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My pet peeve

My pet peeve
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A few months ago someone forwarded me a clip from The Dr. Oz Show where Dr. Oz and Gary Taubes were having a discussion about the merits of carbohydrate restriction.   You can read about it here.

Yes, I get it — much of this sort of TV stuff is for entertainment purposes.  The problem, however, is that folks like us watch these shows and can’t help but be “influenced” by the banter and bravado.   So, let me use this post to clarify two points and highlight one of my pet peeves.

Before I launch into it let me say, for the record, I do not personally know Mehmet Oz.  I know people who do know him well, and have only heard great things about how good a doctor he is and how he provides exceptional care to the patients he still manages to see on his very busy schedule.  I really believe he’s a “good guy” and he wants to help as many people as possible.  I believe he wants to make a very positive difference in the lives of everyone he interacts with.  But that doesn’t mean he’s always right.

POINT #1: In the exchange with Gary, Dr. Oz commented that he had tried a low carb diet once, but after a day (yes, after one day) he immediately abandoned it because he felt so horrible.  He complained of feeling sluggish, constipated, nauseated, irritable, and even complained that his breath turned stale.  I would have to concur that this is not a desirable state to be in.  More broadly, of course, I hear this sort of logic all the time.  I always hear a variation of this.  Sometimes it’s one day, sometimes it’s one week.  Sometimes it’s even one month.  If you’ve been reading this blog for a while you’ll probably be familiar with the idea that reducing carbs without making a few tweaks does feel bad.  If you fail to supplement sodium or fail to consume enough fat, you will feel bad no matter what.  But let’s put that aside for a moment and focus on this more general complaint of, “I tried going low carb for a week but, man, I felt horrible – ergo, carb restriction is bad for you!

I was trying to think of an analogy to explain why this is a very illogical reason for deeming a dietary paradigm “bad.”  Then it hit me!  As some of you know I’m a bit of a “freak” when it comes to exercise, and I don’t really do things in moderation.  [In fact, a year ago I ordered a few t-shirts that said: “MODERATION: The only thing worth doing in moderation” after a friend I swim with commented that moderation is, in fact, the only thing I do in moderation.]

My activities are swimming, cycling, and resistance training (which I always refer to as dry-land training to distinguish it from in-pool training).  I outsource the design of my dry-land training to my trainer, Pat Jak, because I trust him and we are philosophically aligned.  And, frankly, despite all I know about training, Pat knows more.  Every month Pat dreams up a new way to increase the stress I put on my body in an effort to better prepare me for my athletic goals.  There are countless examples of this, but one that really stands out is the first time Pat introduced me to tire flipping.  We went out to the parking lot and there stood (actually, it was lying on its side) a 450 pound tractor tire.  Pat explained that I was going to flip it 6 times down the parking lot, turn around and do it again.  Then do the whole thing again.  24 flips in total.  I had seen NFL linemen doing this, but it never occurred to me that a little wannabe swimmer/cyclist like me should, or could, do this.

Let me be clear, I was very well-prepared to do this. Pat had spent almost a year readily improving my technique and strength in squats and deadlifts to the point where I could deadlift and squat a bar carrying 185 pounds (more than my bodyweight) for 35 and 40 reps, respectively.  But still?

I wish I had a video of what I looked like that first day.  My heart rate came within about 95-96% of my maximum capacity.  I was suffering beyond words.  Every single muscle in my seemingly well-prepared body hurt, not just the next day but for the next week.  My forearms hurt so much I couldn’t carry a 10 pound bag or hold the steering wheel of my car with any force.  My sternum was black and blue and tender to the touch for 2 weeks (which wasn’t helped by repeating the set a week later).  My glutes and erector spinae muscles ached like they’d never ached before.   My wife kept asking me if I had actually paid to endure this.  Had you asked me the next day (or the next week) if tire-flipping “felt good” my response would have made Dr. Oz’s response look tame.  I barely knew my name.

The same thing happened the first time Pat introduced me to jumping pull-ups (doing a pull-up with so much force that you jump off the bar on the way up and catch it on the way down).  And my first time doing Tabata where I had to deadlift a hex bar carrying 185 pounds as many times as I could in 20 seconds, rest 10 seconds, and repeat seven more times.   I could go on and on with examples like this, thanks to Pat’s perverse creativity.

During some of these exercises I would vomit.  I would pass out after a set.  I would drop the weights and collapse.  Before I can get to another performance level, I suffer beyond words.  It’s true in the pool and on the bike, also.  Every time I introduce a profound shock to my system, I disrupt my body, take a few steps backwards (e.g., experience pain and performance loss), and only then do I move forward.   And this has been true going back to when I was a 13-year-old and started training with this sort of intensity.

I’m not alone, of course.  In fact, I would be willing to bet that there is not one of you reading this blog right now who hasn’t done the same thing in your own life.  You just might not realize it. Sure, you’re probably not a tire flipper, a pull-up jumper, or a Tabata lover. But I bet you’ve struggled really hard to overcome something, and during that struggle you’ve really hurt – physically, mentally, or emotionally.  Maybe it was learning to play the piano?  Maybe it was learning a new language?  Maybe it was learning to paint?  Studying for an entrance exam? Working 3 jobs to make rent?  Being a good parent?

What if we had never been willing to go through that uncomfortable barrier?  Where would we be today?  I’d still be doing mickey-mouse exercises that made me comfortable, but prevented progress.  You might still be in that same unsatisfying job because it gave you a predictable paycheck, despite not challenging you.  Your kids might be spoiled because you didn’t discipline them, as it was just easier to let bad behavior slide.  You’d have never met your spouse because you lacked the courage to face rejection.

There is a pervasive and tragic myth in our society.  The first part of this myth appears to be that things should be easy and require little effort at all times.  But the real subtle negative effect of this myth is reflected in our behavior when we often avoid up-front (brief) pain in exchange for long-term (protracted) discomfort.  Why not the reverse?  Why not go through the pain barrier up front and experience the joy and growth later?

Think of most “diets” – you starve yourself, count your calories, and lose weight.  Great, right?  Sure it works up front, and the pain of starvation is actually blunted by the euphoria of weight loss.  But what happens when the long-term discomfort of starvation becomes too much?  You binge.  Then binge again.  And eventually you’re back at the same weight, if not more, than when you started.  And you’re discouraged.  That’s actually the real pain.

One reason, beyond the science supporting it, that I find carbohydrate restriction so gratifying is that it gets easier every day.  At some point I will write about how much I struggled, especially at transition points (e.g., going from “normal” eating to eliminating sugar, or going from non-ketotic low-carb to complete nutritional ketosis), but once I crossed the barrier it got so much easier.  Today I walk around in a state of complete oblivion to the foods I know are bad for me.

People often ask me how long I plan to stay in ketosis.  The answer is, I don’t really know.  It started as a 12 week experiment (which I would have abandoned 3 weeks in, had I not committed to doing the 12 week experiment, given how bad it was going initially).  But 8 months later, with all of those horrible struggles and hard lessons behind me, it’s so much easier and the rewards far outweigh the inconvenience of not eating candy bars and pizza.

I hope you all realize by now that I am decidedly NOT suggesting that everyone become ketotic.  We all have a different genetic makeup and different goals that should be used to shape and guide our eating habits. But all of us must make a choice to move from our comfort zone of what we eat to some place better, if we want to grow (by “grow,” of course, I don’t mean in girth, but rather in “personal evolution”, for lack of a better term).

POINT #2: The notion that you can’t do high-intensity exercise without carbohydrates is simply and categorically false.  Everything about this myth is false – the necessity of so-called “carb loading,” the necessity of carbs for glycogen production, the necessity of glucose to feed your brain, the necessity of carbs to “spike” insulin to drive amino acids into muscles.  All of this mythology is just that.  Every study I have seen that draws these conclusions is replete with methodological errors and without exception does not carry out an apples-to-apples comparison. In time, I hope to address all of these points in greater detail for folks who are interested in combining low carb eating with intense athletic performance. But for now I thought I’d demonstrate that you can flip 450 pound tires or do jumping pull-ups without eating carbohydrates.  Furthermore, if you can do these things without carbohydrates in your diet, you can assuredly carry your suitcase through the airport, carry your groceries to your car, pick up your screaming toddler in the mall, or do virtually any other physical challenge you need to.

Will you be able to do these things the week you initiate a change in your diet?  Maybe not.  I sure couldn’t come close to it.  But if I’ve learned one thing in my life thus far it’s that the best things worth having are worth working for (sorry for the bumper sticker slogan – I couldn’t really think of a non-cheesy way to say that).

The great irony of Dr. Oz’s comments is that someone as talented and accomplished as he is absolutely knows the value of hard work, dedication, perseverance, and optimization.  Dr. Oz is a great athlete, a great surgeon, and a great TV personality.  I guarantee you he worked very hard and struggled to get there, just like the rest of us have in getting to where we are.

Lastly, below is a video from my workout with Pat yesterday.  Nothing “special” about this particular workout other than it demonstrates a few sets of tire flips, one-leg prowler pushes, jumping pull-ups, and a number of other exercises we do. Most importantly, however, I hope it provides some real-life proof that even without carbohydrates in my diet I can do all the things you’re not supposed to be able to do without carbs.  Here’s the best part — so can you.

(In order, the exercises below are: 450 pound tire flips, 1-leg prowler push, triple extension, plyo jumps, horizontal jumps, hex-bar deadlift, kettle bell swings, lying pull-up, jumping pull-up, unstable 1-leg push-up.  This was about half of yesterday’s workout — all done with no carbs, but after a period of adaptation.)

LINK to video (if viewing on email): http://youtu.be/EjpxQJ0ykMc?hd=1

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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 Hurley  February 1, 2012

    How about the simple fact that Dr. Oz ought to know that all those symptoms he described are KNOWN symptoms of the initial transition to low carb, and that after transition is complete, they go away. The fact that he complained about the symptoms after one day is dishonest. It would be like saying it’s bad for a heroin addict to quit because detoxification is so unpleasant.

    (reply)
    • Peter Attia  February 1, 2012

      Mike, awesome analogy. I love when I can count on others to think of better examples than I can think of.

    • Gary Castaldo  February 2, 2012

      I agree! I think carbs is a drug.

    • Christopher Grove  June 4, 2014

      I have often referred to things like doughnuts (Canadian spelling for us, Peter) as not food but drugs. Just because doughnuts and pasta are basically made up of a recognized macro-nutrient doesn’t mean they should be eaten. If people choose to eat them (rare for me) that is up to them but they should recognize them for what they are… their drug of choice.

      (How about some “catsup” on them “doughnuts”!?) :-P

    • Peter Attia  June 5, 2014

      Eh?

    • Christoph Dollis  August 31, 2014

      “I think carbs is a drug.”

      Insane.

  2. Michele  February 1, 2012

    I REALLY gained A LOT from this post and send out a heartfelt and sincere thank you.

    I crave the information I find here more than I do carbohydrates :-)))

    (reply)
    • Karsten  January 16, 2013

      great thoughts on this blog, thanks!

      I’m on low carb for quite some time now (approx 2 years, even not in strict ketosis, some cheat days) and love it! My wife a bit less, she complains I smell of acetone, obviously one of the ketone bodies. Is there a way to avoid that smell and yet stay away from the carbs?

  3. Bob  February 1, 2012

    Slacker ;-)

    I’m on day two of Gary taubes/ You(Peter Attia)- inspired carb cutting, feeling headachy. Thanks for the inspiration to keep at it.

    (reply)
    • Peter Attia  February 1, 2012

      Thanks so much, Bob. I’ll work harder next time :)

  4. Scott  February 1, 2012

    Great post. I really resonate with a lot of what you’re saying. I’m interested in hearing your opinion on the role carbs play with regard to growth. I know from my own experiences that if I want to add any substantial amount of weight I will increase my carb intake, but I’m wondering if you’ve found that simply upping calories is sufficient.

    On an unrelated note, I’d love to see a post on artificial sweeteners. I recently kicked my long standing addiction to them and I’m casually tracking the metabolic changes I have been noticing.

    (reply)
    • Peter Attia  February 1, 2012

      Scott, I’ll be posting on “artificial” sweeteners in a week or two, so please stay tuned. As far as your first question, I guess it depends on what type of growth your asking about. If you’re talking about the addition of lean tissue, I’d focus more on muscle hypertrophy and the nutrients that support it. If you’re talking about adipose (non-lean) tissue, carbs would be a good thing.

  5. tim smith  February 1, 2012

    Any thoughts on using bcaas before/after workouts? Any negative effects to ketosis? Or the low carb process?

    (reply)
    • Peter Attia  February 1, 2012

      Tim, I used to use about 8 gm of BCAA during my dry-land workouts, and chase about 8 gm of glutamine down right after. It did not appear to impact ketosis in a negative way.

  6. Barbara Hvilivitzky  February 1, 2012

    Peter, what an inspiring post!

    I’m committed to improving how I feel and to improving how my aging body can perform daily tasks – all so that I can go into my “golden” years with a smile on my face. And you have given me the smile I needed TODAY to continue, even though my thigh muscles are talking back from the squats I did yesterday.

    WONDERFUL POST!!

    (reply)
    • Peter Attia  February 1, 2012

      Nice work with the squats! Keep it up.

  7. Ian  February 1, 2012

    Peter, thanks for all of your work here.

    I have one comment about this –

    …after a day (yes, after one day) he immediately abandoned it because he felt so horrible. He complained of feeling sluggish, constipated, nauseated, irritable, and even complained that his breath turned stale

    I felt horrible when I stopped smoking. I was certainly irritable and bad tempered. No fun to be around. But I don’t suppose Dr Oz would suggest I go back to smoking again after trying not to for one day. He would tell me (I hope) that the withdrawal symptoms and the addiction would fade away quickly. I know that’s a comparison/point that Gary Taubes makes in “Why we Get Fat” but it strikes me as relevant here. Really, I would love to get stuck into a Snickers bar or some Ben and Jerry’s Cookie Dough ice cream; I miss “sensible” carbs too, like breakfast cereal, potatoes and bread. But now I understand the longer term high price I will have to pay for satisfying those cravings.

