This issue has really affected my health in the last year and it will be a miracle to get to the root of it.

I’ve been doing a very low carb diet for almost 3 years now (not in “keto” though, due to protein-glucose sensitivity). In the last year I developed an extreme fatigue that no doctors had been able to attribute to anything. My new doctor, however, found that I had “rock bottom” testosterone (300 reading) and high reverse T3; both of which can cause bad fatigue. I am only 29 years old. It sounds like the problem has been found, but we don’t know what caused it.
Do you know if it’s possible for a low carb diet to affect these things? I have since found this article that is a little too harsh on LC in my opinion, but it does specifically say that low carb can cause low testosterone and high reverse T3. It felt like it was so specific to what I experienced that it couldn’t be a coincidence. However, it’s also too specific of a topic to have any specific studies or research to prove it one way or the other. I did a little more googling and found another person just like me , that can’t figure out why his testosterone is so low and his reverse T3 is so high. He too is on a low carb diet.

Do you have any info on these things? Have you heard of this being a problem in certain individuals? I don’t blame low carb as a “bad diet”, but I do think its possible any diet can affect people in different ways and I wonder if this is the case for me.

Thanks again to you all for any help and providing the community and people like myself with so much helpful knowledge! :-)

How low is very low, if you are not in ketosis? And please explain what you mean by "protein-glucose sensitivity".

Also, based on the usual ranges for what is considered normal for testosterone, 300 is within that range of 270 to 1070. Rock bottom would be well below the range, not near the low end of normal.

Thanks for your response MickiSue, I'll explain these things.

My very low carb diet: I stayed away from all breads, sugars, pastas, white flour, potatoes, rices, etc and was very strict. So "very low carb" meaning easily under 50g a day.

Testosterone range: 300 is within the acceptable human range, yes, but thats the full range of human males, which includes the elderly, etc. If I was in my 80s and I was tired all the time and my T was low, that would be pretty normal, however it is not normal in the context of a man still in his 20s. My T should be way higher and its actually almost as low as it can be without being an emergency, basically; thats what my doctor means as it being "rock bottom." I never would have guessed it was low T because (luckily) my sexual functions are normal, but thats what the lab results were. After reading about low T, it totally describes my extreme fatigue that doesnt get better after resting.


Protein glucose sensitivity:
However I was not in ketosis. I bought a blood test kit and the expensive keto blood strips that are praised for being accurate. I tested myself every day for a month and a half and kept a diary and made a lot of notes.
I learned that I was sensitive to protein, as some people are. What your body does on low carb is that it converts protein to glucose through gluconeogenesis (with 6k posts, I'm sure you are familiar). However some people can find that their ketosis levels are very sensitive to protein because of this. I found that I had to keep my daily protein intake under 80-100g or so, otherwise my ketones would plummet into low readings that didn't even quality as nutritional ketosis according to the Art and Science Performance book.
The low-carb / low-protein diet was really hard to keep up. It was a struggle to not accidentally have too many protein grams and it was a lot of work. I gave it up and went back to just the regular low-carb diet where I could have meats and cheeses and not worry about it. But as I said, my ketone readings went back to levels that Phinney and Volek say are below the range of actual ketosis (although technically I was creating some minor amount of ketones). So long story short, very low carb but not ketosis.

I had a quick dig around Dr. Michael Eades blog since he tends to cover a lot of science about how hormones interact and effect obesity and lipids. He does mention that hyperinsulemia can raise testosterone levels in women (not men) and in men it can raise estrogen levels. A low carb diet will reverse the trend by lowering insulin, but doesn't seem to have the opposite effect. In other words, in men, insulin levels effect estrogen levels, but not testosterone. Look at Dr. Mike's post on protein sparing effect and scroll down to the comment from July 15, 2006 where Dr. Mike responds to a reader question on this issue.

That doesn't really seem to be your issue anyway. You might also be interested in his blog entry on phthalates in plastics and how they act as an anti-testosterone.

You don't say whether your test level of 300 reflected a significant change from before you started eating LC, so it's hard to know if your change in diet had an effect.

It's not clear how much protein you are eating now. You said you were eating only 80g-100g per day when you were trying to get blood test results that said you were in ketosis. If you're still eating this amount of protein, that could absolutely affect your energy levels. I don't know enough about you to know if that level is sufficient for you, but it sounds low. That's about the amount of daily protein I aim for and I am a 50 year old, sedentary, 5'9" female. With a weight goal of 150 you may be a bit shorter than me, but the average 29 year old man is much more active with way more muscle.

If you're not getting enough protein and enough calories, yes, think you could experience significant fatigue.

I'm not sure if this answers your question, but maybe it gives you some more to explore.

No, I couldnt stick with the low protein diet, so I stopped it. I'm not sure how much I eat, but it is a lot of protein with almost all meals and snacks.

How much fat are you eating? How many calories?

For a young man, excessively low protein levels can be problematic, in and of themselves.

If I were you, and I am not, I would lower carbs to below 20, and keep them there. I would aim for 120 grams of protein and 120 grams or more of fat, daily.

If you are not getting enough fat, and eating primarily protein and moderate (not very low) carbs, then of COURSE at your current weight you're tired. You are not eating enough, period.

You are nearly 6 feet tall, elgrayso, and, being married to a man who is one inch taller than you, who weighed what you weigh at your age, I know skinny men. You didn't used to be one. And, at 205, you had plenty of your own fat to sustain you, along with the fat you got from your diet. At 158, that is no longer the case.

Let us know what happens, OK?

Thanks for the answers. I may have confused some of you earlier. I only did the low-protein thing for about a month and a half when experimenting with keto. The rest of the time I have been on a high protein, high fat diet with 2000+ calories a day.

Hi elgrayso, I've been on this forum for 9-10 years and through the years have seen a lot of people suddenly having thyroid and/or adrenal problems after several years of LC, and then going on thyroid meds, constantly testing and juggling to get the right dose. I refused to do that and kept looking for another answer... a diet-related answer. Even Dr. Atkins never intended dieters to live on LC forever, telling us to start climbing the carb ladder instead. But almost no one does. I know I didn't. lol

Not everyone can hack LC forever, especially once they reach goal and start exercising. It's only in the last couple of years that I finally lost my carb fear and start reintroducing carbs back into my life, and I feel much better for it, especially since starting to read Ray Peat's website. This sounds like where you're at.

Here's a link that's similar to the one above that condenses Peat's info: http://www.functionalps.com/blog/20...-to-metabolism/

You might find it helpful, but a warning... don't freak out about adding a little sugar.