Low carb doesn't have to mean eating carnivore. We offer plenty of vegetarian choices, enjoyed by dedicated low-carb vegetarians and meat eaters alike. (These keto quesadillas are amazing. Just sayin'.)
If you choose a so-called lacto-ovo vegetarian way of eating, low carb will provide all the nutrients you need. Lacto-ovo means avoiding meat, poultry, and fish, while also eating vegetables, nuts, eggs, and dairy.
What vegetables are preferred on a keto diet? A rule of thumb is to avoid those that grow underground — and eat what grows above (read more about carbs in different vegetables).
Picking what's in season is often the best option for many reasons. It's easier to find organically and locally grown produce and they're often more affordable.
Vegetarian meals
Use your imagination and creativity when putting together a vegetarian low-carb or keto meal. Whatever you decide to make, you can always add a bit of fat to your plant-based dish by slicing up some fresh avocado or topping it with a smooth dollop of mayo.
Experiment with different textures and seasonings to create your own favorite recipes.
Vegetarian sides
The ways to prepare vegetables to be great low-carb or keto side dishes are endless. Try different cooking methods and discover the many ways to enhance the wonderful flavors.
Even the most skeptic will have a hard time turning down broccoli fried in butter with a sprinkle of sea salt on top.
Vegetarian snacks
When you are out and about, a filling snack can really come in handy. See below for a selection of our vegetarian alternatives.
Guides
Want more? Living keto goes beyond recipes. Enjoy our selection of guides to help you understand keto and keep it deliciously simple:
A ketogenic diet for beginners
14-day keto diet meal plan with recipes and shopping lists
Ketogenic diet foods – what to eat and what to avoid
Food provides your body with the energy it needs to perform all of life's basic functions, from breathing and pumping blood to more complicated movements and tasks. Even in a state of rest, your body is constantly working. Case in point: your body uses most of its energy stores while resting, which is why it's important to replenish those stores by consuming enough calories each day.
According to the U.S. Department of Agriculture (USDA), a person assigned male at birth should consume between 2000 and 2800 calories per day, whereas a person assigned female at birth should consume between 1600 and 2400 per day on average. Any diet that contains 800 calories a day or less is considered a low-calorie diet. While unhealthy fad diets might lure folks into visions of ultra-quick weight loss, an 800 calorie diet can pose serious health risks, especially if it's not prescribed by your doctor.
In some cases, doctors prescribe low-calorie diets to patients, but, unlike the folks behind fad diets, a medical professional will ensure that there's not only a legitimate, urgent need for the diet, but that the patient will receive all the nutrition and support they need while following the regimen.
Here, we'll delve into the ways a very low-calorie diet can be unsafe and unhealthy as well as some more realistic alternatives when it comes to weight loss goals.
Your body needs nutrients, such as fiber, vitamins, minerals, and protein, to stay healthy day-to-day and in the long term. For example, you need calcium for bone health, potassium or magnesium for heart health, and fiber for gut health, to name a few. Without enough calcium, you put yourself at an increased risk for bone diseases and fractures.
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Without enough potassium or magnesium, your heart rhythms could become irregular, you could experience heart palpitations, or you could have a stroke or heart attack. Too little fiber can lead to constipation, unhealthy blood sugar levels, and even colon cancer. With a diet of 800 calories a day, it's almost impossible to get all the nutrients your body needs.
2. You'll Feel A Lot More Sluggish
A very low-calorie diet will cause your body to go into survival mode. This means your muscles will start to break down for their stored glucose to get your body the energy it needs to function. Even if you work out, your muscle mass will likely decline, giving you less strength for movement of all kinds.
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Furthermore, without consuming enough calories per day, your metabolism starts to slow down in an effort to conserve energy. This will also cause you to feel a lot of unnecessary fatigue.
3. Your Overall Quality of Life Will Probably Decline
Very low-calorie diets can cause a slew of different negative side effects that are not only bad for your health, but uncomfortable. Most likely, you will always feel hungry and extremely fatigued. You may also experience constipation, diarrhea, dizziness, stomach cramps, headaches, dry mouth, and hair loss.
