Gentle Carbs for GABA, Cortisol, and HPA (Adrenal) Dysfunction

Those of us who treat young women know that some women need to eat carbs or what I call gentle carbs.

A keto diet is great in theory, and great for many people. But it does not work for everyone.

For example, a keto diet does not work for young women with normal insulin sensitivity. And it does not work for anyone with HPA axis dysfunction or adrenal fatigue.

What is HPA axis dysfunction

HPA axis dysfunction is about the body’s stress response. It’s actually more about the nervous system than it is about the adrenal glands. Essentially, HPA axis dysfunction means the nervous system is over-stimulated, and it causes elevated cortisol and low blood sugar.

The HPA kind of “low blood sugar” is not a problem with insulin. Instead, it’s a problem with neurotransmitters and stress hormones. HPA dysfunction can also cause cortisol resistance which impairs serotonin production and leads to insulin resistance.

Other symptoms of HPA dysfunction can include include: anxiety, low or high blood pressure, dizziness, brain fog, insomnia, and autoimmune thyroid disease.

What are gentle carbs?

Gentle carbs are starchy foods that are not inflammatory. They include rice and potato and are glucose (not fructose) so they don’t contribute to metabolic disease the way high fructose drinks do. When combined with with protein and fat and vegetables, and eaten as part of a low-GI meal, gentle carbs do not lead to insulin resistance.

In contrast, un-gentle carbs such as gluten grains and high dose fructose (sugar) cause metabolic disease and inflammation.

Starch calms the nervous system

Starch increases GABA because starch feeds the healthy intestinal bacteria, that produce GABA. (GABA is the lovely, calming neurotransmitter that we all need more of.)

Carbohydrates can also improve the cortisol or stress response and increase tryptophan uptake, serotonin, and sleep.

I don’t think everyone should eat high carb. Far from it. I’ve spent decades asking patients to stop eating sugar and flour.

But I do encourage many of my young women patients to eat starch to maintain a healthy stress response and to not lose their periods.


170 thoughts on “Gentle Carbs for GABA, Cortisol, and HPA (Adrenal) Dysfunction”

  1. your belief is incorrect, Steve. if you read more about Maladaptive Stress and the different phases of Adrenal Fatigue you will discover that cortisol is too high in the beginning and over time with chronic stress the cortisol can become deficient. and in the middle you will find it fluctuating with circadian cycles typically lower in the morning and higher in the evening interrupting good sleep. try to be less judgmental, you never know what you don’t know.

  2. Except Adrenal Fatigue is characterized by not enough cortisol, not too much. So you theory is false. Really, do some reading of real people experiences before your write an article.

  3. Hi! I’m 56, post-menopausal (and happy about it!) and recently due to the food supply of the people I live with, I’ve been somewhat forced into a very low/no carb diet. Your description of the effects are pretty spot-on, and it actually felt like I was back in the horror of perimenopause – hot flashes, mood swings, weepy, “I’d stab you to death with my keys but I’m crying too hard to get out of the car” type emotions. They have autoimmune issues and are doing absolutely fabulously on carnivore, but I am frankly hating it and how I feel, and the crap cravings are blinding (peanut M&Ms are my “drug of choice” when I can’t control it). I’ve been having a serving of home made refried beans with breakfast lately and that got me feeling so much better I was wondering if it was a placebo effect. It also helps reduce the cravings.

    I don’t have the budget for testing, but this is one of those “listen to my body” moments. Your list of “gentle carbs” are wonderful to read, I avoid all grains as they seem to inspire fluid retention but pulses, sweet potatoes, and the tomatoes and other bounty coming soon to my garden have changed my outlook and let me feel like I have a reasonable plan to follow. Thank you!

  4. Is it okay to include rice AND potatoes/starchy veg at one meal?
    For example, I am Asian and my Mother often cooks traditional currys and stir fries which contain both rice and either potato, sweet potato or pumpkin along with lots of vegetables, sauce and protein.

    I eat these types of meals once a day, and have oats in the morning and rice for lunch as well… is this too much? I think I eat about 40% carbs, 40% fat and 20% protein

  5. hi im in my mid 40s/perimenopause and irregular period. I had a consultation with you and was told to quit sugar and dairy, which is a struggle specially with sugar. May I know if I manage to quit them and have reasonable periods back, how much gentle carb per meal would you recommend? eg. A fist size of carb with a palm size of protein and vegi about two palm size?

  6. This has definitely been my experience! My explorations with a keto diet to help manage inflammation and balance blood sugar within a hashimoto’s and PCOS diagnoses have at times left me anxious and unable to sleep well.

  7. Hello, would steel cut oats be considered a gentle carb? I’ve been trying to eat only sprouted grains bread, but I guess that probably just as bad with the gluten aspect? I also eat irish oatmeal and sometimes brown rice, sweet potatoes, are these alright? are there any other gentle carbs you could recommend?
    thanks much

  8. This is a really interesting article despite seeming to be largely discussing young women. I am a 55 year old man, on LCHF for around 6 years now and 8 months into IF and EF and feeling pretty amazing. But just recently have been getting bloods checked and have noticed that cortisol is going up (264 nmol/L to 373 nmol/L), still within range but nevertheless. Added to this TSH is increasing from 4.37 mlU/L to 5.58 mlU/L, all within 3 months. Haven’t had T3 or T4 tested yet and really have no symptoms I can detect – energy levels great, at target weight, great appetite control…does this look like what you are describing? Many thanks

  9. If someone presents with functionally low salivary cortisol & high DHEAS, low T4/T3 and low blood glucose (with normal insulin) after an oral glucose tolerance test do you think adrenal dysfunction is most likely the root cause? Or could the thyroid be the cause of the lowered corticosteroids?

  10. I so appreciate this post. I have tried many times to do a paleo diet, and I lose weight quickly. But about the second or third week in, I start getting headaches and anxiety. I could never understand why. This makes a lot of sense! I don’t have issues with protein or fat. I am strict gluten free and have been for over a decade, but struggle to absorb nutrition and thinking SIBO or an underlying fungal overgrowth is a problem. I do struggle with athlete’s foot, for instance.

  11. Ben, I want to thank you for your wonderful, helpful blogs on the various topics. My family attended one of your seminars in Christchurch a year or so ago and have benefited SO much from the ongoing emails we receive. I had been diagonised with type 2 diabetes which I have been able to turn around, yay, so so good, thanks to you!!! I have also had quite bad adrenal fatigue. It was thanks to reading your blogs and doing the ‘test’ that I am now almost sorted with that too. The medical people do the best they can with the information they have to hand but there is nothing as good as using ‘natural’ foods/methods to heal ourselves. Take care, Margaret

  12. Advice for following a candida protocol and including carbs/glucose? I’ve found that my mood and skin health suffer greatly after including sweet potatoes or berries. I also have Hashimoto’s so I avoid potatoes as they’re a nightshade. I’d love to find a carb that works well for me! Thank you!

  13. One more thing… what dose of magnesium do recommend? I am in my mid 50s and wanting to lose belly fat. I do not have PCOS is that makes a difference. Thanks again.


      • Thank you. I happened to have a bottle of magnesium on hand (200 mg) and began taking them. Oddly and happily enough, the next morning I was experiencing much less pain than the day before. I usually wake up with something akin to what I would describe as full-body pain similar to sore muscles. That in and of itself was enough to make me want to continue taking it. I am going to look up the type you recommended and order.

        Thank you. I just thought I was getting “old”. lol

  14. Hi Lara,

    Just found you today and am hoping you still look at the comment section. I have a question about gentle carbs. Is it just potatoes and rice? Is there a comprehensive list somewhere? I searched your site and didn’t come up with anything. Thank you so much.


      • Thank you. Read the article yesterday and will review again. Definitely doing my best to quit sugar again (really think I’m addicted) and I know the longer I avoid it, the less I will want it. It’s a cruel mistress, one that easily takes over my brain… I’ve definitely had those times when I must have sugar and especially at night time. I read once that when a person prowls the kitchen like a cat in search of sugar, it was due to leptin resistance. IDK if it’s true or not, but I’ve definitely had my share of late night prowls for *anything* sugary. It is the bane of my existence.

