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Gravity and insulin: the dynamic duo

Gravity and insulin: the dynamic duo
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Last week I wrote about how carbohydrates are effectively a performance-enhancing substance, at least for certain performances in certain people.  I received many great questions, including some challenging this suggestion, which really pleases me because it demonstrates folks are thinking about tradeoffs and questioning everything.

Is carbohydrate reduction or outright restriction “right” for everyone?  I doubt it.  Besides oxygen and water the list of “universal truths” for human health is pretty short.  Parenthetically, one can still overdose on both oxygen and water – in other words, even these two completely essential compounds can be toxic outside of their ideal ranges.

If you’ve been following this blog and/or this general discussion, you’ve probably asked yourself the question I’m about to pose.  If you haven’t asked it yourself, you’ve likely been asked by someone as you’ve had the discussion with friends or family.  Here’s the question:

If insulin is so important in regulating fat metabolism, why do some people eat whatever they want and not get fat? Conversely, why do some people following the strictest carbohydrate-reduced diet remain fat?

This is a paramount question, and I’m sorry it’s taken me four months to finally get to it.  Before we do get to it let me digress (seemingly) to discuss gravity.  If you know everything about gravitational forces, feel free to skip this section.

 

What is gravity?

 

For the purpose of simplicity I will limit this discussion to Newton’s law of universal gravitation, as it applies to virtually any “gravity scenario” we encounter in our lives, and it’s the law everyone thinks of when they hear the word “gravity.”  Newton’s law of universal gravitation states that every mass in the universe attracts every other mass with a force that is directly proportional to the product of their masses and inversely proportional to the square of the distance between them.

For those, like me, who love equations, here it is:

Gravitation

In this equation, m1 and m2 are the masses of the two spheres, and r is the distance between them.  G is a really, really, really tiny number called the gravitational constant which, as its name suggests, is a constant.

In other words, objects in the universe have attractive forces between them. These attractive forces depend on two things: the masses of the objects (the more the mass, the more the force, since mass is in the top of the equation) and the distance between them (the more the distance between them, the less the force, since distance – squared – is in the bottom of the equation).  No other amount of detail is really necessary to understand the point I’m going to make.

For most objects on earth (excluding the earth), this force of gravitation is actually not particularly dominant.  When I’m standing next to someone, neither of us can feel this force for two reasons: 1) our masses are not high enough, and 2) the distance between us is too great to overcome the really, really, really tiny gravitational constant.  For example, two 80 kg people standing even 1 cm apart only exert 0.004 Newtons on each other, which is completely unnoticeable.  [A Newton is the unit we use to measure force.]

It turns out for most objects on earth that we interact with, gravitational force is irrelevant (actually, it’s what we’d call a “higher order term” if you remember my discussion of ordered terms, or relative importance from this post).  But there is one enormous exception: the earth!  Because the earth weighs so much (about 6 trillion trillion kilograms; no, that’s not a typo – 6 followed by 24 zeros) for pretty much any object on earth ranging from a feather to a 747 to a skyscraper, the force the earth exerts on us (and us back on her) is equal to our own mass multiplied by 9.8 meters per second per second (this number is the acceleration we experience due to gravity).  You can verify this for yourself using the equation above (plug in your mass, the mass of the earth, and the distance from you to the center of the earth).

This is a long way of getting to one of the most often experienced applications of Newton’s Second Law: the net force that acts on a body is equal to the mass of that body multiplied by the change in the mass’s velocity (referred to as acceleration).   When you drop an object, the earth is pulling it towards itself with a force equal to the mass of object multiplied by 9.8 meters per second per second (this unit of m/s/s is the unit for acceleration – the rate of change of velocity).

Here’s a more visceral example: When you are in an airplane taking off on the runway you feel an enormous force on your back, though you’re traveling much slower than when in full flight, when you feel nothing.  Why? In full flight acceleration is zero – velocity, albeit high, is constant – so you feel no force.  On the runway, the plane is accelerating (i.e., changing velocity), so you feeeeel it.

 

Why did I just explain all of this?

We live in a world that is governed by physical laws, of which Newton’s laws are but an important subset.  Do you need to know them?  Nope.  Does understanding them change them?  Nope.  Can you “will” your way out of them? Nope.  Is it better to know them or be completely oblivious of them?  I guess it depends on your personality.  I prefer to know as much as possible about the physical world I live in.  It keeps me safe.

Some of you know everything about gravity that I just explained, and then some.  Some of you just heard it for the first time.  Regardless, the laws of gravitation are universally true and apply to every single one of us, whether we like or are aware of it or not.  Let’s consider a few examples.

Look at this fellow:

Jump 2

Or this fellow:

MJ jump

Are they “defying gravity?”

Are they experiencing a “different” form of gravity than, say, this fellow?

falling-off-the-table

Or this fellow?

belly flop

Not at all.  In fact, each of these four men is actually subject to the exact same universal truth of gravity.  So, why do the first two appear to challenge the law of gravity while the second two appear to exaggerate the law of gravity?

Lots of reasons, probably, but the two most obvious are differences in genetics and differences in conditioning.  No matter how you slice it, Michael Jordan was a completely gifted athlete.  He also outworked virtually everyone, and if you subscribe to the theories of Daniel Coyle, as described in The Talent Code, these two features are complexly weaved together.   What about the guy falling off the picnic table or the guy belly flopping into the pool? Not quite the same genes and nowhere near the same level of conditioning.  As a result, the impact of gravity is more obvious on them.

Here’s another example:  Consider a ledge 10 feet off the ground.  Let’s line these three gentlemen up and ask each of them to jump off the exact same ledge.

Different types

The same law of gravity applies to each of them. No exceptions. Will they all experience the law of gravity in the same way?  Of course, not.  First guy – no problem.  Second guy – probably breaks his leg.  Third guy – probably dies.

Let’s add one more layer of complexity to this.  When I was 16 years old, I could jump off a 10 foot ledge with zero difficulty.  Today, at 39, it would take a bit of practice and a lot of concentration to avoid spraining my ankle and tearing a ligament in my knee.  When I’m 65, I’ll be lucky not to break my leg.  When I’m 85, I’ll be lucky not to break my neck.  Why?  Same gravity, right?  Same genes, right? Yet over time, I will experience gravity differently.  Changes in my body over time lead to a differential experience of the same physical laws.

 

How does insulin fit into this discussion?

Insulin is the most important hormone in our body when it comes to fat mobilization (breakdown) and fat storage.  This is a fact.  There is not one person who studies the endocrine system who will not acknowledge the following quote from Lehninger’s Principles of Biochemistry (the “bible” of biochemistry).

“High blood glucose elicits the release of insulin, which speeds the uptake of glucose by tissues and favors the storage of fuels as glycogen and triglycerides, while inhibiting fatty acid mobilization in adipose tissue.”

In other words, eating glucose (carbohydrates) increases insulin levels in our body.  Insulin drives glucose into liver and muscle cells as glycogen (in small, finite amounts) and into fat cells as triglycerides (in unlimited amounts). Insulin also inhibits the breakdown and utilization of fat, as shown here.

Insulin does not act alone, and the story of fat storage and breakdown is complex if you want to understand every single detail, but the “first order term” is insulin.  I will spend time in the future writing about insulin’s “dance partner,” leptin.  But insulin is probably the General when it comes to determining how the body partitions fat.

So, insulin is sort of like gravity.  It’s in your body whether you know about it or not.  It’s acting on your cells whether you like it or not.  It’s playing a major role in determining your ability to mobilize versus store fat if you believe me or not.

Does this mean insulin has the same effect on everyone?  Does this mean insulin has the same effect on any given person over time? Of course not. Contrast me and my wife.  I look at carbohydrates and start to store fat. If you want a reminder of what I looked like on an “athlete’s diet” of complex carbs and little saturated fat, coupled with 3 to 4 hours of exercise a day, look here, here, and here.  On the other hand, my wife can eat a bag of Oreo cookies for dinner every night, coupled with all the pasta, bread, and rice the world has to offer and not put on one pound (she has weighed about 110 pounds her entire adult life).  How is this possible?  Does this mean insulin doesn’t control fat metabolism?  No, it means we have an entirely different genetic make-up.  Her grandmother is 86 years old, eats bread all day long, is healthy as a horse, and weighs 100 pounds. Conversely, I come from a family where every single man has died of heart disease and looked like the Pillsbury Dough Boy prior to doing so.  I’m genetically programmed to lean towards metabolic syndrome, but I’ve been able to reverse it through strict attention to my eating habits.

This isn’t unique to me and my wife. There is an entire spectrum – a distribution across the population – of people with varying degrees of susceptibilities to the effects of carbohydrate on insulin levels and the commensurate effects of insulin levels on fat storage and breakdown.

And like gravity, the effect of insulin on our metabolism of fat changes over time at the individual level, usually for the worse.

Consider, again, my example: When I was 16 years old I weighed 160 pounds, had between 4 and 5% body fat, a 28-inch waist and a 44-inch chest.  Breakfast consisted of a box (not a bowl) of cereal.  Lunch consisted of 7 turkey and tuna sandwiches (yes, 14 pieces of bread), a gallon of apple juice, and a plate of fries and gravy.  Dinner was a pound of pasta and half a chicken.  Despite eating over 1,000 gm of carbohydrate per day, I was quite resistant to them (i.e., I was very insulin sensitive) and remained exceptionally lean.

Fast forward to three years ago, at the age of 36, I weighed 200 pounds, had 25% body fat, a 36-inch waist and a 44-inch chest.  What changed over 20 years?  I was actually eating considerably less – in both absolute amounts and total carbohydrates – and yes, I was exercising a bit less (3 to 4 hours per day at 36 versus 6 hours per day when I was 16). But, is that the only thing that changed?  What changed in me, and what changes in most people over the same period of their lives, is that I became progressively more insulin resistant.  Most people casually observe that their “metabolism slows down” as they age, but what really happens?

I wish I could definitively tell you why this happens. I can’t. What I can tell you is how it happens. There are many factors, and they certainly vary by person and by individual significance.  The list below is a bit simplified and by no means complete.

  1. Over time, endogenous production of sex hormones (e.g., testosterone, estrogen) becomes altered, and this seems to play a role in fat metabolism.  In addition to sex hormones, other non-sex steroid hormones (e.g., cortisol), which have a strong effect on fat metabolism, may be altered for a variety of reasons including sleep reduction and stress.
  2. Perhaps (at least partially) related to this, the cellular distribution and density of lipoprotein lipase (LPL) also changes.  [Recall, LPL is a very important enzyme on the surface of muscle cells and fat cells.  On muscle cells, it fosters fat oxidation (good). On fat cells, it fosters fat accumulation (bad).]  As we age, we tend to have less LPL on muscle cells and more LPL on fat cells, both of which contribution to fat accumulation rather than fat oxidation.
  3. The membranes of our cells tend to change in fatty acid composition, which may result in more difficulty getting the GLUT-4 transporter into cell membranes to foster glucose flux into cells.  I describe this process in this video.  The more difficult it is to get glucose into cells, the more insulin the pancreas must secrete to exert its eventual effect, the more exposure all cells have to circulating insulin levels.  Higher levels of insulin also exacerbate the phenomenon of more LPL on fat cells and reduced fat oxidation.

These changes are all linked, and probably play a different role of importance in different people at different times in our lives.

 

So what do gravity and insulin have in common?

The forces of gravity and effects of insulin are natural phenomena.  Sure, the comparison is not perfect, but it serves a very important purpose in making the following case:

  1. These forces act on us whether we know it or not and whether we like it or not.
  2. The net impact of these forces on you is highly dependent on your genes, your age, and the choices you make (e.g., practicing gymnastics versus siting on the couch, changing your eating habits versus eating the same old standard foods).
  3. Just because some people seem to “defy” these forces does not negate their existence.  Michael Jordan dunking from the top of the free throw line doesn’t mean I can and doesn’t mean gravity is irrelevant.
  4. What matters most is how these forces act on you. Be less concerned with the folks who lie to either side of you on the population distribution curve (i.e., those more or less impacted by gravity or insulin).  Figure out what works for you and be ready to modify the plan over time, because it will likely get less and less easy to maintain and improve your performance over time.  We may not be able to outrun Father Time, but we can keep him at bay.

 

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About the Author:

Peter Attia, M.D., is the co-founder and President of the Nutrition Science Initiative (NuSI), a non-profit based in San Diego, CA. He received his B.Sc. from Queen's University in Canada and his M.D. from Stanford Medical School in California. After his surgical residency in general surgery at Johns Hopkins he worked as a consultant at McKinsey & Company. He founded NuSI with scientific journalist Gary Taubes in 2012.

Discussion

  1. Mike  April 11, 2012

    I’m a little disappointed that you didn’t cover the effect of gravity on fat storage, I really thought that’s where this was going ;)

    A very well written and entertaining article.

    (reply)
    • Peter Attia  April 11, 2012

      Thanks…wish I could have pulled that off!

