Blog - The Eating Academy | Peter Attia, M.D.

Forget everything you know about nutrition

Forget everything you know about nutrition
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Peter Attia, author of the War on Insulin blogI’m Peter Attia, and I’m about to challenge everything you think you know about nutrition, and how it impacts your health and performance. If you’re interested in losing weight, increasing your endurance, increasing your mental acuity, getting rid of your blood pressure and diabetes medicine, or just learning why almost everything the “experts” tell you is wrong, you’ve come to the right place.

My mission is to demonstrate that insulin — not calories — is at the heart of the most pervasive chronic diseases: obesity, heart disease, and even cancer. Suppressing the secretion of insulin is the key to running your body on your own fat, which leads not only to weight loss, but also to what I call “chronic health” and peak performance.

Where should you start? If you’re here because you want to lose weight, start with How can I lose weight?, which includes succinct dietary guidelines for weight loss and health. You can find out more about me and why I’m writing this blog, or read about my personal journey of nutritional discovery and self-experimentation. Or, if you’re already questioning my sanity, you can check out my quick FAQ, where I tackle some of the most common questions people throw my way. If you’re not much of a reader, check out my videos page for some clips of me talking about these issues.

I plan to update every week or two, so check back soon, or subscribe.  Finally, along the way of my journey, I’ve met some remarkable folks, with some remarkable skills who have helped me.  I look forward to introducing you to them.

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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. Cheryl Baughn  December 16, 2011

    I am interested!

    (reply)
  2. Nelse  December 27, 2011

    Finally! A forum that addresses the body as the machine it is and what types of fuel it needs. The subsidized food industry and behavior modification gurus will not accurately explain to a person how to fuel and maintain the body. The body is a continuous chemistry experiment that reacts in a specfic way to the things you put in it. Our focus should be on 1) the chemical reaction that food causes in your body, and 2) whether the reaction produces your desired result.

    Great stuff.

    Thanks, Peter

    (reply)
    • Pattye  January 29, 2012

      Wow, very very well said!!

  3. Patti  January 9, 2012

    I have looked at so many “answers” I am tired of looking
    This blog has my attention. Thanks

    (reply)
  4. Matthew  January 9, 2012

    Peter,

    I have been reading over your blog (excellent by the way), and try as I might, I can’t ferret out the following questions. Feel free to direct me to an appropriate resource if you’re too busy, but I thought I’d try the expert first.

    1. I am on a reduced carb diet, but I don’t think that I am anywhere near full ketosis. But presumably I have less insulin in my system (than before my dietary change) so my body will metabolize some fat for energy? Or is it an all or nothing proposition? I am assuming that because I am not in full ketosis that I should still be mindful of my fat consumption.

    2. You make reference to the following logic chain in a number of places (and forgive me if I don’t have it quite right): high carb intake = high insulin levels = reduced fat burning = more hunger = excessive eating = obesity. I think I follow the logic, except could you elaborate on the relationship between insulin levels and hunger? Do high levels of insulin literally make you feel hungry, or is the mechanism more complex? I ask because you mention that you eat when you’re hungry, but for someone like me who is not in ketosis, can I do the same or do I need to watch my intake? I can tell you that very rarely do I eat until I am feeling fully satiated.

    Anyway, I’ve probably reduced my carb Intake by over 50% and that combined with lowering my alcohol intake (modestly — I still drink more than the average American, but less than the average Russian!) has put me at a weight less than I was in high school which I thought was virtually impossible. Keep up the good fight, you have convinced at least one person that excess carbohydrate intake leads to all sorts of health issues. I’m still not ready to give them up completely, but even a modest reduction seems to have had a pretty big impact.

    Thanks!

    Matt

    (reply)
    • Peter Attia  January 10, 2012

      Matt, awesome questions. Let me try my best to answer them.

      1. Low carb is NOT an all-or-nothing proposition, but nutritional ketosis is. For most people, a gradual reduction in carbs, beginning with the worst offenders (e.g., sugar, followed by highly refined and processed grains) yields fantastic results, including fat loss, reduction in triglycerides, increase in size and maturity of HDL and reduction of LDL particles number (notice I didn’t say LDL cholesterol concentration, which is irrelevant). Ketosis, however, is a binary place to be, and certainly is not for everyone. The main caveat I give folks is this: If you continue to eat lots of sugar, you’re probably not doing yourself any favors eating much of anything, including fat. Sugar is a metabolic bully, and whatever you eat with sugar, your body will deprioritize metabolizing. In the late 1960’s John Yudkin published a study suggesting that it was pretty harmful to eat “lots” of sugar with fat (maybe even worse than just sugar alone, and certainly worse than fat alone, which causes no harm). If you’re avoiding sugars and highly refined carbs, the only thing else you need to think about is (fat-wise) is reducing your intake of omega-6 fatty acids.

      2. The mechanism isn’t exactly like that, but you definitely have the right idea. Here’s my best explanation of the link to hunger. Not to harp on sugar, but it’s really such a culprit. Fructose (which makes up half of HFCS and sucrose) intake leads to an excess of an enzyme called JNK-1, which inactivates another enzyme called IRS-1. This inactivation of IRS-1 makes the liver (especially) insulin resistant, which means any additional glucose (i.e., even non-sugar carbs) you consume requires higher and higher amounts of insulin from the pancreas – hence, increasing insulin resistance. Recent data suggest that with very high levels of insulin, the ability of the brain to recognize the “hunger hormone” leptin gets reduced. In other words, lots of sugar leads to worsening insulin resistance, which leads to chronically elevated levels of insulin (bad for many reasons, even if appetite weren’t involved), which interferes with our brain’s natural ability to regulate hunger – at least through the leptin pathway.

      Hope this answers your question. Keep up the great work, and congrats on your journey.

  5. Mark Mulholland  January 9, 2012

    Peter, thanks for your blog. I’m looking forward to your future postings,in particular the following from your “coming soon” section: How do I measure my ketone levels and why would I ever want to do so?,How do low carb principles apply to children?, What tests to get done if you want to track your health, What supplements I take and why, How can a vegetarian adopt low carb living?

    Also, I suggest you add a link to your facebook page on your blog. It’s great for sharing information and building your community.

    Cheers,

    Mark

    (reply)
    • Peter Attia  January 10, 2012

      Mark, thanks very much for the feedback and interest. I promise I’ll get to these topics and more in time, so thanks for reminding why it matters. I’ll try to get to one of these questions next week, if my schedule permits. This week’s post (probably Wednesday) will about sugar, so hopefully that holds you over for a while longer.

  6. Ken  January 13, 2012

    Peter, thank you. Your blog has been an eye-opener that’s helped start to put a number of things into perspective for me. Beyond the wealth of information and guidance you convey, you have both a clear, engaging writing style and a fair amount of tact and sensitivity when countering contrary opinions (of which there are obviously many).

    I think, like you, it will take significant dietary changes for me to see the results I’m after, but I’ve been encouraged to start down that path by what you’ve presented. I’ve begun tracking macronutrient ratios, as I begin to decrease my carbohydrate count. It’s a slow process, but now I can get below 150g/day with little effort, and I’m pushing toward my next barrier: < 100g/day. Currently I’m at about 60% fat, 26% protein, and 15% carbohydrate.

    I hope you don’t mind a few questions that I haven’t noticed referenced, as I’ve followed your blog:

    Many sources cite the importance of weekly higher carbohydrate consumption ranging from a single meal to a day or more of “loading” for both health and muscle growth. Do you go through some kind of cycle like this, or are you always in a “low carb”/ketosis state? Can you explain more fully why this should or shouldn’t be done? And, if it should, how do you do it correctly?

    Please keep up the great work. I find myself looking forward to each new post.

    Thanks, again,

    Ken

    (reply)
    • Peter Attia  January 14, 2012

      Hi Ken, thanks very much for your support and kind words. Also, congrats on making these already impressive changes in your life. I can think of 2 ways to address your question, depending on your concern. Concern 1 is the so-called “carb-loading” phenomenon athletes often refer to. Concern 2 is about generating insulin periodically to drive the anabolic function of macro-nutrients (i.e., spike your insulin level to drive more glucose into glycogen stores and more amino acids into muscle). I think you’re asking about #2. I haven’t seen any good, high quality, data to suggest this is necessary, or even helpful, though I know some people swear by this, especially on the amino acid side. I think, even it were actually true, you’d need to do the cost-benefit analysis of weekly bouts of cycling into and out of ketosis. It really takes a while for your body to get completely used to this new state. I wonder if leaving that state every week would make it tougher for your body to be efficient there? I don’t know, however. This is another reason we need to start doing better prospective randomized trials in nutrition.