        Again, thank you. You are appreciated! โ™ฅ

  15. Lara,
    Why do you say that most young women are less likely to be insulin resistant? I’ve spent this evening reading a number of your articles and I have your book and that’s the first i’ve ever heard that!
    I’m in the middle of a diagnosis with PCOS and am trying to get as much info as I can because my doctor just gives me medication and nothing else so i’ve decided to see a specialist at White Lotus in Toronto, Canada and want to make sure I have all the info I can ๐Ÿ™‚
    Thank you!

  16. This is really interesting Lara, thank you so much. I have pcos with my main indicator being very high LH levels. Everything else seems to be normal. I have been told that it’s the pituitary glad that isn’t sending out normal transmissions so I may not be ovulating. Reading about HPA as it seems like a good fit, making sense of my symptoms. I eat too much sugar, even the ‘healthy kind’ so I’ll be cutting that out.
    I do crave carbs so I’m really pleased that potatoes and rice in moderation is absolutely fine. I think this may help my aneamia. You’re really changing lives with the information and guidance you give. Thank you!

  17. Thanks Lara! But why should it be sooooo hard to get to the truth of what works/doesnt work! 30 years I have been on this journey… and recently went on the SCD diet (low enzymes and disaccharides issue) and then got Adrenal fatigue!!!!

  18. P Lee, I did the same thing. I lost weight beautifully, but how I wish I could go back and undo it. I added back in carbs and have gotten better with my sleep, but not like I was. I am also in perimenopause, so I am pretty sure that is also affecting my sleep. I now take magnesium glycinate (300 mg) and melatonin (3 mg) about an hour before bed.

    • Unfortunately, I’ve added in carbs and still have onset and sleep maintenance insomnia. Natural remedies (including magnesium and melatonin) do not work for me. Prescribed sleeping pills haven’t worked reliably as well. I have gained all my weight back and then some, yet my sleep issues are still here. I am 44.

  19. Hi Lara, I stumbled upon this post researching carbs in the face of Adrenal Fatigue. I was diagnosed in November after a long and stressful illness of my mother’s and then dealing with my father after her death. Also I was exercising to relieve those stressors and ended up running 100 miles a month, biking 20-30 and working out 2-3 days a week in addition to mountaineering where I would carry a 40 lb pack for days into the mountains. I went low carb (less than 50 g /day) 5 years ago and it worked beautifully for me until the AF, when I discovered low carb left me out of energy and endurance. Thank you for this insightful article- my husband has been urging me to eat more carbs and I have resisted because I was invested in doing things the way that has worked for me for a long time but I finally have realized that I can no longer force my body to do my will- it has given up! I am subscribing to your site and look forward to more info and insightful articles.

  20. Thank you for this article. I lost weight doing nothing but counting calories. When my weight started to stay steady and I didn’t feel like decreasing my calories any further, I tried the ketogenic diet. I listened to months worth of podcasts, read numerous articles, and was indoctrinated into the cult of keto. Over the span of a year I didn’t lose any more weight …. Nine of the benefits were realised. I was miserable most if the time and some days I was a complete terror to be around. It wasn’t until i read about adrenal fatigue that I realised that I was in a constant state of low blood sugar. Your article explains what happened to me. I have a little website where I have posted some blogs and I was just thinking about writing about this topic….but you have said everything …. I think I will just submit a link to this page. Thank you for confirming what I’ve been thinking …. When I came off the ketogenic diet …I ate sushi ….almost everyday for dinner. I was ME again !!! Now I eat fiber as in chia seeds and I eat sweet potatoes. …BUT like you mentioned and I have discovered , I avoid fructose!

  21. Fascinating! I’ve been ultra low carb for 3 years and have been digressing this past year. I may need to talk my naturopath into letting me have some “gentle carbs”. (Thanks for explaining the difference.) I did splurge earlier this evening eating 1/4 of a sweet potato, including the skin from the whole potato. Yum! Hoping it won’t affect my sugar badly, but it seemed like my body said, “Ahhhh,” like it was feeling relieved. Thank you for this article!

  22. I am 34 and have been diagnosed with adrenal fatigue. My cortisol is low in the am but does fall through the out the day as it should. I eat a lot of carbs and sugars, so I don’t think I am one of the women you are talking about. I have read your book and started taking magnesium and giving up sugar and dairy. I am also taking selenium, chromium, and zinc through a protein shake in the am (it is made to help with insulin resistance. It has many other nutrients, fiber, probiotics in it). My first period after trying this for one month, came after 25 days with almost no cravings or Pms. Is it possible to have adrenal fatigue and insulin resistance. I know your book says insulin resistance is the first thing to treat. Since I have started these changes, my anxiety is so much better!

  23. You views in this article resonate with me. Although I am not a young lady, I am a very healthy 62 year old woman but suffer from low cortisol in the morning, high in the evening. There are periods of time that I do not eat rice, potatoes or the like. I suffer from anxiety, brain fog and low mood which result in the need to isolate frequently for a couple of hours in the afternoon.
    I look forward to experimenting with the gentle carbs and see if I can see some improvement in my symptoms.

  24. What age range is considered “young women”? I’m 36 with normal day time cortisol, borderline low afternoon cortisol (technically normal but lowest normal level), and super high night/before bed cortisol. I eat low carb and am wondering if I should up my intake of gentle carbs. What would you recommend for my age? Testing also shows I have moderate candida overgrowth too so am worried about that. Do you suggest treating the adrenals first or somehow treating the adrenals and candida simultaneously? Thanks a ton! Great article!

  25. I see this post is a little old, so I’m not sure if you would find yourself 100% on the same page now, but I’m not following the general thrust of the article, and I more-or-less disagree with the conclusions, based on personal experience and what I know about nutrition.

    You have said within this article that “cortisol resistance…causes insulin resistance” AND that “young women are [perhaps] less likely to be insulin-resistant.” But since the article is about young women with cortisol issues, that makes no sense.

    Ideally, no one should be cutting out entire food groups. We have macronutrients for a reason — we need them all. We’re not designed to function well with fat, protein, and carbs, and cutting out (or almost completely cutting out) any one of those is not going to be healthy. (There’s some wacky all-carb chick on YouTube — she calls herself “the banana girl” or something like that — and she lost her period on nothing butcarbs.) Balance and real, unprocessed foods are the way to go.

    The explanations of how starches work here doesn’t really make sense either, though. My background is that I wrestled with adrenal fatigue for a long time before finally figuring out that’s what was going on, and a long time more before seeing any improvement, because nobody knew what to do about. In the meantime, it created gut dysbiosis, so I currently cannot digest basically anything starch. Sugars digest fine; starches do not. (I’m not saying sugars are health, just that they digest.) I haven’t had anything starchier than a banana, for the most part, in probably a year, and I’m feeling better than I have in many years — and cycling just fine, too. I wouldn’t recommend it; I’d rather get my gut issues fixed and get back to a more balanced diet. But it has not seemed to cause additional trouble with my cortisol response, or interfere with my reproductive system.

    At the same time, none of the things you said about certain carbs being uninflammatory is particularly relevant to the reasons anyone I’ve ever heard of cuts them out. Excessive carbs can still raise blood sugar, simply by virtue of being carbs that need to be processed, and excessive carbs will still be stored as fat. The major key here is that people need to recognize that “not excessive” does not equal “none.” Just like “if some is good, a lot will be even better” is not true of drugs, so “if less is good, none will be even better” is typically not true of food!

    • Thanks for your detailed comment. Yes, I need to write a post about how dysbiosis can impair the ability to digest starch. My approach with my patients is not to permanently eliminate starch, but rather to treat the dysbiosis, and restore the ability to digest starch.

      All that said, some people do very well on a low-carb diet. Certainly, all of us need to eat less starch than is typical of the standard american diet. I refer specifically to young women in this post because that’s whom I’ve seen run into real trouble by going too low carb. They experience anxiety basically because they have underlying HPA axis dysregulation, and a low carb diet stresses the axis even more. Some young women lose their periods. I have written an updated post on that: Have You Lost Your Period to a Low Carb Diet?

      Yes, of course, many women have lost their period to a high carb diet (which I discuss that in the “lost period” post). And some women do very well on a low carb diet.

      My message would be this: If you have been following a strictly low-carb diet, and you are feeling more and more stressed and anxious, then it’s time to do things differently. And also, just because you felt better off wheat and sugar, it does not necessarily follow that you will feel even better off all starches. (By “you”, I mean “you reader”–not “you Titus”, as I understand that you personally feel better on a low starch diet because of your digestive issues).

      thanks again for adding to the discussion

  26. Hi Dr. Briden. Great article, but I feel the need to address the benefits of adding fruit (preferably organic) to the diet as well.