    • Mike Lyons  September 2, 2012

      Hi Peter,

      Love the site! I’ve been eating ‘primally’ for two years now and never felt better. However I still feel as though there’s a lot more I can learn about nutritional science for optimal health. Your website really supports that aim! Especially liked the three part ketogenic exercise articles. I play soccer in the UK to a decent standard and at 31 would like to see if I still have the best years left in me if I continue to concentrate on eating/living well.

      Keep up the good work!

      Any tips on nutrition for intermittent high-intensity team sports would be much appreciated.

      Thanks,

      Mike

  2. Ellen  April 11, 2012

    Nice post. Okay, now I want to know what I should do to increase LPL on my muscle cells and decrease it on my fat cells?

    (reply)
    • Peter Attia  April 11, 2012

      Less circulating insulin –> less LPL on fat cells. Some evidence (believe it or not) that nicotine also downregulates LPL on fat cells (to test this, I was going to start chewing a box of nicorette every day, but my wife drew the line and said “HELL, no!”).

    • LeonRover  April 11, 2012

      I’m not currently married – twice bitten, once shy. Thus I make my decisions without consulting “her upstairs”.

      GT’s references on nicotine/LPL led me to consider Ellen’s question. My conclusion as to delivery vehicle:

      NOT chewies BUT stickies – AKA the Nicotine Patch.

      A patch delivers:

      i) a steady dose, rather than a spike, I prefer steady-state pharmacodynamics, e.g. patch or skin gels

      ii) applying it in the a.m. will also provide a low dopamine dose which may act synergistically with one’s double expresss ristretto

      iii) has it worked? – dunno, it probably a 2nd order effect with me, even tho’ the daily dose, 12.5 mg Nic, is deemed equivalent to 10-15 cigarettes per day

      iv) I have not smoked for 50 years; I dropped an 80/day habit built up while studying one summer, because the “dopamine reward” was vastly lower than disbenefit of my scratchy throat and sore tongue.

      I might drop it if I judge that I can get “morning energy” hit in a different way.

      Slàinte

    • Peter Attia  April 11, 2012

      All true, for sure. I think my wife just drew the line because she didn’t want me getting hooked on nicotine (even in the form of a patch!).

  3. Elizabeth Hughes  April 11, 2012

    Excellent article. I was directed here by an anaesthetist I work with. He spoke very highly of your blog.

    (reply)
  4. Elizabeth Hughes  April 11, 2012

    I have a question for you regarding hsCRP levels. How important do you think they are in determining both cardiac and overall health? I know I had/have metabolic syndrome. I have been eating primal/paleo since the start of January. In that time, my hsCRP has actually risen from 7.5 to 11.0. I am currently doing a “reset” Whole30 month to see if I am reacting to dairy, fruit or nightshades.
    I have lost 31 lb in 3 months and feel otherwise great- less arthritic pain, better sleep etc. Am I obsessing about the importance of this lab value? Thanks in advance.

    (reply)
    • Peter Attia  April 11, 2012

      hsCRP is certainly suggestive of inflammation, but it’s not the number to be chasing. Single most important number is LDL-P. After that, everything else, including Lp(a) mass and cholesterol, is second fiddle. I’d be more concerned with HOMA-IR than hsCRP, once LDL-P is ok.

    • Sam  April 11, 2012

      Great post it really explain everything in a way that anyone with an open mind can understand. I am a great example of what is in your post. I had a 26 inch waist when I was on my twenties, could eat a medium size pizza all by myself and could not gain any weight, even when I was trying to. As I got older eating less and exercising more I keep gaining weight and having poorer health. Only LC has been able to stop and reverse the deterioration.

      One question as you know there is great resistance to the use of statins from many in the paleo and LC community to reduce LDL-p and cholesterol. What do you think of using Niacin under medical supervision in those opposed to statins?

    • Peter Attia  April 11, 2012

      Crestor (which is a statin) has the single greatest efficacy on lowering LDL-P if the problem is 1) too few (or too few functional) LDL receptors and/or 2) too much synthesis of cholesterol. If the problem is too much absorption, usually through a dysfunctional ATP-binding cassette G5/G8 transporter on the enterocyte, then Zetia (ezetimibe) is the way to go. Niacin is a good drug, but no in the same league.

    • Mark  April 11, 2012

      @Elizabeth –

      I had my hsCRP tested a couple of times last year, with the first time being a couple of months after going on an LC diet and losing lots of weight. My CRP test came back high (I think around 10). I was very worried. My doctor said to wait 30 days and then re-test. I did a ton of research on what exactly a CRP test is for, how to interpret results, etc. The general (and growing) consensus is that CRP is a good test and is indicative of inflammation levels and is important to keep down. But, I also found that CRP levels can vary greatly day to day. So you can’t conclude anything from one test.

      In my case…my idiot doctor prescribed the first CRP (along with the usual blood tests for an annual physical) right after giving me the recommended once-per-decade rabies vaccination. The next day I went for the blood tests, including the hsCRP, and that was what resulted in the high CRP level. 30 days later I took it and it was down to 2.3, which is still a bit higher than I’d like but a vast improvement.

      I will be going in for an annual physical again soon and, like all my blood test results, I’ll be posting them to my blog. So if you’d like to see, subscribe : )

      mark
      http://www.lowcarblearning.com

    • lorraine  April 11, 2012

      I recently read a finding of increased crp with low Carb eating, not believed to be related to inflammation. I’ll have to find that reference.

    • Bill  April 11, 2012

      I realize we’re drifting a bit off topic here, but I must admit I’m surprised to read your views about the dangers of high LDL-P and about statins as a remedy.

      Can you say what evidence you see supporting the idea that high LDL-P promotes heart disease, as opposed to being merely a relatively weak marker for it?

      And what do you see as evidence that pharmacologically reducing elevated LDL-P reduces mortality? In primary prevention at least, I thought the statin clinical trials came up empty, or very close to it, depending on interpretation, for mortality reduction. And even in secondary prevention, the mortality benefit seems quite modest and not well correlated with changes in cholesterol profiles. Perhaps I’ve misunderstood.

    • Peter Attia  April 11, 2012

      Too much evidence to put into a quick answer here and probably even into one blog post, but I will be writing about it. The problem with statins is that most doctors are using them to treat the wrong thing. They treat LDL-C, not LDL-P. LDL-P (or ApoB, if measured correctly) ARE the issue. It will take me a little while to write this up, though.

    • Anon  April 16, 2012

      Looking forward to your post about statins (that you mention in the response). My blood levels of HDL andLDL are in normal range (53 and 125, respectively, with 195 total cholesterol) after almost a year on low carb. My triglycerides are down to about 90. But my hsCRP is 2.3 (and has been elevated in past tests). Doctor is suggesting statin for inflammation, not due to cholesterol numbers. Thoughts?

  5. Kevin Mobloey  April 11, 2012

    Hey Peter, great article. I just reposted it to my FB page as a must read.

    A group of us are collaborating on nutritional readings, food and exercise. One of the guys posted this article to help explain insulin.

    http://weightology.net/weightologyweekly/?page_id=319&fb_source=message

    My take on this article:

    1. The author is working hard to make the point that protein can raise insulin, however the studies used are flawed to me because the fat content trial diets were too low. You have said many times that too much protein will make you fat — I think your conversion anything more than 1.5 grams per kilogram of body weight.

    2. The sentence sums up the flaws in his prospective “if you truly wanted to keep insulin as low as possible…you would eat a low protein, low carbohydrate, high fat diet. However, I don’t see anybody recommending that.”

    3. Your point in this article that genetics impact insulin sensitivity seems to be lost on the author’s argument of how long it takes for insulin to recede after a high carb meal — in some people it could be minutes, hours for others. Your suggestion of n=1 experiments in this blog is to help all of us figure out individual boundaries. Is our limit 20, 50, 200, 500, 1000 grams of carbs per day, and how does that change over the course of our life?

    Please let me know what I missed.

    Thanks again for an excellent article.

    Kevin

    (reply)
    • Peter Attia  April 11, 2012

      It is true that protein stimulates insulin, but NOWHERE near to the same extent as carbohydrates. His suggestion, while joking, is sort of correct if you define “low” protein as 1-1.5 gm/kg/day, which is what someone in ketosis consumes. You can much more protein that that (e.g., >= 2 gm/kg/day) while being low carb and get virtually the benefits of reduced IR, but you won’t get into ketosis. Beyond IR, ketosis offers come cool benefits, which is why I fancy it.

    • Scott  April 12, 2012

      And remember protein also stimulates glucagon. People tend to glance over this very important detail when talking about protein and insulin.

    • Michael  April 13, 2012

      @Kevin Mobloey
      in this blog post Petro D. talks about protein, glucagon & lipolysis:

      http://high-fat-nutrition.blogspot.com/2011/08/i-have-read-good-calories-bad-calories.html

  6. Dave Nelsen  April 11, 2012

    Definitely agree that we all have different insulin sensitivites and the results that stem from this. I think the affects of carbs on heart disease is another matter however. A lot of skinny people have heart attacks so while these people may be spared the spare tire around the middle, but the carbs are doing damage internally.

    On a separate note, when ketonic and you backslide and eat a lot of carbs (say for a big Easter lunch), how long does it take to get back into your low carb ketonic state?

    I’m getting my blood draw tomorrow (I requested the NMR Lipid profile). I explained it to my primary care physician last week. She had to escalate my request to the Western regional medical director, who then in turn had to review with the remaining national leaders of their group. The potential energy hill to get this done is a bit steep, but I’ll keep plugging away. Great post again as usual.

    (reply)
  7. Mariet Hoen  April 11, 2012

    And what about leptin ? I’m insulie resistant. I think that I’m also are leptin resistant!

    http://networkedblogs.com/whHOw

    (reply)
    • Peter Attia  April 11, 2012

      You might be. You’ll have to wait a while for me to get to the “dance partner,” though. Just work on your IR for now. LR should work itself out.

    • Scott  April 11, 2012

      According to Dr. Lustig, if you are hyper-insulinemic, you are by definition leptin resistant. This has to do with leptin and insulin sharing receptors, so elevated insulin will block the elevated leptin. This is why obese people tend to have massively high serum leptin, but don’t feel its effects.

      But there’s good news: when you lower insulin, your body can see all of the leptin, which probably explains why low carb tends to massively reduce appetite.

    • KevinF  April 11, 2012

      Just got finished reading “The Rosedale Diet”. Dr. Rosedale obviously is positioning himself as the Leptin Guy. My takeaway from the book is that combating leptin resistance requires exactly the same approach in every way as combating insulin resistance. In fact one gets the impression you could replace every occurrence of the word “leptin” in his book with the word “insulin” and it would make not a bit of difference.

    • Peter Attia  April 11, 2012

      I think this is essentially true. Mechanisms are very different but treatments are very similar.

  8. Travis Koger  April 11, 2012

    Another great article… another popular share on Google+. Thanks again for your efforts Peter.

    (reply)
  9. Scott  April 11, 2012

    One of the most important elements (in my mind) that makes this process more difficult with aging is the accumulation of dietary induced damage to our innate insulin sensitivity and our underlying mitochondrial function. I imagine it like water against a rock. Years of eating excess fructose/PUFA/transfat (and whatever else we find to be damaging) slowly wears down our bodies, (I think mostly hepatic IR and mitochondrial dysfunction) and once the damage is done, its hard to undo it.

    (reply)
    • Peter Attia  April 11, 2012

      Absolutely, Scott. We do so much harm to ourselves as we age, and unfortunately, some of it is not (easily, if at all) reversible. Young people: pay attention!

  10. Brad  April 11, 2012

    This is brilliant, and to me one of the most important pieces you’ve written as it goes to the heart of the cognitive dissonance that many people feel when they read “Good Calories, Bad Calories.” Most of us know at least someone who can eat anything they like and not gain weight, or know people who’ve lost weight and kept it off on low-fat, high-carb diets, plus there are cultures with low rates of obesity that live on diets high in refined carbs.

    If all this could be boiled down to a nutshell, could it be: “some people can eat lots of carbohydrates without gaining weight, but almost nobody can become obese without eating lots of carbohydrates?”

    (reply)
    • Peter Attia  April 11, 2012

      Thanks so much Brad. I try not to “pick favorites,” but I think I had more fun writing this post than any other post I’ve written to date. I hope it can help folks have the sometimes awkward discussions that get imposed while trying to discuss a complex and nuanced topic like this.

  11. Nicolas  April 11, 2012

    In that case, I want to be like Mike!

    (reply)
  12. Marilyn  April 11, 2012

    Speaking of gravity. . .Wish I could find the Maxine cartoon in which she looks down at her sagging physique and declares, “This diet is really working; my weight is going down.”

    I know someone like your wife. My aunt turned 100 six months ago, and is still going strong. She’s always been little, in spite of the fact that 50-60 years ago, she could eat several roasting ears (corn on the cob) as part of her noontime dinner. One time she told us she put away 8 of them!

    What role does insulin play on protein metabolism? To what extent does insulin resistance cause the general muscle weakening that usually comes with old age?

    (reply)
    • Peter Attia  April 11, 2012

      Insulin does a number of things in protein metabolism, depending on “state.” Insulin is anabolic, so it want to turn amino acids into proteins (e.g., muscle) or glycogen.

