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

What I actually eat (circa Q4 2011)

What I actually eat (circa Q4 2011)
Share

Note to readers: This post was written in December of 2011.  PLEASE do not ask me why I eat ‘this’ or why I don’t eat ‘that’ — as what is shown here does not necessarily reflect what or how I eat today (or more importantly, how you should eat).  My diet evolves constantly, due to my constant tweaking and self-experimentation. Over time, I’ll share it here and there, but what I eat is not at all the focus of this blog.  I ask that you refrains for pursuing questions about what I eat in the comment section.

 

Once people start to “get it” with respect to why carbohydrate reduction, or all-out restriction, leads to good things, the inevitable question I’m asked is, “So….what exactly do you eat?”  I’m always a bit hesitant to get into this.  It’s sort of like asking a pilot, “So…how do you fly this plane?”  It’s a great question, but probably the wrong first question.

For many people it’s so overwhelming to contrast what they currently eat – probably a typical American diet of 500-600 daily grams of carbohydrates (200 grams of which are sugar) – with a diet of less than 50 daily grams of carbohydrate, which is what I consume.  Remember, what I’m showing you here is what I have been eating for about the last 7 months.  For the first 20 months of my nutritional transformation, I was gradually reducing carbohydrate intake from about 600 daily grams to 300 daily grams to 150 daily grams.

It’s really important to understand that carbohydrate reduction is a continuum. There is no “right” amount of carbohydrate to eat.   Let me illustrate this with the following “2 by 2” matrix, below (sorry, once a consultant, always a consultant).  When asking the question, “How much should I reduce my intake of carbohydrates?” it’s a good idea to start with two broader questions:

  1. What is my inherent level of insulin resistance?
  2. What are my goals?


There are technical ways to quantify the answer to the first question, which I will detail in future posts.  However, the simple version of determining your inherent amount of insulin resistance is checking how many criteria of metabolic syndrome are present.  In other words, are you overweight?  Is your waist large?  Is your blood pressure high?  Do you have elevated blood glucose or triglycerides (these are determined from a standard blood test)?  Do you have low HDL cholesterol?  For the purpose of this question, even responding “yes” to one of these questions means you are predisposed to being insulin resistant.  I was a “yes” to 3 of these questions.

Consider this matrix, and let’s use me as an example.

2 by 2

  1. How predisposed am I to insulin resistance?  One look at a picture of me in my non-lean state, coupled with an understanding of my family history, and it’s clear I didn’t hit the genetic lottery with respect to insulin resistance.  Hence, I am towards the right of graph.
  2. What am I optimizing for?  Some folks want to lose 15 pounds.  Others want to have fewer swings in daily energy level, or stop taking their blood pressure medicine.  In my case, I want to maximize as many variables as possible: I want to be as lean as I can; I want to cure my insulin resistance; I want to be sure I never have a single symptom of metabolic syndrome; I want to do everything I can to avoid cancer and Alzheimer’s disease; I want to be metabolically flexible. Hence, I am towards the top of the graph.

As you can see, based on my poor genes and lofty goals, I find myself in the upper right square, which means I need to adopt the greatest amount of carbohydrate restriction. My wife, in contrast, has good genes, coupled with high goals, placing her in the upper left box.  As a result of this combination, she does not need to restrict carbs as much as I do.  If her goals were even more modest, she could get away with very little reduction in carbohydrates – probably just reducing sugar without much reduction in starch.    

Below is a picture of a few of the foods you’ll typically find in my refrigerator.  Note that on average I consume about 4,000 to 4,500 calories per day.  I get this from approximately 400-425 grams of fat, 120-140 grams of protein, and 30-50 grams of carbs.  In addition, there are a number of supplements I consume daily, which I describe in the table below.  In future blog posts I will go into greater detail as to why I consume each of these supplements, but for now I’ll give a very quick explanation.

Finally, note that under no circumstance do I ever count calories (for the sake of limiting them).  When I was first transitioning into ketosis I did need to count how much carbohydrate and protein I was consuming – anything over about 50 grams of carbs and 150 grams of protein makes it difficult to generate sufficient ketones – but I do not ever count calories for the sake of restricting them. I eat when I’m hungry.  I don’t eat when I’m not hungry.

Foods I typically eat

Regular supplements I consume every day

my list of supplements

*I will be writing a great deal about the role of omega-6 and omega-3 fatty acids in our diet in subsequent posts.  However, if you want a quick (albeit high-level and not overly nuanced) overview of the topic, take a look at what Dr. Andrew Weil and Livestrong have to say about it.

One last point on supplements – I do not take a multivitamin at this time, but I am looking into it a bit more closely.   My concern is that 1) they may not be necessary when you remove glucose from your diet (I’ll write about why in the future), and 2) they may actually do direct harm, as a result of contaminants.

 

Ok, at long last, here is a list of what I ate over the past 5 days (excluding water, still and sparkling, which I consume about a gallon of each day)

Wednesday

Breakfast: “Fat shake” (In a blender: 8 oz heavy whipping cream, 8 oz sugar-free almond milk; 25 gm sugar-free hydrolyzed whey protein, 2-3 frozen strawberries)

Lunch: About 4 or 5 oz of assorted cheese (Gouda, Swiss, Manchego), 2 or 3 oz olives, about 4 oz of particularly fat salami and pepperoni

Late afternoon:  About 2 oz of mixed nuts (almonds, walnuts, peanuts), large latte (latte made with heavy fat cream instead of milk) at Peet’s

Dinner: Garden salad with olive oil (lots of extra oil) and balsamic vinegar dressing, about 6 oz grilled salmon with a lot of butter and lemon juice

 

Thursday

Breakfast: Scrambled eggs (6 yolks, 3 whites**, with added heavy fat cream) cooked in coconut oil, 3 or 4 sausage patties (be sure to look for brands not cured in sugar).

Coffee with homemade whip cream (heavy fat cream hand whipped)

Lunch: Half chicken (thigh, breast, wings) with lots of skin; about 2 oz of Gouda and aged-cheddar

Dinner: Wedge blue cheese salad with bacon; 12 oz prime rib with lots of butter; 5 or 6 pieces of asparagus coated in butter

Coffee with half and half cream, 2 cups (the restaurant did not have heavy cream, so I had to settle for half-and-half)

**The reason I typically minimize egg whites, at least when making my own eggs, is to ensure I keep protein intake under about 125 grams per day.   Ketosis is pretty easy to attain if one is eating, say, 2500 calories per day.  However, given my caloric demands – and the requirement that I keep protein intake limited – I really need to go out of my way to ensure I’m not eating too much protein.  I will be writing about this in much greater detail in a future post.

 

Friday

Breakfast: Whole fat latte at Starbucks (made same as above), scrambled eggs (about 4 eggs), bacon (high fat pieces), slice of Swiss and slice of cheddar (since I was eating in the airport, the scrambled eggs were made “normally,” not with the additional fat I use when making my own)

Lunch: About 4 oz of especially fat salami and pepperoni, about 2 oz Parmesan cheese

Dinner: Ground beef sautéed with heavy cream, onions, broccoli, and melted cheese

2 large cups of decaf coffee with homemade whip cream (heavy cream whipped with a touch of xylitol)

 

Saturday

Breakfast: Scrambled eggs (6 yolks, 3 whites, with added heavy fat cream) cooked in coconut oil, 3 or 4 pieces of especially fat bacon (not cured in sugar), about 3 oz of cream cheese

2 cups of coffee with heavy cream

Lunch: Tomatoes with basil and mozzarella and balsamic vinegar and olive oil, about 2 oz raspberries with homemade whip cream

Dinner: Leftover ground beef sautéed from previous night, salad with homemade cream dressing (whole fat Greek yogurt, olive oil, basil, blue cheese, garlic)

1 cup of decaf coffee with homemade whip cream

 

Sunday

Breakfast: Omelet (6 yolks, 3 whites, coconut milk, sautéed onions) cooked in coconut oil, 4 or 5 pieces of the fattest bacon I can find

2 cups of coffee with heavy cream

Lunch: Plate of assorted cheeses (aged Gouda, Swiss loaf, aged Parmesan – about 3 oz), about 2 oz salami, about 1 oz olives

Dinner: Cream of mushroom bacon soup (heavy cream, chicken broth, shredded Parmesan cheese, mushrooms, chopped bacon, garlic, butter, chopped  papers, various spices), leg of lamb (baked in sauce made of red wine, balsamic vinegar, diced tomatoes, garlic, and a lot of spices)

2 cups decaf coffee with homemade whip cream (as above)

 

So there you have it — 5 days in the eating life of Peter Attia.  This may look a bit strange, relative to what you may be eating now, but remember, I’m at the far end of the spectrum – i.e., nutritional ketosis.  You may just be starting your own journey of reducing carbohydrates, but I hope this gives you an idea of what I eat.  In particular, what probably stands out is:

  1. I go to great lengths to avoid sugar which, unfortunately, shows up in virtually every highly processed food.
  2. I eat zero starch (e.g., bread, cereal, rice, crackers, pasta).
  3. I consume only modest amounts of fruit (one serving per day, at most, and only in the form of berries, which contain the least amount of fructose).
  4. I eat vegetables, but primarily because they are a great way to get more fat (e.g., high-fat salad dressings, butter), not because I “need” them.
  5. I go out of my way to eat as much fat as possible, especially monounsaturated and saturated fat (the only fat I avoid is omega-6 polyunsaturated fat).
  6. I have a few “go to” meals that I eat several times per week.  I do this because I really like them and it’s quick and easy make them. Yours need not be the same!
1,066


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. Doris  December 22, 2011

    I just added this feed to my bookmarks. I have to say, I very much enjoy reading your blogs. Thanks!
    Acne medication

    (reply)
    • Cristea Cristian  October 12, 2013

      I Agree!

    • ILEEN HENRY  February 3, 2014

      You talk about the benefits of ketosis but what about the draw backs? I have a lot of diabetes in my family, in fact my sister died at the age of 15 due to ketoacidosis. I have been on my own journey trying to achieve where you’re at. Nutritional ketosis. My question is, since I do not have diabetes and am trying to prevent diabetes, will entering into ketosis help or harm me? Also, what is the quickest and safest way to induce ketosis? I am also been dabbling in IF(intermittent fasting) to help achieve higher ketosis but read somewhere that it could be harmful for women to fast. What is your stance on this? I also have PCOS, do you think achieve a nutritional state of ketosis will help this? I currently measure my ketones with a keto-stix, what are some standards that i would have to meet to say that I am in a state of”nutritional ketosis”?? Thanks for your time

  2. Cholesterol foods  December 26, 2011

    I really liked your blog! It helped me alot… Awesome. Exactly what I was looking for. Thanks!

    (reply)
  3. Evan  December 28, 2011

    This may be a stupid question, but why do you need 4000-4500 calories per day? That seems like a lot. Do you exercise multiple hours a day… or does the [calories in (food)] – [calories out (basal metabolism + exercise)] model of weight gain not apply when you consume mostly fats?

    (reply)
    • Peter Attia  December 28, 2011

      Both. I do exercise quite a bit (though only about half what I used to), but more importantly, my body partitions “fuel” differently now, so my basal metabolic rate (i.e., the rate at which I expend energy when I’m doing nothing) is higher than it was previously.

    • Brooke  July 20, 2012

      I don’t see how your food listings above add up anywhere NEAR 4-4500 calories. Are those ostrich eggs you’re eating?

    • Peter Attia  July 20, 2012

      You know that’s whole cream I’m using, not half-and-half. The shake alone is 1,000 calories.

  4. Scott  December 28, 2011

    Fascinating stuff here. The nutritional ketosis approach makes some sense to me, from the perspective of human evolution (I’m an anthropologist, and even though evolutionary anthro isn’t my specialty, I’m somewhat familiar with research on human evolution and diet). I have a couple questions for you:

    1. Do you plan to continue with this low-carb, low-protein, high-fat diet indefinitely? It seems from your discussion of the performance outcomes of the diet, you do. Would adapting this approach so that nutritional ketosis is used to achieve the basic goals of reducing indicators for metabolic syndrome, and a modified version (still high fat, low carb, low protein) used for long-term maintenance?

    2. Have you thought about the ecological impacts of this dietary shift and what they might be if large numbers of people took this up? To nuance that a bit, leaving aside an animal rights rationale, there are persuasive arguments that producing and consuming animal-based foods is energy and resource inefficient, in comparison with vegetable-based foods, even when it’s produced locally through organic methods. Some of your fats are coming from plant-based oils and other plant-based foods, but it looks like the majority still comes from meat, dairy, and eggs. I’m all for optimizing individual health, but want to do that in a socially and ecologically responsible way.

    Thanks for taking up this experiment and writing about it!

    (reply)
    • Peter Attia  December 29, 2011

      When I started my “experiment” with nutritional ketosis, my intent was to only carry it out for 12 weeks. Four weeks into it, I felt so bad, I regretted the day I was born. Were it not for the fact that I had committed (to myself) completing the experiment, I would have stopped. After all, I had already achieved great results with gradual carb reduction, and I couldn’t imagine this final, seemingly extreme, step was worth it. It turned out – and I will write about this in great detail later on – I was making a few critical errors in my application. Once I corrected these errors, within 3 days, I felt incredible. This experience gave me great insight into how lousy one can feel when you eliminate carbs without addressing a few things. Seven months later, I’m still in ketosis and having a hard time remembering what I was like to not be in ketosis. I can’t really say if I’ll stay here forever (versus, say, highly carb reduced but not ketotic). For now, though, I’m really excited about the results. To date, the “cost” of ketosis (e.g., less sprint speed) is more than offset by the benefits (e.g., near infinite capacity to burn fat across all ranges of activity).

      To your second question, I think it’s an important questions, but one I don’t know enough about (yet) to comment on. I’m currently reading a book Lierre Keith, “The Vegetarian Myth,” which actually addresses this issue. The book, coupled with my own understanding of the impacts of indirect land use change (see Tim Searchinger’s article in Science), has me hesitant to jump to any quick conclusions about how unsustainable my high-fat diet may or may not be. More for me to learn about…

    • Scott C. Irwin  August 11, 2012

      Hi Peter,

      In response to the other Scott who posted on Dec. 28, you wrote:

      “When I started my “experiment” with nutritional ketosis, my intent was to only carry it out for 12 weeks. Four weeks into it, I felt so bad, I regretted the day I was born. Were it not for the fact that I had committed (to myself) completing the experiment, I would have stopped. After all, I had already achieved great results with gradual carb reduction, and I couldn’t imagine this final, seemingly extreme, step was worth it. It turned out – and I will write about this in great detail later on – I was making a few critical errors in my application.”

      My question is have you posted about this “in great detail later on” yet? If so where can I find it on your site? Thanks very much.

      I am going primal (Sisson) have eliminated almost all sugars and carbs and increasing saturated fats (coconut oil, organic whole whipping cream in my omelets, ghee, grass fed steaks when I can etc.). In the last few days I have been experiencing panic attacks (for lack of a better word). Mabye it’s my blood pressure racing? I don’t fully know. I am wondering if this is the low-carb flu I have read about, or I am doing something wrong to which you allude in your own experience above.

      Right now my gut tells me to go eat starch/grains (in small quantity – or get some 85% dark chocolate or something to comfort myself/treat my body). Is this the bad thinking I should push through or am I moving to fast?

      I have to say these panic attacks for lack of a better word are mildly terrifying (if there can be such a thing!) and seemed to coincide with my attempts to go to a diet that eventually supports nutritional ketosis.

      Any thoughts you have on this or if you did write about your experience and can direct me there – I would be grateful for either.

      Really enjoying the dialogue on your blog. Thank you!

      Scott C. Irwin

    • Peter Attia  August 11, 2012

      Scott, I have not (yet) written this post (which will likely be a series, actually). I know it’s important, though, and will certainly get to it. To your question, I have not had experience with this particular symptom. Is it resolving at all? It’s entirely possible this may be transient.

    • Vasco Névoa  November 29, 2012

      @Scott C. Irwin
      As a fellow ex-metabolically sick individual, I can share my experience of carb cravings.
      I think there are 2 distinct mechanisms for the cravings: the lack of metabolic flexibility, and the dominion of the wrong gut flora.

      While the first is relatively easy to resolve with a little education, trial-and-error, and persistence (you just go low carb, don’t ever cheat, and things do get better), the second is not so simple. Low carb allows you to recover the liver, pancreas, adipocytes, mitochondria, etc, and this takes a few weeks to kick in and stabilize completely. In the meantime you will suffer from hiperinsulinism which will prompt hypoglycemia attacks. You recognize them easily (shaking, blurry vision, brain fog, whatever).

      The second type, however, is much more subtle: you go for the chocolate cupboard without actually knowing why. You don’t feel anything specific, except for an eery desire for the brown stuff. This happened to me (and still happens once in a while) long after the metabolic problems were resolved. I had lost all the extra weight, cleansed my liver, and stopped having any hint of hypos long ago, and would still be startled by that sudden need for chocolate after a meal. As I learned the hard way, it all goes away when you have the right kind of gut flora. Bacteria love iron, and chocolate is pretty rich, so that’s one hypothesis. But I’m sure many others can be made.
      It is known that gut bacteria produce neurotransmitters that can hijack the vagus nerve; of course this can only happen if they are living inside your small intestine, because the large intestine (where the gut bacteria should be in very small numbers) is not graced with that nerve. The victims of SIBO (“small intestine bacterial overgrowth”, which by the way, may include also yeasts and fungi in the mix, like Candida Albicans) are usually little more than remote-controlled food cravers, and the gut bacteria have the remote in their hands.

      So… check for the wrong gut flora. Take a lot of diverse probiotics to rebuild it, and persist (it takes a long time). Can’t hurt much, with the lack of sugar and fibre. But you’ll be strengthening the good kind of flora and in the process restoring you small and large intestine mucosa. All great things.

      Starving the pathogenic flora with intermittent fasting is another good technique that helped me a lot. And if all else fails, there’s the fecal transplant. ugh. :) Good luck!

    • Ron  January 9, 2013

      Scott, in regards to your 2nd question check out this video.
      http://www.youtube.com/watch?v=rNON5iNf07o&feature=related

    • mhikl  February 13, 2013

      Scott, the lands we use to raise grains takes up a lot of space that must be denuded of their natural ecosystems and then demand chemical fertilisers for their success. Feed animals need lesser lands, scrub lands that they brows from and help enrich naturally- think bison (buffalo) on the prairies. The amount of calories one needs from animals may be less than is consumed from todays diet dependent upon plants; unless like Dr Peter one is into extreme fitness- most people are not.

      The whole story of plant vs animal ingestion is complex and far beyond the realm or reason of proponents on either side. Our ancient brethren with population success ran through the wild species in their lands, and agriculture had to come about for their survival. (Modern man has done the same to the oceans. Properly managed, they could have continued to be a healthy source of food for humans.) I would speculate that in a perfect world properly managed lands could allow for animal eating without stress to the lands (and less stress to the animals than what we perpetrate on them today).

      And if humans are naturally carnivores (or omnivores) for perfect health, should we be deprived of our needs? Logic taken to extreme would then suggest we also condemn wild carnivores for their behaviour.

    • Louise  December 31, 2013

      In reply to Scott C Irwin – probably no longer relevant to you since your post is over a year old. But I had terrible palpitations/panic attacks when taking coconut oil. I have since stopped. For some reason I am fine with coconut milk contained within foods but not virgin coconut oil. Years ago I blamed the palps on low carb and went vegetarian. Years later, overweight again – I’m going back to low carb, this time without the coconut oil.

  5. Crilly Butler  January 5, 2012

    You mention “the ‘cost’ of ketosis (e.g., less sprint speed)” and Gary Taubes also doesn’t recommend this severe of a no-carb diet for athletes. So how would you modify it if you were recommending dietary changes for athletes who require “sprint speed” as well as high levels of muscular strength? Thanks!

    (reply)
    • Peter Attia  January 5, 2012

      This is a great, but fairly complex question. In short, I would say 99.9% of athletes can, in fact, tolerate low-carb (and even ketosis), provided they do it correctly. It took me MONTHS to figure this out…mostly the hard way. If you are like my friend Ed Moses (13-time world record holder in swimming) who needs to give it all for a 1 minute race, there are still huge benefits from reducing carbs – especially the bad ones – but they can not be eliminated completely. I’m going to write about a remarkable product that I’ve been working with personally, and with many folks I coach, in the coming month or so. It’s called Generation UCAN. You can find a link to it under the “books & tools” section of my blog. This technology gives you a time-release glucose, without the insulin spike, so it does not at all hinder beta-oxidation.

  6. Rik Ganju  January 5, 2012

    I was under the impression that the brain, bone marrow, and liver can oxidize carbs only for the production of ATP? Is 50 grams of carbohydrate enough to meet the needs of these sites?

    (reply)
    • Peter Attia  January 5, 2012

      Great question. Contrary to popular belief, though, the brain is not an obligate consumer of glucose. It can not oxidize fat or protein (directly), which leads to this confusion, but it CAN metabolize beta-hydroxybutyrate (a ketone body). In fact, this is one of the greatest benefits of being in nutritional ketosis – my brain gets sufficient energy indirectly from my fat stores (via the conversion of fat to beta-hydroxybutyrate) that I never have the “bonking” problem of my brain getting unhappy when glucose levels get too low. I’ll be writing much more about this later, but a quick overview of ketosis can be found here: http://eatingacademy.com/nutrition/is-ketosis-dangerous

  7. Charles Lee  January 5, 2012

    Hi Peter

    When you consume MCT oil, do you just eat coconut oil? Or do you buy MCT oil from a health store like GNC?

    (reply)
    • Peter Attia  January 5, 2012

      Great question. As you suggest, coconut (and palm) oil are about 60% medium chain (C6-12) saturated by nature. That said, I consume a “dedicated” (i.e., pure) MCT oil. I take 2 tablespoons (30 mL) every morning, but this is HIGHLY user specific and it takes a while to figure how much to take, and when to take it. Because I take it first thing in the morning, then jump in the pool for a hard swim, I can tolerate a lot of it. A lot of folks who jump right to that level can’t tolerate it (e.g., they get diarrhea).

  8. Katie  January 8, 2012

    Hi Peter,

    You write “It turned out – and I will write about this in great detail later on – I was making a few critical errors in my application. Once I corrected these errors, within 3 days, I felt incredible.” I know you mentioned you will write about this later, but I’m wondering if you could briefly share what the errors were and how you corrected them. I’ve been on a VLC diet (<30 grams per day) since October. It took me about 4 weeks to turn the corner, but I still have many days (several per week) where I feel lethargic, weak and just kind of "out of it". I'm so happy with my radical body transformation that I'm just putting up with the tired days, but I always thought I would have to eventually add back in more carbs after achieving my goals and then just worry about regaining weight. I have read so much in the last 3 months that leads me to believe that for optimum health and longevity I should stay on this plan, but in order to do so I need to fix whatever is preventing me from feeling more energetic and clearer-headed as many people eating this way describe.

    I'm also curious if you are familiar with the writings and diet of Dr. Rosedale? He has written specifically about Leptin's role (along with insulin) in determining if you brain will allow your body to burn fat or not. While recommending a LCHF diet, he distinguishes between fat types and limits beef, cheese and heavy cream to 1-2 servings per week. I'd love your thoughts on both of these topics as your blog posts and diet show you have a differing opinion. I have to admit that after even after all I've researched I still have that little voice that warns me about so much saturated fat and I find corroboration even in the LCHF world. There's just become such a glut of information out there that it's easy to find conflicting information even among people all on a Ketogenic diet and I'm wondering how you worked through all of that information to arrive at a point where you are confident with your nutritional profile.

    Lastly, I've probably read 150+ websites, blogs and books dedicated to LC/Paleo and yours is by far one of the most succinct and easy to understand; it will now be the blog that I share with my friends who want to know how I've changed my diet and body! Thank you so much for documenting your experiences and taking the time to answer questions!

    (reply)
    • Peter Attia  January 8, 2012

      Katie, Thanks so much for your questions and kind praise. When I transitioned about 8 months ago to full (nutritional) ketosis, I spent the first 6 weeks in pure hell. So weak I couldn’t stand without needing to sit again. It was awful, and were it not for the fact that I told myself I was only going to do it for 12 weeks, I would have quit. Fortunately, I had the help of a couple of experts in the field – Steve Phinney and Jeff Volek (authors of one of the books I recommend). I will write about this in much more detail in the future, but I can say the two biggest mistakes I was making were: 1) I was eating too much protein (north of 200 gm/day), and 2) I was not supplementing enough sodium. There are many other little nuances I’ve learned since, but once I fixed those two, within 3 days I was humming along. I haven’t looked back since. Ironically, it was not the consumption of too many carbs that was hurting me.

      I don’t know Dr. Rosedale personally, but I have seen his site and read some of his materials. Your particular question, which is excellent, is a bit nuanced and tough to answer in short space. Leptin levels probably do matter, but they matter in a way that is subservient to insulin levels. In other words, insulin levels are the primary driver of fat regulation, not leptin. Insulin may mediate appetite through leptin (and other hormones), but we shouldn’t lose sight of the “master” hormone in fat regulation. Now, the bigger issue, per the second part of your question is the differences between individuals. Some people do actually have a strong insulin response to dairy. Others to not. Some folks even have what is called a cephalic insulin response to artificial sweeteners, while most people don’t. The key – and this is primarily what I try to accomplish with people I work with one-on-one – is customizing “low-carb” eating for an individual. It’s so important to figure out what works for YOU. What works for me is interesting, and likely informative, but what matters more than anything is what will work for you.

      Please stay tuned as I try to articulate these nuances better and better over time.

    • Anon  January 26, 2012

      Do you find, then, that you need to always measure what you eat to stay ketonic? One reason Taubes’ approach works for me is that I abhor counting and measuring (even if it’s not calories) because it makes eating too complicated. I can easily say “no” to a category of foods, but I can’t easily say 0.25 protein to 0.75 fat. I just cut out starch and sugar, try to eat more fat (in the way of cheese, half and half, eggs, and the non-lean part of meat) than protein, and balance out with broccoli and other non-starchy vegetables. To be ketonic, I suppose I would need to measure everything to maintain the balance and also measure the level of ketones as well. Is there such a thing a partial ketosis, even if you are above 50 grams of carbs? Lastly, what does 150 grams of protein look like and how easy is it to parse given that a steak, for example, will contain a lot of protein, but also a lot of fat?

      By the way, your responsiveness to all of these questions is extremely helpful.

