest thing to give up. Maybe start with whole-grain pasta first or something else. Just give it up one at a time. Make gradual changes. I like what you did that moving towards it gradually. I think that you can stick to it better. And once you see the results are more motivated to make the next change rather than having to give up everything at once, I think that can lead to failure for a lot of people.

Justin: Oh, absolutely. Well, in our MaxLove Project role, we, of course, interact with a lot of families who are in medical crises and want to make big nutritional changes. And they say, “Ok, we are ready. We're going to clean out the pantry and we're just going to start fresh.” And our response is we've seen bad results coming from that approach because it's a shock, and then after a couple of weeks or a month, everyone says, well, we obviously can't do this, so we just need to go back to the old way.

What we have found through MaxLove Project, the most sustainable approach is to start with just one thing, just say what is one change we can make and we know we can stick with it and it doesn't matter what it is. So just make that change and then stick with it. And then when you feel like you, you have a handle on that change that is now a part of your life. Now you can move to another change.

And so if it's something like, all right, we're just not going to buy really high-carb, sugary cereals, like we're just going to have a different type of breakfast and it almost doesn't matter what it is. So just make that change. And then once you're comfortable with that change, now you can think about another change.

Franziska: Yeah, exactly. That's what works. And it becomes easier with each progressive change. The further you go, the more, the less time you'll have to spend making that change. And before you know it, you're following a low-carb diet and it really isn't painful.

Justin: We all have heard that breakfast is the most important meal of the day. If there was one meal where parents are like, where should I start in moving towards a more high-protein, low-carb approach, would breakfast be the one?

Franziska: I really think so. There is some good research that having a higher protein, lower carb breakfast is a great way to start out, kind of primes your body. This is for kids too. Kids need a lot of protein when they're growing.

But for parents who want to stay full and satisfied and not be tempted by the snack cart at work or something, having a good solid breakfast that's lower in carbs, higher in protein and some fat. I think that's definitely a great way to start your day. Best meal to start with.

Justin: We've had a couple of other dietitians on talking about different aspects of the nutrition world, and we've asked them to bust some food myths because we have found in our time with MaxLove Project over the last 10 years learning more about nutrition and nutrition science, so many myths have been busted for us. You know, like everyone should drink eight glasses of water a day. And it turns out there's just no science around that at all. So do you have a food myth or two that you can bust for us?

Franziska: Well, I like the ones that you already mentioned when we talked before, but I think I'm going to stick with a low carb and say that there's a myth that low carb diets are dangerous long term.

And what they do is they'll say this is proven by studies, but the studies are observational studies where they ask people to fill out a questionnaire of what they eat during a typical week, and they ask them to fill that out a few years later. And then they look to see what kind of diseases or if any of the people passed away. And they find that people who eat lower carbs tend to die earlier or get more heart disease or diabetes. But these are self-reported intakes. And they ask questions like, how many times a week do you eat this? Nobody knows, they’re notoriously inaccurate. And also low carb is considered up to 40 to 45% of calories. Even a moderate low carb diet is usually 20, 25% in calories.

And a ketogenic diet, as we know, is like five percent, five to 10 percent. So these aren't even, even if it was true that the people were eating this amount of carbs. It's not that low carb. And what are they eating, besides which carbs are they eating? It's not that they're following a low carb diet is that they're reporting eating French fries or something twice a week instead of five times a week. And that comes out to be a low-carb diet.

So anything, those correlations are inaccurate. Now, we don't have long-term randomized controlled trials because it's impossible to do a study like that. It would be too expensive. And the number of people. We know that in the short term, they are healthy. They have not been shown to cause kidney damage, liver problems, heart disease or anything else. I can just look at people I know who've been following it for a long time and are healthy. I mean, I've been following for 10 years and in my 50s now, and I'm quite healthy. I'm certainly at least as healthy as I was before I started.

But the person I really look to is Dr. Richard K. Bernstein, who has had type one diabetes since he was 12. He's now [87]. In his 40s, he discovered low carb and started following that diet. He's still practicing. He's extremely healthy. He is the longest term low-carber I know most people with type one have a lower life expectancy, usually have at least one complication, either eye disease or heart disease. He's very healthy and he prescribed his diet about 30 grams of carbs a day is his baseline recommendation for people with type one and type two diabetes, very healthy. So I look to him and to many other people who are thriving on a low carb diet rather than these studies that make a low carb diet look scary.

Justin: Oh, yeah, every time I've heard the claim that low carb is bad for you, the person making that claim is always pointing to observational studies. And as you said, they simply ask people what they ate and then they follow them over some time. And so these people are not following a low carb diet. They are just simply reporting what they eat.

So if there's a person who says, you know what, I don't like vegetables, I don't and I don't eat that many French fries, I just eat a lot of steak or I eat a lot of hamburgers or whatever the case is, they may or may not be following a low carb diet. They may just have, say, 40% of their calories from carbs rather than 60%. But they're not following an actual low-carb diet.

Then the other thing that I found, when you dig into the tables, when you dig into the data in these observational studies, invariably I've seen this in every single observational study that opponents of low carb approaches point to is that the lower carbohydrate a person eats, the more cigarettes they smoke, the more alcohol they drink, the lower their income is, the lower their education. So there is clearly many other things going on in the epidemiology world. This would be called the healthy user bias.

Franziska: Yes. And it's the same thing for vegetarians, is the same thing for people who… do all the right things.

Justin: They're also going to the doctor more regularly. They're higher educated, higher income. Right. And well, there's another. So there's the healthy user bias. It's also called the healthy adhere bias, which I like that because there are other studies that have shown that people who are in randomized controlled trials for some drug trials, that the people who take their placebos more regularly are also healthier.

There's some phenomenon where people who are simply more conscientious, who listen to public health advice, who listen to what their doctors say are also happening to be doing a ton of other things that lead to better health.

And so what we see in these observational studies is people who are not following the conventional public health advice to eat less meat, eat more whole grains, right, who are going in the opposite direction of the public health advice, have all of these other poor health behaviors as well.

I know that I've seen at least one study that has gone so far as to pull out individuals who have healthy behaviors, who report having healthy behaviors, but who also report low carbohydrate intake, or I believe this is a study about high meat intake. And in the one study that I'm thinking of and we will link it in the show notes, individuals who are eating a lot of meat, but who are also doing all the other healthy things that, you know, a person should; going to see the doctor regularly exercising and such that they have just as good health outcomes as the individuals who are eating low meat, but are also doing the exercising and going to see the doctor. So meat is not the issue. All right.

Franziska: Meat is definitely not the issue.

Justin: If you just look at these observational studies that simply look at low carb or meat intake and they don't adjust, well, sometimes they will adjust for some things like smoking, but and some other variables.

But there are so many unmeasured variables that go along with all of these lifestyle choices that essentially these observational studies are useless.

Franziska: Exactly. Exactly. But they're the ones that get reported. You know, everyone shares them and you hear them on the news. And I know. Yeah, I agree with you.

Justin: Oh, thank you for busting it. One quick thing, because I do know when it comes to high protein, one thing that is just rampant, is just so common out there. And we work with a lot of doctors just in the cancer world with us here this well, you know, you don't want to eat too high protein because it's going to hurt your kidneys. So can you tell us about this?

Franziska: Yeah, they've actually not found that in any studies, randomized control trials and meta-analysis, of them. So several controlled trials together, they haven't shown that eating higher protein causes any problems to people who have normal kidney function, people with impaired kidney function, especially late-stage kidney disease, definitely higher protein intake can lead to faster progression of the disease. But people with normal, healthy livers and healthy kidneys, eating a higher protein diet has not been shown to jeopardize kidney health. And in fact, people who eat a low carb, higher protein diet that have diabetes, they have shown that that can be protective because it helps to control blood sugar to be on lower carbs. So…

Justin: We can put that one to rest.

Franziska: We can put that one to rest, too. Yes.

Justin: Yeah. Awesome. All right. So let's start wrapping up by checking in with what you think are some of the most interesting things happening either in food product space, if you've seen any cool new food products or the nutrition science space, like what's kind of the cutting edge for you?

Franziska: Well, you know, we almost already talked about it because it's all of the availability of all of these new foods that help support either low-carb or gluten-free lifestyle. I’m seeing it in grocery stores, I'm seeing it in restaurants, both fast food and regular restaurants. Chipotle now has cauliflower rice.

Justin: Yeah.

Franziska: Blaze pizza. Do you have it in Georgia?

Justin: No, but we did back in Orange County, so I'm familiar.

Franziska: Yeah, they had a keto crust. They have a gluten-free crust. And for people who want to do a vegan diet, they have a vegan crust. I really think that, you know, just supporting people by making all these options available and sweeteners too, I think have come a long way. Allulose is a fantastic sweetener too, so much like sugar. When people talk about, “I can't do sugar substitutes because they all have an aftertaste.” Like, “Have you tried allulose?”

Justin: I put this in the show notes.

Franziska: Yes.

Justin: Yes.

Franziska: Take a taste test. And I'm telling you, you won't be able to tell the difference. It tastes just like sugar. So I just...

Justin: It’s magic.

Franziska: Yes. I'm just finding it to be making it so much easier for people who want to follow whichever dietary plan. The food manufacturers are listening. They want to help people who want to make these healthy lifestyle choices. So that's really what I'm seeing. It's a wonderful time to start. Yes, just like you have been doing this for about 10 years, and it's fantastic since it's a good time to start.

Justin: And when we started, we would have to put our whole head of cauliflower through the food processor to get cauliflower rice. And it was just every time just mess everywhere was such a hassle. And the rice bits never turned out exactly the way we wanted them. And now there is frozen cauliflower rice in literally every grocery store: Walmart, Target, big grocery store, small one, it’s like everywhere now.

Franziska: It's everywhere. I love it. And I also see for people who don't have time to do that, zucchini spirals, at least in my grocers. Do they have those already spiraled for you in my just Publix, which are basically the only grocery store we have here in Florida? So they're really, really listening to demand from customers. It's great. And I love the frozen cauliflower rice. In fact, I won't use it tonight because I'm making chili and I love to serve it over cauliflower rice. So much easier than grating it for yourself.

Justin: It really does take the place of rice. And at the same time, you're getting this cruciferous vegetable with a ton of micronutrients and fiber and all this wonderful stuff. It's just…

Franziska: It’s the best of both worlds.

Justin: It is the best. Ok, so I'm going to end with questions that we ask every guest. So the first one is, if you could put a Post-it note on every parent's refrigerator for tomorrow morning, what would that Post-it note say?

Franziska: Ok. Start your day with a high-protein, low-carb breakfast. Eggs if you already have any boiled, if you don't have boiled make yourself a quick omelet or eggs and frozen kale or something that’s already washed and done for you. And you're good.

Justin: Brilliant. And then, last question. What is the last quote you heard that really inspired you?

Franziska: Ok, so this is something I actually heard somebody say, I didn't read it online, and it was just last week, I was watching America's Got Talent, and there was a woman 30 years old who was a singer, a fantastic singer, and she has metastatic cancer. And she said, “You can't wait until things get better to start being happy.”

And she said she was given a 2% chance to live. But she says the 2% chance isn't a zero percent chance. And I just want to do everything that I can do to be happy and to be, you know, to make the most of my life. And I think we all feel this way. This isn't changed anything I felt. But when I hear these stories from people who are just so courageous, it does something to my heart. I was in tears and I thought that's what you should do. Just never wait. Don't say I'm going to wait until I've lost weight to do this. I'm going to wait until our house is in order to do this. Do it now. Nobody knows how much time I have. She has a 2% chance, I hope to God that she makes it. But none of us really know what's going to come.

So I say, you know, live every day to the fullest and be grateful for what you have and to start living your best life right now. And don't wait until everything's perfect, because things are always going to come up. There's never going to be a perfect time, the perfect time to start doing something is now.

Justin: Don't wait to be happy. I love it. Thank you so much, Franziska. This is a wonderful conversation. I think it is going to be so helpful to parents to break all of this complex nutritional science down into really easy bite-sized chunks, so to speak. Thank you so much for your time.

Franziska: Oh, thank you very much for having me, Justin. It was my pleasure. Love talking to you. And I'll talk to you soon.

Justin: Oh, absolutely. We'll have you back on that.

Franziska: That's great. Thank you so much.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We’re so grateful, you've chosen to join us on this Family Thrive journey.

Podcast Ep. 13: What Every Parent Needs to Know About Carbs, Protein, and Fat With Franziska Spritzler, RD, CDE

Close
Theme icon

Podcast /

Content /

Nourish

Podcast Ep. 13: What Every Parent Needs to Know About Carbs, Protein, and Fat With Franziska Spritzler, RD, CDE

Interested in learning more about low-carb diet options? You'll want to listen to our talk with the Low Carb Dietitian herself, Franziska Spritzler, RD, CDE!

Join The Family Thrive community and download the mobile app, all for free!

JOIN TODAY

Key takeaways

1

2

3

Low hassle, high nutrition

Fierce Food: Easy

Fierce Food: Easy

50/50 mixes of powerful veggies and starchy favorites

Fierce Food: Balance

Fierce Food: Balance

Maximize nutrients, minimize sugar and starch

Fierce Food: Power

Fierce Food: Power

Ingredients

Kitchen Equipment

Ingredient Replacement

View replacement list (PDF)

Reading time:

90 minutes

In this episode

Keto? Low-carb? Slow-carb? Low-glycemic? We're getting the science-backed, evidence-based down-low on how cutting back on sugar, refined grains, and processed foods can help our families thrive.

This week, we talk to Franziska Spritzler, who's also known as "the low-carb dietitian." She's a registered dietitian, certified diabetes educator, and author. We talk about swimming against a food environment that's making kids and adults sick, the difference between ketogenic diets verses low-carb, the science behind low-carb eating, and how to incorporate low-carb eating into your family's routine.


Listen here

About our guest

Franziska Spritzler, RD, CDE, known online as the Low Carb Dietitian, is focused on using low-carb nutrition for blood sugar control, healthy weight management and increased vitality.  A former court reporter, Franziska became a dietitian in 2008 in order to “help people improve their health through good nutrition.” Her work promotes low-carb and whole foods to help people manage or beat a number of ailments, including diabetes, hormonal disorders, obesity, and more. Although she no longer consults patients, she continues her work through content creation and research. To read Franziska’s work, head to Diet Doctor or take a look at her book, The Low Carb Dietitian's Guide to Health and Beauty!

Show notes

  • 00:33 - We chat with the founders and hosts of the Metabolic Health Summit, Angela Poff, PhD and Victoria Field in Episode 9!
  • 31:25 - Want to learn more about our review of high-protein, low-carb/low-sugar product reviews? Stay tuned and follow the Give This a Try topic in our Nourish Pathway.
  • 39:00 - Other dietitians that have joined us on The Family Thrive Podcast include Lexi Hall, RDN (Ep. 6), Angela Poff, PhD (Ep. 9), and Tiffani Ghere, RD, CSP, CLEC (Ep. 11).
  • 41:34 - Dr. Richard K. Bernstein is a physician who designed a low-carb diet specifically for those with diabetes.
  • 45:30 - To read more on the Meat-Mixup, click here to see Justin's Pro Perspective on how meat really isn’t as bad as it’s made up to be.
  • 48:52 - Allulose is a low-calorie sweetener that offers the same taste and texture as table sugar. Although it shares a similar chemical structure to a carbohydrate, allulose does not raise blood sugar levels and only contributes a fraction of the calories as regular sugar.
  • 50:35 - At The Family Thrive, we love our cauliflower rice (Seriously, we have so many delicious recipes like this Mexican-Style Cauliflower Rice!). One of our favorite Fierce Foods tips is to swap out white rice for cauliflower rice. This will boost fiber, vitamins, minerals and other micronutrients, and reduce calories and blood-sugar-raising starch. You can also try the 50/50 approach.  
  • 52:00 - Nightbirde is a singer who was featured on America’s Got Talent in 2021. Unfortunately, her health took a turn and she needed to drop out of this season to focus on her battle with cancer. In her social media announcement, she wrote: “Thank you for all your support, it means the world to me. Stay with me, I’ll be better soon. I’m planning my future, not my legacy. Pretty beat up, but I’ve still got dreams.”

In this episode

Keto? Low-carb? Slow-carb? Low-glycemic? We're getting the science-backed, evidence-based down-low on how cutting back on sugar, refined grains, and processed foods can help our families thrive.

This week, we talk to Franziska Spritzler, who's also known as "the low-carb dietitian." She's a registered dietitian, certified diabetes educator, and author. We talk about swimming against a food environment that's making kids and adults sick, the difference between ketogenic diets verses low-carb, the science behind low-carb eating, and how to incorporate low-carb eating into your family's routine.


Listen here

About our guest

Franziska Spritzler, RD, CDE, known online as the Low Carb Dietitian, is focused on using low-carb nutrition for blood sugar control, healthy weight management and increased vitality.  A former court reporter, Franziska became a dietitian in 2008 in order to “help people improve their health through good nutrition.” Her work promotes low-carb and whole foods to help people manage or beat a number of ailments, including diabetes, hormonal disorders, obesity, and more. Although she no longer consults patients, she continues her work through content creation and research. To read Franziska’s work, head to Diet Doctor or take a look at her book, The Low Carb Dietitian's Guide to Health and Beauty!

Show notes

  • 00:33 - We chat with the founders and hosts of the Metabolic Health Summit, Angela Poff, PhD and Victoria Field in Episode 9!
  • 31:25 - Want to learn more about our review of high-protein, low-carb/low-sugar product reviews? Stay tuned and follow the Give This a Try topic in our Nourish Pathway.
  • 39:00 - Other dietitians that have joined us on The Family Thrive Podcast include Lexi Hall, RDN (Ep. 6), Angela Poff, PhD (Ep. 9), and Tiffani Ghere, RD, CSP, CLEC (Ep. 11).
  • 41:34 - Dr. Richard K. Bernstein is a physician who designed a low-carb diet specifically for those with diabetes.
  • 45:30 - To read more on the Meat-Mixup, click here to see Justin's Pro Perspective on how meat really isn’t as bad as it’s made up to be.
  • 48:52 - Allulose is a low-calorie sweetener that offers the same taste and texture as table sugar. Although it shares a similar chemical structure to a carbohydrate, allulose does not raise blood sugar levels and only contributes a fraction of the calories as regular sugar.
  • 50:35 - At The Family Thrive, we love our cauliflower rice (Seriously, we have so many delicious recipes like this Mexican-Style Cauliflower Rice!). One of our favorite Fierce Foods tips is to swap out white rice for cauliflower rice. This will boost fiber, vitamins, minerals and other micronutrients, and reduce calories and blood-sugar-raising starch. You can also try the 50/50 approach.  
  • 52:00 - Nightbirde is a singer who was featured on America’s Got Talent in 2021. Unfortunately, her health took a turn and she needed to drop out of this season to focus on her battle with cancer. In her social media announcement, she wrote: “Thank you for all your support, it means the world to me. Stay with me, I’ll be better soon. I’m planning my future, not my legacy. Pretty beat up, but I’ve still got dreams.”

In this episode

Keto? Low-carb? Slow-carb? Low-glycemic? We're getting the science-backed, evidence-based down-low on how cutting back on sugar, refined grains, and processed foods can help our families thrive.

This week, we talk to Franziska Spritzler, who's also known as "the low-carb dietitian." She's a registered dietitian, certified diabetes educator, and author. We talk about swimming against a food environment that's making kids and adults sick, the difference between ketogenic diets verses low-carb, the science behind low-carb eating, and how to incorporate low-carb eating into your family's routine.


Listen here

About our guest

Franziska Spritzler, RD, CDE, known online as the Low Carb Dietitian, is focused on using low-carb nutrition for blood sugar control, healthy weight management and increased vitality.  A former court reporter, Franziska became a dietitian in 2008 in order to “help people improve their health through good nutrition.” Her work promotes low-carb and whole foods to help people manage or beat a number of ailments, including diabetes, hormonal disorders, obesity, and more. Although she no longer consults patients, she continues her work through content creation and research. To read Franziska’s work, head to Diet Doctor or take a look at her book, The Low Carb Dietitian's Guide to Health and Beauty!

Show notes

  • 00:33 - We chat with the founders and hosts of the Metabolic Health Summit, Angela Poff, PhD and Victoria Field in Episode 9!
  • 31:25 - Want to learn more about our review of high-protein, low-carb/low-sugar product reviews? Stay tuned and follow the Give This a Try topic in our Nourish Pathway.
  • 39:00 - Other dietitians that have joined us on The Family Thrive Podcast include Lexi Hall, RDN (Ep. 6), Angela Poff, PhD (Ep. 9), and Tiffani Ghere, RD, CSP, CLEC (Ep. 11).
  • 41:34 - Dr. Richard K. Bernstein is a physician who designed a low-carb diet specifically for those with diabetes.
  • 45:30 - To read more on the Meat-Mixup, click here to see Justin's Pro Perspective on how meat really isn’t as bad as it’s made up to be.
  • 48:52 - Allulose is a low-calorie sweetener that offers the same taste and texture as table sugar. Although it shares a similar chemical structure to a carbohydrate, allulose does not raise blood sugar levels and only contributes a fraction of the calories as regular sugar.
  • 50:35 - At The Family Thrive, we love our cauliflower rice (Seriously, we have so many delicious recipes like this Mexican-Style Cauliflower Rice!). One of our favorite Fierce Foods tips is to swap out white rice for cauliflower rice. This will boost fiber, vitamins, minerals and other micronutrients, and reduce calories and blood-sugar-raising starch. You can also try the 50/50 approach.  
  • 52:00 - Nightbirde is a singer who was featured on America’s Got Talent in 2021. Unfortunately, her health took a turn and she needed to drop out of this season to focus on her battle with cancer. In her social media announcement, she wrote: “Thank you for all your support, it means the world to me. Stay with me, I’ll be better soon. I’m planning my future, not my legacy. Pretty beat up, but I’ve still got dreams.”

Enjoying this? Subscribe to The Family Thrive for more healthy recipes, video classes, and more.


Justin: We met Franziska when she had just transitioned from being a clinical dietician with the VA to private practice as “The Low Carb Dietitian.” We were looking for a dietitian who could help childhood cancer families reduce sugars and refined grains and boost healthy proteins and veggies, and she was a perfect fit. Over the years, we have watched as she has become a world-renowned expert on the science behind nutrient-dense, whole food eating. She is the author of The Low Carb Dietitian’s Guide to Health and Beauty, and has been an expert contributor at Healthline.com, and is now at DietDoctor.com. 

In this episode, you’ll learn all about low carb nutrition for families, the difference between keto and low carb, why low carb eating works, the myths surrounding low carb approaches, and how to start incorporating low carb eating into your family’s routine. Without further ado, here is my conversation with the amazing Franziska Spritzler. 

So, Franziska, thank you so much again for taking time out of your day to be here with us on The Family Thrive Podcast. 