    (reply)
    • Peter Attia  February 1, 2012

      Ian, I love the analogy. Thanks so much for sharing it.

  8. Robert  February 1, 2012

    Hi Peter-I’m here via Gary Taubes. I read Why We Get Fat, and have been low-carb for almost a year, lost 30 pounds, have about 10 more to go. I have been committed from the very beginning that this would be a way of life, not a temporary fix. I firmly believe in the low-carb, higher-fat concept.

    You mention in your contact section that you have a full-time job. What do you do? Are you a practicing MD? I ask because most sites like this are aiming to make money – by selling a book or a program or videos or supplements. Except for your Amazon links to other people’s books, I can’t see that you’re selling anything. This makes it appear that you are sincerely interested primarily in passing on the info to help others. Not that selling something would necessarily detract from that higher purpose!

    So, I wonder what you do, and do you have plans for the future to sell a book or DVDs or something?

    Not a challenge, just curious.

    (reply)
    • Peter Attia  February 1, 2012

      Robert, you are so spot-on, and I hope people understand that what Gary and I (and many others) talk about is a life-style change, NOT a diet. Your question is a complex one, sort of…My full-time job is working for a bio-technology company. I left clinical medicine in 2006. The blog started in December after I’d spent about year emailing friends and family about my journey and the lessons I was learning. What started out as an email list of 50 people spread into a list of over 300. At that point, I felt it be more efficient to start the blog, which is what I did. My blog, as you point out, is all about challenging the way folks think about nutrition, and hopefully inspiring people to begin their own self-experiment. All that said, what I assumed would be a 2-hour/week commitment (the actual writing of each blog post) has quickly assumed much more time, primarily in response to questions (which I welcome) and other ideas. I am considering a number of ways to sell products, but I will not being doing that through my blog. When it happens, it will be a separate entity and I hope it does not detract from the higher purpose. Thanks for your support.

  9. Anon  February 1, 2012

    Peter – I appreciate the post, but what you describe in your tire flipping (and other strength-training endeavors) is extreme discomfort. What I found distasteful about the Oz-Taubes exchange is that Oz was complaining of relatively minor discomfort, not extreme discomfort. For the average person following Taubes’ advice, there IS NO extreme discomfort. I’ve been on low-carb for about 9 months now. The reason it works for me is that it doesn’t take the same effort or willpower or calorie counting or discomfort as the other diets or exercise programs out there. Gary describes it well when he says you eat how much you want and, although exercise is a good thing, neither it nor starvation are part of the losing weight process. So, although I had some very minor discomfort for the first week or so of my lifestyle change, it was nothing like the discomfort of being obese (now I’m just one BMI point away from not being “overweight”), craving sugars, and subjecting my blood levels to getting closer to the “out of range” levels that would make for more discomfort. I think the real force behind the low-carb approach is that it is actually doable and feasible – I wouldn’t want people who haven’t started it to think they need to go through Herculean efforts to get to the “feeling good” phase. All the best – this blog is a fantastic resource for those trying to make a change!!

    (reply)
    • Peter Attia  February 1, 2012

      You’re absolutely right, and I HOPE no one is inferring from this post that you need to experience tire-flipping-pain to improve your health. I was trying to make the point that I wanted to get stronger and faster. To do so, I had to flip tires and do other crazy stuff (this is an over-simplification, obviously). When I first did these things, it was uncomfortable. Had I been afraid of discomfort, I would not have made progress. Same thing when I first gave up sugar. No, it didn’t hurt *nearly* as much as tire flipping, but I was not happy about it – I craved it all the time for a while. Thank you for your support.

  10. Tom  February 1, 2012

    The first time I tried a low-carb diet I felt so bad I didn’t last a day. But that involved quitting sugar, starches and refined flours cold turkey. I concluded that low-carb diets were unworkable. The second time I tried (right after reading “Good Calories, Bad Calories”) went much better and came after I’d already eliminated sugar and was only eating whole grains. That was 7 months ago. I’ve stuck with it, am down 20 pounds and feel great. I think making those intermediate changes to my diet was very beneficial.

    (reply)
    • Peter Attia  February 1, 2012

      Tom, congrats on your success and thank you for sharing it.

  11. Dominique  February 1, 2012

    Great post! There is so much misinformation out there about low-carb. If you do not do active research and find good information, you are bombarded by people like Dr. Oz (or my own M.D. for that matter)-stating that low fat is the way to go. However, when you try the numerous (low-fat) programs out there, and they don’t work, you feel like a failure (or at least I did). Any change to your diet could be difficult at first,but I am convinced that low-carb is the way to go for me. The beginning (first couple of weeks) was NOT easy. Now, however, after a couple of months, I feel much better, and I do not have those horrible carb cravings or crashes anymore. Life is good and getting better (losing weight and improving my fasting blood sugar). Thanks again!

    (reply)
  12. jake3_14  February 1, 2012

    I’m uncomfortable with what I perceive is a puritannical tone in your point #1. It’s almost as if you believe that we *should* suffer in pursuit of difficult goals. If someone has an easy time of the keto-adaptation process, does s/he any less virtuous or deserving of the health benefits that accompany the change? I understand that perseverance is a useful trait, and dealing with pain stoically is a sign of maturity, but I guess I subscribe to the aphorism, “pain is mandatory in life; suffering is optional.”

    Regarding point #2, are you taking your experiment of n=1 and generalizing it to the entire world? I think there is room to allow for human variability on this point.

    (reply)
    • Peter Attia  February 1, 2012

      Jake, you might be reading too much into this. Re: point #1, I certainly do NOT mean to take that tone, and I certainly hope no one suffered as much as me to get through adaptation. But if they did, they should know they are not alone, and I hope they realize it was worth it. Point I’m making is simply this: few things in life are free. If you want to improve yourself (e.g., reduce your risk of heart disease, flip tires, learn a new language, or quit your heroin habit), it takes work. Depending on what you’re trying to accomplish AND where you’re starting from, it will be differentially challenging. This has nothing to do with achievements being virtuous or folks “deserving” it. No one “deserves” to be unhealthy, and so I guess that implies everyone “deserves” the chance to be healthy.
      Re: point#2, don’t confuse “proof” with the “existence principle.” You’re talking about the former, and I’m talking about the latter. “Conventional wisdom” says without carbs you can’t do anything anaerobic. When you identify an example — even a single one — that violates this “rule,” you call the entire rule into question. That’s what I’m doing. Of course anyone on a low carb diet, who has sufficiently adapted, can do things the “conventionally wise” think impossible. I certainly agree with the notion of human variability. If you look at my blog, I hope you’ll realize that’s the sine qua non of my thesis.

    • jake3_14  February 1, 2012

      Hi Dr. Attia,

      Thanks for responding and clarifying your initial remarks. I apologize for misinterpreting your comments.

    • Peter Attia  February 1, 2012

      No problem. Sorry I didn’t make more sense the first time.

  13. Alexandra Mazzeo  February 1, 2012

    I, too, was going to make the analogy with smoking (having tried and failed to quit many times before succeeding).

    My opinion of Dr. Oz is down in the negative numbers after he promoted the homeopathic HCG diet on his show. To me, that means he’s abandoned the path of science altogether in the interest of ratings.

    As for his other recommendations – it’s tragic seeing all those overweight women (and they’re almost all women) hanging on his words, hoping for a cure, and then one guy comes along with something that actually will help them (Taubes) and he tells them to stay away from it, dishonestly representing his one day of eating pork rinds as a sample of the low carb lifestyle.

    Oz has plenty of other tricks up his sleeve: after the outcry over his promotion of homeopathy, Steve Novella* went on his show in an effort to explain the concept of “evidence.” Oz scored a lot of points with the audience by accusing Novella of mocking their “beliefs.”

    *NeuroLogcia blog. He knows squat about diet, spouting the usual calories in / calories out stuff, but he debunks a lot of pseuoscience very well.

    (reply)
  14. Richard  February 1, 2012

    Peter, you indicate in this post that too little fat can can make a low-carb diet unpleasant. This is the second place I have seen you mention that point. I also noticed early on that high protein / low fat made me feel terrible. Can you shed light on what causes that? Thanks.

    (reply)
    • Peter Attia  February 1, 2012

      I will address this point more broadly in a separate post. Very quickly, though, if you limit carbs and limit protein (to avoid the malaise from over consuming protein), AND you limit fat – you’re doing a starvation diet, which works for a while, but is not sustainable for most people. So fat is actually the only thing you can eat in limitless amounts without the adverse impact on your metabolism.

    • Lisa  February 3, 2012

      I would be very interested in hearing this as well, as it’s the one part of the low-carb discussion that has me torn. I’ve been doing low carb successfully for nine years (I’m 41 years old and a size zero), but I’ve found that a higher protein, lower fat version of the plan has always worked better for me. I’ve tried the high fat way, and for some reason gained weight, had scary heart palpitations, and my cholesterol shot above 300. I was following a strict Atkins phase 1 type of plan, so I can’t figure out what went wrong. I’m wondering if there are certain people for whom a lower fat, higher protein plan is more appropriate, but I admit I’m a little nervous about what I hear regarding eating too much protein. Looking forward to your analysis.

    • Peter Attia  February 3, 2012

      Lisa, you’ve provided another great example of the human variability that can not be forgotten in this discussion. I know it’s frustrating for most of us — we want ONE answer. Unfortunately the human body is too complex for that. If only we could homozygous mice…

    • Eric  February 17, 2012

      Lisa,

      As to the weight gain and palpitations I can’t offer an adequate explaination, but the cholesterol increase is not necessarily an atypical or negative response to transitioning to a high protein, high fat diet. Gary Taubes proposes in “Good Calories, Bad Calories” that “elevated” cholesterol and heart disease are only correlated, not causal, and that high cholesterol is a poor indicator of heart disease risk. He cites that the coveted “below 200 ml” total cholesterol level is an arbitray number with no predictive value or supporting evidence. What is more important is the ratio of the different types of cholesterol/lipoproteins (there are over 10 identified) and general inflammatory profile within the vessels. Of course this is refuted by most cardiolologists but as Dr. Attia has said, the medical community in general deals in treatment, not prevention.

    • Peter Attia  February 17, 2012

      Eric, Lisa, I’m going to be a lot of writing about this in the future, to be sure. Please stay tuned, as it may take a while to get there, but I promise I will. Short answer: it’s all about the number of apoB-carrying lipoprotein particles, NOT the concentration of cholesterol.

    • Elizabeth Link  February 5, 2012

      I actually believe that it goes beyond the starvation factor. If you read the work of Sally Fallon, Weston Price, Weston price.org, there is scientific as well as anecdotal evidence that a diet composed mainly of lean meat very quickly cause illness/nausea. There are anecdotal stories of “primitive people” in Northern climate areas becoming very anxious during long winters when the only animals to eat were very lean. They knew they’d get sick. The nutritionists including S. Fallon at westonprice.org talk alot about the dangers of consuming lots of lean protein without the fat because it RAPIDLY depletes vitamin A stores. Vitamin A is a fat soluable vitamin that only comes in the fat!I personally become nauseous within a few hours of of consuming alot of lean meat. I think it’s fascinating! Possibly the body’s natural way of protecting us from all the downfalls that come with Vitamin a deficiency including kidney, thyroid and eye problems. Peter you may be interested in checking out the information at Westonprice.org. His work, along with Taubes, have been hugely eye-opening in my own journey. The way I see it, Weston Price/ Sally Fallon teach a lot about ancestral wisdom in regaurds to dietary practices and Taubes provides the modern day science that back it all up! I also know Gary Taubes has a lot of respect for Weston Price as a researcher! Thanx for being continued inspiration on this path!
      Elizabeth

    • Elizabeth Link  February 5, 2012

      Additionally, most “primitive” healthy cultures focused on organ meats over muscle meats because they contain a MUCH higher concentration of essential vitamins. I have found organ meats, cod-liver oil, and bone broths to be essential in my low-carb diet. Peter, I hope you read “Nutrition and Physical Degeneration” by Weston Price!

    • Peter Attia  February 5, 2012

      Elizabeth, yes I agree completely. While I have not yet read Fallon and Price, many others have reported this in great detail, perhaps most importantly, Vilhjalmur Stefansson, and I’ve read their work. Yes, a risk of eating lean meat exclusively is depleting vitamins A, D, E, and K. Ironic, isn’t it?

    • Jill  February 2, 2012

      Richard, If you Google rabbit starvation there are some interesting articles about a high protein low fat diet. It seems that at the end of winter the native people were short of food, except for starving rabbits. The rabbits provided very lean protein. However, the natives knew that they would die sooner if they ate the rabbits than if they ate nothing. I am interested in learning more about this as well. Regards, Jill

    • Richard  February 2, 2012

      Jill, Thanks! The Wikipedia entry clears it up.
      http://en.wikipedia.org/wiki/Rabbit_starvation

    • Elizabeth Link  February 5, 2012

      If you check out westonprice.org there is a lot written about the danger of overconsumption of lean protein without the attached fat. It will RAPIDLY lead to Vitamin A deficiency because Vitamin A is required for protein assimilation. Vitamin A is fat soluble and only available in animal fats. There are anacdotal stories about “primitive” people becoming very anxious during a long winter because the animals they had to consume were too lean. They knew consuming them would lead to illness. I personally feel nauseous within a few hours of consuming a lot of lean protein. I think it’s fascinating! Possibly our body’s natural way of protecting us from Vitamin A deficiency with all it’s downfalls including kidney, thyroid and eye problems. Peter you may want to check out the work of Sally Fallon and Weston Price. Their work focuses on the importance of ancestral wisdom in regaurds to dietary practices. I know that Gary Taubes respects the work of Weston Price. Price showsa the way that healthy traditional people ate and Taubes backs it up with modern science!