    • Peter Attia  January 27, 2012

      This is actually a bit complex when directed towards me, specifically, because I eat so damn much (4,000 – 5,000 calories per day), AND I’m ketotic. Because I need to cap both carb and protein amounts, I did need to pay attention for a few months until it became automatic, which it is now. So I never count calories, per se, but I did need to pay attention to the amount of carbs and protein. For what’s it’s worth, I eat carbs:protein:fat in about a ration of 1:3:9, but that’s for ME personally. There is no formula for everyone. It’s about your genes and your goals.

  9. AceRimmer  January 8, 2012

    4000-4500 calories daily is a lot. What is your daily swimming/biking expenditure? I didn’t find any study proving metabolic advantage of keto over carb based diets so I think you’re actualy burning those calories through exercise.

    Re. limited max effort on keto, why dont you try 1-2 days of higher carb to reload glycogen stores (ckd diet approach)?
    I’m also doing lots of biking/running but also lifting/strength training and experienced limited max effort while lifting heavy. After introduction of 1 day high carb/low fat strength is going up and I feel much better overall.

    (reply)
    • Peter Attia  January 8, 2012

      My basal rate has, in fact, increased. In my experience, this is the case in about a third of people, but obviously not everyone. In other words, some people, once ketotic eat less, and some about the same (in # of calories), as they did prior. The other thing to keep in mind is that my daily exercise routine has been constant pre- and post-ketosis, so whatever number of calories I was burning then, I’m burning now, +/- a small amount. The real delta (you can test this with a metabolic cart) is in resting energy expenditure. Keep in mind I’m not trying to hit a calorie target; I’ve only documented it to keep track of my carb/protein intake. The real beauty of being in nutritional ketosis is just that! I don’t ever count calories (except to “report” them). I eat when I’m hungry and I don’t when I’m not.

      To your second point, this is a good idea, and I’ve toyed with it. However, right now, I’ve found a remarkable balance between ketosis and the need for a bit of “glycolytic kick” through a technology called “super starch,” which is made by a company called Generation UCAN. I’ll be writing extensively about this technology in the future. I’m also planning a video presentation, specifically focused on optimizing nutrition for peak athletic performance, soon.

  10. Garry  January 10, 2012

    Knowing what you know now about carb restriction and ketosis, would you say that feeling crappy for a period of time at the outset of dropping to <150g protein and 50g carbs/day is unavoidable? Or can this uncomfortable transitional period be eliminated altogether?

    And do you still suggest slowly reducing carbs over a period of months, or do you now recommend just diving in (no swimming-related pun intended!)? I get the impression from Dr. Westman that he has his patients just go for it all at once.

    (reply)
    • Peter Attia  January 10, 2012

      The good news: you don’t need to suffer like I did (I was in low-carb hell for 6 weeks when I dropped from 150 to 50 gm/day) if you know what I now know.
      The bad news: I need more time to explain why.
      I promise, I will get to it.

  11. Brenda  January 11, 2012

    Ok I’m ready to start . How do I start? I’m 40 5’4″ 169 lbs work in produce business I’m up at 5:00 am go to bed at 10:00 pm live under lots of stress tell me how to find out the right amount of fat intake I need?? I saw your dietary intake but, do I Copy it in my daily life? I honestly do not like to excersise . Besides after work have to come home and cook dinner . So I’m ready help me to start!!!!

    (reply)
    • Peter Attia  January 11, 2012

      Brenda, congrats on taking the first step! This is very important. Certainly stress (for most people) makes it more difficult. The good news is, while I’m a huge fan of exercise for my “big 4″ reasons, you don’t need to do so if weight loss is your primary goal. Take a look at my post called “How can I lose weight.” If you still think you need more help and guidance, send me a personal email. Remember: festina lente!

  12. Mark McPherson  January 22, 2012

    Hi Peter,
    I am a huge fan of Gary Taubes, as his two books completely changed the way I now think about obesity (especially my own).

    The biggest problem I have is actually being able to stay on the low-carb program, as I have suffered the “dual whammy” of boredom with the food choices and also of losing little-to-no weight after the 2nd week (I was not a happy camper); nevertheless, at 340 lbs, I look and feel awful.

    Ironically, I usually do about 1.5 miles on the treadmill every morning, so it’s not like I do nothing, but the scale never moves. I admit I hate the thought of giving up so many of the foods I love (bread, potatoes, sweets), but I also feel that once I can finally experience seeing actual weight loss, that “pain” will be momentary.

    I look forward to reading/watching what you have to share, as I need to be around people who are experiencing success with this.

    (reply)
    • Peter Attia  January 23, 2012

      Mark, thanks very much for sharing your story. It’s hard for me know, exactly, what is as the root of your struggle, but I do wonder if maybe just taking a week to write down and weigh everything you eat to get an accurate assessment of exactly how much sugar and total carbs you’re eating might shed some light? Also, it’s probably a good idea to ask your doctor to check all of your labs to make sure something easily fixable (e.g., low thyroid hormone, low testosterone) isn’t amok. Please stay with it. I’m working on a cookbook to try to address the boredom issue.

    • Mark McPherson  January 23, 2012

      I look forward to the cookbook. Yes, I’ve gotten several tests and there is no low thyroid or any problem brought to my attention, except for high BP. I am beginning to believe that the reason I didn’t lose much, if any weight on low carb, last time, was because I had too much protein.

      So, starting this morning, I’m going to follow your recommendation of high fat, with much lower protein (and of very low carb, of course).

      It’s kind of scary, in a way, to imagine eating all that fat, but I am willing to do this.

      So, I also gather that I should have sufficient sodium. Any other things you recommend (like taking potassium or multi vitamins, etc?)

    • Peter Attia  January 24, 2012

      Yes, it’s a bit “scary” to start eating more fat deliberately, especially for folks like us who grew up brainwashed. The Art and Science of Low Carb Living is a great reference.

  13. Richard  January 22, 2012

    Thanks for posting. I read Gary Taubes’s book a couple of months ago and modified my diet accordingly. Since, I have dropped 33 lbs and feel way, way better than I have in a long time. Your list of foods adds to my repertoire.

    A couple of things that I like include 1) coffee with one tablespoon MCT oil or coconut oil and one tablespoon Kerrygold unsalted butter (from “Bulletproof Exec”.); and 2) “Joe’s Special” for dinner (Google it for recipe…it’s great stuff)!

    (reply)
    • Peter Attia  January 23, 2012

      Congrats on such fantastic work! I’m actually working on a recipe book, which I hope to have ready in maybe 6 months or so of awesome low carb (*and* ketosis friendly) foods, plus a few other twists. Can’t wait to check out suggestions. Thank you.

    • Richard  January 28, 2012

      A low-carb, pro-ketosis cookbook would be great. I would definitely buy it. BTW, just had a Peet’s small latte made with heavy cream — per your notes above. WOW! Terrific! The guy behind the counter said it was a first.

    • Sheri Hunt  April 18, 2012

      Peter
      I am happy to hear you are working on a cookbook. I have been toying with the idea since spending an afternoon sailing with Steve Phinney and Jeff Volek. Would there be interest in thinking about a retail line of specialty foods that are locally sourced (so you don’t have to add preservatives and other ingredients to maintain freshness)? Have you found regions (of the US) where adoption of LCHF is more prevalent? Focused centers where pretotyping some recipes could be beneficial. I would like to help if you are interested. Your message is one to be heard, repeated and acted on. Thanks.

    • Peter Attia  April 18, 2012

      Good ideas. I don’t really have the time to blink right now, because of NuSI, but I would like to put more time into this.

  14. Steve  January 23, 2012

    Hi Peter. Superb info here!
    I’m currently on a low carb diet, I have Crohns disease and it significantly helps with that while also obviously having lots of other benefits. I notice from reading your blog that you struggled a bit at first but felt much better when you reduced protein. Is this something you recommend to everyone? I’m currently trying to put quite a bit of muscle mass on (fat loss is not a big deal for me and maybe other sufferers of crohns, but muscle mass loss can be a pain from time to time) and would like to know if there are any reasons not to increase protein if that is a goal? My energy levels are great and I feel pretty good so far.
    Thanks. Steve.

    (reply)
    • Peter Attia  January 24, 2012

      Steve, the issue for me (the struggle with too much protein) was the result of my desire to be completely ketotic, coupled with my historic protein-consuming habits. Ever since I was in high school, given my training volume, I had always felt I need about 3 gm/kg of protein per day, which put me at nearly 250 gm/day. The problem is that every gram of protein, over about the first 100, starts to “act” a bit like a carb (though only about 25% as much). Hence, when I was consuming 250 gm/day, it was like adding another 37.5 gm/day of carbs [25% x (250-100)], loosely speaking. In reality, I think you can gain more than enough muscle at 2 gm/kg, provided you eat it at the right times. I should probably add this to my list of future blog posts, too…

  15. Mike H  January 23, 2012

    Great post. I was amazed you could eat so much fat and keep your protein intake so low. I have a problem right now where I think I eat too much protein in my efforts to eat fat. This will really help me a lot.

    I have been low carb for about 7 months now, I’ve lost 50 lbs with LESS exercise than before. However, my Body Fat % is still about 17%, and I really want to get under 10%. I’m tired of looking flabby!

    It seems like I can learn a few good tricks here. Namely, using heavy whipping cream abundantly. Also eating more egg yolks than whites in my morning eggs. That’s fine by me because the yolk is the best part anyway ;) I also like the homemade cream dressing idea, and that soup sounds good.

    One thing that worries me, is even though I don’t exercise, I’m consuming more calories than you are in a day. Looking at your intake, I’d eat much more than that normally, I’d be hungry if I didn’t. Maybe if I can up my fat% as high as you I’ll be better off.

    Thanks a TON for all the great info and the fantastic website. I can’t wait to read everything you’ve posted.

    (reply)
    • Peter Attia  January 24, 2012

      There are no exact formulas, unfortunately, just general principles. Be flexible, as you are, and constantly search for what works for you. The key is 1. get good starting data, and 2. be consistent in your measurements and eating habits, until you can really figure it out. Keep up the good work.

  16. Mike H  January 23, 2012

    One other comment I want to make is regarding supplements. I’m currently taking 400 mg of magnesium and putting a lot of salt on my food. The Mg I’m taking is not chelated, does that matter?

    Also, have you looked into taking a vitamin D supplement? There is a great deal of research out there that most Americans are vitamin D deficient and the RDA is much lower than it should be. I’ve been taking 4,000 IU a day and it has basically eliminated my need to take an inhaled corticosteroid to control my asthma.

    (reply)
    • Peter Attia  January 24, 2012

      I do take 400 mg of Mg and it’s not chelated. I don’t take Vit D, as I tend to get plenty of sunlight and my levels are fine (I live in SD and swim outside every day). If you are deficient, though, you definitely want to correct it.

  17. Adrienne Herrell  January 24, 2012

    Fascinating information. Will get started and follow future blogs.

    (reply)
  18. Tanya  January 25, 2012

    Ive already done your steps, except the last one. I’m down from 170 to 139 and would like to get 10 more lbs off. I’m looking for numbers or percentages of calories from fat/protein/carbs. I’ve been tracking calories for months and think it should be easy to tweak things if I just know what I’m shooting for. (5’6, 42yo, hiit workouts & weights 4x week). Thanks!

    (reply)
    • Peter Attia  January 25, 2012

      Tanya, keep up the good work. Just remember – festina lente!

  19. Matt  January 25, 2012

    I see that cured meats like bacon and salami are on the menu. I read that these meats are extraordinarily high in AGEs – this was in that book Wheat Belly. Have you read anything about this and does it concern you? I was really disappointed/anxious when I read it because I had been eating bacon and salami on a regular basis.

    (reply)
    • Peter Attia  January 25, 2012

      The biggest toxin in cured meats is probably he sugar contained in most of them. I do go out to my way (even though it means spending a few extra dollars) to buy the highest quality (i.e., least processed) meats. When you minimize the sugar (e.g., dextrose) in cured meats, you’re automatically minimizing the AGE’s.

  20. tanya  January 25, 2012

    I guess my question is, “Should I go to 50g carbs and 150g protein and unlimited fat?” Based on being a 140lb female who works out 4x week for 45-95minutes with weights and interval cardio. Or is the 50g carbs and 150g protein for someone who is eating 4000 calories/day. (I’m probably not going to hit 2000).

    (reply)
    • Peter Attia  January 25, 2012

      The “magic” 50 gm/day has to do with inhibiting ketosis. It’s actually more nuanced than this, and it depends on the type of carbs (and, as always, genetic factors). For someone like me, eating 4000-5000 calories per day (versus someone only eating 2000 calories per day), it just means a lower overall % of my calories come from carbs. Same “rule” applies for protein intake.

  21. David  January 26, 2012

    Can you talk a little about why you count total carbs vs. net/effective carbs?

    (reply)
    • Peter Attia  January 26, 2012

      It’s a “higher bar” and it’s quicker and easier. For example, it’s pretty easy for me to calculated 40 gm of total carbs per day and know that I’m getting even fewer net carbs.

    • David  January 26, 2012

      Ok, that makes sense. Just wanted to make sure there wasn’t something I was missing from a scientific perspective (new research). I’m ok with the lower bar (~20-30) and checking labels to do the calculation to avoid accumulating too many net carbs.

    • Mark McPherson  February 1, 2012

      “Higher bar”… I love this way of thinking about net carbs

  22. Chris  January 27, 2012

    Hello Peter,

    Great website! I stumbled upon this via one of my random checks of Gary Taubes’ site. Have you come across any research regarding the cooking of meat and related cancer risks? Also, you mentioned that you typically eat salami and pepperoni. Any concerns regarding nitrates and cancer?

    Thank you,

    Chris

    (reply)
    • Peter Attia  January 27, 2012

      Thanks very much for support, Chris. The biggest risk (think of the irisin post from 1/25) is the first order stuff – sugar in the meet that actually leads to the AGE’s. This is where I spend a few extra dollars to get higher quality products, rather the pre-packaged variants. That said, I think you’re better off with pre-packaged pepperoni than, say, fresh corn and potatoes.

  23. Sinai  January 27, 2012

    Hi, I’ve been reading through the site and I might be missing it, but am very interested in doing this kind of “program”, so do you have it published? I read the 5 day sample week. what happens on the 6 and 7 day? is there a “free” day where you can eat what you want (including more carbs?)
    Thanks,
    Sinai

    (reply)
    • Peter Attia  January 27, 2012

      Sinai, there is no “program” here. The blog is really my vehicle for trying to help people understand the science of health and nutrition better. I am in the process of putting together a separate entity that will be focused on the “program” side of things, but it won’t be part of the blog. I’ll address all of these issues and more. Thanks for your interest and please stay tuned. Hopefully there is enough content on this blog to help you get started, though. If you haven’t read it check out the page: How can I lose weight?

  24. Suzi  January 27, 2012

    Great info and website! I too was directed here from Gary Taubes blog. I’m really interested in the high amount of calories you consumed even while losing weight. It really happened for you even without being in a caloric deficit? Or were you just extremely active and therefore in a deficit even while eating 4000+ calories a day? I always understood that low insulin levels helped with satiety but one still needed to be in a deficit to lose weight…but not the case here right?

    (reply)
    • Peter Attia  January 27, 2012

      Suzi, by definition I was in a calorie deficit if I lost weight (take a look at the post titled “Revisit the causality of obesity”), for the First Law of Thermodynamics to be true (which it always is). This meant that despite eating 4,500 calories or so each day I was expending more – not by exercising more or doing more daily activity (which I didn’t do) – but through a greater basal metabolic rate and probably a greater amount of digestion expenditure. Because my insulin levels were reduced, my body made these changes.

    • Kiran Wagle  May 7, 2012

      I think there’s a fundamental misapprehension here about the First Law of Thermodynamics and human bodies. Just *eating* a “calorie” (whatever that means) doesn’t mean it will be burned–as any lactose-intolerant person knows. In order to invoke the First Law, you have to demonstrate that the calories you ate were actually burned, not just excreted.

    • Peter Attia  May 7, 2012

      Not so. First Law only states that energy in less energy out is equal to change. Lots of ways energy can leave a system, including thermogenesis and failure to digest (e.g., excretion in stool). Look at post “Do Calories Matter” for a more detailed description.

    • Peter Attia  January 27, 2012

      Hi Caveman, thanks for passing this link along. I’m assuming you’ve read the actual study, and not just the commentary on the study that you sent. I’ve read this study several times, actually, as it was originally published in 2006. If you haven’t done so, it’s probably worth reading it – it’s only 7 pages. LOTS to say about it, but not enough time right now. I did want to respond, though. Here are a few things to consider when looking at something like this: be clear you define metabolic advantage inclusively. This study looked at some good things (e.g., HOMA-IR, via fasting insulin and glucose), but many completely useless things (e.g., LDL-C, TC-C). Also, we have no idea exactly how the study designers balanced out things like omega-6 and omega-3 ratios. As I’ll be writing about a great deal, after reducing insulin levels, in my opinion, this is probably next on the list to “get right.” Almost certainly, given the delta in PUFA consumption, this was the cause of ALA:EPA:DHA:AA levels. Next, it’s not clear at all that the ketogenic group was receiving the ideal supplementation of sodium, magnesium, and potassium, which is the cause of “feeling bad.”

      However, undoubtedly the biggest criticism I have have this paper is that the “ketotic” group was not really ketotic! If you look at table 3 of the actual paper (not the summary in link you sent), you’ll note that the level of beta-hydroxybutyrate in the low carb group went from 0.1 to 0.2 to 0.2 mM, while the ketotic group went from 0.09 to 0.72 to 0.33 mM. One does not even begin to generate the advantages of ketosis below 0.5 mM, and probably close to 1.0. In other words having a ketone level of 0.33 is the most miserable thing on earth. Why? Because you’re clearly restricting glucose (so your brain is agitated), but you’re not generating enough ketones to fuel your brain. Trust me, I was in the zone of misery for weeks. If you read the work of people who have the most experience treating patients with ketotic diets (e.g., children with intractable seizures, recalcitrant diabetics), they usually keep beta-hydroxybutyrate above 1.0. I check my blood levels every day (and have logged them for nearly 8 months). Anything below about 0.6 feels horrible, and I generally walk around between 1.2 to 2.0 mM. So, I guess my issue with this article is that it didn’t actually do what it set out to do – test a ketotic diet.

      If you really want to get nuanced, you’ll probably note the conflict of interest, also (note the last author on the paper). Hope this helps. Keep in mind, if you’re out there doing your thing and feeling great – that’s awesome. I’m happy for you. Keep it up and please don’t think I’m trying to change you. However, I do feel strongly that people really understand what they are saying. The majority of published studies are not worth the paper they are printed on, so we need to be diligent when we look at them. Finally, if I’m coming across as a bit glib, I don’t mean to, but when someone phrases a question as you have, they won’t get my “gentlest” response. Ask nice, and I’ll answer nice. Ask like a wise-guy, and I may sound a bit glib. Fair?

    • caveman  January 27, 2012

      I’m also low carb/keto athlete like you but not an expert for ketosis. I wanted to hear your opinion about this because you said your bmr is much higher while in ketosis. But how can you be sure ketosis is the cause for this?
      I posted this link because this is the only keto vs non keto study i know about and it doesnt show any bmr increase.
      If i understood correctly, keto group wasnt keto adapted enough?

    • Peter Attia  January 27, 2012

      Caveman, it’s a fair question you’re asking. Yes, you’re correct, the “keto group” was not actually keto. The fact that they went from 0.7 mM at week 2 to 0.3 mM at week 6 says they did not eat the right foods to stay in ketosis. They flirted with it briefly, but ultimately ended up eating too many carbs or too much protein to actually generate sufficient ketones.

      Let me rephrase your question to be sure I’m answering it. You’re really saying, “How do you know that the increase you experienced in BMR going from 150 gm/day of carbs (i.e., Low carb) to <50 gm/day (i.e., ketosis) was accounted for by the actual presence of ketones in your body?” Assuming this is your question, it’s a great one. There is no dispute my BMR increased dramatically during this period, as I lost 4 pounds of fat in 12 weeks while increasing my caloric intake from about 3100 calories per day to 4400 calories per day. Little change in my exercise (except that I stopped doing heavy squats, deadlifts, tire flips and cleans – which probably accounts for the loss of 3 pounds in lean mass). But the question is what drove this change in my metabolism? At the simplest level we can point to at least 3 “changes” – 1. I ate fewer carbs (150 down to 50 gm/day), 2. I ate more fat (about 150 up to 400 gm/day), 3. My body produced high amounts of ketones (I was 0 to 0.1 mM of beta-hydroxybutyrate at the outset, and greater than 1.0 once ketotic). To my knowledge no one has done the experiment you would need to do to figure out if it’s the rise in beta-hydroxybutyrate OR the fall in carbs (and insulin) that effects the change. Or the rise in fat intake for that matter. These 3 are heavily related and therefore not what we’d call independent variables. My guess would be the actual presence of ketones bodies are not what’s CAUSING the effect, but are merely a byproduct of the effect. The CAUSE, I would hypothesize, is the reducing in circulating insulin from fewer carbs ingested. Hope this helps.

  25. mark  January 27, 2012

    I have a question about ordering the whole fat latte’s at Peets and Starbucks. Do they charge more for it? And do you just say ‘latte with full fat cream please?” And do they look at you funny? :)

    (reply)
    • Peter Attia  January 27, 2012

      I ask them to make a latte as they normally would, but instead of using milk, to use whipping cream (aka 35% cream or whole fat cream). I always watch when they make it to be sure I can see the cream they are using, since they probably don’t make it often (or ever). They charge me the same. They look at me VERY funny. In fact, once I had 2 in one day from the same Starbucks and when I ordered the second everyone in the shop came up to see what I looked like because they’d heard about it from the morning shift. You gotta eat fat to lose fat!

  26. Scott  January 27, 2012

    I recently stumbled upon one of your lectures on YouTube and I am already a huge fan.
    I’m curious as to how our bodies handle carbs in the post-workout phase. More specifically, I eat essentially no carbs during the day (except broccoli, spinach, etc.) but immediately after a strength training workout I will have a bowl of oatmeal with protein powder. My thinking was that in the post-workout phase the carbs would be preferentially stored as muscle glycogen, but I don’t know if the biochemistry backs that up. Furthermore I don’t know if these carbs might inhibit my ketosis.
    Any insights you have would be great!

    (reply)
    • Peter Attia  January 27, 2012

      Scott, thanks for the support. I will write a lot about sport-specific implications in the future, but let me try to give a quick though. It is true that if you’re going to eat carbs, the best time to do it is when you’re immediately post a workout when your glycogen stores are depleted. The will ensure, in a reasonably insulin sensitive person (which I’m assuming you are), that your metabolic preference is in glycogen formation FIRST. Keep in mind the size of your glycogen “tank,” though. If you overdo it, you will start to divert the excess into fat storage. It’s pretty hard to be in ketosis with a bowl of oatmeal and other carbs in your diet. The only way to really know would be to test yourself. When I was starting out, I would do 5 or 6 blood tests per day, while varying all sorts of conditions (e.g., exercise, food intake).

  27. Ryan  January 28, 2012

    the reasons you posted at the end is similar to my approach and thinking; this is real exciting.

    (reply)
  28. Dominique  January 28, 2012

    Fantastic and interesting blog,

    discovered via Gary Taube’s site, reading on Dr Oz.

    I live in the UK, 2 years ago my GP told me I should be put on statins as my cholesterol is high -7.2, higher than in my last test. He gave me a year to improve it, as I did not want take them – 40 and on statins hello? I eat all my greens, no junk, cigarettes, alcohol, no or little simple sugars, no processed food, I go to the gym 3 times a week and lift weights, cycle 60 – 80 km a week, walk 30 km at the weekend, how the frack do I have a cholesterol higher than my dad? My friends joke that I should be thinner with the boring food I eat, I am 80 kg and a US size 12, my skeletal muscle mass might be strong, but my visceral fat is far too high. I should be 72 kg ( if only).

    My GP volunteered me to be a guinea pig for a new cholesterol-lowering -drug (I agree for the free health check) after being poked and prodded ( do you know how hard it is to give up coffee as a French person, torture), I was rejected for being too healthy. After reading Dr Annika Dahlqvists, I realised I did not have enough fat in my diet and I decided to ingest 2 table spoons of raw coconut oil a day (not easy), with 1mg of vitamin C and B complex. My HDL is gone up from 1.42 to 1.75, my GP told me , “ok you are one of these people who have a high cholesterol no matter what, go away”.

    I have been overweight since puberty, in my twenties, despite being physically active, I reached the boundary obesity-corner of the charts. I went on diets, lost the the weight and gained it back and some more. In my late twenties, I developed ailments that baffled my GP and after a ruptured ovarian cyst that landed me in hospital, I was diagnosed with PCOS. I was put on the pill and on a strict low fat diet. Within 6 months on the pill (after a welcome relief from symptoms) I felt like a Stepford wife, worse, on the high carb diet I had gained weight, reaching 95 kg for 5.8, putting on 5kg. When I put my concerns to my GP, a woman, she told me that my yo-yo dieting was responsible for my PCOS and that I was obviously cheating on my diet. Something clicked in me and I thought – FU, this is not all on me -. I did some research and stumbled on insulin resistance and found that my symptoms matched, I was alway sweating and hungry for sugar after a meal. I quit my GP, the pill and the high-carb low-fat diet.

    I went on the Atkins diet and lost 15 kg in a year, and worked that if I wanted to keep it off, I had to modify my diet, no simple sugars, no junk, no processed foods, bread, pasta, (for the odd croissant at weekends), Lepicol with digestive enzymes, greens (I like them) and good fats. The endocrinologist that follows me, declared me PCOS free, but with a estrogen dominance. I take after my dad, on his side of the family it’s cardiovascular disease (strong men, who gain weight, never get sick but die of a heart attack after 50 – the women, maybe protected by estrogen, get sick later but are always fat ), my mother is thin and lives on sugar without gaining weight but on her side, liver, stomach and digestive track cancers dominate.

    My problem is that no matter how much I exercise, my fat % does not go down below 33%.
    Even on complex carbs, some protein and vegetables, weight creeps up. If I did not go to the gym, I would be even bigger than I am now. I need to give up carbs again. I train with a lean guy whose body fat is at 10% and lives on pasta, and I swear I have bigger calf muscles than he does.
    I can’t live on the Atkins or Dukan ( too much meat brings digestive problems) for long and I am lactose intolerant since birth, so after 2 weeks of yogurts, ( my limit is 125g a day) fromage frais or full fat cream, even if it’s from goats, my sinuses pack-up and scream – enough is enough woman. If my brain goes foggy by late afternoon, I have never felt mentally – stronger than on the low carb diet but what can I use instead of full fat milk and cheese? Nuts?

