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Short Summary
Main recommendation: On a low-carb or keto diet, start with no fruit and a limited amount of non-starchy vegetables, then add small amounts of fruit later only if you can control the portion. Dr. Eric Westman says total carbohydrate counts matter more than net carbs in his view, and that people on warfarin should discuss their vitamin K intake from leafy greens with their doctor and monitor anticoagulation.
Key Points
- Vegetables provide fiber, minerals, and vitamins; Dr. Westman says fruit is not an essential food the body needs.
- Dr. Westman says he does not know how much prebiotics and probiotics matter, and does not necessarily recommend them, so adding starch to feed gut bacteria is not a concern in his view.
- Berries are the lowest-carb fruit and grapefruit is even lower, but he advises avoiding fruit at first because it is hard to control portions.
- Fruit and nuts are described as trigger foods that stimulate hunger and are hard to stop eating.
- Net carb counting (total carbs minus fiber and sugar alcohols) is less effective in his view, since those assumptions may not always hold; for people with diabetes or metabolic syndrome he starts at 20 total carbs per day.
- Warfarin works by interfering with vitamin K, so high vitamin K greens need to be limited, and anticoagulation should be monitored.
Details Worth Noting
- Concrete instructions:
- Start with no fruit and a limited amount of non-starchy vegetables at the beginning of a low-carb diet.
- If you are taking warfarin, make a list of foods high in vitamin K and avoid or limit them; these include kale, spinach, collards, Swiss chard, parsley, beet greens, dandelion greens, collard greens, and mustard greens. Review the amounts listed for each.
- Check your anticoagulation level to make sure it is okay; many people use home testing kits.
- If you want fruit, eat only a bite or half a piece once in a while, not every day, and stop there.
- Plan to obtain vitamin C from vegetables and other foods you are already eating rather than from citrus or orange juice.
- When cravings for fruit appear, expect them to fade over a few weeks to a month.
- To keep track of carbs, read the nutrition facts panel on the back or side of a product and use total grams of carbs rather than the net carb figure printed on the front.
- For people with diabetes or metabolic syndrome, Dr. Westman starts at 20 total carbs per day, but says some people may do fine at 30 or 40.
- He suggests a practical way to limit fruit: a small piece of fruit or berries in yogurt, or a little fruit with a little cream.
- He notes cravings for fruit may take a few weeks to a month to disappear.
Bottom Line
Dr. Westman treats low-carb fruit and vegetable choices as a matter of total carb limits and personal control, with stricter limits at first and an explicit warning for anyone on warfarin.