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Very low-calorie diets can also lead to an eating disorder. For instance, extreme calorie-cutting can trigger spiked hunger levels, leading to binge eating. Most would probably agree that the pain and discomfort that comes with an 800 calorie a day diet alone make it not worth pursuing.
4. Your Mental Abilities Won't Be As Sharp
Your brain needs a continuous supply of glucose to function normally. Without it, your mental prowess will begin to lag. Glucose isn't the only thing your brain needs either. Nutrients are also necessary to keep it running correctly.
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When you put your body through a very low-calorie diet, your starved brain could easily forget how to do basic tasks like cooking an egg or turning on a lamp. Your ability to focus on anything from a simple conversation to a television show to your work will also decline.
5. You'll Increase Your Likelihood For Gallstones
One of the most common serious side effects of an 800 calorie a day diet is gallstones. This happens because your body will begin to break down fat to get the energy it is missing, which, in turn, causes the liver to secrete higher-than-normal levels of cholesterol.
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When that high cholesterol combines with bile, gallstones can easily form. Gallstones are common for people who are rapidly losing weight. They cause a significant amount of abdominal pain and can even require surgery.
6. The Weight Loss Typically Does Not Last
A meta-analysis of 29 studies (see Resource Links) found that low-calorie diets helped people lose weight in the short term. However, that weight loss usually did not last long-term.
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The reason for this is simple: once you stop the diet, the weight comes right back. Because an 800 calorie diet is not even remotely sustainable for health reasons, steer clear of it, as it won't even give you the results you want.
Alternatives to a Very Low-Calorie Diet
An 800 calorie a day diet is dangerous and unsustainable. Instead, if you want to lose weight by cutting calories, there are several, much safer alternatives.
Try Intermittent Fasting
Intermittent fasting is a pattern of eating where you have periods when you can eat and periods when you cannot. It doesn't matter what you eat during your eating times. The only restriction is when you eat. Some of the most common intermittent fasting cycles are 16-hour and 24-hour fasting periods. The 16-hour fasting cycle allows you to eat for eight hours each day. The 24-hour fasting method is done only twice per week.
Fasting was a part of human evolution; back in the hunter-gatherer days, limited access to food sources meant that people went for day without eating. As such, humans evolved with the ability to function without eating for longer periods of time. Intermittent fasting has become a popular way to lose weight, and studies have shown it to be safe and effective as well when done properly. Be sure to consult a nutritionist or medical professional before starting a fasting regimen.
Photo Courtesy: yulkapopkova/Getty Images
Try a Slightly Higher Calorie Count Per Day
The 800 calorie per day diet may be unsafe, but upping your daily calorie count just a tad is not generally considered dangerous. There are many easy-to-follow 1200 calorie diets and 1200 calorie menus around, and the 1200 calorie diet is within the standards of health safety for many folks. The 1400 calorie diet is another great option for people of all genders. Overall, researchers have found both the 1200 and 1400 calorie diets to be safe and effective ways to lose weight. So long as you consume enough nutrients each day, restricting your calorie count can be done safely.
Resource Links:
"Long-term weight-loss maintenance: a meta-analysis of US studies" viaThe American Journal of Clinical Nutrition
"Estimated Calorie Needs per Day by Age, Gender, and Physical Activity Level" via U.S. Department of Agriculture (USDA)
"Very low calorie diets" via National Health Service (NHS)
Have you recently had an HbA1c blood test? It is quite likely that at least once a year you will have one. It's a common and important test that can measure your long-term average blood sugar levels.
This guide will help you interpret your HbA1c results, and explain why HbA1c is an important way to measure metabolic health. We'll also explain reasons for occasional unexpected variations in HbA1c results and the strengths and weaknesses of the test.
What is HbA1c and why does it matter?