    (reply)
    • Peter Attia  January 28, 2012

      Dominique, thanks so much for sharing your story and your struggle. The tough part of “this” nutrition thing is that we are all quite different in terms of our genetic susceptibility to carbohydrates, and even within the world of carbs, we all respond different to the different variants. As far as the statins go, this is one of the biggest tragedies in modern medicine (next to the nutrition problem). The problem is not that statins are bad or that some people aren’t dramatically helped by them – the problem is that 99% of doctors who prescribe them do so for the wrong reason. They treat the wrong endpoint (e.g., LDL-C instead of LDL-P or ApoB) AND fail to realize how many people don’t actually need them. Obviously, I can’t tell if you should or shouldn’t be on them, but I will write more about this in the future, so hopefully you’ll get a better sense of the questions to ask your doctor.

      What you’ve got to figure out is, what do you want to optimize for? How much are you willing to experiment with the boundary conditions? I can’t really address it here, but I’ll give you an example. My entire life I believed I was lactose intolerant. As I contemplated the transition to ketosis I was a bit concerned about the need to increase dairy. To my surprise, by increasing dairy dramatically and reducing fruit intake, my supposed lactose intolerance vanished within days. In other words, I was intolerant to the 6 servings of fruit per day, not the lactose. I’m not saying this will be your experience, but the more you experiment – and measure outcomes correctly – the more you’ll find your sweet spot. Best of luck as you continue your journey.

    • Dominique  January 28, 2012

      Thank you for your response.

      I will experiment – I already don’t eat fruit – and will “measure outcomes correctly”.

    • Dominique  January 29, 2012

      Sorry, I take 1000 mg of vitamin C, not 1mg, I definitely need to measure correctly !

      Also, I like to clarify, in the UK, the acceptable ratio TC/HDL ratio is 4.5 (mine is 4.9) and is viewed as one key element of your cardiovascular risk. Your age, weight, physical activity, blood pressure, blood sugar, family history, smoking habits are all taken into account. If you have high-blood pressure, family history of heart disease, diabetes, and a TC/HDL > 4.5, you are deemed high risk, then it’s statins for you, no ifs or buts. We don’t get LDL-C or P on our charts, most of us take a while to understand our results anyway.

      Here the obesity levels are rising and the National Health service is concerned about the costs and also the impact of obesity related illness like diabetes 2, heart disease and some cancers will have long term. A cholesterol test is offered to you when you reach 40 and statins are seen as a preventive cure.The campaigns are to eat healthy and limit fat and sugar, yet sugar laden food is cheap and cheerful, and in every processed food it seems. Plus we are in a recession, cupcakes are thriving, vibrant food-colourings, sugar and fat give you a high on the cheap.

      If I told my GP, I am eating fat to lose weight, he would re-open Bedlam just for me.

      Thanks for this site.

    • Peter Attia  January 29, 2012

      Dominique, unfortunately, the ratio of TC/HDL is of little value. When viewing a standard cholesterol panel, the only ratio of value is TG/HDL (but you need to convert to US units). This ratio should be at or below 1.0. I will be writing much more about this in the future.

    • Edward  June 4, 2012

      Hi Dominique,

      When you say, “I can’t live on the Atkins or Dukan ( too much meat brings digestive problems) for long,” Do you mean high fat meat or high protein meat? Have some chicken thighs with skin still on them. Avoid turkey breast. Egg yolks are high fat, fatty bacon is high fat, Avocados are high fat. None of these things are dairy.

      If you do indeed like greens, drown them in olive oil and put some avocados on top. If your greens are broccoli, cover them with Hollandaise. I believe butter contains no or little lactose and almost certainly clarified butter contains no lactose.

      Try checking out Adam Zickerman’s power of 10 slow motion fitness revolution for your weight training. It isn’t really necessary to go to the gym three times a week. Peter is a bit of an exercise nut, so your don’t have to start tossing tractor tires around to lose weight. :)

  29. thinker  January 29, 2012

    Fascinating stuff. I believe you’ve just acquired another whole cadre of fans from the Atkins website, clued in by some followers of Gary’s. Two questions:

    1. Can a regular non-doctor shmoe check their own beta-hydroxybutyrate, & if so how?

    2. I’m especially interested in your conclusion #4 at the end of your original post:

    I eat vegetables, but primarily because they are a great way to get more fat (e.g., high-fat salad dressings, butter), not because I “need” them.

    I’m sure you know Colette Heimowitz, “our” nutritionist over at Atkins. Here’s what she says, and we endlessly repeat, about veggies:
    •Why Are Vegetables Important?
    o http://boards.atkins.com/showthread….Help!!!!/page8
    o From Colette: Now here is my thesis on why veggies are important;
    It is true that protein and fats are “essential nutrients” and carbohydrates are not. However, I consider the nutrients in colorful vegetables extremely important living in the toxic environment we are exposed to on a daily basis.

    Vegetables are important because;

    1. We need the fiber. Fiber comes in two forms: soluble and insoluble. Soluble fiber is made up of sticky substances like gums and pectin, which form a gel-like substance when mixed with liquid. The gel binds with cholesterol and bile acids in the small intestine and eliminates them from the body. Since bile acids are made from cholesterol, more of your body’s cholesterol is used up in replenishing the bile acids. Hence, soluble fiber’s well deserved reputation for lowering cholesterol. Insoluble fiber does not dissolve in water. It absorbs water as it passes through the body, which adds bulk to the stool and speeds up transit time, preventing constipation and diverticulitis. It also helps reduce the risk of colon cancer by moving toxins and cancer causing substances through the digestive tract more quickly. The best sources of insoluble fiber are wheat bran and whole grain products. *Most plant foods contain both types of fiber. Insoluble fiber is more common, found in most fruits and vegetables as well as beans, grains and nuts*.

    2. Vegetables contain fair amount of carotenoids, flavinoids, lycopenes, and other anti-oxidants and phytonutrients important to control free radical pathology from all the chemicals we are exposed to in the environment. When the Atkins diet is followed correctly, incorporating high nutrient-dense vegetables and eventually a limited amount of low-glycemic fruits, phytochemicals are obtained.

    3. Ketones formed by the use of fatty acids for fuel does not disturb the acid base balance but rather it stays within a safe pH level especially true when adequate vegetables are consumed.

    4. Uric acid levels may elevate transiently in a carbohydrate controlled diet but not outside acceptable biochemical levels especially when adequate vegetables are consumed.

    5. Dr. Phinney described foods and nutrients we should eat to help lower our risks of inflammation in the body. The nutrients he found most important were:
    1) Omega 3 fish fats EPA and DHA
    2) Polyphenols, found in tea, wine and cocoa
    3) gamma-tocopherol (not to be confused with alpha-tocopherol/Vitamin E), found in olive oil and canola oil
    4) Fiber from nuts and *fruits and vegetables*

    Nutrients that he found promoted inflammation were:
    1) Omega 6 fats found in corn oil and soybean oil
    2) Iron
    3) trans-fatty acids found in hydrogenated and processed foods
    Overall, the anti-inflammatory foods he recommended for a Carb Restricted (CR) diet were fish, olive oil, nuts, berries, vegetables, low-sugar “dry” wines, and tea. He pointed out that CR diets are naturally anti-inflammatory because they lower WBC count by 15 percent and CRP by 30 to 50 percent, but their effectiveness could be improved with the addition of these foods.

    Among the various principles that we base of recommendations on is the “Good Health Principle” which reads;
    • By adhering to a controlled carbohydrate nutritional approach, an individual who chooses to eat nutrient-dense foods (including adequate fiber from vegetables, healthy fats and supplementation as needed) is more likely to meet his nutritional needs promote good health than he would by following a calorie-restricted, fat-deficient diet. Exercise is also essential for controlling weight, enhancing energy and maintaining a sense of well-being.

    • By selecting low glycemic fruits and vegetables phytochemicals are obtained .

    Could you please comment, in view of your conclusion #4? We’re interested to hear your input. Thanks!

    (reply)
    • Peter Attia  January 30, 2012

      Thanks for your comments and questions. And thanks for your interest in this blog. To your first question, yes, anyone can check (should they choose to) the level of beta-hydroxybutyrate in their blood using a very simple point-of-care device similar to the type one would use to check blood glucose levels. On my page “Books and tools” I provide a link to the Abbott meter I use to check both beta-hydroxybutyrate and glucose levels daily. Urine strips measure a different ketone body, and do so qualitatively, rather than quantitatively, which is why I prefer the blood test. Plus, my daughter is fascinated by the fact that her daddy pokes himself in the finger every morning and gives himself a boo-boo.

      Ok, your next points/questions are excellent, but too long for me to address in this response. I will be addressing them in future posts. I do still stand by my conclusion that the only reason for me to eat veggies it to get more fat (rather than due to some physiologic “need” for them). The “science” of our need for fiber is based on very poor observational epidemiology, courtesy Denis Burkitt, which has been refuted by a number of studies between 1994 and 2000. I’ve written a post about this, and will publish it in the next month or so. Hopefully it will address your concern about fiber (or the lack thereof).

      As far as the other points, I think it’s important to really scrutinize the studies that point to these benefits. These studies are not designed to, and therefore are not really capable of, actually elucidating cause and effect. Just like studies like the China Study that “tell us” meat is bad and plants are good, they can’t separate and isolate the variables on the “cause” and “effect” side. I have also written a post about this entire topic and will try to get it out soon also. So much to write about…

      I’m not sure I understand your point of omega-6 and omega-3 ratios, as it pertains to eating vegetables, but I wholeheartedly agree with what I think you’re saying: we should do everything we can to avoid omega-6 PUFA and go out of our way to consume high quality sources of omega-3 PUFA. The ratio of omega-6 to omega-3 PUFA is probably quite indicative of our body’s inflammatory state. I believe I discussed in this in one of my videos.

      Please stay tuned for future posts on many of the topics you’ve raised and thanks for your interest.

  30. David  January 29, 2012

    I appreciate your insights into Protein with respect to a low carb lifestyle. I know historically I have not been mindful with tracking that. I will certainly look to transition to lower protein levels moving forward to see how it works for me.

    I do have a question. When buying meat that is still on the bone. Is there a rule of thumb or easy way to to calculate the nutritional values? It would seem that all the data I have seen takes the serving size weight with no bone. This is most frustrating for me with chicken wings that I’ll often prepare on the weekends.

    (reply)
    • Peter Attia  January 29, 2012

      This level of precision was only really necessary during my (very difficult) transition into ketosis when my usual eating habits (>250 gm/day of protein) were causing problems. After preparing a few meals with surgical precision, you’ll be able to eye-ball it. Remember, this level of precision was only necessary for ketotis. You do not NEED to do this to make better food choices.

    • Mark McPherson  February 1, 2012

      Your comment about “levels of precision” for ketosis is exactly why I am writing. I lost 11 pounds the first week, following you menu. However, this week, I went up 4 pounds, due to, in my opinion, an increase in my meat consumption. Obviously, I will lower it greatly, but as I reviewed your menu, I noticed you wrote in one place about limiting protein to only 125 grams (4.4 ounces) per day, yet one day you ate a 12-oz prime rib, and another day, 6 oz grilled salmon.

      I ask not to argue (believe, your plan is working very well for me… and I am happy), but for me to remain in ketosis, is it partly trial-and-error, or is the 125 grams protein a number of particular significance?

      Again, bottom line, I am (as of today) taking in waaaaaaaay less protein to get back into ketosis.

    • Peter Attia  February 1, 2012

      Mark, I wish, I *really* wish, I could answer these questions with precision. I can’t. It’s much more “art” than “science” at the individual level. Yes, my protein intake varies from day to day. So, too, do my ketone levels. I have observed — IN MYSELF — that when I consistently eat more than 125-150 gm/day of protein, I bump myself out of ketosis. I simply don’t have enough to data to know for certain this is the case for everyone. Individual variation is non-trivial part of this process. Above all else, I’m delighted that you understand this and are becoming a “self-experimenter,” also. Keep up the good work.

    • Leoni  February 2, 2012

      Mark, I hope Peter will correct me if I’m wrong, but I believe the 125 grams protein per day refers not to the weight of the meat itself but to the actual protein content of the meat, which is only approx 25% of the lean mass total of the meat by weight.

      So, for example, that 12oz prime rib that Peter mentioned eating would only actually contain around 85 grams of actual protein (even less if it was a fatty prime rib).

      Hope this makes sense!

    • Peter Attia  February 2, 2012

      Ahh Leoni, thanks so much for clarifying. I didn’t realize what was causing the confusion. Yes, you are correct. In fact, since I go out of my way to consume the highest fat meat possible, I generally get even less protein per oz of meat.

    • Leoni  February 2, 2012

      No problem Peter, glad I could help in some small way! :)

      I have only just found your blog so will take this moment if I can to also say a quick but heart-felt thank you for the wonderful resource you are building here!

      Not just because of the invaluable information you provide and for helping sort through many of the lingering ‘issues’ which seem to cause such heat in the LC world (and subsequent angst for many of us trying to wade through it all), but also for how you relate it, with warmth and graciousness and regard for your readers. Thank you most of all for that.

    • Peter Attia  February 2, 2012

      Thanks so much for your support and kind words.

  31. Lacie  January 29, 2012

    This is the best low carb blog yet! I found you through Gary Taubes’s latest post (of course) and now have you bookmarked. The simplicity of your explanations is so refreshing, and you handle the inevitable conflicts of cyber interaction well.

    My story is testimony to the diet you recommend. I’m a 53-year-old female, post menopausal as you might guess. 16 months ago I reduced my carb consumption to <50 grams per day and lost 20 pounds within 2 months. I'm not where I want to be in terms of muscle mass and body composition, but I love how I look and feel. I sleep better; I don't get horrible dry skin in the wintertime, my mood is calmer, and I don't get the horrible hunger pangs that used to dog me when my insulin was out of control on my old diet of 150 grams of carb and 70 grams of sugar per day (and that was low compared to the average American – good grief!). I do take .05mg per day of bioidentical estrogen in topical form.

    OK, not a big problem, but it's bugging me anyway. After 16 months of low carbing, my total cholesterol nearly doubled. Here are my old, then new numbers:

    Total C: 140, 255
    Trigs: 52, 54
    HDL: 56, 76
    LDL Friedewald: 74, 168

    My doc, bless his heart, focused on the HDL and trigs and told me not to worry, but he'd like to see the other two numbers come down and told me to "eat less butter and cream." Heh, over my dead body! But isn't the Total C a serum measurement of all circulating cholesterols? That means there's something other than HDL and triglycerides circulating around in there, and I'd like to know what it is and why it nearly doubled after I improved my diet. Not asking for medical advice, just help with understanding why my lipid numbers are so often typical of people who shift to this diet and whether we should be concerned. Thank you!

    (reply)
    • Peter Attia  January 29, 2012

      Hi Lacie, thanks for sharing your experience and thanks for the kind words of support. I’m glad you doctor is focusing on the only valuable information generated by this test (indirectly): TG/HDL. You went from VERY GOOD (52/56 < 1), to EXCEPTIONAL (54/76 << 1). Unfortunately, the LDL-C and TC-C numbers don’t tell us anything. Please ask your doctor to check LDL-P and ApoB. Without these numbers one can’t be sure of your LDL risk. I’ll write about this a lot more in the future, but I recommend you check out the work of Tom Dayspring, MD. My mentor on the lipid side.

  32. Shiv Kumar  January 30, 2012

    Hi Peter,
    Thank you for writing this and all of your other articles. I happened on your blog yesterday afternoon and was going through each of your articles, one by one. What a mass of information and knowledge I have gained. I love that you’re so methodical leaving almost no stone unturned and that you experiment with things and document outcomes so you can share with all of us.

    I feel like I’ve read a book and you’ve kept me engrossed from the first moment. I’ve been following a LCD since July last year. I seem to have plateaued (in weight loss) and was looking at doing a ketogenic diet but had no idea how to eat 80% (or thereabouts) of my calories from fat! This particular post gives me some great tips. However, I don’t have diary either so I may look at using Coconut milk/cream instead.
    What you don’t seem to explain anywhere is:

    1.How do you know you’re in ketosis (I know there are Ketosticks etc. but is there something more reliable)
    2.I was under the impression that once you’re in ketosis and your body acclimatizes to burning fat for energy you won’t see any ketone bodies in urine.

    So I’ve love to know how you know (or test) that you’ve been in ketosis for 7 months.

    You don’t mention any issues with being regular (bowel movements) since being on LCD. I’ve curious if you have trouble and if so what you did. Also, I don’t see much fiber in your diet, does fat help here or do you take probiotics?

    Your results are very exciting and inspiring and the information you have presented is a gold mine. Thank you!

    (reply)
    • Peter Attia  January 30, 2012

      Hi Shiv, glad you’re enjoying this information. I’ve never used urine ketone strips and only use whole blood analysis via my point-of-care ketone meter that measures beta-hydroxybutyrate (see my section on books & tools). Using this, it’s been very easy for me to document my exact degree of ketosis since I started. As far as bowel habits go, mine have improved so much since becoming ketotic, I kick myself for all of those years of suffering with bloating, gas, and other misery. Turns out fructose and gluten are 2 of the most harmful substances for your bowel. The key to healthy bowel habits is actually including sufficient sodium and fat in your diet. If you think you’re still having trouble, consider adding a bit of mineral oil or medium chain triglyceride oil. Keep up the great work!

  33. JPL  January 31, 2012

    Hi Peter. Thanks for all this very interesting information. I’m particularly interested in more info on why eating too much protein was making you feel so lousy. I understand it was keeping you out of ketosis with protein being converted to glucose, and that this was preventing you from reaching your goal. But why was it making you feel bad, and why did reducing protein further to stay in ketosis help you feel better?

    (reply)
    • Peter Attia  January 31, 2012

      The reason so much protein, in this case, was making me feel lousy was that protein – in and of itself – stimulates insulin release. With too much protein, despite “low” enough carb intake, I was prevented from generating sufficient ketones to supply my brain. But I was too low in glucose, also. So I was in what I refer to as the “zone of misery” — a place where you have too few carbs to feed your brain, but too many carbs (plus/minus protein, and in my case too much protein) to allow sufficient ketone formation.

    • JPL  January 31, 2012

      Makes sense! Thanks so much!

  34. JI  January 31, 2012

    peter,
    I’ve never understood how some elite athletes (by elite i mean professional) especially cyclist could perform on a vegetarian diet, what are your thoughts?

    (reply)
    • Peter Attia  January 31, 2012

      I think it is possible, especially because most people in this capacity are very mindful of what they are eating. If you think about it, they are probably going out of their way to avoid not just meat (obviously), but sugar and highly refined “junk” food. If they work with a great nutritionist to ensure a good balance of amino acids (made easier if they still consume eggs and dairy), I think it’s doable. Not for everyone, but I think it can be done.

  35. JI  January 31, 2012

    Peter, during especially hard training blocks i will get the midnight sweats (neogenesis) have you experienced this, has your new diet affected it?

    (reply)
    • Peter Attia  January 31, 2012

      Jeff, I have not experienced night sweats except as when “sick,” even during the most profoundly stressful periods of my training.

  36. Shiv Kumar  January 31, 2012

    Hi Peter,
    Thanks for answering my earlier questions. I have a few more…

    It is known that Omega-3 fatty acids reduce TGs in blood (The Fish Oil and Triglycerides Study by Dr. Christopher Gardner from Stanford). So my question to you is, at what point did you start supplementing with Fish Oil.

    Do you attribute some portion of your weight loss to exercise, or only change in body composition?

    Looking at the graph in your “How I lost weight” post, your lean body mass changed by a pound over the entire period (granted a pound of muscle is quite a bit), but how do you feel about that? Further Doug McDuff (Body by Science fame) says you only need 12 minutes a day. Mark Sission (Mark’s Daily Apple) seems to be of a similar opinion. You obviously seem to disagree? Why?

    Dairy (Casien) I believe (after all the research I’ve done online) has similar effects to Gluten. Again, you don’t seem to concur. What are your reasons for continuing on with dairy?

    What are your thoughts on fermented foods (Kombucha, Kefir, Sauerkraut, Kimchi etc.) as related to gut flora and gut/immune system health?

    (reply)
    • Peter Attia  January 31, 2012

      Shiv, quickly: I consume omega-3 not because of the TG-reducing properties (which I think are small), but because of the counterbalance to omega-6; I don’t “disagree” with folks who work out 12 minutes per day, I’m just optimizing for a different outcome (remember: 5 reasons to exercise and weight loss isn’t one of them); the research on the harm of casien is very weak, to be gentle about. I do not subscribe to it at all. If you want to really understand why this “research” is weak, read Denise Minger’s review of “Forks Over Knives.” As far as fermented foods, I do not have a view other than these effects are certainly not 1st-, 2nd-, or 3rd-order terms. Probably not worth fretting about until one fixes everything else.

    • Shiv Kumar  January 31, 2012

      Peter,
      The study shows that supplementing Omega-3 Oils reduces TGs by about 25%. Your TGs dropped by about 47%. So it’s possible that it was a combined effect, no? These are questions that come to mind and thus need to be asked and answered (eventually at least), and so I ask.

      So since you’ve practically fixed everything else….:)

      Neuroscience professor and aging researcher Dr. Charles V. Mobbs found that a ketogenic diet reversed diabetic nephropathy (in mice). Have you found “reversal” of any chronic aches/pains or other symptoms since being ketogenic?

  37. Al  January 31, 2012

    Peter: thanks for the site and your feedback.

    A bit about me: I decided to lose weight after hitting 257lbs (6’1 frame) and being told I had fatty liver. I decided to change the way I ate after realizing that not only was I NOT losing weight despite running 30 miles a week for 3 months while training for a marathon, I was also losing precious HDL while eating a nutritionist’s recommended “5 fruits a day” for those same 3 months.

    Going low-carb helped me get down to 205 within about 4 to 5 months but then I stalled out despite being convinced that I was eating next to no carbs. Unfortunately I still carry a tire of fat and clearly have a lot of visible excess body fat that I need to clear. Over the holidays I took a break and had as much ice cream, candy and cake (while still avoiding pasta, bread, potato, etc.) and am now back up to 216lbs. I’ve also taken up weight lifting and have experimented with varying amounts of protein and even intermittent fasting. I’m starting to suspect my stall was due to excess protein rather than carbs and I’m gearing up to take another run at the magic 200lb mark by increasing fat while decreasing protein to about 100 to 150grams on a consistent basis (I’m keen to keep lifting weights and don’t want to lose muscle mass).

    My question (finally) is this: are you still losing fat or weight despite eating nearly 5000 calories a day or are you just maintaining? If you needed to lose more fat would you be consuming fewer overall calories within your ketotic state rather than upping your activity levels? In other words, is it fair to say that it is not that the therodynamic relationship between weight gain/loss and calories in/out doesn’t matter it just doesn’t matter as much or in the ways we’ve been trained to believe? Do you think that people who “stall” during low-carb diets are failing to achieve consistent ketosis due to macronutrient imbalances or is it possible that they’re just eating too much fat and this is what’s stalling their weight loss despite their ketosis? (I’m assuming that too much protein or carbs would kick them out of ketosis so if they have an excess while in ketosis it could only come from fat?)

    As an aside, if you had to stop exercising as much as you are currently, how would you change your diet?

    Thanks in advance!

    (reply)
    • Peter Attia  February 1, 2012

      Al, you’re raisin some good points. Let’ me try to respond. I have been at weight equilibrium for about 5 months now, so I suspect this is my “new” normal weight and fat content. That said, I’d like to see one more full year go by, especially to know what a summer of long rides does to me in net (i.e., create a caloric deficit or increase appetite further). The bigger question is why here? Why have I “stalled” so to speak at 170-172 pounds, rather than, say 165-167 pounds? When I know the answer to this question, I will be delighted. Unfortunately, I just don’t…at least not yet. Your next question is a testable one, and is one of the reasons Gary and I, along with others, want to create an organization to fund the right kind of studies to answer these questions.

      To your last question, when I exercise less my appetite goes down. It seems my weight is almost independent of how much I exercise. In fact, it seems to be about 2-3 lb lower when I do NOT exercise.

  38. Shiv Kumar  January 31, 2012

    Peter,

    I’ve found the most cold cuts and other processed meats have in their ingredients dextrose/maltodextrine even though the nutrition label cites 0 carbs (because they’re not required to mention unless greater than 0.5gms I believe). So my question is related to the bacon and sausage patties you consume. Do they have Dextrose (or other ‘ose) in their ingredients? If not I’d love to know what brand these are.

    I currently make my own patties, but would love to have the option to buy bacon and sausage patties for variety.

    (reply)
    • Peter Attia  January 31, 2012

      I seek out brands that have as little as possible. With bacon and sausage, as you point out, this can be difficult, but generally it means ingesting up to 3 or 4 gm a day. With other products, like salami, I buy “pure” products without additives.

  39. Cynthia Valenzuela  January 31, 2012

    You have turned my world upside down. You are right in saying that asking what you eat is the wrong way to start. Your diet goes against everything I currently do, maybe that is a good thing. It just seems like a lot to process all at once.

    (reply)
    • Peter Attia  February 1, 2012

      Cynthia, I’m sorry and I’m delighted – at the same time. Don’t try to process it all at once. Step by step…it took me over a year to get my head around all of this, despite my understanding of biochemistry (or possibly, despite it). Enjoy the journey.

  40. PK  February 1, 2012

    Peter, I definitely “get” the whole low carb life, and have had profound success (nearly 50 lbs down since October 2011). I’m 42 year old Male, 6′ 4″ – went from about ~285 to ~235 lickety split and with minimal trouble (other than that first week of “light-headedness” that scared Dr. Oz into abandoning his attempt at a LCD).

    Your site is a fantastic resource for fine-tuning and strengthening my knowledge banks. Thank you for that.

    Now, if you don’t mind sharing your viewpoints on a couple topics I’m not 100% sure about yet.

    1. Alcohol. I know it ranks (worst to least worst) – Beer – Wine – Hard Liquor. And from what I understand, the better booze (wine, liquor) doesn’t really take you OUT of ketosis (but rather is its “own” ketosis) and what you eat afterward is crucial (don’t pig out on carbs – better yet, don’t eat at all – just drink water).