Franziska: My pleasure. I'm thrilled to be here.

Justin: Yeah. So we have known each other for a number of years. I actually have lost track. So we first met when we asked you to help out with MaxLove Project. So can you tell us a little bit about your memories of how we kind of first started to work together?

Franziska: Yeah. Well, I met you at a conference in Tampa in 2016, Metabolic Health Conference, and we talked a bit about working with MaxLove. And then I met with Audra and I started working with some of the parents of children with cancer who were in like the MaxLove Support Group on Facebook. And that's how we initially started working together. And it was a wonderful experience for me.

Justin: We loved it. And the feedback we have from families was just amazing. They love you. And this was yeah, this was the beginning of a really wonderful relationship. And at the time, you at least were known to us primarily as the Low Carb Dietitian. So that was….

Franziska: Yeah.

Justin: So that was your handle on, you know, in the web world, the Low Carb Dietitian, and you were able to help our families move in the direction of a diet that would reduce blood sugar or reduce insulin and help as an adjunctive modality as they were going through cancer treatments.

So can you tell us a little bit about what has happened since then for you? So you were the Low Carb Dietitian. You still are. People can find you at lowcarbdietitian.com. But where has life taken you since then?

Franziska: Well, when I was working with you, I was in private practice in California. And I've since moved to Florida and I no longer see people in private practice. I write exclusively for dietdoctor.com, and they are low-carb websites. They provide lots of resources to people, ketogenic diets, low carb diets, and just people who want to get healthier. So that's what I do full time now.

I do miss the consulting that I used to do with your families and other people, but I feel like I can reach a kind of a larger audience with my writing. And we're also planning to do some other helpful things, even a coaching program that we're trying to put together.

Justin: So what drew you to low carb in the first place? So this has been a part of your life for more than a couple of years. What can you take us through that personal evolution?

Franziska: Absolutely. So I actually became a dietitian a little bit later in life. I'd already been a court reporter up until 2008. Then I was a dietitian. I practiced traditional guidelines, kind of lower fat, lots of healthy whole grains. Up until 2011, when I found out that my A1C was 5.6%, and that's not terribly high, but it's just below prediabetes, which is 5.7%.

Justin: Oh, so for the listeners A1C. So what does that mean?

Franziska: OK, so hemoglobin A1C is a measure of long-term blood sugar over about three months. And it's not just your fasting blood sugar, which you'll usually get that on a lab and it'll say glucose. That's your fasting glucose or fasting blood sugar. Mine was always normal. I was around 80, but my A1C was quite high, almost prediabetes range. So that was concerning to me. I started testing my blood sugar and realizing that although I had a very nice fasting blood sugar, it was going up very high after eating what I thought were healthy meals.

So I began doing a little research and discovered that people with prediabetes, which it seemed like I had, could get really good results by cutting back on carbs. And that made sense to me because carbohydrates increase blood sugar more than protein or fat does. But I never thought it was a problem for me. I began cutting back, though, and I noticed when I tested my blood sugar, my levels were much better controlled and the lower I ate, the less it went up and the more well-controlled I was. I also discovered that I wasn't hungry as often and I never, didn't need to snack anymore.

So I found this a huge benefit and realized that maybe I was providing information to people with diabetes and prediabetes that wasn't so helpful because it kept them hungry, snacking all day with blood sugar levels kind of going up and down and needing a lot of medication to manage it.

Justin: What was that information that you were giving to patients before coming to low carb? What was that like?

Franziska: So having a very balanced plate. So you want a portion of some kind of grains or potatoes or starch, a small portion of meat and vegetables and maybe a glass of milk for calcium. So that sounds pretty balanced. And making sure not to add a lot of fat to your food, maybe using Egg Beaters instead of eggs to avoid extra fat. So that's the way that I ate and that's the way that I was recommending that other people eat. And I thought it was a healthy way to eat. And it is for some people. Some people do really well with that.

But people who have any kind of blood sugar or metabolic issues tend to do better with lower carbs. But this isn't what's taught in dietetics programs. It certainly wasn't followed in the hospital that I worked at. I worked at a hospital at that time at the VA hospital in Long Beach, California. So, and it wasn't accepted there, which is why after a couple of years of getting increasingly frustrated of not being able to recommend this to patients that I left to go into private practice.

Justin: So that's where the Low Carb Dietitian was born, you were see…

Franziska: Yeah.

Justin: So you saw it first in yourself and you saw it first in your own lab values that when you started to shift the way that you ate these important numbers began to improve, primarily this A1C.

Franziska: The A1C went down from 5.6% to 5%, and it's been there ever since. That was in 2011, by the way. So it's been 10 years. And my blood sugars have been well controlled that entire time. I've been eating low carb the entire time.

Justin: All right. So let's get into the low carb. Like what I really want to get out of this podcast is to give parents an idea of what low carb is like, what it can do with the different scientific rationales for it, because our approach to nutrition, it's focused on whole foods, but there's a component to it where we really want to reduce refined carbohydrates, we want to reduce sugar, and it ends up looking like a low-carb approach.

And so we want to get a handle on this, like what is this and what are the differences between some of the terms that flow around in the low carb world. So can you give us an idea of what the differences between, say, a low-carb approach, other words that parents might know, like ketogenic or paleo or Atkins? So how about we just start with low-carb versus ketogenic? How could we distinguish between those?

Franziska: Ok, so low-carb is a very broad term that kind of encompasses all of those terms that you just brought up, paleo and ketogenic and Atkins. So low carb is just a reduced carbohydrate diet.

So carbs are found in many foods, but primarily things like bread, pasta, potatoes, fruit, and fruit juice. And then in refined carbs, as you talked about, sugars and sweets and potato chips and things like that. So a low carb diet reduces those anywhere from about 20 grams per day, up to 100 grams per day. The average person eats roughly 250 to 350 grams of carbs a day. So a low carb diet can be anywhere in there, but a ketogenic diet is at the very low range of that 20 to 100.

And the purpose of a ketogenic diet is to increase the number of ketones in your blood so they can be used by the brain. Ketones are fat-like compounds that the liver makes. That your brain can use as an alternate energy source. But carbs need to be very low to get the ketones up to that level versus a more moderate low carb diet. Maybe 50 to 100 grams or so would not be producing a lot. You wouldn't, your liver would not be producing a lot of ketones.

Justin: What kind of things could a person eat and still be in, say, the 50 to 100 gram range? So we're not talking about removing all carbs at that point. We can still eat a lot of carb-containing foods. What are some of the things that a person could eat in that range?

Franziska: In that range, probably, you know, small portions of starchy vegetables like sweet potatoes and root vegetables, like carrots and beets, some fruit, perhaps very high sugar fruit. You really want to minimize like bananas and tropical fruits, like pineapple. They've got a lot of sugar. You can have those in very small portions.

But you could have berries. You could also have berries on a ketogenic diet, but maybe some apples and some other less sweet fruits. And beans perhaps, if they agree with your system and even some grains, depending on how sensitive you are to carbs. And that's something that's kind of trial and error. You may not know if you're eating 250 grams of carbs right now and having some symptoms. You may not know how low you need to go to get blood sugar better controlled.

Justin: Oh, yeah. So on a ketogenic diet, we are getting below 20 grams of carbs a day. And the goal of a ketogenic diet, as you said, is to put the body in a state where the liver is now producing ketones.

Franziska: Yes.

Justin: So why would a person want to go that low to be on a ketogenic diet versus just low carb?

Franziska: That's a great question. And for some people, for therapeutic purposes, like people with brain cancer or other neurological issues, epilepsy, those ketones can actually serve as an alternate fuel source for the brain, which may have trouble using glucose. That's glucose or sugar is the usual fuel. Let's say that the fuel that most people use to fuel their brains. People who have neurological issues may get a lot of benefit from a ketogenic diet. It may help to protect the brain, and it can be used as an alternate energy source.

So that's one group that would often benefit from being ketogenic versus low-carb. Many people also find that low carb diets in general, lower hunger, but ketogenic diets being in ketosis, meaning you have a certain level of concentration of ketones in your blood, actually helps to control hunger better. They get a real appetite suppression from that. So that's another reason you might want to do a ketogenic diet as opposed to a low-carb diet.

And some people just find it's really individual, but it's easier to kind of have a more limited food palate than have to worry about how much fruit can I eat. She said a little bit, but how much is a little bit? They find it easier to just, you know what, I'm not going to eat those fruits. I'm just going to eat, stick basically to meat, vegetables, eggs, and those foods instead, and know that I'll always be in ketosis. And it is easier for me than making the judgment call on how many carbs I can have and trying to keep within a certain range.

Justin: For a family that doesn't have any demonstrable health problems. And they're just looking to tighten up their diet and eat a little better, ketogenic diet is not going to be something that they need to worry about.

Franziska: I don't think so. No, no. For the vast majority of people, a low carb diet is, it will be ample to give them the health benefits that they're looking for.

Justin: I get asked this question sometimes, Audra gets asked this, because now when you go into the grocery store, I mean, things have totally changed over the last five-plus years where now we go into places like Target or Walmart and there will be plenty of products now that say keto on them. It didn't use to be like this at all. And so there's a subtle message that, hey, keto. I mean, that has to be better, right?

So an actual ketogenic diet is not necessary for the vast majority of people. A low-carb approach is going to be perfectly adequate. But another thing, what do you think about all of these keto products that are now on the store shelves? I've found that when I actually look at the nutritional facts and I look at the macronutrient profile, that these actually aren't keto. And…

Franziska: A lot of times they’re not.

Justin: Just for any listeners who don't know, Audra and I had Max on a ketogenic diet for many years, and we've been on and off it for his treatment. So we know what it takes to get into ketosis and it's not easy.

Franziska: Exactly. And some of these products have very questionable sweeteners in them that actually can raise blood sugar. IMO's, those can raise blood sugar as much as sugar can.

Justin: So what's an IMO?

Franziska: I said IMO because they're hard to pronounce. Isomaltooligosaccharide.

Justin: Oh, that's a mouthful for ya.

Franziska: Yeah, those are used in syrups, some sweet syrups, and then some low-carb and keto products, mostly keto products, because they can check their will be called a fiber, and then they subtract that fiber from the total carbs and give you a net carb of two or three grams, when in reality, if they're using a lot of IMO's, it could be 10, 15 grams per serving. But someone could think they're only two or three and do a couple of servings and think they're still doing great.

The same thing with sweetener. Now, to tell this, in so many chocolate bars and candies, the thing is, you see them all, only a couple of grams of carb. I can have all I want of these because they're so keto, are so low-carb friendly. And yet again, it's a type of sugar alcohol that can be partially metabolized and raise your blood sugar, therefore decreasing your ketones and you're no longer keto or necessarily even low carb if you're eating a lot of them. So I do think that you need to be very, very careful when you choose keto products. Some of them are just fine. But, you know, it's a craze right now with keto and they're trying to capitalize on that.

Justin: I find many of them to be fine when I look through the ingredients. I don't have a problem with the vast majority of the keto products out there. It's just that they're not keto in the sense that to really get into ketosis, you need a lot of fat and you need to be very moderate with your protein. And many of these keto products have a lot of protein, not necessarily a bad thing. It's just not going to get you into ketosis.

Franziska: Right.

Justin: So we've covered low carb ketogenic. What about Atkins? So if I'm sure there are parents, you've heard of that and they're thinking, what's the difference?

Franziska: Yeah. So Atkins is interesting. It starts off with what's called an induction phase, which is essentially a keto diet. It's less than 20 grams a day. And it actually limits some vegetables depending on how many carbs they have. But it really does allow unlimited amounts of meat and fat. So in that way, it's a little different than a therapeutic keto diet that's meant to increase ketones with the carb levels very low to start.

And the whole idea is to put you in at least mild ketosis and then to keep your hunger down and get you used to eating this way, and then you go through different phases. Phase one, phase two, where you kind of add bad carbs and see how it affects your appetite. See how it affects your weight. Blood sugar. And you kind of find the right carb level for you.

So I actually kind of like that approach for some people. You know, you find what works best for you. And some people may do best, about 20 to 25 grams a carb indefinitely. And others may be able to tolerate between 50 and 100 grams and do really well. But it all almost always or they actually recommend that you do start at the very strict level and then work your way up.

Justin: Paleo. So I'm sure many parents have heard of paleo and they're thinking it might fit into this low-carb world in some way or another. How do you think about Paleo in regard to these other low-carb approaches?

Franziska: Paleo is interesting because it is much lower in carbs than like a standard American diet, but it includes some high-carb foods as well. It's you know, it's basically whole foods, which is great. No dairy, though, or, you know, a primal approach allows some dairy, a paleo, strict paleo approach, though, no dairy, no beans. So no legumes, like even peanuts or anything like that.

And they do technically allow some high-carb fruits and honey even as a sweetener rather than anything artificially sweetened, only natural. So you're going to use a sweetener, use honey. I think they allow stevia leaves, but no stevia processed. So it's basically Hunter-Gatherer, what would people have eaten, you know, millions of years ago? Obviously, we have different food and different animals around different plants. And we had them, but as close to the way that they ate before the invention of modern agriculture as possible.

Justin: So it can be low carb because it doesn't have things like sugar or grains. And yeah, but it can be just as high carb if all we eat is sweet potatoes.

Franziska: Yes. Potatoes and fruit. All right. Yes, sweet potatoes and fruit for almost every meal, then you're certainly going to be getting a lot more carbs than when you get on a low-carb diet.

Justin: Awesome. Ok, so the fourth low carb approach that I wanted to ask about, and then I threw Paleo and there's the fifth is something that I've seen at Diet Doctor over the past several months is a more high-protein approach. I know there are different names for this approach, but can you tell us about this more high protein approach that the Diet Doctor has started to focus on?

Franziska: Yeah, so it's high protein. And what does that mean? Believe it or not, we're still trying to figure out exactly what it means. Diet Doctor...exactly how much protein it is. But it's basically trying to get the most protein per calorie for people who want to lose weight.

Justin: Can I just pause there? So we want to increase protein per calorie?

Franziska: Right.

Justin: All right. So for every calorie we eat, we want the percentage of the protein to be in what range? So if we're eating like 1,000 calories, how much of that should be a protein?

Franziska: So on a high-protein approach, over 30%.

Justin: So 300 calories of that one thousand calories would be protein.

Franziska: 300 as a minimum. And sometimes a little higher.

Justin: Ok.

Franziska: So that's what we're saying for now. And what that means in absolute grams per day is going to depend on the calorie amount that you eat. So a very small woman would have a lower, even if she's eating a high protein diet for her, would be a lot lower in protein than someone like my boss at Diet Doctor who is 6’7”. So, high protein diet looks very different. But they're for the amount of protein per calorie that you're eating, it's similar amounts. So it's just, it's really, yes, focusing on high protein, but not low fat and it's still low carb.

You can even do it, I don't want to say ketogenic exactly because it's not high fat, but at a very low carb level, less than 20 grams of carbs per day, if you want. But we are really recommending that most people do a more moderate, low carb, maybe 30 to 60 grams of net carbs.

And I'll just briefly recommend, mention what net carbs are; that's total carbs, minus all fiber that naturally occurs in food, avocados actually are pretty high in total carbs, but most of them, most of it’s fiber. So when you subtract that out, it becomes a very low-carb friendly food.

Justin: And we subtract out this naturally occurring fiber because it doesn't get turned into blood sugar.

Franziska: Exactly. It either passes right through your system or is converted into fatty acids by gut bacteria. But it does not increase your blood sugar. It does not have any effect on your insulin.

Justin: So with this high protein approach, is it that the concern is less about the carb amount and more of a focus on the protein and that it's really carbs and fat are seen as just together, as just a source of energy?

Franziska: It is.

Justin: Can you explain that part a little bit?

Franziska: Yes. On a high protein diet, or at least the way we're viewing it. We want to maximize calories from protein and not get too much energy from nonprotein sources like carbohydrates and fat. Now, protein is not there to provide energy so much. It's there for muscle building, for preventing bone loss. And protein also can, just like being in ketosis, getting more protein can have an effect on satiety. There are studies that show this.

So for those reasons, we say prioritize protein. You're still, though, if you're getting 30, 35, or even 40% of calories from protein, that's still not more than the fat and carbs put together. So you're still percentage-wise, not getting as much. You probably will be getting more calories from fat than protein if you're following a low carb approach, but just not as many calories from fat as you would on a ketogenic diet or even a low carb approach that has lower protein.

Justin: Awesome. And then one word you used from the science world, satiety. So that's just feeling full.

Franziska: Feeling full and satisfied. So that you eat less. Yes.

Justin: So, ok, so we've covered these different approaches in the low-carb world. So what do you personally prefer for just you, for yourself?

Franziska: So I follow a pretty high protein, low carb diet. I eat probably between 110 to 125 grams of protein per day. I'm five foot eight. It's not terribly high, but it's higher than a lot of people would eat. I eat about 30 to 50 grams of net carbs per day. Total carbs, that's with the fiber of usually 70 or so, because I eat a lot of fiber, a lot of vegetables. And that's what works best for me. Other people I've seen do better with a little less protein, a little more fat. Some people do better with fewer carbs, others with a little more carbs. But that's my personal approach that's worked for me for many years.

Justin: Awesome. Now, this is a tough question, and I totally accept if you just want to say pass, but if you had to recommend an approach just for the average family out there, no major health problems, they just want to do a little better. In what direction would you point them in this low carb world?

Franziska: Yeah, that's a good question. I would say a low carb approach that's moderate, maybe net carbs anywhere from 40 to 60 to start or a little bit more. It depends on the family, I would say. And I again, when we're talking about moderate, I don't think the counting is so important. Like 40 to 60, it could be 30 to 80. You know, it could be a wider range. It could be up to 100 for very active families, really active kids.

You know, the kids, I think up around 100 grams is just fine, maybe more. For moms wanting to lose weight, maybe a little less. So maybe you give them a little more sweet potato and yourself a little less and fill up more on broccoli and some lower-carb vegetables.

Justin: Yeah. Yeah. It strikes me that the counting would be counterproductive.

Franziska: Yes.

Justin: Yeah. That is just too much work. But focusing on food types would be a little more useful. Yeah.

Franziska: Yeah. Yeah. So a good protein source at every meal and no fear of fat. That's something that I mentioned, you know, the way that I used to eat with the Egg Beaters and really being very careful with fat. On a low-carb diet, you have permission to eat more fat. If you're not doing ketogenic diet, you don't have to worry about really dousing everything in butter. But you don't fear fat that can actually make food taste quite a bit better. And the combination of protein and fat is very filling. And then you're getting fiber from vegetables, which is also filling. So it can be a very satisfying diet for everyone.

Justin: Ok, so now I want to get a little bit into the science for parents who want to know, like, why does a low carb diet actually work? Is there some magic sauce in here? The way that I understand it, there are two ways that we can think about this and maybe more that. The first one is that there's some special fattening properties in carbs that because carbohydrate they raise blood sugar, which raises insulin, and this can have knock-on effects with hunger and fat burning.

So there's in the science world, I understand that as the insulin, the carbohydrate-insulin model. And then there's this other approach that it's really focused on hunger and that if we just increase protein and reduce carbs, that we're just not going to be as hungry, and then we're just going to eat less. Are there any other parts of this puzzle that I'm missing?

Franziska: No, I think you summed it up very well. The thing is, we don't have great evidence for either of them. It's hard to say. That's why there's arguments, because we know that low-carb diets work. When you give them to people and you have somebody follow a low-carb diet and a low-fat diet or another type of diet. People end up eating less on a low-carb diet naturally. You tell them they can eat whatever they want and they eat less.

Is that because of insulin or is it because the protein helps them to feel fuller or having more stable blood sugar levels throughout the day without blood sugar and insulin rising and falling? I think it's a combination of both.

But again, we don't have great evidence for either one. We just know that they worked for almost every, almost everyone I know that followed a low carb diet. Whether they have stayed on it long term or not, said “I just wasn't as hungry. I ended up losing weight and I wasn't even that hungry.” And I could go, you know, “I could skip a meal because I wasn't hungry. And why is that?”

Well, we're still trying to figure that out, truly. But I think that blood sugar and insulin are part of it. But I also think that the protein, most people, when they start a low-carb diet, tend to increase the amount of protein when they cut back on carbs, so that can also have an effect.

Justin: Oh yeah. In your professional experience, what are the main reasons that people have a hard time staying on a low-carb diet?

Franziska: Well, it really does come down to personal food preferences, even though there are so many amazing substitutes. For some people, it's just impossible for them to stay on the diet because they either love potatoes or sweets or something so much. I actually find that that's rare, though, for someone who really is interested in health and willing to kind of stick it out.

Beginning can be tough. I find that having a lot of substitutes on hand, being well prepared before you start can make all the difference. One of the big things is at home it may be fairly easy to stay on plan, but then once you go out to eat or you're invited to someone's home, especially in the early stages, it can be really tough. Nobody really wants to impose on their guests or even make a big deal at a restaurant. I can't eat this, what do you have? It gets easier over time. And what's great is that now there's a lot of different options.

But I think those things are hard for a lot of people. And then people have ideas in their head that low-carb just isn't that healthy, that it isn't a way that they can eat forever. And that can be hard to get around too, and especially if they're receiving messages from other people in their lives who aren't supportive. So there's a lot of reasons that low carb can be hard. But I think kind of preparing before you do it and learning about these things and having foods on hand and kind of knowing what to expect can make a huge difference in whether you're successful and able to stick to it.

Justin: Yeah, for us, it was a slow transition when Max was diagnosed in 2011. We just slowly learned about nutrition or the way that nutrition can support him during his treatment. So we moved closer and closer to a ketogenic diet. And when we finally went full in, I mean, it was probably a year and a half of just transitioning slowly, and then we're like, “Ok, let's just take the plunge.”

But I remember when we finally did, going to the grocery stores, I remember going to Trader Joe's in particular, and all of the frozen foods that I used to buy, like I started to look at the nutrition facts and the ingredients. And there were so many I mean, I would probably say 80, 90% of them I just had to put back. It was like, we can't do that anymore. Even though we were making a slow transition when we finally took the leap. Is that all right? We are going to get Max into ketosis and we're going to eat this way.

Oh, there was so much that we had to change. But then learning how to tweak meals, learning how to make the same thing. Oh, we can do spaghetti, but now in a totally different way. We can do mac and cheese, but in a totally different way. And so it was learning about all the different strategies. And then today, of course, it's a lot easier because there are so many products on the market.

Franziska: Absolutely.

Justin: We'll be featuring in The Family Thrive App, a review of high protein, low carb cereals that are now on the market. There were none of these when we started in 2013 when we actually went more stringent toward a ketogenic diet. No cereals like this. No, I don't think there were any breads. There might have been one bread brand. But yeah. So we'll be reviewing cereals. We'll be reviewing low-carb, high-protein pastas. We'll be reviewing low-carb, high-protein breads. All this stuff is now easily available. But we found a wonderful hot dog bun now. So it is a lot easier now.