Hemoglobin A1c (HbA1c, or sometimes just called an A1c) is a way to assess your average blood glucose levels. It differs from a fasting glucose measurement in that fasting glucose is a snapshot of your blood glucose level at that one moment in time, when you first wake up in the morning before eating. The HbA1c, however, is a longer-term measurement that reflects your average blood sugar over the previous three months.1
It can measure this longer time frame because hemoglobin, which transports oxygen in your blood, is a protein that glucose sticks to over time. The more sugar in your blood, the more it sticks to the hemoglobin. When any protein becomes sticky with sugar in this way it's called glycation or glycosylation.
So rather than measuring the amount of glucose in a drop of blood, HbA1c measures the percentage of glucose stuck to the hemoglobin in your blood, or in medical terms, the percentage of glycation of the hemoglobin.
How do you interpret HbA1c numbers?
HbA1c is an important measure because it can be used to diagnose type 2 diabetes or pre-diabetes. It can also be used to monitor how well you are managing your blood sugar levels if you have type 2 diabetes or pre-diabetes, especially if you've made changes to your diet and lifestyle.
The American Diabetes Association (ADA) uses the following cutoff points for HbA1c:2
Normal: less than 5.7%
Pre-diabetes: 5.7% to 6.4%
Type 2 diabetes: 6.5% or higher
A diagnosis of type 2 diabetes or pre-diabetes should usually not be made using only one measurement of your HbA1c. The test should be repeated to confirm that the results are consistent or it should be used in conjunction with a fasting blood glucose, a CGM recording, or an oral glucose tolerance test to confirm the diabetes diagnosis.
HbA1c and average blood glucose
HbA1c result can be translated into an estimated average daily glucose level. Here are the averages and ranges the ADA uses:3
Maintaining blood sugar within a normal range is critically important for long-term health. Does that mean, however, that you're totally fine if your level is consistently 5.6% or below?
Not necessarily.
When your HbA1c is bordering the cuttoffs for pre-diabetes, and your results are trending up, it can be an indicator that you are already experiencing vascular effects of high blood sugar and may be on your way to an eventual type 2 diabetes diagnosis.4
If your HbA1c is obviously quite high — regularly in the type 2 diabetes range— that is a clear indication that your blood glucose is elevated most of the time and you should explore ways to help bring it down to a healthier level, such as with a low-carb or ketogenic diet or intermittent fasting.
Why do low-carb diets often lower HbA1c?
Since HbA1c is an indicator of your long-term blood glucose level, it makes sense that strategies to lower your daily blood glucose levels would also lower your HbA1c. Low-carb and ketogenic diets are powerful ways to do this. If you are not eating sugar, or carbohydrates that rapidly digest to sugar, you won't have excess sugar circulating in your blood.5
Blood glucose may improve so quickly on a ketogenic diet that some people with type 2 diabetes need to reduce or discontinue their insulin on the very first day of adopting the diet.6 (Always work with a physician or other qualified medical professional for this. Do not adjust medications on your own.)
Low-carb and keto eating, however, aren't the only ways to lower HbA1c. This can also be accomplished with a low-glycemic diet, intermittent fasting, and even by incorporating more exercise into your life without much of a change in diet.7
Most of the research comparing low-carb and keto diets to other ways of eating, however, shows that carb restriction is more effective, and moreover, it's effective even without exercise.
In a study comparing different interventions in overweight individuals with type 2 diabetes, pre-diabetes, or metabolic syndrome, subjects who followed a ketogenic diet for 10 weeks (<30 g carbs per day) but did not exercise had much greater reductions in HbA1c than subjects who followed a standard American diet and exercised three to five days per week.8
The American Diabetes Association recently issued a consensus report in which they acknowledged the effectiveness of low-carb and very low-carb diets for improving blood sugar control. The consensus panel noted that multiple meta-analyses have shown that these carbohydrate-restricted ways of eating typically lower HbA1c more than low-fat diets.9
With regard to improving blood glucose control, and thereby improving HbA1c results, the ADA panel wrote: "reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach."10
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Strengths and shortcomings of HbA1c
The HbA1c has strengths and shortcomings. One strength is that it's more informative than a fasting blood glucose. Fasting glucose can be elevated for a number of reasons even on a low-carb or keto diet, such a bad night's sleep, and as noted, it's only a one-time snapshot. HbA1c is a better approximation of your blood glucose levels over the course of many weeks.