      One other point to make, with respect to your current trajectory on carb cutting, the experience is non-linear for many people. Being at, say, 75 gm/day can actually feel significantly worse than being at 25 gm/day. I’ll describe this in more detail in the future.

  7. Charles Lee  January 13, 2012

    Hi Peter

    I use Keto Strips to measure the ketones in my body. The strips indicate that I have some ketones in my body (even though I limit carbs and I get the resulting acetone breath). When I read blogs of people on Low Carb High Fat diets, some brag about the fact that they have a high level of ketones when they test themselves.

    Should I strive to cut down on my carb intake further until the readings indicate a high level of ketones?

    (reply)
    • Peter Attia  January 13, 2012

      Charles, it’s tough for me to say, exactly. There are 3 ways to technically measure ketones, though they are not measuring the same ketone body, per se. Breath analysis and urine strips provide qualitative analysis. The only only way to get a quantitative measurement is using blood. There is a point of care device I use that is made by Abbott labs (you can find a link on the blog) that actually quantifies the amount of beta-hydroxybutyrate in your blood. I think this is the best, and most accurate, way to be “sure.” As a rule of thumb, you are not in a state of nutritional ketosis until your blood level of beta-hydroxybutyrate is greater than 0.5 mM (millimoles). Before worrying about further cuts, which may or may not be necessary, you may want to consider a more accurate test. That said, a better first step is asking the obvious question: How do you feel? Are you getting out of your nutrition what you want (I don’t want to assume I know your goals)? If so, who cares what the strips say, right? Hope this helps.

  8. Dave  January 20, 2012

    Does following a low carb diet like the one you prescribe work for everybody, including the morbidly obese who seem to have the worst genetics (with the presumption that they are otherwise healthy of course)?

    As Taubes points out, its not a matter of willpower, so I deduce that any diet that is dependent on willpower (ie. to control portions and hence total calories) is doomed to failure. So to tie in with my first question, if simply following the diet and letting the dieter’s body naturally regulate their intake of total calories, will this effectively lead all obese individuals into a lean body mass state?

    The reason I ask these questions because I’ve come across the topic of stalling on message boards and wonder if some people no matter how much dieting they do, will simply always be fat. Is leanness achievable for everyone without a lifelong battle of willpower overriding bodily hunger? Are there some people who can never trust their body to regular hunger properly even when they eat all the right foods?

    (reply)
    • Peter Attia  January 21, 2012

      Dave, you’re asking a really good question! One thing I always stress with the folks I work with 1-on-1 is that there is no “perfect” diet for everyone. In fact, I use a framework that divides the world into 9 types of people (depending on genetics and goals). The category you fit into determines how much you probably need to restrict carbohydrates (to overcome your genetic sensitivity to them, and to achieve your desired outcome). But you’re absolutely right – this is not about willpower. Moreover, study after study has shown that starving folks into weight loss works only temporarily. As soon as they resume previous eating habits the weight comes back on. It’s about eating the right foods (based on the idea above of genes and goals), not less food.

      To your real question, there are some people who will always struggle with their weight. The exact explanation is not always clear, but there are many reasons, including genetic factors (obviously), previous eating habits, underlying hormonal irregularities (beyond insulin), and certain medications.

  9. DB  January 21, 2012

    Hi Peter

    I just found your link through Gary Taubes. I have just started my weight loss journey following his advice and expect I will be able to now use your advice also. I am a scientist (marine biology) so not well informed on nutrition, but I understand good science practices and I see that in Gary Taubes and now you. I had all but given up on diets, obviously because I failed so often at the low calorie/low fat diets, but now I feel motivated again because the science for low carbs makes sense!!!! Anyway I really just wanted to say hello.

    (reply)
    • Peter Attia  January 21, 2012

      So glad to hear that you’re pursing an evidence-based approach to eating and congratulations on your new sense of optimism. It’s a tough mental leap – I know. For years I ridiculed low-carb eating (without ever reading the data, mind you), as it just seemed too counter-intuitive.

  10. Konrad S Graf  January 22, 2012

    Dear Peter,

    This is a great site and I already have the sense that your voice will be a clear and distinctive addition to this movement. The project Taubes blogged about sounds like just what is needed now. I read GCBC a month ago and this is just one of the most impressive science books I have ever read, so if Taubes is sending me to a site, I’m going . I started with the Primal Blueprint in November 2010 and have read about 10 books in the broad ancestral health genre since then and done the kind of stage-by-stage self-experimentation that you discuss in your own story. The only carb sources I have now are incidental from vegetables and a fruit once in awhile and I am probably also at over 80% fat calories. I am just curious to compare notes on what your mix of fat sources are. I try to get the fattiest cuts of beef I can find and add lots of coconut oil in cooking, with small amounts of other oils here and there, and some cheeses and cream. What about you? I think Loren Cordain makes a good case against drinking milk in the Paleo Answer, but I question how well that also applies to cream and cheese. Any research on that distinction?

    One other topic, at 40, getting the last extra bits of body fat out seems to be requiring some intermittent fasting. I’m talking about being stuck around 20% and wanting to get to more like 15% (according to impedance scale). I really think age makes a difference here (and my father and grandfather both steadily became heavier throughout their lives at a similar rate). I believe I would not have needed at 30 to add IF to the carb elimination to get the same results. Also, talking about “non-linearity” as above, I have noticed that just fasting for a day or so is considerably easier than eating tiny bits of food! You just totally forget about food (of course this works best *after* getting off of sugar first).

    (reply)
    • Peter Attia  January 23, 2012

      Konrad, thank you so much for your kind words and vote of confidence. I certainly agree with your assessment of GC,BC. It changed my life – literally. Great question about cheese and cream. I don’t drink milk (or even half and half), but I drink heavy cream (whipping cream) like there’s no tomorrow. I also eat a lot of cheese. In my humble opinion, the research on this topic doesn’t really answer the questions. It just confuses things. This is why I advocate for an experimental and personalized approach for everyone. I think only a DEXA can provide you with reliable measures of body composition, especially with small changes. I would really recommend getting one. The impedance scales are pretty inaccurate and highly subject to hydration status.

      When you are in ketosis, it’s amazing how easy you can not just miss a meal or two, but more importantly feel amazing (versus myopically focused on food as I used to). Keep up the good work.

    • Neil  February 18, 2012

      Is it possible to be in ketosis and still enjoy a daily martini or two?

    • Peter Attia  February 18, 2012

      Neil, I don’t drink martinis, but I’ve certainly confirmed that it’s possible to drink a couple of glasses of wine and stay in ketosis. There are a couple of things to keep in mind, though. Dry wines (and presumably martinis) don’t stimulate insulin, which is why I’d be inclined to believe they don’t suppress ketosis. However, ethanol does get converted by the liver into de novo fat and VLDL, so I wouldn’t go overboard…

    • Matt Taylor  February 22, 2012

      The first couple months after I started living low carb I was able to stay in ketosis and lose about 5 pounds per week while drinking quite a bit of bourbon. Too much actually, and I have since cut back for health reasons, and it seemed to stall my weight loss as I approached my ideal weight. I’m not saying it’s a good idea, but it is possible to be in ketosis while enjoying moderate amounts of hard alcohol like a martini or two. It will eventually impede your weight loss though. That’s my experience anyway.

    • Le Sir  June 30, 2014

      I’ve managed to stay in keto as per some keto sticks indication even after drinking a bottle of pinot noir. its dry so not much insulin spike i guess.

  11. Daniel Armak  January 22, 2012

    I have type 1 diabetes, so I control my insulin production manually, with a pump and glucose meter. I can’t much affect the amount of insulin I use; too much or too little and I enter hypo- or hyper-glycemia respectively.

    In this situation, could I benefit from the knowledge & advice on your and Gary Taubes’ sites and books?

