The personal blog of Peter Attia, M.D.

The insulin response (video)


(YouTube link:

This video is part of the interview I did for Open Water Source, but most of what I talk about will interest non-swimmers and non-athletes. (See the rest of the videos in this series.)


Open Water Source: In simple terms, can you describe the insulin response?

Peter Attia, MD: Sure. Insulin is a hormone secreted by an organ in our body called the pancreas. It’s the only organ that can secrete this hormone. The pancreas sits in an area called our retroperitoneum. It’s behind our stomach. This is probably the most important hormone when it comes to how we digest food, take food into ourselves, and how we regulate fat.

When you eat something, it will stimulate insulin to varying degrees, depending on what’s in it. Carbohydrates stimulate insulin more than any other food. And even within carbohydrates, there are different amounts of insulin stimulus that result form it, depending on the simplicity of them. Proteins also stimulate insulin, but to a much lesser degree. And fat doesn’t stimulate insulin at all.

So, here’s how it works. Let’s say you take a bite of your Corn Flakes. Those Corn Flakes get into your stomach. As it exits your stomach, it enters the first part of your bowel called the duodenum. And all of a sudden, it starts to get translocated and it starts to get absorbed into your bloodstream. So now, we have to get it into the cells of your body. That’s where you need that glucose.

How does it get there? Well, that’s how insulin enters the equation. As sugar levels in your blood… And I’m going to use the word “sugar” and “glucose” interchangeably. I apologize for that. Glucose is a very specific type of sugar, and most people, when they hear the term “sugar” they think about table sugar. If I’m ever referring to that, I’ll make that point clear. But nevertheless, this glucose or blood sugar needs to now get into a cell. The pancreas senses this, and it secretes this hormone called insulin.

Insulin is a large protein, or what we call polypeptide. Insulin gets into our bloodstream, so it’s systemic. And it interacts with cells that have receptors for it, and those cells have an insulin receptor. When that insulin peptide protein hits that receptor, it sends off a cascade of events inside of the cell. The most important part of that is it shoots something called a GLUT4 transporter. It’s just a fancy word for a channel, which inserts itself in the membrane of the cell and allows the glucose to enter the cell.

Open Water Source: And we need the glucose for energy? That’s what creates the energy in the cell?

Peter Attia: Glucose is one type of product that we use to generate energy. That’s correct. And here’s the problem. When you don’t have insulin—and some people may have heard of a condition called Type I diabetes or juvenile diabetes, this is a condition where you have an autoimmune response and your immune system attacks the cell of your pancreas that makes insulin. It’s called a beta cell. When people find themselves in this situation, what happens is they continue to eat food and they continue to have blood sugar accumulate, but they can’t get it into their cell. So they effectively starve by not being able to have the glucose in their bloodstream getting to their cells.

Open Water Source: As an athlete, or just a person who wants to be fit, I’m thinking I want to use my fat per energy, because everyone has told me that fat is the best energy source I can have for sustained activity. What does insulin do to my ability to use fat as energy?

Peter Attia: Well, you’re absolutely right. For any type of activity that is what we would call aerobic, meaning where you have enough oxygen in your cells to actually harness the full energy—you’re right. Fat is the far superior fuel. The drawback of insulin is that when insulin levels are high, it promotes fat storage as opposed to fat breakdown. In other words, insulin is what we call an anabolic hormone. It promotes building, not breaking. And that has its role, but when it comes to exercising and accessing fat for energy, the name of the game is keeping insulin levels as low as possible.

Open Water Source: So for performance and also for body composition—in other words, lowering my body fat percentage—it’s imperative that I control my insulin response. Is that correct?

Peter Attia: That’s absolutely correct. Furthermore, there’s a lot of evidence to suggest that chronically elevated levels of insulin lead to a condition called insulin resistance. And what’s not disputed at all in the medical community is that insulin resistance is the hallmark to a much broader condition called metabolic syndrome, which basically predisposes us to virtually every disease we think of that affects the Western population. We’re talking about heart disease. We’re talking about cerebrovascular disease, obviously diabetes, Alzheimer’s disease, and cancer.

Open Water Source: Wow. That’s very interesting. Thank you very much.