    As a victim of a water damaged building, my HPA axis is a nightmare. After 3 years of fighting the resulting fungal infection, my adrenals are not producing adequate DHEA and testosterone. I knew that my low carb diet was no longer keeping things under control, so I took a risk the other day, and decided to add fruit back in, but I ate it ALONE. Compared to the times I’ve tried “gentle carbs” (which would cause weight gain even in moderation), I feel so much lighter! And for the first time in months, I was able to walk around my block in high humidity (the air usually kills my lungs).

    Although I used to get leaner with meals like eggs and oats, my body can no longer tolerate grains. Until my immune system recovers (hopefully), I feel this is the only way I can start to heal my body. As a bodybuilder it kills me to not be able to get more muscular with my modified diet, but I’d rather be a little softer and leaner than bloated with a little more muscle mass and way more bodyfat.

    There is definitely something magical about RAW fruits and vegetables when properly placed in the diet. I hope some of your readers can relate to my story, this and give these foods a try.

    • I wish I could edit my post, but this will have to do for now. I think what I wrote is great for someone who is for the most part healthy. But for myself – the natural sugars gave me a temporary high. I’m now suffering from awful sleep, I can feel my estrogen skyrocketing, and I realize I’ve lost muscle mass.

      My body type is meant to consume animal products and veggies with very few carbs when healthy. Now that I’m sick, I have a hard time tolerating everything. I honestly don’t know what I’m going to eat other than fish and mostly raw veggies, but I once again have learned that sugar feeds fungus. I honestly need to try another antifungal. They say food is medicine, but when you have Mycotoxicosis, it’s definitely not enough ๐Ÿ™

  27. Hi Lara, do you have any suggestion on how to fix the HPA Axis dysfunction? I am almost 50 and am in Perimenopause, which connected or not, seems to have worsened things. Thanks.

  28. Hello,

    I am currently tapering off Lexapro ( prescribed for post partum depression). I suspect I might have Candida and my PMS intensifies when I make a reduction to the Lexapro. I’m at a loss as how to address candida without eating too few carbs while eating enough to support my PMS. In addition weight has been a struggle since pregnancy as Lexapro zaps my metabolism.
    I fear my body has grown addicted to Lexapro as when I get too low on my dosage I have anxiety and panic resurface. I have been on Lexapro for 12 years as my doctor told me if I went off ” it would all come back”. I’m done with living with that fear. I believe my body can heal. I suspect initially the PPD was caused by hormonal lows and possible a autoimmune thyroid condition. Prior to pregnancy I skipped my period for months at a time. However, none of this was considered then.
    Any insight would be appreciated.

    • Hi Jennifer,

      My heart goes out to you. I am no doctor, but I’ve been in your shoes! I was on topamax for years, and some inexperienced Doctor knocked me down a dose then wouldn’t see me bc of insurance (despite being willing to pay out of pocket)! So I kept trying to reduce on my own. With each reduce I got worse, PHYSICALLY, and MENTALLY. Unfortunately they are intrinsically tied. I don’t think this is Candida for you, though I don’t know. I know my gut acts up when my neurotransmitters (what the meds worked on) go haywire. You need to get it off- my advice is go super super super slow, and, find a naturopath that can give natural supplement advice for brain chemistry support WHILE going off. I understand you want to be off, but your body is telling you something with the anxiety. Don’t give up carbs bc of Candida, it was the WORST thing I did for my body while trying to wean off my medication. It caused a whole slew of issues- hair loss, insomnia, panic, depression. I’d say just be very patient with yourself about the Lexapro, and stay on a low dose as long as you can. We harp on meds, but sometimes they save us. I know you want to go off, but I regret going off without other mental support. It sent my body into a really painful state where my liver, hormones, neurotransmitters, thyroid and my gut are out of whack, and I stopped having a cycle. Just be patient with your medicine, and take it slow- listen to your body. Lexapro is a pain in the b with its withdrawals. Find something to support your own serotonin levels- it’s serotonin it works on, as an SSRI. Make sure to get extra sleep, exercise normally, and do NOT go off it if you’re in a stressful time or transitional period in your life. I hope you’re hanging in there <3

      • Hi Theresa,

        Thank you for being in touch! Yes, I know how brutal SSRI withdraw can be and I am so sorry to hear you didn’t have someone to support you. I have been slowly reducing over the past few years. I got down to 1.5 mg from 20mg, only reducing by 10%. I took several breaks, and had a relapse of symptoms last summer and went back up to 5mg. I suspect I have Candida in part based on a food intolerance test that also looked at my reaction to Candida. The test showed I had a moderate amount of Candida. I thought to work on the Candida in hopes that it will help my body let go of the Lexapro dependency. Have you remained off the SSRI? I currently take 5htp alongside the 5mg of Lexapro. my plan is to amp up the 5htp as I wean off the Lexapro.

      • Hi Lara,

        Thank you for being in touch. I had a food intolerance test done that also looked at Candida. The test showed I had moderate Candida overgrowth. I want to address the possible Candida overgrowth in hopes that doing so will help lessen my PMS (anger, anxiety, depression) and make the Lexapro tapering go smoother. I recall reading there is a connection to Estrogen and Candida so I thought it wouldn’t hurt to try. However, I have had intense reactions to both approaches I have tried, Candiclear and Candex. It’s hard to tell if I was experiencing die-off or if my body just didn’t agree with the supplements.

  29. I am 49, and have been diagnosed with adrenal fatigue, and thyroid issues. 12 years ago I weighed 94 pounds from over dieting, and stress. Now I’m at 169, and am only 5″2′. I’m taking NDT, and doing a flip flop with the low carb diet after reading that it could affect sleep. It doesn’t seem to help me lose but 5 lbs. anyway. I have terrible insomnia that has improved some with adding some carbs back. Do you have advice or an article for older women? I also have heavy periods that have been helped some with nattokinase.
    Thanks Angela

  30. When you say fructose, do you mean high Fructose Corn Syrup, or even the fructose from fruit? I have been doing the Trim Healthy Mama plan for three years now, and about a year ago, after getting down to a weight I haven’t seen since college, I suddenly put on 10lbs in about 6 mos. I was thinking maybe I was eating too many low carb meals for too long, and not enough carbs. But that’s been my only symptom. Is that a symptom of HPA dysfunction? How do I go about finding if I have that? Thanks so much for the article!

    • I mean any kind of high dose fructose: sugar, high-fructose corn syrup, honey, dried fruit and fruit juice.
      Was there a medication that might have caused the sudden weight gain? hormonal birth control, antidepressant, antihistamine, antibiotics?

  31. I’m 45 and have had my adrenals tested. I have adrenal fatigue and now take licorice root, pregnenolone and dhea. I have also been following THM but I usually let loose on weekends to a small degree – I’m just not perfect on weekends. I have a hard time not feeling tired in the afternoon 3-6 ish. But I usually have one E meal a day at least. Any ideas?

      • DId you get the answer to this? THM is Trim Healthy Mama. I am so interested in your reply. I too have used this diet and feel I have neglected carbs. I am anxious and have insomnia, but I don’t want to regain the weight by adding in starchy carbs.

        • I wouldn’t wish insomnia on my worst enemy…it zapped 2 years of my life and I attribute it to a no/low carb diet due to being diagnosed with sibo…Yes, I lost 20 lbs but the hormonal and sleep issues that came were unwanted side effects. I have now gained back the pounds lost as well as gained an extra 10 lbs…but can now fall and stay asleep for 4 hrs uninterrupted…which is quite welcomed at this point…I am still trying to stabilize my hormonal and sleep issues but this is no quick fix…it took 8 to 9 months for me to even get to this point while on a diet that added back rice and potatoes.

  32. I am delighted to have found you, Lara! Eating half a sweet potato mashed with butter for breakfast keeps me going till lunch. Oats never did, and I couldn’t understand why I was so hungry an hour later when they were supposed to be such a great breakfast food. Even scrambled eggs on wholemeal toast never did it for me, against all main-stream advice. I’ve been grain-free for 4 days now and doing great! I couldn’t have managed going 100% Paleo, and since I have zero DHEA, testosterone and am definitely adrenally fatigued, doing Paleo would have been seriously bad for my health. Thank you!