    However, what is your position on alcohol in general? Do you drink at all? If so, when? How does the “buzz” fit into the whole ketogenic picture?

    My case in particular is, that I might have a bottle or two of red wine from time to time (late at night, before bed), and make sure I still add my supplements and hydrate beyond belief.

    My weight loss during those periods isn’t as profound, but it is either stable or moderately lower (maybe a pound or two lower a week). When I abstain from alcohol consumption entirely – the fat loss is noticeably accelerated. Note that I am still very careful to restrict all other carb sources otherwise.

    I mention this because Dr. Eades mentions removing alcohol (and coffee for that matter) during the first phase of his “cure for the middle aged middle” book.

    However, I was lucky, and didn’t suffer from excess visceral fat – just subcutaneous fat.

    2. Fitness Intensity. It’s obvious you are a high-intensity workout person, very impressive how you jam so much into your day.

    What are your thoughts about the “Slow Burn” or “Super Slow” workout methods? Where you perform extremely slow repetitions (20 sec. each rep) to the point where you reach complete and utter muscle failure after maybe 4 to 6 reps and under 90 seconds.

    The premise is working out 30 minutes per week may have similar “gains” to frequent exercise, but with much more time for other endeavors or projects. I know people who have succeeded greatly on this, but it requires precise discipline.

    My initial thoughts on this are:

    - that not only will it provide you with a better future for your joints, but

    - perhaps this high intensity training should be reserved for those in competitive sports where time, distance and skill depend on it?

    I think “Slow Burn” is the book I have (not nearby at the moment), and again Dr. Eades provided the forward for that book.

    Look forward to your commentary. Again – thank you so much for this, your writing style, tone and reader involvement is exactly what this community needed!

    Cheers,
    Perry

    (reply)
    • Peter Attia  February 2, 2012

      Perry, I do consume alcohol in moderation, which is all I’ve ever done since my 26th birthday when I decided I would never drink in excess again. Actually, this was a decision I made the DAY AFTER my 26th birthday. I’m sure you can use your imagination. Ok, so I drink 2-3 glasses of red wine a week — pretty consistently. I can’t speak to Mike Eades’ claim, as I’m not familiar with the data. Red wine is about 4% sugar by weight (and of course, this varies by wine), so I suspect too much of it would take me out of ketosis. For someone on a non-ketotic LCD, though, I think wine and liquor is really only causing harm in the following way: any ethanol you can’t immediately oxidize your liver with convert to fat and eventually VLDL. So, I don’t think excess ethanol intake makes sense when trying to shed fat.

      To your second question, I think it depends on your goal. If your goal is weight loss, I don’t think it matters — exercise is not the answer as it plays a tiny role. So the type of exercise (e.g., duration, intensity, frequency) should be driven by a functional goal.

  41. Dominique  February 1, 2012

    My body seem to like a high fat diet better than a protein one. I have lost weight in less than a week, I don’t have scales, I go by clothes.
    I can eat foie-gras with a spoon (I come from where it’s made in France), but even after a few days of olives, smell cheeses, macademia nuts, mozzarella, my brain gets fuzzy around 4 pm and people in the office ask me if I am on something. I don’t use heavy machinery, so the world is safe, well almost.
    Sour-cream for breakfast is a bit weird. I am using astringent teas and herbs with my food to prevent sinusitis.

    I am fairly crap at math, but why does the TRG/HDL ratio has to be done in mg/dl and not in mmol/l. Is it a US thing?
    And another thing, is your system or maybe your liver overloaded by all the fat you are losing on this diet?

    (reply)
    • Peter Attia  February 2, 2012

      Because the molar conversion of TG and HDL is different, they need to be in units of mass/volume for this “rule” to work. When in moles you need to include the conversion factor. To avoid this, I just do the conversion up front and always calculate in mg/dl.

  42. jeff  February 1, 2012

    Peter
    As someone who hit the genetic lottery (good genes high goals)and a competitive cyclist and no issues with insulin resistance 5ft 9in about 155lbs 9% body fat. I’d like to get the benefits you experienced with utilizing fat during aerobic events, saving my carbs for anaerobic moments.
    Would you start by eliminating fructose and watching my carbs, whats a good rule of thumb for what my carb intake should be to get some of the benefits you experienced?

    (reply)
    • Peter Attia  February 1, 2012

      Jeff, yes, it sounds like you’re one of the lucky ones. To quote Napoleon Dynamite…”Lucky!” Even in someone like you, I think performance can be improved, especially aerobically, by reducing sugars and simple carbs in an effort to reduce insulin levels and increase your body’s preference for fat oxidation. This will allow you to spare your glycogen for the times you most need it (peak exertion) and therefore require less feeding during athletic events. Perhaps you might consider starting with a small change, like sugar and very simple carbs?

    • jeff  February 2, 2012

      Peter
      Thanks for the tips. I’ve begun my 2 week experiment, eliminating simple sugars, goodbye ice cream, and limiting my complex carbs to around 150g/day or less which isn’t restricting myself all that much, I’ll look out for fructose.

      At the end of two weeks I’ll let you know my results.

      I’d like to see some loss of fat tissue in the 2 to 3 lb range. I weighed in this morning at 156.

    • Peter Attia  February 2, 2012

      Jeff, keep us posted. It might take longer, though, for this to translate to athletic results.

    • jeff  February 2, 2012

      Peter
      Would you expect to see weight loss in two weeks? I don’t do any kind of calorie counting just eat when I’m hungry and stop when I’m full.
      I will be really monitoring athletic response with my powermeter. I have a coach that designs my workout schedule and monitors my watts-workouts. Performance gains are usually measured from race results, its winter now no racing, or field tests of which I’m not due for one in the short term.
      I will be looking for changes in perceived exertion while riding. So if cruseing at 220 watts suddenly becomes more than a PE of 5 I’ll know something is up. Just as I’ll know if it feels much easier.

    • Peter Attia  February 2, 2012

      You might, but it’s a function of a few complex and intertwined factors. Let’s see what happens. Also, I wouldn’t be so quick to abandon the plan in 2 weeks in your power drops. It could take a few months to adjust. Or not…

  43. Kelley  February 1, 2012

    Hello Peter,

    I discovered your blog yesterday, and haven’t stopped reading (that makes for a lot of hours in front of the computer)! 15 years ago I followed a low carb diet with great success. Back then, I consumed a lot of dairy (not being aware that I was allergic). My question to you, is that I noticed that you use large quantities of cream and cheese – what could I substitute in lieu of dairy? I’m also allergic to whey, although I do seem to tolerate small amounts of butter.

    (reply)
    • Peter Attia  February 1, 2012

      Kelley, great questions. Probably best to ask your nutritionist, but using more oils (e.g., using lots of oil in a salad dressing) is a great way to get the fat content without the dairy. Thanks for reading.

  44. Roy Harju  February 1, 2012

    Hi Peter,

    Great blog. I got here from Taubes as well. I was blown away by both of his books recently and have lost 20 lbs in the last 2 months. The one thing I found he didn’t address was the low carb athlete, so I was very excited to see his mention of your background as an athlete and that is what led me here. Being an endurance athlete myself (ultra running and cycling) I was still clinging to the notion that despite the low carb diet being ideal for health and weight loss, one needed a high carb diet for optimum athletic performance. Thanks for showing your research as to why this is not the case. What’s your take on the concept of needing to replace glycogen stores after a long workout?

    (reply)
    • Peter Attia  February 1, 2012

      Hi Roy, appreciate your feedback and interest. The answer to your question depends on your dietary paradigm. If you consume carbs then, yes, you will want to pay attention to replacing glycogen as soon as possible post-workout. In reality, if one is insulin sensitive (and that’s a big “if”), unfilled glycogen stores typically take priority over fat storage.

  45. tivoboy  February 2, 2012

    First I’d like to say, REALLY EXCELLENT BLOG! Lots of incredibly good information here for any reader. At some point, this is going to be a BOOK for certain. At a minimum it should become a video series or seminar.

    The question I have is about “what you eat”. In some of the earlier posts, and earlier in your journey towards dietary ketosis, are you STILL EATING SOME OF THE FOODS YOU LIKE ONCE A WEEK? There seems to be quite a bit of relevant data that mostly during high caloric deficits, so low calorie diets of any type, the reduction in various systemic hormones that are beneficial for maintenance of proper metabolization of fat and FFA can occur and the introduction of some dramatic carbohydrate consumption can offset this or up-regulate them to normal levels. Is this advisable, part of your eating protocol or just either not relevant or bunk science?

    Also, the ability to eat something more interesting than FATS and PROTEINS and cruciferous vegetables once in a while can be key to maintaining a diet or eating regimen over the long term.

    Are you still able to satisfy any of those legacy cravings and/or do you feel the consumption of such items is beneficial from either a metabolic/hormonal level or eating plan perspective?

    TIA
    TB

    (reply)
    • Peter Attia  February 2, 2012

      Thanks so much for the kind comments. There are no “cheat” days in my eating habits any longer, and frankly it’s made it MUCH easier. Cravings are long gone. I can have dinner with friends at a restaurant where everyone orders my formerly favorite deserts and I’m unmoved by it. For me, one of the big problems with “cheat” meals was it was too easy to go from 1 to 2 to 3 … That said it is all a personal choice based on individual differences. My wife still eats ice cream and chocolate chips at least once or twice a week, plus other foods I would not eat. By she’s got a system that works for her.

    • Steven  August 21, 2012

      Thanks so much for your site! It has really been reassuring to see all this real science coming straight from the mouth of a doctor.

      One question: Did you or will you in the future take any time off for holidays? I’ve been very diligent for about two months now, and I have absolutely no desire to “cheat” or binge as I did on past diets.

      However, when I tried low fat, high carb diets, I would seem to restrict myself too much. I did not allow myself to eat with my family on Thanksgiving, or even to splurge just a little bit on my birthday. Eventually, after about a year of successfully keeping weight off, my willpower weakened and I began to slowly gain weight again. I ended up back where I started, plus some. I realize there are probably some ketosis friendly items at the Thanksgiving table. But, at least for me, that is not the same as eating real Thanksgiving staples, or family recipes.

      So the question is, would it be realistic to take about a week off of low carb dieting for the week between Christmas and New Year’s Day? Or possibly a day off for Thanksgiving or a birthday? I realize this would kick me out of ketosis rather easily, but I feel as if it may be the key to actually making this a lifestyle and not a crash diet. Would this significantly set me back? How much weight could a person realistically put back on while taking a week off? And what’s all this I hear about cheating being a “metabolic reset?”

      Thanks!

    • Peter Attia  August 23, 2012

      There’s no “right” answer to this question. Highly personal. Obviously eating anything you want for a week a year has minimal harm physiologically (within reason), but for some it may make the mental part tougher. For others, it might be ok. Personally, I like to eat as well as I can every day.

  46. Eric U.  February 2, 2012

    Peter, thanks for your post. I have a question a bit off to the side:

    What do you do with your extra egg whites? Or do you buy yolks separately?
    I go through tons of eggs, and would love to drop a bit of the protein out, but I just can’t see wasting all that food by throwing away the whites. Also, I like to buy high-quality eggs [pastured if I can get them] and I’ve never seen pastured yolks for sale.

    Do other folks in your household eat them?

    (reply)
    • Peter Attia  February 2, 2012

      Others in my house to do eat the whites, but if I’m solo I do, unfortunately, have to “waste” them. Ironic, I know, given that there are folks out there doing the exact opposite…interesting arbitrage opportunity perhaps?

    • Eric U.  February 2, 2012

      Yeah, there are health-food stores selling organic egg whites. If people start shifting more toward low-carb, maybe they can just buy good eggs, split them, and sell to both sides ;’>.

      Thanks!

    • Joanna  May 12, 2012

      You could use the egg whites to do sugar-free macaroons (whipped egg whites + shredded coconut). I’ve seen recipes for these, but haven’t tried them without sugar yet.

    • Travis Koger  May 14, 2012

      If you’re looking for a great Macaroons recipe for egg whites, check this out.

      http://paleofood.com/baked.htm#almondmacaroons

      My wife makes a variation of it so it is a little more high-fat, low-carb friendly than the paleo version on this site using the following ingredients:

      Lemon nut macaroons

      2.5 cups almonds / hazelnuts
      1 teaspoon cinnamon
      1 lemon – zest
      4 egg whites, beaten
      1/4 cup Xylitol
      4 tablespoons lemon juice

      Grind nuts coarsely. Combine cinnamon, lemon zest, Xylitol and lemon juice. Beat egg whites until very stiff, fold into nut almond mixture and blend. Drop from a teaspoon onto baking paper. Bake 30 minutes at 135c or until golden brown. Cool on rack – eat – enjoy!

  47. Mike Ryan  February 2, 2012

    Hi Peter,

    Great blogs! I found you through Gary Taubes as many others have. I rarely post replies or questions, but I could use some suggestions on tweaking my diet. Some background on me… I am 46, 5’11″ and currently weigh 296 lbs with 210 lbs of lean mass. I am fairly active outside of work (desk job, with a little walking/stairs around the plant). I started the low carb lifestyle after several years using the Zone diet with limited success. I have always been very muscular and athletic, but always carried more fat than I would have liked. In September 2010, I weighed 341 lbs. How I got there is a long story that I will spare everyone. Over the next year, I exercised and followed the zone and lost a whopping 9 lbs. I was generally good about my carb choices, sticking with limited whole grains and fruits and veggies. In september 2011, I start the low carb experiment. Since starting, I have lost 38 lbs with no additional exercise, and feel great, but the weight loss has slowed dramatically. I have had exactly 2 slices of bread since september (CHristmas eve, homemade, tasted great but made me feel horible.), and virtually no other starches or sugar. I eliminated fruit and generally only eat green veggies or salads. I keep my carbs below 30 grams per day and my protein at ~170 grams per day. Total calories are around 1800. Fat comes priamrily from meats, olive oil, eggs, nuts and half and half in my coffee. I was considering decreasing my protein slightly, and increasing my fat a bit to move the calories to about 2000. I was concerned that I might be eating too few calories, but I would expect that as long as I keep protein adequate to support body repair, and have sufficient fat stores, calorie needs should be met by the fat stores, regardless of calorie intake. Do you have any suggestions on what direction to go? Thanks, Mike.

    (reply)
    • Peter Attia  February 3, 2012

      Hi Mike, thanks for kind words and support. Congrats on losing the first 50 or so pounds. It’s a great question you’re asking and not one I can easily answer over the internet. I think it might make sense to embark on a series of experiments? I know it’s hard to be patient sometimes (I’m actually quite impatient myself), but I’d suggest changing ONLY variable at a time, and giving each tweak 2-3 weeks before making the next change. For example, consider changing the amount you consume of the following: nuts, dairy, total protein, just to name a few. Keep us posted.

  48. sherry  February 2, 2012

    i’ve been on Atkin’s for 6 weeks. I lost 12 lbs in 2 weeks, gained 2 back and haven’t lost anything in the last 3 weeks. I only have 15-20 lbs to lose so everyone is telling me to just be patient. It’s hard to be patient and I wonder, after reading your blog, if I’m not eating enough fat. I’m following 20 g of net carbs per day with 12-15 coming from veggies. No fruit, no nuts, only 3 oz cheese per day, sometimes mayo with salad, a couple of tablespoons per day of salad dressing. I don’t have a hard time without sugar and high carbs if I’m getting results. I don’t know, I’m feeling really bummed and don’t know how to improve my results. Any advice?

    (reply)
    • Peter Attia  February 3, 2012

      Sherry, thanks so much for reaching out and congrats on your progress to date. I think being patient is a good idea. It’s really tough for me troubleshoot without “seeing” you, unfortunately, but sounds like you’re doing things well. If you’re feeling well, it might be worth staying the course, if energy levels are low, maybe more fat makes sense? I’d also prioritize MUFA then SFA, then omega-3. Just avoid the omega-6.

  49. stuart  February 3, 2012

    I am ApO-3/4 genome type and some others including 4/4 have found that high saturated fat diets above ~30g/day is not favorable to lipids. I have been low carb for about a year now my ApoA-1/B ratio is .497 probably not on the low side but my VAP last year was very good.
    I wonder if you are ApO-3/3 genome type and could comment on the diet possibly not working for some groups of people?
    Also would a high saturated fat diet have negative long term affects on the gallbladder and liver.
    I am presently trying to go lower carb <40g but I find that I get nauseous in the morning and have migraine muscle cramps in the head lasting 3/4 of the day starting from the morning and can't seem to get back down to 18%BF from my present 22%. I came on from a Trackyourplaque forum that mentioned you on Gary Taubes website.
    I find your site one of the best I have read and hope to find a solution to my dilemma here as I read through it.

    (reply)
    • Peter Attia  February 3, 2012

      Hi Stuart, thanks for the question. I don’t know (yet) my apo genome. My ApoA1 to ApoB100 is about 0.36 on last check, I think. 0.497 is pretty damn good, too, though. As for your question regarding Apo 3/4, there are all sorts of misinformation out there about how diet affects various lipid concentrations in people with the E4 allele. Apo E is involved with the clearance of VLDL, IDL, HDL and chylomicrons. There is little high-level evidence data on how diet induced lipid changes if those with various apoE isoforms affect CAD. There is also erroneous data out there on apoE4 and omega-3 FA and also its affect on sterol absorption. Classically folks are taught E4 is associated with hyperabsorption of sterols, but the data are very mixed. I asked Tom Dayspring (in my opinion, one of the most knowledgeable persons on the entire topic of lipoproteins) for his view and he suggested some great reading on the topic. If you want, I can send you the papers.

  50. JLMK  February 3, 2012

    Peter,

    Just a quick shout out to say congrats and well done for publishing this blog. I stumbled upon your blog, via Taubes, via Paul Jaminet’s PHD.

    So I guess you’re already preaching to the choir in my case, but I find that I’m learning new stuff anyway.

    Best,
    JLMK

    (reply)
    • Peter Attia  February 3, 2012

      JLMK, thanks so much for your support. It’s great to know people find this valuable. Hope we can all learn from each other on the journey.

    • jenseale  February 14, 2012

      i loved Gary Taubes book and found this site on his blog…you eat how I am starting to… finally found the same like me..I feel great and losing weight… your food pic looks like my frig now! yea! So glad I found this site! You rock!

  51. Janet  February 3, 2012

    Hi Peter,
    This is just a quibble and really not the point of your post at all, but when you say “good genes” would you say that this is just a subjective short-hand for genes that are desirable in a food-abundant society? In a food-scarce situation, I would think those same genes wouldn’t be quite so desirable, and in fact healthy people with “poor genes” would be at an advantage because their bodies are so efficient at converting carbs to fat storage. I know it’s semantics, but I would think the “good genes” are really just “inefficient genes” that happen to be desirable in a food abundant society.

    (reply)
    • Peter Attia  February 3, 2012

      Janet, this is actually a VERY interesting point! I’ll need to think a bit more about it. There are really 2 issues at play, food quantity versus food quality. No doubt that our ancestors encountered food both less regularly and less abundantly than we do, but they also never encountered the poor quality of food we encounter. The other side of this is the idea that it the world we live in today (abundant, crappy food) some people (about 10-20% of the population) seem completely immune from the deleterious side-effects. Is that the ideal genome? More importantly, how did those folks fare 10,000 years ago? Interesting stuff…

    • Joshua Wardrop  February 24, 2012

      Interestingly (to me at least) those people with ‘great genes’ who stay thin no matter what junk they eat, dont seem to be able to add a lot of muscle mass easily. We might be seeing a simple tradeoff of immune system vs strength potential, and we certainly benefit as a society from both types.

    • Peter Attia  February 24, 2012

      Great insight. Insulin is certainly an anabolic hormone, and there are 2 edges to this sword.

    • MMD  February 25, 2012

      Question… dont you know want good fat? isnt heavy cream bad for you… I get the no starch and minimize sugar… but can you clarify fats?

    • Peter Attia  February 25, 2012

      Are you suggesting saturated fat is harmful? Why do you think this is the case?

  52. Nate  February 4, 2012

    I’ve searched hither and yon and I’m having trouble finding bouillon without sugar in it. Any tips?

    (reply)
    • Peter Attia  February 4, 2012

      Nate, the only way (I know of) to get it with absolutely ZERO sugar is to make it yourself. This is too time-consuming for me, so unfortunately, I buy store brands which have some (less than 1 gm) dextrose, typically. Unbelievable, isn’t it, that sugar is virtually everything we eat?

    • Krowe  February 7, 2012

      Try the Rapunzel brand vegan vegetable at Whole Foods. (which seems also to be the Edward & Sons brand)

  53. Matt Taylor  February 4, 2012

    Found your blog via Gary Taubes’ site. Glad I did. The first question that came to my mind was, “Where does this guy find the time to respond to all these blog questions?” Don’t answer that! But keep up the good work and thanks.

    (reply)
    • Peter Attia  February 4, 2012

      Thanks so much, Matt. I hope I can keep up with the responses. Appreciate the support.

  54. colby  February 4, 2012

    Hi Peter-

    The question I have is much more complex when I think about it, but in short: I’m a type 1 diabetic in good control on an insulin pump. since “normal” people have insulin secreted per homeostasis, how do you think my basal rate insulin is affecting my goal to reach ketosis, or come close to it? if i was to not take ANY bolus insulin (for food or to correct a high BG) I average about 35 units of humalog insulin a day. another question I have which I suprisingly can’t get a clear answer from my doctor/nutritionist about is this: suppose i am in a state of nutritional ketosis and my current bg is 80. if i test my ketones on a ketostix, would i find minimal ketone bodies in my urine, or would it read negative? obviously through education i understand the difference bewteen ketosis and ketoacidosis, but having type 1 kind of confuses things for me. again, love reading your blog. thanks in advance!

    (reply)
    • Peter Attia  February 4, 2012

      Colby, for a T1D it would not be wise for me to try to provide any advice on line. Too many factors. I’d suggest reading Richard Bernstein’s book and working closely with your doctor. Because a T1D makes no insulin, you will still require some amount to prevent your ketones from getting too high (a non-diabetic does not need to “think” or worry about this, because their pancreas makes sufficient insulin and if ketones ever get too high, insulin is secreted and suppresses them).

      Bottom line — if you reduce carbs you will require both a lower basal rate and a lower bolus.

  55. Paula  February 4, 2012

    Hey, just realized last week (since we were having company over) that chocolate mousse is a FINE dessert on this eating plan (just use Truvia rather than sugar, and use bittersweet chocolate)!!! Mmmmmm!!!! My son had me make more the next day. Reserve some of the whipped cream for the top!

    Glad to make your acquaintance Dr. Attia! Here’s my story (57-year-old female):

    Jan2010 labs (pre-low carb high fat – WEIGHT 168) – IN SHORT, ME AS A SUGAR-BINGING IGNORANT CARBOHOLIC-BINGER SINCE BIRTH:
    HDL=52; LDL=156; TRI=105

    March2010 READ Taubes’ “GCBC” COVER TO COVER, HUBBY & I WENT FROM S.A.D. TO LCHF WITH A VENGEANCE

    Sept2010 labs (post-low carb high fat – WEIGHT 152)
    HDL=65; LDL=159; TRI=54; (didn’t test for VLDL but Apo B was 98 with reference range <109)

    July2011 labs (post-low carb high fat – WEIGHT 150)
    HDL=67; LDL=158; TRI=48

    My husband's high blood pressure normalized (took a couple of months) but his gastric reflux with which he'd suffered for YEARS and sometimes severely was gone in 2 days and never returned. This is not to mention the disappearance of aches & pains, great immunity and energy… What's not to love?

    Appreciate your take on Omega 6/3. A huge part of the puzzle. Down with peanut butter, up with wild-caught salmon! Super-Walmart (sorry folks) carries it, marked "sustainable"! Three grades all the way up to rather expensive sockeye. Invest in a Sous Vide Supreme and you'll be set for life!

    I think another importance piece of the puzzle MIGHT be "The Devil in the Milk" (read the first article that comes up when you google that): A1 cattle vs. A2 cattle. Jordan Rubin has a new enterprise, Beyond Organic, and an 8000 acre farm with A2 completely-green-fed cattle. With his farm newly up and running, he sells meat and milk products (I like his Amasai, plain – to which I add cinnamon and a bit of Truvia). He's into probiotics big time (cured himself of Crohn's etc. when young – amazing story, wrote "The Makers Diet" Look at his before and after pics!). Asked himself what were real riches, and ended up with the answer: land and cattle. His most recent book, Live Beyond Organic, is good. In line with your diet, Dr. Attia!!!

    So glad you've teamed up with GT! The world ain't seen nuthin' yet! :-)

    (reply)
    • Peter Attia  February 4, 2012

      Paula, great work on reducing your risk of heart disease. Keep in mind, though, without a lipid NMR test, it’s hard to be 100% sure you’re fully dialed in. Might be worth considering that test. Thanks so much for your enthusiastic support.

  56. Russ Stresing  February 5, 2012

    My thanks to you and Gary Taubes for making all of this more accessible because of the way you both get your points across. I read “Good calories, Bad Calories” and got to the end before I realized it was 500 pages. What I’m gathering from your description of your process is that there are no ‘cheat days’. I went several weeks following the menu instructions in “Why We Get Fat” before spending 2 weeks in Orlando with my son and daughter-in-law during which they expected Papa’s cooking, but not the “new” Papa. And I succumbed to my own culinary prowess and cheated.

    Being that this is Super Sunday (NFL, note the absence of ‘bowl’ in sequence with the rest. Don’t sue me), I’m guessing that even this one day of…ahem…’cheating’ takes me back to day zero.

    Thanks again for all you do.

    (reply)
    • Peter Attia  February 6, 2012

      Thanks, Russ. Cheat days, for me, make no sense, but for some it’s a nice way to test the waters a bit.

    • Russ Stresing  February 13, 2012

      I was more inquiring whether I had to fast again (“Why We Get Fat”) and if a single day or an instance of ‘cheating’ undoes a lot of the benefits of a low/no carb diet.

    • Peter Attia  February 13, 2012

      Sorry, I don’t understand the context of this question.

    • Kathleen  March 6, 2012

      Hi Peter,

      I came across a low-carb site which advocates a weekly cheat day in order to raise one’s leptin back to “normal” levels, stating that low leptin levels could slow the BMR and stall weight loss and/or fat loss.
      Yet another low-carb advocate states on his site that low leptin is a positive change, because it results in less hunger; he made no mention of the BMR.
      I understand that cheat days are not a part of your practice. And certainly I can live without them if they are not useful. But do you have any thoughts on these conflicting statements around leptin levels, plateaus, and strategic cheating? Would leptin levels be a different concern for those of us who flirt on the edge of ketosis rather than actually living in ketosis?