About the Author:

Peter Attia, M.D., is a physician in private practice in NYC and CA. His practice focuses on longevity and healthspan. His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things.


  1. Morgan  January 18, 2012

    So Peter,

    I find this so fascinating, especially since my boyfriend’s mom is an athlete and just switched to a low-carb diet (she’s also hypoglycemic, so I’m really relieved she’s laying off the sugar and starch).

    But she was reluctant. She plays tennis a couple of times a week, and the last time she tried low carb (Atkins), she had a couple of fainting spells on the tennis court. She’s a fierce competitor, so I assume she fainted because she was trying to go all-out anaerobic, but had no glycogen stores to fuel it.

    So, for someone like my boyfriend’s mom (non-endurance athlete), what do you recommend she eat before a tennis game for maximum performance, minimum damage?


    • Peter Attia  January 18, 2012

      Actually, I suspect her fainting spells had much more to do with low sodium, than low glycogen. One of the common issues overlooked by most folks on a low carb diet is the change in how the body processes sodium. A typical high-carb diet causes the kidneys to retain sodium. Without getting into the nuances of it, when one restricts carbs (as you do on the Atkins diet), your kidneys start “releasing” more sodium. For people with normal blood pressure, this often results in light-headedness, especially while exercising. For people with high blood pressure, this often allows them to stop taking their blood pressure medicine (nice bonus). As I had normal blood pressure even on a high carb diet, I went through this period of “hypotension” once I became completely ketotic. I was, however, quickly able to fix it by supplementing sodium in the form of bouillon (I use about 1 to 4 grams of additional sodium per day – depending on how much I’m exercising). Problem solved almost overnight.

    • Jill  January 18, 2012

      More sodium might help with my leg cramps?

    • Peter Attia  January 18, 2012

      Hard for me know over email, but it’s very common for people who stop consuming carbs to cramp. The reason is actually potassium depletion, but that’s actually caused by the kidneys excreting excess sodium. So, yes, easiest way to fix problem, if in fact the cramps are caused by this, is to replace sodium (and probably magnesium). Once I got all of this “tuned up” everything got immediately better.

  2. sooz  January 22, 2012

    10% of fat turns to glucose in the body, so why doesn’t fat stimulate insulin (as stated in the video)? Having Type 1 diabetes and wanting tight control, I have to bolus for both fat and protein along with carbs. Granted, you’d have to eat 1.5 cups of butter to equal the carb value of 2 slices of sliced white bread, so even with moderate amounts of fat, the response would be minimal, but still has to be taken into account. Fat does elicit an insulin response, otherwise how does the glucose get metabolised?.

    • Peter Attia  January 22, 2012

      Sue, fat, under no circumstance, ever turns back into glucose. This also includes fat that was made out of glucose. In other words, once the body undergoes de novo lipogensis (makes fat out of carbs), it’s a one-way metabolic street. I think what you may be experiencing with the need for insulin injection with “fat” is the effect of the protein and carbs that accompany fat. For example, even butter has a little bit of protein. Pure cream has a tiny bit of lactose (a carb) and protein, too. As you’ve noted, protein does illicit an insulin response (though much smaller than carbs). I do plan to write about Type 1 diabetes in more detail in the future. Thanks so much for your patience and interest.

    • Brian Hardaway  July 21, 2015

      I believe that Sue was referring to the glycerol backbone of fats that are consumed. the glycerol backbone constitutes roughly 10% of the total mass of fat consumed. The body can take two glycerol molecules and make one molecule of glucose. Therefore, 10% of the fat mass consumed is available for glucose production.

  3. Stephanie  January 23, 2012

    You have a great gift for ease of speech and nice clarity in your explanations. I’ll enjoy checking in on your work in the future and look forward to reading/watching/learning from you.

    • Peter Attia  January 24, 2012

      Thanks so much. Really appreciate the support.

  4. Neicee  January 24, 2012

    Found your website via Gary and it’s wonderful to find another site to explore and learn. Thank you for the simplest explanation of insulin and our responses to it I’ve ever read. Looking forward to more wonderful articles.

    • Peter Attia  January 24, 2012

      Thanks so much. Appreciate your support.