    (reply)
    • Peter Attia  January 22, 2012

      Daniel, questions like yours, and those of others, make me realize I really do need to include a post, or a series of posts, specifically, about Type 1 diabetes. One of my best friends from residency, who is now a cardiac surgeon in the Midwest, also has Type 1. I’ve learned a lot from his experience, along with what I’ve read. Speaking of books, I highly recommend you read the book “The complete guide to achieving normal blood sugars,” by Dr. Richard Bernstein (who is, himself, a Type 1 diabetic). You may never get off insulin completely, but you can definitely reduce the amount you need, and fluctuations in blood glucose.

  12. Nina Cobalt  January 22, 2012

    Peter

    What a shame that you call it a war on insulin. As Dr Robert Lustig says, every hormone has 2 effects: acute & chronic, one can be useful and the other can be harmful.

    http://www.youtube.com/watch?v=m8dWNbEscOw

    Nina

    (reply)
    • Peter Attia  January 23, 2012

      Hi Nina, thanks so much for your comment and the point you make. I thought long and hard about what to call this blog. There certainly was no perfect name. You’re absolutely right, though. Without ANY insulin most of us would not survive, so perhaps a “war” on something not entirely bad is a bit of a stretch. That said, I really wanted to call to attention the paradigm shift. It’s not about the number of calories you eat, it’s about how you body chooses to store versus burn those calories. Insulin plays a bit role in this.

  13. Peter  January 24, 2012

    For years I exceeded the conventional prescribed diet: complex carbs, abundant greens and fruits, lean protein and nil saturated fat. I treadmilled uphill 4 miles at 15% incline 4-5 times a week. Though slim and fit, my cholesterol count kept climbing over time. 6 months ago it shot up from 160 to 203. Blaming it on my genes, my doc prescribed me Simvastatin statin. I took it. My TC proceeded to plummet to 130 and then 119. Unnoticed by me at that time, markers on trig % count went up and HDL down in the past two results. My doc congratulated me and told me to keep eating my daily bowl of oatmeal for breakfast. But blaming the DNA as root cause gnawed at me.
    Then I read Protein Power by the Eades and had the proverbial light bulb after the section on how carbs, fats and protein are processed. I concluded that my high carb intake caused an insulin level that triggered my liver to pump out the high cholesterol and triglyceride. I decided to trash my food pyramid. Since mid December 2011 I ditched my statin and ate LCHF, <25 carbs per day.
    From Taube's GCBC, understanding the science and history, in particular, how Ancel Keys used data to finger dietary fat as demon, how he crusaded it, ultimately becoming a dogma, used by Feds for public policies, gave me the rationale and confidence that LCHF is the right thing for myself and family. LCHF is just a logical sequence of events from such a paradigm shift.
    Establishments ranging from the medical infrastructure, media, politicians, and commerce have most of the traditional platforms to promote the low-fat mantra. Sites like yours, like insurgents, are winning hearts, minds and mouths, one at a time. In April I have a lipid panel and likely a chat w/ my doc. I hope I will be able to talk the science talk, with logic and calm. Keep it up. Thanks.

    (reply)
    • Peter Attia  January 24, 2012

      Peter, this is a powerful story, and I’m so glad you were able to see your way out of the mess you were in. The REAL tragedy with statins is not that they shouldn’t be used at all (I believe there are some folks for whom they are indicated), it’s that most doctors do not understand the lipidology data and treat the WRONG thing (LDL-C instead of LDL-P). As you observed, the only thing of value you can gather from a “standard” cholesterol test is the ration of HLD-C to TG. Yours moved in the wrong direction and you took action. Very nice work.

  14. Peter  January 24, 2012

    When I tell relatives, friends and co-workers, especially those already afflicted w/ symptoms from metabolic disorder, about my cholesterol journey, re-education and the resulting radical change in eating plan for our family, I can almost see their eyeballs rolling back with skepticism. Oh yeah, it’s the Atkin thing and everyone knows that it’s just another dangerous fad diet. The science and logic I lay forth just bounce off their anti-fat dogma, insulating their mindset like a Gore-Tex jacket. After all, how dare I say the conclusion on studies like those by the eminent T. Colin Campbell of China Study and Dr. Esselstyn, whose diet plan is touted by Cleveland Clinic and Pres. Clinton, are statistically not valid. Such impudence from someone who’s got no medical credentials! Keeping my story short I direct them to books and sites like yours. You guys got the ‘street’ creds. Keep fighting and educating us. I still have much to learn. Thanks.

    (reply)
    • Peter Attia  January 24, 2012

      If you really want to help people understand how poorly done that work was, direct them to Denise Minger’s write up on both The China Study, and Forks Over Knives. She’s done an amazing job of it. Thanks so much for the support.

  15. Leslie  January 24, 2012

    After going through your site, I’m submitting some feedback to you in hopes that your site will become more user friendly to women. I know that it seems like one approach can serve many users, but with women, we cannot follow the guidelines established for men, by men, without consequences that require additional consideration and efforts.

    For example. I see you advocate a high fat/low carb diet. In women, high fat still accumulates in the body and will create an abundance of estrogen because we cannot process as much as fat we might eat in a daily diet as fuel – living an average life where we don’t exercise 4-6 hours a day (who has the time?). When too much estrogen is created – or even when a slight imbalance between estrogen and testosterone is created, tumors will grow and cancer becomes a potential. Men’s bodies naturally process fat more easily because men inherently have a higher degree of testosterone and a naturally lower degree of estrogen, while women’s bodies contain the opposite combination of high estrogen and low testosterone. As a woman who has experienced an even lower degree of testosterone (due to medication) and an increase in estrogen due to a higher fat diet, I grew fibroid tumors which are quite large by comparison to my size. My size which at the time was in the acceptable BMI range.

    Another thing you have written on your site is that obesity causes specific diseases such as gall bladder illness. I’m here to say obesity can have nothing to do with that – DIET and how your body processes fat and cholesterol has everything to do with gall bladder illness. I was by no means obese when my gall bladder problems struck or when I ended up in the emergency room having my gall bladder removed. In fact, I think it was because I was nowhere near obese that no one thought my gall bladder was the problem. I know in self help it’s important to take a stand and support it with documentation. I’m a self help author, so I understand the approach. However, the word obesity has been overused as a panicky buzzword in health issues striking fear into every mind; and when people are not obese, they tend to breathe a sigh of relief as if they can do as they please digestively without any issue because they are not obese. In order for your important perspective to be widely considered, I believe it is equally important to impress that ANYONE can contract these issues if they are abusing their body in any way shape or form with poor diet and bad choices.

    (reply)
    • Peter Attia  January 25, 2012

      Leslie, these are great points. Let my try to address them in order.

      This is a complex issue. It’s clear that women and men alike benefit from a low-carb diet, though it seems more difficult for women on average. As you point out, estrogen undoubtedly plays a role in this difference, though I suspect a few other factors are play. Age, for example, plays a role (both for men and women). As men age, they have less testosterone, which results in down-regulation of lipoprotein lipase (LPL) on abdominal fat cells, leading to a greater accumulation of abdominal fat. Post-menopausal women have a seemingly more difficult time losing weight than their pre-menopausal counterparts. To your first point, I think you’re right that my blog is a bit more biased towards my demographic. I think the reason for this (though not intentional) is that I have tried to make it as “personal” as possible. I had no intention of ever being a “blogger,” as I have 2 full-time jobs, a family, a night/weekend job, and a training schedule. Initially I started just emailing this stuff (e.g., my story and the science supporting it) to friends and family. The logistics of managing the email trail got to be too much, as people passed it around, and I eventually converged to where I am today. With that said, when I work 1-on-1 with clients (in my capacity as a health coach), I completely customize nutrition to them and their exact needs based on their genes (including, of course, gender, but much more broadly) and their goals. What I, personally, eat probably only represents what 10-20% of the population “needs” to be eating. I have bad genes and enormous aspirations, so I really restrict carbs, which implies I must eat a lot of fat. It works exceptionally well for me and many others (by “well,” I mean according to the metrics I use to evaluate performance: body composition, athletic performance, measurable disease risk, mental acuity, and energy levels). But, I work with many folks who I do not put in a state of ketosis. My wife, for example, eats nowhere like me…

      To your second point, I think you’re referring to the figure I’ve borrowed from the 2006 Nature article where obesity is shown to impact a host of diseases, including gallbladder disease. You are correct, that being obese does not MEAN you will have gallbladder disease, and that the disease is the result of liver and gallbladder not handing bile efficiently. However, it is the case that, on average, the vast majority of people with gallbladder disease are, in fact. overweight, if not obese. There are always exceptions, as it sounds like you were, but obesity is big risk for gallbladder disease.