    • Peter Attia  March 6, 2012

      Kathleen, this topic deserves more time than a quick response. I will write about leptin more generally in the coming months. My quick answer, though, is that if (like me), you’re happily in ketosis, I think the “benefit” of leaving ketosis each week is probably not worth it. But you probably know me well enough to know my macro response – it never hurts to do a good experiment on yourself.

  57. Anthony  February 6, 2012

    Dr Peter. Do you subscribe to requiring a post workout meal for any of the reasons popular fitness culture state? If there is something specific you have post workout, I would love to know.
    Thanks, Anthony – Brisbane, Australia

    (reply)
    • Peter Attia  February 6, 2012

      Stay tuned. Will get to this.

  58. David  February 7, 2012

    Any philosophy on when (time of day) to take supplements? Does it matter?

    (reply)
    • Peter Attia  February 7, 2012

      Not really. It’s sort of a function of how your body “handles” it. For example, for some, magnesium is hard on the stomach and/or acts like a laxative. Obviously, this would suggest certain times of day more favorable than others. The only supplements I’m particular about with timing are MCT oil and fish oil. MCT I always do first thing in the morning. Fish oil with dinner to ensure I’m consuming it at a time when my liver is secreting lots of bile.

    • Michele  February 17, 2012

      Peter, If you manage to find the time to explain why you take the fish oil at at time when you are secreting a lot of bile, it would be greatly appreciated. I take mine in the morning. I will now try taking them in the evening as you do and will wait and see if you provid the info as to “why”.
      Thank you very much!

    • Peter Attia  February 17, 2012

      Sure, bile aids in the absorption of fat. I want to make sure I “suck up” every molecule of fat. I worry that if I take it with nothing else, I may not secrete enough bile to really absorb every drop.

  59. Shane  February 7, 2012

    I noticed you have a diet consisting of fat salami and/or pepperoni. I have tried purchasing these items only to discover that dextrose is an ingredient in every selection–including my local deli’s selection. Do you have any suggestions? Or is the level of dextrose so neglible in these meats that worrying about consuming it is unnecessary?

    (reply)
    • Peter Attia  February 7, 2012

      Shane, I really have 2 choices (both of which I’m employ): 1. only buy those with “negligible” amounts (i.e., less than 1 gm per serving), or 2. pay an lot more for the variants (usually at the deli in Whole Paycheck, I mean Whole Foods) that have zero sugar.

  60. Shelly  February 7, 2012

    Hi Peter. Quick question about bouillon–I read in WWGF how/why Gary drank chicken broth and when I went to <30 carbs/day or so, I tried it. I found that I became so bloated, gaining a least a couple pounds of water weight (I assumed). I eat loads of salty, fatty meats and salt most of my foods liberally with sea salt, have normal to low bp, do a strenuous 2 hr. hike 3x/wk., drink coffee and water when thirsty. Does everyone really need to consume bouillon of some kind when going low carb? I don't like it. Thanks, Shelly

    (reply)
    • Peter Attia  February 7, 2012

      Shelly, it’s more a function of how much salt your kidneys are dumping, relative to what you take in. It’s possible you’re getting enough salt via other food, though I can’t get enough that way. I think you need to consume it, regularly at least, if you feel otherwise great (e.g., no lightheadedness or loss of energy).

  61. Mina M  February 8, 2012

    Hello Peter,

    I am new into the ketogenic diet area, but ive jumped on the band wagon a couple of weeks ago. That being said, I was wondering how would one go about calculating the daily calories needed? I’ve followed a carb rich diet for a while and lost 40 pounds, now I’ve lost 15 more but I am not sure whats the proper amount of calories I need. I am 5’8″ 320pounds and workout 5 times a week, with HIIT cardio 3 times a week.

    The reason I ask is I hit a plateau and seem to be losing steam by 2-3pm which is unusual for me. Please let me know your thoughts.

    Thanks!

    (reply)
    • Peter Attia  February 8, 2012

      Mina, the simplest thing I would suggest at this point is to not count calories at all. Just limit carbohydrate intake and eat when you’re hungry; stop when you’re not. Give it 12 weeks or so without interruption (or “cheating”). Beware of hidden carbs and sugars, though, so get very comfortable with labels.

    • Mina M  February 9, 2012

      Peter,

      Thanks for your reply. I actually follow the sacred rule of ketogenic diets of keeping the macros at 65% fat, 35% protein, and 5% carbs.

      I initially found out that I was under feeding at 1700 Cals. I upped to 25-2700 and we’ll have to wait and see. Wish me luck. Thanks for your website and your inspiration.

      -Mina.

  62. Aaron  February 8, 2012

    Hello Dr. Attia –

    Thank you for putting this blog together and making an effort to respond to so many comments. I wondered if you could talk more about the level of whey protein and dairy you ingest during the course of your meals laid out here. There is a lot of conflicting information on the internet regarding dairy and its role as an insulin secretogue (whatever fractionate is most responsible); could you write a little bit about your thoughts on the issue?

    I’d be interested to hear if you had to experiment with the level of dairy in your diet, have certain types of dairy that you avoid (clearly you avoid milk), and if you could talk briefly about the types of responses that people have to the ingestion of dairy, whey, and casein.

    Also if you could comment on why milk is included in the ‘hyper-glucidic breakfast test’ used to diagnose reactive hypoglycemia, that would be helpful. Would other dairy items of equivalent caloric value subsitute equally well in this test, or does preparation matter? What does that mean for dairy’s role in insulin secretion?

    That’s possibly too much to ask in one sitting, but thank you in advance.

    -Aaron

    (reply)
    • Peter Attia  February 8, 2012

      Aaron, thanks for your interest in the blog. I probably need to write a post on this topic (dairy), given the understandable confusion out there. Quick answer: different insulin response for different people *and* different dairy source. E.g., 2% milk vs. 35% whole cream; me vs. someone else. There is no single answer to this question. I’ll have to pass on the rest for now. Sorry.

  63. Debbie  February 9, 2012

    I’m not supplementing with any salt – how would I know if I need to? I’m not counting carbs, calories or anything, but aside from lots of vegetables and salad, and a square of dark chocolate a day, I’m not eating carbs. If I try adding salt to my food, I find the taste awful, way too salty. I know Atkins recommends adding salt to the diet, so I’m nervous.

    Thanks,
    Debbie

    (reply)
  64. Brent  February 9, 2012

    Really enjoying all of your posts. I have been living a pretty clean paleo lifestyle but feel like I need to reduce my carbs even more. Living paleo according to Robb Wolfs book, I have eliminated dairy from my diet. I notice you use heavy cream frequently. Do you have any issue with inflammation from l actor intolerance? Is it worth worrying about?

    (reply)
    • Peter Attia  February 9, 2012

      Brent, dairy is a bit of grey area. For some, it doesn’t sit well, not just in the immediate phase, but more chronically (inflammation, insulin response). For others, dairy is well tolerated. I seem to fall in the latter camp, but I also need to be thoughtful about which dairy. Milk does not treat me well, nor does low-fat yogurt. As I trade more lactose and protein for fat, I do much better. I heavily monitor my inflammation and I appear able to maintain a very low inflammatory environment, though I suspect my reduction in omega-6 PUFA has the most to do with it. You will probably want to experiment a bit with this on yourself.

    • Joe  February 21, 2012

      Pete:

      Through what procedure is it exactly that you “heavily monitor [your] inflammation”, please? A blood test? How often? Have you graphed it against time, on the site?

      Also, I’m for some reason not having luck with your search feature. For example, if I type “inflammation” into the search field (but without the quotes) the search feature returns “No Results Found”. Obviously, the word “inflammation” does indeed exist on your site, so I guess I’m not clear what part of your site that the search actually searches.

      I’m using the most recent version of Firefox. Is it working for you?

    • Peter Attia  February 21, 2012

      Joe, I use a blood and cheek cell test through Lipid Labs (see my page on books and tools I use). Search tool fixed! Thanks for flagging.

    • Joe  February 22, 2012

      Peter:

      Couldn’t figure out how to reply to your reply, so I’m replying to my own post. I looked at your Books & Tools page, as you suggested, and can’t find any reference to the “Lipid Labs”, regarding tests for inflammation.

      By the way, the Search feature seems to be working fine now. Thanks.

    • Peter Attia  February 22, 2012

      Sorry, on the page it’s listed as Omega3Test.com.

  65. Brent  February 9, 2012

    You mention that in your beginning “transition” stage you limited your protein and carb intake to no more than 150 & 50 grams respectively. That only works out to about 800 or so calories. Do you need to be highly calorie restrictive in the early stages to achieve weightless through ketosis?

    (reply)
    • Peter Attia  February 9, 2012

      Brent, you may have missed that I was also eating 400 gm/day of fat. I was actuate eating more calories than I was before entering ketosis. So, no, you do not need to calorie restrict.

  66. Lisa  February 9, 2012

    Peter, could you please tell me what brand of bacon you use that is sugar free? I have gone to every natural food store in my area and all the bacon I see has evaporated cane juice or sugar. Thanks!

    (reply)
    • Peter Attia  February 10, 2012

      Lisa, one brand I use a local grocer brand with less than 1 gm of dextrose per 3 or 4 pieces and no (other) added sugar. Another option is the really expensive stuff from Whole Paycheck (Whole Foods) that the butcher certifies has no sugar. I don’t lose sleep if there is a touch of dextrose in it, but I really avoid sucrose.

  67. Glen T  February 10, 2012

    Peter,

    I really appreciate the personal interaction you provide on this site as it is extremely helpful in understanding the transition to a low-carb diet. I have a two part question regarding the timing and quantity of meals along with exercise and reduced carbs.

    I do not have a problem with weight control and am not attempting to reach dietary ketosis. I began the transition to a LCD for the other health benefits. I am currently limiting sweets and refined carbs with the intent to slowly eliminate additional carbohydrate sources over the coming months.

    I only eat two meals a day with breakfast between 11:30 am and 12:30 pm and dinner around 6:00 to 6:30 pm. This also means I fast approximately 16-17 hours between dinner and breakfast each day. Before attempting to reduce carbs, breakfast consisted of an apple, banana, six ounces of non-fat yogurt, and a bowl of whole grain cereal with soy milk each day. I now have that about 3 times a week with the other days consisting of three eggs with some type of meat or cheese and maybe an apple once in awhile. My intention is to continue to reduce these breakfast carbs. Most dinners consist of approximately 3/4 pound of meat with a large amount of salad, green beans, or asparagus. However, I also have a couple of dinners a week that include burritos or brown rice and/or whole wheat pasta. I rarely feel hunger between meals, and if I do I have a snack of salami and cheese, or a handful of almonds.

    I start each day walking my dogs for about an hour at a distance of approximately 4 miles over some mild hills and fields. This is followed by 20-30 minutes of exercise on a Nordic Trak and a recumbent bike while working with ten pound weights (aproximately 700 reps). That is followed by approximately 10 minutes of stretches and floor exercises. After that I have a cup of coffee and then eat breakfast about 90 minutes later.

    My first question is about timing. Do you think there are negatives with this timing of meals and exercise, especially considering the 16 hour fast. Secondly, do you see a problem with this amount of food in two meals a day with reduced carbs if there is no issue with feeling hunger and weight is stable? Would three meals a day and/or more quantity of food provide other benefits in your opinion? Or is this more a matter of if it isn’t broken, don’t fix it? I am 6″1″ and weigh 165-170 pounds.

    Thanks again for the blog.
    Glen

    (reply)
    • Peter Attia  February 10, 2012

      Glen, thanks for your questions. Referring to my irisin post where I talk about “ordered terms,” what you eat (first order term) is probably much more important than when you eat it or even how much of it you eat. The question, in your case, it what you’re optimizing for, since you sound really lean and healthy. If you’re feeling great now I don’t see any reason to change anything. There are lots of things to tweak — both what you eat (e.g., swap out the low fat yogurt for some fat yogurt), and when you eat, but I’m not sure I’d suggest any changes unless you’re trying to fix something.

  68. Mark McPherson  February 10, 2012

    Hi Peter,
    I was at Whole Foods looking at magnesium & potassium. There are several varieties, including pill form, liquid form, etc., some cheap, some expensive, that I thought I’d ask and see if you have a preference as to what kind/form/brand you take.

    I hate to just buy based on price, as I don’t know that “more expensive” means “better quality”.

    (reply)
    • Peter Attia  February 10, 2012

      I use a generic brand in capsule form.

  69. Dan Hackam  February 11, 2012

    Peter, I decided to post these questions online rather than by private email, in case there are other docs out there who can learn from these issues. I’ve also added a question or two to the end.

    1) I truly buy into the carbohydrate hypothesis of disease but where I run into trouble with my patients is over increasing the intake of saturated fat. I experience profound resistance from my patients when I recommend they replace CHO with meat, eggs, cheese, high fat dairy (e.g. cream), etc. Any thoughts on getting around this issue? I have thought of just providing a list of foods they should AVOID (i.e. they all contain CHO), and let them choose the remainder for themselves – without ever touching on the issue of what to replace the CHO with. I did read on your site that you feel that a list is too ‘prescriptive’. What do you suggest instead? (I should state that I also tell my patients to buy Westman/Vollek/Phinney’s New Atkins book and Gary Taubes’ “Why we get fat” book – I have photocopied the book covers for them).

    2) Is it worth starting on a statin to offset the (admittedly likely small) risks of increasing saturated fat consumption? For example, if there is only a 10% chance that the Keys hypothesis is correct (and it’s probably more like 1%), are we (you and I) running the risk of clogging our arteries by boosting our intake of saturated fat and dietary cholesterol?

    3) A recent Cochrane review concluded that “Dietary change to reduce saturated fat and partly replace it with unsaturated fats appears to reduce the incidence of cardiovascular events”. I would love to send you this paper – drop me a line at dhackam@uwo.ca. It was published by Hooper et al in the July 2011 issue of Cochrane Database of Systematic Reviews (http://www.ncbi.nlm.nih.gov/pubmed/21735388). Now if this is indeed correct, wouldn’t increasing saturated fat in the diet have the reciprocal effect – ie increase the incidence of cardiovascular events”?

    4) For the sicker patients in my practice – the elderly, those who have diabetes/hypertension/dyslipidemia and post-stroke – what level of CHO restriction would you recommend? This is a critical issue – CHO restriction in more vulnerable secondary prevention patients. As you know, the side effects of CHO restriction can be severe on the physical and psychological levels – until true ketoadaptation occurs (which can take 6-8 weeks or longer). Many of these patients are highly medicated with drugs that will lower their blood pressure and blood glucose – which will be fired down even further by CHO restriction.

    5) Any tips on dealing with the two biggest issues in keto-adaptation: constipation and dizziness/lightheadedness?

    6) Were you aware of a trial published circa 1994 or 1995 with magnesium supplementation in coronary patients which showed increased cardiovascular events? (versus placebo). Here is the link:
    http://www.bmj.com/content/307/6904/585

    Certainly the use of health supplements has always worried me – when these things are tested, they invariably turn out to be harmful or neutral rather than beneficial as previously claimed (exception really being omega-3 fatty acids, which have had 3 negative trials of late – heavily criticized trials I should add). None of the vitamin antioxidants have panned out well when tested in definitive RCTs.

    (reply)
    • Peter Attia  February 11, 2012

      Dan, all of these are fantastic questions, but I can’t do them justice in this quick response. Here’s my attempt at giving you a quick answer:

      1. Yes, this is the biggest single hurdle we face. When I’m confronted with this, I usually ask people, “Why is eating saturated fat bad for you?”
      2. I don’t see why. I’d rather use measurable objectives. For example, check lipid NMR for LDL-P and only treat if LDL-P gets too high, based on risk factors.
      3. Please do send, but I’ve seen many such studies — the reciprocal argument does not (necessarily) hold true, even assuming this meta analysis is based on good data, which many are not.
      4. Very individual, but if done properly (re: NOT how I did it), keto-adaptation can be very quick (less than a week) and very simple. Requires support, up front though. Not enough to just give someone a book, as I’m sure you know.
      5. Salt and appropriate oil intake cure both overnight.
      6. This study is not particularly convincing for 2 reasons: i) the patient population is very narrow (and very sick); ii) the “significance” of it did not show up in the intention-to-treat group. Any time a study has do to strip out a lot of patients, one has to ask if other things are going on.

      Excellent questions. Thanks you.

    • Lisa  February 13, 2012

      What is appropriate oil intake to relieve constipation? Every low carb web site or book I read says water and green vegetables are the key, but this hasn’t helped and I don’t want to up the vegetables any further. I haven’t seen anything about oil. Is there literature on this?

    • Peter Attia  February 13, 2012

      Either mineral oil or MCT oil (medium chain triglyceride) work best. Don’t forget about salt. If you’re not supplementing salt, that also plays a role.

    • Garry  February 14, 2012

      I read that Cochrane Review last week as well. There appeared to be a 14% reduction in risk for cardiovascular events. I’d be interested in finding out what kinds of dietary modifications those studies involved.

  70. ingrid  February 11, 2012

    I just subscribed to your blog! I love it. Couple of questions, how do you keep protein down when eating low carb? I find that when I eat fatty meats or chicken the protein is automatically high. I’m 5’9 127lbs and have about 126g protein a day. I run marathons as well and although I was miserable when I first switched to lo carb the benefits now are amazing! Am I eating too much protein?

    When do the sugar cravings stop!? I am getting a lot better at controlling them but when they hit they hit hard! I have strawberries and blueberries on hand just in case but I really want to limit that.

    Last, do you use salt tabs during long runs (1-2 hours)? I have found that they help me a ton but are they ok to use. I’ve had many long runs (without salt tabs) ending with my face covered with salt.

    Thanks for reading!! My new favorite blog.. :)

    (reply)
    • Peter Attia  February 11, 2012

      Ingrid, it was definitely a challenge during the first few months as I transitioned from non-ketotic LC to ketotic LC. At your size, you could easily get by less protein – probably in the order of about 80-90 gm/day. As far as sweet craving, it seems that you might be better off trying to go “cold turkey,” rather than intermittently allowing yourself to snack on fruit? Just an experiment worth doing. Also, consider eliminating all non-sugar substitutes and diet drinks, if you can consume any. I use bouillon for my salt replacement before and after my really long bike rides.

    • ingrid  February 12, 2012

      Thanks Peter! Thankfully, I don’t consume any other sugar unless it’s from fruit. That was hard at first but it’s only after I run that I feel like I need a piece of fruit. I know I can cut the fruit out all together! Any hints as to what to eat after a long workout? Sometimes the feeling is so overwhelming! I don’t go overboard usually just a pear or a few grapes but if there is something else I can replace it with please tell me.. :)

      Thanks for your response! I know you’re a busy guy!

    • Peter Attia  February 12, 2012

      Sounds like your body may be “starving” during workouts. When your body is adequately accessing fat during a workout, the workout tends to remove appetite. When I get back from a long ride, even if I’ve eaten less than 10% of the calories I burned, my ketones are high (around 5 mM) and I don’t have much appetite for a few hours.

    • ingrid  February 12, 2012

      oh. wow ok. I usually don’t eat a full meal until about an hour or so after I workout. I’ll up the fat and ax the fruit.

      THANK YOU!

  71. Andrew Feldman  February 11, 2012

    I am JUST learning about this. I am not very good at counting calories or other typical metrics you mention though I can easily recognize sugar and carbohydrates on labels. I am just not sure where to begin. It probably does not help that I am about to go to Italy for vacation for 10 days. Looking forward to learning more!
    Andrew

    (reply)
    • Peter Attia  February 11, 2012

      Buckle up, Andrew. Get ready to change your life.

  72. Dan Hackam  February 12, 2012

    A quick follow-up query.
    Peter, regarding your “fat shake” which sounds delicious, I would like to try this (breakfasts have been either egg-based or turkey/chicken sausage-based, and I really need to add some variety to this routine).

    Regarding some of the ingredients, where are you purchasing sugar-free almond milk and sugar-free hydrolyzed whey protein? I thought virtually all almond milk is loaded with carbohydrate (even not the sugar-added variety) – perhaps I am wrong on this.

    Also, regarding “heavy whipping cream” is that the 35% variety that comes in the dairy section? I noticed today that dextrose was the third ingredient listed in my 18% table cream – hard to escape these added sugars.

    Thanks so much for your assistance.

    Dan Hackam

    (reply)
    • Peter Attia  February 12, 2012

      The almond milk I guy (from Trader Joe’s) has no sugar in it. It has 2 gm of non-sugar carbohydrate per 8 oz (by “sugar” I mean sucrose or HFCS). Yes, I use 35% cream, also known as whole fat or whipping cream. The brands I use do not contain any added dextrose. My 8 oz portion contains 88 gm of fat (not a typo), 7 gm of carbs, 5 gm of protein.

  73. Diana Attuso  February 12, 2012

    Hi Dr. Attia,
    I’m very glad to find your blog web site (via Mr. Taubes web site). I have read Protein Power, much of Mr. Taubes written work, Atkins & most of The Art and Science of Low Carbohydrate Living among other low-carb literature. I feel that I have a pretty good grasp on the carb-restricted diet. Have you experienced or heard of people finding that around, 4 or 5 weeks in, they become overly fatigued much of the time. You may have already covered this in your web site, so forgive me if I am asking you to repeat yourself. But could you give me some ideas as to why people may be experiencing this fatigue? I realize this is a broad question but a list of possibilities would be appreciated. Thanks, Diana

    (reply)
    • Peter Attia  February 12, 2012

      Diana, could be any number of reasons including, but not limited to, not enough fat, too much protein, not enough sodium, not enough magnesium, too much carbohydrate. Tough to say without a work-up, so to speak.

  74. Jill  February 12, 2012

    Hi Peter,
    Thanks enormously for your sharing all of this information. I am looking at your videos on JumpStartMD as well. Can you recommend an app for tracking food intake to help guide choices as I transition to a very different approach to eating? I see there are a number of them out there with mixed reviews from users. I am interested in getting weight loss results as quickly as possible for an upcoming ten-mile run. Thanks,
    Jill

    (reply)
    • Peter Attia  February 13, 2012

      Jill, I am not familiar with any food-tracking apps, so I can’t really recommend any. When I was transitioning into ketosis (the only time I needed to actively monitor the amount of what I was eating – at least in terms of carb and protein content), I used this website: http://nutritiondata.self.com/

      I still find this website, coupled with a good scale and a spreadsheet, to be all I need.

  75. Christine Armer  February 13, 2012

    Hi Peter,
    Thanks so much for your site and time. I found you today from the GT site. Can you give me some information about what type of fat coconut oil is and how good it is for you? Also, dosen’t coconut milk have a lot of sugar? I have recently bought coconut oil and love the taste. One more thing…how do you get your vitamine C?

    (reply)
    • Peter Attia  February 13, 2012

      Coconut oil is virtually all saturated fat, so it’s a “good” fat. Coconut WATER is sugar water I wouldn’t touch it with a 10 foot pole, but coconut milk is actually mostly fat. 4 oz of coconut milk has about 25 gm of fat, 3 gm of carb, and 2 gm of protein. Perfect ketotic food choice.

  76. Scott R  February 13, 2012

    I love this blog already. When counting carbs, how do you factor in “net carbs?” I guess the better question is: how does fiber (both soluble and insoluble) affect our bodies production of ketones? I wonder because I’m very low carb right now, but I also love nuts and seeds, and want to make sure I don’t overdo it.
    Thank!
    Scott

    (reply)
    • Peter Attia  February 13, 2012

      I count total carbs because it’s a “higher bar,” so to speak. I know if I keep total below 50, net is lower.

  77. Mike  February 13, 2012

    Why would I consider a ketogenic diet over a normal diet and or why would I want to get extreme at 5% of carbs vs a mild ketosis? The possible side effects seem pretty risky as far as sodium loss etc.

    (reply)
    • Peter Attia  February 13, 2012

      Mike, I’m not saying you (or anyone else) *should*. It’s what I do. What you do is your choice, if it makes you live better. But you could also ask yourself the following question: Why would you consider getting on an airplane and flying to Hawaii? There’s a chance the plane could crash and it will actually cost you money to go? Presumably, the answer is that it’s worth the tradeoffs.
      Everything in life is a tradeoff. Ketosis, by the way, is binary. Either you are or you are not. No such thing as mild ketosis, when referring to nutritional ketosis. Carb restriction is relative.

  78. Garry  February 14, 2012

    Peter, thanks for this fantastic blog. I’m a bariatric physician in Pasadena, who also likes to do endurance athletics (marathons, triathlons) and I found your posts on the measurements of fitness really enlightening. As you mentioned, the performance sports cultures is riddled with recommendations for carbo loading. I always wondered how to reconcile athletics with a ketogenic diet. Thank you.

    The question I have is about your protein restriction; Do you limit your protein intake because it is an insulin secretagogue. Do we know how much insulin gets secreted from protein ingestion relative to carbs?

    (reply)
    • Peter Attia  February 14, 2012

      Garry, I’m glad you are enjoying this content. To your question, yes, I “limit” protein because too much inhibits ketosis. The reason I say “limit” is that my most standards I consume a completely normal amount of protein — about 1.5 gm/kg/day.

  79. Patrick  February 14, 2012

    Peter:

    Great blog. I’ve been following a low carb diet now since September and have lost about 35 pounds.

    One question I have is there any long term studies that raise concerns about staying in ketosis essentially indefinately?

    I really started doing Atkins, but as you know, Atkins starts adding in carbs, primarily veggies, until you essentially find the point at which you start to gain weight (or stop losing). I’m not sure I want to eat that many veggies unless it is really necessary to optimize health. I take it from your blog that you don’t necessarily think we need to increase veggies for health reasons?

    Thanks.

    (reply)
    • Peter Attia  February 14, 2012

      Patrick, it depends how you define long-term. Perhaps the best work is that of V. Steffanson who spent several years living with the Inuit who are obviously ketotic indefinitely. I think I have one of his books on my recommended reading section. The decision to eat different carbs (e.g., vegetables) is more a function of what you’re optimizing for. Food diversity, perhaps?

  80. Gelo  February 14, 2012

    Hi Peter,
    Any suggestion on how to make improvements on going to the bathroom?
    I am not new to the low curb diet, but that issue always a big one for me.
    I guess my body needs a lot of fiber to finish the job.
    Thank you for your help.