Franziska: It's much easier now. And I'm glad you have all of those. That sounds great. That’s awesome.

Justin: So, Franziska, what are the biggest misunderstandings around low-carb nutrition that you come across?

Franziska: I just think that a lot of people think that low-carb diets are fad diets, that they're unsustainable, that you can't do them long term, and that they are you know, they basically all you're eating on a low carb diet is butter and bacon. And you don't have a lot of variety. And this just isn't true.

You're only cutting out the very high-carb foods like pasta, bread, potatoes, cereal, and fruits, and sweets, and starches. But you can have everything else. You can still have so many other things. And it really can be a very well-balanced diet.

There was a dietitian from New Zealand who did a study years ago to show that a low-carb diet provides ample amounts of vitamins, minerals, everything you need to be healthy. I think that's another misconception that a low-carb diet lacks some healthy foods like whole grains.

Well, whole grains are great if you tolerate them, but there's nothing magical. There's nothing in whole grains that's unique to them that you can't find in other foods, like vegetables and nuts and seeds. So I think those are the misconceptions. If it's just a very fad-like diet that can't be maintained.

Justin: Oh, yeah. We've been, you know, almost 10, 10 years on a low carb approach in one way and it's just the way we eat now. And the one thing that we found right away was, oh, our plate is mostly vegetables. Like if we do, you know, chicken and broccoli or a steak, you know, it's like half the plate is broccoli. And it didn't use to be like that.

So for a typical meal beforehand, there might be a protein, but then there are definitely be a starch that would be filling up most of the plate and then maybe a little bit of the vegetables on the side. And so now with a low carb approach, it's a lot of veggies. We’ve removed the starch and then keep the protein. I have no doubt that we eat way more veggies today than we did before.

Franziska: I feel the same here and same with all the people that I've ever worked with. And many people have reported to me on what they eat. I eat vegetables at breakfast now, which I never did before. So, you know, I eat vegetables three times a day. And yeah, so it can be extremely healthy and sustainable.

That's the misconception that low carb is a fad diet, it's unbalanced because you're getting lots of nutrition with a low carb diet. If you're doing it in a healthy way, of course, you can just eat, you know, just bacon and eggs for every meal. That's, you know, you get to eat bacon and eggs on a low-carb diet. That's wonderful. But for a really well-balanced diet, you want to include vegetables and some other fruits as well, and lots of different protein sources.

That's what makes the diet healthy, is having a lot of variety. And you can still get lots of variety on the low-carb diet.

Justin: Awesome. So if a family is thinking, you know, we want to move in this direction, we don't need to, you know, drastically reduce carbs or go keto, but we would like to move in this direction. What are a few things they can start to think about changing in from the standard American approach to move in this direction?

Franziska: Well, I would say to start with, get rid of the white starches and sugars in your house, get rid of them, donate to a food bank if you don't want to throw things out. I understand not wanting to throw them out. But if you want to get started on this, that's the first place to start.

If you're already doing whole grains and you've gotten rid of most of the sugar in your life, then I would just start to slowly cut back on those things.

Maybe one at a time. Like, you know, some people love cereal. If whole-grain cereal is the hardest thing to give up. Maybe start with whole-grain pasta first or something else. Just give it up one at a time. Make gradual changes. I like what you did that moving towards it gradually. I think that you can stick to it better. And once you see the results are more motivated to make the next change rather than having to give up everything at once, I think that can lead to failure for a lot of people.

Justin: Oh, absolutely. Well, in our MaxLove Project role, we, of course, interact with a lot of families who are in medical crises and want to make big nutritional changes. And they say, “Ok, we are ready. We're going to clean out the pantry and we're just going to start fresh.” And our response is we've seen bad results coming from that approach because it's a shock, and then after a couple of weeks or a month, everyone says, well, we obviously can't do this, so we just need to go back to the old way.

What we have found through MaxLove Project, the most sustainable approach is to start with just one thing, just say what is one change we can make and we know we can stick with it and it doesn't matter what it is. So just make that change and then stick with it. And then when you feel like you, you have a handle on that change that is now a part of your life. Now you can move to another change.

And so if it's something like, all right, we're just not going to buy really high-carb, sugary cereals, like we're just going to have a different type of breakfast and it almost doesn't matter what it is. So just make that change. And then once you're comfortable with that change, now you can think about another change.

Franziska: Yeah, exactly. That's what works. And it becomes easier with each progressive change. The further you go, the more, the less time you'll have to spend making that change. And before you know it, you're following a low-carb diet and it really isn't painful.

Justin: We all have heard that breakfast is the most important meal of the day. If there was one meal where parents are like, where should I start in moving towards a more high-protein, low-carb approach, would breakfast be the one?

Franziska: I really think so. There is some good research that having a higher protein, lower carb breakfast is a great way to start out, kind of primes your body. This is for kids too. Kids need a lot of protein when they're growing.

But for parents who want to stay full and satisfied and not be tempted by the snack cart at work or something, having a good solid breakfast that's lower in carbs, higher in protein and some fat. I think that's definitely a great way to start your day. Best meal to start with.

Justin: We've had a couple of other dietitians on talking about different aspects of the nutrition world, and we've asked them to bust some food myths because we have found in our time with MaxLove Project over the last 10 years learning more about nutrition and nutrition science, so many myths have been busted for us. You know, like everyone should drink eight glasses of water a day. And it turns out there's just no science around that at all. So do you have a food myth or two that you can bust for us?

Franziska: Well, I like the ones that you already mentioned when we talked before, but I think I'm going to stick with a low carb and say that there's a myth that low carb diets are dangerous long term.

And what they do is they'll say this is proven by studies, but the studies are observational studies where they ask people to fill out a questionnaire of what they eat during a typical week, and they ask them to fill that out a few years later. And then they look to see what kind of diseases or if any of the people passed away. And they find that people who eat lower carbs tend to die earlier or get more heart disease or diabetes. But these are self-reported intakes. And they ask questions like, how many times a week do you eat this? Nobody knows, they’re notoriously inaccurate. And also low carb is considered up to 40 to 45% of calories. Even a moderate low carb diet is usually 20, 25% in calories.

And a ketogenic diet, as we know, is like five percent, five to 10 percent. So these aren't even, even if it was true that the people were eating this amount of carbs. It's not that low carb. And what are they eating, besides which carbs are they eating? It's not that they're following a low carb diet is that they're reporting eating French fries or something twice a week instead of five times a week. And that comes out to be a low-carb diet.

So anything, those correlations are inaccurate. Now, we don't have long-term randomized controlled trials because it's impossible to do a study like that. It would be too expensive. And the number of people. We know that in the short term, they are healthy. They have not been shown to cause kidney damage, liver problems, heart disease or anything else. I can just look at people I know who've been following it for a long time and are healthy. I mean, I've been following for 10 years and in my 50s now, and I'm quite healthy. I'm certainly at least as healthy as I was before I started.

But the person I really look to is Dr. Richard K. Bernstein, who has had type one diabetes since he was 12. He's now [87]. In his 40s, he discovered low carb and started following that diet. He's still practicing. He's extremely healthy. He is the longest term low-carber I know most people with type one have a lower life expectancy, usually have at least one complication, either eye disease or heart disease. He's very healthy and he prescribed his diet about 30 grams of carbs a day is his baseline recommendation for people with type one and type two diabetes, very healthy. So I look to him and to many other people who are thriving on a low carb diet rather than these studies that make a low carb diet look scary.

Justin: Oh, yeah, every time I've heard the claim that low carb is bad for you, the person making that claim is always pointing to observational studies. And as you said, they simply ask people what they ate and then they follow them over some time. And so these people are not following a low carb diet. They are just simply reporting what they eat.

So if there's a person who says, you know what, I don't like vegetables, I don't and I don't eat that many French fries, I just eat a lot of steak or I eat a lot of hamburgers or whatever the case is, they may or may not be following a low carb diet. They may just have, say, 40% of their calories from carbs rather than 60%. But they're not following an actual low-carb diet.

Then the other thing that I found, when you dig into the tables, when you dig into the data in these observational studies, invariably I've seen this in every single observational study that opponents of low carb approaches point to is that the lower carbohydrate a person eats, the more cigarettes they smoke, the more alcohol they drink, the lower their income is, the lower their education. So there is clearly many other things going on in the epidemiology world. This would be called the healthy user bias.

Franziska: Yes. And it's the same thing for vegetarians, is the same thing for people who… do all the right things.

Justin: They're also going to the doctor more regularly. They're higher educated, higher income. Right. And well, there's another. So there's the healthy user bias. It's also called the healthy adhere bias, which I like that because there are other studies that have shown that people who are in randomized controlled trials for some drug trials, that the people who take their placebos more regularly are also healthier.

There's some phenomenon where people who are simply more conscientious, who listen to public health advice, who listen to what their doctors say are also happening to be doing a ton of other things that lead to better health.

And so what we see in these observational studies is people who are not following the conventional public health advice to eat less meat, eat more whole grains, right, who are going in the opposite direction of the public health advice, have all of these other poor health behaviors as well.

I know that I've seen at least one study that has gone so far as to pull out individuals who have healthy behaviors, who report having healthy behaviors, but who also report low carbohydrate intake, or I believe this is a study about high meat intake. And in the one study that I'm thinking of and we will link it in the show notes, individuals who are eating a lot of meat, but who are also doing all the other healthy things that, you know, a person should; going to see the doctor regularly exercising and such that they have just as good health outcomes as the individuals who are eating low meat, but are also doing the exercising and going to see the doctor. So meat is not the issue. All right.

Franziska: Meat is definitely not the issue.

Justin: If you just look at these observational studies that simply look at low carb or meat intake and they don't adjust, well, sometimes they will adjust for some things like smoking, but and some other variables.

But there are so many unmeasured variables that go along with all of these lifestyle choices that essentially these observational studies are useless.

Franziska: Exactly. Exactly. But they're the ones that get reported. You know, everyone shares them and you hear them on the news. And I know. Yeah, I agree with you.

Justin: Oh, thank you for busting it. One quick thing, because I do know when it comes to high protein, one thing that is just rampant, is just so common out there. And we work with a lot of doctors just in the cancer world with us here this well, you know, you don't want to eat too high protein because it's going to hurt your kidneys. So can you tell us about this?

Franziska: Yeah, they've actually not found that in any studies, randomized control trials and meta-analysis, of them. So several controlled trials together, they haven't shown that eating higher protein causes any problems to people who have normal kidney function, people with impaired kidney function, especially late-stage kidney disease, definitely higher protein intake can lead to faster progression of the disease. But people with normal, healthy livers and healthy kidneys, eating a higher protein diet has not been shown to jeopardize kidney health. And in fact, people who eat a low carb, higher protein diet that have diabetes, they have shown that that can be protective because it helps to control blood sugar to be on lower carbs. So…

Justin: We can put that one to rest.

Franziska: We can put that one to rest, too. Yes.

Justin: Yeah. Awesome. All right. So let's start wrapping up by checking in with what you think are some of the most interesting things happening either in food product space, if you've seen any cool new food products or the nutrition science space, like what's kind of the cutting edge for you?

Franziska: Well, you know, we almost already talked about it because it's all of the availability of all of these new foods that help support either low-carb or gluten-free lifestyle. I’m seeing it in grocery stores, I'm seeing it in restaurants, both fast food and regular restaurants. Chipotle now has cauliflower rice.

Justin: Yeah.

Franziska: Blaze pizza. Do you have it in Georgia?

Justin: No, but we did back in Orange County, so I'm familiar.

Franziska: Yeah, they had a keto crust. They have a gluten-free crust. And for people who want to do a vegan diet, they have a vegan crust. I really think that, you know, just supporting people by making all these options available and sweeteners too, I think have come a long way. Allulose is a fantastic sweetener too, so much like sugar. When people talk about, “I can't do sugar substitutes because they all have an aftertaste.” Like, “Have you tried allulose?”

Justin: I put this in the show notes.

Franziska: Yes.

Justin: Yes.

Franziska: Take a taste test. And I'm telling you, you won't be able to tell the difference. It tastes just like sugar. So I just...

Justin: It’s magic.

Franziska: Yes. I'm just finding it to be making it so much easier for people who want to follow whichever dietary plan. The food manufacturers are listening. They want to help people who want to make these healthy lifestyle choices. So that's really what I'm seeing. It's a wonderful time to start. Yes, just like you have been doing this for about 10 years, and it's fantastic since it's a good time to start.

Justin: And when we started, we would have to put our whole head of cauliflower through the food processor to get cauliflower rice. And it was just every time just mess everywhere was such a hassle. And the rice bits never turned out exactly the way we wanted them. And now there is frozen cauliflower rice in literally every grocery store: Walmart, Target, big grocery store, small one, it’s like everywhere now.

Franziska: It's everywhere. I love it. And I also see for people who don't have time to do that, zucchini spirals, at least in my grocers. Do they have those already spiraled for you in my just Publix, which are basically the only grocery store we have here in Florida? So they're really, really listening to demand from customers. It's great. And I love the frozen cauliflower rice. In fact, I won't use it tonight because I'm making chili and I love to serve it over cauliflower rice. So much easier than grating it for yourself.

Justin: It really does take the place of rice. And at the same time, you're getting this cruciferous vegetable with a ton of micronutrients and fiber and all this wonderful stuff. It's just…

Franziska: It’s the best of both worlds.

Justin: It is the best. Ok, so I'm going to end with questions that we ask every guest. So the first one is, if you could put a Post-it note on every parent's refrigerator for tomorrow morning, what would that Post-it note say?

Franziska: Ok. Start your day with a high-protein, low-carb breakfast. Eggs if you already have any boiled, if you don't have boiled make yourself a quick omelet or eggs and frozen kale or something that’s already washed and done for you. And you're good.

Justin: Brilliant. And then, last question. What is the last quote you heard that really inspired you?

Franziska: Ok, so this is something I actually heard somebody say, I didn't read it online, and it was just last week, I was watching America's Got Talent, and there was a woman 30 years old who was a singer, a fantastic singer, and she has metastatic cancer. And she said, “You can't wait until things get better to start being happy.”

And she said she was given a 2% chance to live. But she says the 2% chance isn't a zero percent chance. And I just want to do everything that I can do to be happy and to be, you know, to make the most of my life. And I think we all feel this way. This isn't changed anything I felt. But when I hear these stories from people who are just so courageous, it does something to my heart. I was in tears and I thought that's what you should do. Just never wait. Don't say I'm going to wait until I've lost weight to do this. I'm going to wait until our house is in order to do this. Do it now. Nobody knows how much time I have. She has a 2% chance, I hope to God that she makes it. But none of us really know what's going to come.

So I say, you know, live every day to the fullest and be grateful for what you have and to start living your best life right now. And don't wait until everything's perfect, because things are always going to come up. There's never going to be a perfect time, the perfect time to start doing something is now.

Justin: Don't wait to be happy. I love it. Thank you so much, Franziska. This is a wonderful conversation. I think it is going to be so helpful to parents to break all of this complex nutritional science down into really easy bite-sized chunks, so to speak. Thank you so much for your time.

Franziska: Oh, thank you very much for having me, Justin. It was my pleasure. Love talking to you. And I'll talk to you soon.

Justin: Oh, absolutely. We'll have you back on that.

Franziska: That's great. Thank you so much.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We’re so grateful, you've chosen to join us on this Family Thrive journey.


Justin: We met Franziska when she had just transitioned from being a clinical dietician with the VA to private practice as “The Low Carb Dietitian.” We were looking for a dietitian who could help childhood cancer families reduce sugars and refined grains and boost healthy proteins and veggies, and she was a perfect fit. Over the years, we have watched as she has become a world-renowned expert on the science behind nutrient-dense, whole food eating. She is the author of The Low Carb Dietitian’s Guide to Health and Beauty, and has been an expert contributor at Healthline.com, and is now at DietDoctor.com. 

In this episode, you’ll learn all about low carb nutrition for families, the difference between keto and low carb, why low carb eating works, the myths surrounding low carb approaches, and how to start incorporating low carb eating into your family’s routine. Without further ado, here is my conversation with the amazing Franziska Spritzler. 

So, Franziska, thank you so much again for taking time out of your day to be here with us on The Family Thrive Podcast. 

Franziska: My pleasure. I'm thrilled to be here.

Justin: Yeah. So we have known each other for a number of years. I actually have lost track. So we first met when we asked you to help out with MaxLove Project. So can you tell us a little bit about your memories of how we kind of first started to work together?

Franziska: Yeah. Well, I met you at a conference in Tampa in 2016, Metabolic Health Conference, and we talked a bit about working with MaxLove. And then I met with Audra and I started working with some of the parents of children with cancer who were in like the MaxLove Support Group on Facebook. And that's how we initially started working together. And it was a wonderful experience for me.

Justin: We loved it. And the feedback we have from families was just amazing. They love you. And this was yeah, this was the beginning of a really wonderful relationship. And at the time, you at least were known to us primarily as the Low Carb Dietitian. So that was….

Franziska: Yeah.

Justin: So that was your handle on, you know, in the web world, the Low Carb Dietitian, and you were able to help our families move in the direction of a diet that would reduce blood sugar or reduce insulin and help as an adjunctive modality as they were going through cancer treatments.

So can you tell us a little bit about what has happened since then for you? So you were the Low Carb Dietitian. You still are. People can find you at lowcarbdietitian.com. But where has life taken you since then?

Franziska: Well, when I was working with you, I was in private practice in California. And I've since moved to Florida and I no longer see people in private practice. I write exclusively for dietdoctor.com, and they are low-carb websites. They provide lots of resources to people, ketogenic diets, low carb diets, and just people who want to get healthier. So that's what I do full time now.

I do miss the consulting that I used to do with your families and other people, but I feel like I can reach a kind of a larger audience with my writing. And we're also planning to do some other helpful things, even a coaching program that we're trying to put together.

Justin: So what drew you to low carb in the first place? So this has been a part of your life for more than a couple of years. What can you take us through that personal evolution?

Franziska: Absolutely. So I actually became a dietitian a little bit later in life. I'd already been a court reporter up until 2008. Then I was a dietitian. I practiced traditional guidelines, kind of lower fat, lots of healthy whole grains. Up until 2011, when I found out that my A1C was 5.6%, and that's not terribly high, but it's just below prediabetes, which is 5.7%.

Justin: Oh, so for the listeners A1C. So what does that mean?

Franziska: OK, so hemoglobin A1C is a measure of long-term blood sugar over about three months. And it's not just your fasting blood sugar, which you'll usually get that on a lab and it'll say glucose. That's your fasting glucose or fasting blood sugar. Mine was always normal. I was around 80, but my A1C was quite high, almost prediabetes range. So that was concerning to me. I started testing my blood sugar and realizing that although I had a very nice fasting blood sugar, it was going up very high after eating what I thought were healthy meals.

So I began doing a little research and discovered that people with prediabetes, which it seemed like I had, could get really good results by cutting back on carbs. And that made sense to me because carbohydrates increase blood sugar more than protein or fat does. But I never thought it was a problem for me. I began cutting back, though, and I noticed when I tested my blood sugar, my levels were much better controlled and the lower I ate, the less it went up and the more well-controlled I was. I also discovered that I wasn't hungry as often and I never, didn't need to snack anymore.

So I found this a huge benefit and realized that maybe I was providing information to people with diabetes and prediabetes that wasn't so helpful because it kept them hungry, snacking all day with blood sugar levels kind of going up and down and needing a lot of medication to manage it.

Justin: What was that information that you were giving to patients before coming to low carb? What was that like?

Franziska: So having a very balanced plate. So you want a portion of some kind of grains or potatoes or starch, a small portion of meat and vegetables and maybe a glass of milk for calcium. So that sounds pretty balanced. And making sure not to add a lot of fat to your food, maybe using Egg Beaters instead of eggs to avoid extra fat. So that's the way that I ate and that's the way that I was recommending that other people eat. And I thought it was a healthy way to eat. And it is for some people. Some people do really well with that.

But people who have any kind of blood sugar or metabolic issues tend to do better with lower carbs. But this isn't what's taught in dietetics programs. It certainly wasn't followed in the hospital that I worked at. I worked at a hospital at that time at the VA hospital in Long Beach, California. So, and it wasn't accepted there, which is why after a couple of years of getting increasingly frustrated of not being able to recommend this to patients that I left to go into private practice.

Justin: So that's where the Low Carb Dietitian was born, you were see…

Franziska: Yeah.

Justin: So you saw it first in yourself and you saw it first in your own lab values that when you started to shift the way that you ate these important numbers began to improve, primarily this A1C.

Franziska: The A1C went down from 5.6% to 5%, and it's been there ever since. That was in 2011, by the way. So it's been 10 years. And my blood sugars have been well controlled that entire time. I've been eating low carb the entire time.

Justin: All right. So let's get into the low carb. Like what I really want to get out of this podcast is to give parents an idea of what low carb is like, what it can do with the different scientific rationales for it, because our approach to nutrition, it's focused on whole foods, but there's a component to it where we really want to reduce refined carbohydrates, we want to reduce sugar, and it ends up looking like a low-carb approach.

And so we want to get a handle on this, like what is this and what are the differences between some of the terms that flow around in the low carb world. So can you give us an idea of what the differences between, say, a low-carb approach, other words that parents might know, like ketogenic or paleo or Atkins? So how about we just start with low-carb versus ketogenic? How could we distinguish between those?

Franziska: Ok, so low-carb is a very broad term that kind of encompasses all of those terms that you just brought up, paleo and ketogenic and Atkins. So low carb is just a reduced carbohydrate diet.

So carbs are found in many foods, but primarily things like bread, pasta, potatoes, fruit, and fruit juice. And then in refined carbs, as you talked about, sugars and sweets and potato chips and things like that. So a low carb diet reduces those anywhere from about 20 grams per day, up to 100 grams per day. The average person eats roughly 250 to 350 grams of carbs a day. So a low carb diet can be anywhere in there, but a ketogenic diet is at the very low range of that 20 to 100.

And the purpose of a ketogenic diet is to increase the number of ketones in your blood so they can be used by the brain. Ketones are fat-like compounds that the liver makes. That your brain can use as an alternate energy source. But carbs need to be very low to get the ketones up to that level versus a more moderate low carb diet. Maybe 50 to 100 grams or so would not be producing a lot. You wouldn't, your liver would not be producing a lot of ketones.

Justin: What kind of things could a person eat and still be in, say, the 50 to 100 gram range? So we're not talking about removing all carbs at that point. We can still eat a lot of carb-containing foods. What are some of the things that a person could eat in that range?

Franziska: In that range, probably, you know, small portions of starchy vegetables like sweet potatoes and root vegetables, like carrots and beets, some fruit, perhaps very high sugar fruit. You really want to minimize like bananas and tropical fruits, like pineapple. They've got a lot of sugar. You can have those in very small portions.