A major shortcoming, however, is that the HbA1c provides no information about insulin levels. It's possible — common in fact — to have a normal HbA1c but very high insulin.11 Elevated insulin levels mean your pancreas is working hard to keep your blood glucose at normal levels. Chronically high insulin is a major driver of metabolic disease even when fasting glucose and HbA1c are normal.12
Another shortcoming of HbA1c is that it's based on the assumption that red blood cells (RBCs) live approximately 120 days. However, for reasons we'll explore shortly, this is not always the case. HBA1c therefore may not be a completely accurate reflection of average blood glucose in people whose RBCs have a shorter or longer lifespan.13
However, while the absolute number may be open to interpretation, the trend in the results of your HbA1c can be very helpful. For instance, if your red blood cells have a longer half life, your absolute A1c will tend to be higher. However, if that number goes down over time as you lose weight or embark on other lifestyle changes, then that trend information is very useful feedback that your blood sugar control is improving. And if your HbA1c is trending up, that means you need to pay attention to bringing your blood sugar back under control.
Reasons why your HbA1c might be higher or lower than expected
In some cases, the HbA1c may not be a completely accurate proxy for estimated average blood glucose. In fact, some people with very poor blood glucose control may have a lower-than-expected HbA1c, while those with excellent blood glucose control may have an HbA1c that's slightly higher than expected. That may be because of any of these factors:
Shorter RBC lifespan: Chronically elevated blood glucose may be damaging to RBCs, which may shorten their lifespan to less than 120 days in someone with poorly-controlled type 2 diabetes.14
A shorter lifespan means these cells have less time for blood sugar to stick to them (to become glycated). In such a situation, it's unlikely that someone would have an HbA1c in the non-diabetic range, but it might be lower than would be expected, leading individuals and their physicians to believe their diabetes is better controlled than it actually is. One case series reported the higher the HbA1c, the shorter the RBC lifespan — as short as 81 days — and the greater the underestimation of the actual blood glucose level.15
Longer RBC lifespan: While no research has yet confirmed this assumption, many low carb researchers hypothesize that healthy people — or people who have recently adopted a low carb diet — may have longer RBC lifespans. At this stage, however, this is conjecture.
However one study did show that in people who don't have diabetes, RBCs can live as long as 145 days — more than three weeks longer than the typically cited 120-day average.16 This longer life span could give the cells more time to become glycated, which could result in an artificially high HbA1c.
In these individuals fasting glucose would likely be normal and glucose after meals would be normal as well. People in this scenario would likely not have an HbA1c in the diabetic or pre-diabetic range, but it might be higher than they would otherwise expect — for example, 5.4% rather than 5.0%.
Anemia: Another factor affecting RBC lifespan and, therefore HbA1c, is anemia. Some types of anemia result in a shortened lifespan for RBCs, contributing to an artificially low HbA1c. However, iron deficiency anemia may be associated with higher HbA1c in both people with diabetes and without.17In fact untreated iron deficiency anemia can misclassify people as having diabetes. One study's authors note: "Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c."18
Genetic factors: Ethnic and genetic factors may influence RBC structure, and may therefore influence RBC lifespan and HbA1c. People of African, Mediterranean, or Southeast Asian descent may have hemoglobin variants that influence the accuracy of HbA1c.19 Other variants are found in individuals from other parts of the world. Some laboratories take hemoglobin variants into account in their tests, but others don't. These variants include genes for sickle cell anemia and beta thalassemia.20
Other ways to assess glycemic control beyond HbA1c
HbA1c can be helpful when assessing metabolic health, but is best when used as part of a larger picture. Here's a quick look at some additional ways to evaluate your blood sugar control and metabolic health:
Fasting insulin test or HOMA-IR: As mentioned earlier, many people have high insulin levels even when their HbA1c and fasting glucose are normal. A fasting insulin test can tell you whether your fasting insulin level is high, and combining fasting insulin with fasting glucose gives your homeostatic model assessment of insulin resistance (HOMA-IR).21
The HOMA-IR may be a more informative measurement than either fasting insulin or glucose by themselves because it helps you see the relationship between insulin levels and blood glucose levels, and tells you how insulin sensitive or insulin resistant you are.