    (reply)
    • Peter Attia  February 14, 2012

      Nope, not fiber. You need more salt and more oil in your diet. Supplemental fiber is actually harmful.

    • Mark Jacobs  March 12, 2012

      Thank you so much for this post and information. I am curious though in what way is fiber harmful? I have done low carb before only to “ease up” then next thing I know I am full blown addicted to carbs and sugar and feel miserable. I am resolved to stay in the low carb lifestyle but constipation is an issue. Why is fiber harmful?

    • Peter Attia  March 12, 2012

      Supplemental fiber probably exacerbates promotion of diverticular disease. The treatment for constipation is sufficient sodium, water, and oil.

  81. Gelo  February 14, 2012

    Thank you.

    (reply)
    • Debbie  March 12, 2012

      I eat plenty of oil and salt – since I eat deli meat almost daily – and constipation is still the way it is. Perhaps some of us have permanent problems in this area – I had eating disorders for years, and perhaps this is the result: a “motility problem,” as one doctor termed it. I had no result after my colonoscopy prep, so… Anyway, it’s a problem. Eating more – enough to maintain a higher weight, and I’m not skinny at all – helps, so it’s a toss up.

    • Peter Attia  March 13, 2012

      Hmmm. Ask your doc about trying mineral oil.

  82. Gelo  February 15, 2012

    Peter, Thank you for your help.
    Can you please tell me how much oil and salt I need to eat every day to avoid constipation?
    I am 5,8” and 240 LB my goal is to get to 180.
    Thank you.

    (reply)
    • Peter Attia  February 16, 2012

      No magic number. You need to experiment with it. It’s highly dependent on your activity level and genetic factors.

  83. Jordan Schwartz  February 16, 2012

    Wow..I was literally going to post the question “Can you post your food log?”. This information is super invaluable. Thank you. I have a question.. I know you mentioned that you eat when you are hungry and don’t when you aren’t. Does time play a role at all? I keep reading about intermittent fasting and how good it is to try and consume your daily intake within a small shorter window leaving the larger share of your day fasting. I’m definitely not a calorie counter but I am concerned that grabbing a piece of salami at midnight will slow down my progress. What are your thoughts?

    Thanks.

    (reply)
    • Jordan Schwartz  February 16, 2012

      Oops…Sorry… I must have missed the similar question asked earlier.

    • Peter Attia  February 16, 2012

      Jordan, it might, but I have not looked into that with any great effort. Also, it may matter if you are in or not in ketosis. It’s hard for me to understand why there would be a value of doing this while already in ketosis, but possibly if you’re not. Bottom line, though, I don’t really know. Would need to see some data.

  84. Elton  February 16, 2012

    Great Blog! Its nice to find another low carber into endurance sports and with a medical background.

    I have a couple questions for you after reading about what you eat. I have been low carb for about 8 years now, I also enjoy experimenting. I have never been over-weight, I went low carb because the evidence convinced me it was the correct way to eat. I have always felt that if I was on the correct diet I would not need supplements, I could get everything I need from my food. Do you think you would take so many suppliments if you did not excercise so much?

    Another minor issue I have: I rely a lot on a really fatty soup my wife makes from chicken wings and thighs. It looks almost like lard until I heat it up. I have a cup of that a day. How do I figure out the fat content of it?

    With all the blogs and books I have read over the years, I have never read anything about the lack of sodium issue, so I’ll have to do more research on that.

    Thanks again.

    (reply)
    • Peter Attia  February 16, 2012

      Elton, glad you’re finding this helpful. I take the supplements I do because they help me perform better in day-to-day life, not just exercise. Some (sodium and magnesium) are essential, given my state of ketosis. Others, like MCT oil, just make me feel better overall. The soup sounds awesome. I’d love the recipe. The only accurate way to figure out the fat content would be to take it a lab where they can do calorimetry (basically, burn and measure heat produced), but I can’t imagine that information would be of value beyond curiosity.

    • Elton Wilson  March 19, 2012

      Yes, But I am very curious person…
      So I have been adding a teaspoon of bullion to my daily soup and I think its helping. My headaches have been absent recently. I did start taking magnesium and fish oil as a test, but I get really sick on the magnesium vitamins, which I found is a common side effect. Any advice on this? Eat more spinach :)?

      Do you take bouillon when you travel?

      I also noticed a lot of people commenting on you eating salami. I also eat salami almost daily (Salami with Cream Cheese, yum!). I get a Nitrate free brand online, but if I don’t have any on hand, I get a high quality brand from Safeway. I have been looking for good studies on whether nitrosamine does actually cause cancer in humans, but so far I haven’t found anything convincing. I also feel that the sodium nitrate protects me from food poisoning better. Also, vegetables contain just as much, if not more, sodium nitrate as Salami. And if you eat vegetables with a protein, they can combine to form nitrosamine. And beer is one of the highest sources of nitrosamine, but no one ever talks about that.
      Have you studied the nitrosamine issue at all?

  85. jeff  February 16, 2012

    Peter,
    I’ve hit my 2 week trial run. I’ve eliminated simple sugars and limited carbs to around 150g/day, most day less than that.
    One concession I made was to be sure to have my energy drink during rides and a recovery drink post ride. I prefer GU drink.
    It was not particularly hard for me to limit carbs to 150 or less a day.
    The results have been pretty good. I lost about 1 lb but unscientifically I feel trimmer. My only issues were the first few days I got slightly light headed and just needed to eat something, usually almonds.
    I haven’t noticed a performance decline although I’m in week 1 of a 3 week block of killer TT intervals so the results are not in yet.
    I’ll continue with the low carb/no sugar diet for another 2 weeks and see what happens.
    I definitely feel more full and get less extreme hunger cravings every day.

    (reply)
  86. David  February 17, 2012

    Your fat shake recipe is very similar to mine, except that I use a quarter cup of wild blueberries instead of strawberries, and I add two heaping tablespoons of flax seed meal. How do you feel about flax seed meal? Some say it’s as good as or better than fish oil when it comes to providing omega-3. Do you agree?

    (reply)
    • Peter Attia  February 17, 2012

      Flax seed his high linolenic acid (omeaga-3), but it has pretty poor conversion to EPA and DHA, relative to aquatic sources of omega-3. Hence, I prefer to get my n-3 through marine sources.

  87. Anthony  February 18, 2012

    Dr Peter.
    I notice you include in your diet processed meats, salami, pepperoni etc. In last weekends newspaper here in Australia it inlcuded an article on processed meats increasing the risk of pancreatic cancer. It was referring to a report out of Sweden (no refence or link to the actual report) warning of the overconsumption of processed meats due to being high in fat & salt (we can ignore those 2) as well as additives like nitrates for maintaining colour. What is your opinion on such matters and your take on the additives such as nitrates?
    On a seperate and not so glamerous subject, I read a great paper debunking the myth that meat rots in your stomach/colon etc. It pointed the finger at vegetables, legumes etc that are the culprit to gas and presumably a sizable number 2. Did you notice any differences when you cut out the carbs etc in regards to number 2′s? It might be a bit personal to ask this question, but I have noticed a considerable difference and I put it down to the food I ingest (being full of the nutrients my body wants)being consumed by the body and I put less food (that the body doesn’t really want or can break down effectively)in that is likely to end up out as waste.
    Maintain the rage.
    Anthony – Brisbane, Australia

    (reply)
    • Peter Attia  February 18, 2012

      Anthony, when I buy meats like salami and pepperoni I tend to buy the ones with the least processing. That said, the studies that suggest the harm of these additive are not really constructed (at all, actually) to allow such conclusions. They are retrospective and observational. To be safe, I’m willing to play a bit of a premium to reduce them.
      As far as gas and other gastrointestinal discomfort, I actually experienced and almost overnight difference when I stopped eating fruit and vegetables. I had spend my entire life thinking I was lactose intolerant. It was probably fructose and components of fiber that was killing my gut.

  88. ingrid  February 21, 2012

    Hi Peter! I’ve been in ketosis for the past week and it feels fantastic!I took your advice and reduced the amount of protein I was eating.
    I’m gearing up for a marathon in one month.

    I started LC almost a month ago and my training has gotten much better! I’m between 10-15g of carbs. Do you have any tips on how to prepare food wise on the days leading up to the race? This is my first time running on LC and I’m a little nervous.:)

    Thanks!

    (reply)
    • Peter Attia  February 21, 2012

      Ingrid, excellent news. If you are in ketosis there is no need to “carb load” to do anything like that. Just make sure you are appropriately hydrated, have plenty of sodium on board, and enough fat in the tank. You should be getting close to your final long run before your taper, so make sure you really experience some stressful conditions to mimic the demands.

    • Michele  February 22, 2012

      Hi Peter, Hello Commenters,
      I realize this is a very specific request but if you or anyone else frequenting this site knows about any blogs/insiders concerning LCHF and martial arts, the info would be greatly appreciated. There’s a lot out there concerning LCHF and endurance sports but I cannot seem to find any reputable info by googling this topic…Many thanks in advance!

    • varunner  April 28, 2014

      Ingrid-

      How long did it take you to adjust to diet as an endurance runner and when did fat lass begin? I have been at this a couple months and feel like I am getting heavier? Curious!

  89. ingrid  February 21, 2012

    you’re right! my last long run IS this weekend. Thank you for the awesome advice! My goal is to run 3:10..my pr is 3:17. I think I can shave off the 7 minutes!

    I’ll let you know how I do!

    Thank you again!

    (reply)
    • Peter Attia  February 21, 2012

      Holy cow…3:10 is *movin’* Let us know how your last long training run goes this weekend. 1 gm of bouillon 2-3 hours before the run in 750 mL hot water.

    • ingrid  February 21, 2012

      will do!

    • ingrid  February 23, 2012

      hello peter!

      So, I moved my long run to this morning because I’m running an 8k this weekend. I have to say thank you Peter for the great advice!

      At 5:30am this morning I drank 750ml of bouillon. I didn’t plan on running until 8:30 so I went back to bed. What would you recommend on race day? I plan on taking a shuttle at 5:45am to the starting line and the race begins at 7:30am. do I have my bouillon at 4:30am?

      This morning I ran 20 miles at 8:00 min/mile…45 seconds slower than my 7:15 pace for the marathon. I felt great! The bouillon really helped! It was also a bit warm out.

      Last question, how would I up my fat without raising protein? I’m really finding it difficult when I consume a lot of fatty meat to keep my protein down. I love meat and i’m trying to stay below 100g of protein.

      Thanks!

    • Peter Attia  February 23, 2012

      Look at what I eat and try to experiment. You can probably easily get to 1.5, if not 2 gm/kg/day.

    • ingrid  March 18, 2012

      Hi Peter! Well I ran the l.a.marathon this morning and I PR’d! I ran 3:07.40..10 minutes faster than my time last year. I did the same routine you told me…750ml of bouillon 3 hours before the race. I had a fatty meal the night before but not too fat. I also drank tons of water every day..pretty close to your gallon per day. I think that
      saved me! Low carb made me feel lighter!

      Thanks so much Peter for all that you do..:)

    • Peter Attia  March 18, 2012

      Holy cow, Ingrid! That is a remarkable time. I guess you’ll be at Boston next year? Great job and thanks for updating us.

  90. Kypros  February 21, 2012

    Hi again Peter,

    Are you aware of any effects that a high fat diet has on testosterone levels?

    Best,

    Kypros

    (reply)
    • Peter Attia  February 22, 2012

      I am not, but I am aware that low fat intake and, specifically, low cholesterol intake can lower testosterone levels. Of course, A LOT of things can lower testosterone levels, including over-training.

  91. Mark  February 22, 2012

    Peter,
    Nice blog. Just wondering if you have come over any good remedy for ketosis inflicted bad breath. When I am in ketosis my breath is very bad. Also, I am super tired when I workout when I am in ketosis. I’ve upped my carb intake to about 100g/day and feel less tired during workouts. Being in ketosis and metabolic workouts have confused me. An article on workout and ketosis would be awesome.
    Thanks,
    Mark

    (reply)
    • Peter Attia  February 22, 2012

      Mark, I don’t seem to have much experience with that problem, except to note that after a few weeks (in most) it seems to go away. As for fatigue, I really went through this for a few weeks, also. I really need to ensure I was in ketosis (not just flirting with it), that I was getting sufficient minerals (sodium, magnesium, potassium are the most important), and that I was getting enough fat. These 3 things, coupled with patience, got me there. It really took me about 12 weeks to really adapt, though.

  92. Travis Koger  February 23, 2012

    This is proving complicated indeed when dairy stops you from losing weight… yes I am one of those ones. Very hard to get enough fat, particularly with snacks.

    Still, I am only a few days in and eating a lot more than I was when concentrating mostly on protein and not fat. I found that I could only lose weight consistently by reducing the amount I ate. Any extra meals etc would cause me to stop losing. However after 12 months I have lost 70lbs and only have another 30lbs to go.

    Looking forward to the high fat change improving things.

    Love your work Peter.

    (reply)
  93. Ian  February 23, 2012

    Great blog…you’ve re-inspired me (to make everyday low carb not just week days…the beer might be a test though!)

    One thing that does concern me is the constant bad press for processed meats, and how they ’cause cancer’. Without any contrary advice, it does worry me slightly,as I eat alot of bacon/ham/sausage.
    What do you think about this?

    (reply)
    • Peter Attia  February 24, 2012

      Ian, a lot of this bad press is really based on observational studies. I’ll be writing about this quite a bit in the future, so please stay tuned.

  94. Chris Adams  February 24, 2012

    Hi Peter,

    I assume when you say 2-4 g sodium that is what you mean, rather than 2-4 g “salt”. I’ve been having some tiredness issues & it looks like my sodium/salt levels have been too low, especially given the hot Adelaide summer, the amount I sweat & my exercise load.

    Great blog.

    (reply)
    • Peter Attia  February 24, 2012

      Correct, I supplement my diet with 2 to 4 gm/day or sodium in the form of bouillon, so all in I consume 4 to 6 gm/day of sodium.

  95. Judy E  February 24, 2012

    You state that you eat “zero starch”. John McDougall, MD, Santa Rosa, CA has a book to be published in May, The Starch Solution. He asserts: “The human diet is based on starches. The more rice, corn, potatoes, sweet potatoes, and beans you eat, the trimmer and healthier you will be — and with those same food choices you will help save the Planet Earth too.” In prior publications, he lists an extensive bibliography citing clinical studies and trials, peer reviewed articles, anthropological/historical evidence, etc., as well as anecdotal evidence of his many patients who achieved weight loss and healthier lipid and metabolic profiles by following his program. He espouses an essentially vegan diet replete with starches, which seems to be in diametric contradiction to your and Gary Taubes’s thinking and analysis. Could you please comment on this, or can we merely conclude that “different programs work for different people”, or that there is perhaps “junk science” associated with one or the other interpretation. Thank you very much.

    (reply)
    • Peter Attia  February 24, 2012

      Judy, great question. Dr. McDougall is a proponent of a body of research that is also supported by folks like Colin Campbell and Dean Ornish. I wrote a post about this topic (broadly) that I think you might find interesting: http://eatingacademy.com/nutrition/why-weight-watchers-is-actually-a-low-carb-diet
      When you read this, focus on the quality of the “science” that supports this work. If you really have an interest in understanding this better, I would highly recommend you read Denise Minger’s work on this: http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ followed by http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/ followed by Mike Eades excellent work on this topic: http://www.proteinpower.com/drmike/cancer/the-china-study-vs-the-china-study/

      I know what you’re thinking…geez, I ask a simple question and I get 2 hours worth of reading assignments! Unfortunately, if you really want to understand this issue, it requires being critical of the science. My last point is actually a bit of a correction to your point about these recommendations being diametrically opposite to what folks like me and Gary say: We ALL share the most important belief — there is ZERO role in human diet for sugars and highly refined grains/carbs. Again, this suggests they are probably the worst offending agents. Perhaps the individual difference we do are just that.

      Final point: Here is the most *important* element of this discussion — how rigorous does the science need to be to based recommendations on it? Everything emerging from the work of McDougall and others is based on retrospective observations which show correlations, but which under no circumstance show, or even suggest, causation. Do how can we know?

    • Judy E  February 24, 2012

      Great thanks for your reply and the reading is well worth it. While it is true that you are all on the same page when it comes to sugars and refined carbohydrates, the amount of so called complex carbs (often also high glycemic as in white potatoes) that Dr. McDougall claims one can eat in any amount as long as no fat of any kind is paired with it would seem to have a deleterious effect on insulin secretion, ergo fat accumulation and metabolic syndrome. Yet presumably his patients achieve weight loss and improvements
      in their metabolic profiles. What am I missing here?

      Many, many thanks for your kind reply and for taking the time to maintain this blog.

    • Peter Attia  February 24, 2012

      Judy, it seems that some percentage of the populate is very tolerant of carbs, probably 10-20 or 10-30%. My wife is in this category, for example. The simple removal of the most “bad” dietary offenders does wonders for them (like everyone), but they can seem to tolerate modest amounts of glucose. Remember, 5 or 6 smokers do NOT die of lung cancer. It doesn’t mean smoking is “good for you.” Even when you strip out the folks that die prematurely of emphysema, heart disease, etc., it seems a non-trivial number of smokers do not suffer the ill-effects of tobacco.

      To be clear (I hope everyone is reading this point!!!!): MY GOAL IS NOT TO GET EVERYONE TO EAT LIKE ME. MY GOAL IS TO GET FOLKS TO THINK CRITICALLY ABOUT WHAT THEY EAT, JUST AS THEY THINK CRITICALLY ABOUT OTHER HEALTH CHOICES THEY MAKE, SUCH AS SMOKING AND HEROIN USE.

  96. debbie prim  February 24, 2012

    Peter I have been trying to live this way I am 49 and 75 lbs over weight and I am so tired of being fat I am going to keep reading your blogs I hope I will be able to do this also. Thank you for your expertise.

    (reply)
    • Peter Attia  February 24, 2012

      Debbie, whether you’re 49 and 75 pounds overweight or 75 and 49 pounds overweight, it’s never too late to try something new, especially if what you’ve been doing to date isn’t working.

  97. carolyn  February 28, 2012

    now that i’ve read some more of your blog all i can say is keep up the good work!

    my son suggested i read taubes’ ‘gc,bc’ (very dense, almost scholarly)and afterwards i went on to his more accessible ‘wwgf’. both were eye-openers. from my teens i always struggled with my weight and was constantly discouraged by my doomed attempts to get rid of it and keep it off. i couldn’t figure it out-why others ate as much or more than me but stayed slender.

    taubes’ proposal, as counter-intuitive as it strikes one, seems to come closest to a sort of unified field theory of obesity, in an occham’s razor way. that our own FDA has been _lying_ to us, pushing the food pyramid, is shocking. (what else are they not telling us.)

    my history–i’m a mother of 5, all but one baby was over 10 lbs. my oldest, an ob/gyn, says that was a sign i was destined to develop diabetes, which i formally did a year ago (fasting blood sugar-129). now that i’ve been on a more or less low carb diet for a few months, blood sugar went down to 115 and i dropped 14 lbs with nothing more than normal hunger.

    it doesn’t seem like much, but it’s a triumph for me given my previous failures. still a long way to go but now i have a road map.

    4 of my kids still live with us and i’m the cook. taubes wrote of the likelihood that my big babies’ pancreases could be in overdrive, and i’ve warned them all of their legacy and need to exercise vigilance. i gave away all the carby food in my pantry and now prepare only low carb meals. it seems to be working out.

    (reply)
  98. Kathy  February 29, 2012

    Great website! Can’t wait to see more. Thank you for doing this.

    I am, however, completely confused on the protein issue. You say you aim for 2gm protein/kg (body weight, right?) – yet in your daily intake you’ve noted on one day, for example, a 12 oz steak after lots of dairy during the day, and of course, dairy has protein as well.

    If I’m doing the math right, the 2gm/kg would equal about a 5 oz serving of protein (meat is what I’ve got in mind) a day.

    What am I missing? What am I figuring wrong? Not that I’m going to mimic what you do – no way! I’m not that active. I’m trying to understand the concept, though. I think I’m eating far too much protein, but having a hard time finding what else to eat.

    oh, also, if the kg does refer to body weight, is that current weight, or what you’re aiming for?

    Thanks again.

    (reply)
  99. Kathy  February 29, 2012

    I’m sorry, I hit send to soon! I meant to say that for me, that would be about 5 oz of protein, since I weigh just under 160, but even if you weigh 200 pounds, wouldn’t that be about 6 oz?
    Yet 150 grams in equiv to…just about 6 oz, but given what you’ve logged for what you actually eat….I’m confused!

    Thanks.

    (reply)
    • Peter Attia  February 29, 2012

      Kathy, an ounce of meat (or cheese or any piece of food) has a lot of water in it, too. So a 12 oz steak (if you eat a higher fat steak, like I do) might have only 60-75 gm of protein. So my protein consumption is, on average, about 120-150 gm/day.

  100. John Dawson  March 13, 2012

    High Blood Pressure

    In your supplementation recommendations, a couple of times you have recommended levels of sodium supplementation “if you have normal blood pressure”. And if you have high blood pressure, what is the recommendation? Is nutritional ketosis contraindicated for those with high blood pressure?

    (reply)
    • Peter Attia  March 13, 2012

      On the contrary! In fact, virtually every person I have personally worked with who had high BP and was taking medication for it, had to stop the medication within a month. I only make this point to say that folks with normal BP tend to be more sensitive to a drop in BP.

  101. April C  March 13, 2012

    Hi Peter,
    Thank you for this excellent site and also all the time you are devoting to answering questions! (Have you thought about a forum?)

    I was led here after reading Taubes book, and to say the least I am absolutely blown away. I have been a long time believer in reducing processed starches and sugars out of my diet, but the idea about increased sodium and fats are new to me. I have never been able to go extremely low carb and am wondering if this is why. Also, the kicker about Taubes book that enthralled me is that I am sedentary, but I don’t want to be! Somewhere in there he said that once fuel is used differently by our body, then energy levels should increase. I want to be active and have energy, especially to run around with my husband and kids. (I am 36, muscular build, but would like to lose about 40-50 pounds).

    (I also was drawn to the book because my husband has recently been diagnosed with metabolic syndrome and diabetes and currently taking metformin….he is the “fit but fat” guy, runs, lifts, carries concrete around our house, and hits a tractor tire with a sledge, lol, his doc is of the “exercise more, eat less camp, which is also frustrating. I have huge influence on him since I do the majority of the cooking.)

    Anyway, my main questions are… (I have a ton, but will continue to read all of your posts and comments before I ask more, plus I now have Good Calories, Bad Calories to read)…

    1. how bad am I “messing up” if I restrict my carbs pretty low during the week, but then not as much on the weekends…(particularly with beer and/or a couple slices of pizza)? The reason I ask is that you mentioned somewhere that going in and out of ketosis may not be a good idea metabolically, but maybe I am not really going ketonic if I have a “free night” every week anyway?

    2. If having a free night isn’t a bad idea, should I be concentrating still on increasing fat and sodium during the week that I am low carb?

    3. If I do increase fat and sodium, and reduce protein, what will my body tell me when or if I eat too much fat and sodium?

    I really hope these questions make sense and if it is easier to point me to a book or a previous post to answer them, please do! :)

    Thank you!

    (reply)
    • Peter Attia  March 13, 2012

      Some smoking is better than no smoking, from a physiologic perspective. However, for some people (like me), it’s psychologically easier to stop smoking altogether. These are personal questions and there is no “right” answer. You’ve got to figure out what works for you. As far as sodium goes, it’s only really an issue when you’re carb intake is very low.

  102. KevinF  March 14, 2012

    Peter, curious if you have you ever consumed chia seeds for the Omega-3? Those things are absolute nuclear bombs of Omega 3, and have about a 3:1 ratio of Omega 3:Omega 6 (more 3 than 6). Tricky part is how to eat it, but I find a tablespoon makes a good addition to Fage yogurt.

    (reply)
    • Peter Attia  March 14, 2012

      They are high in ALA, but it’s not clear they convert efficiently to the guys we *really* care about: EPA, DHA. I don’t think anything comes close to marine sources of omega-3. I’ll write about this down the line…

  103. Teri Walker  March 15, 2012

    Wow, totally on fire with all of this, but I am confused on “don’t count calories” part…I am 5’2″, about 120lbs, want to be 110, fit and lean. Have been following insulin resitant low carb plan for 6 weeks now..feel awesome (have fibroyalgia which has been much improved)lost some weight and feel completely satisfied with my menu plans, which is mostly whole foods/veggies/protien. My question is How do you consume so much, including high fats, and maintain weight control? I am eating a lot, feeling full and have never gone over 1300cal per day, or over 38% carbs! I feel like I should have lost more by now, according to your science, so am I doing something wrong? :) Teri

    (reply)
    • Peter Attia  March 15, 2012

      You are doing nothing wrong! Keep up the good work. Weight is but one narrow component of human health and performance. Think of the long game, not the 2 month game.

    • Kay  March 31, 2012

      Terri,

      I also have fibro, and was wondering about your initial approach to going low carb. Did you starting count carbs right away or just eliminate categories? Did you go straight for Ketosis or back your way in as Peter did?

      How long did it take you to start feeling bette? (I’m your height and not only is my current weight way above yours my-it-would-be-nice-if-I-got-there-weight is well above your current weight.) I just really want to get to that place where I can say I’m feeling awesome.

  104. Garry  March 16, 2012

    Peter, can I ask why you prefer Xylitol as your sweetener. From the studies I’ve seen, sucralose seems to have a lesser impact on insulin and glucose than Xylitol. In a 1989 study – Xylitol vs. glucose: effect on the rate of gastric emptying and motilin, insulin and GIP release, Xylitol increased fasting insulin levels three to four-fold. Granted, it’s far less than sucrose, but I would think that you would want to minimize any effect on insulin. Thanks.

    (reply)
    • Peter Attia  March 16, 2012

      I prefer the taste and I’ve documented that it has no (or minimal at most) impact on my ability to generate ketones. These properties vary by person.

  105. Kathryn  March 16, 2012

    Out of curiosity: why do you still eat any carbs (plant foods) at all? Wouldn’t it be easier (psychologically not having to limit yourself to a tiny portion and not having to measure carbs) to just stick to fat and meat a la Steffanson/Inuit? Thank you.