  15. Matt  February 1, 2012

    I think people find it easy to use this tactic with food, because they fail to see their health as part of their overall project of self-fulfillment. Striving is for work; food belongs to the world of entertainment – a “reward” for hard work. What they fail to see, however, is that the pleasures associated with the full realization of human potential far outstrips any childish, self-indulgent amusement. I see way more satisfaction in you flipping that tire than I’ve ever seen in someone eating ice cream. I think everyone knows this deep down. The trick is getting people to incorporate their health into into their broader vision of a successful life. I think sites like yours can help people do that. Great post.

    (reply)
  16. Shiv Kumar  February 1, 2012

    Hi Peter,
    We’re all humans and different. I don’t believe it’s about perseverance or the ability to bear pain, or about being always right or wrong (you seem to imply that Dr. Oz is wrong here).

    And it’s certainly got nothing to do with logical thinking. It’s about desire and how hard we’re willing to work at achieving our desires and goals. A lot of people are willing to persevere in their desire to amass wealth and yet these same people want to pop a pill to keep them healthy. So it’s not a personality trait either it seems.

    And then there are others whose nature is such that when they do something (anything really) they do it with a lot of gusto, passion and perseverance. Things that, in their mind (or to them) are “important” You’re obviously this kind of person. I am too.

    Some people I know are extreme critical/logical thinkers, except when it comes to religion, diet ?, politics or anything they’re passionate about. They seem to be completely different people during these times.

    You say, “But the real subtle negative effect of this myth is reflected in our behavior when we often avoid up-front (brief) pain in exchange for long-term (protracted) discomfort. Why not the reverse? Why not go through the pain barrier up front and experience the joy and growth later?”

    It’s our primal/instinctive side battling with our logical side. It’s like taking a pet to the Vet. No amount of reasoning is going to convince a pet that after the vet has finished doing what she is going to, it’s all going to be alright. The primal brain only see’s the here and now and can’t reason about the future. Some kids start whaling at the sight of a syringe. So obviously they know what is it and presumably the earlier experience fixed their problem, but they can’t reason that far out. All they remember is the pain of the *very first* injection.

    Like many other things, when it comes to diet, only those who want to, will, no matter what kind of diet. What I’ve learnt is that when I’m trying to convince friends and family about what I’ve learnt about low carb and ketogenic diets I have to alter my spiel (or angle of attack) and tailor it to the individual.

    Lastly, I feel your writings (in this post) about athletic performance on a very low carb diet should be another post because a lot of people would have these concerns and would like to know what you have demonstrated so clearly, but a post titled “My Pet Peeve” will not be where they’ll look for such inspiration.

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    • Peter Attia  February 1, 2012

      Shiv, to be clear, I DO think Dr. Oz is wrong in his implication (not his observation, which seems pretty straight forward). You make a great point about the title of this blog potentially missing some readership…I’ll have to think about that.

  17. Lacie  February 1, 2012

    Although I agree with the content of the post, the video was the really cool part. We don’t all have to be that athletically driven, but each of us has our own inertia to overcome, and it pays to know the depth of our resistance.

    You also got my imagination going. I’m 53 and have always daydreamed about taking up competitive canoe racing. If you know anything about it, you know it’s insanely grueling even for younger athletes, plus women are at an evolutionary disadvantage for this particular sport. But when I watched your video, I realize that I COULD do it, even at my age, if I chose to, made the commitment, and did the work. That’s a pretty powerful lesson to take away and it applies to many other areas of life.

    Peter, do you and your PT have a particular tradition (such as Crossfit) that forms the basis of your workouts, or is it completely free form? Just curious

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    • Peter Attia  February 1, 2012

      Wow, Lacie, YOU just made my day. If my little post could help you realize that you CAN do it, I am honored. Pat and I don’t follow a particular tradition, per se, but we do focus on functional movement. The workout you say, for example, focused a lot on hip-dominant movements. More than happy to put you in touch with him if you want to ask for a referral in your geography?

  18. Helga  February 1, 2012

    I’d just like to add, ridding you diet of carbohydrates doesn’t have to be painful. I’ve been gradually eliminating things for the past few months, not unlike you did. I started with sugar, then flour, then fruit. I’ve had no real negative symptoms. Maybe very mild nausea a couple of times. I did have one immediate positive effect- I’ve struggled with low blood sugar issues through my adulthood and with carbohydrate elimination they disappeared immediately. 8pm dinner reservation no longer strike fear in the heart of my partner. I’ve also been very pleased that my athletic performance never diminished at any point in the process. I guess it can be hard, but it may not be for you. So anyone who has had similar issues with blood sugar or is thinking of restricting carbs but hasn’t tried yet can be assured by my experience, it may be easier than they have heard.

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    • Peter Attia  February 1, 2012

      Absolutely, Helga. THANK YOU for pointing this out. Reading some of the comments today I realize I may not have been clear enough in my first point – cutting carbs is NOWHERE near as tough as flipping tires!

    • Jill  February 2, 2012

      Helga, I didn’t find low carbing difficult. I eat entre and main course, then say I have had sufficient. I am enjoying better health. I don’t want to eat any other way now.

  19. Kyla  February 1, 2012

    Last week my trainer made me throw up from working out and we totally high-fived.

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  20. Janknitz  February 1, 2012

    Sheesh! How many people feel absolutely rotten on the SAD, day after day and don’t quit that? But they give up after one day of feeling bad on low carbs????

    I do think one of the things that low carb/paleo authors fail to do is warn people sufficiently that they are going to feel bad at first, why and what to do about it.

    Also, it would be nice to see a plan that either steps down the carbs slowly to ease the transition, or has people specifically take in more fat (i.e. coconut oil) in preparation for the low carbing so that they’ll get a jump start on ketosis. I know a step down can’t be too slow because the cravings would sabotage it, but perhaps in increments over the course of a week–120 net carbs/day, then 100, then 75, then 50, finally 20.

    This works. I nicely avoided the “low carb flu” both times I’ve started by “dipping my toe” in the water with a lower carb plan (The Zone, the first time, and Jorge Cruise’s Belly Fat Cure this time) first. Once I was doing well on those plans, it was very easy to reduce my carbs down to ketogenic levels without feeling lousy.

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  21. Tim  February 1, 2012

    Fabulous website. Great info. Thanks for all the work u do on it Doc.

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  22. Vance  February 2, 2012

    Great post, Peter! I’m certainly not the athlete you are, but my experience is similar to yours in some ways. For me, the transition to a low carb diet (30 grams or less/day) was never that big a deal. Less than a small “bump in the road,” I would say. I do brutally intense bodybuilding-type workouts four times per week (I’ll turn 60 in March), and I’ve actually had my strength go UP while shedding body fat on protein and fat and only the few carb grams in the veggies I include with my last meal of the day. I seem to thrive on this type of program. Thanks again for an excellent post!

    (reply)
    • Peter Attia  February 2, 2012

      Vance, excellent news. Thank you for sharing with us. I hope I’m still tire flipping at 60, too.

  23. Mike  February 2, 2012

    What about acetone breath mentioned on wikipedia? Does the wife complain?

    (reply)
    • Peter Attia  February 2, 2012

      Mike, unless she (and everyone else) aren’t telling me something, it does not appear to be a problem.

  24. Jill Brown  February 2, 2012

    Fascinating and thoughtful post. Must have taken a little while to compose.

    My contribution is that, while I am curious about these ideas and want to understand them, I do not aspire to low-carb eating. I do not eat meat, and so necessarily eat plenty of plant-based food, ie carbs. Not too many grains, but tons of legumes and tempeh.

    But I am very fussy about the quality of what I eat, we make beautiful food from scratch, and I am not overweight or unhealthy. Never eat pizza or candy and never have.

    I think we have to be guided by our values in life. One of my cardinal values is not to eat meat. But I’m highly sympathetic to low-carbing. A fellow traveller.

    (reply)
    • Peter Attia  February 2, 2012

      Jill, thanks so much for your comment. A lot of folks ask me how people who don’t eat meat can be healthy if what I say is true. I think you give an excellent example of that. People like you, though you don’t eat meat, are doing such a good job eliminating the worst offenders in our diet (sugars, highly refined carbs), that you’re actually far less impacted by the other carbs you eat. I’ll actually be writing about this so much more in the future, because I think it creates a lot of confusion. Congrats on your food choices and thanks again for sharing.

  25. Woody Hill  February 2, 2012

    Dr. Attia,

    Thank you for your posts. I appreciate the work you do spreading the low carb, ketosis adaption message. I have a question for you. I’ve been doing low carb very similar to your diet that you wrote about with one cheat day. I remember reading a post where you started with a cheat day and then got right back on your normal low carb diet.

    What are your thoughts on a cheat day and the effects of one high carb day per week? Dr. Phinney wrote about one high carb cheat day will stop keto-adaption and Dr. William Davis wrote that low density LDL particles spike with only one high carb day and stay higher than we want. I’m 30 with no health problems and I’ve never had any weight problems. I have a cheat day mainly as a reward and to keep some sanity. Thank you and I appreciate your time and thoughts!

    Woody

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    • Peter Attia  February 2, 2012

      Woody, I only did “cheat” days or “cheat” meals in the beginning when I was just cutting sugar, simple carbs, etc. I don’t do this any more for 2 reason: 1. Even a single “cheat” meal will take me out of ketosis (I have documented this by accident), and I don’t feel as good, and 2. Paradoxically, intermittent cheating makes it hard to eat correctly day-to-day, at least for me. Again, I think this is a personal choice, but I think folks should at least experiment with “immersion.”

    • Woody Hill  February 3, 2012

      Dr. Attia, thank you for the reply and I appreciate your time!

    • York  April 10, 2012

      Peter (and anyone else with a view on this topic, like, for example, Erick Minor), what do you think about the theory propounded by trainers and bodybuilders and the like, that cheat days spike the metabolism and are important for maximizing fat loss?

      You and Dr. Phinney and others explain that cheat meals or cheat days stop keto-adaption (or interrupt ketosis); but is it possible that, even with this interruption/cessation of ketosis, the cheat meal/day does (or can, in fact) increase (or as some claim, maximize) fat loss (perhaps through other hormone regulation/ body fat regulation effects)?

      - sorry to be so imprecise and unscientific, but i am fairly unschooled in this area.

      By cheating, I’m referring to practicing a ketogenic (i.e., high fat/moderate protein/low carb) diet most of the time (say 3-6 days in a row), followed by a cheat day or cheat meal (which entails high carb intake). A great many bodybuilders – and other physique-minded folks who spend a lot of time and effort trying to figure out the optimal formula for getting lean – believe very strongly in the cheat meal/day. Tim Ferriss and others attest to its efficacy. and I personally note that when I’ve followed a cheat day formula (6 days ketogenic, and 1 cheat day), I was leaner than when I follow my ketogenic lifestyle.

      (Note: I switched to low carb-all-the-time because I figure I’m lean enough, and I’m doing this to be healthy for the longterm and not to get as lean as possible).

      Please let me know what your thoughts are. Thanks so much!

    • Peter Attia  April 10, 2012

      Possible, but I’m not familiar with the data. The issue may be one of insulin spikes, rather than carb or “metabolism” spikes, per se, given that insulin is an anabolic hormone.

    • York  April 11, 2012

      Thank you, Peter. Can you explain a little more what you mean? Is it that an insulin spike increases the building of muscle, which might also increase fat-burning?
      I know you haven’t read the data, but is that what you’re speculating?

    • Peter Attia  April 11, 2012

      Insulin “builds.” It drives fat and carbohydrate into storage. It drives glucose into muscles and liver as glycogen. It drives amino acids into muscle. You don’t need too much insulin to do #2 and #3.

  26. Troy Leitzsey  February 2, 2012

    I totally get what you say about getting through the difficulties to reach a goal. When I was just a few days into my transition from high carb to high fat, I thought my chest felt “congested.” I didn’t have chest pains, but it worried me a bit. If I hadn’t just read GC,BC, then I might have gone right back to low fat, high carb, whole grains to “cleanse” myself. Instead, I stuck with it, and the sensation went away in a couple of days and hasn’t returned since. (Compare that to late 2008, when I was a heavy drinker of HFCS sweetened colas and really did have chest pains.)

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  27. Barbara Hvilivitzky  February 2, 2012

    Peter, question re: weights, and frequency of workouts.

    Is it better to start low, with many reps, and frequently? or is it better to start fairly heavy, low reps (to failure?) and only twice a week? I think the new trend tends to favour the latter. What do you think, especially for us out here in “beginner-land”?

    (reply)
    • Peter Attia  February 2, 2012

      Barbara, my best advice would be to actually work under the supervision of a very qualified trainer. Despite my history of weight training, I still find this to be one of the most safe and efficient uses of my training time. I think it’s all that much more true for folks who may have less experience. Experience and goals will determine what you do.

    • Barbara Hvilivitzky  February 2, 2012

      Thank you, Peter, for your reply, however, there are so many of us who simply can’t afford, or don’t have access, to trainers!! We don’t have much choice other than to cobble together something at home. Small town living, on a retiree’s budget, doesn’t allow for all the terrific options some have!!

      But I realize you can’t possibly respond to each request for individual advice. I’ll just keep reading and pick up what I can, in general, from what you post, and from what others do as well. Thanks again.

    • Michele  February 3, 2012

      Dear Barbara,

      I tried the book “The Power of 10″ about slow motion weight training using less weight and, as mentioned, slower movements. The book puts together plans for you and even has a section for those who have to do training at home or in a hotel room because they travel for business.

      I am confident that you will eventually find something that fits you and feel very inspired by your desire to be in good health.

  28. Dominique - €€€  February 2, 2012

    With respect, I believe you are being a bit harsh on Doc Oz.

    He is from the Harpo stable, she has had a few of these Doc du Jour. Bet he is mindful of not biting the hand that fed him ( a woman who puts her face on every cover of her mag and the last page, is a monster that needs to be handled right) and the ones who support him now ( weight watchers – who teach people how to eat by points – and it works apparently, their products are shocking. You lose weight but you are hooked on their low-fat junk). The Doctor wore scrubs on Harpo, so not to be confuse the audience with the other “specialists” on her shows . He is trying to make the overweight lose some of their crap habits, maybe eat some real food, with actual taste and favour and cut the sugar. He is getting them to walk, little steps, you are on a very different level, as your video can testify.
    With the weight of the network on him, he may not want a fat-diet related headache.