  33. Hi Lara. Thank you so much for making this information available online. I have a binge-eating disorder and put on a lot of weight in the last year after multiple years of purging and starving in high school. Mostly with sugar… I started having unbelievable, 10-out-of-10 period pain and cramping after sex, cystic acne along chin and neck, chin hair growth etc. I was also prescribed 50mg Vyvanse (stimulant; lisdexamphetamine) for my ADHD last year which has improved my life a lot but I suspect amped my anxiety and adrenal fatigue way up. I even ate 100% keto for 8 months and that helped a little, but not as much as I was expecting. Hair came out in handfuls in the shower… I felt like I was physically falling to pieces.

    Magnesium, allowing rice and potatoes but no sugar, and heavy weight lifting have changed my life. So simple. Hard work with an eating disorder and something of a sugar addiction, but sooo simple. Just wanted to say thank you again. I feel like I can function again, am losing weight normally, and have regrown a lot of hair that doesn’t snap in a gentle breeze. My doctor wanted to prescribe metformin but after some discussion, she was happy to monitor me while trying magnesium first and she’s thrilled. ๐Ÿ™‚

  34. Thank you for the section about gentle carbs. I am on the Adrenalan Fatigue diet that I picked up on the internet and was wondering if I am allowed to have sweet potato chips with my chicken. The other thing that is bothering is oats, I thought it is wheat. I get very sick of wheat, had an experience the other day when someone said I am allowed whole grain?? I bought whole grain Pro-vita biscuits and started to couch again and that was the only thing I had that was not stated in the diet. They say oats is also good for cholestrol, I get so tired of the eggs and veggies in the morning. I am so glad about the low carbs that I can add, will try and see if it effects me. I have been very sick for 20 years, had asthma and stomach problems. I am off my stomach tablets and feels much better.

  35. I find your article annoying because you presume that everyone with adrenal fatigue has high cortisol….I have low cortisol and do better when I keep my carbs low, especially in the evening……carbs basically obliterate all other hormones in favour of insulin.

    • No need to be annoyed because I actually state: “For those with HPA dysfunction, cortisol is both too low (daytime) and too high (night-time). Furthermore, the body and brain do not respond to cortisol the way that they should.”

      I fully acknowledge that low-carb works for some, and I’m glad a low-carb diet works for you. Just to clarify: Are you a young woman? That is the main group I’m talking about in the article. I have seen low-carb to be a problem for young women if they have cortisol that is too high or too low.

  36. Wow, I love this article. Im so glad I found your page. I am a 33 year old female who was low carb for probably the last 5 years…until recently when I discovered how important carbs are for adrenals. I have what I believe to be severe adrenal fatigue (waiting on test results)…I have dealt with severe anxiety for some time now and can never relax. I also did a Cyrex autoimmune test this year and I have antibodies in my adrenals. I just started incorporating more carbs and already feel so much better. But someone recently told me that when meat is overly cooked, you lose the taurine which helps bile flow and its better to eat meat raw or steamed. Have you heard of this? I normally cook mine well because Im worried about parasites. I wanted to get your opinion on this! I have tried numerous diets and supplements and never feel better and now react to most supplements and am starting to react to food…like bone broth I used to not react to and now I do. So I want to make sure I’m eating meat properly because I feel like nothing works for me and I’ll do anything at this point. Thanks for your time!

    • Hi Julie, Thanks for sharing your story about a low carb diet.

      I think there’s another question earlier in the comment stream about taurine and cooking. My understanding is that a lot of it is lost with cooking. I routinely prescribe taurine (in combination with magnesium).

  37. Hi, I tried low carb diets a few times for my PCOS. Every time I tried I would get anxiety. Now I’m making sure to eat at least 100 grams of carbs a day and make most of them gentle carbs. I tried intermittent fasting but I think I didn’t get enough carbs. I’m going to try it again but with enough carbs. Thank you for your information.

  38. I know this article is 2 years old but I still have a question. Everything I am reading about GABA says taurine increases the GAD enzyme thereby helping to elevate GABA. Animal meat is a good source of taurine. I’m confused now.

    • Great question. I love taurine, and I often prescribe it as a supplement (combined with magnesium). Taurine does promote GABA synthesis and also is a GABA agonist at the receptor. And Yes, meat is the best food source of taurine, which is one of the reasons that I encourage my patients to eat meat and starch.
      I quoted that one animal study that found reduced GABA with protein, but almost three years later, I’m not sure how useful an animal study is for this. I can’t say that I’ve seen anxiety from high protein diets, but I have seen it from low starch diets, especially in women.

  39. What do you do when you have SIBO, (Hashimoto’s, celiac, fibromyalgia). And likely PCOS which leads me to your blog (thanks, I’ll keep reading). Have been intermittent fasting for three months. Low/no starch except what’s in thyroid meds (Synthroid, Cytomel — can’t do the “natural” choices as I go in the dumps). Feel best when I don’t eat at all! ๐Ÿ™ Hair’s falling out NOW after all these years? Could be not enough protein? Chiro/nutritionist told me to exercise and that’s it after one round of herbals for SIBO. Exercise=pain (I do walk).

    • Do you have true celiac disease? If so, how are your gliadin antibodies? Is it possible that you’re exposed to trace gluten somewhere? If you’re true celiac, then even a tiny amount of gluten will contribute to all your other condition.

  40. Hi Lara, thanks for posting this article. I have PCOS and have adrenal fatigue so definitely benefit from including gentle carbs in my diet. However my question is about including rice in the diet for women with PCOS. I have heard it is better for women with PCOS to go grain free, and I assume that includes rice? Interested in your thoughts on this one!

    • It really depends on the type of PCOS (see my PCOS Type post). If you are strongly insulin resistant, then you can temporarily reduce all starch, but generally I find rice to be quite helpful for hormone balance.

  41. Hi Lara,

    Some great info on your site!
    My comment is about rice. I just did the RPAH strict elimination diet and was encouraged by the dietitian to eat rice. I was avoiding it because of what it does to my skin. I started eating it, and what a freaking cascade of symptoms. Rosacea, acne, sore joints, swelling fingers & toes (chilblains and rheumatoid arthritis symptoms). I get this from any grain (plus asthma). I don’t seem to handle any kinds of sugars. None at all. Yet I crave them. Yet, it’s like any at all, makes my skin oilier than you could ever imagine. The dietitian didn’t understand how someone could react so adversely to rice, and potatoes, etc. Is it possible I could have some rare condition that prevents me from metabolising sugars? My insulin is normal on paper but clinically I’m a mess. I have seen countless specialists about different symptoms and they scratch their heads and shrug.

    • I’m also surprised by that kind of reaction to rice, because it is usually very gentle. Did you introduce any other foods at the same time?

      • Sometimes with other new foods, other times not. The response is always the same. I’ve tried removing the rice and eating other new foods in isolation and not gotten the reaction, then rice without the new foods, and I react. I have read lectins can attack arthritis, and I certainly experience this. Is it possible something in grains enters my bloodstream through a compromised gut wall and attacks my skin and joints? Or is it upsetting my blood sugar?

        • I doubt it’s a blood sugar effect (especially if you eat combined with meat and vegetables, thereby having a low GI meal). You must have a sensitivity or allergy to rice, which is certainly possible, although not common.

    • Ing: I recommend you find someone who does Cyrex Labs food sensitivity testing. If they’re a naturopath, they may also be able to get to the bottom of your complex symptoms. Cyrex labs has a test for gluten and the 24 most common cross-reactive foods with gluten. This includes all the grains, including rice, and potatoes. In my experience, as a nutritionist working with hundreds of people who have taken this test, rice and potatoes are very common food sensitivities especially when the person is gluten-sensitive. Eating foods you’re immune system has lost tolerance to creates inflammation that can affect any area of the body, hence the widespread symptoms.
      There are also people who are lectin sensitive, but that is fairly rare. I have only seen 4-5 people out of hundreds I’ve worked with. Lectins are found in grains, beans, nuts, seeds, eggs, dairy, nightshades.
      Good luck finding a practitioner who works to lower inflammation system-wide. It sounds like that would be a great place to start to help you heal.