    (reply)
    • Peter Attia  March 16, 2012

      I’d give them all up if I could, but it does become a practical challenge to be at near zero. Remember, I don’t eat carbs in the sense you’re thinking. Virtually all of my carbs are from cheese, a few veggies, nuts, eggs — but I consume these things to get the fat they offer.

  106. Rosalyn  March 16, 2012

    Peter,
    I have began researching uncured sugar free bacon. Many of the products I have come across say that they are “uncured/sugar free”; however, I am seeing cane sugar or brown sugar listed in the ingredients. Do you recommend/prefer any particular brands?

    (reply)
    • Peter Attia  March 16, 2012

      I just look for ones that have, at most, 1 gram of dextrose per serving. They’re out there.

  107. Rosalyn  March 16, 2012

    Peter,
    I promise I’m not stalking. It’s just that I feel like it is the first day of college: EXCITING! I feel like I have FINALLY found a nutritional path. Maybe I was ripe for it because I have been reading and researching so much on nutrition (and I will continue to do so)! Anywho, I LOVE YOUR “menus”. YUMMMMMMOOOOOO! Cant wait to try them–especially the cream dressing. I had given up “cream” dressings entirely (can you say misery?) And finally, my husband is listening! He can’t wait to incorporate this new lifestyle into our lives. Oh yeah, how interesting to see on my local news that studies have come out advocating against PROCESSED foods…ya think? :-) I look forward to continuing to learn with you!

    (reply)
    • Peter Attia  March 16, 2012

      Congratulations. You’re about to change your life for the better, I’d bet.

  108. Rosalyn  March 17, 2012

    Thank you, so much, for responding. Your passion for helping people “re-think”/”re-learn” what we thought we knew about nutrition and eating is totally apparent.
    I have searched this blog for the answer to my question (as I do NOT want you to repeat yourself), and have not been unable to find the answer. Are protein grams measured after the meat is cooked?

    (reply)
    • Peter Attia  March 17, 2012

      Good question. I’m not sure. I would guess they report protein content in the format the food is most typically consumed, but I don’t actually know.

    • John Dawson  March 17, 2012

      Hi Rosalyn

      I have wondered about this, too. If/when you find the answer, would appreciate your posting it.

  109. Lise  March 18, 2012

    I can only eat small amounts of meat on occasion and try to avoid it. Other than eggs, what other options do you suggest? Tofu is not an option.
    Thank you

    (reply)
  110. Lise  March 18, 2012

    I looked at what you eat, there is a lot of meat, hence my question.

    (reply)
    • Peter Attia  March 18, 2012

      Non-meat foods make up 80% of caloric intake. Are you saying you can’t eat dairy also? It should not be difficult to get more than enough calories from non-meat sources. If you don’t eat dairy or eggs, it does get tough, though. In this case, at the very least, getting rid of sugar and highly-refined carbs is still a huge win and gets you probably 50% of the benefit.

  111. Lise  March 18, 2012

    I eat eggs, dairy, some seafood but I can barely stomach meat anymore. I guess I am confused because I watched a video where you talk about asking the waiter for all the fat off the meat. I was envisioning having to gobble up huge amounts of animal fat.
    I am reading more of your posts and learning it is more than the Atkins eat-all-the-meat that you can plan.

    (reply)
    • Peter Attia  March 18, 2012

      Correct. In fact, when I first tried to get into ketosis (very unsuccessfully, I might add), I was heavily punished by the amount of meat I consumed. My protein levels were 225-250 gm/day. Way too much to make ketones (since amino acids stimulate insulin production, also). So I’ve had to reduce protein intake by about 50%, much of which has come in the form of reduced meat intake. Because of my large caloric demand — but the need to fix carbs below 50 gm/day and protein below about 125 gm/day — I go out of my way to eat fat. I almost never (except for fish) consume “lean” meats. For me, that’s a “waste” of protein. So when I eat meat, I’m really going out of my way to get as much fat as possible along for the ride. I could easily do what I do if I decided to give up meat, provided I could still eat dairy and eggs (and ideally fish, too).

    • Lise  March 20, 2012

      Thank you Peter. That is reassuring. I do have a questions about your fat shake. I made one this morning (minus the whey protein – I didn’t have any), and within 15 minutes I had a tiny little headache which then progressed into a pounding headache and nausea less than an hour later, I had to leave work. Is an increase of fats a possibility in this case?

    • Peter Attia  March 20, 2012

      Hmmmm. Not likely from the fat. Probably any number of other things (dehydration, for example).

  112. lorraine  March 19, 2012

    Creamy salad dressing is awesome. Thanks!

    (reply)
  113. Mike  March 20, 2012

    Hi Peter,

    You are doing a great job with the blog, keep it up. I just had a question, normally body breaks down carbs to smaller units (glucose) and uses the glucose as an energy source to fuel the brain and the rest of the body. In the absence of carbs, (and presence of fat) the liver breaks down the fat to release ketones.

    My question is, how reliable are ketones as a source of energy, especially to the brain? I see that one of the goals that made you follow a Ketogenic diet was “improved mental acuity”. Can you elaborate on that, please?

    I am a student so I hope you can see my concern.

    Also, if this diet is to be used as a weight loss method. Shouldn’t the amount of fat intake be less (but definitely more than carbs) so as to avert the body to use more of the stored fat?

    Thanks :)

    (reply)
    • Peter Attia  March 20, 2012

      B-OHB is actually a better metabolic substrate for the brain because it’s derived from fat which, even in the most lean individual, is near infinite relative to glycogen. When your brain is glucose-dependent (like it is for most people), it is very sensitive to the roller coaster of glucose levels in the bloodstream, especially when one (as most do) consumes foods that spike insulin levels and cause the body to really work hard to maintain euglycemia.

  114. John Vogt  March 20, 2012

    Peter,
    I saw in the things you eat a picture of coconut oil. Isn’t this a good source of medium chain fatty acids? Why do you take a supplement for it instead of using the oil? Have you tried the unsweetened coconut milk form Trader Joe’s? I use it instead of almond milk and it has less carbs and more fat. I am thinking of using coconut oil and coconut milk to make ice cream. Have you tried either for this purpose? Also what do you consider an adequate protein level for a non-exercising male who should be around 80 kilograms. Is one gram per kilogram enough?

    Thanks

    (reply)
    • Peter Attia  March 21, 2012

      Yes, coconut and palm oil are about 60% MCT (also contain longer than 12-14 carbons, too, which is why they are solid at room temp). I will have to look into your suggestion of unsweetened coconut milk. I cook a lot with coconut milk, but it’s really thick, so I’m guessing what you’re using it different.

    • Debbie  March 30, 2012

      How about coconut flakes? A healthy fat?

  115. johngdc  March 21, 2012

    Great blog!

    Question: I am a power/oly lifter and martial artist (brazilian jiu jitsu and muay thai). While I have kept carbs low for sometime now, I had also kept protein up to 1 gram per pound of lean body mass which in my case is something like 210 grams per day. I am 6’4″ 260 lbs and about 20% BF.

    Carbs are easily under 50 per day. But the ketostix say negligible/trace or negative every day.

    Standard advice to lifters like myself has always been a gram of protein per pound of LBM. Are you saying that this directly conflicts with my ability to achieve ketosis?

    I am concerned with preservation of LBM but really would like to get leaner (12%)

    Thanks!

    (reply)
    • Peter Attia  March 21, 2012

      Your protein intake is too high to allow your body to make ketones. If you feel fine and you are happy with your performance, why change anything? However, if you want to do a ketosis-self-experimient, you will need to reduce protein to roughly 150 gm/day (and I’d recommend in that case getting carbs down to about 30 gm/day). I suspect you may have to give up a touch of lean tissue, but you will get leaner. One way to find out: Do a 12-week test with a DEXA on both sides.

    • johngdc  March 21, 2012

      Thank you for the response.

      I am most concerned about getting leaner and yes, doing a self experiment with ketosis. I also believe that leaner will help my endurance and stamina, ie. carrying less ‘useless’ weight.

      I’m already under 30 grams of carbs per day.

      Is there a “formula” for protein/day? ie X per lb of LBM?

      I’m happy to follow your advice and thoroughly enjoy self experimentation as it appears you do as well!

      Thanks again

    • Peter Attia  March 21, 2012

      Not when it comes to ketosis. The formula is something like this: “effective” carb consumption is about = total carbs + 25% of protein above 100 gm. So 40 gm of carb and 160 gm of protein is about 55 gm of “effective” carb. Goal is keep “effective” carb below about 50.

    • johngdc  March 27, 2012

      what do you know, you were absolutely right :)

      i cut protein to 150 grams per day, upped the fat and now the stix are purple.

      total LBS are coming down and bf% is as well – thank you!

      I did also get the DEXA scan which i think was wildly off in its calculations. I did some more research online and found that there are a lot concerns with its accuracy. heck, I didnt even fit completely in the machine scan area – top of head and bottom of my feet were cut off!

  116. johngdc  March 21, 2012

    Not to be argumentative, but would that same theory apply to a woman who weighs 115 lbs?

    (reply)
    • Peter Attia  March 21, 2012

      It seems to, roughly. The implication is that for folks like me (and perhaps you), who eat more total calories you need a higher % to come from fat.

    • johngdc  March 21, 2012

      does that strike you as being a difficult logical proposition to digest? or am I just brainwashed?

    • Peter Attia  March 21, 2012

      Brainwashed. Just like I was.

    • johngdc  March 21, 2012

      I beg your pardon, but I just need to have this restated for me one more time so I can begin to digest it:

      Irrespective of bodyweight, sex or body composition, we convert protein consumed in excess of 150 grams to something that is “effectively” a carbohydrate that limits ketosis.

      Is that right?

    • Peter Attia  March 21, 2012

      Is this a test, or are you really asking me again? :)

    • johngdc  March 21, 2012

      Thanks for dealing with my obtuseness! I’ve got a DEXA scan set for tomorrow and I’m capping protein at 150 from now on. Will do an experiment and see what happens.

  117. johngdc  March 21, 2012

    and PS i’ve been thwarted by three different places who have DEXA scanners – saying I need a referral and a diagnosis first. Even if I self pay! What a strange world we live in where a person can’t pay market rate for a diagnostic exam.

    (reply)
    • Peter Attia  March 21, 2012

      Talk to a local university that may use one for research purposes.

  118. Lin Whitehead  March 22, 2012

    Hi Peter – thanks for all your hard work; makes great reading. I read Gary Taubes last year and decided to try the approach pre holiday in France with v fast weight loss; started 11st11 then by 10 days was 11st5. Then I went to France and ate a lot of bread. Tried slim world religiously in Jan to convince myself the “traditional” slimming method wouldn’t work for me and it didn’t, so started with low/zero carb last week, but loss is much slower and fluctuates; is that normal? Was the first time just such a body-shock to the system that this time it will just be a bit slower? Am sure am doing everything right – have even given up my morning cuppa tea, which for an English woman is pretty much treason.. Thanks Lin

    (reply)
    • Peter Attia  March 23, 2012

      Yes, this is a typical response, though the exact reason is not clear. Moral of the story: don’t go back and forth.

  119. Adam  March 22, 2012

    Hi,
    Do you have a preferred brand/source of the liquid fish oil you mention? I find the quality & provenance of the various mass-produced omega-3 capsules somewhat hard to gauge–and many of the ‘premium’ offerings I’ve found at Whole Foods etc. are shockingly expensive.

    (reply)
    • Peter Attia  March 23, 2012

      Carlons.

    • Maryann  July 31, 2013

      Hi Peter,

      You and Dr. Dayspring use this brand, so I switched from my softgels of another brand. I think there must be a good reason that you both use this. My husband asked me what the difference is, but I am not sure…is it better absorbed because it is liquid? Less chance of impurity? I just got my bottle of Carlsons and the dose is 1600 mg per teaspoon of Omega 3s (rather than 1000 per capsule). Our doctor has us on 2000 twice per day; is there a simple way to measure this? I think I remember reading that overdoing omega 3 is potentially harmful. Also, the label says to take with food; is that necessary? Thank you, maryann

    • Peter Attia  August 1, 2013

      Not sure of question context. A teaspoon is 5 mL if that helps.

    • Maryann  August 1, 2013

      I’m sorry…

  120. Lindsay Jane Whitehead  March 23, 2012

    Thanks Peter; agreed re not going back and forth, but I needed to convince myself (and GP!) that the “normal” healthy eating mantra we’ve all grown up with didn’t work for me. Re your forthcoming recipes, will you collaborate? Karen Barnaby’s low carb gourmet is good – the almond puff pancakes rock!!

    (reply)
    • Peter Attia  March 24, 2012

      I haven’t really thought about it, but it could be a good idea.

  121. Rosalee  March 25, 2012

    Peter,
    If I understand right, you supplement with sodium 2g/day generally and bump it to 4g/day on very active days. So how much sodium are you typically consuming daily prior to the supplementation? I’m trying to get a sense of optimal total sodium consumption/day.
    Thanks

    (reply)
    • Peter Attia  March 25, 2012

      I get about 2-3 gm/day from food.

  122. Anthony  March 26, 2012

    Hi Dr Peter.
    I suspect I am in Ketosis hell. I didn’t plan to get here, I just wound up in a state of not eating carbs. I just got used to it after initially, just reducing them. It is about week 4 or so & I feel lousy. 1 course of action would be to ensure my protein levels are not too high, and increase my sodium intake, or could you just take in some carbs (above 50 grams per day) to reverse this state? Or is it not as simple as that? I also apologise because of my state I don’t have the patience reading through the site to try and find any alternative answers, nor do I really feel like weighing food. It has gotten bad when I can’t be bothered reading through your website. By the way, I love fat shakes.

    (reply)
    • Peter Attia  March 26, 2012

      See what happens when you fix the protein levels and supplement sodium. You may need to weight food if you aren’t good at accurately assessing how much you consume.

  123. Tom  March 27, 2012

    Peter,

    You are clear you like to optimize your omega 3 to 6 ratio but in the list of foods you show a lot of olive oil that is high in 6. Is this balanced by the omega 3 elsewhere? Do you consider olive oil a “safe 6″? Thanks for your blog. It is so important to have someone with your background dedicated to converting the countries thinking on diet.

    (reply)
    • Peter Attia  March 27, 2012

      I do. The omega-6 I strive to avoid are the big 4: soy, canola, safflower, and sunflower. Plus, I supplement with EPA and DHA from very high quality fish oil. So my ratio of n-6 to n-3 is less than 3:1 and I’m working on getting to down to 1:1.

  124. Rosalee  March 27, 2012

    Peter, I notice that you drink a lot of water. Is that due to your high activity levels or is it to help flush out toxins, or other?

    Thanks again for all of your quick responses to me and others.

    (reply)
    • Peter Attia  March 27, 2012

      Primarily because of exercise, but I think most people would do better to drink more than they do.

  125. Joe Alberti  March 29, 2012

    Hi, Peter,
    I am enjoying reading your blog and visiting your website. I wondered what oil you use to cook with?
    Also, as I’m new to it, I want to understand more about the basics of lowcarb eating, as you would recommend. I’m talking practical stuff, like lists of foods and samples of menus that expand on what you’ve written above. Can you recommend a book that you highly endorse, one that informs choices you make when, say, food shopping? I have BTW switched to Carlson’s fish oil and love it. Thanks for the recommendation.
    -Joe

    (reply)
    • Peter Attia  March 29, 2012

      I only cook with butter or coconut oil. A great reference book is the recent book by Steve Phinney and Jeff Volek (it’s under my books and tools section).

  126. johngdc  March 29, 2012

    Peter – I cut the protein to 150 or under and the scale started moving down again. Thanks for the tip.

    After reading what you had wrote, I also then noticed it in a book by Lyle McDonald. Are you familiar with him and how do you think your philosophies match up?

    (reply)
    • Peter Attia  March 29, 2012

      I’m familiar with his book, but I don’t know him personally.

  127. Debbie  March 30, 2012

    Hi Peter,

    I eat a processed turkey a lot – in that case, must I still drink bouillon? I haven’t read much on the blog about the salt supplementation issue. Would an odd odor in one’s urine indicate a salt problem?

    Can you also at some point address the fats in the diet issue? It is really hard for me still to just load on more fat – and yet, I’m thinking that could be what my diet is lacking. I think I’m eating plenty of fat, but perhaps not. I’m still in that old mindset where cheese is a no-no, especially since I’m always congested. But, I’m experimenting; perhaps dairy has nothing to do with my allergies. We’ll see.

    Anyway, is eating cheese, for instance, in a salad okay for a meal without some animal protein as well? What if for dinner I just want eggs and cheese in a salad? (I eat only lunch and dinner, by the way. Breakfast was causing weight gain.) I’ve been assuming that I must eat a certain amount of animal protein every day. So, if you can speak to some of these issues at some point, I’d appreciate it.

    Thanks so much,
    Debbie

    (reply)
    • Peter Attia  March 30, 2012

      I’ll speak to these issues in future posts.

    • Debbie  March 31, 2012

      Thanks so much. This is a fantastic forum. I’ve never wanted to participate or share my food/weight experiences before. Thank you!

  128. johngdc  March 31, 2012

    i tried the latte with heavy cream today, all 820 calories and 88 grams of fat.

    delicious!

    (reply)
  129. Maryann  March 31, 2012

    Hi Doctor Peter,

    I notice you drink small amounts of red wine. (Obviously, this is an option added back in moderation when weight goals are met.) Is red better than white for our purposes? I thought that white had less carbs; but I think I remember Gary saying red has less sugar. Would a zero carb choice like gin, scotch, etc. be better?

    Secondly, is it better to have a drink on an empty stomach or before, rather than with, dinner? I believe Gary said that your body (liver) prioritizes the alcohol, it is easy energy, and turns everything else present at the time to fat storage. It seems like a drink on its own would do less to derail ketosis and cause much less fat storage if not with food. Thank you!

    (reply)
    • Peter Attia  April 2, 2012

      Red wine (dry) is maybe 4 or 5% sugar, so a glass or two is pretty minimal in terms of sugar load. The issues with ethanol is less about the sugar (unless you’re drinking sugar drinks) and more about the actual fate of the ethanol, which mostly ends up as VLDL. Bottom line, if you’re going to drink 1) don’t drink sugary drinks, and 2) Do so in moderation to spare your liver the unceremonious task of converting it all to fat/VLDL.

    • Anu  April 2, 2012

      To piggy back on this question — I’ve noticed very different effects of a glass of wine when I’m in ketosis and without. The other night I had just one glass of wine with dinner — a dry white. I found that I rapidly became extremely sleepy on that one glass, couldn’t stay awake beyond 10:30 pm (when I normally sleep around midnight) and woke up at 2:30 am feeling absolutely alert — my heart was beating very fast and I felt both hungry and thirsty. After tossing and turning for an hour, I gave up and researched this on the internet — it seems that insomnia is a common side-effect of drinking large amounts of alcohol, due to low blood sugar and subsequent adrenal gland activation. I wonder if this effect is exacerbated during ketosis — since my blood sugar normally doesn’t go up and down at all.

  130. Matt Taylor  April 1, 2012

    I really enjoy the “fat shakes”, and so does everybody else I make them for. I prefer blackberries myself, and I am working on a blackberry ice cream based off your wife’s infamous recipe too.

    (reply)
    • Peter Attia  April 1, 2012

      Mmmmm. Keep us posted on that one.

    • Maryann  April 2, 2012

      Thank you very much Doctor Peter, maryann

    • Matt Taylor  April 28, 2012

      Blackberry ice cream:
      - 3.5 cups heavy cream.
      - 1 cup unsweetened almond milk.
      - 2 cups blackberries.
      - 1 tablespoon raspberry extract (or blacberry if you can find it).
      - 2 tablespoons xylitol.
      - 1 tablespoon stevia.

      Blend before putting into the ice cream maker.

  131. Sven  April 9, 2012

    He peter really enjoy your site awesome and lots of information :)

    Would you say that a ketonic state is the “best / natural” state for your body? Im into low carb eating but never been overweight or anything (i can eat basicly anything without putting on lots of extra weight). Still for health benefits, diseases in the future, I decided to eat healthy. I dont really have an idea on how my body responds. You say that your wife can eat more carbs, but then should you then really eat more carbs?

    It looks like I dont really respond on oil.I can take 2 tableapoons of coconut oil without any increase in energy, same as i can eat lots of sugars without increase in energy (used to tank down red bull).

    How can i find out what is right for my body? (self experimenting?)

    Thanks :)

    Sven

    (reply)
    • Peter Attia  April 9, 2012

      Sven, I just did an interview today that sort of touched on this point. It will be out end of the is week, or early next week. I’ll post a link to it. Short answer: there is no “best” — it’s all about tradeoffs and optimization.

  132. Mark  April 9, 2012

    Hi, Peter.

    I have a question regarding MTCs and ketone bodies. I have seen mentioned (maybe here?) that MTCs can serve as a catalyst to ketosis; and I’ve seen posted elsewhere people stating that coconut oil puts them into ketosis.

    I’m fairly ignorant on the subject of biochemistry, but my understanding is that MTCs are metabolized directly through the liver, and the resulting ketones aren’t a result of body fat breakdown, but from breakdown of the oil. Is this the case, and if so, would this 1) give the appearance of ketosis (positive reading on test strips) when one may not actually be metabolizing body fat, and 2) prioritize the MTC sourced ketones and therefore delay the breakdown of body fat until the ketones produced from the MTC oil is expended?

    Thanks.

    (reply)
    • Mark  April 9, 2012

      Also, I meant “MCT,” not “MTC.” If that wasn’t apparent. It’s Monday, and I’m a little brain dead.

    • Peter Attia  April 9, 2012

      Correct. MCT’s either get oxidized immediately by the liver, or excreted. The “thinking” is that it using some MCT “primes” the liver for making ketones out of endogenous fat stores.

  133. Maryann  April 9, 2012

    Hi Doctor Peter,

    In the Volek/Phinney book you recommended to me, on p 167-168 they discuss the temporary increase in bad cholesterol that can be expected with significant weight loss. My husband is not experiencing dramatic, sudden weight loss; he has lost 20 lbs in 6 months. His LDL went up 100 points (to 188), his triglycerides went up 40 (to 177), OxLDL/HDL is up to 57, and C-Reactive protein went up to 21. These numbers went up dramatically since they were tested only 3 months ago, when he had perhaps a 10 lb loss at the time. Is it normal to be this elevated with only a 20 lb loss? The book you recommended states that this is associated with more dramatic weight loss, of 30 lbs or more. Is this safe to sustain? If so, how long is it safe to be this way? The book says it should only last a month or two. What should we do if the numbers don’t resolve? Thank you very much, maryann

    (reply)
    • Peter Attia  April 10, 2012

      Possible, but usually TG responds very quickly. Of course, none of these numbers are particularly meaningful and the only one that really, really matters is LDL-P, but with all of them moving in the wrong direction another check is warranted soon.

  134. Maryann  April 10, 2012

    LDL-P is what exactly? If the numbers stay poor, what do you think he is doing wrong in this low-carb lifestyle? Thank you, maryann

    (reply)
    • Peter Attia  April 10, 2012

      LDL-P is the number of LDL particles. If that number is poor and stays poor, it would be prudent to use medication to fix it. Many people (at least 30%, if not more) have normal LDL-C (the cholesterol number typically checked), but abnormal LDL-P. This is called discordance.

  135. Maryann  April 10, 2012

    Thank you :)

    (reply)
  136. PaulaM  April 14, 2012

    Peter,
    Can I initiate one last inquiry in this thread?
    We both live in SD:
    1. can you really get whole-fat Fage yogurt in town and where? I NEVER see it.
    2. where do you get your grass-fed meat?
    3. the foods you eat photo shows a wonderful salami (or close) – where can I get that without sugar, etc?
    4. high-quality liquid fish oil; I want the best and you seem to have found it, but of which brand do you speak? (I use Carlson’s now)
    5. spread the word(s)!

    Thanks!
    PM

    (reply)
    • Peter Attia  April 14, 2012

      I’m guessing this is not the last question on this thread, but…

      1. Whole Foods is the only place I can find it.
      2. I typically don’t, since I eat virtually no other omega-6, I figure I can tolerate a bit more in my steak.
      3. Whole Foods, but it’s pricey.
      4. Carlson’s also (this is what I use: http://www.carlsonlabs.com/p-70-very-finest-fish-oil-lemon-flavor.aspx)

    • Alexandra M  April 14, 2012

      It’s very easy to make your own Greek style yogurt. I make a quart every weekend.

      I use 1/2 gallon of whole organic milk (organic because it’s ultra pasteurized):

      1. Heat milk gently to 110 degrees F then transfer to glass bowl

      2. Stir in 1/4 – 1/3 yogurt saved from the last batch (use some plain Stoneyfields or Dannon the first time)

      3. Preheat the oven to 175 degrees F, then TURN IT OFF.

      4. Put the bowl in the oven and leave 8 hrs (overnight)

      5. When the yogurt is set, line a large colander with a dampened VERY clean tea towel and pour in the yogurt. In 2-3 hours you should have 1 quart of very thick yogurt.

      I usually whisk it to get out any lumps.

      TIP: I made a little magnetic sign to put on the stove that says YOGURT!! It keeps me from accidentally turning on the broiler – again. :D

      (If you don’t use ultra pasteurized milk, you must heat it to 165F – or even 185 – then let it cool.)

    • Peter Attia  April 14, 2012

      How do you titrate to the “right” amount to fat? This looks very cool!

    • Alexandra M  April 14, 2012

      “How do you titrate to the “right” amount to fat?”

      That is the $64K question that I’ve been asking everyone for years! My yogurt comes out even thicker than Fage – almost like sour cream, so I’m just guessing it contains even more fat. My other big question is how much lactose is consumed by the bacteria and is there a point at which it is all consumed? Would that be after 8 hrs, or 12, or 24? Are any remaining milk sugars contained in the whey that drains out?

      Does anyone happen to have some gas chromatography–mass spectrometry equipment lying around the garage?

      Next up, homemade creme fraiche…

    • KevinF  April 14, 2012

      Paula, please note that you can buy full-fat Fage Total on Amazon.com. I have no idea how they deliver perishables like that, but they do.

      The stores I use for things like grass-fed beef don’t have locations in South Dakota; but what you want is the type of store that sells organic and “real” foods. Maybe you have a regional chain up there.

      You might see if there’s a farmer’s market in your town. Those guys usually seem to sell organicky stuff, and you might find a local rancher there who sells grass-fed meat, as well a nice stuff like pasture-eggs.