But you could have berries. You could also have berries on a ketogenic diet, but maybe some apples and some other less sweet fruits. And beans perhaps, if they agree with your system and even some grains, depending on how sensitive you are to carbs. And that's something that's kind of trial and error. You may not know if you're eating 250 grams of carbs right now and having some symptoms. You may not know how low you need to go to get blood sugar better controlled.

Justin: Oh, yeah. So on a ketogenic diet, we are getting below 20 grams of carbs a day. And the goal of a ketogenic diet, as you said, is to put the body in a state where the liver is now producing ketones.

Franziska: Yes.

Justin: So why would a person want to go that low to be on a ketogenic diet versus just low carb?

Franziska: That's a great question. And for some people, for therapeutic purposes, like people with brain cancer or other neurological issues, epilepsy, those ketones can actually serve as an alternate fuel source for the brain, which may have trouble using glucose. That's glucose or sugar is the usual fuel. Let's say that the fuel that most people use to fuel their brains. People who have neurological issues may get a lot of benefit from a ketogenic diet. It may help to protect the brain, and it can be used as an alternate energy source.

So that's one group that would often benefit from being ketogenic versus low-carb. Many people also find that low carb diets in general, lower hunger, but ketogenic diets being in ketosis, meaning you have a certain level of concentration of ketones in your blood, actually helps to control hunger better. They get a real appetite suppression from that. So that's another reason you might want to do a ketogenic diet as opposed to a low-carb diet.

And some people just find it's really individual, but it's easier to kind of have a more limited food palate than have to worry about how much fruit can I eat. She said a little bit, but how much is a little bit? They find it easier to just, you know what, I'm not going to eat those fruits. I'm just going to eat, stick basically to meat, vegetables, eggs, and those foods instead, and know that I'll always be in ketosis. And it is easier for me than making the judgment call on how many carbs I can have and trying to keep within a certain range.

Justin: For a family that doesn't have any demonstrable health problems. And they're just looking to tighten up their diet and eat a little better, ketogenic diet is not going to be something that they need to worry about.

Franziska: I don't think so. No, no. For the vast majority of people, a low carb diet is, it will be ample to give them the health benefits that they're looking for.

Justin: I get asked this question sometimes, Audra gets asked this, because now when you go into the grocery store, I mean, things have totally changed over the last five-plus years where now we go into places like Target or Walmart and there will be plenty of products now that say keto on them. It didn't use to be like this at all. And so there's a subtle message that, hey, keto. I mean, that has to be better, right?

So an actual ketogenic diet is not necessary for the vast majority of people. A low-carb approach is going to be perfectly adequate. But another thing, what do you think about all of these keto products that are now on the store shelves? I've found that when I actually look at the nutritional facts and I look at the macronutrient profile, that these actually aren't keto. And…

Franziska: A lot of times they’re not.

Justin: Just for any listeners who don't know, Audra and I had Max on a ketogenic diet for many years, and we've been on and off it for his treatment. So we know what it takes to get into ketosis and it's not easy.

Franziska: Exactly. And some of these products have very questionable sweeteners in them that actually can raise blood sugar. IMO's, those can raise blood sugar as much as sugar can.

Justin: So what's an IMO?

Franziska: I said IMO because they're hard to pronounce. Isomaltooligosaccharide.

Justin: Oh, that's a mouthful for ya.

Franziska: Yeah, those are used in syrups, some sweet syrups, and then some low-carb and keto products, mostly keto products, because they can check their will be called a fiber, and then they subtract that fiber from the total carbs and give you a net carb of two or three grams, when in reality, if they're using a lot of IMO's, it could be 10, 15 grams per serving. But someone could think they're only two or three and do a couple of servings and think they're still doing great.

The same thing with sweetener. Now, to tell this, in so many chocolate bars and candies, the thing is, you see them all, only a couple of grams of carb. I can have all I want of these because they're so keto, are so low-carb friendly. And yet again, it's a type of sugar alcohol that can be partially metabolized and raise your blood sugar, therefore decreasing your ketones and you're no longer keto or necessarily even low carb if you're eating a lot of them. So I do think that you need to be very, very careful when you choose keto products. Some of them are just fine. But, you know, it's a craze right now with keto and they're trying to capitalize on that.

Justin: I find many of them to be fine when I look through the ingredients. I don't have a problem with the vast majority of the keto products out there. It's just that they're not keto in the sense that to really get into ketosis, you need a lot of fat and you need to be very moderate with your protein. And many of these keto products have a lot of protein, not necessarily a bad thing. It's just not going to get you into ketosis.

Franziska: Right.

Justin: So we've covered low carb ketogenic. What about Atkins? So if I'm sure there are parents, you've heard of that and they're thinking, what's the difference?

Franziska: Yeah. So Atkins is interesting. It starts off with what's called an induction phase, which is essentially a keto diet. It's less than 20 grams a day. And it actually limits some vegetables depending on how many carbs they have. But it really does allow unlimited amounts of meat and fat. So in that way, it's a little different than a therapeutic keto diet that's meant to increase ketones with the carb levels very low to start.

And the whole idea is to put you in at least mild ketosis and then to keep your hunger down and get you used to eating this way, and then you go through different phases. Phase one, phase two, where you kind of add bad carbs and see how it affects your appetite. See how it affects your weight. Blood sugar. And you kind of find the right carb level for you.

So I actually kind of like that approach for some people. You know, you find what works best for you. And some people may do best, about 20 to 25 grams a carb indefinitely. And others may be able to tolerate between 50 and 100 grams and do really well. But it all almost always or they actually recommend that you do start at the very strict level and then work your way up.

Justin: Paleo. So I'm sure many parents have heard of paleo and they're thinking it might fit into this low-carb world in some way or another. How do you think about Paleo in regard to these other low-carb approaches?

Franziska: Paleo is interesting because it is much lower in carbs than like a standard American diet, but it includes some high-carb foods as well. It's you know, it's basically whole foods, which is great. No dairy, though, or, you know, a primal approach allows some dairy, a paleo, strict paleo approach, though, no dairy, no beans. So no legumes, like even peanuts or anything like that.

And they do technically allow some high-carb fruits and honey even as a sweetener rather than anything artificially sweetened, only natural. So you're going to use a sweetener, use honey. I think they allow stevia leaves, but no stevia processed. So it's basically Hunter-Gatherer, what would people have eaten, you know, millions of years ago? Obviously, we have different food and different animals around different plants. And we had them, but as close to the way that they ate before the invention of modern agriculture as possible.

Justin: So it can be low carb because it doesn't have things like sugar or grains. And yeah, but it can be just as high carb if all we eat is sweet potatoes.

Franziska: Yes. Potatoes and fruit. All right. Yes, sweet potatoes and fruit for almost every meal, then you're certainly going to be getting a lot more carbs than when you get on a low-carb diet.

Justin: Awesome. Ok, so the fourth low carb approach that I wanted to ask about, and then I threw Paleo and there's the fifth is something that I've seen at Diet Doctor over the past several months is a more high-protein approach. I know there are different names for this approach, but can you tell us about this more high protein approach that the Diet Doctor has started to focus on?

Franziska: Yeah, so it's high protein. And what does that mean? Believe it or not, we're still trying to figure out exactly what it means. Diet Doctor...exactly how much protein it is. But it's basically trying to get the most protein per calorie for people who want to lose weight.

Justin: Can I just pause there? So we want to increase protein per calorie?

Franziska: Right.

Justin: All right. So for every calorie we eat, we want the percentage of the protein to be in what range? So if we're eating like 1,000 calories, how much of that should be a protein?

Franziska: So on a high-protein approach, over 30%.

Justin: So 300 calories of that one thousand calories would be protein.

Franziska: 300 as a minimum. And sometimes a little higher.

Justin: Ok.

Franziska: So that's what we're saying for now. And what that means in absolute grams per day is going to depend on the calorie amount that you eat. So a very small woman would have a lower, even if she's eating a high protein diet for her, would be a lot lower in protein than someone like my boss at Diet Doctor who is 6’7”. So, high protein diet looks very different. But they're for the amount of protein per calorie that you're eating, it's similar amounts. So it's just, it's really, yes, focusing on high protein, but not low fat and it's still low carb.

You can even do it, I don't want to say ketogenic exactly because it's not high fat, but at a very low carb level, less than 20 grams of carbs per day, if you want. But we are really recommending that most people do a more moderate, low carb, maybe 30 to 60 grams of net carbs.

And I'll just briefly recommend, mention what net carbs are; that's total carbs, minus all fiber that naturally occurs in food, avocados actually are pretty high in total carbs, but most of them, most of it’s fiber. So when you subtract that out, it becomes a very low-carb friendly food.

Justin: And we subtract out this naturally occurring fiber because it doesn't get turned into blood sugar.

Franziska: Exactly. It either passes right through your system or is converted into fatty acids by gut bacteria. But it does not increase your blood sugar. It does not have any effect on your insulin.

Justin: So with this high protein approach, is it that the concern is less about the carb amount and more of a focus on the protein and that it's really carbs and fat are seen as just together, as just a source of energy?

Franziska: It is.

Justin: Can you explain that part a little bit?

Franziska: Yes. On a high protein diet, or at least the way we're viewing it. We want to maximize calories from protein and not get too much energy from nonprotein sources like carbohydrates and fat. Now, protein is not there to provide energy so much. It's there for muscle building, for preventing bone loss. And protein also can, just like being in ketosis, getting more protein can have an effect on satiety. There are studies that show this.

So for those reasons, we say prioritize protein. You're still, though, if you're getting 30, 35, or even 40% of calories from protein, that's still not more than the fat and carbs put together. So you're still percentage-wise, not getting as much. You probably will be getting more calories from fat than protein if you're following a low carb approach, but just not as many calories from fat as you would on a ketogenic diet or even a low carb approach that has lower protein.

Justin: Awesome. And then one word you used from the science world, satiety. So that's just feeling full.

Franziska: Feeling full and satisfied. So that you eat less. Yes.

Justin: So, ok, so we've covered these different approaches in the low-carb world. So what do you personally prefer for just you, for yourself?

Franziska: So I follow a pretty high protein, low carb diet. I eat probably between 110 to 125 grams of protein per day. I'm five foot eight. It's not terribly high, but it's higher than a lot of people would eat. I eat about 30 to 50 grams of net carbs per day. Total carbs, that's with the fiber of usually 70 or so, because I eat a lot of fiber, a lot of vegetables. And that's what works best for me. Other people I've seen do better with a little less protein, a little more fat. Some people do better with fewer carbs, others with a little more carbs. But that's my personal approach that's worked for me for many years.

Justin: Awesome. Now, this is a tough question, and I totally accept if you just want to say pass, but if you had to recommend an approach just for the average family out there, no major health problems, they just want to do a little better. In what direction would you point them in this low carb world?

Franziska: Yeah, that's a good question. I would say a low carb approach that's moderate, maybe net carbs anywhere from 40 to 60 to start or a little bit more. It depends on the family, I would say. And I again, when we're talking about moderate, I don't think the counting is so important. Like 40 to 60, it could be 30 to 80. You know, it could be a wider range. It could be up to 100 for very active families, really active kids.

You know, the kids, I think up around 100 grams is just fine, maybe more. For moms wanting to lose weight, maybe a little less. So maybe you give them a little more sweet potato and yourself a little less and fill up more on broccoli and some lower-carb vegetables.

Justin: Yeah. Yeah. It strikes me that the counting would be counterproductive.

Franziska: Yes.

Justin: Yeah. That is just too much work. But focusing on food types would be a little more useful. Yeah.

Franziska: Yeah. Yeah. So a good protein source at every meal and no fear of fat. That's something that I mentioned, you know, the way that I used to eat with the Egg Beaters and really being very careful with fat. On a low-carb diet, you have permission to eat more fat. If you're not doing ketogenic diet, you don't have to worry about really dousing everything in butter. But you don't fear fat that can actually make food taste quite a bit better. And the combination of protein and fat is very filling. And then you're getting fiber from vegetables, which is also filling. So it can be a very satisfying diet for everyone.

Justin: Ok, so now I want to get a little bit into the science for parents who want to know, like, why does a low carb diet actually work? Is there some magic sauce in here? The way that I understand it, there are two ways that we can think about this and maybe more that. The first one is that there's some special fattening properties in carbs that because carbohydrate they raise blood sugar, which raises insulin, and this can have knock-on effects with hunger and fat burning.

So there's in the science world, I understand that as the insulin, the carbohydrate-insulin model. And then there's this other approach that it's really focused on hunger and that if we just increase protein and reduce carbs, that we're just not going to be as hungry, and then we're just going to eat less. Are there any other parts of this puzzle that I'm missing?

Franziska: No, I think you summed it up very well. The thing is, we don't have great evidence for either of them. It's hard to say. That's why there's arguments, because we know that low-carb diets work. When you give them to people and you have somebody follow a low-carb diet and a low-fat diet or another type of diet. People end up eating less on a low-carb diet naturally. You tell them they can eat whatever they want and they eat less.

Is that because of insulin or is it because the protein helps them to feel fuller or having more stable blood sugar levels throughout the day without blood sugar and insulin rising and falling? I think it's a combination of both.

But again, we don't have great evidence for either one. We just know that they worked for almost every, almost everyone I know that followed a low carb diet. Whether they have stayed on it long term or not, said “I just wasn't as hungry. I ended up losing weight and I wasn't even that hungry.” And I could go, you know, “I could skip a meal because I wasn't hungry. And why is that?”

Well, we're still trying to figure that out, truly. But I think that blood sugar and insulin are part of it. But I also think that the protein, most people, when they start a low-carb diet, tend to increase the amount of protein when they cut back on carbs, so that can also have an effect.

Justin: Oh yeah. In your professional experience, what are the main reasons that people have a hard time staying on a low-carb diet?

Franziska: Well, it really does come down to personal food preferences, even though there are so many amazing substitutes. For some people, it's just impossible for them to stay on the diet because they either love potatoes or sweets or something so much. I actually find that that's rare, though, for someone who really is interested in health and willing to kind of stick it out.

Beginning can be tough. I find that having a lot of substitutes on hand, being well prepared before you start can make all the difference. One of the big things is at home it may be fairly easy to stay on plan, but then once you go out to eat or you're invited to someone's home, especially in the early stages, it can be really tough. Nobody really wants to impose on their guests or even make a big deal at a restaurant. I can't eat this, what do you have? It gets easier over time. And what's great is that now there's a lot of different options.

But I think those things are hard for a lot of people. And then people have ideas in their head that low-carb just isn't that healthy, that it isn't a way that they can eat forever. And that can be hard to get around too, and especially if they're receiving messages from other people in their lives who aren't supportive. So there's a lot of reasons that low carb can be hard. But I think kind of preparing before you do it and learning about these things and having foods on hand and kind of knowing what to expect can make a huge difference in whether you're successful and able to stick to it.

Justin: Yeah, for us, it was a slow transition when Max was diagnosed in 2011. We just slowly learned about nutrition or the way that nutrition can support him during his treatment. So we moved closer and closer to a ketogenic diet. And when we finally went full in, I mean, it was probably a year and a half of just transitioning slowly, and then we're like, “Ok, let's just take the plunge.”

But I remember when we finally did, going to the grocery stores, I remember going to Trader Joe's in particular, and all of the frozen foods that I used to buy, like I started to look at the nutrition facts and the ingredients. And there were so many I mean, I would probably say 80, 90% of them I just had to put back. It was like, we can't do that anymore. Even though we were making a slow transition when we finally took the leap. Is that all right? We are going to get Max into ketosis and we're going to eat this way.

Oh, there was so much that we had to change. But then learning how to tweak meals, learning how to make the same thing. Oh, we can do spaghetti, but now in a totally different way. We can do mac and cheese, but in a totally different way. And so it was learning about all the different strategies. And then today, of course, it's a lot easier because there are so many products on the market.

Franziska: Absolutely.

Justin: We'll be featuring in The Family Thrive App, a review of high protein, low carb cereals that are now on the market. There were none of these when we started in 2013 when we actually went more stringent toward a ketogenic diet. No cereals like this. No, I don't think there were any breads. There might have been one bread brand. But yeah. So we'll be reviewing cereals. We'll be reviewing low-carb, high-protein pastas. We'll be reviewing low-carb, high-protein breads. All this stuff is now easily available. But we found a wonderful hot dog bun now. So it is a lot easier now.

Franziska: It's much easier now. And I'm glad you have all of those. That sounds great. That’s awesome.

Justin: So, Franziska, what are the biggest misunderstandings around low-carb nutrition that you come across?

Franziska: I just think that a lot of people think that low-carb diets are fad diets, that they're unsustainable, that you can't do them long term, and that they are you know, they basically all you're eating on a low carb diet is butter and bacon. And you don't have a lot of variety. And this just isn't true.

You're only cutting out the very high-carb foods like pasta, bread, potatoes, cereal, and fruits, and sweets, and starches. But you can have everything else. You can still have so many other things. And it really can be a very well-balanced diet.

There was a dietitian from New Zealand who did a study years ago to show that a low-carb diet provides ample amounts of vitamins, minerals, everything you need to be healthy. I think that's another misconception that a low-carb diet lacks some healthy foods like whole grains.

Well, whole grains are great if you tolerate them, but there's nothing magical. There's nothing in whole grains that's unique to them that you can't find in other foods, like vegetables and nuts and seeds. So I think those are the misconceptions. If it's just a very fad-like diet that can't be maintained.

Justin: Oh, yeah. We've been, you know, almost 10, 10 years on a low carb approach in one way and it's just the way we eat now. And the one thing that we found right away was, oh, our plate is mostly vegetables. Like if we do, you know, chicken and broccoli or a steak, you know, it's like half the plate is broccoli. And it didn't use to be like that.

So for a typical meal beforehand, there might be a protein, but then there are definitely be a starch that would be filling up most of the plate and then maybe a little bit of the vegetables on the side. And so now with a low carb approach, it's a lot of veggies. We’ve removed the starch and then keep the protein. I have no doubt that we eat way more veggies today than we did before.

Franziska: I feel the same here and same with all the people that I've ever worked with. And many people have reported to me on what they eat. I eat vegetables at breakfast now, which I never did before. So, you know, I eat vegetables three times a day. And yeah, so it can be extremely healthy and sustainable.

That's the misconception that low carb is a fad diet, it's unbalanced because you're getting lots of nutrition with a low carb diet. If you're doing it in a healthy way, of course, you can just eat, you know, just bacon and eggs for every meal. That's, you know, you get to eat bacon and eggs on a low-carb diet. That's wonderful. But for a really well-balanced diet, you want to include vegetables and some other fruits as well, and lots of different protein sources.

That's what makes the diet healthy, is having a lot of variety. And you can still get lots of variety on the low-carb diet.

Justin: Awesome. So if a family is thinking, you know, we want to move in this direction, we don't need to, you know, drastically reduce carbs or go keto, but we would like to move in this direction. What are a few things they can start to think about changing in from the standard American approach to move in this direction?

Franziska: Well, I would say to start with, get rid of the white starches and sugars in your house, get rid of them, donate to a food bank if you don't want to throw things out. I understand not wanting to throw them out. But if you want to get started on this, that's the first place to start.

If you're already doing whole grains and you've gotten rid of most of the sugar in your life, then I would just start to slowly cut back on those things.

Maybe one at a time. Like, you know, some people love cereal. If whole-grain cereal is the hardest thing to give up. Maybe start with whole-grain pasta first or something else. Just give it up one at a time. Make gradual changes. I like what you did that moving towards it gradually. I think that you can stick to it better. And once you see the results are more motivated to make the next change rather than having to give up everything at once, I think that can lead to failure for a lot of people.

Justin: Oh, absolutely. Well, in our MaxLove Project role, we, of course, interact with a lot of families who are in medical crises and want to make big nutritional changes. And they say, “Ok, we are ready. We're going to clean out the pantry and we're just going to start fresh.” And our response is we've seen bad results coming from that approach because it's a shock, and then after a couple of weeks or a month, everyone says, well, we obviously can't do this, so we just need to go back to the old way.

What we have found through MaxLove Project, the most sustainable approach is to start with just one thing, just say what is one change we can make and we know we can stick with it and it doesn't matter what it is. So just make that change and then stick with it. And then when you feel like you, you have a handle on that change that is now a part of your life. Now you can move to another change.

And so if it's something like, all right, we're just not going to buy really high-carb, sugary cereals, like we're just going to have a different type of breakfast and it almost doesn't matter what it is. So just make that change. And then once you're comfortable with that change, now you can think about another change.

Franziska: Yeah, exactly. That's what works. And it becomes easier with each progressive change. The further you go, the more, the less time you'll have to spend making that change. And before you know it, you're following a low-carb diet and it really isn't painful.

Justin: We all have heard that breakfast is the most important meal of the day. If there was one meal where parents are like, where should I start in moving towards a more high-protein, low-carb approach, would breakfast be the one?

Franziska: I really think so. There is some good research that having a higher protein, lower carb breakfast is a great way to start out, kind of primes your body. This is for kids too. Kids need a lot of protein when they're growing.

But for parents who want to stay full and satisfied and not be tempted by the snack cart at work or something, having a good solid breakfast that's lower in carbs, higher in protein and some fat. I think that's definitely a great way to start your day. Best meal to start with.

Justin: We've had a couple of other dietitians on talking about different aspects of the nutrition world, and we've asked them to bust some food myths because we have found in our time with MaxLove Project over the last 10 years learning more about nutrition and nutrition science, so many myths have been busted for us. You know, like everyone should drink eight glasses of water a day. And it turns out there's just no science around that at all. So do you have a food myth or two that you can bust for us?

Franziska: Well, I like the ones that you already mentioned when we talked before, but I think I'm going to stick with a low carb and say that there's a myth that low carb diets are dangerous long term.

And what they do is they'll say this is proven by studies, but the studies are observational studies where they ask people to fill out a questionnaire of what they eat during a typical week, and they ask them to fill that out a few years later. And then they look to see what kind of diseases or if any of the people passed away. And they find that people who eat lower carbs tend to die earlier or get more heart disease or diabetes. But these are self-reported intakes. And they ask questions like, how many times a week do you eat this? Nobody knows, they’re notoriously inaccurate. And also low carb is considered up to 40 to 45% of calories. Even a moderate low carb diet is usually 20, 25% in calories.

And a ketogenic diet, as we know, is like five percent, five to 10 percent. So these aren't even, even if it was true that the people were eating this amount of carbs. It's not that low carb. And what are they eating, besides which carbs are they eating? It's not that they're following a low carb diet is that they're reporting eating French fries or something twice a week instead of five times a week. And that comes out to be a low-carb diet.

So anything, those correlations are inaccurate. Now, we don't have long-term randomized controlled trials because it's impossible to do a study like that. It would be too expensive. And the number of people. We know that in the short term, they are healthy. They have not been shown to cause kidney damage, liver problems, heart disease or anything else. I can just look at people I know who've been following it for a long time and are healthy. I mean, I've been following for 10 years and in my 50s now, and I'm quite healthy. I'm certainly at least as healthy as I was before I started.