  5. Michele  January 26, 2012

    Dear Mr. Attia,
    I realize each case is very specific, but I would like to understand the relationship between thyroid hormones and insulin sensitivity.

    Do you have any experience with how thyroid hormones affect insulin sensitivity? I did really well with reducing carbs (not to the level you have) before but since my thyroid has been removed it doesn’t seem to work the same way anymore. This is certainly related to the fact that I’m not on the right dose of replacement thyroid hormones.

    Would my question be a good topic for a post???

    • Peter Attia  January 27, 2012

      Yes, I think this would be a good topic for a blog post, especially because there is some conflicting evidence out there about the role, specifically, that hypothyroidism plays in the ability of insulin to exert its effect. That said, if you do have hypothyroidism, you should definitely ensure that your doctor helps you correct it.

  6. Michele  January 27, 2012

    Thank you for the timely response and I am really looking forward to the post. I also saw that the topic landed on the “Coming Soon” list. This makes me very happy.

    I am working on sorting out the dosage problems with an Endocrinologist. If I discover any relevance to the topic of insulin, I will post the information.

  7. Aaron  January 31, 2012

    Hi Peter,

    I’m wondering if you have been following the debate on Joseph Mercola’s website between Paul Jaminet and Ron Rosedale. Their discussion hinges upon whether there is a dietary need for carbs to maintain adequate blood glucose levels.

    Jaminet says there is and advocates consuming about 100g of “safe starches” daily. Rosedale says that “safe starches” is an oxymoron, since all starch and sugar consumption will raise insulin levels (as you point out in your interview).

    On the other hand, many people on very low carb diets seem to suffer from hypoglycemic attacks when their blood glucose level dips too low. Apparently, in these individuals, gluconeogenesis us not working as it should, leading to a glucose deficiency.

    I’m curious to hear your thoughts on this. Is there such a thing as “too low carb,” as Jaminet maintains, or can gluconeogenesis be impaired in some individuals or during some circumstances (for example, pregnancy), perhaps due to too many years of consuming a high-carb diet?

    • Peter Attia  January 31, 2012

      Aaron, “Safe” is a very amorphous term. For example, 6,000 mg of Tylenol will kill some people, and only cause a stomach ache for others. Genetic susceptibility is everything. I would agree that no amount of starch is “GOOD” for you – but there are highly diverse genetic responses to starch that render different doses to have different levels of harm. For a rare few, almost any amount of starch does not cause enormous damage. That said, even these lucky few do see significant improvement in other (i.e., not weight-related) parameters of health. Carbohydrates, however, are categorically NOT “essential” in the way fat and protein is. That I’ll stand by forever.

    • Alexa Garib  February 2, 2017

      I have the same question you have. Exactly the same….I am not able to find a response anywhere. I was extremely hypoglycemic in a ketogenic diet…all the time… balancing electrolytes didn’t change anything…I just should try adding more protein …I don’t know…I am prediabetic…

  8. Paul  February 7, 2012

    Great site, Peter – found you through Gary Taubes, and looking forward to great things to come in your working together.

    It might be constructive and educational for you to post your lipid and glucose panels, as Gary did last year.

    I’m an athlete and endurance cyclist who, on a very high carb, low-fat diet, could never lose those last 5 pounds to improve my climbing. My strategy had been to double my training – but I only put on more fat – of course, I consumed maybe 3 times the refined carbs.

    Since cutting out sugar, and trying to control, but not yet completely eliminate carbs – I’m somewhere in the middle of your path – (I’m probably around 200 whole grain grams and yams) I went from 145 to 136 (I’m 5’9″) with no effort.

    The big change in my diet is lots more eggs and cheese.

    Being the experimenter myself, I’m planning on having a new panel done. My last, pre-new-lifestyle was 134 cholesterol, HDL/LDL 53/71, Tri’s 50, glucose fasting 85.

    What changes might you expect, and should I be concerned with a rise in total cholesterol?


    • Peter Attia  February 8, 2012

      Paul, thanks so much for the comments and support. I’ve already posted my numbers. Look under the 2nd or 3rd part of my personal journey. Since you’re using a standard cholesterol panel, we can’t actually glean much. At most, we can estimate risk from your ratio of TG to HDL, which is already very good at about 1.0. If you want to really understand your risk profile you’ll need to do a lipid NMR.