      I LOVE your point about expanding this beyond obesity. As I mentioned, when I work with clients, 1-on-1, I really focus on the 5 elements I mentioned above (note, “obesity” is only one of them). Very important for folks to appreciate how much the benefits transcend “just” body composition.

  16. Yogesh Verma  January 25, 2012

    Love your site Peter! I loved the way you put the flawed calories in/out math into question when it comes to weight loss. I am totally convinced that long term weight loss can only be achieved by controlling the intake of carbs.

    (reply)
  17. Troy Leitzsey  January 25, 2012

    Peter, I just found your blog and look forward to catching up. Thank Gary Taubes for the reference. I’ve recently read his books on diet, and they have certainly given me a new perspective on health.

    I have tried to follow a healthy diet according to conventional wisdom off and on through my adult life. Of course, conventional wisdom is that a low fat diet based on plants is the best choice. A couple of years ago I read The China Study by T. Colin Campbell. Then last year I read The 80/10/10 Diet by Douglas Graham. These books seemed to make a lot of sense to me at the time. However, after someone referenced Gary Taubes in an online discussion, I decided to read his book in order to “debunk” the other person in the debate. Well, needless to say, after reading Gary’s books, I’m the one who gained a new perspective and finally saw the glaring holes in the nutritional debate condemning animal derived foods and especially fat.

    I still like The China Study because it does say that processed food should be avoided, but in its focus on meat protein as a potential source of disease (without also discussing the equally strong correlations to be found with refined carbohydrate consumption) it fails to fully condemn the dangers of processed carbohydrates. I no longer like the 80/10/10 book. Now that I’ve read more fully about the metabolic processes it has become clear that Douglas Graham is a charlatan and a quack.

    So, keep the blog going! I look forward to reading more!

    (reply)
    • Peter Attia  January 25, 2012

      You hit the nail on the head, Troy. The China Study has some good observations, but unfortunately draws the wrong conclusions. You should, if you’re still interested, see Denise Minger’s work on both TCS and Forks Over Knives. Keep up the great work on your own journey.

    • Troy Leitzsey  January 27, 2012

      Peter, I had viewed “Forks over Knives” when I was on the other side, so to speak. I first heard of it on the 30-bananas-a-day website (I kid you not! I never could manage to go completely raw or fruitarian, though.) Then I watched it again after reading Gary Taubes books. I tell you it’s almost like night and day how clearly the errors stood out the second time. And I just read Denise Minger’s review of it per your suggestion. Amazing!

    • Peter Attia  January 27, 2012

      Troy, keep spreading the word. The real trouble with pseudoscience is that at the surface it “looks” like science…it “feels” like science, and if you haven’t been trained in real scientific ways, it’s easy to get fooled. I don’t know Denise Minger personally, but I look forward to meeting her at some point. I’m so impressed by her critical thinking on this issue, especially given her apparent lack of formal “training” (or, as I’ve said a few times, maybe that’s her advantage).

  18. Charlie Lopez  January 26, 2012

    Found your website through Gary Taube’s blog recently. I love it!

    Question: I’ve lost 148 pounds and 35% body fat doing low-carb the past 15 months (slowly progressed to a more Paleo approach). I track my food using MyFitnessPal, and I’ve noticed that I tend to be low-carb but higher protein than fat. I’m wondering if I’m not maximizing my results better by going low-carb, high-fat.

    Also, if I want to add more fat to my diet, do I just choose fattier meats, even if it is conventional grain-fed? The few times I purchase grass-fed, I’m all about the fattiest slices, but I’m not sure if my skepticism with fattier cuts of conventional, grain fed is justified or not.

    Was wondering if you could provide some insight on these issues. Thanks! And keep up the great work!

    (reply)
    • Peter Attia  January 27, 2012

      Charlie, first off congrats on an AMAZING journey. You’re an inspiration. I’d have hard time telling you to change anything right now, though, given your trajectory. Remember, we are all different. I plateaued with high protein and low carb (because I was not able to enter complete ketosis), and I wanted greater results. That’s why I reduced my protein intake form a HUGE amount (about 250 gm/day) to a normal amount (about 120 gm/day), while keeping carbs low. I also increased my fat intake, so net calories actually went up. If you can afford it, I do recommend grass- over grain-fed, but it’s because the meat contains less omega-6 polyunsaturated fats. Don’t worry, I’ve got a whole post ready on this topic, too.

    • Matthew Shade  February 2, 2012

      Peter,

      My pants are literally falling off and I’m scared people will group me in with the teens who wear their pants half way down their butts!

      I’ve stopped counting calories (well, at least I don’t write them down anymore) and have a similar question as Charlie’s post. I’m pretty happy with where I am. I’d be happy to maintain my current weight for the rest of my life, though I can say sometimes I want to see how low I can go.

      I would classify my diet as reduced carb, low/moderate fat. I’m starting to worry if I’m not eating enough fat? If my energy levels are fine (and they are), is there any reason for me to up my fat intake (besides the fact that I love crispy chicken skin)?

      Thanks again as always for taking the time to educate the masses.

    • Peter Attia  February 2, 2012

      Matt, congrats on the complete metamorphosis you’re undertaking. I’m glad you’re counting calories and I hope you’re enjoying your new eating habits. I think the best approach to take is one of a patient experimentalist. Everyone has a slightly different response. I also recommend changing only one variable at time.
      For example, you may consider reducing carbs and increasing fats 2:1 (i.e., for every 2 gm less of carb you ingest, ingest 1 gm additional of fat, which makes it almost isocaloric). See how that changes you? For me, more fat feels better. Too much protein feels bad. Too much carb feels really bad.

  19. Helga  January 27, 2012

    I love your self experiments! You seem like you have excellent access to testing. I’ve always wondered if the body was smart enough to know the difference between sweet tastes and actual sugar. Have you considered testing your insulin response to substances like stevia? I know Gary Taubes for one suspects the body may respond in the same to these sugar substitutes as it does to sugar. Have you tried such a thing and do you think it’s worth a test?

    (reply)
    • Peter Attia  January 27, 2012

      Great question, Helga. Gary is right – it’s actually different for everyone. I do know that for me, personally, the following sugar substitutes do NOT raise insulin levels: xylitol, aspartame, and sucralose. I have not tested any others on myself. There are some people, however, who do experience what’s called a cephalic insulin response to these substances. I’ll be writing a post about this shortly.

  20. Jason Mart  January 28, 2012

    Peter,

    I am writing to first off, to congratulate you on your excellent, readable, intelligently and gracefully written blog, and to commend you for the confidence that you must have inspired in Gary Taubes to have him essentially pass you the flaming torch. I would have loved to have been a fly on the wall of that meeting room. (here is a blog post subject suggestion that would be really appreciated….”My Dinner With Gary”… 27 Questions I had for Gary Taubes and His answers.” I know a ton of people would like to read that, and not just people who are currently reading your blog.)

    I was going to delay writing you until I had achieved some impressive personal weight loss milestone but then once I read Charlie Lopez’s post above, I knew that my meager achievements would not be worthy (Congratulations Charlie by the way!!!)

    I want to thank you and Gary for something a bit broader than just giving me the knowledge to help me lose 15 of the 45 lbs I need to shed, by putting all the insulin resistance, carb, fat intake information in its proper perspective. What I would like to do is to thank both Gary Taubes and you Peter, for helping me to fairly rapidly stop being such an insufferable, judgmental unsympathetic condescending snob when it came to how I viewed fat people. (It became increasingly ironic of course as I was packing on a few more pounds every year until I was technically Obese myself , but old patterns die hard, and hey, “Sure I am getting a bit plump but jeeze, look at that guy over there! Wow, he is REALLY fat and he must be a slothful glutton while I on the other hand am always really working at trying to lose weight”….).