  13. Erick Minor  April 11, 2012

    Great article! Keep them coming.

    (reply)
  14. James  April 11, 2012

    Great post. I’m glad you included lipoprotein lipase in the discussion. It doesn’t often get mentioned, but it appears to be a very important part of how nutrients (fat) get partitioned in the body. For people interested in how rapidly LPL at the muscle can be “shut off” by inactivity (or conversely, how easy it is to keep LPL activated at the muscle), this is an interesting study: http://jp.physoc.org/content/551/2/673.abstract?ijkey=16413705a94af3ee1428dbd34d00753a30340e7d&keytype2=tf_ipsecsha

    It does use a rat model, but I think the finding is still relevant and adds to the rapidly expanding body of knowledge about the dangers of being sedentary.

    (reply)
  15. Maryann  April 11, 2012

    Great article Peter, thank you! Although, you forgot the third catagory of readers…the ones who skipped the science explanation and went straight for the conclusion :)

    Have you heard of Capsiate Natura?(capsiatenatura.com) Would this act in the same way as nicotine? There are studies on the website; however, I am not qualified to interpret them. A doctor with a radio show sells them as a safe way to lose weight by increasing calorie burn.

    (reply)
    • Peter Attia  April 11, 2012

      I have not heard of it. Not enough time to review it now, unfortunately.

  16. Alexandra M  April 11, 2012

    Oooh, I really liked that! Especially since people keep pointing to Jimmy Moore as THE definitive example of the results of low carb dieting.

    (reply)
  17. Greg  April 11, 2012

    Peter,

    Like you and others, I’ve been an athlete all my life—from wrestler to long distance runner and cyclist. Unlike you, even when I was 16 I was never able to eat anything that I wanted. Even as a teen I would easily put on the fat and pounds. As you can imagine making weight for wrestling was a battle, and altough ok, I was never a lean ectomorphic distance runner.

    The side benefit of this perhaps has been a constant awareness that I could always get fat, unlike those who march ignorantly from a youth of skinniness while drinking mountain dews to an obese adulthood. On the other hand, like you I was slowly putting on pounds through my 30’s w/ a high-carb, low fat “athlete’s diet.” Thankfully I’ve managed to learn about the low carb approach in the past year and changed my diet accordingly.

    (reply)
    • Peter Attia  April 11, 2012

      Yes, I really paid a price in my late 20’s and early 30’s by not accepting that “something” had changed in my body.

    • Greg  April 11, 2012

      And…incidentally, my wife weighs like 100 lbs and can eat whatever she wants as well. That said, she has been low-carbing to some (smaller) degree, and reports far fewer blood sugar swings.

  18. KevinF  April 11, 2012

    What I’ve learned from this is that when you were 16 you were clearly insane.

    (reply)
  19. Dennis in Canada  April 11, 2012

    I think I can offer some anacdotal information on nicotine and fat.

    I started smoking at age 12, and quit when I was 32. My weight at the time was about 155. Withing two months, I ballooned to 195. By age 50, that number had creeped to about 205. My wife, who had also began smoking as an adolescent, barely gained any weight at all when she quit smoking with me.

    Personally, I’m inclined to speculate that the LPL/nicotine relationship may also be like insulin and gravity. While I nicotine may have been working wonders at keeping me thin, it likely had little effect on my wife.

    In any case, we both went low carb at the turn of the year, and as of today, I’m back down to 165, and feeling like I’ve just been given a new lease on life. As for the wife, she went low carb with me, and even though she was never over weight, she has seen a loss of inches in all of the places she was hoping for.

    Great blog with lots of interesting perspectives.

    (reply)
  20. Martin  April 11, 2012

    Peter, are you familiar with the hypothesis that Robb Wolf writes about in this post:

    http://robbwolf.com/2012/03/09/paleo-diet-inflammation-metformin/

    The main point, in short, is that insulin resistance is in fact caused by the immune system’s reaction to the systemic inflammation caused by the leaking gut, i.e. intestinal bacteria getting out into the blood stream. The gut permeability is in turn body’s reaction to the antinutrients present e.g. in the grains but also to sugar. The mechanism would then be similar to the one that occurs with sepsa. Jeff Volek also mentions this hypothesis in his recent interview with Jimmy Moore (I hope got the idea right).

    Of course, as your main point is, the understanding of the exact mechanism changes nothing about how it affects us and what we should do to possibly avoid it. By the same token, we have no real clue what gravity really is, why would 2 masses attract each other. The formula you give is just an approximation which happens to be about right at the scale of things that we’re mostly concerned with :-)

    (reply)
    • Peter Attia  April 11, 2012

      A little familiar, but working to get more familiar. Robb has been sending me some great papers, and we’re speaking in Reno together next week, so we’ll lots of time to discuss in person. I really can’t wait.

    • Paula  April 13, 2012

      Hey Peter,

      I know you wont have time, but right soon in Rob Wolf’s The Paleo Solution PODCAST #125 on iTunes is an interesting take on fat and dietary fat.

      Seems you two have some talkin’ to do.

    • Peter Attia  April 13, 2012

      Will do.

  21. Fritz Ziegler  April 11, 2012

    Thank you for this great essay, Peter.

    Since you like equations, I think I have it all figured out for you:

    B = C x I

    Where:
    I = Carb intolerance
    C = Carbs
    B = Blubber

    You can take it from here: proving it, measuring the effects, finding the variables that influence the degree of carb intolerance, and so on.

    Seriously, I appreciate your work immensely and look forward to your post every week.

    Thanks again,
    Fritz

    (reply)
    • Peter Attia  April 11, 2012

      Great formula. The “actual” one probably has a few higher order terms, but this is a great start.

  22. Odille Esmonde-Morgan  April 11, 2012

    A very interesting article.

    And what about the cumulative effect of consuming all that insulin – metabolic resistance. It would be very interesting to follow children who ate a low carb (say under 120-150g carbs) ALL their life, from childhood (but I imagine you’d have the devil’s own job fining a sample population!).

    Would they suffer the same decline of proper function of insulin action as a control group eating the normal western high carb diet? I know I’m unlikely to ever see the effects of such a study (I’m 59) but I suspect the answer might be no, and that they might retain their ‘metabolic advantage’ through their lifetime.

    (reply)
    • Peter Attia  April 11, 2012

      Some folks have actually suggested that children are larger today than 50 years in part because of so much more sugar and simple carbs leading to increased insulin secretion and insulin-like growth factor (IGF). In other words, a world with less sugar may actually result in not just slimmer, but shorter kids. ZERO data here, just the speculation of some.

  23. Molly  April 11, 2012

    I sort of felt like you are saying at 54 and being insulin resistant, this last 45 lbs ain’t budging. Is it still right to put up the fight? I’ve been doing this for a year and 3 months. Lost 50 lbs but now I’m stuck.
    Am I going to be stuck here forever?

    (reply)
    • Peter Attia  April 11, 2012

      Not sure, to be honest with you. Might be worth re-checking how insulin resistant you (have your doctor do a HOMA-IR and OGTT).

    • greensleeves  April 12, 2012

      Molly, many women your age report this problem. Some start losing again (slowly) when they take low-dose metformin. Talk to your doctor. Menopause and peri-menopause are a different country. Your body will never be the same. You will not ever have your 25-year-old body again. Sorry.

    • Barbara Hvilivitzky  April 13, 2012

      Hi Molly! At 66, way past menopause, and needing to shed some pounds, I found the ONLY thing that budged fat around the middle for me was intermittent fasting, calorie restriction, and adding fat (coconut oil, MCT oil, butter, cream). I fast from 7pm until 3pm the next day, then eat around 1300 cal in one or one and a half meals (low carb of course). I have been doing this every day for 2 weeks and the fat is starting to melt. However, I must report not a huge amount off the scale – but I can see a BIG difference visually when I look at my “middle.” I don’t know if this is right for everyone but after months of frustration I’m pretty happy with my fat loss. Just a thought for you….

  24. Janknitz  April 11, 2012

    “1.Over time, endogenous production of sex hormones (e.g., testosterone, estrogen) becomes altered, and this seems to play a role in fat metabolism. ”

    I wonder if this isn’t a chicken and egg conundrum? Perhaps the excess insulin is what alters the endogenous production of sex hormones–not the other way around. For women like me who have PCOS, low carbohydrate diets seem to have a big impact on reducing excess testosterone and normalizing estrogen levels.

    P.S.
    I’ve known smokers who refuse to give up smoking because they’d rather risk various nasty cancers, COPD, etc than take a chance getting fat. Fat Phobia lives.

    (reply)
  25. Johannes Oecolampadius  April 12, 2012

    I read Taubes Readers Digest Article a year ago or so. I started following that and went from 236 pounds to 187 pounds in 14 months. Never going Back!

    (reply)
    • Debbie  April 12, 2012

      That’s fantastic! Congratulations!

  26. jake3_14  April 12, 2012

    I’ll be the odd man out here and say I thought the gravity analogy wasn’t quite apt and overcomplicated your point. Whether or not you believe Ron Rosedale about the primacy of leptin in contributing to obesity, I think his metaphor of talking and listening is more appropriate. Athletic stars like the young Michael Jordan and Mary Lou Retton challenge gravity and are constrained by it, not communicating with it. In contrast healthy cells “listen” to insulin/leptin and respond appropriately. As Jordan and Retton age, they get worn down by gravity and succumb to it, probably reluctantly acknowledging it. In contrast, insulin-resistant cells don’t succumb to insulin/leptin as we age; they become “deaf” to insulin/leptin from all its “shouting.” But even at an advanced age, when athletes retire, our bodies can again “hear” the weight control hormones when their volume decreases.

    Also, using a blanket statement that we’re all biochemically, genetically, or even epigenetically unique is an unsatisfying answer to why some people who eat poorly don’t gain weight. Don’t we know anything worth telling the lay public about this variation?

    (reply)
    • Peter Attia  April 12, 2012

      Jake, that’s why I love ya, man.

    • Derek  January 27, 2013

      Hi jake3_14, Peter, I am new to your blog and read this post and Jakes’ comment. I am educated layman and have often wondeed if A.G.E. products are not to blame for insulin resistance. I rarely see it implicated as the causative factor, but it fits really well. The non-enzymatic glycation of all cell receptors throughout the body could easily account for insulin resistance. AGEs would correlate nicely with sugar consumption and the resultant blood concentrations over time. This could account for differences between individuals. Some people eat poorly but did not increase blood level concentrations as much as you may have. People often under report or estimate what they actually ate in the past. A bias if you will. Also, eating pattens could account for large differences in outcomes. For example low dosages of fructose, under 30g/day have been shown to be catalytic and generate a 3 fold increase in hepatic glycogen production. Thus, a “poor eater” could inadvertently be eating a piece of fruit a half hour before his regular meals and routinely express lower concentrations of blood sugar than you do on a more “sensible” diet that is lower in carbs. This would result in less AGE damage and hence less insulin resistance over 10,000 meals.

    • Peter Attia  January 27, 2013

      Could play a causal role. Could be an effect. Hard to know.

    • Derek  January 27, 2013

      P.S. I flipped over to HFLC about a year and a half ago. I have lost about 25 pounds so far. I was only about 50 pounds over weight to begin with, so the slow pace makes reasonable sense. I mention this only because in my previous comment I used the word “sensible”. I do believe that low carb, high fat, moderate protein is indeed sensible.

  27. Charlie  April 12, 2012

    Peter, you mentioned that you’ll be speaking in Reno next week. Where? Is it open to the public?

    (reply)
    • Peter Attia  April 12, 2012

      It’s not, I don’t think. It will be me, Gary Taubes, Robb Wolf, and Tara Dall. I will check if there is any more room and let you (and other Reno folks) know if it is. The talk is at Specialty Health to a group of local physicians.

    • steve  April 13, 2012

      Be interested in your feedback from the talk, particularly with regard to what Dr. Tara Dall has to say about diet. I believe she favors low carb(particlularly for those who generate lots of small LDL particles- a genetic tendency for many), but not sure she is there with regard to saturated fat intake. In fact I believe her website says to limit it. Be interested in hearing what she has to say about that particularly for patients who have some degree of CAD or family history. I think Dr. Dayspring has moved towards to the lower carb paradigm, and no longer fears sat fat, something many lipidologists still do. Thanks.

    • Peter Attia  April 13, 2012

      I’ve cooked a high fat dinner for Tara and her husband! She loved it (of course, it’s possible she was just being polite!). Tara and I talk about this stuff a lot will continue to do so.

  28. Antonio  April 12, 2012

    looking at the young Peter A’s eating habits and the current habits i’m wondering if eating less carb back in the day, and maybe more fat to keep the calorie intake equal, would have made a difference regarding current carb intolerance? can a pancreas “burn out” or become dysfunctional trying to regulate a hi carb intake in youth?

    Tony

    (reply)
    • Peter Attia  April 12, 2012

      Possible. Unlikely I experienced pancreatic burnout (as documented by OGTT), but it may certainly have contributed to my IR later in life.