    Dr Oz is not going to endorse the – eat fat to lose fat – apotheosis on TV(maybe privately ) or that saturated fat does not make you fat, when it goes against the dogma of the times. He would be excommunicated, not a good place to be. Also in economic terms, protein and fat are getting more expensive, what if you can only feed your family on cheap carbs? Should you not be taught to eat the right kind?
    Are you waiting for the Lord of Finance to say that they had a hand in the downfall? No way, instead they blame the collapse of the housing-Ponzi scheme in the greed of the poor who took NINJA mortgages and not on the shameless creatures who sold them knowing it was daylight robbery. I am not, does not mean I believe their crap.

    (reply)
    • Barbara Hvilivitzky  February 2, 2012

      But Dominique, the whole point of Peter (and others) blogging on this topic is to counter the tremendous influence “Harpo” and Dr. Oz have on the general population. We must do our best to get Peter’s message out there!

      If Dr. Oz (and by extension “Harpo” and that ilk) are never seriously challenged nothing will change.

  29. Dominique - €€€  February 2, 2012

    With respect again, you are not an average Joe are you? Your impressive CV, your confidence, your job now (algae into energy, bless you), your blogging and your workouts scream overachiever, and you seem fairly nice to boot, not even smart arsed about it. Got to say, the video makes you not just a “freak” about working out, maybe for some, also a little nuts :-).
    Not everybody is happy dealing with that amount of physical of physical discomfort, (unless they pay for it and that is for another blog) even if they are able to delay gratification for a goal. Some might be put off be hit or just scared. Doctors preach moderation. You did get some t-shits made, do you wear them? Gary Taubes is getting a following, the fat diet is not for everyone, some people will get there, this blog is reaching people who question the prevalent dogma when things are not working as they should. Chill, people have different velocities and comfort zones. DR Oz is defending his patch, he may have a profound distaste of fat, not everybody has Inuit blood in them.

    (reply)
    • Barbara Hvilivitzky  February 2, 2012

      Again, Dominique, thank goodness there are people like Peter, and Mr. Taubes, who DO have very impressive CVs who are willing to give of their very valuable time to blog on these topics.

      Every Tom, Dick, and Harriet with an M.D. or PhD after his or her name has been blaring out the low-fat mantra for so many years now and it has been very difficult to counter that message with voices that have credibility. Frankly we don’t want “average Joes” getting out the right message!

      So let’s not snipe too much if Peter’s enthusiasm for fat, and high velocity workouts, don’t please everyone. They need to be “out there” right now!!!!

      The fact that we can get these post of such fantastically high quality, for FREE, just blows me away. Let’s take advantage of it!!

    • Dominique - €€€  February 6, 2012

      Barbara,

      No you don’t want an snake oil merchant giving you another diet.

      At the same time, you want Gary Taubes and Peter Attia message to go to the average Joe and Jane who are doing everything right and still put on weight and can’t afford a doctor.

      When you are wealthy, you have access to better quality food, you can afford grass-fed meat and butter and green leafy vegetables.

      How can you implement this diet on a minimum wage or on food stamps? How can you implement this diet when a bag of rice goes a longer way than a steak? Or when sugar and fat filled food gives you love and comfort when none is in your life. What about in a run-down neighbourhood with no supermarket that sell meat or vegetables but only junk-food outlets?
      I am not speaking from a place of envy. When you have a food budget and easy-cheap-processed food is cheap and filling, how are you explain than fat and proteins ( getting more and more expensive) are the things you should be buying? If you have £5 dollars a day, isn’t the junk-food outlet giving you 3 meals – full of fat-sugar-carb for the day making perfect sense?
      If you want the diet to be popular, you need to work the message and the economics.

    • Barbara Hvilivitzky  February 7, 2012

      I’m sorry that I can’t give you links but I have seen sites where people have taken very limited budgets and have managed to eat low-carb. It does take time, and skills but it can be done. Part of the skill involves being able to make stews from cheap meats and make them serve as dinners and lunches, and using chicken thousands of ways etc. Eggs and cheese are often cheaper ways to get protein and fat. And every grocery store sells meat that is on it’s last day of saleability – I know because I often buy it and freeze it. And veggies too are always on sale on their last legs – great for soup and stew. And cheese ‘heels’ are a bargain.

      It can be done. But as I say education is often the key.

  30. Stacy Van Meter  February 2, 2012

    Peter,
    Really enjoying your blog – thank you! Question: I have a 12 year old daughter who swims competitively 20+ hours a week and does some personal training outside the pool. She is seeing some crazy success and will likely come out top in the central zone this summer for her age group. I am wondering about pre-teens/teens who swim this much and the messages they are getting about high carb intake. I wouldn’t dream of restricting her carbs … but I also question the need for 65% of her calories to come from carbs.

    (reply)
    • Peter Attia  February 2, 2012

      Stacy, I think your instincts are correct. At her level of performance, I think overall carb reduction might cost her some speed. Keep one thing in mind, though. Depending on her races (I like the 50 fly, 100 breast, and 200 IM best), the ratio of training time to race time is huge. While her races may be at all-out anaerobic pace, much of her training is not. Hence, I think it’s valuable to shift some carbs around. For example, she will likely perform better without sugars and simple “junk” carbs (e.g., chips, highly refined breads). Also, she will likely benefit for a higher intake of monounsaturated fats and omega-3 fats. I’ve helped a few elite swimmers (Olympians, world record holders) tweak their nutrition a bit in a similar way, and it’s helped them train much harder, which translates to better racing. Finally, check out Generation UCAN products as a superior product to the usual sports drinks.

    • Stacy Van Meter  February 6, 2012

      Thanks Peter!

  31. Matt  February 2, 2012

    Have you read Stephan Guyenat’s Blog? He’s been getting a lot of buzz on his critique of Taubes’s and your carbohydrate hypothesis. His counter-contention seems to be that fat metabolism is not regulated in fat tissue but rather by the brain. That what matters is leptin and a host of other hormones and their relation to the brain, and not insulin. It would be nice – and maybe important – to see a counterargument from your camp.

    Here’s a snippet:
    “I’ve already demonstrated that it makes no sense to invoke insulin as a mechanism between carbohydrate consumption and body fatness. Another problem with the hypothesis is a thing called the insulinogenic index (II). The II is simply a measure of how much eating a food increases insulin, per unit calorie (28). It turns out, it doesn’t correspond with the carbohydrate content of the food very well. In particular, protein-rich foods such as beef can increase insulin secretion as much as certain starch foods such as pasta, or more. High-protein diets, as many of you know, aid with weight loss.”

    This is a direct assault on much of what you’ve been saying. People have already asked Taubes to respond to this. Any plans or is it actually too tenuous to worry about?

    (reply)
    • Peter Attia  February 2, 2012

      Matt, yes, I’m very familiar with Guyenat’s arguments. Actually, he and Gary have gone back and forth on this point a number of times. I think Gary most recently posted another response to his response to Gary’s response to his response on Nov 25. Gary and Stephen have gone back and fourth 10 times so far, I think. So, I guess I think Gary is doing a pretty good job of presenting the counterargument. The larger point, of course, is that this is exactly why we need an organization like NuSI to put these arguments aside and move to the actual experimental phase of the discussion. In other words, let’s start doing incredibly well-controlled prospective efficacy studies to better elucidate the mechanisms of action with respect to fat storage and metabolism.

  32. Fox  February 2, 2012

    Peter,

    Thank you so much for what you’re doing here! It’s extremely useful, motivational, and informative.

    You may already know this, but there is a “technical term” (from behavioral economics) for what you were describing with short-term v. long-term behaviors. It’s known as “hyperbolic discounting”: http://en.wikipedia.org/wiki/Hyperbolic_discounting

    “Given two similar rewards, humans show a preference for one that arrives sooner rather than later. Humans are said to discount the value of the later reward, by a factor that increases with the length of the delay.”

    In this case, people are discounting the rewards of a low carbohydrate diet, opting for the more immediate reward of avoiding pain and maintaining their comfortable status quo.

    (reply)
    • Peter Attia  February 2, 2012

      Thanks so much. I was not aware of this term.

  33. D  February 2, 2012

    Peter, how do you like using a hex/trap bar?

    I work out at my home using different types of push-ups, pull-ups, and kettlebell training. I’ve been looking into buying a trap bar, like the one you were using in the awesome vid you just posted(btw, you train a lot like MMA fighters do). They seem pretty practical to use at home. But I’ve never actually used one and they’re not cheap. Any thoughts?

    (reply)
    • Peter Attia  February 2, 2012

      If I were to train at home and buy equipment the hex bar would definitely be one of the things I would buy. I love it. I did martial arts and boxing from the age of 13 to 24 (though not MMA), so maybe that’s why I’ve gravitated to this sort of training, even though my sports have changed.

  34. Dan  February 2, 2012

    Peter, Love the post, but I have to say the examples do make you seem a bit extreme. I was worried it might scare people away but judging by the comments I was wrong. Just to let you know I am a believer, I started training for an Ironman and reached my plateau wieght I have been to before, start really watching what I ate and dropped 9 pounds in January! Keep up the good work!

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  35. Traci  February 3, 2012

    Dr. Attia, I loved your workout video! Good for you and keep up the good work! I just wanted you to know how thankful I am to you for starting this blog. THANK YOU.

    (reply)
    • Peter Attia  February 3, 2012

      Traci, you’re very kind. Thanks for your support.

  36. JB  February 3, 2012

    Peter,

    LOVE this blog. You and Taubes are amazing. I am a lean guy, totally comfortable with my weight and physical ability. However, I would like to “live as long as possible” (wouldn’t we all!). So my question to you is, is it “healthier” to eat low carbs…or are you just talking about weight loss/fat loss. Hypothetically, say two 135 lb guys with the same body type manage to stay at 135 their whole lives (for the sake of argument, i know in reality no two people are the same). But one does it by eating “normal” (like me) and the other eats no carbs. All else being equal, would the carb free guy be healthier and live longer? Or are you not commenting on the healthiness of eating carbs and just talking about “staying thin” or reducing fat?

    Thank you.

    (reply)
    • Peter Attia  February 3, 2012

      JB, I think of 5 ways to improve myself: body composition (which impacts health directly), reduced risk of disease, increased energy levels and functionality, increase mental acuity, and enhanced physical performance. Different folks prioritize different elements but, yes, the benefits of correcting poor eating habits go far beyond weight management. Stay tuned to blog as I try to address these.

  37. John P.  February 3, 2012

    Peter, I found your blong after Gary mentioned on his website. I am currently enrolled in undergrad majoring in Science of Nutrition and Dietetics. I first heard the method of low carb dieting from Dave Palumbo a former Bodybuilder turned diet coach. I myself am an avid resistance trainee. This sparked my intrest to the point I found Dr. Scott Connelly, founder of MET-RX who also believes in this philosphy and I believe has been in contact with Gary. Long story short I totally I agree with this notion of insulin control but am entering a field I believe to be misinformed. How can everyone be right when we have this epidemic of metabolic syndrome upon us? I would love for your input and am extremely excited to continue reading your blog.

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    • Peter Attia  February 3, 2012

      John, I guess I would say I DON’T believe everyone is right. In fact, I believe the formal dietary recommendations of the USDA, ADA, AMA, AHA, and NIH are actually wrong. Furthermore, I think there is no single factor that more explains the chronic state of unhealthiness that is afflicting our nation. We’ll need good people like you on the front lines, questioning the dogma and trying to use the correct information to help folks.

  38. John P.  February 3, 2012

    apparently I do not proof read very well :(

    (reply)
  39. Marilyn  February 3, 2012

    Something that comes through loud and clear to me is that you were able to achieve your impressive results not only because you had the motivation to keep going through the physical discomfort, but also because you had a teacher — a very good teacher — who knew exactly what you needed and what you should expect, and was there to support you all the way.

    Granted, achieving success with low carb is very small potatoes (ok, small cauliflowers) compared to the level of training you do, but in a very real sense, many people embarking on low carb could also use a good teacher. As it is, most people come to low carb armed only with what they’ve read in books and/or on the internet. Furthermore, many are not overly confident about this low-carb idea because they’ve also read on the internet how dangerous the Atkins fad diet is. So when they begin the diet and feel crummy, they bale. My hunch is that some will do some more reading and will gain enough knowledge and confidence to make it work at a later time.

    Looking forward to more of your posts.

    (reply)
    • Peter Attia  February 3, 2012

      Marilyn, you are so correct! I have a coach for pretty much every aspect of my life, including my life actually (yes, I have a life coach). I’m just obsessed with self-improvement and I don’t feel entirely qualified to oversee myself. I learn so much from my teachers and mentors. I hope to transmit as much of that as possible to others through the blog. Thanks for such a great insight.

  40. Elna  February 3, 2012

    Hi Peter
    Learned of your cite from Gary’s blog. I’m a 31 y.o who’s been low carbing for almost a year now. My question- I know you have a daughter, and am wondering if your daughter is off sugar and carbs?
    My other question: I don’t have children yet but am trying to conceive and hear that staying on low carb while pregnant isn’t safe. What are your thoughts on this and having young children on low carb?
    My main reason for not eating sugar and wheat is for health not weight necessarily.
    Thanks

    (reply)
    • Peter Attia  February 3, 2012

      My daughter (and wife) are not ketotic, but really do limit sugar. I’ll be addressing both your excellent questions in a post (currently on my “coming soon” list). Love that you’re concerned about this, though. Please stay tuned and I’ll try to address these before you’re pregnant. Promise.