  42. Hello Lara,

    Your website has been a shining light in my sea of anxiety while going through a state of unknown physical ailments and mental distress. I had written to you nearly a month ago about hair loss, and going off medication and Birth control. I am also on spironolactone, was on 50mg (25mg 2X), now I am taking 25 mg 1X a day in morning to taper. I have lost more than half the hair on my head as a result of Topamax withdrawals and still have 100 mg to taper. The naturopathic doctor I saw said that my adrenals are fatigued, and that I have blood levels that show extremely low metabolism and am over reactive to reflex testing. I have two questions. One, topamax is an anticonvulsant that enhances GABA activity in the brain by calming/depressing the central nervous system. As I go off of it, I am noticing my body is extremely tense, especially at night. I was suggested to take slow release pregenenolone and rhodiola. However, Ive read the side effects of pregnenolone and am terrified to take any sort of hormone that will mess with my hair more, as well as CAUSE acne after I know my face is going to already break out from getting of BCP and spironolactone. Are these safe to take? Two, he suggests I go off BCP as soon as the pack is through, yet is it crucial to wait until I am finished the pack, or can I stop now? Will this help with avoiding acne? He mentioned I should avoid grains to avoid acne, but Im already sugar free and vegan (though I eat eggs and greek yogurt because they’ve never caused cystic acne.) If I go no grain life will be considerably more difficult. However, my body has been gaining weight when I barely eat anything now, and I have no energy when I do eat. I am unsure what to do, and feel so out of sorts. Do you do Skype chats?

  43. Thank you so much for this information. I also have been a victim of the low carb movement. I was also going high protein, which likely made things even worse. I can’t wait to get my health back. The anxiety, depression and insomnia has been tough.

    I can’t believe how much I let stuff I read on the Internet dictate how I would eat! I literally didn’t have any carbs for 8 months doing a ketogenic diet. it totally messed up my nervous system. since 5hat happened though, I have been doubting that that was the caus3… I kept telling myself “no, that couldn’t have made me this bad, I am just somehow defective”. nope… I just stopped listening to my precious body.

    I used to be a professional athlete. I was in incredible shape and guess what made up the bulk of my calories? Carbohydrates!! I’m going back to the promise land . I feel stupid but I have learned my lesson

    • You are not alone! I could have written the same comment (except for the professional athlete part lol). You live, you learn. I’ve been healing from my mistakes for a couple years now.

      • Thank yiu Simone,

        How is the healing process been for you? has your condition inproved? Do you think it has been ultimately a positive experience, even though it was painful? my spirit wavers, and it’s hard to see light at the end of the tunnel sometimes. Do you have any advice as someone who is 2 years ahead od me on the learning curve (either nutritional or spiritua/psychological)?

        Thank you

  44. Thank you for an informative article! I am overweight and suffer from PCOS and I also have adrenal fatigue so carbs are like a double edged sword in my situation. When I abstain from carbs I feel horrible. Yet I’m struggling to lose weight so I feel like I’m between a rock and a hard place. What do you suggest?

  45. Hi Lara, thanks for this. It’s something I’ve slowly been finding out for myself after a few years on a low carb / moderate to high protein/fat diet riddled with sugar binges. I do have one question, does it matter whether I am consuming my safe starches/gentle carbs with each meal, or just balancing the day overall? I tend to have a lower-carb breakfast and lunch which helps me feel more alert during the workday, and then eat more starchy things for dinner. Thank you!

    • Yes, I usually recommend starch with dinner. It’s calming and promotes sleep. Fine to have a low-carb breakfast if you feel well with that.

  46. Thank you so much for this Lara, I’m so glad I found your website! My naturopath implied that I was imagining the fact that every time I cut out carbs my gut flora gets so upset that I end up with severe indigestion, nasea and excessive bloating/gas. I also get so anxious I border on panic attacks. I’m a celiac, so I don’t have gluten grains anyway, and was pretty devastated to hear that I was perhaps doing my already compromised thyroid more damage by eating rice, buckwheat and quinoa (by the way- what’s your stance on quinoa? I still don’t understand the link to thyroid issues properly). Anyway, thanks again… I am so so glad I found you!

  47. Hi Laura, I have low T3, low serotonin, low GABA, low DHEA – and multiple food intolerances. The last foods I lost tolerance to was potatoes, rice, buckwheat and all alternative grains and seeds. As I have salicylate intolerance I don’t tolerate squash, sweet potatoes, root beets, carrot. I try to get enough gentle carbs from plantain and tapioca (but tapioka is goitrous, meaning not that good for low T3). Do you have any other suggestions for gentle carbs – I really need it as I am so tired all the time.

  48. Hi. What is the gentle carb recommendation for…:) if I have very very low DHEA verified by saliva and blood tests and normalish cortisol levels. I also have severe IBS and lately depression. I have eaten low carb high fat for years …I dropped 20 lbs quick but now slowly gained it all back….not from eating different… But from stress I think. I eat tons of carrots but maybe need more rice? Green veggies cause mostly bloat….:(


  49. So glad to have found this- I have been struggling with hypothyroid/autoimmune thyroid and also high cortisol levels for 3 years now. I have seen two NDs and it was suggested that I try fasting and/or paleo/keto to help with weight gain. I have been dragging myself though less than 50 g of carbs a day (often 25-40). I see now that without the insulin from carb consumption the reason for my low T3 levels even with natural dessicated thyroid. And having all of that T4 meant it was being converted into reverse T3. I am so grateful for this “lightbulb moment.”

  50. Hi Laura,
    I love how you suggest the importance of gentle carbs. I am 19 years old and I currently struggle with acne, blood sugar problems, low T3 levels indicating an underactive thyroid, and I have not gotten my period in almost two years now. I have tried to heal my gut and get candida/ gut dysbiosis issues under control and I have tried paleo two different times in the past two years, but I got very sick both times, and my T3 levels showed to be at their lowest then also (I assumed because of the lack of carbs). About 1.5 months ago I added back in non-gluten grains and I have felt much better and my digestion is also better which I find to be interesting. I have been addressing my elevated cortisol levels for a while and my DHEA-Sulfate levels seem to be within a good range now, but I still have a TSH above 3.0 and low free T3 levels. Also, I have been taking my morning temps and they are usually always at 97.5 degrees, despite taking Thyrocsin by Thorne along with many other supplements. I am at a loss at what I should be doing now because I know that I am still having thyroid problems which might explain my persistent acne, amenorrhea, etc., but I don’t know if I should be looking further into changing up my diet again (despite having a really balanced, whole foods diet that is gluten, dairy, soy, and refined sugar free) or if I should just consider taking a thyroid medication at this point. Sorry for such a long, personal comment. I guess I am just wondering if you have any suggestions. Also, do you think there is a specific amount of complex carbs that I should aim to get each day? (being 5’4” and 120 lbs). I really appreciate any feedback that you have to offer.

    • Hi Natalie,
      A TSH consistently above 3 is a problem, and yes, might be a problem for your periods. The first thing to think about is: Is your thyroid problem autoimmune? Do you test positive for thyroid antibodies? If so, then you need to correct autoimmunity, and that might mean doing more work on your gut and intestinal permeability. Yes, you might also need thyroid hormone.

      To support adrenal and thyroid health, you probably need about 100-150 grams carbohydrate as a Gentle Starch (rice, potato, squash, sweet potato, beet). Please avoid all concentrated sugar — not just refined sugar. Concentrated sugar also includes dates, fruit juice, agave etc.

  51. Wow! After reading this now I know why my TSH has gone up from normal to 6.83 in the two years I’ve been paleo. I went to a naturopath 2 years ago and she put me on a strict paleo diet w/no sweets (honey) and I lost 20 lbs. This was to cure Candida. Candida is gone and so was my very nice body. Gained 10 lbs back and I have been working with a new Dr. Who put me on extra Selenium after taking me off Armour Tyroid which I only took for three days. I need carbs and today I had a veggie sushi roll and boy it was good. I want to add more to my diet like honey or maple syrup bit if I eat it I get dizzy. Why am I getting dizzy? I will eat rice now to see if it helps. I just want to get my thyroid back to normal. I see myself in a lot of these posts. I also only sleep a few hours a night 4-5 is a good sleep for me. I take very potent probiotics daily because I’m afraid the Candida will come back. Can you suggest some reading for me to understand how to get back on track? Thanks!

  52. You have an inspirational blog Lara! Would you also include other gluten-free grains as ‘gentle carbs’ – like the alkaline buckwheat, millet and amaranth? I noticed you do include quinoa as a gentle grain, although you mentioned the slight risk of toxicity in the saponins, making rice your preferred grain to recommend. Rinsing quinoa is recommended to remove the saponins (and potentially reduce saponins causing gut irritation). Do you find this helpful advice for people keen on including quinoa in their gentle carbs list?