  29. Birgit  April 12, 2012

    Peter,
    Very interesting post, also the most challenging for me to understand all the issues. Will have to take more time to research. I was surprised that hypothyroidism was not mentioned as an extremely common cause of obesity/weight loss resistance at least in women. On the other hand I have to admit that most of what I thought were low-thyroid hormone symptoms, especially lack of energy, brain fog, sleep disturbances, went away when I started eating low-carb.
    My husband is one of those people who can eat all the carbs he wants. But he never abused sugar in his youth the way I did. Wonder if that may make the difference (sugar and other high-carb foods together).

    (reply)
    • Anu  April 12, 2012

      My boyfriend is the same way and I’m beginning to think his diet when young had a lot to do with it. He eats and has always eaten lots of high-fat foods — small oily fish, plenty of eggs, sour cream and butter. At the same time he doesn’t eat much sugar and never has. He says growing up he would have half a grapefruit to eat after lunch at school and no dessert after dinner. Dessert was a very occasional indulgence. He also dislikes a lot of the common ways in which people get sugar highs — he hates ice cream, chocolate, creamy desserts of any kind, nuts etc. So 99 % of the time he never finds a dessert on a menu that he wants anyway. Eating with him has had me rethinking a lot of the entitlement I used to feel to sugary things on a regular basis.

  30. Laura G.  April 12, 2012

    I am having a real problem with friends/family/strangers commenting on my ‘unhealthy’ way of eating. They see the results in me–and I LOVE how I feel when I eat VLC, but what the heck??!!!! if one more person says ‘well what about grains? you can probably have healthy grains, right? like whole grains? and what about fruit? you arent getting all your nutrients!!! you eat so unhealthy…” etc etc etc. They dont believe the FACTS and I cant be assed explaining it to them-cause they dont want to believe…but how do YOU handle that?

    (reply)
    • Peter Attia  April 12, 2012

      Turn it around on them. Ask THEM why grains are good for you? Why fat is bad for you?

    • Alexandra M  April 12, 2012

      *eyeroll* Because “everyone knows” that fat clogs your arteries and “everyone knows” that whole grains can help you lose weight! That’s a direct quote from an article in the “Health” section of last week’s newspaper (I’ve written a letter to the editor).

      After a few false starts and yoyoing since January, my weight loss has finally got going. I’ve lost 11 pounds in six weeks (not as fast as I used to lose, but I’m 57, so I’ll settle).

      I have a group of friends that exchanges emails every day, and naturally one of the perennial topics is our attempts to lose weight and get fit. I’m the only one who’s losing weight – the rest are all complaining that in spite of exercising every day (one is bicycling 50 km/30 miles every day!) and being hungry all the time, they can’t lose weight. They know I do low carb. I can’t tell you how many times I’ve explained it to them, posted links to peer-reviewed journal articles, shown them the science. As far as they’re concerned, the “science” says “eat less exercise more.” So they just keep trying harder to avoid “greasy” food, to eat even less, and to exercise even more.

      It is SO frustrating to see a bunch of people who can’t lose weight giving each other “expert” advice on how to lose weight. Will they ask me how I’m succeeding? No. They know the answer they’ll get and they don’t want to hear it.

      Now they’re talking about whether they should try appetite suppressants!

      Sometimes I despair. I really do.

    • Travis Koger  April 14, 2012

      Alexandra,

      Totally understand what you are going through with your group of friends. A few of my friends are in the same boat. They have been trying to lose weight for a long time. They exercise regularly, ie daily, to try and shift they weight and have done the normal thing of reduce fat and increase fibre.

      Yet these same friends have seen me lose over 80lbs in the last 18months and are well aware of what I eat and have spoken to me about what I am doing and how well I am doing. There is only one person who changed to high-fat, low-carb… she did it for four weeks and lost about 8lbs, more than she had ever lost previously when trying to lose weight. However after the four weeks, she started to feel guilty that she was doing something wrong because she was not eating enough fibre/grains etc. So she went back to the way she was doing her diet… and of course she stopped losing weight. By this time though she was convinced (not sure how she could not see her own evidence) that fibre/grains is the right way forward.

      Very frustrating to say the least.

  31. Peter  April 12, 2012

    Here’s a puzzler. A female relative, in her 70’s, must monitor her blood glucose level at home and follows a low fat high complex-carb diet, prescribed to by her doc and dietician, to keep her healthy. I convinced her to do a self-experiment.
    Day 1, she woke, did a glucose reading: 89
    Breakfast on bowl of oatmeal w/ raisins, waited 1 hr. glucose: 270

    Day 2, wake-up glucose: 89
    Breakfast on 2 eggs fried in butter & 1 Ital sausage. 1 hr glucose: 195

    The jump in blood glucose of 200% from oatmeal was expected. But now could eggs and sausage cause a 105% increase in blood glucose? Is it that some of the ingested protein got converted into glucose, which triggered insulin. And due to insulin resistance, the blood glucose level remained high?

    BTW, after the oatmeal test, she became more skeptical on her current high-carb eating plan.

    (reply)
    • Peter Attia  April 12, 2012

      Wow, assuming those readings are accurate (and that’s a big IF), it says she is very, very IR. In time, with the correct diet, she can fix this, though. The 195 suggests here liver is immediately turning protein into glycogen AND her liver is pouring out glucose.

    • Alex  April 12, 2012

      Maybe try the test without any prepared foods, you never really know what’s in sausage unless you make it yourself. 4 scrambled eggs cooked in butter with a pat of butter melted on top is a fab breakfast! 6 hours of satiety for me. The best butter IMO, is Kerry Gold.

      My former husband went through the same process of eating the craptastic A.D.A. diet and, as instructed, managed it with ever increasing doses of insulin.

      Best of luck!

    • moreporkplease  April 13, 2012

      I agree with Peter – very IR. Peter, why do you say post-menopausal women can resolve their IR solely with diet? Don’t we know that for the vast majority of women after 45 that this is emphatically not the case? I’m a believer in the benefits of low-carb, but don’t we have to offer some truth here? Most of these women stall out permanently after 6 or 7 months until they add back metformin or another drug.

    • Peter Attia  April 13, 2012

      I didn’t say (or at least didn’t mean to imply) that all post-menopausal woman can resolve their IR with diet alone, but eliminating carbs will probably get them as far as they will get with diet. Whether metformin can help beyond that is another issue, and it probably can, but I’d always recommend diet first. I’m also not sure of the claim that “most” stall out. Huge selection bias, recall. We don’t know the size of the denominator.

    • lorraine  April 13, 2012

      Even though 195 isn’t good, it’s still much better than 270, so the low carb/high fat meal did demonstrate the principle, even with her level of glucose intolerance. The overall high numbers are related to IR. That the liver cranks away making glucose when a meal has just been digested is one of the real evils of diabetes, IMO, and this could also be a factor in her numbers. Is she on diabetes medication? Not that meds really fix much (I work with people on multiple injectable/oral med combos that still hit BGs of 500), but I was just curious.

  32. Dominique  April 12, 2012

    How does excericse play into all of this? Does it reduce insulin levels? Does it impact leptin?
    I know there are issues with exercising to lose weight (after reading WWGF)….
    I’m just wondering if anyone can point me in the direction of where to read up on exercise and hormone levels…..Thanks

    (reply)
    • Peter Attia  April 12, 2012

      Exercise impacts IR somewhat, especially during the actual time you are exercising. However, the impact of food choices far outweighs this.

  33. Paula  April 12, 2012

    YES! Over time we do experience insulin differently. In my 20’s I was a slim, strict vegetarian for almost 7 years. A lifestyle that in my 40’s would make me ravenously hungry, obese, and in a constant hypoglycemic state… Great stuff. Found you on Jimmy Moore’s LivinLaVidaLowCarb.

    (reply)
  34. Laura G.  April 12, 2012

    Their response to “why are grains and low fat good for you?” would be–” well, you need the nutrients and fat is bad for you”.
    Your program works. I am highly insulin resistant and I was not losing weight on 1000cals a day. With VLC I feel great, and am losing weight…I am living proof this works–and ppl know that, but they say its an unhealthy diet and a fad. Just wanted to know how you handle the pressure from the flack you would get from the medical community….

    (reply)
    • Peter Attia  April 13, 2012

      Great story, thanks for sharing. I would still ask of such folks, “Why is fat bad for you?” How many people can provide a real answer to that question?

    • Mark Jacobs  April 16, 2012

      Fat is bad for you because that is all we have heard from our government, media, and medical community for decades. It is purely a response to what we as society have heard for way too long.

      If you have never heard of Tom Naughton read this post which I found very entertaining but more importantly informative.

      http://www.fathead-movie.com/index.php/2009/04/19/can-your-own-bologna-kill-you/

      Tom produced a documentary/comedy (I know that sounds contradictory) named Fat Head. I watched it on Netflix and it opened my eyes to the bad science and politics behind the USDA. this movie in turn has given me a hunger to learn as much as I can about low carb high fat eating. This blog by Peter is certainly one of my favorites.

      I am reading all I can from Peter, Mark Sisson, Gary Taubes, Dr. Michael Eades. I wish I had found this years ago.

  35. Al  April 12, 2012

    Peter: great post as always. Just wondering how fasting (intermittent or otherwise) plays into regulation of IR? Is there a known waterfall of “sources” the body consumes in the absence of new food that works in favor of reducing IR? Just wondering if you could briefly describe the likely biochemical reactions (in their respective orders) that occur when one fasts? I’ve been going on 16 hour intermittent fasts (basically skip breakfast and eat no later than 8pm) and the results have been striking though I’m not sure why since my overall aggregate caloric intake and macro-distribution hasn’t changed from just eating LC or VLC on a 3 meal schedule.

    (reply)
    • Peter Attia  April 13, 2012

      Al, I’m still trying to figure this out myself. The data I have seen on this (Mark Sisson did a nice series on this) are not really applicable to someone like me who is already keto-adapted. Most of these studies involve folks doing IF around regular diets. What, specifically, are the results you’ve personally noted? How frequently are you fasting?

    • Al  April 13, 2012

      I’ve been doing it every day for about 6 weeks now in response to being stalled on vlc for about 4 months or so. In the first few weeks the weight didn’t budge but I felt more energy during the day and found I needed less sleep so I kept going – especially since I found I didn’t miss breakfast during the week. On weekends my noon meal is always bacon, eggs, cheese but during the week I take grass-fed beef to work in a tupperware container and that’s my first meal, usually just after noon.

      Around the fourth week the weight started coming off at the rate of about 2 pounds a week, tomorrow I do my weekly weigh-in and expect to be down further if my pants are any indication. I’m still eating mostly vlc but feel less anxious about cheating with sweet potatoes, dark chocolate and ice cream now and then after my last meal – usually between 7pm and 8pm. Most mornings I’ll drink espresso with heavy ceam and some I’ll add a dab of grass fed unsalted butter or coconut oil. Othwerise its just water, tea, coffee and seltzer, same as my pre-IF vlc diet.

      Since you mention Sisson, you and he seem to have a difference of opinion on one matter – he claims the research shows that people who train in fasted states develop more efficient glycogen utilization while I think your last article suggested that if you’re not filling up Glycogen regularly then you’re probably not very efficient at using it.

      I am a bit worried about whether I’ll end up losing muscle mass along the way but if I ever get too skinny I’d try creatine and protein supplements as a way to bulk back a bit if the steak and eggs don’t work.

    • Peter Attia  April 13, 2012

      I’m not sure we differ on this point necessarily, but the data are not perfect, because they are not looking at people who live in a keto-adapted state. This is why I’m doing some of these experiments on myself. I do think that giving up a lot of fat tends to cost someone a bit of lean tissue, also. Anabolic versus catabolic forces at play.

  36. lorraine  April 12, 2012

    I really enjoyed this one. So, can I ask you to bump a topic on your “Coming Soon” list? The one all the way at the bottom, on insulin resistance and hypothyroidism. A HUGE topic for menopausal women. I have a client who’s endo put her on metformin for her increasing waist and it appears as though her thyroid medication hit home way more effectively; i.e., her symptoms went way down and her serum T3 also went down. My theory is that the metformin reducing the IR also reduced thyroxine resistance, and she had better uptake.

    (reply)
  37. Elna Cain  April 13, 2012

    Hi Peter
    I have a quick question that my husband has posed. We have been doing lowish carb for over a year and trying to get pregnant with no success yet. He feels that b/c we are in a ketosis state that my body won’t sustain a pregnancy due to the energy it would take to carry a baby. He states that when you are trying to work out in a ketosis state it’s harder to gain muscle b/c growing muscle is metabolically expensive and your body doesn’t have the xtra calories it would require, ergo getting pregnant would be harder on a ketosis body.
    My husband would like for me to consume 150 gm of carbs daily to get me out of ketosis but I just am not sure about this.
    Any input would be greatly appreciated. Sorry this question is on this thread but it’s the most recent post.

    (reply)
    • Peter Attia  April 13, 2012

      I can’t really provide any advice on this, unfortunately. I am not aware of any evidence that ketosis inhibits pregnancy. Also, “lowish” carb typically doesn’t lead to ketosis. Is is possible you are not actually ketotic and there is another explanation?