    • Paul  February 8, 2012

      Awesome – thanks!

  9. Jennifer Walker  February 8, 2012

    I’m curious if the insulin response has a limited life span. I’ve been working since last July to change my diet & relationship with food and cooking. Some days it is a struggle and frankly, there are some foods that I can’t imagine never eating again. Knowing they will trigger the insulin response causes some anxiety for me because I’m not sure how the insulin cycle works.

    For instance, if I eat something carb-rich for breakfast, e.g. a pancake, if not used up, does that insulin remain in my body for the rest of the day, forcing everything that I eat after the pancake (lunch, dinner, snacks, etc.) into my fat-cells? Or, does each episode of the insulin response have a limited life-span? Can I limit the effect of insulin-evoking foods by eating them then waiting a certain amount of time before I eat anything else? Or will consuming them with high-protein foods help curb the effect? IS there any way to mitigate the effect of isolated consumption of my guilty pleasure foods?

    • Peter Attia  February 8, 2012

      Jennifer, great question. I hope I’m understanding it correctly. Insulin, itself, is a very short lasting hormone – it breaks down quite quickly (relative to, say, a steroid hormone). So if you eat a piece of bread for lunch and spike your insulin level, it should be back to “normal” by dinner. BUT here’s the catch…what is “normal?” My “normal” (i.e., fasting) insulin level used to 6. Now it’s undetectable. Also, I used to spike to 36, now I spike to 5 or 6 with the exact same glucose load.

      So the less you expose yourself to carbs, the more sensitive you are to the effect of insulin, and the less you need to secrete, when you actually need it.

  10. Russell Holtslander  February 26, 2012

    I am a diabetic who has managed it thruough low carb ( Atkins ), and have never heard it explained so well as in this video. I actually went to an 8 hour training diabetes class, where we ate a lot of subs, and fruit, with when I got home my blood sugar was over 300. They were horrible at explaining diabetes, and I was more confused afterwards. I queried my docto, and he knew even less, so I hit the library. In DANDR, it is explained much better, but this video is simplistic, and easy to understand. This disease is very serious, but simple to understand, and explain.. so I have no idea why they make it so comlicated, and then tell you to manage it, instead of defeat it. Maybe so they can charge me medical bills?

    • Peter Attia  February 27, 2012

      Yes, it’s very counter-intuitive how diabetes is “managed” traditionally. Like putting gasoline on a fire.

  11. Rob Grantham  March 3, 2012

    Hi Peter,

    This is a fantastic explanatory video of the insulin response and how insulin control plays a central role of weight management. Love your blog by the way, awesome! In your opinion does the lipid hypothesis have any bearing on heart health or is this now considered an outdated model? I just don’t get how doctors can still get away with telling people to cut fat, eat healthy grains and exercise more.

    • Peter Attia  March 3, 2012

      Thank you, Rob. I’m glad you find this helpful. All of these themes are linked (obesity, insulin resistance, chronic disease), but there is a lot of dogma out there.

  12. Jack  April 10, 2012

    Hello Dr. A: Just found your site and love it. Quick question about palmitic acid. If too much carbs converts to PA, does that make sat fat a bad thing? Or is this conversion just one part of the 3 parts to trig?


    • Peter Attia  April 10, 2012

      Jack, eating saturated is not a bad thing, but making it is. You never want to turn glucose into palmitic acid, but unfortunately, that’s what most people do.

  13. jack  April 10, 2012

    Hello Doc – Thanks for answering my question so quickly! Really appreciate your help. Now when PA is converted in the body, are LDL also converted? Also, what other ways does the body convert sat fat on its own?

    I noticed on the foods you eat, you don’t eat any organs. Why so?

    Just heard your intervew with J.Moore. Super cool what you are doing !
    Thanks again,

    • Peter Attia  April 11, 2012

      Are LDL converted to what? I’d have to go back and check my fat tables, but I think PA is the only SFA we make de novo.

  14. jack  April 11, 2012

    Thanks Doc, for the response back.