    Fat Snobbery is of course pervasive in our society but thanks to you and Gary, as I am trimming up, I have replaced my terrible, embarrassingly judgmental attitude with two very different feelings; first sadness that most people just don’t understand the truth about why they are fat, and second anger that they have been so badly mislead by all of the industry, governmental, media and other supposed “experts”. The very ones who are charged with properly informing us about our diet and our health and establishing nutritional standards that make us healthier not sicker are continually leading us further and further down the absolute wrong road.

    The way to change this of course, is through further research, better data, and spreading the significant levels of knowledge base that currently exists, and I applaud your efforts in that regard.

    Thank you for making me less judgmental and for raising my ire and my hackles at the misinformation peddlers.

    One modest suggestion. Please place a SEARCH field at the top right of the home page of your blog. It would be a real help. I have tried to find blog discussions you reference in your writings and it is really hard to accomplish. If I just can’t find the SEARCH field it is not because I have not looked for it…(maybe it is just well hidden). This is really easy to correct. Great Blog, Peter.

    On behalf of all the fat people whom I now approach with empathy, I thank you. Please also thank Gary for me as well.

    Jason

    (reply)
    • Peter Attia  January 28, 2012

      Jason, thank you so much for your gracious and insightful comments. I know how you feel about transitioning from being judgmental to being empathetic (and there is a difference between being sympathetic and being empathetic). As you point out, the key to changing the world starts by changing the science. That’s what we aspire to do with our non-profit, NuSI.

      As for the first time Gary and I met, that would be a funny post, but I think Gary should it write it. I think he was just so shocked that some crazy guy showed up at his front door with 20+ pages of questions. I think we only got through 2 pages before it became clear we should be doing “something” together.

      As far as a search box, look at the top right of each page right beside the little magnifying glass. Let me see if I can get a color change to make it stand out. You’re not the first person to ask about it. My apologies.

  21. Mark McPherson  January 28, 2012

    Hi Peter,
    I liked what you’ve written so much, both my mother and I decided to follow your menu plan, emphasizing high fat, low protein, and very low carb. In only five days, we have EACH lost 8 pounds. Eight pounds per person!

    Additionally, because we have had plenty of fat, we are both satiated and have had NO “carb pull”, meaning neither of us have had any cravings for sweets.

    I must share that there is part of me that felt some trepidation about using all this cream, or butter, or oil, but not only do I “get” the principles behind it, we are now experiencing verifiable results.

    Thank you for sharing your own story, as it is making a difference.

    (reply)
    • Peter Attia  January 28, 2012

      Mark, congratulations to you and your mother, not just for the great results, but more importantly for having the courage to read the science and give it a try, despite your pre-existing biases. Do keep in mind that optimized low carb living requires a number of other tweaks (e.g., additional sodium, magnesium, and even potassium). I’ve written a bit about this, and will do much more late. If you’re looking for some quick info, though, check out Steve Phinney and Jeff Volek’s book (on my books & tools section).

    • Mark McPherson  January 29, 2012

      I cannot find anything on your site about magnesium or potassium. I will certainly take them, but do you have a link that goes into this (especially recommended doses, etc.)?

    • Peter Attia  January 29, 2012

      Look at the table in the post What I actually eat. It should be there.

  22. Damian  January 30, 2012

    Hi Peter I think your information on your website makes perfect sense . I actually came across it whilst researching a low starch diet and benefits from a low starch diet because I have anklyosing spondylitis
    There is alot of evidence out there pointing out starch is the culprit for this arthritis disease do you have any more to say on the harmfully effects of eating starch.

    Thanks Damian

    (reply)
  23. Robert  January 31, 2012

    Peter – I just found your blog through your interview on A Sweet Life. I’m a Type I Diabetic that has been eating Paleo (less than 50 grams of carbs per day) for the past year. My insulin use is now typically around 17 – 20 units per day, have less than a 6.0 a1C and rarely have to bolus with my meals. I’m 5’7″ 160 pounds and practice Crossfit religiously. I’m launching a blog that I plan on including all my lab results and weekly CGM reports to show through real life experience that this is the right way to control Type I Diabetes. Keep up the good work.

    (reply)
    • Peter Attia  February 1, 2012

      Robert, thanks so much for sharing this amazing story. You’ve changed your life forever. Keep up the great work and keep inspiring others.

  24. Jason  February 2, 2012

    Peter,

    I would have sent this as a brief personal note but I am instead sending my question and comment in via a post in case my question is shared by others.

    First off although I have been in ketosis for a bit over a month, I am not certain what levels I should expect over time. Can you help with general guideline “range” levels for say 5’10” 200 lb male and perhaps a 5’4” 140’ female?

    Secondly if I have say 5 to many strawberries and screw up my ketosis…what is the long and short range impact.

    Finally, I think one of the thrusts of the crusade to better educate people is to begin by correcting inaccuracies on major prominent medical sites. e.g. the misinformation spread by the prominent Mayo Clinic site is a good example…coming perilously close to mixing up ketosis with ketoacidosis.

    http://www.mayoclinic.com/health/low-carb-diet/nu00279/nsectiongroup=2

    The problem with these sites is personally vexing…when my wife saw me put a pat of butter in my tea when using half and half she thought I was hanging out with the wrong types on the internet! People who go hear to read about ketosis at the Mayo will have a decidedly negative impression making my goals even more difficult.

    Perhaps you could set up a landing page where readers report prominent medical websites that have low-carb / high-fat diet misinformation (I know, I know, it is nearly everywhere). Then you can draft a stock letter and post it along with the site directors reply information. Kind of a forum for change at the information distribution level. Maybe readers could contribute copies of Gary’s book as long as the main contact agrees to read and comment on it for The War on Insulin. A little bit interactive. A chance for readers to become involved. A chance for an Army of Davids to take up their slings etc etc.

    May I also suggest a pledge/donations page to support the database where readers pledge to donate as you help them meet their own specific goals. Include the tax exempt numbers etc.

    Let me begin. I hereby pledge to donate $100 to Peter and Gary’s National Database Project when I am below 200 lbs for one month and an additional $100 for each 10 lbs kept off for one month down to my goal weight of 170 lbs.

    (reply)
    • Peter Attia  February 3, 2012

      Jason, thanks for the questions and comments. I promise I will address the questions around ketosis, but I need to do a real post (or rather, a series of posts) to properly address it. Please do clarify what you mean by “range,” so I can think of how to address that.

      Ok, second, I’m really flattered by your suggestion. Thank you for such a vote of confidence. In the coming months, probably May or so, Gary and I will be launching the Nutrition Science Initiative (NuSI). At that time I’ll lay out what our goals are and what folks can do to help, if they agree with our mission. Please stay tuned and thanks again for your pledge of support. Really means a lot, Jason.

  25. Dorian  February 3, 2012

    Peter, I found you through Gary Taubes, whose books have motivated me to alter my nutrition over the last few years, particularly the reduction in carbs. My first question for you involves the multi-week transition period you experienced on the way to ketosis. While I am not trying to get to ketosis, I wonder if it’s possible to inadvertently get close to ketosis (but not all the way there) so that the transition period lasts indefinitely? In other words, is there a transition (purgatory) zone where a person can get stuck in, because they are not eating few enough carbs to be in ketosis while not eating enough carbs to be out of the border zone?

    Thank you!

    (reply)
    • Peter Attia  February 3, 2012

      Dorian, what are possibly referring to is a place some of us have been — the so-called “zone of misery.” It’s on my list of future posts, so hopefully I can get there soon.

    • Dorian  February 6, 2012

      Is there a way to know if you are in this “zone of misery”? And is there a way to get out of it? Thanks! (And I’ll watch for your future post as well.)

    • Peter Attia  February 6, 2012

      You feel horrible is usually the best “test.” There are other “hints,” but how you feel matters more than anything else.

    • Mary Beth  February 29, 2012

      I’m so excited to have found you and the wealth of information you are providing. Please hurry with your promised post on the “zone of misery.” I think I’m there and it’s wearing me out!

  26. Mike  February 3, 2012

    Hi Peter,

    What do you think about newer bodybuilding keto diets recommend more protein and moderate fat like Palumbo diet, Lyle Mcdonald Ultimate diet 2? They recommend up to 1.5g protein per lbm and claim high protein is more muscle sparing for athlete. I’m about to start keto diet with lots of lifting, running and biking but I’m getting contradictor information about protein/fat intake.