But the person I really look to is Dr. Richard K. Bernstein, who has had type one diabetes since he was 12. He's now [87]. In his 40s, he discovered low carb and started following that diet. He's still practicing. He's extremely healthy. He is the longest term low-carber I know most people with type one have a lower life expectancy, usually have at least one complication, either eye disease or heart disease. He's very healthy and he prescribed his diet about 30 grams of carbs a day is his baseline recommendation for people with type one and type two diabetes, very healthy. So I look to him and to many other people who are thriving on a low carb diet rather than these studies that make a low carb diet look scary.

Justin: Oh, yeah, every time I've heard the claim that low carb is bad for you, the person making that claim is always pointing to observational studies. And as you said, they simply ask people what they ate and then they follow them over some time. And so these people are not following a low carb diet. They are just simply reporting what they eat.

So if there's a person who says, you know what, I don't like vegetables, I don't and I don't eat that many French fries, I just eat a lot of steak or I eat a lot of hamburgers or whatever the case is, they may or may not be following a low carb diet. They may just have, say, 40% of their calories from carbs rather than 60%. But they're not following an actual low-carb diet.

Then the other thing that I found, when you dig into the tables, when you dig into the data in these observational studies, invariably I've seen this in every single observational study that opponents of low carb approaches point to is that the lower carbohydrate a person eats, the more cigarettes they smoke, the more alcohol they drink, the lower their income is, the lower their education. So there is clearly many other things going on in the epidemiology world. This would be called the healthy user bias.

Franziska: Yes. And it's the same thing for vegetarians, is the same thing for people who… do all the right things.

Justin: They're also going to the doctor more regularly. They're higher educated, higher income. Right. And well, there's another. So there's the healthy user bias. It's also called the healthy adhere bias, which I like that because there are other studies that have shown that people who are in randomized controlled trials for some drug trials, that the people who take their placebos more regularly are also healthier.

There's some phenomenon where people who are simply more conscientious, who listen to public health advice, who listen to what their doctors say are also happening to be doing a ton of other things that lead to better health.

And so what we see in these observational studies is people who are not following the conventional public health advice to eat less meat, eat more whole grains, right, who are going in the opposite direction of the public health advice, have all of these other poor health behaviors as well.

I know that I've seen at least one study that has gone so far as to pull out individuals who have healthy behaviors, who report having healthy behaviors, but who also report low carbohydrate intake, or I believe this is a study about high meat intake. And in the one study that I'm thinking of and we will link it in the show notes, individuals who are eating a lot of meat, but who are also doing all the other healthy things that, you know, a person should; going to see the doctor regularly exercising and such that they have just as good health outcomes as the individuals who are eating low meat, but are also doing the exercising and going to see the doctor. So meat is not the issue. All right.

Franziska: Meat is definitely not the issue.

Justin: If you just look at these observational studies that simply look at low carb or meat intake and they don't adjust, well, sometimes they will adjust for some things like smoking, but and some other variables.

But there are so many unmeasured variables that go along with all of these lifestyle choices that essentially these observational studies are useless.

Franziska: Exactly. Exactly. But they're the ones that get reported. You know, everyone shares them and you hear them on the news. And I know. Yeah, I agree with you.

Justin: Oh, thank you for busting it. One quick thing, because I do know when it comes to high protein, one thing that is just rampant, is just so common out there. And we work with a lot of doctors just in the cancer world with us here this well, you know, you don't want to eat too high protein because it's going to hurt your kidneys. So can you tell us about this?

Franziska: Yeah, they've actually not found that in any studies, randomized control trials and meta-analysis, of them. So several controlled trials together, they haven't shown that eating higher protein causes any problems to people who have normal kidney function, people with impaired kidney function, especially late-stage kidney disease, definitely higher protein intake can lead to faster progression of the disease. But people with normal, healthy livers and healthy kidneys, eating a higher protein diet has not been shown to jeopardize kidney health. And in fact, people who eat a low carb, higher protein diet that have diabetes, they have shown that that can be protective because it helps to control blood sugar to be on lower carbs. So…

Justin: We can put that one to rest.

Franziska: We can put that one to rest, too. Yes.

Justin: Yeah. Awesome. All right. So let's start wrapping up by checking in with what you think are some of the most interesting things happening either in food product space, if you've seen any cool new food products or the nutrition science space, like what's kind of the cutting edge for you?

Franziska: Well, you know, we almost already talked about it because it's all of the availability of all of these new foods that help support either low-carb or gluten-free lifestyle. I’m seeing it in grocery stores, I'm seeing it in restaurants, both fast food and regular restaurants. Chipotle now has cauliflower rice.

Justin: Yeah.

Franziska: Blaze pizza. Do you have it in Georgia?

Justin: No, but we did back in Orange County, so I'm familiar.

Franziska: Yeah, they had a keto crust. They have a gluten-free crust. And for people who want to do a vegan diet, they have a vegan crust. I really think that, you know, just supporting people by making all these options available and sweeteners too, I think have come a long way. Allulose is a fantastic sweetener too, so much like sugar. When people talk about, “I can't do sugar substitutes because they all have an aftertaste.” Like, “Have you tried allulose?”

Justin: I put this in the show notes.

Franziska: Yes.

Justin: Yes.

Franziska: Take a taste test. And I'm telling you, you won't be able to tell the difference. It tastes just like sugar. So I just...

Justin: It’s magic.

Franziska: Yes. I'm just finding it to be making it so much easier for people who want to follow whichever dietary plan. The food manufacturers are listening. They want to help people who want to make these healthy lifestyle choices. So that's really what I'm seeing. It's a wonderful time to start. Yes, just like you have been doing this for about 10 years, and it's fantastic since it's a good time to start.

Justin: And when we started, we would have to put our whole head of cauliflower through the food processor to get cauliflower rice. And it was just every time just mess everywhere was such a hassle. And the rice bits never turned out exactly the way we wanted them. And now there is frozen cauliflower rice in literally every grocery store: Walmart, Target, big grocery store, small one, it’s like everywhere now.

Franziska: It's everywhere. I love it. And I also see for people who don't have time to do that, zucchini spirals, at least in my grocers. Do they have those already spiraled for you in my just Publix, which are basically the only grocery store we have here in Florida? So they're really, really listening to demand from customers. It's great. And I love the frozen cauliflower rice. In fact, I won't use it tonight because I'm making chili and I love to serve it over cauliflower rice. So much easier than grating it for yourself.

Justin: It really does take the place of rice. And at the same time, you're getting this cruciferous vegetable with a ton of micronutrients and fiber and all this wonderful stuff. It's just…

Franziska: It’s the best of both worlds.

Justin: It is the best. Ok, so I'm going to end with questions that we ask every guest. So the first one is, if you could put a Post-it note on every parent's refrigerator for tomorrow morning, what would that Post-it note say?

Franziska: Ok. Start your day with a high-protein, low-carb breakfast. Eggs if you already have any boiled, if you don't have boiled make yourself a quick omelet or eggs and frozen kale or something that’s already washed and done for you. And you're good.

Justin: Brilliant. And then, last question. What is the last quote you heard that really inspired you?

Franziska: Ok, so this is something I actually heard somebody say, I didn't read it online, and it was just last week, I was watching America's Got Talent, and there was a woman 30 years old who was a singer, a fantastic singer, and she has metastatic cancer. And she said, “You can't wait until things get better to start being happy.”

And she said she was given a 2% chance to live. But she says the 2% chance isn't a zero percent chance. And I just want to do everything that I can do to be happy and to be, you know, to make the most of my life. And I think we all feel this way. This isn't changed anything I felt. But when I hear these stories from people who are just so courageous, it does something to my heart. I was in tears and I thought that's what you should do. Just never wait. Don't say I'm going to wait until I've lost weight to do this. I'm going to wait until our house is in order to do this. Do it now. Nobody knows how much time I have. She has a 2% chance, I hope to God that she makes it. But none of us really know what's going to come.

So I say, you know, live every day to the fullest and be grateful for what you have and to start living your best life right now. And don't wait until everything's perfect, because things are always going to come up. There's never going to be a perfect time, the perfect time to start doing something is now.

Justin: Don't wait to be happy. I love it. Thank you so much, Franziska. This is a wonderful conversation. I think it is going to be so helpful to parents to break all of this complex nutritional science down into really easy bite-sized chunks, so to speak. Thank you so much for your time.

Franziska: Oh, thank you very much for having me, Justin. It was my pleasure. Love talking to you. And I'll talk to you soon.

Justin: Oh, absolutely. We'll have you back on that.

Franziska: That's great. Thank you so much.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We’re so grateful, you've chosen to join us on this Family Thrive journey.


Justin: We met Franziska when she had just transitioned from being a clinical dietician with the VA to private practice as “The Low Carb Dietitian.” We were looking for a dietitian who could help childhood cancer families reduce sugars and refined grains and boost healthy proteins and veggies, and she was a perfect fit. Over the years, we have watched as she has become a world-renowned expert on the science behind nutrient-dense, whole food eating. She is the author of The Low Carb Dietitian’s Guide to Health and Beauty, and has been an expert contributor at Healthline.com, and is now at DietDoctor.com. 

In this episode, you’ll learn all about low carb nutrition for families, the difference between keto and low carb, why low carb eating works, the myths surrounding low carb approaches, and how to start incorporating low carb eating into your family’s routine. Without further ado, here is my conversation with the amazing Franziska Spritzler. 

So, Franziska, thank you so much again for taking time out of your day to be here with us on The Family Thrive Podcast. 

Franziska: My pleasure. I'm thrilled to be here.

Justin: Yeah. So we have known each other for a number of years. I actually have lost track. So we first met when we asked you to help out with MaxLove Project. So can you tell us a little bit about your memories of how we kind of first started to work together?

Franziska: Yeah. Well, I met you at a conference in Tampa in 2016, Metabolic Health Conference, and we talked a bit about working with MaxLove. And then I met with Audra and I started working with some of the parents of children with cancer who were in like the MaxLove Support Group on Facebook. And that's how we initially started working together. And it was a wonderful experience for me.

Justin: We loved it. And the feedback we have from families was just amazing. They love you. And this was yeah, this was the beginning of a really wonderful relationship. And at the time, you at least were known to us primarily as the Low Carb Dietitian. So that was….

Franziska: Yeah.

Justin: So that was your handle on, you know, in the web world, the Low Carb Dietitian, and you were able to help our families move in the direction of a diet that would reduce blood sugar or reduce insulin and help as an adjunctive modality as they were going through cancer treatments.

So can you tell us a little bit about what has happened since then for you? So you were the Low Carb Dietitian. You still are. People can find you at lowcarbdietitian.com. But where has life taken you since then?

Franziska: Well, when I was working with you, I was in private practice in California. And I've since moved to Florida and I no longer see people in private practice. I write exclusively for dietdoctor.com, and they are low-carb websites. They provide lots of resources to people, ketogenic diets, low carb diets, and just people who want to get healthier. So that's what I do full time now.

I do miss the consulting that I used to do with your families and other people, but I feel like I can reach a kind of a larger audience with my writing. And we're also planning to do some other helpful things, even a coaching program that we're trying to put together.

Justin: So what drew you to low carb in the first place? So this has been a part of your life for more than a couple of years. What can you take us through that personal evolution?

Franziska: Absolutely. So I actually became a dietitian a little bit later in life. I'd already been a court reporter up until 2008. Then I was a dietitian. I practiced traditional guidelines, kind of lower fat, lots of healthy whole grains. Up until 2011, when I found out that my A1C was 5.6%, and that's not terribly high, but it's just below prediabetes, which is 5.7%.

Justin: Oh, so for the listeners A1C. So what does that mean?

Franziska: OK, so hemoglobin A1C is a measure of long-term blood sugar over about three months. And it's not just your fasting blood sugar, which you'll usually get that on a lab and it'll say glucose. That's your fasting glucose or fasting blood sugar. Mine was always normal. I was around 80, but my A1C was quite high, almost prediabetes range. So that was concerning to me. I started testing my blood sugar and realizing that although I had a very nice fasting blood sugar, it was going up very high after eating what I thought were healthy meals.

So I began doing a little research and discovered that people with prediabetes, which it seemed like I had, could get really good results by cutting back on carbs. And that made sense to me because carbohydrates increase blood sugar more than protein or fat does. But I never thought it was a problem for me. I began cutting back, though, and I noticed when I tested my blood sugar, my levels were much better controlled and the lower I ate, the less it went up and the more well-controlled I was. I also discovered that I wasn't hungry as often and I never, didn't need to snack anymore.

So I found this a huge benefit and realized that maybe I was providing information to people with diabetes and prediabetes that wasn't so helpful because it kept them hungry, snacking all day with blood sugar levels kind of going up and down and needing a lot of medication to manage it.

Justin: What was that information that you were giving to patients before coming to low carb? What was that like?

Franziska: So having a very balanced plate. So you want a portion of some kind of grains or potatoes or starch, a small portion of meat and vegetables and maybe a glass of milk for calcium. So that sounds pretty balanced. And making sure not to add a lot of fat to your food, maybe using Egg Beaters instead of eggs to avoid extra fat. So that's the way that I ate and that's the way that I was recommending that other people eat. And I thought it was a healthy way to eat. And it is for some people. Some people do really well with that.

But people who have any kind of blood sugar or metabolic issues tend to do better with lower carbs. But this isn't what's taught in dietetics programs. It certainly wasn't followed in the hospital that I worked at. I worked at a hospital at that time at the VA hospital in Long Beach, California. So, and it wasn't accepted there, which is why after a couple of years of getting increasingly frustrated of not being able to recommend this to patients that I left to go into private practice.

Justin: So that's where the Low Carb Dietitian was born, you were see…

Franziska: Yeah.

Justin: So you saw it first in yourself and you saw it first in your own lab values that when you started to shift the way that you ate these important numbers began to improve, primarily this A1C.

Franziska: The A1C went down from 5.6% to 5%, and it's been there ever since. That was in 2011, by the way. So it's been 10 years. And my blood sugars have been well controlled that entire time. I've been eating low carb the entire time.

Justin: All right. So let's get into the low carb. Like what I really want to get out of this podcast is to give parents an idea of what low carb is like, what it can do with the different scientific rationales for it, because our approach to nutrition, it's focused on whole foods, but there's a component to it where we really want to reduce refined carbohydrates, we want to reduce sugar, and it ends up looking like a low-carb approach.

And so we want to get a handle on this, like what is this and what are the differences between some of the terms that flow around in the low carb world. So can you give us an idea of what the differences between, say, a low-carb approach, other words that parents might know, like ketogenic or paleo or Atkins? So how about we just start with low-carb versus ketogenic? How could we distinguish between those?

Franziska: Ok, so low-carb is a very broad term that kind of encompasses all of those terms that you just brought up, paleo and ketogenic and Atkins. So low carb is just a reduced carbohydrate diet.

So carbs are found in many foods, but primarily things like bread, pasta, potatoes, fruit, and fruit juice. And then in refined carbs, as you talked about, sugars and sweets and potato chips and things like that. So a low carb diet reduces those anywhere from about 20 grams per day, up to 100 grams per day. The average person eats roughly 250 to 350 grams of carbs a day. So a low carb diet can be anywhere in there, but a ketogenic diet is at the very low range of that 20 to 100.

And the purpose of a ketogenic diet is to increase the number of ketones in your blood so they can be used by the brain. Ketones are fat-like compounds that the liver makes. That your brain can use as an alternate energy source. But carbs need to be very low to get the ketones up to that level versus a more moderate low carb diet. Maybe 50 to 100 grams or so would not be producing a lot. You wouldn't, your liver would not be producing a lot of ketones.

Justin: What kind of things could a person eat and still be in, say, the 50 to 100 gram range? So we're not talking about removing all carbs at that point. We can still eat a lot of carb-containing foods. What are some of the things that a person could eat in that range?

Franziska: In that range, probably, you know, small portions of starchy vegetables like sweet potatoes and root vegetables, like carrots and beets, some fruit, perhaps very high sugar fruit. You really want to minimize like bananas and tropical fruits, like pineapple. They've got a lot of sugar. You can have those in very small portions.

But you could have berries. You could also have berries on a ketogenic diet, but maybe some apples and some other less sweet fruits. And beans perhaps, if they agree with your system and even some grains, depending on how sensitive you are to carbs. And that's something that's kind of trial and error. You may not know if you're eating 250 grams of carbs right now and having some symptoms. You may not know how low you need to go to get blood sugar better controlled.

Justin: Oh, yeah. So on a ketogenic diet, we are getting below 20 grams of carbs a day. And the goal of a ketogenic diet, as you said, is to put the body in a state where the liver is now producing ketones.

Franziska: Yes.

Justin: So why would a person want to go that low to be on a ketogenic diet versus just low carb?

Franziska: That's a great question. And for some people, for therapeutic purposes, like people with brain cancer or other neurological issues, epilepsy, those ketones can actually serve as an alternate fuel source for the brain, which may have trouble using glucose. That's glucose or sugar is the usual fuel. Let's say that the fuel that most people use to fuel their brains. People who have neurological issues may get a lot of benefit from a ketogenic diet. It may help to protect the brain, and it can be used as an alternate energy source.

So that's one group that would often benefit from being ketogenic versus low-carb. Many people also find that low carb diets in general, lower hunger, but ketogenic diets being in ketosis, meaning you have a certain level of concentration of ketones in your blood, actually helps to control hunger better. They get a real appetite suppression from that. So that's another reason you might want to do a ketogenic diet as opposed to a low-carb diet.

And some people just find it's really individual, but it's easier to kind of have a more limited food palate than have to worry about how much fruit can I eat. She said a little bit, but how much is a little bit? They find it easier to just, you know what, I'm not going to eat those fruits. I'm just going to eat, stick basically to meat, vegetables, eggs, and those foods instead, and know that I'll always be in ketosis. And it is easier for me than making the judgment call on how many carbs I can have and trying to keep within a certain range.

Justin: For a family that doesn't have any demonstrable health problems. And they're just looking to tighten up their diet and eat a little better, ketogenic diet is not going to be something that they need to worry about.

Franziska: I don't think so. No, no. For the vast majority of people, a low carb diet is, it will be ample to give them the health benefits that they're looking for.

Justin: I get asked this question sometimes, Audra gets asked this, because now when you go into the grocery store, I mean, things have totally changed over the last five-plus years where now we go into places like Target or Walmart and there will be plenty of products now that say keto on them. It didn't use to be like this at all. And so there's a subtle message that, hey, keto. I mean, that has to be better, right?

So an actual ketogenic diet is not necessary for the vast majority of people. A low-carb approach is going to be perfectly adequate. But another thing, what do you think about all of these keto products that are now on the store shelves? I've found that when I actually look at the nutritional facts and I look at the macronutrient profile, that these actually aren't keto. And…

Franziska: A lot of times they’re not.

Justin: Just for any listeners who don't know, Audra and I had Max on a ketogenic diet for many years, and we've been on and off it for his treatment. So we know what it takes to get into ketosis and it's not easy.

Franziska: Exactly. And some of these products have very questionable sweeteners in them that actually can raise blood sugar. IMO's, those can raise blood sugar as much as sugar can.

Justin: So what's an IMO?

Franziska: I said IMO because they're hard to pronounce. Isomaltooligosaccharide.

Justin: Oh, that's a mouthful for ya.

Franziska: Yeah, those are used in syrups, some sweet syrups, and then some low-carb and keto products, mostly keto products, because they can check their will be called a fiber, and then they subtract that fiber from the total carbs and give you a net carb of two or three grams, when in reality, if they're using a lot of IMO's, it could be 10, 15 grams per serving. But someone could think they're only two or three and do a couple of servings and think they're still doing great.

The same thing with sweetener. Now, to tell this, in so many chocolate bars and candies, the thing is, you see them all, only a couple of grams of carb. I can have all I want of these because they're so keto, are so low-carb friendly. And yet again, it's a type of sugar alcohol that can be partially metabolized and raise your blood sugar, therefore decreasing your ketones and you're no longer keto or necessarily even low carb if you're eating a lot of them. So I do think that you need to be very, very careful when you choose keto products. Some of them are just fine. But, you know, it's a craze right now with keto and they're trying to capitalize on that.

Justin: I find many of them to be fine when I look through the ingredients. I don't have a problem with the vast majority of the keto products out there. It's just that they're not keto in the sense that to really get into ketosis, you need a lot of fat and you need to be very moderate with your protein. And many of these keto products have a lot of protein, not necessarily a bad thing. It's just not going to get you into ketosis.

Franziska: Right.

Justin: So we've covered low carb ketogenic. What about Atkins? So if I'm sure there are parents, you've heard of that and they're thinking, what's the difference?

Franziska: Yeah. So Atkins is interesting. It starts off with what's called an induction phase, which is essentially a keto diet. It's less than 20 grams a day. And it actually limits some vegetables depending on how many carbs they have. But it really does allow unlimited amounts of meat and fat. So in that way, it's a little different than a therapeutic keto diet that's meant to increase ketones with the carb levels very low to start.

And the whole idea is to put you in at least mild ketosis and then to keep your hunger down and get you used to eating this way, and then you go through different phases. Phase one, phase two, where you kind of add bad carbs and see how it affects your appetite. See how it affects your weight. Blood sugar. And you kind of find the right carb level for you.

So I actually kind of like that approach for some people. You know, you find what works best for you. And some people may do best, about 20 to 25 grams a carb indefinitely. And others may be able to tolerate between 50 and 100 grams and do really well. But it all almost always or they actually recommend that you do start at the very strict level and then work your way up.

Justin: Paleo. So I'm sure many parents have heard of paleo and they're thinking it might fit into this low-carb world in some way or another. How do you think about Paleo in regard to these other low-carb approaches?

Franziska: Paleo is interesting because it is much lower in carbs than like a standard American diet, but it includes some high-carb foods as well. It's you know, it's basically whole foods, which is great. No dairy, though, or, you know, a primal approach allows some dairy, a paleo, strict paleo approach, though, no dairy, no beans. So no legumes, like even peanuts or anything like that.

And they do technically allow some high-carb fruits and honey even as a sweetener rather than anything artificially sweetened, only natural. So you're going to use a sweetener, use honey. I think they allow stevia leaves, but no stevia processed. So it's basically Hunter-Gatherer, what would people have eaten, you know, millions of years ago? Obviously, we have different food and different animals around different plants. And we had them, but as close to the way that they ate before the invention of modern agriculture as possible.

Justin: So it can be low carb because it doesn't have things like sugar or grains. And yeah, but it can be just as high carb if all we eat is sweet potatoes.

Franziska: Yes. Potatoes and fruit. All right. Yes, sweet potatoes and fruit for almost every meal, then you're certainly going to be getting a lot more carbs than when you get on a low-carb diet.