    In terms of LDL, are LDL convert to help shuutle the sat fat into storage? Is this why converting sat fat problematic? What I’m confused about is if the converted fat the same as the dietry sat, why is it bad for us?
    Thanks again! ‘

    • Peter Attia  April 11, 2012

      It doesn’t work like that. I’ll write about lipoproteins another day, though. Stay tuned.

  15. jack  April 11, 2012

    thanks! looking forward to it!

  16. David  November 20, 2012

    Hey Peter,

    it’s David here from Australia 🙂

    I only recently found you …. the subject matter is fabulous … and beyond compelling!

    My question is can the humble human like myself seriously expect to get his body fat composition below 10% eating a diet high in saturated fats, low in carbs, i.e.: zero starch / sugars, and moderate in protein?


    Kind regards,

    • Peter Attia  November 20, 2012

      David, you’re actually asking 2 questions, unfortunately neither of which I know the answer to. The first — can you get your body fat to 10%? — may depend at least as much on your genes as your diet. The second — assuming the answer to the first question is ‘yes,’ what is the best diet to get you there? — may also depend on your genome and epigenome. Of course, this is all academic, so the best way to figure it out is to start experimenting with different macronutrient combinations.

  17. David Anthony Guzzo  November 21, 2012

    Hello Peter, thanks for the response!

    I was kinda hoping you would say “of course you can David, you can get ripped to shreds!” 🙂 or at least tell me you know of someone, anyone, perhaps yourself, who has achieved low levels of body fat on a high fat, moderate protein, low carb nutrition plan.

    I’ve been living the low carb lifestyle now for approximately 2 months with some surprising results, and the truth is everything has been going really well and perhaps I was hoping to get a confidence boost/confirmation that I’m on the right track. (some self doubt was creeping in, you know, that little voice in the mind)

    Once I got my head around the concepts in the books by Gary Taubes, I started applying and tweaking them on a daily a basis. I also found some excellent information by Dr. Eric Westman of Duke University, which prompted me to totally avoid eating starch and sugar, and keeping my carbs below 20 grams a day.

    I’ve lost my appetite and so far it’s been very easy. No side effects, no cravings, no hunger, and my energy levels are very good.

    Over the last 2 months I have dropped over 10kg, and in the last 3 weeks, after cutting out starch and sugar I’ve dropped over 4kg.

    So I’ve embarked on my own “experiment” to see what is possible, how my body adapts, with the goal of lowering my body fat composition.

    Since I found your blog I’ve pulled right back on having animal protein with every meal and increasing my fat consumption throughout the day.

    I’m still feeling great.

    I have a history of yo-yo dieting after competing in the 12 week Body-for-Life challenge in 2000. I achieved a lean, fit, ripped physique, all based on will power, excessive cardio and resistance training. I had constant hunger for the whole 12 weeks, even got the shakes at times, and of course I was shown the ropes by a classic body builder at my local gym.

    After 12 weeks it worked, but it was hell, and no surprises when I tell you it was impossible to maintain.

    So I’m going to continue with this low carb lifestyle, have some patience, see what happens over the next few months, and let you know how I go.

    thanks, you’re time is appreciated!

    kind regards,

    • Peter Attia  November 21, 2012

      David, very impressive results. Keep in mind, especially as a former “yo-yo dieter,” that consistency is the most important thing. Find a place you can sustain, even if less dramatic in carb reduction. I think the slow approach to a sustainable place is better than the dramatic intervention with frequent recidivism. My 2 cents…

  18. David Anthony Guzzo  November 23, 2012

    Hi Peter,

    thanks for your 2 cents …

    I just purchased some coconut oil and ran a quick search of your website for info on how to use it …

    I found a page called “How can I lose weight?”

    and as I searched with enthusiasm for coconut oil information I found a quote from you …

    “After fixing my diet, I lost 35 lbs of fat and reduced by body fat percentage from about 25% to 7%.”

    I believe my question has been answered when I asked: “Can the humble human like myself seriously expect to get his body fat composition below 10% eating a diet high in saturated fats, low in carbs, i.e.: zero starch / sugars, and moderate in protein?”

    today is 4 weeks no starch, no carbs and the scales tell me I’ve shed another kilogram …

    I have absolutely no doubt in my mind it was pure body fat!

    kind regards,

    • Peter Attia  November 24, 2012

      It’s still not entirely clear that what worked for one person will work for the next. Best not to fixate on the results of others.