    • thanks Jodie. Yes, rinsing quinoa in warm water reduces its saponins. Yes, I classify other grains such as buckwheat, millet, amaranth and even oats (for some people) as Gentle Carbs. Rice is my favorite though.

      I’m long overdue for a post about Wheat and Gluten sensitivity. I will try to work on that for December.

  53. Hi
    I am 55 year old post menopause, as I was going through menopause I had a number of intolerance’s to Stevia, then hair dye then bananas, oats. I began to get very tense and very anxious I did not want to take any treatments for the menopause out of fear I may have some kind of reaction.
    For the past 5 years my system was I think in this adrenal fatigue situation.I consulted a dietitian she put me on a low to medium salicylate and amine eating programme which I have remained on. It seemed to be working and I am to scared to introduce any hight salicylate level food( my Dad had salicylate intolerance)
    At the beginning of this year a beautiful friend helped me to increase my intake of carrots beets and greens I stopped eating rice and potato.She advised me not to eat the combination of these starchy foods with my meat protein which worked for me, so I read now that it is all good to have some rice or pumpkin with my protein?
    I am now stopping my sugar intake that has been a challenge I am a sweets person my passion was baking.(I didn’t realize just how much sugar I was eating.I don’t eat any processed food but enjoyed home made sweets).
    Also I see that fruit contain sugars so is it ok to eat fruit I steam apples and pairs and it is now Mango season these are fruits I love.
    My dear friend who has been such a tremendous support has put me onto your information so glad she did. You have provided much needed information, and an understanding.
    Thank you

  54. Hi I lost weight , around 3 stone on a very low carb diet a few years ago. The weight loss was great and I did it over a year and a few months but I found that my mood altered and I had a period of six weeks depression during which I hit the sugar and put a stone back on. I do think the low carb affected my mood. I have fibromyalgia which amongst other things is believed to be an HP axis contributed problem and adreanal fatigue is also common with Fibro I think I am better off on a mixed diet of home grown potatoes and veggies as well as meat , fish etc. Too much salad and fruit upsets my gut so I keep those in moderation. I think keeping an eye on your intake of what western society sadly put forward as ‘treats’ ie sweets, cakes, fast food etc is a good way forward and keeping on a diet of unprocessed foods to include all food groups ie new potatoes with butter, carrots, sprouts and braised steak for example. I also find that knocking off bread is highly beneficial but as you say it is the gluten sensitivity that is the problem. Home made sweet things like flapjack made with oats honey and butter are ok in moderation too. I feel better on that kind of diet than on low carb alone.

  55. I am very very thin with insulin resistance AND hpa dysfunction. They definitely can coexist. I feel very stable eating low carb but my low ft3 I believe is making my hair thin at my temples horribly.

  56. Hey Lara,
    This is the best article I have ever read! I’ve been having horrible insomnia and anxiety for a year after doing Crossfit and low carb dieting.. I spent thousands trying to figure out what was wrong but no one was able to give me answers. I figured out on my own with the AIP diet and adding sweet potatoes helped tremendously and then I found your article.. I am now taking adrenal support and stopped any intense exercise but My question is does this ever reverse and go back to normal? I’ve been gluten free for 4 years but I just started adding good carbs back into my diet, including starches… But I would like to be able to workout again without experiencing the insomnia and anxiety

    • Yes, low-carb-induced adrenal fatigue does reverse. It can take anywhere from 2-6 months to reestablish normal gut flora and normal HPA feedback.

  57. Wow, thank you so much for this! I was on a low carb diet for over seven years and also highly stressed. As my symptoms worsened, I thought I must be eating too many carbs so I would reduce and reduce until even kale became ‘too sweet.’ I was basically eating beef, eggs, greens, ghee, coconut oil, lemons and fermented vegetables. At some point my system began to collapse in some pretty serious ways–digestion, fatigue, cognition, hormones, no period, serious weight loss, migraines… Thanks to a friend who mentioned that women may need carbs, I have begun to re-introduce them with some improvements, along with a real effort to reduce stress…slow but steady… My trip up is that I’m worried about blood sugar issues and find myself nervous each time I eat that I might be eating too many carbs. (Ironically my blood sugar seems to stay more stable with fruit or honey than with rice, etc.) I know each metabolism is unique, but…Any advice? Much appreciation for all you’re sharing!

    • I have heard the same thing from many patients: that their blood sugar is more stable when they reintroduce starch. I recommend that you not fear starch, but eat the amount that feels good to you. As you get healthier, you should be able to trust your own appetite for starch.

  58. Hi, I am a 40 year old woman, who has not had my period for 7 months, then I got it for two months, and now I haven’t had it for 2 months (been checked out gyno wise and no cause for concern – stress is problem!).
    I suffer from Adrenal Fatigue, Insomnia and Anxiety. I’ve been eating a Paleo Diet for 1.5 years now and although I initially lost around half a stone, I’ve put it back on again (I’m a normal weight, so not a massive issue), but I’ve been trying out missing breakfast (although allowing one coffee & cream in the morning), in order to stop more weight gain! NB – I only have 1 coffee a day ๐Ÿ™‚
    I wondered if I should be lower carb, or would I need to eat as you describe “for a younger woman”? i.e. should I eat gentle carbs with every meal, or limit sometimes? I do find I am better without sugar (from fruit) and I don’t generally eat sugar in other forms, except in wine & dark 85% chocolate a few times a week…
    Also, why are sweet potatoes and yams not the best? I love them!

    • Hi Carla, Given your symptoms (insomnia and anxiety), I recommend that you eat some gentle carbs (including sweet potatoes) with every meal. Dinner is the most important time to have some (to promote sleep).

  59. This article is what I have been looking for!! I was wondering what % of carbs women should aim for a day? I’ve been eating low carb and struggling to find the right ratio for me.

    • hi Jessica, I encourage my patients to find the amount of Gentle carb that feels good for them. Every person is different, and it depends so much on underlying insulin sensitivity, as well as stress level and adrenal function. As long as you’re healthy in other ways, then you should be able to trust your own appetite for starch. (The same cannot be said for concentrated sugar. Generally, I recommend that my patients entirely avoid concentrated, dessert-type things)

  60. What an awesome article! Your perspective on gentle vs un gentle carbs is bang on! And so if your explanation on the importance of carbs for the HPA axis.

      • Lara

        I consumed mostly Quinoa for 2 years on and off 2x a day for my meals. And this year I did drink ACV with water afte meals once a day. Then I got really thin….strict meals due to eczema…

        now i have AFS. does this mean I have depleted my body of magnesium? Are my potassium high?

        I get ill if i eat bananas ..fruit type and the cooking type and also react badly with avocadoes…im confused

  61. How do I know if Candida is causing low taurine levels and in turn low Gaba? In addition, taking Gaba supplements cannot fix the problem since it does not cross the blood brain barrier. So what other supplements/whole food can I take to balance these levels?

      • hi Lara

        ive tried magnesium oil lotion but i ended up having palpitations and spaced out… ive readits because my adrenals are weak due to AFS. so its not good for adrenals.

        iim also worried to have sunlight as i dont have VIT K2 yet to balance D3 supplements..

        I have HPA too so do you think my current diet with himalayan salt gives me sodium supply but i was also told to have potassium from food to balance if i retake magnesium along with vit d3, K2, How about calcium ?

        I got weak when I did sunbathing for a few minutes maybe because of no K2 and it displaces just more calcification inn wrong places?

  62. Is fruit a strict no no when it comes to HPA and nervous system disorders? I have been told that low GI fruits like green apples and berries are ok in moderation. I use them in smoothies with some veggies also. My issues are low cortisol, hypoglycemia, low blood pressure, low gaba. I have not found low carb diet to be helpful in treating any of these symptoms, however, with the added ca dida which comoetes with taurine, the pre ursor to gaba, I hรขve been severely restricting wheats, flours,sugars.

    • As long as you can digest fruit ok, then I think fruit is fine for HPA axis. My point in this article is that those with HPA dysfunction need carbohydrate.

  63. what would your opinion of legumes as “Slow Carbs” as defined by Timm Ferris in the book the 4 Hour Body? A system that I’m having success with myself. It promotes Animal proteins, Veggies & greens, legumes and water! No calories from beverages, nothing white (except cauliflower) Though I’d sure love some rice or potato once in a while! I can have whatever I want once a week. while I’m losing weight… I am REALLY gassy. To the point of discomfort much of the time. Have tried all sorts of methods to reduce that effect, to no avail. But if that’s the price of dropping the tons… then do be it.