    • greensleeves  April 13, 2012

      Hi Elna: You will enjoy the work of Dr. Michael D Fox in Florida. He’s a fertility specialist who uses very low carb diets to help women get pregnant.

      His experience is that ketosis helps many women become more fertile. The Swedish low carb doctor Andreas Eenfeldt interviewed him a couple of years ago. Well worth watching. Eenfeldt’s own wife got pregnant and carried to birth on 30 carbs a day just last summer. The baby’s beautiful and healthy.

    • Elna Cain  April 13, 2012

      Thanks Peter for responding
      I will get some ketone sticks to make sure I am or not in Ketosis. My husband thinks I am but I believe I eat enough fruit to get me out of it. I tracked my food intake on CRON-O-METER and my average carb is around 80 gms a day so who knows if I am. Gary Taubes does say that anything under 120 gm of carbs puts you into ketosis but I feel i eat enough fruit and dairy to be out of it.
      Do you agree that ketosis makes your body “sub par” since when you think about building muscle– it is quite taxing on your body when you don’t consume carbs? It makes sense that getting pregnant would be the last think my body is thinking of if it’s in ketosis

    • Peter Attia  April 13, 2012

      If you’re eating 80 gm/day you are not in ketosis, especially with even modest amounts of fruit. It’s tough to be in ketosis above 50 gm/day.

    • Peter Attia  April 13, 2012

      I’m not sure there are enough data to say that ketosis is definitely sub-par for building muscle. It’s a hypothesis right now, that must be weighed against personal observation and available data. Bigger issue for you is fertility, if I’m understanding your question, though. Check out the video.

    • moreporkplease  April 13, 2012

      Hi Elna:

      “It makes sense that getting pregnant would be the last think my body is thinking of if it’s in ketosis”

      I don’t quite understand why you say this. Do you have a study or such?

      Being in ketosis for a while will resolve your insulin issues, and Dr. Lustig’s statement is that high insulin blocks the leptin from reaching your brain properly.

      Your ovaries also have leptin receptors, probably because your body wants to know you are fat enough to carry a baby to term before it wastes energy making an egg.

      If you have chronically high insulin, your ovaries aren’t sensing your leptin correctly either and in that feedback between ovaries and brain the proper signal gets lost. This is actually 1 of the 2 causes of PCOS.

      And this is why Dr. Fox can get so many women preggers after an appropriate time on a strict low-carb diet. Once your ovaries recognize that you actually possess the energy stores (body fat) to successfully carry a baby, you will start to ovulate again/more/better, and you will greatly improve your chances of having a lovely baby of your own.

    • Bill  April 14, 2012

      “If you’re eating 80 gm/day you are not in ketosis, especially with even modest amounts of fruit. It’s tough to be in ketosis above 50 gm/day.”

      I could be a counterexample here. I just had a Nutreval (FMV and plasma) test done, and it showed a ß-OH-butyric acid level of 15.9 mmol/mol creatinine (normal range <=2.8). This was an early AM fasted FMV sample.

      But I'm pretty certain I eat more than 50g carbs/day, since I generally eat two big pieces of fruit (not just berries, but also bananas, apples, pears, etc.) plus one reasonable portion of starch (rice, potato, or sweet potato). Using Fitday, I've estimated by carb consumption at 100g daily, perhaps a bit more but certainly less than 150g. I've estimated my protein consumption at about 84g/day.

      I always assumed I wasn't in ketosis with this diet. Now it would appear I am, at least some of the time. Not sure what to make of it.

    • Peter Attia  April 14, 2012

      Bill, I’m not sure this measurement is the same as the one we do in whole blood which gives B-OHB in whole blood in milimoles, rather than relative to creatinine. Of course, if you’re ingesting a lot of MCTs, I guess it’s possible, though it seems unlikely.

    • Bill  April 14, 2012

      Peter, I believe this was from the FMV urine sample. My doc was initially concerned about the extremely elevated ß-OH-butyric acid. But when told that I eat a low carb diet, the Genova Diagnostics biochemist told him that it was diet induced ketosis. I don’t understand it either given my diet, but there it is. Perhaps I’ll try to verify this myself with Ketostix.

    • Peter Attia  April 14, 2012

      The only reliable way to know you are in nutritional ketosis is to actually measure B-OHB levels in blood, and confirm you are above 0.5 mM (ideal is in the range of 1 to 2 mM). You don’t *need* to do this, of course, but it’s the only way to document. A bit of ketones in the urine is very common for anyone on a low carb diet, even if not ketotic.

  38. Martin  April 13, 2012

    Peter, you mention elsewhere that you use MCT as a supplement.

    Do you think there is a big difference between pure MCT vs coconut oil which also contains MCT? I’m specifically interested if pure MCT offers any sport performance advantages but also if it’s even better than coconut oil for inducing ketosis and promoting fat-loss.

    (reply)
    • Peter Attia  April 13, 2012

      Coconut is about 60% MCT, which is fine. I consume both pure and MCT and lots of coconut. Mostly just convenience.

    • Martin  April 13, 2012

      Thanks, that’s what I thought.

  39. Maryann  April 13, 2012

    Hi Peter,

    I love your blog! I learn so much from your generous, caring commentary. I feel that you attract a wide range of people who are big fans of the science of low carb. But the conversation seems to swing between people like you who are striving for, or already living, nutritional ketosis (or, as you just said, being keto-adapted). Some of us seem to want to optimize health, lose or maintain weight, and reduce disease risk with a low-carb lifestyle that does not involve nutritional ketosis. I saw Dr. Eric Westman interviewed, and he said just one day of cheating throws the body out of nutritional ketosis and it could take 2 to 4 weeks to regain it. He also spoke about the incredible amount of fat needed(as you have also). When you speak to your readers about high fat intake, and caution those who are struggling about moderate protein, is this advice meant specifically for the elite, ketoadapted low-carbers such as yourself? Or is the advice the same for everyone? I could be misunderstanding and unintentionally consume an unhealthy amount of fat, since I am not pursuing the state of nutritional ketosis. I am in ketosis according to ketosticks; however, if I understand correctly, that is a general report card on how the body is functioning and not an indicator of nutritional ketosis (is that right?). Is there a difference in the advice you intend to give to these two audiences you have? Sometimes it is not clear if the comment left refers to someone truly in nutritional ketosis or just an average low-carber. It seems to be an important distinction. Many thanks, Maryann

    (reply)
    • Peter Attia  April 13, 2012

      The modest intake of protein requirement is strictly for someone striving for nutritional ketosis, and is not necessary for someone working towards non-ketotic low carb eating, which is certainly a much easier needle to thread. That said, you don’t need to be ketotic to enjoy fat, including saturated fat. Eat when hungry. Stop when not hungry. Enjoy!

  40. Michael  April 13, 2012

    in this 1h documentary they show young students who are resistant to obesity:

    http://www.bengreenfieldfitness.com/2011/05/why-are-thin-people-not-fat/

    it’s obvious that for most people youth is a shield against hormonal troubles

    (reply)
  41. Maryann  April 13, 2012

    So 1. the ketosticks do indicate being in a state of ketosis? And 2. the bullion recommendation applies to anyone in ketosis? Thanks again, maryann

    (reply)
    • Peter Attia  April 13, 2012

      Yes, I recommend anyone in ketosis be supplementing with bouillon.

  42. Gary Althiser  April 13, 2012

    Hey Pete,

    First off, how, for the love of all things good in the world, did you fit that much food in your stomach as a kid, and how did your parents not go broke? Wow — at first I thought you were kidding about how much you ate. That amount of food could literally feed a family of 4! :)

    Second, I don’t think you’ve ever made a definitive statement on your beliefs of exercise and fat loss (unless I’ve missed it in one of the blogs??). Do you believe similarly to what Gary believes – most exercise, cardio especially, does nothing for fat loss?

    “The net impact of these forces on you is highly dependent on your genes, your age, and the choices you make (e.g., practicing gymnastics versus siting on the couch, changing your eating habits versus eating the same old standard foods).”

    Are you suggesting that ‘practicing gymnastics’ or something similar would lead someone to be lean, not vice versa (someone who is lean practices gymnastics because that’s just how they’re wired) like Gary believes?

    Curious as to your answer, especially since you cited the talent book at the beginning.

    Thanks again!

    (reply)
    • Peter Attia  April 13, 2012

      Actually I wanted to eat more, but my mom drew the line at 7 (I wanted 8) sandwiches. I think the role of exercise is complex, but my views are more aligned with those of Gary’s than conventional wisdom. Obviously my own personal experience colors this (I, and many I knew, were in the “fit but fat” camp). So it’s hard for me to see how more exercise is the answer, especially when you see entire populations of people who are largely overweight, despite a lot of physical activity. I just have not seen any convincing data that exercise is the key to controlling weight.

    • Martin  April 13, 2012

      When it comes to exercise: I no longer think the expanded calories matter that much. But if I move a lot and do my sports (climbing, running, MTB) I am more happy, literally, and less likely to (over)eat the junk food. In other words, at least in my case, exercise and activity regulate my eating behaviour by directly affecting my mood!

  43. Mike Hurley  April 13, 2012

    The more you think about it, the more you realize insulin hypothesis is freaking solid. I really hope one day that it becomes common knowledge for everyone and we all look back and think about how silly and wrong we were between the 70’s and 2010’s.

    (reply)
  44. PaulaM  April 13, 2012

    There are two Paula people commenting, so I am changing mine to PaulaM.

    Always a lot to ask and I resist. So, curious, Peter, somewhere on your blog you showed us a bit of your training. What is/are your goal(s)? It really appeared to me that of a professional athlete. Like hours per day, no? How much is enough if you aren’t poised to use that body to produce income? Ya know? How is your training changing based on what you are learning?

    thanks!

    (reply)
    • Peter Attia  April 13, 2012

      I’m far from being a pro athlete and have not been in that kind of shape for 20 years. I train because I love it. Same reason others play the piano. I had dinner with a good friends last night who is an engineer, but who plays the piano 2-4 hours per day (same as my training). Why? It’s his “juice!” No one is paying him or will pay him, but he loves it.

  45. Dominique  April 14, 2012

    Fascinating site you’ve got here, Peter, and this article is particularly interesting. My question is, how do you explain entire cultures (such as the Japanese, or many other Asian cultures) that consume high levels of carbohydrates- thus (presumably) provoking insulin surges daily- and yet consistently show very low rates of overweight/obesity and chronic disease?

    On a slightly more practical note, does regular (factory farmed) meat/dairy vs. grass-fed/pastured meat/dairy cause much a difference in terms of weight loss in someone who is adopting a VLC diet? I would think that feeding animals a grain-based diet would affect the composition of their fatty tissues, thus possibly changing the effect it has when someone eats meat from that animal…any thoughts?

    (reply)
    • Peter Attia  April 14, 2012

      Question 1 is on the list. Big difference between grass- vs. grain-fed meat is in the breakdown of fat you’re getting on the PUFA side. Grain-fed is more omega-6; grass-fed is more omega-3.

  46. Gerry  April 14, 2012

    A huge thank you for this blog Peter, like many posting here I was led to you by reading Gary Taubes. I have two heartfelt pleas to make….

    1) Please don’t let your attention to this blog de-rail you from publishing – especially that potential recipe book you mention elsewhere. For those of us convinced by the science ( at least as Gary suggests as the ‘null hypothesis) it would be the main practical tool for making this way of living a reality if, like me, you stare blankly into the fridge and decide boiling an egg would be less challenging….

    2) Please please please when doing so – remember the urgent need to include cheaper recipes and plenty of them!

    As a single woman on a low income living in the midst of a long-term recession in the UK I need to count every penny – I don’t have the stress of providing for a family, but of course without a freezer the size of a garden shed I don’t have economies of scale also. Fatty meat is cheaper than lean (yay!), but that’s about the only break we get, and it still ain’t cheap.

    It breaks my heart to see whole families sitting down to eat at MacDonalds or similar fast food establishments almost every day because it’s just so damned CHEAP! Mum and dad often labouring under significant obesity and all the kids well on the way to joining them – it makes me so very angry that another young generation are well on the way to a lifetime of chronic health problems, our children are so precious but parents need informing not just on what is a healthy diet, but how to achieve it on low incomes.

    Keep up the brilliant work, but don’t delay too long in getting out those publications…. :-)

    (reply)
    • Kathleen  April 16, 2012

      Gerry,

      “As a single woman on a low income living in the midst of a long-term recession in the UK I need to count every penny”

      I find that the bones of pastured animals are very affordable. But I live in the United States most of the time.

      Bone marrow and cartilage are quite tasty and VERY nutritious–especially the yellow marrow concentrated in and near the joints and vertebrae. And once you have roasted the bones and consumed the marrow, you can make delicious stock with what is left and extract more nutrition from the bones that way.
      There are plenty of recipes on the web for this. (I would suggest a crock pot) And plenty of information on the health benefits of marrow.
      Make friends with your local/regional organic farmers. It pays to know the Homies!