Justin: Awesome. Ok, so the fourth low carb approach that I wanted to ask about, and then I threw Paleo and there's the fifth is something that I've seen at Diet Doctor over the past several months is a more high-protein approach. I know there are different names for this approach, but can you tell us about this more high protein approach that the Diet Doctor has started to focus on?

Franziska: Yeah, so it's high protein. And what does that mean? Believe it or not, we're still trying to figure out exactly what it means. Diet Doctor...exactly how much protein it is. But it's basically trying to get the most protein per calorie for people who want to lose weight.

Justin: Can I just pause there? So we want to increase protein per calorie?

Franziska: Right.

Justin: All right. So for every calorie we eat, we want the percentage of the protein to be in what range? So if we're eating like 1,000 calories, how much of that should be a protein?

Franziska: So on a high-protein approach, over 30%.

Justin: So 300 calories of that one thousand calories would be protein.

Franziska: 300 as a minimum. And sometimes a little higher.

Justin: Ok.

Franziska: So that's what we're saying for now. And what that means in absolute grams per day is going to depend on the calorie amount that you eat. So a very small woman would have a lower, even if she's eating a high protein diet for her, would be a lot lower in protein than someone like my boss at Diet Doctor who is 6’7”. So, high protein diet looks very different. But they're for the amount of protein per calorie that you're eating, it's similar amounts. So it's just, it's really, yes, focusing on high protein, but not low fat and it's still low carb.

You can even do it, I don't want to say ketogenic exactly because it's not high fat, but at a very low carb level, less than 20 grams of carbs per day, if you want. But we are really recommending that most people do a more moderate, low carb, maybe 30 to 60 grams of net carbs.

And I'll just briefly recommend, mention what net carbs are; that's total carbs, minus all fiber that naturally occurs in food, avocados actually are pretty high in total carbs, but most of them, most of it’s fiber. So when you subtract that out, it becomes a very low-carb friendly food.

Justin: And we subtract out this naturally occurring fiber because it doesn't get turned into blood sugar.

Franziska: Exactly. It either passes right through your system or is converted into fatty acids by gut bacteria. But it does not increase your blood sugar. It does not have any effect on your insulin.

Justin: So with this high protein approach, is it that the concern is less about the carb amount and more of a focus on the protein and that it's really carbs and fat are seen as just together, as just a source of energy?

Franziska: It is.

Justin: Can you explain that part a little bit?

Franziska: Yes. On a high protein diet, or at least the way we're viewing it. We want to maximize calories from protein and not get too much energy from nonprotein sources like carbohydrates and fat. Now, protein is not there to provide energy so much. It's there for muscle building, for preventing bone loss. And protein also can, just like being in ketosis, getting more protein can have an effect on satiety. There are studies that show this.

So for those reasons, we say prioritize protein. You're still, though, if you're getting 30, 35, or even 40% of calories from protein, that's still not more than the fat and carbs put together. So you're still percentage-wise, not getting as much. You probably will be getting more calories from fat than protein if you're following a low carb approach, but just not as many calories from fat as you would on a ketogenic diet or even a low carb approach that has lower protein.

Justin: Awesome. And then one word you used from the science world, satiety. So that's just feeling full.

Franziska: Feeling full and satisfied. So that you eat less. Yes.

Justin: So, ok, so we've covered these different approaches in the low-carb world. So what do you personally prefer for just you, for yourself?

Franziska: So I follow a pretty high protein, low carb diet. I eat probably between 110 to 125 grams of protein per day. I'm five foot eight. It's not terribly high, but it's higher than a lot of people would eat. I eat about 30 to 50 grams of net carbs per day. Total carbs, that's with the fiber of usually 70 or so, because I eat a lot of fiber, a lot of vegetables. And that's what works best for me. Other people I've seen do better with a little less protein, a little more fat. Some people do better with fewer carbs, others with a little more carbs. But that's my personal approach that's worked for me for many years.

Justin: Awesome. Now, this is a tough question, and I totally accept if you just want to say pass, but if you had to recommend an approach just for the average family out there, no major health problems, they just want to do a little better. In what direction would you point them in this low carb world?

Franziska: Yeah, that's a good question. I would say a low carb approach that's moderate, maybe net carbs anywhere from 40 to 60 to start or a little bit more. It depends on the family, I would say. And I again, when we're talking about moderate, I don't think the counting is so important. Like 40 to 60, it could be 30 to 80. You know, it could be a wider range. It could be up to 100 for very active families, really active kids.

You know, the kids, I think up around 100 grams is just fine, maybe more. For moms wanting to lose weight, maybe a little less. So maybe you give them a little more sweet potato and yourself a little less and fill up more on broccoli and some lower-carb vegetables.

Justin: Yeah. Yeah. It strikes me that the counting would be counterproductive.

Franziska: Yes.

Justin: Yeah. That is just too much work. But focusing on food types would be a little more useful. Yeah.

Franziska: Yeah. Yeah. So a good protein source at every meal and no fear of fat. That's something that I mentioned, you know, the way that I used to eat with the Egg Beaters and really being very careful with fat. On a low-carb diet, you have permission to eat more fat. If you're not doing ketogenic diet, you don't have to worry about really dousing everything in butter. But you don't fear fat that can actually make food taste quite a bit better. And the combination of protein and fat is very filling. And then you're getting fiber from vegetables, which is also filling. So it can be a very satisfying diet for everyone.

Justin: Ok, so now I want to get a little bit into the science for parents who want to know, like, why does a low carb diet actually work? Is there some magic sauce in here? The way that I understand it, there are two ways that we can think about this and maybe more that. The first one is that there's some special fattening properties in carbs that because carbohydrate they raise blood sugar, which raises insulin, and this can have knock-on effects with hunger and fat burning.

So there's in the science world, I understand that as the insulin, the carbohydrate-insulin model. And then there's this other approach that it's really focused on hunger and that if we just increase protein and reduce carbs, that we're just not going to be as hungry, and then we're just going to eat less. Are there any other parts of this puzzle that I'm missing?

Franziska: No, I think you summed it up very well. The thing is, we don't have great evidence for either of them. It's hard to say. That's why there's arguments, because we know that low-carb diets work. When you give them to people and you have somebody follow a low-carb diet and a low-fat diet or another type of diet. People end up eating less on a low-carb diet naturally. You tell them they can eat whatever they want and they eat less.

Is that because of insulin or is it because the protein helps them to feel fuller or having more stable blood sugar levels throughout the day without blood sugar and insulin rising and falling? I think it's a combination of both.

But again, we don't have great evidence for either one. We just know that they worked for almost every, almost everyone I know that followed a low carb diet. Whether they have stayed on it long term or not, said “I just wasn't as hungry. I ended up losing weight and I wasn't even that hungry.” And I could go, you know, “I could skip a meal because I wasn't hungry. And why is that?”

Well, we're still trying to figure that out, truly. But I think that blood sugar and insulin are part of it. But I also think that the protein, most people, when they start a low-carb diet, tend to increase the amount of protein when they cut back on carbs, so that can also have an effect.

Justin: Oh yeah. In your professional experience, what are the main reasons that people have a hard time staying on a low-carb diet?

Franziska: Well, it really does come down to personal food preferences, even though there are so many amazing substitutes. For some people, it's just impossible for them to stay on the diet because they either love potatoes or sweets or something so much. I actually find that that's rare, though, for someone who really is interested in health and willing to kind of stick it out.

Beginning can be tough. I find that having a lot of substitutes on hand, being well prepared before you start can make all the difference. One of the big things is at home it may be fairly easy to stay on plan, but then once you go out to eat or you're invited to someone's home, especially in the early stages, it can be really tough. Nobody really wants to impose on their guests or even make a big deal at a restaurant. I can't eat this, what do you have? It gets easier over time. And what's great is that now there's a lot of different options.

But I think those things are hard for a lot of people. And then people have ideas in their head that low-carb just isn't that healthy, that it isn't a way that they can eat forever. And that can be hard to get around too, and especially if they're receiving messages from other people in their lives who aren't supportive. So there's a lot of reasons that low carb can be hard. But I think kind of preparing before you do it and learning about these things and having foods on hand and kind of knowing what to expect can make a huge difference in whether you're successful and able to stick to it.

Justin: Yeah, for us, it was a slow transition when Max was diagnosed in 2011. We just slowly learned about nutrition or the way that nutrition can support him during his treatment. So we moved closer and closer to a ketogenic diet. And when we finally went full in, I mean, it was probably a year and a half of just transitioning slowly, and then we're like, “Ok, let's just take the plunge.”

But I remember when we finally did, going to the grocery stores, I remember going to Trader Joe's in particular, and all of the frozen foods that I used to buy, like I started to look at the nutrition facts and the ingredients. And there were so many I mean, I would probably say 80, 90% of them I just had to put back. It was like, we can't do that anymore. Even though we were making a slow transition when we finally took the leap. Is that all right? We are going to get Max into ketosis and we're going to eat this way.

Oh, there was so much that we had to change. But then learning how to tweak meals, learning how to make the same thing. Oh, we can do spaghetti, but now in a totally different way. We can do mac and cheese, but in a totally different way. And so it was learning about all the different strategies. And then today, of course, it's a lot easier because there are so many products on the market.

Franziska: Absolutely.

Justin: We'll be featuring in The Family Thrive App, a review of high protein, low carb cereals that are now on the market. There were none of these when we started in 2013 when we actually went more stringent toward a ketogenic diet. No cereals like this. No, I don't think there were any breads. There might have been one bread brand. But yeah. So we'll be reviewing cereals. We'll be reviewing low-carb, high-protein pastas. We'll be reviewing low-carb, high-protein breads. All this stuff is now easily available. But we found a wonderful hot dog bun now. So it is a lot easier now.

Franziska: It's much easier now. And I'm glad you have all of those. That sounds great. That’s awesome.

Justin: So, Franziska, what are the biggest misunderstandings around low-carb nutrition that you come across?

Franziska: I just think that a lot of people think that low-carb diets are fad diets, that they're unsustainable, that you can't do them long term, and that they are you know, they basically all you're eating on a low carb diet is butter and bacon. And you don't have a lot of variety. And this just isn't true.

You're only cutting out the very high-carb foods like pasta, bread, potatoes, cereal, and fruits, and sweets, and starches. But you can have everything else. You can still have so many other things. And it really can be a very well-balanced diet.

There was a dietitian from New Zealand who did a study years ago to show that a low-carb diet provides ample amounts of vitamins, minerals, everything you need to be healthy. I think that's another misconception that a low-carb diet lacks some healthy foods like whole grains.

Well, whole grains are great if you tolerate them, but there's nothing magical. There's nothing in whole grains that's unique to them that you can't find in other foods, like vegetables and nuts and seeds. So I think those are the misconceptions. If it's just a very fad-like diet that can't be maintained.

Justin: Oh, yeah. We've been, you know, almost 10, 10 years on a low carb approach in one way and it's just the way we eat now. And the one thing that we found right away was, oh, our plate is mostly vegetables. Like if we do, you know, chicken and broccoli or a steak, you know, it's like half the plate is broccoli. And it didn't use to be like that.

So for a typical meal beforehand, there might be a protein, but then there are definitely be a starch that would be filling up most of the plate and then maybe a little bit of the vegetables on the side. And so now with a low carb approach, it's a lot of veggies. We’ve removed the starch and then keep the protein. I have no doubt that we eat way more veggies today than we did before.

Franziska: I feel the same here and same with all the people that I've ever worked with. And many people have reported to me on what they eat. I eat vegetables at breakfast now, which I never did before. So, you know, I eat vegetables three times a day. And yeah, so it can be extremely healthy and sustainable.

That's the misconception that low carb is a fad diet, it's unbalanced because you're getting lots of nutrition with a low carb diet. If you're doing it in a healthy way, of course, you can just eat, you know, just bacon and eggs for every meal. That's, you know, you get to eat bacon and eggs on a low-carb diet. That's wonderful. But for a really well-balanced diet, you want to include vegetables and some other fruits as well, and lots of different protein sources.

That's what makes the diet healthy, is having a lot of variety. And you can still get lots of variety on the low-carb diet.

Justin: Awesome. So if a family is thinking, you know, we want to move in this direction, we don't need to, you know, drastically reduce carbs or go keto, but we would like to move in this direction. What are a few things they can start to think about changing in from the standard American approach to move in this direction?

Franziska: Well, I would say to start with, get rid of the white starches and sugars in your house, get rid of them, donate to a food bank if you don't want to throw things out. I understand not wanting to throw them out. But if you want to get started on this, that's the first place to start.

If you're already doing whole grains and you've gotten rid of most of the sugar in your life, then I would just start to slowly cut back on those things.

Maybe one at a time. Like, you know, some people love cereal. If whole-grain cereal is the hardest thing to give up. Maybe start with whole-grain pasta first or something else. Just give it up one at a time. Make gradual changes. I like what you did that moving towards it gradually. I think that you can stick to it better. And once you see the results are more motivated to make the next change rather than having to give up everything at once, I think that can lead to failure for a lot of people.

Justin: Oh, absolutely. Well, in our MaxLove Project role, we, of course, interact with a lot of families who are in medical crises and want to make big nutritional changes. And they say, “Ok, we are ready. We're going to clean out the pantry and we're just going to start fresh.” And our response is we've seen bad results coming from that approach because it's a shock, and then after a couple of weeks or a month, everyone says, well, we obviously can't do this, so we just need to go back to the old way.

What we have found through MaxLove Project, the most sustainable approach is to start with just one thing, just say what is one change we can make and we know we can stick with it and it doesn't matter what it is. So just make that change and then stick with it. And then when you feel like you, you have a handle on that change that is now a part of your life. Now you can move to another change.

And so if it's something like, all right, we're just not going to buy really high-carb, sugary cereals, like we're just going to have a different type of breakfast and it almost doesn't matter what it is. So just make that change. And then once you're comfortable with that change, now you can think about another change.

Franziska: Yeah, exactly. That's what works. And it becomes easier with each progressive change. The further you go, the more, the less time you'll have to spend making that change. And before you know it, you're following a low-carb diet and it really isn't painful.

Justin: We all have heard that breakfast is the most important meal of the day. If there was one meal where parents are like, where should I start in moving towards a more high-protein, low-carb approach, would breakfast be the one?

Franziska: I really think so. There is some good research that having a higher protein, lower carb breakfast is a great way to start out, kind of primes your body. This is for kids too. Kids need a lot of protein when they're growing.

But for parents who want to stay full and satisfied and not be tempted by the snack cart at work or something, having a good solid breakfast that's lower in carbs, higher in protein and some fat. I think that's definitely a great way to start your day. Best meal to start with.

Justin: We've had a couple of other dietitians on talking about different aspects of the nutrition world, and we've asked them to bust some food myths because we have found in our time with MaxLove Project over the last 10 years learning more about nutrition and nutrition science, so many myths have been busted for us. You know, like everyone should drink eight glasses of water a day. And it turns out there's just no science around that at all. So do you have a food myth or two that you can bust for us?

Franziska: Well, I like the ones that you already mentioned when we talked before, but I think I'm going to stick with a low carb and say that there's a myth that low carb diets are dangerous long term.

And what they do is they'll say this is proven by studies, but the studies are observational studies where they ask people to fill out a questionnaire of what they eat during a typical week, and they ask them to fill that out a few years later. And then they look to see what kind of diseases or if any of the people passed away. And they find that people who eat lower carbs tend to die earlier or get more heart disease or diabetes. But these are self-reported intakes. And they ask questions like, how many times a week do you eat this? Nobody knows, they’re notoriously inaccurate. And also low carb is considered up to 40 to 45% of calories. Even a moderate low carb diet is usually 20, 25% in calories.

And a ketogenic diet, as we know, is like five percent, five to 10 percent. So these aren't even, even if it was true that the people were eating this amount of carbs. It's not that low carb. And what are they eating, besides which carbs are they eating? It's not that they're following a low carb diet is that they're reporting eating French fries or something twice a week instead of five times a week. And that comes out to be a low-carb diet.

So anything, those correlations are inaccurate. Now, we don't have long-term randomized controlled trials because it's impossible to do a study like that. It would be too expensive. And the number of people. We know that in the short term, they are healthy. They have not been shown to cause kidney damage, liver problems, heart disease or anything else. I can just look at people I know who've been following it for a long time and are healthy. I mean, I've been following for 10 years and in my 50s now, and I'm quite healthy. I'm certainly at least as healthy as I was before I started.

But the person I really look to is Dr. Richard K. Bernstein, who has had type one diabetes since he was 12. He's now [87]. In his 40s, he discovered low carb and started following that diet. He's still practicing. He's extremely healthy. He is the longest term low-carber I know most people with type one have a lower life expectancy, usually have at least one complication, either eye disease or heart disease. He's very healthy and he prescribed his diet about 30 grams of carbs a day is his baseline recommendation for people with type one and type two diabetes, very healthy. So I look to him and to many other people who are thriving on a low carb diet rather than these studies that make a low carb diet look scary.

Justin: Oh, yeah, every time I've heard the claim that low carb is bad for you, the person making that claim is always pointing to observational studies. And as you said, they simply ask people what they ate and then they follow them over some time. And so these people are not following a low carb diet. They are just simply reporting what they eat.

So if there's a person who says, you know what, I don't like vegetables, I don't and I don't eat that many French fries, I just eat a lot of steak or I eat a lot of hamburgers or whatever the case is, they may or may not be following a low carb diet. They may just have, say, 40% of their calories from carbs rather than 60%. But they're not following an actual low-carb diet.

Then the other thing that I found, when you dig into the tables, when you dig into the data in these observational studies, invariably I've seen this in every single observational study that opponents of low carb approaches point to is that the lower carbohydrate a person eats, the more cigarettes they smoke, the more alcohol they drink, the lower their income is, the lower their education. So there is clearly many other things going on in the epidemiology world. This would be called the healthy user bias.

Franziska: Yes. And it's the same thing for vegetarians, is the same thing for people who… do all the right things.

Justin: They're also going to the doctor more regularly. They're higher educated, higher income. Right. And well, there's another. So there's the healthy user bias. It's also called the healthy adhere bias, which I like that because there are other studies that have shown that people who are in randomized controlled trials for some drug trials, that the people who take their placebos more regularly are also healthier.

There's some phenomenon where people who are simply more conscientious, who listen to public health advice, who listen to what their doctors say are also happening to be doing a ton of other things that lead to better health.

And so what we see in these observational studies is people who are not following the conventional public health advice to eat less meat, eat more whole grains, right, who are going in the opposite direction of the public health advice, have all of these other poor health behaviors as well.

I know that I've seen at least one study that has gone so far as to pull out individuals who have healthy behaviors, who report having healthy behaviors, but who also report low carbohydrate intake, or I believe this is a study about high meat intake. And in the one study that I'm thinking of and we will link it in the show notes, individuals who are eating a lot of meat, but who are also doing all the other healthy things that, you know, a person should; going to see the doctor regularly exercising and such that they have just as good health outcomes as the individuals who are eating low meat, but are also doing the exercising and going to see the doctor. So meat is not the issue. All right.

Franziska: Meat is definitely not the issue.

Justin: If you just look at these observational studies that simply look at low carb or meat intake and they don't adjust, well, sometimes they will adjust for some things like smoking, but and some other variables.

But there are so many unmeasured variables that go along with all of these lifestyle choices that essentially these observational studies are useless.

Franziska: Exactly. Exactly. But they're the ones that get reported. You know, everyone shares them and you hear them on the news. And I know. Yeah, I agree with you.

Justin: Oh, thank you for busting it. One quick thing, because I do know when it comes to high protein, one thing that is just rampant, is just so common out there. And we work with a lot of doctors just in the cancer world with us here this well, you know, you don't want to eat too high protein because it's going to hurt your kidneys. So can you tell us about this?

Franziska: Yeah, they've actually not found that in any studies, randomized control trials and meta-analysis, of them. So several controlled trials together, they haven't shown that eating higher protein causes any problems to people who have normal kidney function, people with impaired kidney function, especially late-stage kidney disease, definitely higher protein intake can lead to faster progression of the disease. But people with normal, healthy livers and healthy kidneys, eating a higher protein diet has not been shown to jeopardize kidney health. And in fact, people who eat a low carb, higher protein diet that have diabetes, they have shown that that can be protective because it helps to control blood sugar to be on lower carbs. So…

Justin: We can put that one to rest.

Franziska: We can put that one to rest, too. Yes.

Justin: Yeah. Awesome. All right. So let's start wrapping up by checking in with what you think are some of the most interesting things happening either in food product space, if you've seen any cool new food products or the nutrition science space, like what's kind of the cutting edge for you?

Franziska: Well, you know, we almost already talked about it because it's all of the availability of all of these new foods that help support either low-carb or gluten-free lifestyle. I’m seeing it in grocery stores, I'm seeing it in restaurants, both fast food and regular restaurants. Chipotle now has cauliflower rice.

Justin: Yeah.

Franziska: Blaze pizza. Do you have it in Georgia?

Justin: No, but we did back in Orange County, so I'm familiar.

Franziska: Yeah, they had a keto crust. They have a gluten-free crust. And for people who want to do a vegan diet, they have a vegan crust. I really think that, you know, just supporting people by making all these options available and sweeteners too, I think have come a long way. Allulose is a fantastic sweetener too, so much like sugar. When people talk about, “I can't do sugar substitutes because they all have an aftertaste.” Like, “Have you tried allulose?”

Justin: I put this in the show notes.

Franziska: Yes.

Justin: Yes.

Franziska: Take a taste test. And I'm telling you, you won't be able to tell the difference. It tastes just like sugar. So I just...

Justin: It’s magic.

Franziska: Yes. I'm just finding it to be making it so much easier for people who want to follow whichever dietary plan. The food manufacturers are listening. They want to help people who want to make these healthy lifestyle choices. So that's really what I'm seeing. It's a wonderful time to start. Yes, just like you have been doing this for about 10 years, and it's fantastic since it's a good time to start.

Justin: And when we started, we would have to put our whole head of cauliflower through the food processor to get cauliflower rice. And it was just every time just mess everywhere was such a hassle. And the rice bits never turned out exactly the way we wanted them. And now there is frozen cauliflower rice in literally every grocery store: Walmart, Target, big grocery store, small one, it’s like everywhere now.

Franziska: It's everywhere. I love it. And I also see for people who don't have time to do that, zucchini spirals, at least in my grocers. Do they have those already spiraled for you in my just Publix, which are basically the only grocery store we have here in Florida? So they're really, really listening to demand from customers. It's great. And I love the frozen cauliflower rice. In fact, I won't use it tonight because I'm making chili and I love to serve it over cauliflower rice. So much easier than grating it for yourself.

Justin: It really does take the place of rice. And at the same time, you're getting this cruciferous vegetable with a ton of micronutrients and fiber and all this wonderful stuff. It's just…

Franziska: It’s the best of both worlds.