  19. David Anthony Guzzo  November 25, 2012

    The exact response I expected, thank you!

  20. Harvey  December 14, 2012

    My daughter is 16 years old and was diagnosed with insulin resistance. Her doctor told us that her insulin is not enabling glucose to enter her cells and prescribed metformin. My daughter eats alot of carbohydrates. I don’t think metformin the way to go. I am arguing that she reduce drastically reduce carbs. Thoughts?

    • Peter Attia  December 14, 2012

      You are correct, Harvey. The best first option to treat IR is removal of sugar and simple carbs (e.g., bread, cereal, pasta).

  21. James  January 21, 2013

    Dr. Attia, Very interesting thoughts – thank you very much for the site and videos. I was prompted to look into sports nutrition issues – specifically how do athletes bodies respond (in insulin terms) to “high energy” drinks and gels during training and competition. It also follows a recent book I’m reading by Robert Lustig (Fat Chance) on the perils of sugar – fructose in particular – and the association with metabolic syndrome. Regarding your comment about suitability of a Ketogenic diet at an individual level, I speculate if benefits might also depend on blood-type (after Dr. Richard D’Adamo’s hypothesis; Eat Right for Your Type), as well as activity type. Indeed, Lustig makes reference to different ethnic groups’ historic pre-disposition to certain food groups, e.g. all protein, animal fats or carbohydrate based on gains and pulses etc. He believes that some of these groups today appear to suffer higher rates of metabolic syndrome and disease than others when consuming a high sugar and fat diet. In terms of a very low daily carbohydrate consumption, I would be interested to know also what role you see fibre playing in the Ketogenic Diet ?

    Many thanks, James Kavanagh (in the UK).

    • Peter Attia  January 21, 2013

      I probably get 20 gm of fiber, maybe more, per day. Doesn’t seem to have an appreciable impact.

  22. Guido Vogel  February 28, 2013

    Hi Peter,

    Jamers Krieger seems to disagree with you in about every aspect. Here is the first part of his article about insulin:

    He claims (backed with data & references):
    1. The fact is that insulin is not this terrible, fat-producing hormone that must be kept as low as possible and
    2. Protein stimulates insulin secretion as well. In fact, it can be just as potent of a stimulus for insulin as carbohydrate

    What is your take?

    • Peter Attia  February 28, 2013

      Context is everything, Guido. This topic is too complex for quick response, so I hope you can wait until I can do this topic justice. Yes, protein, depending on formulation, can be a very potent stimulator of insulin, but most people eat much more carbohydrate than protein.

  23. Guido Vogel  March 1, 2013

    Hi Peter,

    Don’t know if you need to address this separetley. Apparently, I was not the only one asking the question, you want to refer to this link:

    Being a layman who used to be overweight, I liked Mark Sisson’s comments very much. Look at the big picture, find out the factors with highest impact (first order logic) and communicate to the public.

    Never a sugar eater, I cut out all wheat carbs (bread, pasta), rice and potatoes of my diet and lost 10 Kgs. I also almost entirely got rid of my daily Pariet 20mg (Rabeprazole) that I took in order to handle my stomach pains.

    Your (and Gary’s) work is *much* appreciated.

    • Peter Attia  March 2, 2013

      Very interesting thread there. Don’t have the time to read it all, unfortunately.