    • Edmund Brown  February 7, 2012

      Elna,
      My wife was diagnosed with gestational diabetes during her routine pregnancy screening. She immediately went low carb and never had a blood sugar above 120 during her entire pregnancy, fasting was in the 70s and 80s (this is normal). Our son was born normal weight and shape. She also said her appetite changed dramatically after dropping the carbs, going from sudden severe pangs, to more gradual pangs of duller intensity. The nutritional counseling she received as part of the “care” advised moderation in all things including carbs. I for one am convinced she made the right choice in limiting her carbohydrate intake as strictly as she did.

  41. colby  February 3, 2012

    I don’t know which I’m more impressed with; your workout or that you pulled it all off listening to that atrocious music. Either way, I’m a 20 year type 1 diabetic and truly enjoy reading all of your information on ketosis and the benefits of that diet. I am currently trying to wean myself from 90% of carbs except those that come from fruit. Great post!

    (reply)
    • Peter Attia  February 3, 2012

      Colby, that is hilarious! Yes, the music can be…um, interesting…Glad to hear about your plans.

  42. Morgan  February 4, 2012

    Peter,

    Great post – great resource I can direct all those I know struggling through the transition to the low-carb lifestyle.

    I am curious as to the relationship between nutritional ketosis and inflammatory bowel diseases. I have both Endometriosis (and just had a laparoscopy 6 weeks ago with Stanford’s own Dr. Camran Nezhat) and Inflammatory Bowel Disease. I am 22 and have struggled all my life trying to find a menu that won’t upset my stomach, as most of my symptoms are gastrointestinal. I have a very irritable system, and have been given many recommendations as what to eat. As far as palate goes, I have always preferred meats, fats, nuts and cheeses; so, naturally, the low-carb life is a win-win for me. However, I have been eating a ketogenic diet for nearly 3 weeks now, and I am not able to find any GI relief. Do you have any advice or knowledge on inflammatory bowel diseases and a meal plan similar to your own? Despite my GI doctor’s advice to eat the “B.R.A.T” diet (bananas, rice, apple sauce, and toast), I have been weary to deviate from my ketogenic meal plan because I am not sold on the BRAT or liquid diet. I’m hoping that my body will adjust and start digesting the fats better, but have not been successful yet in doing so. Any advice you can offer is greatly appreciated. I really love what you and Gary are doing. I am eager to see the research that NuSci starts doing and hopefully participate in!

    Cheers!

    Morgan

    (reply)
    • Peter Attia  February 4, 2012

      Morgan, I’m sorry to hear of all you’ve been through at such a young age, especially. Like you, I see *nothing* good coming from the BRAT diet, and am not convinced by any evidence supporting it. I wish I knew the answer to your question, but unfortunately I do not for certain. I have some experience working with people with non-specific IBD (negative biopsies, negative for gluten sensitivity) who, within weeks, had complete resolution of symptoms with elimination of wheat. I would encourage you to experiment with different variations of your intake and, as best you can, please try to record as many “outcomes” as possible to better assess your treatment plan.

    • Marilyn  February 7, 2012

      Morgan, I don’t have anything like you have. I just have a garden variety cranky gut. But the very thought of applesauce gives me a belly ache. Prior experience would make it easy for me to skip the toast. (I’m fine with rice, though.) The meats, fats and cheeses you mentioned are my happy foods. So are eggs (sometimes I get complaints about pepper if I use it). For me, nuts are sometimes too “scratchy.” Wishing you the best!

    • Becky  March 14, 2012

      Hi Morgan,
      I was diagnosed with Crohn’s disease in 2009, and have since gone on low carb diet with success. In fact I have none of the symptoms of crohn’s anymore, am on no medications, and I can eat whatever I want. But back when I was having symptoms, I went on low carb and experienced increased symptoms. Then I discovered the soluble fiber Inulin. (not to be confused with the hormone Insulin) I took about 10 grams per day for quite a while until I hadn’t had symptoms for a long time. Now I do not need it at all. Your intestinal lining has been injured and you need to heal it. Inulin is a “pre-biotic”, meaning it is what benificial bacteria eat. In mother’s breast milk there is a type of pre-biotic called “trans galactooligosaccharide” that balances the intestinal tract. Somewhere along the line we upset this balance by eating sugar, taking antibiotics, etc…. which causes an imbalance and inflammation. You need to heal your intestinal lining before you can get rid of symptoms. Doing low carb by itself won’t help, I’ve tried it. You need to do the low carb and take the fiber supplements. I know it adds carbs, but for the healing it is essential. Then after you are healed, you won’t need the soluble fiber anymore. Hope this helps.
      Becky

  43. John K  February 5, 2012

    Peter – I’ve been on the ketogenic diet for 3 months and it’s worked very well. I’ve lost weight, felt better and have had improved performance in many areas of my life. I often can go for many hours without feeling hungry or being compelled to eat, which is wonderful.

    I was wondering if eating a higher calorie high fat diet might increase basal metabolic rates better than eating a lower calorie high fat diet. Do you have any evidence one way or the other on that?

    Many thanks for your blog.

    (reply)
    • Peter Attia  February 5, 2012

      John, there is probably a great deal of individual variation. The only thing I can really say is that empirically I’ve observed both. In other words, I’ve seen folks (like me and many other) who sustain weight loss at a higher calorie, but much higher fat, diet. Conversely, I’ve seen the reverse, where people sustain weight loss on fewer calories of high fat. In both cases, folks feel completely satiated. This is actually a question that can be and hopefully will be studied by NuSI.

  44. Anthony  February 6, 2012

    Hi Dr Peter. I cut out grains from my diet last December 1st. My only carbs were to be from vegetables, and maybe the occassional hit of berries. All of these symptoms you described when going low carb were never an issue for me. In fact I only felt better, never worse. Perhaps it is different for everyone, or maybe I made the transition the right way. My protein and fats went up exactly the same time as the grains were eliminated. Most of workouts are done pre breakfast or first meal, or prior to my next meal – that is, I have not eaten for the preceding few hours. It has never once had a negative impact on my workouts, so I agree that to have carbs is not essential for a high intensity workout. For Dr Oz to bail out after 1 day? If that is right, that is a pretty poor effort.
    Love the website.
    Best regards, Anthony – Brisbane, Australia

    (reply)
    • Peter Attia  February 6, 2012

      Thanks, Anthony. Yes, it is very different for everyone, which is why I get a but frustrated with the one-size-fits-all mentality of carb reduction.

    • Mike  May 9, 2012

      I also found low carb pretty easy to handle, until I tried to actually get low enough for ketosis. After 4 days of <25g/carbs I got pretty severe symptoms…extreme fatigue, nausea, fever, headache, sore kidneys, muscle aches and dizziness. I was just starting to test positive on the ketostix and wanted to tough it out, but had to quit. I just felt too sick and could barely walk around the house.

      I'd try again if I thought it'd be easier the second time around. Perhaps my fat intake was too low. For me there was a world of difference between say 70g and 20g of carbs in terms of comfort.

    • Peter Attia  May 9, 2012

      Sounds like you were far too low in sodium intake, actually.

    • Mike  May 10, 2012

      That does seem likely. I was taking 1-2 chicken stock cubes a day, but I may have started them too late in the process, or that may have been too little.

  45. DominiqueA  February 6, 2012

    Thanks again for your blog. I was wondering if you will be posting about reactive hypoglycemia. I have been following a low carb (20 grams) diet for a few months. I have noticed I hit a stall recently. I began testing my blood sugar and noticed that I would start in the high 80s/low 90s and then I would check my blood sugar after eating. My blood sugar would actually drop about 5 to 7 points (generally mid to low 80s). I recently changed my eating pattern to eat more often (still sticking to low carb)….I was just wondering if you have encountered this or if you will post about this issue. Thank you!

    (reply)
    • Peter Attia  February 6, 2012

      I wasn’t planning to write about this any time soon, but I have had some experience with it. If you are symptomatic, you should consult with your doctor.

  46. Dave  February 6, 2012

    I felt like I was in a state of chronic hangover for about a week. But I knew what to expect so I wasn’t discouraged, in fact I was motivated because I knew I was doing the diet correctly to hit these symptoms.

    (reply)
  47. Joseph  February 6, 2012

    Excellent work with the site Peter, thank you for your efforts.

    I recently was diagnosed as a Type 2 Diabetic. I have been following Mark Sisson’s Primal program for the past year so going vlc is not terribly difficult.

    One question I have for you is, I have read a lot lately about possible concerns linking low carb to adrennal and thyroid issues. What is your thinking on this? I obviously need to stay vlc regardless with my insulin issues but just was looking for your opinion on that issue.

    Tremendous blog, thanks again.

    (reply)
    • Peter Attia  February 6, 2012

      Joseph, I have not any credible evidence linking carbohydrate reduction/restriction to endocrine adrenal or thyroid issues. Keep up the good work on your VLC journey.

  48. Helga  February 6, 2012

    My biggest issue so far has been more social. I don’t like to be a pain when it comes to food, but I haven’t found a really easy way to tell people, “I don’t want to eat that”, without having to explain why for 30 minutes, and without seeming rude. Any suggestions?

    Just a note to Dominique… low 80′s is really not “low blood sugar”. I would agree with Peter if it causes low blood sugar symptoms there may be another problem, but most people don’t get symptomatic until it drops to into the 50′s. It makes sense to me that you would see a drop with eating since you secrete some insulin to help you digest the carbs and protein in your food.

    (reply)
    • Peter Attia  February 6, 2012

      Helga, you’re asking a great, and important question. It’s really a personal issue. For example, when someone has an allergy to gluten, for example, should they feel “bad” for refusing gluten-containing foods? I don’t think so. If someone with a peanut allergy came to my house, I would be very comfortable NOT serving nuts at all. As silly as this sounds, when I’m at a restaurant, I actually tell the server that I have an allergy to sugar, which allows them to help me scrutinize the food to be sure I’m not eating sugar (which seems to show up in most marinades and sauces). For most, this approach is probably too “extreme,” but it’s my body, right?

  49. Neil  February 7, 2012

    Speaking of people on a lean mean kick, I once read that when consuming alcohol one should stick to lean meat because dietary fat is more easily stored when your liver is turning the alcohol into citrate. So let’s say we’re at a barbecue, we should grab the chicken with our wine or whatever, as opposed to the steak or burger, which most of us would normally opt for (if we’re not opting for both). Any truth to this?

    (reply)
    • Peter Attia  February 7, 2012

      Hi Neil, I have not heard this before. To be honest with you, it doesn’t make great “biochemical” sense. The far bigger issue I would be concerned with is consuming sugar with alcohol. The reason is that ethanol (“alcohol”) and fructose (half of sugar) are both ONLY metabolized by the liver. The more you overload your liver with them, the more your body turns them both into fat and, ultimately, VLDL (LDL remnant). So if you’re going drink, do not consume any sugar with it.

  50. Krisna Hanks  February 10, 2012

    Peter,

    I greatly appreciate your work on this topic. There is an overwhelming amount of bad information out there and it’s refreshing to see brave souls speaking out with intelligence against the status quo. Bravo!

    While I understand the logic in wanting to demonstrate a herculean workout regime on the low-carb diet, I hope it does not deter individuals my age (middle-age) from giving the low-carb lifestyle a try. Also I think it’s important that individuals don’t get the idea that you have to approach food or exercise with an all or nothing mentality. As a former professional dancer I have seen my share of drastic diets and work hard these days to encourage a more nuanced lifestyle approach to others. That said, getting the message out is vital and I appreciate your efforts!

    My reason to write is simply that I have NOT experienced any side effects and believe it is because of a slow build-up process, which gave my body time to adjust.

    First I’m a 54-year old female, who still works out very consistently but not in an attempt to beat my personal best every day, I work out because I love it and want to be able to do it on a regular basis. My weekly routine is run twice a week only a mile or two, Pilates twice a week, kettle bells/weight lifting once a week and in the summer swimming and bike riding are added to the mix. Some folks would say this is not moderation but I am not flipping tires or doing what I would call extreme activities, just solid exercise that with the proper training most average, non-injured or handicapped persons could do.

    I have slowly with a relaxed approach been adopting the low-carb regime. I was greatly influenced a couple years ago by Gary Taube’s’ “Good Calories Bad Calories”, and from that point on starting cutting down on carbs. Nothing organized, structured or pre-conceived. No measuring, counting or notating, simply paying attention to my body and all its’ galleon of information. Mind you, as a former professional dancer I am highly sensitive and acutely aware of what makes my body feel good, achieve optimal performance and sustainability.

    My process over the last couple years has just been a slow, steady exodus of carbohydrates, until the last two months, my first experiment in what I feel is very low carb-restriction, not 100% abstention, but certainly low by US standards. Again I’m not measuring, counting etc.

    For example here’s what I ate yesterday:

    Breakfast: Handful of walnuts, half banana, couple scoops of full fat plain yogurt with a little bit of cream over the top. Espresso with half and half.
    Lunch: Omelet with side of homemade sauerkraut.
    Post-workout drink: Glass of chocolate milk
    Dinner: Stir-fry of kale, bok choy and sirloin tips. Glass of red wine.

    My point is workouts have remained the same without any real side effects. All the terrible side effects Dr. Oz or others have mentioned I have not experienced. It could be because I took a more nuanced approach to adoption or maybe have not been doing this very low ratio of carbs long enough. Time will tell, either way I feel great!

    P.S. I agree with a previous post, Sally Fallon and the Weston Price Foundation have some brilliant information out there!

    (reply)
    • Peter Attia  February 10, 2012

      Krisna, thanks so much for sharing this with us. Keep the awesome work.

  51. Don  February 12, 2012

    Peter, what a great post. I am a personal trainer and after much research I have had a big change in the way that I think and how I advise my clients. My goal is to truly help others and not let my ego or preconceived ideas get in the way of their success. Thanks for all of your insightful information.

    Don

    P.S. Have you heard of carbsane? She is a LC blogger and man she really does not like Gary Taubes

    (reply)
    • Peter Attia  February 12, 2012

      Thanks, Don. I’m glad you’re finding this helpful.