Justin: It is the best. Ok, so I'm going to end with questions that we ask every guest. So the first one is, if you could put a Post-it note on every parent's refrigerator for tomorrow morning, what would that Post-it note say?

Franziska: Ok. Start your day with a high-protein, low-carb breakfast. Eggs if you already have any boiled, if you don't have boiled make yourself a quick omelet or eggs and frozen kale or something that’s already washed and done for you. And you're good.

Justin: Brilliant. And then, last question. What is the last quote you heard that really inspired you?

Franziska: Ok, so this is something I actually heard somebody say, I didn't read it online, and it was just last week, I was watching America's Got Talent, and there was a woman 30 years old who was a singer, a fantastic singer, and she has metastatic cancer. And she said, “You can't wait until things get better to start being happy.”

And she said she was given a 2% chance to live. But she says the 2% chance isn't a zero percent chance. And I just want to do everything that I can do to be happy and to be, you know, to make the most of my life. And I think we all feel this way. This isn't changed anything I felt. But when I hear these stories from people who are just so courageous, it does something to my heart. I was in tears and I thought that's what you should do. Just never wait. Don't say I'm going to wait until I've lost weight to do this. I'm going to wait until our house is in order to do this. Do it now. Nobody knows how much time I have. She has a 2% chance, I hope to God that she makes it. But none of us really know what's going to come.

So I say, you know, live every day to the fullest and be grateful for what you have and to start living your best life right now. And don't wait until everything's perfect, because things are always going to come up. There's never going to be a perfect time, the perfect time to start doing something is now.

Justin: Don't wait to be happy. I love it. Thank you so much, Franziska. This is a wonderful conversation. I think it is going to be so helpful to parents to break all of this complex nutritional science down into really easy bite-sized chunks, so to speak. Thank you so much for your time.

Franziska: Oh, thank you very much for having me, Justin. It was my pleasure. Love talking to you. And I'll talk to you soon.

Justin: Oh, absolutely. We'll have you back on that.

Franziska: That's great. Thank you so much.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We’re so grateful, you've chosen to join us on this Family Thrive journey.


Justin: We met Franziska when she had just transitioned from being a clinical dietician with the VA to private practice as “The Low Carb Dietitian.” We were looking for a dietitian who could help childhood cancer families reduce sugars and refined grains and boost healthy proteins and veggies, and she was a perfect fit. Over the years, we have watched as she has become a world-renowned expert on the science behind nutrient-dense, whole food eating. She is the author of The Low Carb Dietitian’s Guide to Health and Beauty, and has been an expert contributor at Healthline.com, and is now at DietDoctor.com. 

In this episode, you’ll learn all about low carb nutrition for families, the difference between keto and low carb, why low carb eating works, the myths surrounding low carb approaches, and how to start incorporating low carb eating into your family’s routine. Without further ado, here is my conversation with the amazing Franziska Spritzler. 

So, Franziska, thank you so much again for taking time out of your day to be here with us on The Family Thrive Podcast. 

Franziska: My pleasure. I'm thrilled to be here.

Justin: Yeah. So we have known each other for a number of years. I actually have lost track. So we first met when we asked you to help out with MaxLove Project. So can you tell us a little bit about your memories of how we kind of first started to work together?

Franziska: Yeah. Well, I met you at a conference in Tampa in 2016, Metabolic Health Conference, and we talked a bit about working with MaxLove. And then I met with Audra and I started working with some of the parents of children with cancer who were in like the MaxLove Support Group on Facebook. And that's how we initially started working together. And it was a wonderful experience for me.

Justin: We loved it. And the feedback we have from families was just amazing. They love you. And this was yeah, this was the beginning of a really wonderful relationship. And at the time, you at least were known to us primarily as the Low Carb Dietitian. So that was….

Franziska: Yeah.

Justin: So that was your handle on, you know, in the web world, the Low Carb Dietitian, and you were able to help our families move in the direction of a diet that would reduce blood sugar or reduce insulin and help as an adjunctive modality as they were going through cancer treatments.

So can you tell us a little bit about what has happened since then for you? So you were the Low Carb Dietitian. You still are. People can find you at lowcarbdietitian.com. But where has life taken you since then?

Franziska: Well, when I was working with you, I was in private practice in California. And I've since moved to Florida and I no longer see people in private practice. I write exclusively for dietdoctor.com, and they are low-carb websites. They provide lots of resources to people, ketogenic diets, low carb diets, and just people who want to get healthier. So that's what I do full time now.

I do miss the consulting that I used to do with your families and other people, but I feel like I can reach a kind of a larger audience with my writing. And we're also planning to do some other helpful things, even a coaching program that we're trying to put together.

Justin: So what drew you to low carb in the first place? So this has been a part of your life for more than a couple of years. What can you take us through that personal evolution?

Franziska: Absolutely. So I actually became a dietitian a little bit later in life. I'd already been a court reporter up until 2008. Then I was a dietitian. I practiced traditional guidelines, kind of lower fat, lots of healthy whole grains. Up until 2011, when I found out that my A1C was 5.6%, and that's not terribly high, but it's just below prediabetes, which is 5.7%.

Justin: Oh, so for the listeners A1C. So what does that mean?

Franziska: OK, so hemoglobin A1C is a measure of long-term blood sugar over about three months. And it's not just your fasting blood sugar, which you'll usually get that on a lab and it'll say glucose. That's your fasting glucose or fasting blood sugar. Mine was always normal. I was around 80, but my A1C was quite high, almost prediabetes range. So that was concerning to me. I started testing my blood sugar and realizing that although I had a very nice fasting blood sugar, it was going up very high after eating what I thought were healthy meals.

So I began doing a little research and discovered that people with prediabetes, which it seemed like I had, could get really good results by cutting back on carbs. And that made sense to me because carbohydrates increase blood sugar more than protein or fat does. But I never thought it was a problem for me. I began cutting back, though, and I noticed when I tested my blood sugar, my levels were much better controlled and the lower I ate, the less it went up and the more well-controlled I was. I also discovered that I wasn't hungry as often and I never, didn't need to snack anymore.

So I found this a huge benefit and realized that maybe I was providing information to people with diabetes and prediabetes that wasn't so helpful because it kept them hungry, snacking all day with blood sugar levels kind of going up and down and needing a lot of medication to manage it.

Justin: What was that information that you were giving to patients before coming to low carb? What was that like?

Franziska: So having a very balanced plate. So you want a portion of some kind of grains or potatoes or starch, a small portion of meat and vegetables and maybe a glass of milk for calcium. So that sounds pretty balanced. And making sure not to add a lot of fat to your food, maybe using Egg Beaters instead of eggs to avoid extra fat. So that's the way that I ate and that's the way that I was recommending that other people eat. And I thought it was a healthy way to eat. And it is for some people. Some people do really well with that.

But people who have any kind of blood sugar or metabolic issues tend to do better with lower carbs. But this isn't what's taught in dietetics programs. It certainly wasn't followed in the hospital that I worked at. I worked at a hospital at that time at the VA hospital in Long Beach, California. So, and it wasn't accepted there, which is why after a couple of years of getting increasingly frustrated of not being able to recommend this to patients that I left to go into private practice.

Justin: So that's where the Low Carb Dietitian was born, you were see…

Franziska: Yeah.

Justin: So you saw it first in yourself and you saw it first in your own lab values that when you started to shift the way that you ate these important numbers began to improve, primarily this A1C.

Franziska: The A1C went down from 5.6% to 5%, and it's been there ever since. That was in 2011, by the way. So it's been 10 years. And my blood sugars have been well controlled that entire time. I've been eating low carb the entire time.

Justin: All right. So let's get into the low carb. Like what I really want to get out of this podcast is to give parents an idea of what low carb is like, what it can do with the different scientific rationales for it, because our approach to nutrition, it's focused on whole foods, but there's a component to it where we really want to reduce refined carbohydrates, we want to reduce sugar, and it ends up looking like a low-carb approach.

And so we want to get a handle on this, like what is this and what are the differences between some of the terms that flow around in the low carb world. So can you give us an idea of what the differences between, say, a low-carb approach, other words that parents might know, like ketogenic or paleo or Atkins? So how about we just start with low-carb versus ketogenic? How could we distinguish between those?

Franziska: Ok, so low-carb is a very broad term that kind of encompasses all of those terms that you just brought up, paleo and ketogenic and Atkins. So low carb is just a reduced carbohydrate diet.

So carbs are found in many foods, but primarily things like bread, pasta, potatoes, fruit, and fruit juice. And then in refined carbs, as you talked about, sugars and sweets and potato chips and things like that. So a low carb diet reduces those anywhere from about 20 grams per day, up to 100 grams per day. The average person eats roughly 250 to 350 grams of carbs a day. So a low carb diet can be anywhere in there, but a ketogenic diet is at the very low range of that 20 to 100.

And the purpose of a ketogenic diet is to increase the number of ketones in your blood so they can be used by the brain. Ketones are fat-like compounds that the liver makes. That your brain can use as an alternate energy source. But carbs need to be very low to get the ketones up to that level versus a more moderate low carb diet. Maybe 50 to 100 grams or so would not be producing a lot. You wouldn't, your liver would not be producing a lot of ketones.

Justin: What kind of things could a person eat and still be in, say, the 50 to 100 gram range? So we're not talking about removing all carbs at that point. We can still eat a lot of carb-containing foods. What are some of the things that a person could eat in that range?

Franziska: In that range, probably, you know, small portions of starchy vegetables like sweet potatoes and root vegetables, like carrots and beets, some fruit, perhaps very high sugar fruit. You really want to minimize like bananas and tropical fruits, like pineapple. They've got a lot of sugar. You can have those in very small portions.

But you could have berries. You could also have berries on a ketogenic diet, but maybe some apples and some other less sweet fruits. And beans perhaps, if they agree with your system and even some grains, depending on how sensitive you are to carbs. And that's something that's kind of trial and error. You may not know if you're eating 250 grams of carbs right now and having some symptoms. You may not know how low you need to go to get blood sugar better controlled.

Justin: Oh, yeah. So on a ketogenic diet, we are getting below 20 grams of carbs a day. And the goal of a ketogenic diet, as you said, is to put the body in a state where the liver is now producing ketones.

Franziska: Yes.

Justin: So why would a person want to go that low to be on a ketogenic diet versus just low carb?

Franziska: That's a great question. And for some people, for therapeutic purposes, like people with brain cancer or other neurological issues, epilepsy, those ketones can actually serve as an alternate fuel source for the brain, which may have trouble using glucose. That's glucose or sugar is the usual fuel. Let's say that the fuel that most people use to fuel their brains. People who have neurological issues may get a lot of benefit from a ketogenic diet. It may help to protect the brain, and it can be used as an alternate energy source.

So that's one group that would often benefit from being ketogenic versus low-carb. Many people also find that low carb diets in general, lower hunger, but ketogenic diets being in ketosis, meaning you have a certain level of concentration of ketones in your blood, actually helps to control hunger better. They get a real appetite suppression from that. So that's another reason you might want to do a ketogenic diet as opposed to a low-carb diet.

And some people just find it's really individual, but it's easier to kind of have a more limited food palate than have to worry about how much fruit can I eat. She said a little bit, but how much is a little bit? They find it easier to just, you know what, I'm not going to eat those fruits. I'm just going to eat, stick basically to meat, vegetables, eggs, and those foods instead, and know that I'll always be in ketosis. And it is easier for me than making the judgment call on how many carbs I can have and trying to keep within a certain range.

Justin: For a family that doesn't have any demonstrable health problems. And they're just looking to tighten up their diet and eat a little better, ketogenic diet is not going to be something that they need to worry about.

Franziska: I don't think so. No, no. For the vast majority of people, a low carb diet is, it will be ample to give them the health benefits that they're looking for.

Justin: I get asked this question sometimes, Audra gets asked this, because now when you go into the grocery store, I mean, things have totally changed over the last five-plus years where now we go into places like Target or Walmart and there will be plenty of products now that say keto on them. It didn't use to be like this at all. And so there's a subtle message that, hey, keto. I mean, that has to be better, right?

So an actual ketogenic diet is not necessary for the vast majority of people. A low-carb approach is going to be perfectly adequate. But another thing, what do you think about all of these keto products that are now on the store shelves? I've found that when I actually look at the nutritional facts and I look at the macronutrient profile, that these actually aren't keto. And…

Franziska: A lot of times they’re not.

Justin: Just for any listeners who don't know, Audra and I had Max on a ketogenic diet for many years, and we've been on and off it for his treatment. So we know what it takes to get into ketosis and it's not easy.

Franziska: Exactly. And some of these products have very questionable sweeteners in them that actually can raise blood sugar. IMO's, those can raise blood sugar as much as sugar can.

Justin: So what's an IMO?

Franziska: I said IMO because they're hard to pronounce. Isomaltooligosaccharide.

Justin: Oh, that's a mouthful for ya.

Franziska: Yeah, those are used in syrups, some sweet syrups, and then some low-carb and keto products, mostly keto products, because they can check their will be called a fiber, and then they subtract that fiber from the total carbs and give you a net carb of two or three grams, when in reality, if they're using a lot of IMO's, it could be 10, 15 grams per serving. But someone could think they're only two or three and do a couple of servings and think they're still doing great.

The same thing with sweetener. Now, to tell this, in so many chocolate bars and candies, the thing is, you see them all, only a couple of grams of carb. I can have all I want of these because they're so keto, are so low-carb friendly. And yet again, it's a type of sugar alcohol that can be partially metabolized and raise your blood sugar, therefore decreasing your ketones and you're no longer keto or necessarily even low carb if you're eating a lot of them. So I do think that you need to be very, very careful when you choose keto products. Some of them are just fine. But, you know, it's a craze right now with keto and they're trying to capitalize on that.

Justin: I find many of them to be fine when I look through the ingredients. I don't have a problem with the vast majority of the keto products out there. It's just that they're not keto in the sense that to really get into ketosis, you need a lot of fat and you need to be very moderate with your protein. And many of these keto products have a lot of protein, not necessarily a bad thing. It's just not going to get you into ketosis.

Franziska: Right.

Justin: So we've covered low carb ketogenic. What about Atkins? So if I'm sure there are parents, you've heard of that and they're thinking, what's the difference?

Franziska: Yeah. So Atkins is interesting. It starts off with what's called an induction phase, which is essentially a keto diet. It's less than 20 grams a day. And it actually limits some vegetables depending on how many carbs they have. But it really does allow unlimited amounts of meat and fat. So in that way, it's a little different than a therapeutic keto diet that's meant to increase ketones with the carb levels very low to start.

And the whole idea is to put you in at least mild ketosis and then to keep your hunger down and get you used to eating this way, and then you go through different phases. Phase one, phase two, where you kind of add bad carbs and see how it affects your appetite. See how it affects your weight. Blood sugar. And you kind of find the right carb level for you.

So I actually kind of like that approach for some people. You know, you find what works best for you. And some people may do best, about 20 to 25 grams a carb indefinitely. And others may be able to tolerate between 50 and 100 grams and do really well. But it all almost always or they actually recommend that you do start at the very strict level and then work your way up.

Justin: Paleo. So I'm sure many parents have heard of paleo and they're thinking it might fit into this low-carb world in some way or another. How do you think about Paleo in regard to these other low-carb approaches?

Franziska: Paleo is interesting because it is much lower in carbs than like a standard American diet, but it includes some high-carb foods as well. It's you know, it's basically whole foods, which is great. No dairy, though, or, you know, a primal approach allows some dairy, a paleo, strict paleo approach, though, no dairy, no beans. So no legumes, like even peanuts or anything like that.

And they do technically allow some high-carb fruits and honey even as a sweetener rather than anything artificially sweetened, only natural. So you're going to use a sweetener, use honey. I think they allow stevia leaves, but no stevia processed. So it's basically Hunter-Gatherer, what would people have eaten, you know, millions of years ago? Obviously, we have different food and different animals around different plants. And we had them, but as close to the way that they ate before the invention of modern agriculture as possible.

Justin: So it can be low carb because it doesn't have things like sugar or grains. And yeah, but it can be just as high carb if all we eat is sweet potatoes.

Franziska: Yes. Potatoes and fruit. All right. Yes, sweet potatoes and fruit for almost every meal, then you're certainly going to be getting a lot more carbs than when you get on a low-carb diet.

Justin: Awesome. Ok, so the fourth low carb approach that I wanted to ask about, and then I threw Paleo and there's the fifth is something that I've seen at Diet Doctor over the past several months is a more high-protein approach. I know there are different names for this approach, but can you tell us about this more high protein approach that the Diet Doctor has started to focus on?

Franziska: Yeah, so it's high protein. And what does that mean? Believe it or not, we're still trying to figure out exactly what it means. Diet Doctor...exactly how much protein it is. But it's basically trying to get the most protein per calorie for people who want to lose weight.

Justin: Can I just pause there? So we want to increase protein per calorie?

Franziska: Right.

Justin: All right. So for every calorie we eat, we want the percentage of the protein to be in what range? So if we're eating like 1,000 calories, how much of that should be a protein?

Franziska: So on a high-protein approach, over 30%.

Justin: So 300 calories of that one thousand calories would be protein.

Franziska: 300 as a minimum. And sometimes a little higher.

Justin: Ok.

Franziska: So that's what we're saying for now. And what that means in absolute grams per day is going to depend on the calorie amount that you eat. So a very small woman would have a lower, even if she's eating a high protein diet for her, would be a lot lower in protein than someone like my boss at Diet Doctor who is 6’7”. So, high protein diet looks very different. But they're for the amount of protein per calorie that you're eating, it's similar amounts. So it's just, it's really, yes, focusing on high protein, but not low fat and it's still low carb.

You can even do it, I don't want to say ketogenic exactly because it's not high fat, but at a very low carb level, less than 20 grams of carbs per day, if you want. But we are really recommending that most people do a more moderate, low carb, maybe 30 to 60 grams of net carbs.

And I'll just briefly recommend, mention what net carbs are; that's total carbs, minus all fiber that naturally occurs in food, avocados actually are pretty high in total carbs, but most of them, most of it’s fiber. So when you subtract that out, it becomes a very low-carb friendly food.

Justin: And we subtract out this naturally occurring fiber because it doesn't get turned into blood sugar.

Franziska: Exactly. It either passes right through your system or is converted into fatty acids by gut bacteria. But it does not increase your blood sugar. It does not have any effect on your insulin.

Justin: So with this high protein approach, is it that the concern is less about the carb amount and more of a focus on the protein and that it's really carbs and fat are seen as just together, as just a source of energy?

Franziska: It is.

Justin: Can you explain that part a little bit?

Franziska: Yes. On a high protein diet, or at least the way we're viewing it. We want to maximize calories from protein and not get too much energy from nonprotein sources like carbohydrates and fat. Now, protein is not there to provide energy so much. It's there for muscle building, for preventing bone loss. And protein also can, just like being in ketosis, getting more protein can have an effect on satiety. There are studies that show this.

So for those reasons, we say prioritize protein. You're still, though, if you're getting 30, 35, or even 40% of calories from protein, that's still not more than the fat and carbs put together. So you're still percentage-wise, not getting as much. You probably will be getting more calories from fat than protein if you're following a low carb approach, but just not as many calories from fat as you would on a ketogenic diet or even a low carb approach that has lower protein.

Justin: Awesome. And then one word you used from the science world, satiety. So that's just feeling full.

Franziska: Feeling full and satisfied. So that you eat less. Yes.

Justin: So, ok, so we've covered these different approaches in the low-carb world. So what do you personally prefer for just you, for yourself?

Franziska: So I follow a pretty high protein, low carb diet. I eat probably between 110 to 125 grams of protein per day. I'm five foot eight. It's not terribly high, but it's higher than a lot of people would eat. I eat about 30 to 50 grams of net carbs per day. Total carbs, that's with the fiber of usually 70 or so, because I eat a lot of fiber, a lot of vegetables. And that's what works best for me. Other people I've seen do better with a little less protein, a little more fat. Some people do better with fewer carbs, others with a little more carbs. But that's my personal approach that's worked for me for many years.

Justin: Awesome. Now, this is a tough question, and I totally accept if you just want to say pass, but if you had to recommend an approach just for the average family out there, no major health problems, they just want to do a little better. In what direction would you point them in this low carb world?

Franziska: Yeah, that's a good question. I would say a low carb approach that's moderate, maybe net carbs anywhere from 40 to 60 to start or a little bit more. It depends on the family, I would say. And I again, when we're talking about moderate, I don't think the counting is so important. Like 40 to 60, it could be 30 to 80. You know, it could be a wider range. It could be up to 100 for very active families, really active kids.

You know, the kids, I think up around 100 grams is just fine, maybe more. For moms wanting to lose weight, maybe a little less. So maybe you give them a little more sweet potato and yourself a little less and fill up more on broccoli and some lower-carb vegetables.

Justin: Yeah. Yeah. It strikes me that the counting would be counterproductive.

Franziska: Yes.

Justin: Yeah. That is just too much work. But focusing on food types would be a little more useful. Yeah.

Franziska: Yeah. Yeah. So a good protein source at every meal and no fear of fat. That's something that I mentioned, you know, the way that I used to eat with the Egg Beaters and really being very careful with fat. On a low-carb diet, you have permission to eat more fat. If you're not doing ketogenic diet, you don't have to worry about really dousing everything in butter. But you don't fear fat that can actually make food taste quite a bit better. And the combination of protein and fat is very filling. And then you're getting fiber from vegetables, which is also filling. So it can be a very satisfying diet for everyone.

Justin: Ok, so now I want to get a little bit into the science for parents who want to know, like, why does a low carb diet actually work? Is there some magic sauce in here? The way that I understand it, there are two ways that we can think about this and maybe more that. The first one is that there's some special fattening properties in carbs that because carbohydrate they raise blood sugar, which raises insulin, and this can have knock-on effects with hunger and fat burning.

So there's in the science world, I understand that as the insulin, the carbohydrate-insulin model. And then there's this other approach that it's really focused on hunger and that if we just increase protein and reduce carbs, that we're just not going to be as hungry, and then we're just going to eat less. Are there any other parts of this puzzle that I'm missing?

Franziska: No, I think you summed it up very well. The thing is, we don't have great evidence for either of them. It's hard to say. That's why there's arguments, because we know that low-carb diets work. When you give them to people and you have somebody follow a low-carb diet and a low-fat diet or another type of diet. People end up eating less on a low-carb diet naturally. You tell them they can eat whatever they want and they eat less.

Is that because of insulin or is it because the protein helps them to feel fuller or having more stable blood sugar levels throughout the day without blood sugar and insulin rising and falling? I think it's a combination of both.

But again, we don't have great evidence for either one. We just know that they worked for almost every, almost everyone I know that followed a low carb diet. Whether they have stayed on it long term or not, said “I just wasn't as hungry. I ended up losing weight and I wasn't even that hungry.” And I could go, you know, “I could skip a meal because I wasn't hungry. And why is that?”