  24. Saahil Outsider  November 11, 2013

    Hi peter,I have been reading your blog and gary taubes work from quite a while.I want to congratulate for such an awe-inspiring work,you guys really deserve a huge pat on your back for you tremendous contribution to nutrition and in turn medical world as well.I have a grave problem related to my aunt and I’m unable to solve it and quite perplexed due to that.
    My aunt is type-1 diabetic,she got a byepass surgery in 2002, currently have retinopathy,neuropathy,insomaniac,high blood pressure and its all due to her high chronic blood glucose levels.Though I know that you dont offer medical advice here so I highly apologize for that but as I have put her on low carb diet but still her blood sugars are fluctuating a lot and causing severe risk to her health.Doctors in India arent able to cure her sugar at all and they offer very stupid advice to control sugar levels(like eating fruits).So,kindly tell me what’s can be the best possible way to keep her sugar levels low as I have already cut almost all high GI carbs and slow as well(execpt for one chappati and lactose from dairy as she cant consume non veg so source of first class protein for her is too less).
    She takes LANTUS insulin(5 units at night) and HUMINSULIN(30/70…14 units pre breakfast and 12 units predinner…she alters dosage according to her blood sugar levels which she checks daily empty stomach in morning and predinner at night)

    Her diet plan-:
    In morning(on waking up)-cup of tea without sugar + 5 almonds
    breakfast- chappati stuffed with green leafy vegetable and a glass of milk + 1 spoon of flaxseed
    Brunch- 100 gms cottage cheese
    Lunch- 100 gms cottage cheese + small bowl of green vegetable + small bowl of salid(radish,tomatoes,cucumber)
    Evening snacks- tea + 50 gms cottage cheese
    Dinner- 2 whole eggs+ small bowl of salid+1 spoon flaxseed

    Her morning fasting blood gluocose is between 150-220 and her pre dinner blood gluocose is 300-400
    As doctors are unable to fix her sugar issues so kindly guide me atleast in diet(if not in medicine)
    Any support will be highly appreciated

  25. Robin McFee  April 16, 2014


    Do you know of any kind of hormonal response to an influx of lipids into the bloodstream? Do you think in the future we will have an equivalent of the glycemic index for fats?

    For example, perhaps a coffee made with heavy cream might result in a much faster influx of fat into the bloodstream than a bowl of high fiber flax seeds.

    • Peter Attia  April 16, 2014

      The stress response does this. As epinephrine and norepinephrine are secreted, large amounts of lipolysis increase FFA in bloodstream.

  26. Robert Smith  November 18, 2014

    Hi Peter I am overweight and lost 60lbs in 2009 but since gained it back I believe my IR has gone up and it is much harder to lose the weight now any suggestions? Also what would be the best route to achieve dietary ketosis when insulin resistant

  27. Linda Abernethy  December 20, 2014

    I’ve followed you and Gary Taubes for a relatively short while. Just finished Taubes’s book(Good Calories, Bad Calories). I have subscribed to your site though I do not think I have received any posts or updates. Today I received from a short film entitled something like, Paleo Diet Negates the Benefits of Exercise. The premise is that insulin spikes as much or more in response to protein as it does in response to carbohydrates, even sugar. Dr. Michael Greger truly pushes a “plant based diet” almost to a religious degree. You mentioned and know that protein can/does raise insulin levels, but what about Dr. Greger’s sitings re: carbohydrates cause less of a spike than protein?

    Thanks in advance for any clarification on this,

    • Peter Attia  December 30, 2014

      You summed it up: “almost to a religious degree” — generally a bad sign.

  28. Dave  February 10, 2015

    “And fat doesn’t stimulate insulin at all.”

    Yes, they certainly do.

    • Mandi K  March 9, 2015

      You seem to be confusing the fat cells that make up part of the body with the fat we eat?

    • Veronica Verhoff  May 18, 2016

      Dave, I’m not sure you’re reading that study carefully. They’re discussing how ASP released by fat augments glucose stimulated release of insulin, so it’s in the presence of glucose. And is unrelated to a post-prandial fat response. ASP is released by adipocytes (fat cells).

  29. Ron  May 21, 2015

    Hi Peter,

    I’ve been low carb for over 3 years now – and loving it. Lost a stubborn 40 lbs, off BP meds, lipid numbers went from “you have serious issues” to text-book (kind of worried about this as well — whose to say what textbook is; really — if [they’ve] been wrong about the science all along, then how do we really know what “normal” lipid profile is? I mean, is it possible that the so-called “normal” lipid profile IS the bad one?

    In any event, just quasi-concerned about long-term effects of a diet I, not only partake in but, also encourage with my family. Which brings me to conundrum stuff like this….

    I’d like your thoughts on this video.