    (reply)
    • Peter Attia  February 3, 2012

      Mike, I’m not familiar with the data suggesting that. Doesn’t mean it’s wrong, but I can’t give an informed point of view.

  27. Eric  February 4, 2012

    I recently discovered your site via Gary Taubes’s. You provide a lot of information in a very accessible format; I am sure I will visit often in the future.

    You say in your intro that you’re going “to challenge everything [I] think [I] know about nutrition”. One area where I don’t think you (or Gary Taubes, et. al.) have challenged my thinking regards my belief that most of the benefits you claim come from suppressing insulin secretion can be obtained as effectively and more safely on a plant based diet than on a diet high in animal products, which is the one you seem to endorse.

    My own experience is that back in 2005, at the age of 37, a blood test revealed HDL and total cholesterol levels that were considered on the borderline of the safe range. After reading your article, I went back to the results and calculated my triglyceride/HDL ratio; it was 1.82. At the time I was not overweight.

    I made some significant lifestyle changes, including more frequent and more demanding exercise, cutting back on bread and other refined carbs, and drastically reducing my consumption of fatty processed meats and my beloved French cheeses. My consumption of complex carbs such as lentils, brown rice, oats, etc. increased. A blood test in 2008 resulted in a TAG/HDL ratio of 0.49. My HDL was above the upper bound of the “normal” range.

    Encouraged, I continued with the above changes, becoming nearly, but not quite, a vegetarian. My consumption of sugar was already very low, but I reduced it further by avoiding so called “healthy” snacks such as fruit juices. Complex carb consumption was further increased to substitute for the reduced meat consumption. A blood test in early 2011 resulted in a TAG/HDL of 0.37. Part of this may have been due to total alcohol abstinence in the month prior to the test. (It’s my understanding that alcohol elevates TAG.)

    So clearly a lot of changes were made, and it’s not possible to say how much (if at all) each change contributed to the improved test results. The point is that, over the whole period, my consumption of foods high in complex carbs moved in one direction: up. Furthermore, I did not have any of the concerns that someone eating foods that you say you eat would (or should) have: PCBs and mercury in farmed fish, antibiotics and growth hormones in meat, not to mention that for much of their lives (with the exception of beef) farm animals are likely to have been fed soya, corn, or grain-based foods while living in confinement. In other words, not eating the food or living the lives that they were designed for. Then there the concerns about elevated homocysteine levels and their relation to heart attack risk, carcinogens produced in the cooking of meat, etc. I could go on. None of these issues are raised on your website (correct me if I’m wrong) or in Taubes’s books.

    Finally, you say repeatedly (as does Taubes) that glucose is the most powerful stimulant of insulin. True, but isn’t the issue which FOODS elicit the strongest insulin response? And can’t this be quantified? For example, isn’t it the case that the insulin index for lentils is between that for fish and beef? And don’t many other grain based foods such as oatmeal or wholewheat pasta have a low index?

    Thanks again for the website. I look forward to your challenges to the thoughts above.

    (reply)
    • Peter Attia  February 4, 2012

      Eric, thanks for your questions and comments. You’re asking some great questions I can’t address in a quick response, but I’ll try to touch on them. First, it is very easy to improve your eating habits even if you choose not to consume meat, and even if you choose to avoid all animal products and adopt a 100% plant-based diet. The worst offenders of all are sugars and very simple carbs, which are easily avoidable in both of these settings. I personally choose to consume animal products, but I understand that this is a personal decision. I do think it’s very important for folks to be clear WHY they consume a plant-based diet, should they choose to. When people tell me they eat plant-based for ethical reasons or personal distaste for meat, I would never try to “talk them out of this position.” However, when someone tells me they are eating a plant-based diet for health reasons, I generally point them to exceptional commentaries by Denise Minger. If you haven’t already read her commentary on The China Study and Forks Over Knives, I can’t recommend them enough.

      As far as your numbers — very impressive (assuming you calculated these in mg/dL). It suggests to me 2 things: 1) you are genetically probably not predisposed to heart disease to begin with, and 2) you clearly eliminated the simple carbs and sugars in your diet as demonstrated by driving down TG and driving up HDL-C. Hard to really your overall risk profile without an NMR measurement of LDL-P and/or a direct measurement of ApoB, but your TG/HDL-C is pretty impressive.

      Glucose is a powerful stimulant on insulin, but it more complicated than this. Certainly, as you point out, the foods you consume matter most (versus the individual polysaccharides, for example). However, don’t confuse glycemic INDEX with glycemic LOAD. Eating a food with a high GI, but few actual grams of carbs is probably less harmful than consuming a modest GI food in large amounts (e.g., contrast a slice of watermelon with a large bowl of brown rice).

    • Eric  February 5, 2012

      Peter,

      Thanks for your quick response.

      I was actually referring to the insulin index, not the GI or glycemic load. My understanding is that this index measures the insulin response itself (as opposed to changes in blood glucose), which would seem to be the most relevant quantity if the objective to is keep insulin levels down. (More details here: http://en.wikipedia.org/wiki/Insulin_index). My question was, what would be the basis for preferring an animal-derived food (e.g. beef) over a plant-derived food (e.g. lentils) if they have roughly similar insulin indices? Obviously there are other considerations, such as the type of protein, fat, fiber content, etc., but from the standpoint of insulin secretion, it’s not clear to me why the animal-derived food should be preferable.

      Thank you for recommending the critique of “The China Study”. I have read the book, but felt it side-steps some key questions, such as why some of the healthiest populations, e.g. the Okinawans, have traditionally included large amounts of of fish or game in their diet.

      My TG and HDL results were in mmol/L (the tests were done in the UK), but as both were in the same units, that would not impact the TG/HDL ratio.

      Best regards,

      Eric

    • Peter Attia  February 5, 2012

      I understand Eric, but my point with always keeping glycemic load in mind is one of substrate availability. In other words, if you consume a food that stimulates X amount of insulin, but actually has very little de novo lipogensis precursor, you may transiently inhibit fat mobilization due to high insulin levels, but not storing more. Conversely, if you eat something that stimulates 0.8X, but provides a great deal of de novo lipogensis precursor, you are probably more likely — in net — to create a more “fattening” environment. Obviously, this is 1) non-linear, 2) subject to great genetic variability, and 3) transient over time.

      Hence, the less you are exposing yourself to repeated glucose loads, the more you can lower your glucose response. This is why, for example, my OGTT — despite the exact same glucose load — showed such dramatic improvement. One other point to keep in mind (and I don’t know the answer, but it’s worth pointing out): the insulin index may not take into account the AUC (area under curve), which is probably the most important issue of insulin secretion.

      As far as TG to HDL-C ratio, it does need to be done in mg/dL for the standard I’ve described to “hold.” Even though both of yours are in mmol/L, this ratio is calculated as [mass] to [volume], not [moles] to [volume]. There are plenty of on-line converters, including this one: http://www.onlineconversion.com/cholesterol.htm

  28. Jason Mart  February 4, 2012

    Peter,

    Again, Thank you for your insights and sharing your knowledge with all of us.

    A couple of items….

    First off although I have been in ketosis for a bit over a month, I am not certain what levels I should expect over time. Can you help with general guideline “range” levels for say 5’10” 200 lb male and perhaps a 5’4” 140’ female? The readings I am getting (+ – 5 mG/dL) on my Bayer strip seem mighty low.

    Secondly if I have say a bit too many strawberries and screw up my ketosis…what is the long and short range impact? How long does it take to reestablish ketosis.

    Finally, I think one of the thrusts of the crusade to better educate people is to begin by correcting inaccuracies on major prominent medical sites. e.g. the misinformation spread by the prominent Mayo Clinic site is a good example…coming perilously close to mixing up ketosis with ketoacidosis.

    http://www.mayoclinic.com/health/low-carb-diet/nu00279/nsectiongroup=2

    The problem with these sites is personally vexing…when my wife saw me put a pat of butter in my tea when using half and half she thought I was hanging out with the wrong types on the internet! People who go hear to read about ketosis at the Mayo will have a decidedly negative impression making my goals even more difficult.