    • If legumes cause you significant digestive bloating, then you should not eat them in quantity. You can have them sometimes, but not as a staple. The symptom is annoying, but it’s much more than that. If your digestion is that unhappy, then you can bet that your intestinal bacteria are not happy.

      I agree with the meat, veggies and greens approach (plus organic butter for satiety). But I cannot see that legumes have any part in that. I am more and more convinced that a small amount of Gentle Carb (or Safe Starch according to Paul Jaminet) is appropriate for most people. Non-gluten, non-fructose starch. It does not have to be a lot, but enough to satisfy the intestinal bacteria’s requirement for resistant starch, and enough to feel full and to not crave sugar.

      • I should clarify that the discomfort is from holding it in in certain situations… like trying not to ruin someone’s day by walking into a cloud! Do you recommend any probiotics or any such item to deal with the gas? I do rather enjoy the beans as long as I vary them. It seams to work as I’ve dropped 37lbs since Christmas. And I will add some rice to the diet (a couple billion Asians who eat it allot and are skinny can’t all be wrong). Thanks for your response.

        • You might find that your gassiness subsides over time as your intestinal bacteria adjust to your new diet. And yes, you could look at treatments such as probiotics (I cannot recommend specific treatment in this online forum). You may also want to look at information FODMAP diet to understand why legumes are so gassy.

  64. Absolutely love your blog The information is excellent and RELEVANT.most of my health issues have been resolved but years ago I really would have been helped by all this info…One question though….I take prescription thyroxine 50mg and Thyroid extract 120mg daily…and feel my old self most days…..Will I have to do this the rest of my life ? Hashimoto diagnosed about. 5years ago..(.after feeling like I was going insane)…My Naturopath said if I am feeling good why do I want to change things….Thyroid extract is made from pigs and I really am not happy about that..(animal cruelty etc).Gluten,sugar and almost dairy free and now vegetarian (new year)….No way do I want to risk going back the way I was before Thyroid extract..Some days could not even walk….Seems to me Thyroid problems are common or is that just because I have it and see it.

    • Hi Sherida. I would recommend to read the beautiful book of Janie Bowthorpe, Stop the thyroid madness. She explains well what we have to do with pigs and what vegeterians should for they thyroid health. Diet is

  65. This is the article I was hoping to read one day. I’ve always suffered from insomnia. But things got much worse after I went Paleo, then low-carb, then ketogenic. Many doctors suggest (in case of adrenal fatigue) not to eat carbs (of any kind) but just fats and proteins with some veggies (not even fruit). I’ve got really broken. I recently reintroduced rice (but feeling guilty!!! and stupid for feeling guilty!) and things are improving. Not perfect, after so many years of insomnia. Plus, I also developed allergies to pretty much any food I eat. Moreover, I developed hypothyroidism (taking desiccated thyroid) which doesn’t seem to improve without some carbs (despite medication) and adrenal fatigue (in his new book Chris Kresser says the for T4 to convert in T3 needs insulin. That’s why prolonged low-carb diets create sluggish thyroid in certain people). My life sucks and I hope introducing some gentle carbs is the resolution to my health problems. During the holidays, after almost 4 years, I ate 400 grams of milk chocolate in a day. I hadn’t felt better in years.

    • Thank you for sharing your experience. You are not alone. I’ve spoken to a number of patients who got a little broken with a strict low-carb diet. Low-carb damages the nervous system and the intestinal bacteria.

    • This sounds a lot like what happened to me Marco. I did Paleo for 18 months, then added white potatoes and rice back. Also some high quality GF bread as a treat occasionally. But I still feel bad (I was diagnosed with adrenal fatigue in June 2012). I’m actually a lot worse now because I avoided all carbs for so long while simultaneously running marathons and nursing two babies. I really thought I was doing the right thing to improve my health but I was actually really screwing myself over. It’s depressing. Two years ago my symptoms are mild compared to now. I am pretty sure I have Hashimotos now; I’m getting tons of labs done this week. I have a long road to recovery.

  66. Very much enjoyed your articles–so informative! I’m new to the whole “gluten is the devil” mentality that I’ve recently read about from others, but find you to have a more methodical and wise approach–especially as it applies to HPA issues. I now realize that the thyroid disease (hypo) with which I have suffered from for nearly 2 decades actually has it’s root in HPA Axis Dysfunction. Am on thyroid medication and under a Dr.s care along that line but have had near chronic belly issues that are the opposite problem of the usual constipation. Now that I realize that HPA is the root problem, I have a few questions to which I cannot seem to find answers.

    Question: Is gluten bad for us now ONLY BECAUSE it has been GM-ed (genetically modified) over the years and there are very few original/ healthy wheat sources available to us now? Wasn’t it an enormously healthy and important part of our ancestors diets? At least that is what we’ve been lead to believe.

    For example, here is a link and write up for organic kamut berries that I discovered about a year ago, purchased and love very much. ( Unfortunately I didn’t know enough at the time to simply observe my health / bodily responses to the consumption of it.

    The issue now for me is that I live overseas and if I order it, Ill need to do so in bulk, which would be a pretty expensive and bad idea if this PARTICULAR PRODUCT is on the list of “bad” foods for an HPA sufferer…OR…if I need to “try” it and record my results. If I understand the root reasons gluten is considered a poor diet choice for most and particularly for the HPA Dysfunctional, then I could make a more educated and informed decision about this item and those like it.

    Question: In general would you believe that THIS PARTICULAR gluten source would be equally as bad for me / us SIMPLY BECAUSE IT IS WHEAT / GLUTEN? Or might it be like the rice you mentioned as perhaps a healthy “gentle carb”? If GM is the root problem with gluten, then might this be one of those more rare, heirloom grains, that is not only acceptable but…dare I hope…beneficial?

    It seems that GMO is the real “devil” in terms of the root problems with ALL THESE FOODS people used to eat with what appears to be fewer health issues. DO YOU THINK THIS IS A TRUE OBSERVATION? If not, I am delighted to be lead to any / all I am missing in understanding these issues–books, articles, comments, etc. I totally get the sugar / fructose problems, but so far I cannot see this gluten issue clearly.

    Kindest Regards,

    • Hi Robin,

      The HPA axis dysfunction issue is separate from the gluten issue. (although inflammation from gluten is a source of stress and can worsen HPA dysfunction).

      The gluten problem is not necessarily a GM problem. Gluten was harmful long before there was GM. Yes, modern varieties of wheat have more gluten and more inflammatory than ancestor grains spelt and kamut, but many of those changes occurred first with selective breeding (farming), not GM.

      Gluten is inflammatory for everyone to some degree. Some people tolerate it better than others. I think that biggest factor is gut integrity. The intestinal permeability created by antibiotics may be contributing to the epidemic of gluten intolerance that we see now.

      Gluten grains were never a healthy food for humans (or any animal). Fossil records show that a decline in stature and health of human populations when they were forced to rely on gluten grains for food. Grains support the masses of people, but those with the resources chose higher nutrient foods such as meat and starchy vegetables.

  67. Hi I am a Naturopathic and Nutritional Clinician in Perth, WA and I agree. I find those with HPA, adrenal and nervous system dysfunction respond much better to some gentle Carbs combined properly with correct amounts of protein and fat. Great article ๐Ÿ™‚

  68. Wow this is a real eye opener for me, as a 35 year old woman with adrenal fatigue who eats a heavy meat paleo diet but crashes and guiltily scoffs a packet of rice crackers or a hand roll when exhausted. I’ll check out that book and add gentle carbs to a meal. Very interesting about the high protein / GABA connection. I eat lots of meat but then supplement with GABA. Had no idea. thank you so much, I always learn something from your newsletter.

  69. Very interesting. Lately I have been eating some more carbs from grains ( rice and quinoa) and find that my digestion is improved also my energy. I find it interesting that you say intestinal flora needs some carbs to feed on. I also find it interesting that you might suggest rice over fruit since fruit is high in fructose and with the emerging evidence that cancer really is a metabolic disease that feeds on fructose there is more reason to eat good quality non gluten grains
    Wonderful food for thought.
    Thank you

  70. I was very interested to hear you say that eating less often is better for us. I came to the conclusion long ago that I am much better if I don’t eat too often. Also, despite the repeated stress on breakfast being the ‘most important meal of the day’, while I don’t always do it, I find missing breakfast does not make me tired or excessively hungry, but rather the opposite. Is this the same thing as your intermittent fasting? I’m also glad you say some starch is necessary, but have to say I do not seem to have any problem with a small amount of bread.