  52. Connie  February 13, 2012

    I don’t find it suprising that Dr. Oz felt terrible after one day of eating low-carb. I don’t have any specific information handy to site, but one can find plenty out there on gluten & its opioid effect. There aren’t, to my knowledge, any scientific or research to truly substantiate this, though. Going off of gluten (which is in most of what the typical American eats, including what’s hidden due to wheat derivative food additives) can cause withdrawl symptoms, including irritability & nausea. These symptoms can last for days or weeks–again, ancedotal evidence not research-based evidence. I personally experienced this for 3-4 weeks when I went GF to help manage autoimmune/Hashimoto’s thyroiditis. At the time I just thought it was being overwhelmed with making a huge life-style change. Much later I started finding information on gluten/opioid withdrawl.

    (reply)
  53. Clarence  February 16, 2012

    This is one of the best sites I’ve come across in awhile. Three years ago, I weighed 347 pounds, I was 20 years old and I was on the brink of depression. I lost eighty pounds on a Low fat high cardio diet in a year and a half, and gained back 40 pounds in 6 months, my total body fat % when I started was 46%, when I lost eighty it had shrunk to 34%, when I gained back 40 it had gone back up to 40% body fat. Which meant I had lost more lean body mass and put on more fat when I regained the weight.

    I had a horrible experience with Atkins when I was 14, I had a urinary tract infection and constipation, nausea, and dizziness. So, like you point out, like Doctor Oz did, I wrote off the diet as a stupid fad.

    After I found Gary Taubes Good Calories, Bad Calories, I began researching the low carbs in depth, checking out all the research I could find that he quoted, reading up on all the diets they recommend, and reading and researching the diets that attacked theirs. Eventually, I decided the science supported low carb. I jumped right in. The first two weeks I’d have to stuff myself with salads and broccoli to keep several unpleasant bathroom experiences from happening. I suffered vertical hypotension, one time, coming incredibly close to passing out, and collapsing to the floor and weight for the world to stop spinning. After two weeks however, all of these symptoms dissapeared. And after a month, I was able to start a vigorous body-weight lifting regimen.

    My body fat is down to 24.9 and I’ve dropped only 50 pounds (only 10 pounds lighter than I previously was on a low fat diet, and yet, nearly 8% less fat).

    I saw that Dr. Oz episode and the one thing I think everyone should also point out is that Dr. Oz stuffed himself. He ate more than he would ever eat, which isn’t health no matter what your eating. One of the most common sense things of a low carb diet is eating until your full and stopping.

    Thanks for this great site, really love it, keep it up.

    (reply)
    • Peter Attia  February 16, 2012

      Clarence…wow…THANK YOU for sharing this powerful story, which I hope others can learn from. Thank you, again, for sharing this story and congratulations on your journey.

  54. Eric  February 17, 2012

    Dr. Attia,

    You mentioned you would be posting information on exercise and the low carb hypothesis. In all of my reading thus far the low carb hypothesis makes perfect sense phisiologically until I apply it specifically to aerobic exercise. I am a phyiscal therapist and have had extensive exercise physiology in my training. I have been unable to reconcile the low carb hypothesis with body of research supporting carbohydrates as improving aerobic performance;it appears seems undeniable. Paradoxically, anthropological evidence seems to indicate otherwise as indiginous people around the world are able to chase down big game over miles while maintaining an almost zero carbohydrate diet. I will be glad to hear your thoughts and what you have found in the reseach in regards to this topic.

    (reply)
    • Peter Attia  February 17, 2012

      Eric, the best I can offer right now is a suggestion to check out Part 4 of my personal journey: http://eatingacademy.com/how-a-low-carb-diet-affected-my-athletic-performance
      Hopefully this gives some input I can do the topic more justice.

    • George  February 22, 2012

      I am a long distance runner and my running is so much better since I switched to low carb. I’ve never hit the wall and I’ve won the grandmasters award (first over 50) in many races. It is truly amazing what a difference eating low carb has made! I now plan to run 100 miles in the summer.

    • Peter Attia  February 22, 2012

      George, I’ve always felt that of call athletic endeavors nothing is more suited to ketosis than ultra-distance endurance events. Keep up the great work.

  55. Birgit  February 21, 2012

    Great blog! I hope Dr. Oz will see the light. Judging by the various topics he presents on his show he is looking for answers. Just yesterday he recomended 7 Keto and Forskolin on his show to encourage fat burning while eating carbs,LOL.

    (reply)
  56. Eating in Orlando  February 23, 2012

    That interview was like fingernails on the black board. Oz insisting on cholesterol test numbers…without discussing his own results! Or listening to the detailed reasons why test numbers are not the end goal of achieving health. On TV,there is never time for detailed thought. It has to be a sound bite.

    Taubes did post his test numbers, I would like to see Oz do the same. I don’t think he will ever follow up, just move on to the next topic.

    (reply)
  57. Sean  February 25, 2012

    Peter, you are much too kind to Dr. Oz.

    I found my way to your site by way of his show when I stumbled on his Gary Taubes show. When I saw the hatchet job he did on Gary, I bought Gary’s book, why we get fat. I just finished reading Good Calories Bad calories and Gary’s website got me to here.

    If I had no life, I swear I’d create a web site called The Dr Oz diet. Each day I’d add to the “diet” with the daily Dr Oz recommendations. Each show he has another list of “miracle natural fat burners” or “foods to reduce stress” or some other such nonsense that he peddles to his audience of sedentary housewives as sure fire ways to solve every problem under the sun.

    It would be impossible to follow even a weeks worth of recommendations with all the different things he insists we should be eating each day.

    He’s just interested in the ratings if you ask me.

    Anyway, Dr. Oz happens to be my pet peeve, so I thought I’d share.

    I’m a mountain biker who recently joined the low carb world so I’m interested to read your site and learn from your experiences.

    Thanks

    (reply)
    • Peter Attia  February 25, 2012

      Sean, like I said, I don’t know him personally, but I do suspect he cares. Perhaps the endless “miracles” are a symptom of a larger problem — frustration with the fact that conventional wisdom is failing many people in their quest to be healthier. Glad you’ve found the site. Hope you continue to find it helpful.

    • Sean  March 1, 2012

      Peter, thanks for responding. I can’t resist one more post on Dr Oz after I saw his show yesterday. He has a “Derriere Diet” he guarantees will get rid of women’s Butt Fat. The key component? Eat complex carbs. Here is the description from his web site:
      The Derrière Diet

      Surprisingly, a key element to losing butt fat is eating carbs. Because your butt is prone to storing fat, incorporating complex carbohydrates will be helpful. They break down slowly, giving you a steady stream of energy without storing fat. So if you add foods like whole grains and pasta to your diet, while keeping simultaneously your fat intake low, you’ll start to see results. Make sure to keep your diet restricted to no more than 275 grams of carbs, 150 grams of protein, and 34 grams of fat. Check out the sample meal plan below, full of protein and complex carbs, but low in fat, to get an idea on how you can succeed on the derrière diet.

      OK, that’s the last comment on Dr Oz, I promise. Great web site, thanks for giving us the benefit of your experiences.

    • Peter Attia  March 1, 2012

      Oh…this is interesting…

  58. Russell Holtslander  February 26, 2012

    I am A low carber who prefers Atkins Induction, and rarely go over 40 even when I up the limit. Most days it is 15-20 net carbs. I have congestive heart failure, so I am no athlete. Low carb has gotten me thru some rough medical years.. 2 ICD’s, a hernia, burst appendix, gout,diabetes, and last February a gullbladder( the easy surgery..lol ). Now after healing up, I recently started seriously getting back to the gym. I went a few times a week for the last few years when able, but just maintained( well, tried ). I started February 1st, and decide to experiment, and see if I could increase my lifts while doing low carb. I walk 60 minutes every other day, and the next is 30 minute walk plus 4 exercises. I chose bench press, lat pulldowns, triceps pressdowns, and barbell curls. I know I will have to add more variety, but I want to see if I can make gains on the same lift. I do 2 sets. Set 1 I do a weight 10 reps, and in set 2, I go to failure. If I can do 12 reps in the torso exercises I raise the weight 10 lbs., 15 reps for the arm exercises. I have made surprising increases over the past month. Some has to do with my depleted state from heart problems, but that is also a detriment too, so it balances out. Certainly no one is going to tell me I am only successful because I have CHF. I was actually starting to believe that I couldn’t gain muscle on low carb, which sounds absurd now, since I am eating 35-40% protein, the building block of muscles. When I stall, I am going to change up exercises, and add some sets as I get healthier, but it is nice to know the truth, and also know my capabilities. Seems a lot of people are just guessing at their health, and repeating popular statements, with no basis in fact.

    I think I am becoming addicted to your website..lol. Every article is almost identical to what I have experienced. I can’t stop reading. Someone feels exactly how I do. Are the others paid off? the results are all around us. I respect your stance though. Attacking them doesn’t help us get any healthier, and maybe they think they are doing good.

    (reply)
    • Peter Attia  February 27, 2012

      Thank you, Russell. I’m glad you’re enjoying it as much as I am.

  59. Connie Cj Jackson  March 27, 2012

    Wow, this is the first time I have read your blog, but I guarantee it will not be the last. I have been paleo for the past 4 months after having tried just low-carb or Atkins several times over the past several years. This is the first time I have not had the cravings I used to have and don’t even miss the things I don’t eat. I am, however, a cyclist. I try to ride about 100 miles a week in the winter, and 200 in the summer (Although admittedly there are weeks where I fall short) but I had been listening to the people telling me that I need carbs. I love cycling and it’s really the only exercise I have truly loved doing. I will read more of your blogs and gather information. So gld this is out there for people like me!

    (reply)
  60. TMouseNZ  April 17, 2012

    hehehe – showed my daughter (15) your tyre flips and she said “doesn’t he know how wheels work?”.

    Awesome workout – I like your trainer’s style :D

    (reply)
    • Peter Attia  April 17, 2012

      That is awesome! You can let her know I do not!

  61. samantha  May 4, 2012

    You sure have made great progress! How much have your lifts progressed over time? From your video, you are doing a 20kg kettle ball – what are your deadlift/squats now in comparison to before?

    (reply)
    • Peter Attia  May 4, 2012

      It’s relative. At 18 years old, 160 lb, I squated 495, deadlifed 505, and benched 275. Today, at 170, I’m a fraction of that. I don’t max lift. I rarely deadlift more than 315 or squat more than 250, though obviously at reps. But I’m no weaker than I was, say, at 35 years old.

  62. Zephir  May 7, 2012

    Dear Dr. Attia, Hello from Nova Scotia! I just love your website!! -I found your blog via Jimmy Moore’s website and I am thrilled. You simply “rock”! -I loved your post regarding Dr. Oz’s show and well, your workout kind of puts his idea of “no energy” to bed. I am so excited to be on this journey and as a “reversed” type II (altho’ I know better than to think my genes have reversed :)), I realize just how important low carb/high fat/moderate protein is to me personally. -I love being in the state of ketosis and while my weight loss is currently not budging (I need to shed about 30 lbs.), my body fat is melting off, inch-wise). I admit to easily slipping out of a ketogenic state in the past, through an occasional brew (not a low-carb one :))or french fries, but that’s over now. I recognize how even the slightest addition of a few extra carbohydrates causes me to leave the ketogenic state -or not eating enough fat…and therefore, sometimes it was purely by accident that I had derailed my own efforts…and of course, I would get discouraged and re-addict myself with carbs…and a vicious cycle repeated itself. Not anymore! I’m feeling the freedom I have more than ever before and I’ve learned so much about my blood glucose and body, that I’m not willing to negotiate my freedom for a piece of pizza or cookie, any longer. In Dr. Oz’s world, compromise is everything and when you’re literally hungry, even “royalty” such as himself may just say, “Let them eat cake”.

    (reply)
    • Peter Attia  May 8, 2012

      Wow, Nova Scotia. Don’t you guys have your own special time zone? I used to date a girl there. She was FOUR AND A HALF hours ahead of California time! Keep up the great work.

  63. Zephir  May 8, 2012

    Thrilled you wrote back! :) -Thank you, Dr. Attia-it’s not like I think you don’t have much to do! :)) One could say that “time stands still here in N.S.”, as the pace is pretty peaceful. I am a Mom of 4 great kids (11-16) and they are so amused, watching me dancing around the room after doing 2.5 miles on the track with a 17 lb. vest on and then vigorously dancing for a straight hour, before I do 3 more miles via video tape after I eat. For me, with fibromyalgia on top of my metabolic “nuances”-the camoflauged type II, I have to tell you, I have accomplished a great deal in about a year. I could not move like this last year; in fact, it was difficult to get out of bed due to pain in the night and getting up tired (still happens, but..). -I still have the sore hip/upper back/lower back issues, but since I was not getting any better doing less exercise, (i.e. the pain is always ‘just there’), I had decided that I would work through the pain, something very akin to what you said when you are challenged at the height of your exercise. Dr. Attia, I am barelling through this pain (medication-free, give or take an occasional tylenol) and I am noticing that the pain is lessening or if I get “shots” of pain in the hip/buttock/neck area at night, I at least feel strong enough to deal with it. I remember reading Dr. Richard K. Bernstein’s book regarding type II diabetics and a little known fact in the diabetic world, that they often experience “glycation of tendons”. For this reason, the label “fibro” is attached to their siezed up condition, due to a blood sugar roller coaster that literally hardens tendons; ergo, why many diabetics complain of severe leg/tendon pain. -He has some sort of vacuum extractor in his office to actually help the most severe cases (and believe me, there was a point where I was willing to fly to Mamaroneck to use it! lol). However, the stable blood sugars seem to be helping the side leg bands loosen which is helping me to do little intervals of running, even. I also want to tell you that yesterday, at 16 grams of carbs. in total, I finally now see a light pink showing up on the urine strips that I use! It seemed with more calories (i.e. 2100 verses the 1600 I was consuming), I have an easier time to get into ketosis and also, I dropped a pound too. So…as you can see, I am keen to do this and I truly thank you for this amazing site, your dietary examples (can’t wait to make your wife’s ice cream for my hubby & kids!-My kids eat the way I do, except for the 16 year old :), but more importantly, your living example. You are helping so many people…Sincerely, Mary

    (reply)
  64. Erica  May 8, 2012

    Dr. Peter,
    I do fuel my kids with my carbs. Son is 14, 5’11″ and 115lbs. Daughter is 11, 4’10″, 67 lbs. They both turn 12/15 on Aug.3. I am doing my best to limit the sugar, but the youngest one had severe liver disease as an infant, recovered and has never tolerated fat! She is my sugar hound..craves it all the time. When kids are growing, does the sugar cause them damage to their arteries like adults? I am definitely worried.
    Thanks,

    (reply)
    • Peter Attia  May 8, 2012

      Erica, I’ll be doing a post at some point specifically on this topic. In the mean time, just limiting sucrose (table sugar) and high fructose corn syrup and liquid fructose (e.g., fruit juice) is a great start.