      (I hope I have not grossed anyone out here)

  47. charles grashow  April 14, 2012

    You said – hsCRP is certainly suggestive of inflammation, but it’s not the number to be chasing. Single most important number is LDL-P. After that, everything else, including Lp(a) mass and cholesterol, is second fiddle. I’d be more concerned with HOMA-IR than hsCRP, once LDL-P is ok.

    http://www.theheart.org/article/767865.do

    in patients with only moderately elevated LDL-C, clinicians would do better to pay attention to HDL levels and triglycerides as markers for future CAD risk rather than worrying about testing LDL-P.

    “Although it’s good to be aware of LDL-P, it’s expensive to test. We show that HDL-C and triglycerides provide similar predictive information. Most doctors do not look at HDL-C or triglycerides because, unlike LDL-C, treatment for these parameters is not mainstream clinical practice. It would be more useful to be aware of these results, particularly in those with the metabolic syndrome, abdominal obesity, or diabetes,” he said.

    Your thoughts

    (reply)
    • Peter Attia  April 14, 2012

      Categorically false, though I guess it depends on your definition of “similar.” The discordance between LDL-C — even when coupled to HDL-C and TG — to LDL-P is poor. Look at the work of Bill Cromwell and Jim Otvos and Tom Dayspring. 30% discordance. Is it worth saving a few dollars to risk the lives of 30%? I guess it’s a judgement call, but for me, my friends, my family, and my clients, it’s an absolute no-brainer. I’ve been fooled more times than I can I count by a perfect LDL-C, HDL-C, and TG, only to have a 90% percentile LDL-P show up!

  48. penny Olivier  April 14, 2012

    Hi Peter
    So glad I found this blog.I competed in Ironman 2 years ago using a high carb/low fat diet.I lost some weight during training, only to pick it all up again when just cycling afterwards.I switched to a high fat/low carb diet & lost 15kg in just over 2 months.I consume about 40g carbs a day & feel great.I have been doing this for the last 6 months. I now cycle 100km on fat, protein water, no carbs, & have no energy swings.If I consume carbs whilst training now, I don’t feel good as I get reactive hypoglycaemia.Also how do I work out exactly how much fat to use per day? I just bring fat into every meal. I am running now again & want to start swimming too. I am 1.70m &; now weigh 57kg (I was 73,5kg).My weight has stabilised but I can’t lose any more weight.So how do I calculate that I am actually taking in enough fat per day for my energy requirements? What is bouillon & why do you use it?I live in South Africa.
    Kind regards
    Penny

    (reply)
    • Peter Attia  April 15, 2012

      Penny, let hunger be your guide once you reduce carb — and especially sugar — intake. Your body will “know” how much fat it needs. I use bouillon to get extra sodium, which is necessary in a very low carbohydrate state.

  49. charles grashow  April 15, 2012

    http://www.nutritionandmetabolism.com/content/5/1/6

    Eggs modulate the inflammatory response to carbohydrate restricted diets in overweight men

    Conclusion
    A CRD with daily intake of eggs decreased plasma CRP and increased plasma adiponectin compared to a CRD without eggs. These findings indicate that eggs make a significant contribution to the anti-inflammatory effects of CRD, possibly due to the presence of cholesterol, which increases HDL-C and to the antioxidant lutein which modulates certain inflammatory responses.

    (reply)
  50. charles grashow  April 15, 2012

    Dr. Attia

    Which test would you choose

    The NMR test or this test by Shiel Labs

    http://www.shiel.com/PDF/OxLDLTMTBrochure.pdf

    (reply)
    • Peter Attia  April 15, 2012

      Shiel doesn’t do NMR as far as I can tell. No brainer.

  51. charles grashow  April 15, 2012

    Shiel does the NMR a/o 3/12 – so they do both – I take it you recommend the NMR whether Shiel of Labcorp?

    (reply)
    • Peter Attia  April 15, 2012

      Technically the only company that actually DOES NMR is Liposcience. Everyone else contracts with them. If you’re asking me who does the best set of other tests, in addition to NMR, I’d say Health Diagnostics Laboratory, Inc. (HDL, Inc.)

  52. charles grashow  April 15, 2012

    Is the NMR test done thru Lab Corp acceptable? My insurance would cover it.

    (reply)
    • Peter Attia  April 15, 2012

      Any NMR is done through Liposcience.

    • maryann  April 16, 2012

      The Labcorp test “NMR LipoProfile” has a registered trademark; perhaps this means they contract to Liposcience like Shiel does.

  53. charles grashow  April 15, 2012

    Liposcience also recommends this diet

    http://www.liposcience.com/userfiles/content/files/healthyliving.pdf

    Limit your intake of red meat, eat fish at least once a week (avoid fish that’s fried or served with heavy sauces or butter), and eat lean skinless chicken and turkey

    Bad Fats
    Saturated fats:
    Palm oil, palm kernel oil, coconut oil. Also fatty beef, lamb, pork, poultry with skin, lard & cream, butter, cheese, and dairy made from non-reduced fat milk. Many baked goods and fried foods.

    Good Fats
    Monounsaturated fats:
    Olive oil, canola oil, peanuts (natural peanut butter), avocados, seeds (sunflower and sesame).
    Polyunsaturated fats:
    Soybean oil, corn oil, safflower oil. Includes essential fats like Omega-3 and Omega-6 which comes from fish like salmon, mackerel, herring, and trout. This essential fat can also be found in walnuts, sunflower seeds, and supplements.

    Not so good

    (reply)
    • Peter Attia  April 15, 2012

      Liposcience does NMR, not nutrition.

  54. Ken  April 15, 2012

    I want to share another “praise the lard” story. My background is I’m a 6′, 185lb, 50 year old male. I’m fairly athletic–relatively lean and muscular, a runner, and lift weights. I’m also an insulin sensitive diabetic. I still have a descent 2nd phase insulin response, but my 1st phase is severely diminished. It doesn’t take a whole lot of carbs to send my postprandial readings up over 200 mg/dl.

    After reading Bernstein a couple years ago, I adopted a low carb diet. Initially not as low as what he advocates, but like a lot of us low carbers discover, the lower we get, the more stabile the blood sugar and less insulin needed. Over a period of time, I ended up with a VLC diet, but never consciously added any fat. I’m one of us in which the low fat mantra is very ingrained. My diet has been exclusively meat, cheese, eggs, and nuts, with my meat choices kept on the lean side.

    Over the past several months, I’ve realized I have symptoms similar to hypothyroidism, which happens to run in the family genes. I’ve resorted to always wearing a sweatshirt or sweater, and seem to be relatively tired and lethargic. Even family members have noticed and have urged me to get a thyroid test.

    Several weeks ago, I discovered this website through a reference over on the diabetes daily board. I was instantly fascinated, and managed to devour both Taubes’ books, along with Phinney and Volek, in fairly short order. I got out my food scale that I hadn’t used in over a year, and starting monitoring what I was eating. I was astounded to realize that a full half of my calorie consumption is protein, and that my total caloric intake had dropped off significantly.

    For the past couple weeks, I’ve been adding the fat. Wow, just wow! The sweatshirts are back in the closet. The constant stomach growling has subsided. I have more energy, more desire to run and workout, and just feel better and more clear headed. I wonder if I haven’t been living in that “zone of misery”. I suspect I’ve been maybe touching ketosis at times, but certainly never sustaining it with the amount of protein I’ve been consuming.

    Those berry fat shakes are wonderful! My next step is to get an ice cream maker.

    Many thanks to you and this website Peter.

    (reply)
    • Peter Attia  April 16, 2012

      Ken, this is an excellent story. Thanks so much for sharing it will us. Did you every have laboratory documented low T3 and elevated TSH? If so, I’d like to see them now if you’re feeling better.

    • Ken  April 16, 2012

      Unfortunately not Peter. It would be interesting to know if the thyroid was involved at all. I actually had a visit with my Dr. a few weeks back, and he was having me come back in for a fasting blood draw to do some testing that would include the thyroid tests. I didn’t get around to it, then discovered what my diet was doing, and decided to wait. I’ve pondered dropping the fat again for awhile and then testing, just for curiosity sake. Now that I highly suspect what my problem has been and know the solution for it, it might not be easy to get back there.

  55. GT  April 15, 2012

    I have been a fan of both you and Gary Taubes and want to thank you for not only taking the time to write these posts, but also the time to personally respond to follow up questions. I always find the information extremely helpful and easy to understand, but I always seem to come back to one question and I will use something you wrote about your wife and her grandmother as an example.

    You mention they are fortunate to have genes that allow them to consume large amounts of both refined and complex carbohydrates without having a noticeable effect on how insulin production affects their weight and health. I know each person has to find the correct balance for themselves so here is the general question. If a person can tolerate a large carbohydrate intake like your family members, would they still be able to significantly reduce their risk of metabolic syndrome by reducing that intake, or does the fact that they stay slim and healthy mean they don’t need to be concerned about it unless they do start to see an increase in their weight? In other words, is it a good idea to keep carbohydrates at a minimum even if you can tolerate them for the trade off of a lower risk of metabolic syndrome?

    (reply)
    • Peter Attia  April 16, 2012

      Great question. Even if someone can tolerate lots of carbs from a fat accumulation and IR perspective, they will still reduce other risks for diseases by reducing the worst offenders in their diet. It might not be as dramatic as it is for those of us who are more IR, but every bit matters. Think of it this way: many smokers don’t die of lung cancer, but quitting smoking still reduces their odds.

  56. D  April 16, 2012

    Wow, they got almost everything backwards except for the MUFA’s and omega 3’s.

    (reply)
  57. Rosalee  April 16, 2012

    To Penny:

    Bouillon is simply chicken broth.

    (reply)
  58. Jeff Johnson  April 16, 2012

    Hi Peter – Jeff would like to comment – so forth with

    Jeff’s Operating System and Browser is too old to make a post on Jimmy’s Moore’s blog – so I’ll do it here – hopefully

    Jimmy’s current weight is 304 – from a low of 215 in 2006 and general baseline of 240 or so

    His average calorie intake is 2800 calories – 2000 of which is fat and 50 grams carbs

    He asked on his blog – somewhat as an aside – if someone could explain the mystery of why? his weight kept creeping up – even as he exhorts he is eating very clean and low carb

    Mystery Explained: eating that much Fat/calories requires eating far fewer than 50 grams carbs per day just to maintain a stable weight

    How to fix him: Day’s he eats high fat/calories should include very very low carbs – this will stablize his weight on those day’s

    Day’s he wants more veggies and carbs(50 grams) – he has to reduce the amount of fat(400-600 calories max) and limit protein to 180 grams or so to eliminate further glucose production (carbs)

    Day’s he wants to lose weight: Calories – around 2000 and 1200 to 1500 if? he ever gets down to below 200 pounds

    Two methods – both low carb

    1. High fat/Protein controlled(180 grams Max) and very low carbs – either protein or fat or both have to be calorie controlled here to get calories low enough

    2. Much lower fat(400 calories max)/protein controlled(180 grams or less) and carbs still below 50 grams – this diet would be 1700 calories at max

    Since Jimmy love’s his 50 grams of veggies and love’s high fat – the only path before
    him is to clearly understand the relationship between fat and carbs – the more fat/calories you you eat the lower carbs need to be – and vice versa – the more carbs eaten(even if only 50 grams) – the lower the fat needs to be

    Mother nature does not have in it for Jimmy Moore – its the very simple dynamic that exists between carbs and fats

    One caveat: To help reduce carb absorption –

    One level teaspoon of a mixture of Dry beans/lentil/peas – wheat/barley – rice/millet – this mixture must be perfectly dry when eaten

    Back problems: this same mixture at one teaspoon will if soaked(fermented) have a totally different effect in helping with the Vitamin K utilization and production and therefore Calcium function –

    Will this fix Jimmy Moore? – probably not – he dislikes me one thing and I do not have three P.H.D’s trailing my name for another

    In Summary: there is no mystery – only what appears to be a befuddled understanding of the Carb/Calorie/Fat and Protein Dynamic(glucose production above 180 grams or so) and there intertwined relationship and dependence on one another

    (reply)
    • Paul  April 16, 2012

      Jeff,
      Where did you get the 180 gr of protein max figure from?
      Paul

    • KevinF  April 16, 2012

      I don’t know why we’re talking about Jimmy Moore. However, I’d say 2800 cals sounds like a lot of energy intake to me. I’m no featherweight myself — 220 lbs and still considerably overweight — and I’ve never approached even 2500 cals while low-carbing. I seldom exceed 2000, and I’ve been averaging about 1600 … while losing on avg. 1.5 lbs a week (and with no hunger pangs and cravings of course). Even during weight gaining periods of my life I doubt I ate anything like 2800 cals more than once or twice a month. I also seldom-to-never approach 180 grams of protein. Not even sure how I’d do that.

  59. Kathy  April 16, 2012

    Okay, I normally avoid the “sue to make things right” line of thinking – I don’t like what I see as the “litigation happy” nature in our society. That doesn’t mean, however, that litigation is never appropriate.