    • Hi Joan, Yes, one method of intermittent fasting is to skip breakfast. If one is genuinely hungry for breakfast, then breakfast is a good thing. But it should never be forced if there is no appetite. As your health improves, then you may find that you are hungry for a non-grain breakfast. Rather than “eating breakfast makes you healthy”, I think that the truth is: “people with a fast metabolism are hungry for breakfast”. But fine to limit eating between 10am-6pm (8 hour diet)

    • Clinically, I’ve found that some people need more starch than others. Namely, young nervous women with HPA axis dysfunction need a regular serving of rice, potato or squash with every meal. I had thought that those with significant insulin resistance (and no significant HPA dysfunction) benefit from the majority of meals with no starch, at least in the short-term. But I’m currently in the middle of Paul Jaminet’s book (Perfect Health Diet) thanks to a comment above, and he makes a pretty compelling case that everybody needs 30% carb (by calorie).

  71. Thanks Lara – are you also saying that intermittent fasting is bad if we have depleted adrenal levels? I have been doing Paleo for a couple of years and have recently been adding in gentle starches after reading Paul Jaminet’s book – he recommends intermittent fasting but he says nothing in his book about adrenals/HPA axis dysfunction. Thanks,

    • Hi Diane, thank you for leading to me to Paul Jaminet’s book. Interesting that his term “safe starch” is very much what I mean by “gentle carb”. That is, not inflammatory. Not gluten. Not fructose. I love it that he supports rice. In the summary that I skimmed tonight, he doesn’t go into how glucose can support HPA axis, but he does talk about how very low carb suppresses thyroid.

      In answer to your question, no intermittent fasting is not bad for everyone with adrenal fatigue. I am a fan of 16-20 hour fasts. We just need to be aware that fasting does raise stress hormones. That might not be helpful for some people some of the time. For someone with chronic HPA dysfunction, it might be best to fast on a non-work, non-stress day.

      • Just a follow up comment. I read The Perfect Health Diet, and loved it. Paul and Shou-Ching have make a very strong case for giving our body what it wants: starch, protein and fat. I really enjoyed his chapter on intermittent fasting, and the explanation about how cell autophagy (clean-up) kicks in at 16 hours fasting. I’m doing a gentle fast tonight as I write this. Just a couple tablespoons of apple sauce and coconut cream to soften the evening. As Paul says in the book, fasting should not be an ordeal. It should feel good.

        • You have just made me want to read this book as well. I’ve had PTSD for twelve years, and suffer from chronic high cortisol and alternating adrenal fatigue. I find I have to eat frequently, or my anxiety shoots up. Yet I am fascinated by the benefits of intermittent fasting. Applesauce and coconut cream sound amazing, and could possibly get me through? Well, I’m definitely going to read the book. I am thirsty for knowledge as I’m desperate to heal, and have found this journey so incredibly exasperating. I tried LCHF, and while I lost a few pounds for the first time in a decade, I am starting to not feel so great. I found your article SO inspiring and educational, and exciting because I love rice and sweet potatoes and have missed them terribly! All I want is to heal….I’ve done the emotional work, so I’ve been working on my body for the past four years, trying desperately to reverse this high cortisol and HPA dysfunction. It’s frustrating that it’s been so difficult to do that after so much effort. I am incredibly grateful for your article and for sharing your knowledge.

          • How is your healing going? I too have ptsd and chronic elevated cortisol along with hpa axis problems. I’ve been doing keto and starting to feel worse and worse.

  72. I have suffered from HPA axis dysfunction as a young athlete, and was diagnosed with CFS. Although I avoid grains for the most part, I find I can’t not eat sweet potatoes, etc and adding white rice to my diet every now and then helps too, especially during periods of stress, which surprised me at first. From professional experience (I’m a sport nutritionist), I find that men with HPA axis dysfunction need more CHO compared with females with the same issues.

    Thanks for the post!

  73. Hi Lara my daughter and myself are on a low allergy diet and for a few years were on a high protien diet this only lead us into many more health problems. We realised this diet didn’t suit us due to many more health problems occurring and started eating carbs again ..It also is taking us awhile to improve the damage it did….Thanks for your information it explain so much to me . I just knew this was not good for us I never knew why and I thought it was just us ๐Ÿ™‚

  74. I’m a nutrition therapist who often recommends a rather strict 21-day anti-inflammatory diet for folks who need to lower their inflammation quickly while they’re healing their gut with supplements to eliminate infections. Most people do very well on this diet, but those who feel best are the ones who follow my advice to eat starchy vegetables with every meal. This is an extreme example, but I’ve learned exactly what you describe above and see examples of it weekly.
    When I eliminate all grains, legumes and nightshades (potatoes) as well as yams and sweet potatoes in a group who usually suffers from HPA axis issues, they feel much better when eating carrots, beets, turnips, parsnips or winter squashes at every meal.
    I’ve seen extremely active men crash without starchy vegetables when they remove grains due to HPA axis issues combined with high activity.
    Great post!

    • Hi Erin, Yes, vegetables like beet and squash are the best option for many people. And so nutrient-dense. Thank you for your comment.

    • HI Erin, just wondering, why eliminate yams? I thought it was comparable to the other gentle vegetable carbs?

      • Penelope,
        The 21-day diet I recommend eliminates potatoes (even sweet potatoes/yams) because in our office we do food intolerance testing (Dr. Carroll Food Intolerance Evaluation Method) and some patients test intolerant to all potatoes (I realize these are not all in the same food family). We eliminate the potato starches for the 21 days only. After the patient challenges the food when they return it to their diet, if there is no reaction they can resume eating all potatoes (from the nightshade, dioscoreaceae and convolvulacea families). Note: the potato is a common food to cause food sensitivities (nightshade).

    • Hi Diane, Yes, older women and men sometimes need this approach. But in my clinical experience it is usually women under 35yo. Not sure why. I’d love to hear from other clinicians about this. Of course, some young women are seriously insulin resistant and must restrict all starchy food. I wrote the post in response to some young, thin, nervous patients that I’ve had recently. Really crashing on meat and salad diet.

      • I’m 41,and insulin resistant. I also have mild low thyroid and chronic elevated cortisol levels. I’ve been doing ketogenic for 2 months, but I’m getting more and more anxious. Just wondering what diet you recommend for a 41 year old with anxiety issues who is also insulin resistant?

  75. What a fantastic post! Great information to share. I experienced this myself, as I was healing. While I have heard other folks talking about lower carb, I have found that moderate “gentle carbs” are important to my wellness.

    • Hi, I was wondering if you could share the two studies you mentioned in your article (about protein and GABA and carbs and cortisol). I believe that I have HPA dysfunction from the symptoms I’m experiencing but also want to lose fat and gain muscle. From what I’ve read most fat loss plans are very low carbohydrate and high protein so this is interesting and I would like to learn more.

        • i was an idiot and didn’t link my insomnia to the no/low carb diet i was on for a year. i continued because it allowed me to alleviate my sibo/gut issues. after reading your article, i increased my carbs to 150 gms/day for a month or two now, with no effects. Do you think since I was on the diet for so long that I’ve done permanent damage and that my insomnia is irreversible? I don’t want to lose hope, but I’m really tired of not being able to fall asleep and stay asleep. I used to sleep so well until this stupid diet! I am 110 lbs and 5′ 1 inch and lead a sedentary lifestyle. Is 150 gms/day of carbs on 1200 calories/day enough or do I need to add more? Thanks for your advice! My 150 gms of carbs are from white rice/gluten free toast/bananas due to limited options due to sibo. i have been so upset at myself for listening to the dr who said some of his patients with sibo find they do well on a no carb diet. I did this for a full year and got insomnia 2 weeks into the diet, but did not even connect. I thought the lack of sleep was due to my poor gut. So I did this no carb diet to myself for a full year with a year of insomnia. Adding in carbs for 2 months now, but no effects on sleep. Did I do permanent damage?

          • I cannot imagine that you would have done permanent damage to your sleep. But you made need other support such as magnesium to transition back to normal sleep.

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