    “”Diabetes is a disease of fat toxicity in our organs””

    He eloquently states that fat, especially saturated fat, is the root cause of insulin resistance! Can you debunk this please?

    Just tired of the back and forths!


  30. Julia  June 2, 2015

    What an excellent, informative site that you’ve created! I’m so grateful to have stumbled across it and have been reading through your many articles and FAQs.

    I’ve just started in the last month to drastically reduce the carbohydrates in my diet after years of struggling with my weight and being very diligent about going to the gym- cardio and weights. My interest in making a change came when I read Gary Taubes’ book and thought his approach made a lot of sense. Perhaps because I’m so tired of struggling with my weight, it really hasn’t been difficult for me to give up rice, bread and pasta. Following Taubes’ suggestions on eating on the low end of the glycemic index scale, I eat a lot of vegetables, cheese and fattier meats (including snacking on bites of salami) which make me feel more satiated. Thus far (since early May) I feel better than I have in quite a while- I have more energy, feel generally more cheerful and my skin tone is clearer.

    My question is essentially that I have not yet noticed a change in my weight, though I do understand that changes for women are not necessarily as quick as for men. I realize I should try to keep track of my carbs but I’m not sure what kind of targets I should aim for? Also I’ve begun to think more about dairy and insulin, more precisely whether cheese and full-fat milk (which I drink and has effectively cured my lactose intolerance) which both have a low glycemic index, are indeed spiking up my insulin? Is this perhaps a possible reason why my weight has yet to change? (for reference, I am about 5’9″, around 198lbs- my body frame is probably on the larger side).

    Any thoughts (or hints on where you might have written about this before) about this are much appreciated. Again, congratulations on your wonderful site.

  31. Kishore  January 20, 2016

    Hi Peter,

    Very informative… Just a clarification… on a low carb diet… the body burns the carbs first and then, does it go to the dietary fat or body fat?

    In other words, how much fat is too much fat in ones diet? heard some part of fat is used to regulate hormones…. thanks for your advice…. Goal – Body composition..

  32. Caralina  February 17, 2016

    Can you clarify cardio for fat loss. I want all the short cuts as far as utilize fat the most. I tend to do fasted, is this the best? As far as not having energy, I take a supplement to deal with that so no worries. Also, what if someone binges like crazy. Is it more effective to do cardio immediately after or a few days. Thank you in advance for any help on subject. Caralina

    • Caralina  February 17, 2016

      Can you clarify cardio for fat loss. I want all the short cuts as far as utilize fat the most. I tend to do fasted, is this the best? As far as not having energy, I take a supplement to deal with that so no worries. Also, what if someone binges like crazy. Is it more effective to do cardio immediately after or a few days. Thank you in advance for any help on the subject. Caralina

      I’d like to add I do at least 60 minutes cardio? Is there a point where body stops burning fat? As for a bad night of eating I mean should we just do cardio immediately or few days later fasted for breaking down fat.

  33. Srinath  December 22, 2016

    Hello and thanks for the awesome video as well as an awesome and informative site.
    I had a question generally regarding insulin response to foods. I am insulin fasting, so I eat fat only on days I am fasting, and generally I have reversed my pre-diabetes and lost 90+ lbs getting down to a near under weight 147 lbs (69.5″ tall male with just smaller than medium build). But I am shooting for single digits body fat and hope to maintain it. I am hoping to find fat only foods that have some flavor so I can eat that on days I need to fast. So my question is about essentially condiments – Mayonnaisse – the all fat kind (dukes), Mustard – vinegar and mustard and 0 calories, hot sauce again 0 calories cos its peppers and vinegar. and small bites of pickled pepperoncini peppers. Almost 0 calories. I could eat maybe 3 of these peppers a day – for a total of under 1 calorie from anything other than fat. Will this cause an insulin reaction ? Thanks so much for your input in advance.

  34. Chris BeHanna  June 24, 2017

    Do you have any ideas regarding people who suffer from non-diabetic hypoglycemia? People who have had bariatric surgery, for example, or who have lost their stomach and duodenum to cancer, may exhibit dumping syndrome and serious crashes in blood sugar. What course might they follow to try to control serum insulin levels and thus access fat for energy during exercise?


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