Well, we're still trying to figure that out, truly. But I think that blood sugar and insulin are part of it. But I also think that the protein, most people, when they start a low-carb diet, tend to increase the amount of protein when they cut back on carbs, so that can also have an effect.

Justin: Oh yeah. In your professional experience, what are the main reasons that people have a hard time staying on a low-carb diet?

Franziska: Well, it really does come down to personal food preferences, even though there are so many amazing substitutes. For some people, it's just impossible for them to stay on the diet because they either love potatoes or sweets or something so much. I actually find that that's rare, though, for someone who really is interested in health and willing to kind of stick it out.

Beginning can be tough. I find that having a lot of substitutes on hand, being well prepared before you start can make all the difference. One of the big things is at home it may be fairly easy to stay on plan, but then once you go out to eat or you're invited to someone's home, especially in the early stages, it can be really tough. Nobody really wants to impose on their guests or even make a big deal at a restaurant. I can't eat this, what do you have? It gets easier over time. And what's great is that now there's a lot of different options.

But I think those things are hard for a lot of people. And then people have ideas in their head that low-carb just isn't that healthy, that it isn't a way that they can eat forever. And that can be hard to get around too, and especially if they're receiving messages from other people in their lives who aren't supportive. So there's a lot of reasons that low carb can be hard. But I think kind of preparing before you do it and learning about these things and having foods on hand and kind of knowing what to expect can make a huge difference in whether you're successful and able to stick to it.

Justin: Yeah, for us, it was a slow transition when Max was diagnosed in 2011. We just slowly learned about nutrition or the way that nutrition can support him during his treatment. So we moved closer and closer to a ketogenic diet. And when we finally went full in, I mean, it was probably a year and a half of just transitioning slowly, and then we're like, “Ok, let's just take the plunge.”

But I remember when we finally did, going to the grocery stores, I remember going to Trader Joe's in particular, and all of the frozen foods that I used to buy, like I started to look at the nutrition facts and the ingredients. And there were so many I mean, I would probably say 80, 90% of them I just had to put back. It was like, we can't do that anymore. Even though we were making a slow transition when we finally took the leap. Is that all right? We are going to get Max into ketosis and we're going to eat this way.

Oh, there was so much that we had to change. But then learning how to tweak meals, learning how to make the same thing. Oh, we can do spaghetti, but now in a totally different way. We can do mac and cheese, but in a totally different way. And so it was learning about all the different strategies. And then today, of course, it's a lot easier because there are so many products on the market.

Franziska: Absolutely.

Justin: We'll be featuring in The Family Thrive App, a review of high protein, low carb cereals that are now on the market. There were none of these when we started in 2013 when we actually went more stringent toward a ketogenic diet. No cereals like this. No, I don't think there were any breads. There might have been one bread brand. But yeah. So we'll be reviewing cereals. We'll be reviewing low-carb, high-protein pastas. We'll be reviewing low-carb, high-protein breads. All this stuff is now easily available. But we found a wonderful hot dog bun now. So it is a lot easier now.

Franziska: It's much easier now. And I'm glad you have all of those. That sounds great. That’s awesome.

Justin: So, Franziska, what are the biggest misunderstandings around low-carb nutrition that you come across?

Franziska: I just think that a lot of people think that low-carb diets are fad diets, that they're unsustainable, that you can't do them long term, and that they are you know, they basically all you're eating on a low carb diet is butter and bacon. And you don't have a lot of variety. And this just isn't true.

You're only cutting out the very high-carb foods like pasta, bread, potatoes, cereal, and fruits, and sweets, and starches. But you can have everything else. You can still have so many other things. And it really can be a very well-balanced diet.

There was a dietitian from New Zealand who did a study years ago to show that a low-carb diet provides ample amounts of vitamins, minerals, everything you need to be healthy. I think that's another misconception that a low-carb diet lacks some healthy foods like whole grains.

Well, whole grains are great if you tolerate them, but there's nothing magical. There's nothing in whole grains that's unique to them that you can't find in other foods, like vegetables and nuts and seeds. So I think those are the misconceptions. If it's just a very fad-like diet that can't be maintained.

Justin: Oh, yeah. We've been, you know, almost 10, 10 years on a low carb approach in one way and it's just the way we eat now. And the one thing that we found right away was, oh, our plate is mostly vegetables. Like if we do, you know, chicken and broccoli or a steak, you know, it's like half the plate is broccoli. And it didn't use to be like that.

So for a typical meal beforehand, there might be a protein, but then there are definitely be a starch that would be filling up most of the plate and then maybe a little bit of the vegetables on the side. And so now with a low carb approach, it's a lot of veggies. We’ve removed the starch and then keep the protein. I have no doubt that we eat way more veggies today than we did before.

Franziska: I feel the same here and same with all the people that I've ever worked with. And many people have reported to me on what they eat. I eat vegetables at breakfast now, which I never did before. So, you know, I eat vegetables three times a day. And yeah, so it can be extremely healthy and sustainable.

That's the misconception that low carb is a fad diet, it's unbalanced because you're getting lots of nutrition with a low carb diet. If you're doing it in a healthy way, of course, you can just eat, you know, just bacon and eggs for every meal. That's, you know, you get to eat bacon and eggs on a low-carb diet. That's wonderful. But for a really well-balanced diet, you want to include vegetables and some other fruits as well, and lots of different protein sources.

That's what makes the diet healthy, is having a lot of variety. And you can still get lots of variety on the low-carb diet.

Justin: Awesome. So if a family is thinking, you know, we want to move in this direction, we don't need to, you know, drastically reduce carbs or go keto, but we would like to move in this direction. What are a few things they can start to think about changing in from the standard American approach to move in this direction?

Franziska: Well, I would say to start with, get rid of the white starches and sugars in your house, get rid of them, donate to a food bank if you don't want to throw things out. I understand not wanting to throw them out. But if you want to get started on this, that's the first place to start.

If you're already doing whole grains and you've gotten rid of most of the sugar in your life, then I would just start to slowly cut back on those things.

Maybe one at a time. Like, you know, some people love cereal. If whole-grain cereal is the hardest thing to give up. Maybe start with whole-grain pasta first or something else. Just give it up one at a time. Make gradual changes. I like what you did that moving towards it gradually. I think that you can stick to it better. And once you see the results are more motivated to make the next change rather than having to give up everything at once, I think that can lead to failure for a lot of people.

Justin: Oh, absolutely. Well, in our MaxLove Project role, we, of course, interact with a lot of families who are in medical crises and want to make big nutritional changes. And they say, “Ok, we are ready. We're going to clean out the pantry and we're just going to start fresh.” And our response is we've seen bad results coming from that approach because it's a shock, and then after a couple of weeks or a month, everyone says, well, we obviously can't do this, so we just need to go back to the old way.

What we have found through MaxLove Project, the most sustainable approach is to start with just one thing, just say what is one change we can make and we know we can stick with it and it doesn't matter what it is. So just make that change and then stick with it. And then when you feel like you, you have a handle on that change that is now a part of your life. Now you can move to another change.

And so if it's something like, all right, we're just not going to buy really high-carb, sugary cereals, like we're just going to have a different type of breakfast and it almost doesn't matter what it is. So just make that change. And then once you're comfortable with that change, now you can think about another change.

Franziska: Yeah, exactly. That's what works. And it becomes easier with each progressive change. The further you go, the more, the less time you'll have to spend making that change. And before you know it, you're following a low-carb diet and it really isn't painful.

Justin: We all have heard that breakfast is the most important meal of the day. If there was one meal where parents are like, where should I start in moving towards a more high-protein, low-carb approach, would breakfast be the one?

Franziska: I really think so. There is some good research that having a higher protein, lower carb breakfast is a great way to start out, kind of primes your body. This is for kids too. Kids need a lot of protein when they're growing.

But for parents who want to stay full and satisfied and not be tempted by the snack cart at work or something, having a good solid breakfast that's lower in carbs, higher in protein and some fat. I think that's definitely a great way to start your day. Best meal to start with.

Justin: We've had a couple of other dietitians on talking about different aspects of the nutrition world, and we've asked them to bust some food myths because we have found in our time with MaxLove Project over the last 10 years learning more about nutrition and nutrition science, so many myths have been busted for us. You know, like everyone should drink eight glasses of water a day. And it turns out there's just no science around that at all. So do you have a food myth or two that you can bust for us?

Franziska: Well, I like the ones that you already mentioned when we talked before, but I think I'm going to stick with a low carb and say that there's a myth that low carb diets are dangerous long term.

And what they do is they'll say this is proven by studies, but the studies are observational studies where they ask people to fill out a questionnaire of what they eat during a typical week, and they ask them to fill that out a few years later. And then they look to see what kind of diseases or if any of the people passed away. And they find that people who eat lower carbs tend to die earlier or get more heart disease or diabetes. But these are self-reported intakes. And they ask questions like, how many times a week do you eat this? Nobody knows, they’re notoriously inaccurate. And also low carb is considered up to 40 to 45% of calories. Even a moderate low carb diet is usually 20, 25% in calories.

And a ketogenic diet, as we know, is like five percent, five to 10 percent. So these aren't even, even if it was true that the people were eating this amount of carbs. It's not that low carb. And what are they eating, besides which carbs are they eating? It's not that they're following a low carb diet is that they're reporting eating French fries or something twice a week instead of five times a week. And that comes out to be a low-carb diet.

So anything, those correlations are inaccurate. Now, we don't have long-term randomized controlled trials because it's impossible to do a study like that. It would be too expensive. And the number of people. We know that in the short term, they are healthy. They have not been shown to cause kidney damage, liver problems, heart disease or anything else. I can just look at people I know who've been following it for a long time and are healthy. I mean, I've been following for 10 years and in my 50s now, and I'm quite healthy. I'm certainly at least as healthy as I was before I started.

But the person I really look to is Dr. Richard K. Bernstein, who has had type one diabetes since he was 12. He's now [87]. In his 40s, he discovered low carb and started following that diet. He's still practicing. He's extremely healthy. He is the longest term low-carber I know most people with type one have a lower life expectancy, usually have at least one complication, either eye disease or heart disease. He's very healthy and he prescribed his diet about 30 grams of carbs a day is his baseline recommendation for people with type one and type two diabetes, very healthy. So I look to him and to many other people who are thriving on a low carb diet rather than these studies that make a low carb diet look scary.

Justin: Oh, yeah, every time I've heard the claim that low carb is bad for you, the person making that claim is always pointing to observational studies. And as you said, they simply ask people what they ate and then they follow them over some time. And so these people are not following a low carb diet. They are just simply reporting what they eat.

So if there's a person who says, you know what, I don't like vegetables, I don't and I don't eat that many French fries, I just eat a lot of steak or I eat a lot of hamburgers or whatever the case is, they may or may not be following a low carb diet. They may just have, say, 40% of their calories from carbs rather than 60%. But they're not following an actual low-carb diet.

Then the other thing that I found, when you dig into the tables, when you dig into the data in these observational studies, invariably I've seen this in every single observational study that opponents of low carb approaches point to is that the lower carbohydrate a person eats, the more cigarettes they smoke, the more alcohol they drink, the lower their income is, the lower their education. So there is clearly many other things going on in the epidemiology world. This would be called the healthy user bias.

Franziska: Yes. And it's the same thing for vegetarians, is the same thing for people who… do all the right things.

Justin: They're also going to the doctor more regularly. They're higher educated, higher income. Right. And well, there's another. So there's the healthy user bias. It's also called the healthy adhere bias, which I like that because there are other studies that have shown that people who are in randomized controlled trials for some drug trials, that the people who take their placebos more regularly are also healthier.

There's some phenomenon where people who are simply more conscientious, who listen to public health advice, who listen to what their doctors say are also happening to be doing a ton of other things that lead to better health.

And so what we see in these observational studies is people who are not following the conventional public health advice to eat less meat, eat more whole grains, right, who are going in the opposite direction of the public health advice, have all of these other poor health behaviors as well.

I know that I've seen at least one study that has gone so far as to pull out individuals who have healthy behaviors, who report having healthy behaviors, but who also report low carbohydrate intake, or I believe this is a study about high meat intake. And in the one study that I'm thinking of and we will link it in the show notes, individuals who are eating a lot of meat, but who are also doing all the other healthy things that, you know, a person should; going to see the doctor regularly exercising and such that they have just as good health outcomes as the individuals who are eating low meat, but are also doing the exercising and going to see the doctor. So meat is not the issue. All right.

Franziska: Meat is definitely not the issue.

Justin: If you just look at these observational studies that simply look at low carb or meat intake and they don't adjust, well, sometimes they will adjust for some things like smoking, but and some other variables.

But there are so many unmeasured variables that go along with all of these lifestyle choices that essentially these observational studies are useless.

Franziska: Exactly. Exactly. But they're the ones that get reported. You know, everyone shares them and you hear them on the news. And I know. Yeah, I agree with you.

Justin: Oh, thank you for busting it. One quick thing, because I do know when it comes to high protein, one thing that is just rampant, is just so common out there. And we work with a lot of doctors just in the cancer world with us here this well, you know, you don't want to eat too high protein because it's going to hurt your kidneys. So can you tell us about this?

Franziska: Yeah, they've actually not found that in any studies, randomized control trials and meta-analysis, of them. So several controlled trials together, they haven't shown that eating higher protein causes any problems to people who have normal kidney function, people with impaired kidney function, especially late-stage kidney disease, definitely higher protein intake can lead to faster progression of the disease. But people with normal, healthy livers and healthy kidneys, eating a higher protein diet has not been shown to jeopardize kidney health. And in fact, people who eat a low carb, higher protein diet that have diabetes, they have shown that that can be protective because it helps to control blood sugar to be on lower carbs. So…

Justin: We can put that one to rest.

Franziska: We can put that one to rest, too. Yes.

Justin: Yeah. Awesome. All right. So let's start wrapping up by checking in with what you think are some of the most interesting things happening either in food product space, if you've seen any cool new food products or the nutrition science space, like what's kind of the cutting edge for you?

Franziska: Well, you know, we almost already talked about it because it's all of the availability of all of these new foods that help support either low-carb or gluten-free lifestyle. I’m seeing it in grocery stores, I'm seeing it in restaurants, both fast food and regular restaurants. Chipotle now has cauliflower rice.

Justin: Yeah.

Franziska: Blaze pizza. Do you have it in Georgia?

Justin: No, but we did back in Orange County, so I'm familiar.

Franziska: Yeah, they had a keto crust. They have a gluten-free crust. And for people who want to do a vegan diet, they have a vegan crust. I really think that, you know, just supporting people by making all these options available and sweeteners too, I think have come a long way. Allulose is a fantastic sweetener too, so much like sugar. When people talk about, “I can't do sugar substitutes because they all have an aftertaste.” Like, “Have you tried allulose?”

Justin: I put this in the show notes.

Franziska: Yes.

Justin: Yes.

Franziska: Take a taste test. And I'm telling you, you won't be able to tell the difference. It tastes just like sugar. So I just...

Justin: It’s magic.

Franziska: Yes. I'm just finding it to be making it so much easier for people who want to follow whichever dietary plan. The food manufacturers are listening. They want to help people who want to make these healthy lifestyle choices. So that's really what I'm seeing. It's a wonderful time to start. Yes, just like you have been doing this for about 10 years, and it's fantastic since it's a good time to start.

Justin: And when we started, we would have to put our whole head of cauliflower through the food processor to get cauliflower rice. And it was just every time just mess everywhere was such a hassle. And the rice bits never turned out exactly the way we wanted them. And now there is frozen cauliflower rice in literally every grocery store: Walmart, Target, big grocery store, small one, it’s like everywhere now.

Franziska: It's everywhere. I love it. And I also see for people who don't have time to do that, zucchini spirals, at least in my grocers. Do they have those already spiraled for you in my just Publix, which are basically the only grocery store we have here in Florida? So they're really, really listening to demand from customers. It's great. And I love the frozen cauliflower rice. In fact, I won't use it tonight because I'm making chili and I love to serve it over cauliflower rice. So much easier than grating it for yourself.

Justin: It really does take the place of rice. And at the same time, you're getting this cruciferous vegetable with a ton of micronutrients and fiber and all this wonderful stuff. It's just…

Franziska: It’s the best of both worlds.

Justin: It is the best. Ok, so I'm going to end with questions that we ask every guest. So the first one is, if you could put a Post-it note on every parent's refrigerator for tomorrow morning, what would that Post-it note say?

Franziska: Ok. Start your day with a high-protein, low-carb breakfast. Eggs if you already have any boiled, if you don't have boiled make yourself a quick omelet or eggs and frozen kale or something that’s already washed and done for you. And you're good.

Justin: Brilliant. And then, last question. What is the last quote you heard that really inspired you?

Franziska: Ok, so this is something I actually heard somebody say, I didn't read it online, and it was just last week, I was watching America's Got Talent, and there was a woman 30 years old who was a singer, a fantastic singer, and she has metastatic cancer. And she said, “You can't wait until things get better to start being happy.”

And she said she was given a 2% chance to live. But she says the 2% chance isn't a zero percent chance. And I just want to do everything that I can do to be happy and to be, you know, to make the most of my life. And I think we all feel this way. This isn't changed anything I felt. But when I hear these stories from people who are just so courageous, it does something to my heart. I was in tears and I thought that's what you should do. Just never wait. Don't say I'm going to wait until I've lost weight to do this. I'm going to wait until our house is in order to do this. Do it now. Nobody knows how much time I have. She has a 2% chance, I hope to God that she makes it. But none of us really know what's going to come.

So I say, you know, live every day to the fullest and be grateful for what you have and to start living your best life right now. And don't wait until everything's perfect, because things are always going to come up. There's never going to be a perfect time, the perfect time to start doing something is now.

Justin: Don't wait to be happy. I love it. Thank you so much, Franziska. This is a wonderful conversation. I think it is going to be so helpful to parents to break all of this complex nutritional science down into really easy bite-sized chunks, so to speak. Thank you so much for your time.

Franziska: Oh, thank you very much for having me, Justin. It was my pleasure. Love talking to you. And I'll talk to you soon.

Justin: Oh, absolutely. We'll have you back on that.

Franziska: That's great. Thank you so much.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We’re so grateful, you've chosen to join us on this Family Thrive journey.

Discover Nourish

See more
Podcast Ep. 13: What Every Parent Needs to Know About Carbs, Protein, and Fat With Franziska Spritzler, RD, CDE

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Podcast Ep. 13: What Every Parent Needs to Know About Carbs, Protein, and Fat With Franziska Spritzler, RD, CDE

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Preparing to thrive before the baby arrives: Three steps to support new moms’ mental and emotional health

Podcast

Preparing to thrive before the baby arrives: Three steps to support new moms’ mental and emotional health

By

Bridget Cross, LCSW, PMH-C

Podcast Ep. 21: Thriving Through the Teen Years with Jena Curtis, EdD, and Vanessa Baker, Parent-Teen Relationship Coach

Podcast

Podcast Ep. 21: Thriving Through the Teen Years with Jena Curtis, EdD, and Vanessa Baker, Parent-Teen Relationship Coach

By

The Family Thrive Podcast

Parenting Is the Spiritual Practice the World Needs Right Now

Podcast

Parenting Is the Spiritual Practice the World Needs Right Now

By

Justin Wilford, PhD

New Research: One science-backed trick for parents to build stronger muscles

Podcast

New Research: One science-backed trick for parents to build stronger muscles

By

The Family Thrive Expert Team

New Research: Parent intimacy may reduce adolescent depression

Podcast

New Research: Parent intimacy may reduce adolescent depression

By

The Family Thrive Expert Team

New Research: High-carb meals activate brain areas associated with addiction and hunger

Podcast

New Research: High-carb meals activate brain areas associated with addiction and hunger

By

The Family Thrive Expert Team

New Research Tuesday: One More Reason to Avoid Pop Tarts, Cheez-Its, and Other Processed Snacks

Podcast

New Research Tuesday: One More Reason to Avoid Pop Tarts, Cheez-Its, and Other Processed Snacks

By

The Family Thrive Expert Team

New Research: Micronutrients in colorful fruits & vegetables linked to improved brain health

Podcast

New Research: Micronutrients in colorful fruits & vegetables linked to improved brain health

By

The Family Thrive Expert Team

New Research: Probiotics improve body weight, body fat, and heart health in adults

Podcast

New Research: Probiotics improve body weight, body fat, and heart health in adults

By

The Family Thrive Expert Team

Ask the Experts: Should my Teen Have a Cellphone?

Podcast

Ask the Experts: Should my Teen Have a Cellphone?

By

The Family Thrive Expert Team

Preparing to thrive before the baby arrives: Three steps to support new moms’ mental and emotional health

Pro Perspective

Preparing to thrive before the baby arrives: Three steps to support new moms’ mental and emotional health

By

Bridget Cross, LCSW, PMH-C

Podcast Ep. 21: Thriving Through the Teen Years with Jena Curtis, EdD, and Vanessa Baker, Parent-Teen Relationship Coach

Podcasts

Podcast Ep. 21: Thriving Through the Teen Years with Jena Curtis, EdD, and Vanessa Baker, Parent-Teen Relationship Coach

By

The Family Thrive Podcast

Parenting Is the Spiritual Practice the World Needs Right Now

Pro Perspective

Parenting Is the Spiritual Practice the World Needs Right Now

By

Justin Wilford, PhD

New Research: One science-backed trick for parents to build stronger muscles

New Research Tuesday

New Research: One science-backed trick for parents to build stronger muscles

By

The Family Thrive Expert Team

New Research: Parent intimacy may reduce adolescent depression

New Research Tuesday

New Research: Parent intimacy may reduce adolescent depression

By

The Family Thrive Expert Team

New Research: High-carb meals activate brain areas associated with addiction and hunger

New Research Tuesday

New Research: High-carb meals activate brain areas associated with addiction and hunger

By

The Family Thrive Expert Team

New Research Tuesday: One More Reason to Avoid Pop Tarts, Cheez-Its, and Other Processed Snacks

New Research Tuesday

New Research Tuesday: One More Reason to Avoid Pop Tarts, Cheez-Its, and Other Processed Snacks

By

The Family Thrive Expert Team

New Research: Micronutrients in colorful fruits & vegetables linked to improved brain health

New Research Tuesday

New Research: Micronutrients in colorful fruits & vegetables linked to improved brain health

By

The Family Thrive Expert Team

New Research: Probiotics improve body weight, body fat, and heart health in adults

New Research Tuesday

New Research: Probiotics improve body weight, body fat, and heart health in adults

By

The Family Thrive Expert Team

Ask the Experts: Should my Teen Have a Cellphone?

Pro Perspective

Ask the Experts: Should my Teen Have a Cellphone?

By

The Family Thrive Expert Team

Subscribe to get all the goods

Join for free
Login