    Perhaps you could set up a landing page where readers report prominent medical websites that have low-carb / high-fat diet misinformation (I know, I know, it is nearly everywhere). Then you can draft a stock letter and post it along with the site directors reply information. Kind of a forum for change at the information distribution level. Maybe readers could contribute copies of Gary’s book as long as the main contact agrees to read and comment on it for The War on Insulin. A little bit interactive. A chance for readers to become involved. A chance for an Army of Davids to take up their slings etc etc.

    May I also suggest a pledge/donations page to support the database where readers pledge to donate as you help them meet their own specific goals. Include the tax exempt numbers etc.

    Let me begin. I hereby pledge to donate $100 to Peter and Gary’s National Database Project when I am below 200 lbs for one month and an additional $100 for each 10 lbs kept off for one month down to my goal weight of 170 lbs.

    (reply)
    • Peter Attia  February 4, 2012

      Jason, urine strips are qualitative, but blood strips (which is what I use) are qualitative. The ideal range for nutritional ketosis is 0.5 to about 2.0 mM while fasting. Exercise can change this dramatically, of course. Once NuSI is up and running, we’ll certainly have a donation link available. Thanks so much for the support.

    • Stuart  February 12, 2012

      I’m in Canada and the Abbott ketones is in mmol/L cannot find mM conversion? my reading is .3 and when very low carb Mg Ca Sodium is too low.
      I went from 18%BF to 22%BF same weight went to a naturopath/dietian who said have andrenal exhaustion have to cycle carbs and saw this article
      “The telltale Thyroid-Cholesterol signs you need more carbs”
      http://chriskresser.com/chris-masterjohn-on-cholesterol-and-heart-disease-part-3

      wonder if can comment as naturopath tells me longterm keto lo carb causes problems as above.

    • Peter Attia  February 12, 2012

      Stuart, sorry I should have been more clear, mM and mmol/L are the same thing, so if you’re at 0.3, you’re not quite there. You’re clearly carb restricted, but not yet in nutritional ketosis. You want to be above 0.5 mM, at a minimum, and ideally between about 1.0 and 3.0. My guess is that you might be failing to adequately supplement sodium into your diet. When you restrict carbs a lot of changes take place in the way your body handles Na, K, Mg. Best thing to read on this is Phinney and Volek’s book (under my Books and Tools section). Obviously, you should have a workup for any adrenal concern your doctor has, but I wouldn’t assume a properly formulated low carb or ketotic diet is the cause.

  29. Frannie  February 7, 2012

    Peter….I found your blog via Taubes blog and am thrilled. I first heard of Gary Taubes while reading Sugar Nation by Jeff O’Connell. I read GCBC in 2 days. As a woman with PCOS, I know I am insulin resistant. Last summer I even bought myself a glucose meter from the drugstore, so that I could test my fasting and post-prandial levels. I am a medical technologist and thus I have this incessant need-to-know numbers. I am 38, Hispanic and I know if I didn’t change my diet, DM type 2 and its known accomplices would follow. Thankfully my glucose levels have been in the non-diabetic range despite the standard American diet thus far. One month ago, I started eating low carb, keeping my carbs to about 50 grams/day and have already dropped 10 pounds. When I was first diagnosed with PCOS about 10 years ago, my MD at the time, gave me a sheet of paper that talked about a vague non-inflammatory diet that helped alleviate PCOS signs/symptoms in some women but certainly it did not mention anything about low-carb. I wished I had had your blog back then to refer to!

    (reply)
    • Peter Attia  February 7, 2012

      Frannie, great work on your LC journey. Keep up the good work and thanks for sharing your own experience.

  30. Ellen Davis  February 9, 2012

    While researching the subject of sugar alcohols for my ketogenic site, I was surprised to learn that the sugar alcohols have been shown in several studies to inhibit ketosis. Here’s a few examples: http://www.ncbi.nlm.nih.gov/pubmed/1175862
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1197501/?tool=pubmed

    The studies aren’t recent, but it might be another good reason to avoid large amounts of sugar substitutes, especially if you are trying to stay in ketosis.

    My personal favorite is Erythritol.. no stomach distress, but I limit the amount to a teaspoon once or twice a day.

    (reply)
    • Peter Attia  February 9, 2012

      Ellen, it varies from person to person. Like I said in my sugar substitute post, I have documented repeatedly that xylitol does not in any way inhibit ketosis in me. It certainly might in some, but this again speaks to the individual variation factor. Steve Phinney has also reviewed xylitol on a number of subjects and found the same. I can’t speak to the others. The key is definitely figuring out what works for each person.

  31. Brad F  February 10, 2012

    Peter
    Following you from afar, and I am enjoying your blog.
    You will thoroughly enjoy this:
    http://intelligencesquaredus.org/index.php/past-debates/obesity-is-the-governments-business/

    Brad

    (reply)
    • Peter Attia  February 10, 2012

      Brad, thanks for passing this along for us. Look forward to checking it out.

  32. David  February 11, 2012

    Not sure if you’ve covered this elsewhere on your blog. I took a look, but couldn’t find anything.

    I have been surfing the low carb blogosphere lately and landed on one of Stephan Guyenet’s critiques on insulin/obesity (http://wholehealthsource.blogspot.com/2012/01/insulin-and-obesity-another-nail-in.html). Curious about your take on his stance.

    Regardless of the why, even Guyenet says that a low carb diet is great for losing weight. So, by no means am I looking to stop the changes I’ve made. But, am curious as to the why.

    (reply)
    • Peter Attia  February 11, 2012

      Stephan and Gary Taubes have debated this point back and forth 9 or 10 times. Check Gary’s blog for the thread.

    • David  February 13, 2012

      I’ve spent some time the last few days reading Taubes’s blog. However, it seems more time is spent debunking Guyenet’s theory (Food Reward) than is spent defending his own (Carb / Insulin). Which leaves me curious if Guyenet’s criticisms are at all valid. Or just blowing smoke.

    • Peter Attia  February 13, 2012

      Probably a better question for Gary, though I’m sure he’d rather not be spending time on this interaction. What is your view, reading both sides?

  33. David  February 13, 2012

    Not sure if there is a limit to the number of replies per post, but I was not given the option to reply to you above.

    My dive into the low carb blogosphere started by stumbling onto your site a few weeks ago. Understandably, highly intertwined with what Gary is saying. It all makes sense to me and thus seems logical. And has the great added benefit of “working” when I step onto the scale.

    Admittedly, I haven’t spent a ton of time on Guyenet’s site yet. But, Food Reward does seem a bit wonky. Certainly, I get that people are more likely to over eat food that tastes good and not over eat bland food (in the short term). However he loses me at the increase in “set point” (in the long term). Not sure if this (set point increase) is theory or scientifically proven (thus my need to spend more time on his site).

    Long story short, and getting back to my original question, as someone without a scientific background, I’m curious if the science Guyenet states disproves Carb / Insulin has some validity or if he just has a different interpretation of past studies(I hope he’s not just blowing smoke to help prop up his own hypothesis).

    (reply)
    • Peter Attia  February 13, 2012

      David, I know Gary very well. He’s one of the most intellectually curious people I know. If he disagrees with Guyenet, it’s because he does not agree with the science. Who you chose to believe will be up to how you interpret the data. Maybe we don’t yet have enough data to make that distinction?

  34. Mark McPherson  February 14, 2012

    Hi Peter,
    My first couple weeks went great, as I lost about 13 lbs (I originally started at 335 lbs). But another two full weeks have passed and already I have plateaued. I can’t figure it out. Carbs are not a problem, as I eat very low. I have lessened my protein intake and ensure I have a good amount of fat (cream, butter, oil), but the scale is not dropping. I don’t seem to require as much water as I did the first few weeks, so I guess I am not in ketosis… but I don’t know why. Any thoughts?

    (reply)
    • Peter Attia  February 14, 2012

      Mark, could be dairy, could be non-sugar sweeteners? Try experimenting with these.

    • Bear  February 23, 2012

      Peter, I have a question along the lines of Mark’s. After reading your blog carefully, about one month ago, my wife and I changed up our low-carb diet, which we’d been following for about six months (going from moderate fat intake to high fat, while also reducing protein… basically, we are trying to apply the ratio of 69% of calories from fat, 23% from protein, and 8% from carbs) – and to our surprise, we actually gained weight. Granted, it wasn’t much weight; but it was surprising. During our one month of high fat/low carb intake, we’ve steadily gained a little bit of weight (and we’ve been weighing ourselves daily, at the same time each day).