    It seems to me, that much like the class action suit against the tobacco industry in the 90’s, the very bad line on dietary advice being put forth by the federal government and the medical “industry” should be challenged. They do not have the science to back up what they claim, while there is a good deal of evidence on the side of low-carb to call into serious question the advice to eat low-fat high-carb.
    The number of people, now world-wide, who are suffering and dying because they are doing exactly what they are told to do for health is mind-boggling. Shouldn’t this be challenged in a primary and very public fashion? There does not need to be a claim that “low-carb is the way,” in order to do this. Has there been any thought about something like this among people like you, Peter, Gary Taubes and others?

    (reply)
    • Peter Attia  April 16, 2012

      A lot of people are talking about this. Not sure the legal case can be made yet, but it’s getting close. The legal question is this: Is there sufficient evidence to suggest that what we are being told to eat is harmful?

  60. maryann  April 16, 2012

    Hi Doctor Peter,

    I checked the Health Diagnostics Lab website, and I can’t believe how elaborate the prepararion and shipping of samples is (inverting, allowing to clot, centrifuge). It doesn’t seem possible that my doctor’s office would take the time to do this. Would that make the results unreliable (if they merely refrigerated the sample and did none of these other things)?

    Shiel offers 2 NMR tests contracted to Liposcience, one with lipids and one without (they are listed as recently added on their test menu page). Which one is better, how long is fasting, and is it worth doing if the doctor’s office doesn’t handle the specimen as described in the HDL website?

    Thank you very much, Maryann

    (reply)
    • Peter Attia  April 16, 2012

      I have all the stuff at my house, so I do this for my clients. For people not in San Diego, I recommend working with your doctor to arrange for you to have a blood draw at a local lab. It’s very easy and the prep is completely standard for all blood work. It’s worth doing it right to get all of the information. You must spin the sample to get insulin levels, also.

  61. sugaraholics.com  April 16, 2012

    I’m glad to read you say that insulin resistance can be fixed, for I had gotten the idea one was stuck with it even when weight and other factors normalized.

    Age is also such an important factor, as mentioned; I was skinny in youth, lean adult, got heavy in perimenopause–a pattern I’ve seen dozens of times in friends. I used to hear from my mother’s generations that being lean, sleeping well, etc, would all change with age for women, and they were right for the most part. Clearly the cumulative effects of too much carbs/insulin.

    (reply)
    • Peter Attia  April 16, 2012

      It can definitely be reduced in EVERYONE and even fixed in MOST people. For some it’s more difficult than others, to be sure. Many factors involved, of course (age, gender, genetics, history of attempts).

  62. David Nelsen  April 16, 2012

    Peter, a few questions:
    1. At my current weight I should have about 150 gm of protein per day. Does this need to be evenly distributed throughout the day? I if save up most of it for an evening steak, will the load on my liver be too much?

    2. I know we want to get complex green vegetable carbs – but if I keep my carbs under 40 gm/day does it matter if some of them are sugars? My main treat is Cool Whip which is about half fat & half sugar. I could never get your ice cream recipe to come out the way I wanted.

    3. I use sugar free Metamucil for waste plumbing issues. It’s all fiber and or some artificial sweetener. Can my dose of fiber kick me out of ketosis? Dose size is about 20 gr give or take. It tastes sweet, but has no net carbs or added sugars.

    Thanks,

    Dave

    P.S. When I first read the title of your post I thought it read “Gravy and Insulin” and thought to myself – this is going to be a good one!

    (reply)
    • Peter Attia  April 16, 2012

      David, I’ll try to address this sort of question in subsequent posts dedicated to troubleshooting ketosis.

  63. Mark Jacobs  April 16, 2012

    Really enjoyed this post! Thank you for your efforts and all the time it takes for research.

    This blog has been one of the most informative and useful for me during my low carb way of eating. I started March 10 and have lost 20 pounds to date (April 16) and feel bette than I have in years.

    Thank you again, keep them coming.

    (reply)
    • Peter Attia  April 16, 2012

      Congrats. Keep up the great work.

    • Debbie  April 17, 2012

      Thanks. I’m taking a high quality CAL/MAG supplement daily. My neightbor just told me to eat a banana – and he is open to low-carb/high fat – but only to a point. It seems the issue for many people, me included, is whether or not to completely eliminate carbs. I’m going to try upping the salt and fat even more. If anyone – especially women – perhaps women over 50 – can share with me what works for them, in terms of diet, and fatigue issues, I’d really appreciate it. I’m committed to this diet, since as someone who gains weight very quickly, with a lifetime history of obesity and eating disorderds, although at a normal weight these past 20 or so years, I am definitely very IR. But I want to feel a lot better than I do. Thanks.

    • Katie  April 17, 2012

      20 pounds in one month is astonishing. Congratulations!

  64. Debbie  April 16, 2012

    I didn’t realize muscle cramping was a possible salt deficiency symptom. I’ve been drinking my two cups of bouillon per day, except on weekends switch to a vegetable juice that contains salt. I woke up last night with a wicked leg cramp. Up the salt? I’m concerned about having too much salt – should that be any concern at all? Thank you!

    (reply)
    • Peter Attia  April 16, 2012

      Low salt, leads to high aldosterone, leads to kidneys kicking out potassium to save salt, leads to feeling horrible and cramping.

    • Debbie  April 17, 2012

      Should one supplement potassium as well? Would sufficient amounts be in a high-quality multi? Thanks again.

    • Peter Attia  April 17, 2012

      Most people don’t need it if they get enough sodium and magnesium.

  65. Joshua Wardrop  April 16, 2012

    Hi Dr Attia, love the post. I know this is a tad off topic, but I wanted to mention something I’ve noticed since pushing for nutritional ketosis:

    My entire life, I’ve consumed gobs of caffeine and energy drinks, making me generally resistant to their effects. I drink triple serving energy drinks or a 200mg tablet of caffeine if I want the nice energy buzz.

    After gradually cleaning up my diet, my sensitivity to these effects has increased dramatically. Now, I hardly need a single serving of energy drink to get an energy boost BETTER than I’m used to, and if I take a 200mg capsule of caffeine it feels like ‘too much’. In general, this is WONDERFUL imo, since I need a lot less to get the results I’m looking for, it saves money, and I have less worries of approaching any form of withdrawal or side effects from their usage.

    Do you think insulin resistance was contributing to dilute the chemical response? Is it a related side effect? Note: Even though I have lost weight in raw pounds, I’d been far thinner and more active than I am now in the past, without this being true, so it isn’t weight related per say.

    (reply)
    • Peter Attia  April 16, 2012

      It’s possibly related to IR, but it might also be that you’re consuming fewer of them? Or both? My mental energy levels are much higher, though I don’t think I get a particularly huge kick from caffeine (though I never have).

  66. Helga  April 16, 2012

    I’d love to hear of your progress with the Nutrition Science Institute. Will it be in conjunction with a university? Completely independent?

    (reply)
    • Peter Attia  April 17, 2012

      I’ll let everyone know as we get ready to launch. Stay tuned.

    • Helga  April 17, 2012

      If you need someone with a background in biochemistry, statistical analysis, and fund raising, you know how to contact me.

    • Peter Attia  April 17, 2012

      Thank you!

  67. lorraine  April 17, 2012

    I just caught PBS’s America Revealed first episode, “Food Machine”. It’s remarkably well done, and of interest to anyone who cares about nutrition and the impact of our industrial food production on health and the environment. It can be viewed online at PBS here. I really recommend it

    http://www.pbs.org/america-revealed/episode/1/

    (reply)
  68. Tangie Solow  April 17, 2012

    What do you think of the connection between a ketogenic diet and the production of kidney stones? I’ve read that there is quite an increase statistically in kidney stones in children put on a ketogenic diet to reduce seizures. I don’t know if this is also true for adults.

    I’m new at this, but so far I love eating high fat, moderate protein, very low carb. I have issues with frequent migraines and have been “pre-diabetic” and always hungry for years. I did Paleo for about 8 months, but was still always hungry and my glucose numbers were still too high. Adding more fat and reducing carbs to a minimum seems to be working really well. For the first time in memory I’m not hungry! It’s still too soon to know how it will affect the migraine situation.

    I would love to find a physician or nutritionist to support me. I am doing this ketogenic journey on my own, with constant reading and listening to podcasts about low carb living. I have googled every which way to find a local MD or nutritionist who specializes in or at least would be supportive of this way of eating, and haven’t come up with anyone. Is there a trick or a code word to use to find someone? My regular docs are mildly interested when I tell them what I am doing, but they are definitely not into the low carb world.
    i live in Santa Cruz, just in case you know or have heard of anyone near who might be a resource for me.
    I enjoy following your blog and appreciate very much the work you are doing and your generosity in sharing it. Thank you.

    (reply)
    • Peter Attia  April 17, 2012

      It can happen in people who are predisposed to developing stones, especially if they fail to supplement with sufficient potassium and don’t consume enough water. In other words, if you’ve ever had a stone in the past, make sure you do these things. I wish I knew where all the good doctors were. Best thing I can recommend is being really open with your doctor and finding out if they are wiling to support you. If not, it’s probably worth looking for a new doctor.

    • maryann  April 17, 2012

      Hi Tangie, try looking on lowcarbdoctors.blogspot.com (a link on Jimmy Moore’s website). Hope this helps! Maryann

  69. Claudia  April 17, 2012

    Was wondering if there would be any benefit trying to get a higher ketone score. I remember you said it’s binary-in or out. But is a 3.0 mmol/L better than a 1.0? Is it diet,individual differences?

    (reply)
    • Peter Attia  April 17, 2012

      You’re right, it’s binary in terms of metabolic preference. In both cases you describe the liver is making ketones to feed the brain and muscles (versus, say, 0.2 mM), but in the second case you have more fat being converted to B-OHB and more B-OHB available for energy.

  70. Claudia  April 17, 2012

    Thanks, very interesting. I didn’t understand that before. BTW, just FYI, after adding even more fat, I’m losing a few centimeters around my mid-section though still not losing grams on the scale. I’m a constant mM 3.1 and in menopause, if this helps anyone. Thanks so much for all you’re doing.

    (reply)
  71. count bitcoin  April 17, 2012

    I love you.

    (reply)
    • Peter Attia  April 17, 2012

      I love your slogan: Knowledge is only Cumulative if you bother to Accumulate it. Nice!

    • count bitcoin  April 18, 2012

      Oh, my, gods…. I just realized something that brought on a tsunami of emotions, at the top of the list regret, relief, on a crest of frustration.
      Thanks on the slogan, I’m a writer/app developer and it’s always nice to have the written word appreciated (your writing style is excellent for this material). Back to the revelation that struck my concrete, idiotic, moronic, ignorant skull.
      Your profession of the misery you went through due to sodium deficiency has finally sunk in as it applies to me (I think it was the “looking at carbs makes me fat” comment that made me realize we share a similar IR profile and willingness to self experiment).
      I read Good Calories Bad Calories a few times, back when it was new, on an obscure recommendation from Nassim Taleb. The book’s worn down binding is resting on a shelf a few feet from my chair here.
      I’m guessing I can plot a graph of the last, I don’t know, five years, where I had these attacks of nausea, where each attack lined up with my entering ketosis. Let me go back a bit. I got fat in my mid 20’s and GCBC dropped me back to normal in no time.. But these attacks, and this general feeling of malaise all this time… IT WAS THE SODIUM???!!!! AHHHHHHH!!!!
      OK, I’ll be over this tomorrow, but I’m still annoyed at this second. So I just had it click tonight that, wait a minute, maybe I’m not just a “low energy person”. I bought the bullion and drank some a couple hours ago and I’m already feeling intensely better. Arrrgh…
      Thanks Peter. I really hope you know how silly and grateful you have made me feel, thanks to your self experimentation and altruistic sharing on these internets.
      OK, I’ve calmed a bit. Always look on the bright side of life, right doc?

  72. Katie  April 17, 2012

    Dear Peter,

    I found your absolutely incredible blog today and can barely stay off of it to study. I am a dental student in a very medically-based curriculum, so aside from biochemistry and anatomy, I am also exposed to overall health and fitness recommendations and advice.

    Trying to keep my family healthy is infinitely harder than staying healthy myself. Fortunately, my very athletic little brother dropped pounds on a low carb diet, so he didn’t need much convincing. My overweight, pre-diabetic parents with blood pressure problems and hypertension (among other health problems) are steadfastly in the low-fat, high-carb camp. I have recently provided blog links and short-n-sweet descriptions of insulin actions on glucose and fat metabolism, but sometimes I feel that it’s going in one ear and out the other.

    Do you have any recommendations for how to encourage and educate close family and friends without going overboard and risking them shutting you out?

    Thank you so much and you are an inspiration. Maybe someday I’ll do a tire lift.

    (reply)
    • Peter Attia  April 17, 2012

      It takes time. It’s really hard to overcome a lifetime of misinformation. Imagine the first generation to be told the earth was round? I thinking reading Why We Get Fat is a great place to start, if they are willing to be open.

  73. Michele  April 18, 2012

    http://www.box.com/s/100d8671b8160e03867e

    Hi Katie,…am struggling to do the same with my family. My father already has type II diabetes.

    Above is a link of a short “presentation” I put together for my parents. Although it is not particularly focused on pre-diabetics (rather a full-fledged diabetic like my dad), perhaps you can modify it a tick to speak to your parents.