Fructosamine: Similar to HbA1c, fructosamine levels indicate your glycemic control but during the previous two to three weeks rather than months.22 Fructosamine is a compound formed when glucose sticks to other proteins in the blood that only exist for 14 to 21 days. The percentage of glycated proteins in the fructosamine test reflects average glucose levels during this shorter timeframe. It is not believed to be affected by red blood cell lifespan.
In addition to being an indicator of glycemic control, fructosamine can be useful for gauging the recent impact of changes in diet, medication, and lifestyle. (However, fructosamine is not a routine test and may not be available everywhere.)
Glycated albumin: Albumin is one of the most abundant proteins in blood, and sugar in the blood sticks to it over time. Its percentage of glycation reflects mean glucose levels over the prior two to three weeks.23 This test is relatively new and is not widely available.
Continuous glucose monitor (CGM): Measuring blood glucose in real-time with a CGM provides very useful data about your blood sugar levels. If you've been surprised by an HbA1c that's higher than you expected, a CGM may show you more reliably what your blood glucose is doing after meals and throughout the day.
HbA1c plus an oral glucose tolerance test (OGTT): Drinking a 75g glucose solution and measuring your immediate blood sugar response, called an OGTT, can assess your blood sugar control when combined with the results of your HbA1c. In fact, one study found that, based solely on HbA1c, 73 % of subjects appeared to have normal blood glucose levels, but the OGTT showed that their blood glucose rose into the diabetic range.24 Do note, if you've been following a low-carb or ketogenic diet, the OGTT may give a false result. Most keto-friendly physicians recommend that you "carb up" by consuming 100-150 grams of carbs daily for about a week prior to taking the test in order to prepare your body to once again burn carbs — otherwise it may falsely indicate that you have diabetes.25
Triglyceride to HDL ratio: A fasting blood test that looks at the relationship between your triglycerides and your high-density lipoprotein (HDL) provides information about your metabolic health without measuring blood glucose at all.
To get the ratio divide your triglyceride number by your HDL number. The closer the ratio is to 1 the better, with the cut off for a "low" ratio being 1.7 — as long as the HDL is above 40 mg/dL. The higher the triglycerides and the lower the HDL, the higher the ratio, with a hazardous ratio being anything above 3.0.26A high TG-HDL ratio is part of the diagnostic criteria for metabolic syndrome and insulin resistance and predicts increased risk for type 2 diabetes as well as cardiovascular disease and heart attacks.27
Waist to height ratio or waist to hip ratio: The size of your waist in relation to your height, or in relation to your hips, are both indicators of metabolic health and insulin sensitivity. Greater abdominal circumference is related to a greater risk of diabetes, hypertension, cardiovascular disease and overall mortality even in people of normal weight.28
To get your ratios just divide your waist measurement by either your height or hip measurement to get a number. Or you can use an online calculator. A waist to height ratio less than 0.5 indicates good insulin sensitivity, while a higher number indicates insulin resistance. Likewise, a waist to hip ratio of less than .9 for men and .85 for women is healthy.
Summary
HbA1c is a very important measurement of your metabolic health that should ideally be taken regularly — perhaps once a year — by your doctor. If you have received a diabetes diagnosis it should be taken more often, perhaps once every three months.
The trend of your HbA1c results over time gives you a good indication of your blood sugar control. Lifestyle changes like low carb eating, intermittent fasting, and increased exercise can improve blood sugar levels and your A1c.
Like any other health marker, however, a single HbA1c result does not give a complete picture of your health. It helps to work with a qualified medical professional to understand the total picture of your health, using different clinical measurements as well as your own assessment of how you feel.
What vegetables are preferred on a keto diet? A rule of thumb is to avoid those that grow underground — and eat what grows above (read more about carbs in different vegetables).