  65. Karen  May 17, 2012

    Thank you for all the great information in your pages. I just wanted to tell you I think that (among other things) you may have put me back on the bike. I was eating low carb and not getting through my rides at all, and so gave it up and gained the weight back. It is harder to be a cyclist at a higher weight, so the whole cycle (no pun intended) has been incredibly frustrating for me. But maybe chicken broth will fix this. I hope so, I’m going to try. I have very low b/p already, carb or no carb I rest around 104/64 most days, so it seems to me additional sodium could easily be a big help.

    I am 51, pre-menopausal, although I have had a hyster (kept ovaries), so there’s surely lots going on with hormones. But this should definitely be an improvement I had been making broth anyway from organic locally raised chickens.

    Many thanks, I’m feeling hopeful about this summer cycling season.

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  66. Richard  July 3, 2012

    Dr. Attia

    I thought about this post of yours for a while, and then it struck me why this post was so significant, in terms of Dr. Oz and you, and a low carb diet. It isn’t exactly that Dr. Oz didn’t work hard or work hard enough, although obviously he didn’t.

    No, the point is that he felt bad after one day, essentially immediately upon undertaking the change in diet. What he failed to recognize is that he was experiencing something akin to, or similar to, a withdrawal from a drug of some sort. It was his body demanding more carbs, wasn’t it? That should have given him a clue about what he was dealing with. That is, if carbohydrates are just another food, or if grains, probably mostly wheat, are just nothing and so neutral, in terms of human consumption, why did he get the the painful and difficult reaction?

    That is, after all, part of the equation we are dealing with, although I think the idea of food reward is a little misleading, and perhaps misguided.

    It’s not just food reward, it’s a dependence on a certain type of nutrition. Now, how we get from just having a few carbs, probably contained in a sweet potato type of food, to stuffing ourselves on pasta with delicious (who can deny it?) pasta sauce, that is another issue. But it’s real enough.

    Dr. Oz was possibly too busy to be self-aware enough to recognize the problem or issue he was experiencing at the time. But the sensation he had is not so uncommon. The amusing part is of course that everyone agrees the reaction to the low carb diet is distressing at first. Dr. Oz could have known that, and had a better grip about what it meant.

    (reply)
    • Peter Attia  July 3, 2012

      Yes, it’s a shame when showmanship trumps honesty.

  67. Scott Janicola  August 13, 2012

    Hi, Dr. Attia. A friend of mine turned me onto your blog yesterday. I perused some of your posts and I’m intrigued. I’m an open-minded triathlete and have subscribed to the 50-60% carb diet especially when training volume increases and I’m in full blown race season. When training/racing I consume an electrolyte rich drink (EFS) on the bike along with golden potatoes/Honey Stingers/Clif Bars/… Pretty standard, I’d imagine.
    Naturally, training volume and race distance (sprints through full distance triathlons) demand different fueling requirements.
    Is there a protocol that I can test drive/experiment with along with a detailed plan for implementation for daily and training nutrition?
    Also, do you have a “Reader’s Digest” version of your philosophy to get my feet wet in your philosophy?

    Thanks so much.

    Scott Janicola

    (reply)
    • Peter Attia  August 14, 2012

      Scott, welcome aboard. Not really sure which of my posts would the “RD” version. Probably depends on which concept you’re looking for. Perhaps others can weigh in.

  68. Mary Ann Delaney  August 22, 2012

    Hi Peter!

    I have been catching up on your writings.
    I came upon this and it really struck a chord inside me. “Today I walk around in a state of complete oblivion to the foods I know are bad for me.” I have been trying to verbalize this for quite some time and your words hit the mark. The way I was saying it was, “I don’t eat anything that hurts me.” I am happy to have another way to express exactly how I feel. Thank you so much.

    (reply)
    • Kim  September 18, 2012

      Hi ,
      I feel really silly.. as I am new to this Blog and website.. I have been searching and searching for the information on the zone of misery… as I think I am in it.. and I want to get out of it… I also do not know how to email Peter.. can anyone help me?
      Thanks
      Kim

    • Peter Attia  September 19, 2012

      I’ll try to get to this topic in the next few months.

    • Perry  September 19, 2012

      Kim,

      I have not found much written about the ‘zone of misery’. I’ve been doing a ketogenic diet for the last four months and have struggled to stay in ketosis. I feel like I’ve been in some version of the ‘zone of misery’ a couple of times.

      What does your ketone meter read when you are feeling bad? I believe Peter’s standard is that you need to be 0.5 or greater to be in ketosis. When I was feeling down, my meter readings were 0.1 or ‘low’ even though I was eating low carb (apparently not low enough).

      To get back into ketosis, do the things discussed elsewhere on this site to get into ketosis…reduce carbs, reduce protein, you may well need to reduce dairy.

      Everybody’s biochemistry is different, so you’ll need to experiment to find out what works for you.

  69. Jared  September 20, 2012

    Hi Peter,

    During my trials in ketosis, I play tennis, I noticed a few things. During the first hour, I felt normal. The second hour I was feeling quite good and even more energized than when I started. The third hour I felt like I was on cloud nine with a huge amount of energy. I am curious if you experience these sorts of things in your experiments. Is this a rise in ketone production in the body? Any way to replicate this for the beginning? Coconut oil perhaps or more time in a ketogenic state for the body to learn to produce more ketones at the beginning?

    Also, do you do a specific lifting plan or different everyday? Appears very crossfitish in your dryland lifting.

    Thanks,
    Jared

    (reply)
    • Peter Attia  September 21, 2012

      Yes, you’ve hit on a great observation that I do experience and many folks do, also. MCT oil may speed this up, but it needs to be weighed against the potential for gastrointenstinal symptoms. I do this kind of training 3x/week in the swim season and 2x/week in the cycling season.

  70. gm  October 22, 2012

    Hi Peter — I’ve always wanted to do tire flip/prowler pushes, it’s so cool that you have a gym that lets you do that. Remember to attack the zipper on your kb swings!

    1. I’m in either ketosis or non-ketotic low carb. I know it’s one of these two because I’ve kept trace carbs under 30g for ten days and I definitely experienced keto flu. Your tip about NaCl supplementation was an absolute lifesaver. Do you remember if Stanford Med School had faculty/staff that studied ketosis? I’m a student and I’d like to do some B-OHB testing to see how I respond to resistance training and food.

    2. As a vegetarian, I get protein from dairy. I understand that this may inhibit fat loss, but I don’t understand why and I’m having a hard time finding literature that explains this effect. Is it because of the propensity for insulin spikes?

    (reply)
    • Peter Attia  October 22, 2012

      I don’t know anyone at Stanford that is measuring this. The device to measure it (under my books and tools section) is practically free, and the strips (if you follow the link) are about $2-3/each.
      The dairy question is a tough one, and I don’t think we *know* the answer. It could be insulin, but it could be something else.

  71. gm  October 23, 2012

    Thanks so much for your response! I’ll follow your lead and ask for the B-OHB tester for Christmas :)

    (reply)
  72. Eduardo  November 8, 2012

    Interesting article, I’ve been myself on ketosis for a few months (at least trying to be). I try to stick to an almost all meat diet but I do eat a few vegetables. This is actually an issue, since I get some heat at work and from friends about eating exclusively meat. My energy levels are much better of course and I rarely nap during the day anymore. I actually didn’t find it hard to make switch to ketosis. How much carbs does it actually take to go off ketosis?after I’ve had some beer, cake and a bit of carbs (mostly due to peer pressure) sometimes, even for a few days, and I don’t find that it has impacted much my goals of fat loss. I find that sleep is really important for fat loss. So you never take anything for recovery? According to Lyle McDonald if you take carbs after training if replenishes your glycogen stores and doesn’t get you out of ketosis. This hasn’t impacted your training performance?

    (reply)
    • Peter Attia  November 8, 2012

      No, I do consume some carbs post workout. Most often nuts, or Superstarch, or veggies.

  73. Michael  January 9, 2013

    Peter, what was wrong 3 weeks into your 12-week experiment that made you want to abandon it? And what did you do to break out of that — just let your body adjust over weeks or months?

    (I personally did great my first few days of ketosis, but now a week later, my legs feel like lead.)

    (reply)
    • Peter Attia  January 9, 2013

      I wasn’t getting enough (i.e., supplementing enough) sodium, and I was over-consuming protein –> Very lightheaded and lethargic.

  74. Eric Reichwaldt  January 24, 2013

    Peter,

    Let me start by saying your site has led someone who averaged reading 1 book every 3 years to reading 4-5 of your articles every night, as well as a few chapters in several books on nutrition and exercise, and for that I thank you! One of the books that through an incredibly round-about way led me to your site was “Body By Science” by Doug McGuff. I was curious if you had heard of it or read it, and if you have ever done self experimentation with it? I am going to be doing my own self-experiment with trying to sustain keytosis while doing McGuff’s once-a-week high-intensity protocol and measuring my gains.

    (reply)
    • Peter Attia  January 24, 2013

      First and foremost, that’s great to hear, Eric. It suggests you are becoming more curious. That’s one of the most important human traits, in my opinion. I know the book you’re talking about, though I have not read it. Should I?

    • Eric Reichwaldt  January 25, 2013

      I have found it profoundly interesting, and I think you should! Being that your an endurance athlete, it won’t help you much in that realm. But as far as your “dry-land” training goes, the concepts presented could allegedly provide you all the results you’re looking for, with minimal time given maximal effort. I can’t personally attest to the validity yet, but as I mentioned, after my Air Force fitness test is out of the way at the end of the month, I plan on devoting 8 weeks to strictly following Dr McGuff’s “Big 5″ workout and tracking my progress. I would love to hear your thoughts on the book if you get a chance to review it.

      BTW, I have been eating low carb for just over 3 weeks now and only learned of keytosis last week in “The Art and Science of Low-Carb Performance.” After reading about the regime used to reach the keyto-adapted state, I began reviewing my food log and started wondering if I had already achieved this without intentionally setting off to… I haven’t been hungry in weeks, I’ve lost 18lbs in under a month, and I seem to be full of energy (much unlike my other periods of weight loss), and the only negative was I felt eerily winded after a metabolic conditioning workout last night (which was primarily anaerobic). So curiosity got me and I ordered some urine test strips, and sure enough, this mornings keytone level was somewhere between 1.5 – 4, but closer to 4! I am running my 3rd marathon in May, and I’m hoping keytosis and superstarch, paired with my training, can help make it my best!

  75. luis  January 27, 2013

    Hi Peter,
    I was wondering if you could expand on your comments made on point #2, specifically with respect to the myth of “the necessity of carbs to “spike” insulin to drive amino acids into muscles”.
    I see that statement in just about every muscle building magazine and website (www.muscleandstrength.com is one I read a lot).
    They all recommend that you need to spike your insuline in order to absorb glucose, (from the intake of maltodextine or dextrose) and amino acids into your muscles during and after a heavy workout.

    You mentioned all the studies you have read that defend that claim are flawed. Could you go into more detail (maybe even with some biochemistry as you have done for the cholesterol series) explaining your point of view and why you disagree with the standard “spiking insuline is good during heavy lifting” mantra?

    Thanks and I enjoy reading your posts.
    Luis

    (reply)
    • Peter Attia  January 27, 2013

      All evidence I have seen suggests that as little as 25 gm of protein immediately post work-out leads to excellent muscle synthesis. Certainly that will produce a rise in insulin, especially if using something like hydrolyzed whey. I have seen evidence that you need simple carbs to spike insulin to drive hypertrophy or anabolism. I’m not saying it’s not so, but I haven’t seen great evidence for it.

  76. Philip Washlow  April 5, 2013

    Peter,

    Your blog is fascinating, I agree with everything I have read so far and believe that NUSI is going to save the world (dramatic I know). The only thing I have to say (as a certified CrossFit coach) from watching your video of working out is be careful of your knee positioning. It is understandable for form to break down on heavy tire flips performed at a fast pace but from watching your deadlifts it looks like your right knee is tracking pretty far inside of your big toe. I understand that watching a few lifts doesn’t constitute understanding someone’s movement patterns but with the ridiculous number of ACL injuries (which are nearly all preventable) any chance I have to cue someone to externally rotate and track their knees outward I make it a point to do so. Thank you for all that you are doing for the world by trying to introduce no-nonsense research about nutrition.

    (reply)
    • Peter Attia  April 7, 2013

      Thanks, Philip! I’m always appreciative of any feedback. I’ll be flipping the tire and doing some heavy squats later this afternoon, so I’ll be sure to watch for that.

  77. Kelley  April 28, 2013

    After reading Why We Get Fat, by Gary Taubes, I realized that I needed to become a more rigorous thinker (and, by extension, a more critical reader). That’s really what it’s all about. Your blog challenges me to do so, Peter, as well as Gary’s and a few others. (Thank you for that.) Do you read Sam Harris, renowned (and outspoken and controversial) atheist? I’m not sure I’d call myself an atheist (I’m more agnostic), and I don’t know if I agree with everything Harris says, but, damn, he can construct an argument. Yet he manages to avoid bullying, unlike other atheist writers. I find it extremely valuable to follow his reasoning on many topics. Anyway, you and he challenge me in similar ways, interestingly. I guess it comes down to questioning conventional wisdom.