    Best of luck,
    Michele

    (reply)
    • Travis Koger  April 18, 2012

      Michele,

      Great presentation and thanks for sharing it. My only issue with it is your inverse food pyramid. Personally I would have thought that you should swap around the vegetables and ‘healthy fats’ sections. Seeing that the source is Mark’s Daily Apple, I assume that it is more pushed towards Paleo/Primal rather than HFLC?

    • Michele  April 19, 2012

      Hi Travis…to be quite honest, you are right. I would also switch the healthy fats and vegetables section because the fat is more important.

      I’m currently struggling with getting this info through to my parents in an easily digestible way. This is hard sell but absolutely necessary for my dad’s type II diabetes! If you have improvements or other inputs, I’m all ears!

    • Travis Koger  April 19, 2012

      Michele,

      I am currently working on my parents also. They are starting to take the point, but not because I have provided them with the science from GT or PA, but because they have seen my progress. Unfortunately they also want it the easy way, i.e. where can I buy the meals from etc.

      If they do end up fully on HFLC, I will definitely be talking to them about their motivations and what finally made it click though.

      As for the presentation, I think it is pretty good how it is, bar the one point I made earlier. The problem I see though is that I am not sure people are swayed by presentations unless they are actively seeking out the information. I don’t feel that presentations help to convince people that are already sceptical or firmly in the other camp, purely because they feel they are being sold something. But, that is just my opinion.

    • Katie  April 20, 2012

      Dear Michelle,

      Thank you for the presentation – it looks exactly like the information I’ve been trying to tell my parents, only easier to understand. I hadn’t realize that my dad lacked the fundamental understanding of what “carbs” actually were, until he expressed dismay when I told him he couldn’t eat pasta or bread.

      I wish the best of health for you and your parents!

  74. Paul  April 23, 2012

    Thank you Peter, informative! I like that comparison quite a lot.

    It seems there are distributions within distributions. IOW – there are a fair number of rail thin folks that eat like your wife but still eat themselves into metabolic syndrome and diabetes.

    (reply)
  75. Penny  April 23, 2012

    You said, “Less LPL on muscle cells and more LPL on fat cells as we age” could it be due to the fact that most people lose muscle as they age therefore there is less LPL available. Maybe a combination of less muscle and less LPL? I am a 52 year old female weight lifter and have 12-15% bodyfat. I carry less bodyfat and more muscle mass than when I was younger. No, I don’t take any drugs or hormones. I am doing the same thing you are doing. I use my body as an experiment. Increasing my fat intake (60-80%), the past 2 years has had amazing positive ramifications. The fact that I didn’t experience any side effects from menopause, my period just gradually stopped at age 50, was one nice side effect! I also maintain normal energy levels throughout the day. I don’t get psychotic or ‘the shakes’, if I miss a meal.

    (reply)
    • Peter Attia  April 23, 2012

      It’s certainly possible. Same problem both ways, though I wonder if those effects (i.e., less muscle, more fat) are actually exacerbating the problem that is occurring for a separate reason?

  76. lockdownd  April 23, 2012

    Hi Peter,
    I went to lecturepad.org to learn more about lipids. It sounds like NMR is the gold standard lipid blood test and a VAP panel sounds like it’s one step below. It doesn’t appear you’ve had an NMR blood test – is that due to cost? Availability?
    thx,
    Eric

    (reply)
    • Peter Attia  April 23, 2012

      At the time I started my testing I did not know enough to realize how important NMR was. Of course, now it’s the only thing I do, but for consistency, I needed to stay with the inferior technology.

  77. Ron  January 18, 2013

    How low does my blood sugar have to be to burn fat instead of store it and is lower better? I have only seen one estimate and it was 90. But I would like to know your thoughts on it?
    Thanks

    (reply)
  78. Oliver  June 23, 2013

    Hi Peter,

    Regarding your wife’s ability to eat carbs all day without putting on an ounce of weight, how does her health spec pan out? Does eating in such a way have effects on here health, mood swings, well being? I ask because i’m the same in terms of no effect on weight gain but notice a real shift in health, mood, well-being when on a high carb diet to high fat diet. I actually gain weight by eating less carbs so it seems.

    Be interesting to here your thoughts.

    At this moment in time I tend to think for us ‘hardgainers’ there is an unknown element at play here and i wish i new what it was. Never seen a good answer for why some people can eat carbs all day without gaining any weight if this whole insulin thing is so true. Hopefully one day some of the focus from easy gainers will come over to hard gainers.

    (reply)
    • Peter Attia  June 24, 2013

      It does have some impact on her biomarkers (e.g., LDL-P, TG, HDL-C), but she really seems pretty immune to even very high amounts of CHO.

  79. Carlos  August 12, 2013

    ‘It is true that protein stimulates insulin, but NOWHERE near to the same extent as carbohydrates. ‘

    The data out there would like to disagree.
    Especially protein shakes. They blast my body with insulin.

    you can release more insulin from eating Cottage cheese than eating a bit of dextrose..

    (reply)
    • Peter Attia  August 12, 2013

      But the amount of protein you’re consuming is less in total substrate load than, say, a carb-filled shake. Also, the preferential metabolic path for that hydrolyzed whey protein shake is amino acid reconstitution first, then gluconeogensis second. But yes, overfeeding with protein (see JAMA 2012, Smith and Bray) will result in fat gain. Not sure about your claim of cottage cheese vs. dextrose, gram for gram, which is always the way to do a comparison like this.

  80. Jeff Johnson  August 13, 2013

    ………………..
    ………………..
    …………….

    CONCLUSIONS: Among persons living in a controlled setting, calories alone account for the increase in fat; protein affected energy expenditure and storage of lean body mass, but not body fat storage

    http://www.ncbi.nlm.nih.gov/pubmed/22215165

    (reply)
  81. Norm  August 13, 2013

    Hi Peter,
    I was wondering if there was a way to find out (of course won’t be precise) about IR by monitoring glucose levels in blood?

    I’m taking around 6 grams of salt a day most of which by diluting in water, would it be better to take sodium supplement instead?
    If I’m taking enough sodium, do I still need to supplement megnesium?

    Many Thanks

    (reply)
    • Peter Attia  August 13, 2013

      Following glucose levels is undoubtedly the least accurate way to track IR. Fasting insulin is better, and even TG to HDL-C ratio.

  82. Babs  September 9, 2013

    Hi Peter,
    Love your blog and the depth of information. Have been devouring it for weeks now! I’m committed to doing what I can to become more insulin sensitive. A few questions that keep hanging around for me (hopefully not stupid questions!) — 1) I understand that the only way to truly measure insulin is with a fasting insulin test, and I understand that a high blood glucose level suggests the pancreas is pumping out increased insulin to bring it back down, but is it also then reasonable to assume that a low blood glucose level implies a low insulin level? 2) I recently had my fasting insulin and glucose levels tested. I see there is a “HOMA-IR calculator” available on the web. Would inputting my numbers in this give an accurate result? (when I input my numbers the result was 3.21!)

    (reply)
    • Peter Attia  September 9, 2013

      Yes, provided you’re using the correct units. HOMA-IR is a quick, but not remarkably accurate, way to test IR. OGTT is better.

  83. charl  January 30, 2014

    Hi Peter, thoroughly enjoyed the Gravity revision. I really expected some conclusion about the speed at which fat moves in gravity vs muscle, but I think i know the answer to that. But anyways, I also have a question about blood glucose levels when in ketosis after exercise and after meals. I don’t have a ketone monitor but I can measure glucose.

    Typical suggested levels of blood glucose for diabetes patients is between 7.7 and 4.5mmol/L. The low range of blood glucose is from 4.4 to less than 2.8mmol/M.

    Have your experiments provided some baseline data on your blood glucose levels while in ketosis.

    Is there a blood glucose level mmol/M at which ketosis is interrupted?
    thanks for a great resource

    (reply)
    • Peter Attia  January 30, 2014

      Addressed in detail in other posts.

  84. Norm  February 11, 2014

    Hi Peter,
    I was wondering if you could please comment on higher than expected HbA1c (5.5-5.9) among low carb/ketotic people. Is there a discordance that exists in this regard; less glucose leads to longer life span of red blood cells, hence higher HbA1c?

    (reply)
    • Peter Attia  February 11, 2014

      Not sure this is really documented or anecdotal.

  85. Vicente  July 13, 2014

    Hi Peter,
    in the following study (table 4)
    http://ajcn.nutrition.org/content/66/5/1264.full.pdf
    they say that eggs, cheese and beef make our body release more insulin than pasta (for the same grams of food). Am I mistaken?

    I am sorry to bother you, but if that is true, shouldn’t it be advisable to eat pasta instead of beef, cheese or eggs? It is a honest question. I don’t get it. I don’t eat wheat and that is not going to change, but I would like to understand the data on that study.

    (reply)
    • Peter Attia  July 14, 2014

      You’re misinterpreting the table.

    • Vicente  July 14, 2014

      Hi Peter,
      thank you for your answer.

      I believe the authors of the study also do that interpretation:
      “However, some protein and fat-rich foods (eggs, beef, fish, lentils, cheese, cake, and doughnuts) induced as much insulin secretion as did some carbohydrate-rich foods (eg, beef was equal to brown rice and fish was equal to grain bread).” (pages 1273-4)

      I did a google search looking for opinions on that study and I found Mark Sisson’s talking about the glucagon release compensating for the insulin release in high-protein foods:
      “For people without diabetes, the insulin and glucagon responses mitigate each other, and we’re looking at a healthy picture.”
      http://www.marksdailyapple.com/insulin-index/#axzz37RETKYCM

      Gary Taubes also talks about glucagon when asked the same question:
      “Glucagon works opposite insulin on the fat tissue itself and so would be expected to mute or counteract entirely any fat accumulation stimulated by the insulin”. He also says that indeed lean meat can have that effect and it is advisable to eat meat with a high fat percentage. Moreover, instead of using only the AUC values he suggests the effect of that insulin release “is muted because it takes considerably longer to digest protein from meat”. I couldn’t find any graph showing the curve of serum insulin for meat compared with a high-carb food.
      http://www.healthcentral.com/diabetes/c/36758/20088/gary-round-3

      Three more comments:
      1) I haven’t found another study corroborating/updating/expanding the insulin release data. Weird…
      2) I suppose when you are keto-adapted the results are completely different. That would be interesting to see.
      3) Are 120 min response curves too short? Would we see something different in longer experiments?

      Thanks again for your time!

  86. larry  July 15, 2014

    Peter,although Vincente seems satisfied with your answer and his followup research re the ajcn article table concerning the insulinogenic effect of various foods, I’m still confused. I interpreted it the same way Vincente originally did. And I have seen other articles speaking to the significant insulinogenic effect of protein such as whey and beef. If proteins and many other non carbohydrate rich foods trigger significant insulin release and, therefore, at least temporarily halt fat burning, don’t they have essentially the same effect as some higher glycemic foods?

    I know you have noted the substrates have different fates. But if de novo lipogenesis is minimal unless carb loads are extreme, it would seem that as far as fat loss/gain the most significant effect of raised insulin is the duration of the elevation and the halt to fat burning, So wouldn’t we would want to watch the timing and mix of consumption of any highly insulinogenic foods ?
    Maybe you can’t respond to this in a comment but it seems to deserve more discussion. thanks

    (reply)
    • Peter Attia  July 15, 2014

      I believe Vincente was responding to the column that noted the insulin response per g of CHO, which will certainly be higher in the protein meals. I’m looking at the AUC columns. Also, this is for a fixed kcal dose of each food, so it’s a bit misleading, since most people eat more of the energy from CHO than from protein and fat combined.
      I’m not saying protein doesn’t stimulate insulin, I’m saying this table is easy to misunderstand, glucagon notwithstanding.

    • Vicente  July 15, 2014

      Hi Peter and larry,
      the data that surprised me is from the third column (starting from the right side) of table 4:

      “Insulin AUC per g serving weight:”
      — White pasta: 22
      — Beef: 50

      Almost everybody says protein is less insulinogenic than carbs and that column came as a surprise to me. Surprising but I suppose not that important because I don’t think the absolute amount of protein in the diet is a variable I want to play with. The question for me is “more fat and less carbs or more carbs and less fat?” If protein is making the body release insulin, it doesn’t matter because I don’t want to eat less (nor more) of it. I don’t even think glucagon’s role is important for the same reason.

      Table 4 from the study doesn’t kill the insulin hypothesis, as long as low-carb diets do reduce the overall insulin release (see figure 1A from http://ajcn.nutrition.org/content/91/3/578.full.pdf+html).

      From the same figure 1A, I am not sure 120 min is enough to compute the insulin AUC. Some insulin release curves seem to reach as far as 4h.

      And I insist, may be we need a “table 4″ for keto-adapted people.

  87. Norm  July 16, 2014

    Hi Vicente,

    Todd Becker has discussed protein-insulin issue at length here:

    http://livinlavidalowcarb.com/blog/does-insulin-deserve-a-bad-reputation-the-low-carb-experts-weigh-in/9458

    (reply)
    • Vicente  July 17, 2014

      Thanks Norm,
      it is a really interesting link.

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