      We do eat cheese and heavy cream, as well as Xylitol and Stevia – but, we also use the ketosticks to see if we’re ketogenic. And the ketosticks have been indicating that we’re ketogenic. So, our question is, how could we be gaining weight on the high fat/low carb diet when (according to the ketosticks) we’re definitely in ketosis?

      And we have a second question. We’re speculating that the reason for the weight gain might be the fact that we’re actually eating quite a bit more calories now that our attitude has changed to “praise the Lard”/bring on the butter & heavy cream. We know (thanks to Gary Taubes and others, including you) that calories-in/calories-out has got it all wrong, but: is it possible that our weight gain has to do with the fact that we’ve been consuming a lot more calories?

    • Peter Attia  February 23, 2012

      It’s really tough for me to troubleshoot issues like this. When I work with folks 1-on-1 it takes me weeks with lots of data to even begin to solve problems. It would be irresponsible of me to suggest to you that I could do it. It could be so many things, many of which you’ve named. I’d definitely suggest doing some “experiments” on yourself, as you’ve already started. Also, urine ketone sticks are not always accurate, which is not to say you’re not in ketosis, just to point out that sometimes even that can be an issue.

  35. Bear  February 23, 2012

    Thanks Peter. And thanks for the responsiveness!

    Agreed – we will continue with “experiments” on ourselves. I’ve gotten several friends and a few family members to try out the high fat/low carb lifestyle (after they’ve been sufficiently persuaded by the writings of Taubes/Volek & Phinney/you/Drs. Eades & others – or by my attempt at summarizing what I’ve read). We’re proud of how these friends and relatives are doing. The big hurdle in their minds, of course, is that it goes against the fat-is-evil indoctrination/misinformation that has been thrown at us for decades.

    We were hoping that our switch to the 69/23/8% ratio (as opposed to the low carb/moderate fat ratio we’d been utilizing previously) would lead to some noticeable bodyfat loss – for many reasons of course, including to better nudge our friends & relatives along this path… Anyway, we’ll keep experimenting. And yes, it is and has been noted that the ketone sticks aren’t super reliable.

    (reply)
  36. DominiqueA  February 23, 2012

    Curious if you saw the latest drug that may be approved (Qnexa). I’m interested in seeing the studies conducted with this and specifically what diet the participants followed….

    http://www.latimes.com/health/la-he-qnexa-fda-20120223,0,1643846.story

    (reply)
    • Peter Attia  February 23, 2012

      Briefly. But who wants to take a drug when you can fix the problem by what you eat? This is actually a sad commentary on how dependent we, as a society, have become on quick fix medications. I’m not saying all medications are bad. Not at all. But this does not strike me as the “right” answer.

    • DominiqueA  February 23, 2012

      I agree- Eating FAT is an appetite suppressant for me-no pill required. Thanks.

  37. Kristina  February 25, 2012

    Thank you so much for your blog. You do a great job communicating science in such a way that I can put it to practical use.

    I checked the Coming Soon page and didn’t see a topic that sounded close to one about people who have been told to limit fat due to a history of gall stones. Is this a topic that you would be able to address in the future?

    I am also interested in your future topics about low carbs relating to children and pregnant women. I was wondering if you might cover the ketogenic diet in relation to children with seizures? Or morning sickness, ankle swelling, gestational diabetes, or any thing else we consider normal in pregnancy these days that can be addressed by diet?

    (reply)
    • Peter Attia  February 25, 2012

      Kristina, will do. I have been asked about this before (over high-fat dinners), so I’ll put it on the list. Thanks very much for your interest.

    • David Hogan  April 4, 2012

      +1 For this topic – a friend of mine has been told to avoid fat due to a gall stone, and also told that he must lose weight because of fatty liver.

  38. Gavyn  March 9, 2012

    Hi Peter,

    I just wanted to say thanks for indirectly saving me a fair chunk of money. I stumbled upon the whole Paleo/caveman “movement” recently and have done a ton of research into the how’s and why’s of this lifestyle. I had been about to embark on a course in nutrition but having looked at the course curriculum, it seems to be promoting the old adage that fat is bad, and crabs are good. I realise this is simplifying things a bit, but the teachings seem to be outdated and would be totally pointless, so I am now spending the money more wisely on books (Gary Taubes etc) and hopefully, once I find a nutritional course that offers progressive thinking, I can pursue this and try and help others find a healthier lifestyle and to avoid the errors of conventional wisdom.

    Thanks again.

    (reply)
  39. bobby dean  March 19, 2012

    I low carb and am off Humalin N 24 units a day, it made my legs swell,and made me hungry my BG are running 5 and 6 sometimes up to 7 PP and trying to reduce them even more. I have been using a few units of humlaog to reduce them when they hit 7.
    Is my body better off running at 5 to 7, I know I wont get an A1C under 5.1 which is my goal. as worried that extra insulin floating around in my system is inflammatory.
    BTW I have lost weight eating this way and got off over 110 units of humalog a day as BG numbers used to be double.If I sue too much i egt lows and get as hungry as a horse so trying to fine balance and reduce inflammation in arteries etc.I eat only whole nutritional foods, no wheat,nothing white but cauliflower, no fruits nor hi starch veg.

    (reply)
    • Peter Attia  March 19, 2012

      Great work on your progress. Check with your doctor on changing your insulin requirements, as they are sure to go down.

  40. bobby dean  March 21, 2012

    Oh my doc tells me to do what works, he likes me to use lots of insulin and if lows then drink OJ, I dont want lows and dont want Oj in my body:)

    (reply)
    • Peter Attia  March 21, 2012

      Might be time for a new doc…

  41. william  June 19, 2013

    Hello Dr. Attia,

    I need some help/direction with what I am going through right now.

    I am a single 60 something male that just went to the hospital emergency room for acute cholecystits and admitted to the hospital for a week.

    I started eating mostly an all meat diet for weight loss on 8/16/2009. First I went through a week of looking really bad and then my energy level shot through the roof. Eventually I cheated here and there at times with carbs for various reasons.

    In 2010 I went through a time where I had super dry itchy skin all over, even in the weirdest places like the tear duct of my eye. Places behind my knees and on my fingers really got real dry and itchy. Now looking back I always wondered how this could be when I ate so much animal fat? It seems clear either I didn’t break into the all meat diet the right way – or down the road I simply added too much bad stuff back into my diet.

    Up to this point I have been “pretty healthy”, active, exercise, ate what some might call good food, maybe just too much etc.

    In 2010 I had a physical and it showed elevated FBG of 105 and I the doc found blood in the stool sample. I was scheduled for a colonoscopy and endoscopy showing a couple polyps (removed), inflammation, some diverticulitis – can’t remember if there was anything else. Doc wanted to put me on proton pump inhibitors and I refused. I was put on the 5 year plan for colonoscopy.

    I found a link on line about heartburn / GERD by Chris Kresser. I tried the Betaine HCI and got up to 10 capsules before I noticed any burning at which time I reversed the amount I was taking except a maintenance dose (1 per meal and almost never have heartburn or acid reflux now).

    My recent hospital showed a thickened gallbladder, fatty liver, and inflammation. I had stones and sludge removed and there was a stricture of the gallbladder which opened up through the ERCP that was performed. The good news is that the biopsies they took came back negative. Of course the solution is to remove the gallbladder. Meeting with surgeon in a few weeks, no appointment scheduled yet and at this point I do not intend to have the GB removed.

    Low carb, Paleo type diets have been good to me even though it might not sound like it, but I have not been good to me in some ways. I don’t want to give up my gallbladder because of the important functions it provides and the negative conditions that could develop with heart and circulatory if you don’t have one.

    Is there anyway to keep my gallbladder and stop fooling around with my health?

    Thanks for any response,

    william

    (reply)
  42. Bryan  December 3, 2014

    Great site. Lot of great science discussion. You make a compeling case for the central role of insulin in obesity. My question is about the ketogenic diet. Are there any studies that connect the changes in lipid profile induced by nutrional ketosis with real reduction in cardiovascular events or mortality?

    (reply)

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