    (reply)
    • Peter Attia  April 28, 2013

      Well, that’s a real skill and something we should all strive for, regardless of position — being able to argue a point with facts, and not resorting to authority or attacks.

  78. Kelley  April 28, 2013

    AND, as a lifelong dancer (and a longtime Jazzerciser, which obviously isn’t nearly as rigorous as tire-flipping or CrossFit but is still a very effective workout), I would agree with Philip about making sure your knees align with your middle foot (or at least your big toe) during exercise. Cheers!

    (reply)
  79. Mike G  May 17, 2013

    After extensively reviewing your work, which I tremendously appreciate, I am making an effort to get as low a count of carbs as possible. I eliminated simple carbs a few years ago and lost ~100lbs in ~9months. However, I was calorie counting and cut back on fats. Thus I was taking in a fair bit of complex carbs. I regained a bit in the last two years. Thus I am redoubling my effort to get to the weight I was at or lower. My first passion is cycling. I always thought I needed simple carbs for fuel while riding, a carb loaded electrolyte drink like GU and gels, shots or blocks. However, since severely restricting all carbs over the last three weeks I’m finding I need to eat less while riding and my performance doesn’t suffer so much. I’ll go for a 4-5 hour ride (or more) on the weekend. However, I’ve only brought simple carb things while riding. My thought process was that I’ll burn it off. It didn’t really enter my thought process that there was other fuels that my body can use (fats and ketones). So if I understand correctly consuming simple carbs even while endurance exercising may not be the best choice while maintaining a low carb lifestyle. What kinds of foods would you recommend? Later this year I’ll do a 8 hour (for me) supported ride. However, the foods provided will be carbs for sure. I suspect I can not do a ride like this w/o eating. So my question is what would be good choices for fueling endurance exercise while transitioning/maintaining to a ketonic diet. OR How do you discover/expand your limits w/o bonking in the middle of nowhere, a very unpleasant situation…

    (reply)
    • Mike G  May 17, 2013

      Found it on your site… UCAN

      A slow release carb source that minimizes insulin spikes and allows me to better utilize my fat stores as a fuel source! :-) I’ll try some soon…

  80. Logan Quinn  August 13, 2013

    “if we want to grow (by “grow,” of course, I don’t mean in girth, but rather in “personal evolution”, for lack of a better term).”

    But you are not lacking in better terms. Better words than grow/growth are “change”, “progress”, “mature”, “adapt”, or “evolve”.

    Out society is obsessed with “growth” as a positive notion. To me it’s a swear word, worse than George Carlin’s expletives as it is far more insidious, worming itself into our subconsciousness. Our culture, our businesses, our institutions, and our governments are so focused on growth. Growth is a cancer that is weakening our economy, our environment, our national security, and even our health.

    I found this page upon researching you after seeing a couple YouTube videos of your talks. I’ve had the same question you’ve presented for many years. Maybe people are overweight because of any number of underlining illnesses or injuries and obesity, diabetes, heart disease, etc are the resulting symptoms. I think the solution is to go back and fix whatever was broken in the first place, and then with the results of your research, nurse people back to health. But the current medical paradigm doesn’t seem very interested in taking this approach, they just keep prescribing drugs to treat the symptoms and have no time to try and figure out what’s causing them, and even the insurance companies don’t want to cover investigative testing. I could go on but I’m going to end my rant now and thank you for pursuing truth in medicine.

    (reply)
    • Peter Attia  August 13, 2013

      Thank you, Logan. Appreciate your take.

  81. Colin  September 21, 2013

    Peter,

    Where did you buy the shirts that said “Moderation: The Only Thing I Do In Moderation”. I am exactly this way and really want that shirt.

    Thanks!

    (reply)
    • Peter Attia  September 21, 2013

      I had 10 made for me and few swim teammates who shared my philosophy.

  82. Tristan Diggs  October 4, 2013

    Hello Peter, I have two questions for you regarding strength gains and diet . I have been following a keto diet (i.e. high fat, low carb, medium protein ) for the past 3 months. I have been keeping my fat high with carbs below 50 grams a day and protein at about 1.5 grams per kg of body weight. Is there any advice you can give me on structuring a keto diet for maximum strength building? Also, are you aware of John Kiefer’s CarbNite Solution for quick fat loss and body recomposition, I am interested in your opinion as to whether or not this would optimal for building strength and fat burning.

    Thank you very much and I appreciate your response.

    Sincerely, Tristan Diggs

    (reply)
    • Peter Attia  October 4, 2013

      Tristan, I have read his e-book, though I’m not sure I am convinced of his logic. It could be right, but I’m not sure I agree.

    • joseph yang  February 24, 2014

      Tristan are you still doing such a keto diet for strength training? how are your results?

  83. Richard  October 23, 2013

    Am 85 with 84 yrs of sedentary life. Your material and Taubes enthrall me, but the technicalities are mostly above my head. I am being counseled by a professional “diabetologist/lipidologist” who would have me severely limiting my salt and saturated fat. The latter I can refute but the matter of sodium leaves me confused. Would you
    have any comment about Taubes’ recent article “Salt, We Misjudged You” and the vicious refutation by the venerable Michael L. Jacobsenon, Executive Director, Center for Science in the Public Interest (http://www.nytimes.com/2012/06/06/opinion/salt-in-your-food-the-effects-on-health.html) ?

    (reply)
    • Peter Attia  October 24, 2013

      Richard, the Institute of Medicine recently released a report saying the evidence for sodium reduction was poor and that it may be harmful. Obviously, this did not sit well with CSPI. In reality, though, I suspect there may be some subset of people — perhaps those with impaired renal function — in whom sodium restriction is an acceptable strategy for managing elevated blood pressure. I expect to see this addressed scientifically in the next 3-5 years.

  84. Matt  December 5, 2013

    Hi Peter,

    Thanks for all the knowledge and information you put out. Please could you clear up something for me. Im in my first week of LCHF and would like to clarify if I need to deplete my current glycogen stores before ketosis will begin? I understand there is a 2-3 week period of adaption, will exercise ( and thus depletion of glycogen stores ) speed this process up? On my recent runs my legs have been very “heavy”, is this due to lack of glycogen and not being adapted as yet? Thanks so much, Matt

    (reply)
    • Peter Attia  December 5, 2013

      Not really, but it’s more complicated than I can really explain quickly. Glycogen stores will never be fully depleted. Probably 30-40% only.

  85. Ed Palermo  December 5, 2013

    Peter,

    Recently jumped into carb restricted world to cure my carb/sugar cravings. Though I have always been athletic and exercised moderately I have never been able to lose the 10-15 pounds I put on after college, which included playing running back for my Universities football team. No one looks at me and says “overweight” but I know that 185-190 range is too much for me – 5’11″. Also, while my lipids are all good and resting blood sugar is 86, my dad died from a stroke and was type 2 diabetic so I was looking for a way of life to head off that potential future. I have done my research and decided to begin an Atkins induction type approach. An example day would be eggs and bacon, lunch of burger, no bun on bed of greens and dinner being leafy salad or non-starch veggie (spinach usually) and a steak, chicken or fish. I have been good at avoiding all extraneous carbs and have had no sugar. Felt great for four days… no induction flu. Better yet, no cravings and greatly reduced digestive symptoms. Also, had vivid dreams and woke up early feeling energized. All GREAT so far.. On day four though, I awoke around 1 am with a pounding heartbeat and feeling extremely anxious. Not craving any food but very nervous. I was able to relax only after getting up and reading for about an hour and having a slice of whole grain bread. Since then it has been happening regularly, always at night and I start by sleeping restlessly and then waking up with terrible anxiety. I would hate to go back to my old style of eating which would include far to many carbs and sugar- pizza, ice cream cake and plenty of bread products. Any advice would be greatly appreciated.. Also,I think it might be important that many of my previous carb heavy meals were at dinner which would invariably be followed by a sugary dessert- could this have caused my body to “expect” this abrage of carbs at night? Is it maybe why my problems wake me in the middle of the night but seem to have no effect during day? One more thing, I take bullion 2x’s per day and have been supplementing with a multi, potassium 99, and magnesium… Thanks again

    (reply)
    • Peter Attia  December 9, 2013

      Ed, it’s impossible for me to troubleshoot via a blog, but in my experience a subset of people transitioning to very low carb intake go through a transient period of sleep disturbance. You may try eating something high in fat and protein before bed (e.g., a piece of cheese, a spoon of almond butter), though obviously I’d need to know much more to have a better idea.

  86. joseph yang  February 24, 2014

    hi Dr Attia, i saw your reply on your lifts at age 18. They are definitely impressive for a 160 lber at 18.
    would you mind answering more questions? You’ve made some interesting insight on ketogenic adaptation being able to perform anaerobic, (in your body at least). However is it more less or more effective than say, a more balanced diet? Most anaerobic athletes still swear by high protein with moderate carbs. You’ve definitely provided alot of supporting evidence that ketogenic could be great for endurance athletes.

    Anyway, at 18, what was your height, body composition, and macronutritional diet spread? How many years of training did you train for strength, hypertrophy, or maxpower up to that point, and when did you stop?

    now as an older adult, you’ve been prioritizing endurance, so no doubt your strength is nowhere near its potential, though it’s still not bad. I wish we could clone you now, and put one Dr Attia on ketogenic, the other on a balanced, and fastfoward 4 years and see which one gains strength better. What do you think, do you think ketogenic can match and possibly even overtake a balanced diet for strength and hypertrophy? (at least in your body).

    a little about me: i am opposite body type of you. I am naturally super skinny, at 5’9″ my untrained weight is probably around 130lbs or less, (i’m male). I’m 155-160 now, 8-10% bodyfat, and fairly strong, after many years of strength and hypertrophy training on a highprotein, moderate carb, low fat diet. I believe my frame was shortchanged, as i didnt get enough calcium as a child, and also was on very high protein diets. I read the blog on what your daughter eats, and i think our philosophies on childhood nutrition coincide, at least i approve what your daughter is eating. Thus for me, gaining fat is never a problem, (unless my prednisone dosage climbs up, and my Cushing Syndrome takes over, another story), gaining muscle is very difficult, so i dont cut carbs, for the insulin anabolic effect. I am willing to try ketogenic though, for strength training, maybe not in the near future, but you’ve got me interested.

    (reply)
    • Peter Attia  February 25, 2014

      At 18 I was probably 55-60% carb, 20-25% protein. I was 5’10″ and based on calipers about 5% body fat. Waist was 28″ and chest was 42″. I trained 6 hours per day, 6 days per week from the age of 14 to 19. Of course, none of this pertains to me anymore…

  87. Mike  May 2, 2014

    Hey Peter,

    just fyi: There’s a famous Mark Twain Quote that you might like:

    Everything in moderation, including moderation.

    :-)

    P.S.: I’m using ketosis as a weight loss tool – so far it’s working great. Thanks for being one of the greatest sources of info on ketosis on the Internet!

    (reply)
  88. Phil  May 9, 2014

    Very interesting article Peter. How about gaining muscle in ketosis. Is it possible?

    I’ve seen some respected authors say that it’s close to impossible: http://crackingthemusclecode.com/low-carb-diets-and-building-muscle/?ref=1368

    Is this mythology also? Thanks in advance.

    (reply)
    • Peter Attia  May 9, 2014

      Possible, as demonstrated by a Volek study I’ve referenced elsewhere, thought not ideal diet for maximum hypertrophy phase.

  89. Jillian  May 15, 2014

    Peter,
    I’ve been struggling with the motivation to lose my last 15 lbs/lean out for my upcoming wedding, this post is exactly what I needed to read. You do an amazing job with your writing and research. I’ve used deep ketosis as a weight loss tool in the past and will be using it soon to attempt to reach my goal! I have been searching for info on anaerobic activity while in ketosis, I would love to continue my resistance training and sprint sessions sans carbs. Thanks for the motivation and the information! :)

    (reply)
  90. Marshall  May 16, 2014

    Hi Peter, this is my first time running across your blog. I actually got here from a post you made about overcoming absurd levels of back pain (something I am a little too familiar with, albeit on a decidedly lesser scale than yourself).

    Both posts impress me – I appreciate your thoroughness. This is what leads me to take the time to ask you for clarification on your claim that:

    “The notion that you can’t do high-intensity exercise without carbohydrates is simply and categorically false. Everything about this myth is false – the necessity of so-called “carb loading,” the necessity of carbs for glycogen production…”

    I am a huge proponent of nutritional ketosis. I evangelize it nearly every day. Yet, I have not heard the claim made that you absolutely do not need carbs to perform high-intensity exercise. I suppose this depends on how you characterize “high-intensity”. It is my understanding that one cannot perform above 85% of one’s 1-rep max without the use of glycogen; fast-twitch muscle fiber cannot provide maximized output using FFA or ketone bodies alone.

    I primarily refer to research presented Lyle McDonald’s “The Ketogenic Diet” – with which I am sure you are probably quite familiar. To what evidence do you refer that would indicate you need absolutely no carbs whatsoever? I generally stick to a TKD, and carb-load with 30-35g of medium-high glycemic carbs before a workout.

    Trust me when I tell you I would love to be wrong! If you get the time, I would appreciate any response you could provide on the matter!

    All the best,
    -Marshall

    (reply)
    • Peter Attia  May 16, 2014

      Agree that you need glycogen and creatine phosphate to do these activities. My point is that you don’t need copious quantities of CHO to achieve that. Even in NK, taking in 20-30 g of CHO per day, one can still maintain two-thirds the glycogen stores of a person eating 10x that.

  91. Martin Williams  August 24, 2014

    You’re such a god guy, Attia. It’s your stuff, rather than Noakes’s, or anyone else’s, that’s going to change the world.

    (reply)
    • Martin Williams  August 24, 2014

      Typo: You’re good, but not, I think, a god.

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