  137. PaulaM  April 14, 2012

    Yeah, maybe not. And it’s still Friday the 13th here (not the 14th as your server reports ie Eastern Time).

    Very generous of you to answer – and I’m grateful for all (now, if only I can get my soon-to-be-fired Internal Med doctor to say something, ANYTHING, worth hearing).

    Whoops, just remembered: last week I had Peet’s make me a latte w heavy cream — they didn’t want to and of course charged accordingly. Delicious!

    (reply)
  138. Martin  April 14, 2012

    The main problem I see (I’ve been on a low-carb paleo diet for 2 years now so no-carbs is not a problem) is how to reduce protein in a natural way (e.g. separating yolks from whites is not natural). My main source of protein and fat is meat and eggs. I honestly have no idea what the proportions of calories from protein vs fat it is and I do not want to know. I also eat coconut oil (in coffee and for cooking) and olive oil (in salads).

    Would you have any tips how to establish a natural balance of protein / fat? I’ve already tried eating eating more fat (e.g. even more coconut oil in coffee and even more olive oil in salad) hoping that I would naturally start eating a bit less of meat but I’d rather not count how much grams of protein vs fat my steak contains in order to reduce the former.

    (reply)
    • Peter Attia  April 14, 2012

      Martin, this protein problem is sort of unique to folks like me who eat an enormous number of total calories. If I eat just 3 eggs, for example, I don’t need to do this. It’s only when I’m eating 8 eggs, that I’ll remove some whites.

  139. Arla  April 14, 2012

    Hi Peter! Just listened to your interview on Ben Greenfields site and really enjoyed it!
    Was wondering if you recommend a supplement brand for sodium chloride. Would it
    be best to take supplements if we didn’t want to drink bouillon?
    Thanks!

    (reply)
    • Peter Attia  April 14, 2012

      I just use bouillon or heavy duty salt tabs, but much prefer bouillon.

  140. carol  April 14, 2012

    Dear Dr. Attia,

    What kind of condiments can I use on the low carb way of eating? Can I use hot sauce, a bag of pork rinds for a snack, lemon juice from a real lemon for fish, pepper, salt, Mrs Dash, different varieties of other spices? Thank you for this wonderful and informative website.
    Thanks for any information regarding condiments.

    (reply)
    • Peter Attia  April 15, 2012

      Check the ingredient label. Try to minimize sugar intake.

  141. Arla  April 15, 2012

    What about miso instead of bouillon?

    (reply)
    • Peter Attia  April 15, 2012

      Sure, as long you’re getting the sodium.

    • Travis Koger  April 15, 2012

      Miso is pretty high in carbs, 21% nett carbs. Sodium is pretty high though.

  142. Rosalee  April 16, 2012

    I have been eating less than 50g of carbs per day since 23 Mar 12. I average about 34g/day. I’ve been religiously tracking everything. At first weight loss was rapid and I lost 8 lbs in the first 2 weeks. However, for the past week and a half I haven’t lost anything. My sodium intake averages 4.3g/day and I do not exercise strenuously. I was thinking that my protein intake may be too low. I average about 120g/day, but estimate my lean body mass to be about 160-165 lbs so I guess I should be getting 150g of protein /day. Does it make sense that I stopped losing weight because I’m not eating enough protein? I would have thought I’d lose weight by losing muscle or something.

    (reply)
  143. Rosalee  April 16, 2012

    Oh and my calories are on average 2000/day and my fat intake is typically at 145g-150/day.

    (reply)
    • Travis Koger  April 16, 2012

      Rosalee,

      Obviously I’m not the expert here, but I would have thought that your protein consumption is too high compared to your fat. If you look at the breakdown of what Peter is eating, your protein levels are almost the same as his are, and yet his fat is 400-425g. This is fine if you have extreme energy requirements as Peter does (and mentions), but with lower energy requirements, and lower fat, the protein also needs to be reduced to maintain the ratio.

      I work on 80% fat, 15% protein and 5% carbs. In most cases if I maintain that ratio, regardless of the actual count, I am likely to lose weight or in the least maintain. I find that if my protein goes up to 25-35% of the ratio, with fat being the sacrifice, I will gain weight… not much though.

  144. Brian  April 16, 2012

    Hi Peter, great website with super info that I discovered through a podcast at Ben Greenfield.
    My question is how conserned I should be about the carbohydrates in nuts and seeds. These things are filled with nice fats and I use them frequently as snacks, but ex. almonds are 20g carbs/100g so the 30-40 g carb limit is very easy to exceed.
    Thanks for an interesting blog !

    (reply)
    • Peter Attia  April 16, 2012

      They are much better than the carbs in bread, pasta, and cereal, which are almost always made worse by the addition sugar. Not all carbs are created “equal.”

    • Brian  April 16, 2012

      but even though these carbs are the “good guys” they still are carbs and needs to be counted as a part of the recommended daily maximum intake rigth (30-40g)?

    • Peter Attia  April 16, 2012

      I keep total below 30-40, and all of my carbs are “good guys.” I eat zero “bad guys.” In other words, all my carbs are from nuts, veggies, *trace* fruit, and dairy.

    • Travis Koger  April 16, 2012

      Brian,

      Don’t forget to remove the fibre grammage from the carbs with nuts. You then end up with the nett carbs and a more accurate carb count.

      I understand that nett carbs should be carbs – fibre – polyols = nett carbs.

      Happy to be corrected if I am wrong though.

    • Travis Koger  April 16, 2012

      I am currently experimenting with only eating Brazil nuts with my other meals. Brazil nuts have a really good amount of fat, low nett carbs and less protein than peanuts.

  145. lockdownd  April 17, 2012

    Hi Peter,
    Rather than supplement with Bouillon for extra sodium, could one just use extra salt on their food?
    Thanks,
    Eric

    (reply)
    • Peter Attia  April 17, 2012

      Sure, but for most it’s just easier to use lots of salt on food AND add about 2 gm of sodium via bouillon.

    • Michele  April 18, 2012

      Eric, Peter…I have been salting my food but am still getting massive headaches after training. I tried putting a pinch of salt in the post-traing water I drink and this seemed to help (although just a bit). I’m also supplementing magnesium.

      Could drinking over 2 liters of water per day, as do most who train regularly, further increase the need for salt?

  146. Marlane  April 17, 2012

    I haven’t been through your whole blog yet, so may be missing this somewhere, but how do you KNOW you are ketotic? Do you measure ketone concentration daily in urine or something?

    (reply)
    • Peter Attia  April 17, 2012

      Yes. I measure B-OHB in my blood.

  147. Rosalee  April 18, 2012

    Thanks Travis, I’ll try and up my fat intake even more. I find it hard to add more fat without adding some carbs unless I just want to drink oil lol. Avocados have more carbs than I would expect and all of the cream I have found has a least 1g of carbs per tbsp.

    This is so frustrating, I’ve actually gained weight this week. According to the old calories in- calories out model I should have lost 2 lbs. Glad I read Gary Taubes’ Why We Get Fat? because otherwise I would be freaking out and going back to my carbs right about now.

    I’m going to try this for another 2.5 months before I decide whether it is worth it. I am looking forward to becoming fully keto-adapted, I don’t like that my muscles seem to burn now just from walking the usual 3 flights of stairs in my building.It makes me feel like an old lady and I’m only 30!

    (reply)
    • Travis Koger  April 18, 2012

      Rosalee,

      You could also try reducing your protein intake at the same time to balance out the ratio. My point of the original comment was that your protein level is the same as Peter’s, but with a much lower fat intake. But he is requires the higher fat and protein levels due to the energy output he has, namely the 2-3hrs of fairly intense exercise per day he does. If you do not have the same energy requirements, by increasing the fat intake and leaving the protein where it is, you will likely be eating too much food. By that I don’t mean that you will be eating too much calories, but just physically too much food.

      For me, when I eat too much food, even with the correct ratio, I fell too bloated and stuffed rotten. It ends up making me feel lethargic and extremely low in energy. By eating only when you are hungry and not eating until you feel overfull, but at the same time sticking to the ratio, you start to work out the correct levels of each nutrient type to provide you with enough energy and not feel overfull. When I overeat I gain weight, typically because at the same time I do not increase my energy output.

  148. Brian  April 18, 2012

    Hi Peter,
    besides minerals, is there any Vitamins that you don’t get through your diet and therefore need to supplement?

    (reply)
  149. Carol  April 19, 2012

    Will eating this way reverse my heart disease, and my one 70% blockage in one of my heart arteries? Thanks for any information.

    (reply)
    • Peter Attia  April 19, 2012

      If we believe that drugs that lower LDL-P reverse heart disease, then a diet that can reverse LDL-P should have an effect, also. The key, of course, is measuring your current risk (i.e., LDL-P) and evaluating if the treatment has an effect (i.e., is your diet changing it).

  150. Nathan Smith  April 20, 2012

    You are not concerned about all the cholesterol you consume with sour cream, steak, cheese, butter, and egg yolks? I’m curious to hear a doctor’s explanation on how cholesterol in our diet affects us.

    (reply)
    • Peter Attia  April 20, 2012

      This is a great question, Nathan, and I’ll be writing SO MUCH on this topic in the future. I can’t do this topic justice right now except to say the following: the cholesterol we eat (called endogenous cholesterol) has little, if any, bearing on exogenous cholesterol production (that produced by our bodies). It’s this exogenous cholesterol we need to prevent from getting into our artery walls.

    • KevinF  April 21, 2012

      Peter don’t you have your endo’s and exo’s mixed up?

    • Peter Attia  April 21, 2012

      Not sure what I wrote, but it wasn’t that exogenous is what we eat and endogenous is what we make, then I apologize for the confusion.

  151. Ria O  April 21, 2012

    Hi Peter-
    Firstly thank you so much for sharing your knowledge and insights on this blog- I have no idea how you find time to do it with the demands of family, work and training as well but I am just so grateful that you do. I am in Australia and have found it very difficult to find any sensible and medically informed advice on this subject – so this amazing! Just a couple of questions.
    1. I think I understand the principles of eating fat in a ketogenic diet, which is what I am following, but what role do you think fat should play in the diet of the rest of the family who do not have same IR issues that I do? What if the kids are eating a meal with potato? Assuming portion size of potato remains the same, is it in fact better to add butter and milk and make mash potato, or to roast it in suitable fat- or does this just add calories when the carb load from the potato is the same? If your insulin levels are raised by the carbs in the potato, does that have an impact on how the fat you eat with it is metabolised?
    2. Probably a dumb question- but can people put on weight when eating a ketogenic diet? If someone was eating nearly all fat but well in excess of their daily calorific requirements, would they then start to store that energy as fat? Or would they just burn it off thru digestion, exercise etc?

    (reply)
    • Peter Attia  April 21, 2012

      Good questions.
      1. If eating carbs and fats, it’s more likely you’ll store the fat than burn it.
      2. Yes, even on a ketogenic diet it is possible to create a positive energy balance.

  152. Rosalee  April 21, 2012

    Update – I’ve broken through the 3 week plateau! Yay! I think I was overeating but did not realize it because I’ve been doing it for so long. I think it stems from being gluten intolerant and my body was always sending signals to my brain that it was hungry because it was never getting any nutrients. My Dr. originally suspected celiac disease/gluten intolerant when I was deficient in just about every nutrient, mineral, neurotransmitter, hormone, you name it despite eating lots of veggies and taking a variety of vitamins and supplements. So when I went low carb/high fat and felt satiated for the first time in a long time, I didn’t realize that I didn’t need to eat as much to feel that way.

    I reread the FMBF book by Tom Venuto that I had purchased a few years ago and discovered that my basic metabolic rate was way different then what fitday had suggested. It now makes sense that I wasn’t losing weight because I was eating enough to be at a maintenance level.

    All that to say, I am so grateful for this blog and the encouragement to experiment because without that I probably would have given up, thinking it doesn’t work, and gone back to my old way of life. So thank you so much Peter and everyone who posts here! :)

    (reply)
  153. Kathy  April 22, 2012

    Peter,
    I’m wondering if I’ve missed a discussion on your blog somewhere about carbs in coffee and heavy cream – I’ve been looking, but haven’t found it, so my apologies if I’m repeating something.
    Do you address the number of carbs in heavy cream and coffee somewhere? I read today that coffee has 1 g carb/10oz, and heavy cream 1g/tbsp. that’s alot when you drink coffee laced with lots of heavy cream the way I do! Is there some conversion here with the cream that I don’t understand, or do we really get 16 g carbs/cup of cream? and the coffee? Thanks.

    (reply)
    • Peter Attia  April 22, 2012

      1 cup of heavy cream (whipping cream) in liquid form has 88 gm of fat (55 gm of which are saturated), 5 gm of protein, and 7 gm of carbohydrate. About half that carb is turned into lactate, which doesn’t really “act” like a carb, insulin-wise. Standard brewed coffee has not a gram of any carb/protein/fat.

  154. Sugaraholics.com  April 22, 2012

    Dr.A: My Livestrong food database, and other cal-count sources I use, list one cup of coffee as anywhere from .3 to .8g carb, which isn’t much unless like me you drink coffee by the pot. As a person who has to be very strict, less than 30g daily, I do count my coffee just to err on the safe side. Same with eggs, cream, and other food with negligible carbs.

    Great webpage!

    (reply)
  155. Kathy  April 23, 2012

    Thank you for your response. I was having a hard time staying on-line, so I was rushing and didn’t add that I’ve seen several different carb amounts for both coffee and heavy cream. I figured the cream might have something else going on (the conversion issue) but I was really puzzled by the carbs listed in coffee!
    This is another reason your website is so important for people trying to do low-carb. There is a ton of confusion out there, including among nutritionists and dieticians. I find your information trustworthy since I know you not only have a medical background, but you’re delving in deeply because of your personal committment.
    So thanks again.

    (reply)
  156. medstudent  April 29, 2012

    fat shake is awesome, but also mildly terrifying.

    It’s getting up near 1,000 calories (800 just in the cream, according to my container). I’m all up to speed on the problems with focusing on calories-in-calories-out, and the basic biochem at play. But I’m still pretty struck by how easily that many calories goes down (it does produce incredibly lasting fullness though).

    Anyway, this leads to a more general question about physical activity–do you think you’d get fat if you ate what you eat above without much exercise (or something significantly less than 4 hrs/day–way, way out of the realm of most of your readers experience, I’m sure)?

    (reply)
    • Peter Attia  April 29, 2012

      Almost certainly, but if I wasn’t doing any exercise my appetite would be a fraction of what it is. Most people, if eating the *right* foods, are fine if they are truly guided by their appetite. On days I’m traveling on not working out, I typically eat less.

    • John Dawson  April 29, 2012

      Hey medstudent. I think the fat shake is awesome too, but I’m just not burning enough calories to have it regularly. I do have my own version of it most days for lunch, cutting the heavy cream back to 4 or 5 ounces, with 8 ounces of unsweetened almond/coconut milk, and Peter’s favorite protein powder.

  157. lorraine  April 30, 2012

    Peter, if you’re already IR, is there a way to differentiate if dairy is part of your problem? The post-prandial insulin is going to be high no matter what was consumed, right?

    I know you tested for dairy/xylitol, but if I have the timeline right I think you did this at the point of entering ketosis, when your IR was already resolved. If someone has IR pretty much the same as your original levels on the first OGTT, do you think it meaningful to do a dairy challenge (there’s a lot of dairy in the diet)? Thanks, your thoughts are always very helpful.

    (reply)
    • Peter Attia  April 30, 2012

      Fair point. My second OGTT was before ketosis, but still at a point in time where much of IR had resolved. A dairy challenge is certainly a good idea.

  158. steve  April 30, 2012

    Expanding on Medstudent’s question, I have always tended to overeat. True, in the past it has always been starches that I overate and it has been plainly obvious, but now that I’m doing an experiment of my own, the same patterns seem to apply. The good news is that I do generally feel more satiated during the day, and the 4PM hunger pangs I used to get are completely gone. But I find myself continuing to go “back to the kitchen” after 7 or 8pm, only this time instead of boiling up some pasta, I’m frying up another pork chop. I do exercise 10-15 hours per week, but it’s hard to imagine that’s enough to justify the calories I’m eating. When eating a high fat diet, one can seem to get up above 4000 calories really, really fast.

    Anyway, because of the evening habits, while I would love to follow the “let the appetite be your guide” advice, I’m afraid that I’m just prone to overeating regardless of what macronutrients I eat, and might be one of the unlucky people who still has to pay attention to portion sizes, even when attempting ketosis. I’d be interested (and this is my question to you) to know signs you would look for. How would I know if I should NOT let appetite be my guide?

    (reply)
    • Peter Attia  April 30, 2012

      It’s a fair point, and certainly not something I fully understand yet. It’s quite possible to resolve insulin issues, but not leptin issues. Or something else. Some folks may eat more out of “habit” than “hunger.”
      One thing that may help shed light on this is tracking what you eat. Not with any attempt to change it, but just to observe it for 4 or 5 days.

  159. Alexandra M  April 30, 2012

    I’ve been seeing a lot of questions from people newly interested in restricting carbohydrates who are vegetarians or even vegans and wanting to know what they can eat. I’ve tried looking up vegan and vegetarian low carb, but they all seem to rely heavily on tofu and seitan for protein. Do you have any other ideas? Because I’d hate to see people decide that low-carb isn’t for them because there isn’t anything they can (or will) eat on it besides leaves and coconut oil. And some people don’t like coconut!

    (reply)
    • Peter Attia  April 30, 2012

      Definitely a great point. I think vegetarian versus vegan is a big difference in challenge, the former being a bigger challenge. But both are absolutely possible, especially if not aspiring for full-blow nutritional ketosis. Simply eliminating all sucrose and HFCS, and only taking in fructose in the form of fruits and vegetables would give a huge benefit.

  160. Sam  May 1, 2012

    I’ve been trying to up my fat intake and this weekend I made Jello sugar free instant pudding with heavy whipping cream instead of skim milk. Wow was it good! It was pudding you could cut into wedges. Super rich, super filling. Crazy-good dessert. Am I killing myself though with the cornstarch they use as a thickener. Does all that fat outweigh all that carbohydrate? Each serving (not including the cream) was 8g of carbohydrate (0g sugar), which I assume came from cornstarch. It threw me out of ketosis but I thought it was such a good weekend treat I didn’t care.

    (reply)
  161. medstudent  May 1, 2012

    So what kinds of foods have the omega-6 polyunsaturated fat that you avoid? I did some googling, but quickly got bogged down in minutiae. I’m guessing you have a top five at the ready.

    (reply)
    • Peter Attia  May 1, 2012

      Let’s address this when I write more about PUFA in the future. My views on omega-6 are slowly in the midst of a change right now.

    • KevinF  May 2, 2012

      Medstudent, FYI, Omega-6 PUFA’s are basically found in seeds, nuts, and grains. Sources rich in Omega 6′s therefore are seed-based oils (safflower, sunflower, corn, canola, etc.) and the margarines made from them, and things fried in them (e.g., french fries); most nuts; and things that eat grain (grain fed cows).

      If you’re looking to avoid PUFA’s an option is to use monunsaturated fats (olive, avocado, macadamia); real butter; grass fed beef instead of grain fed; and macadamias as the best nut.

    • KevinF  May 2, 2012

      Should also add, coconut oil (nearly all saturated fat and therefore not an O-6 PUFA) is not only another option, it’s now my fave, Good Lord — Nutiva, you can spoon that stuff out of the jar for dessert it’s so good.

    • medstudent  May 7, 2012

      grass fed instead of grain fed! that’s a new one. tastes way better anyway.

    • steve_whitaker  February 28, 2013

      Looking at the nutritional data on coconut oil, it looks very high in Omega-6, as below, and highly inflammatory,

      http://nutritiondata.self.com/facts/fats-and-oils/508/2

      unless this is not actually coconut oil, but a blend perhaps?

      Makes sense though as coco”nut” would probably suggest it has O6′s in as other nuts do, i.e. sunflower, safflower etc.

      Great blog by the way, totally changed my way on thinking about food, keep up the great work.

    • Peter Attia  February 28, 2013

      Might be a blend. The stuff I use is almost all SFA. Small fraction of MUFA.

  162. lockdownd  May 1, 2012

    Hi Peter,
    wanted to clarify something – hopefully it’s not old ground. I’ve been cutting up bouillon cubes into about 2g squares and drinking them every morning as your table suggests. However, based on the package, that’s not going to give 2g of sodium. So does the 2g recommendation apply to bouillon cubes or sodium?
    thx,
    Eric
    PS bought Volek/Phinney on your recommendation. Great read – very technical. Reminds me of you and Taubes :)

    (reply)
    • Peter Attia  May 2, 2012

      See previous responses to this question in various comment threads.

  163. David Nelsen  May 7, 2012

    Peter, I have been strugglng to get into full blown ketosis. I have the blood meter recommend but only have a high reading of 0.4 for ketones. I started weighing everything this weekend and deteremined my problem is too much protein. My problem is how to get enough fat for satiety without getting too much protein. I am going to try and make home made Cool Whip with Xylitol. What do you eat to get fat without carbs or protein? I am going to retest my ketones after a few days of keeping protein below 150 gram and see where I’m at. Thanks, Dave

    (reply)
    • Mark  May 8, 2012

      Dave -

      Sauteed mushrooms in butter and olive oil, heavy cream in coffee, spinach salad with olive oil based dressing and macadamia nuts are good go-to sources for fat calories without all of the protein.

  164. johnk  May 8, 2012

    Good news in the NY Times as one food writer Peter Kaminsky seems to have figured out the LCHF lifestyle for himself.

    http://www.nytimes.com/2012/05/09/dining/the-author-peter-kaminsky-on-how-to-eat-wisely.html

    (reply)
    • KevinF  May 8, 2012

      Interesting. Mr. Kaminsky talks of things that have flavor and are satisfying, but what he’s really doing is avoiding things that spike blood sugar and cause hormonal-induced hunger. (Mozzarella and prosciutto with a few olives and oil is one of my typical lunches now — maybe 3 or 4 ounces of food and it’s a satisfying lunch). He could skip the lentils and spelt and embrace the sausage and bacon a bit more, but he’s halfway there.

    • Peter Attia  May 8, 2012

      Another great example of the common fallacy: I added more X to my diet (X can be anything from antioxidants to seaweed to snakeoil to kitten paws)…I also removed Y from my diet (Y is typically sugar, grains, refined carbohydrates). Conclusion: Look at how amazing X is!

  165. John Vogt  May 8, 2012

    Do you have either a recommended or preferred sweetener. Many new ones are out there. Do sugar alcohols cause you digestive distress? Does your wife use a sugar substitute for baking? Do you use any wheat flour substitute? Any you would recommend? A lot of them have soy in them. I guess you can see why Gary Taubes found it impossible to keep up with the blogs.

    (reply)
    • Peter Attia  May 8, 2012

      I personally use xylitol when I use anything at all, which is quite rare. Only in homemade ice cream and a few other things. Everyone needs to figure out what works for them with respect to fat metabolism, GI distress, etc. If you can do without, do without.

  166. johngdc  May 9, 2012

    Have you seen any connection between this type of diet and stomach ulcers?

    (reply)
    • Peter Attia  May 9, 2012

      Nope.

    • Alexandra M  May 9, 2012

      Johngdc – It’s been known for some time that the vast majority of peptic ulcers are caused by the bacterium Helicobacter pylori, a discovery made in 1982 by Barry Marshall and Robin Warren and for which they were awarded the 2005 Nobel prize.

      http://en.wikipedia.org/wiki/Helicobacter_pylori

      “Some skepticism” doesn’t really begin to describe the way their hypothesis was received at first and Marshall ended up drinking a beaker of cultured H. pylori to make his point. (He became quite ill with gastritis but recovered.) Antibiotics are now the standard treatment.

    • johngdc  May 10, 2012

      actually, the physicians in my family all agree that that literature is outdated and they’ve cited to studies that show otherwise.

      my blood panel will be back soon, so we’ll see.

  167. johngdc  May 9, 2012

    Pancreatitis?

    (reply)
    • Peter Attia  May 9, 2012

      Only if there is other pathology underlying it.

    • johngdc  May 10, 2012

      Interesting. Well, my blood panel will be back soon so we’ll see. Logic (not medicine) seems to me that increased fat intake could lead to complications with the pancreas and/or gall bladder.

      I’m as big of an advocate of no carb diet as there is around me, ketotic now for a while. But this health concern is, well, a concern.

      I’ll need ammo to fight my traditional physician and physicians in my own family if the blood panel shows any link to my diet and whatever condition i’m suffering from.

  168. Xiaolei  May 9, 2012

    Hi Peter,

    I am on a crusade to balance my omega 3 and 6 right now and I have been excited and confused by the sea of information and ideas available. I have found two interesting sites with oil profile ratios: http://efaeducation.nih.gov/sig/esstable.html and http://fanaticcook.blogspot.ca/2009/04/omega-6-and-omega-3-in-foods.html

    It seems to me that Olive oil is not the best oil in terms of omega 3,6 balance despite its low Polyunsaturated and high monounsaturated fats content. Even canola oil has a better oil ratio than olive oil. As a result, I think olive oil, if used in excess, could be a disaster for omega 3,6 balance (coconut oil seems to be moderate and butter is a clear winner).

    I don’t understand why do people care about amount of Saturated fat and monounsaturated fat regarding omega 3,6 balance? Should we care only about omega 3,6 ratio and quantity and apply moderation when consuming food with high omega 6:3 ratio, such as olive oil,grass-fed beef or avocado? Since the more we consume oil with high 6:3 ratio, the less impact the fish oil supplement is going to have in terms of 6:3 balance. That is, my omega 6:3 ratio is 10:1 if I consume 10 tablespoon of olive oil or 2 tablespoon, but my ratio is going to be a lot better if I take fish oil supplement while consuming only 2 tablespoon olive oil.

    The reason I try to investigate is because I have a body that is prone to inflammation and since I started a diet (around 2-3 weeks) that is heavy on nuts, olive oil and avocado, I recently have experienced some moderate inflammation reaction with no change in other aspect of my life. I have ordered fish oil from Carlson lab(BTW, thanks for the link)but I wonder whether such 6:3 imbalance would be harmful even for people who are less prone to inflammation.

    (reply)
    • Peter Attia  May 10, 2012

      Hold your horses a bit. I’m not so sure any more this is important. I’m going to write about this in the future, but in the interim, spend more time worrying about getting lots of omega-3, and less time worrying out less omega-6 or even the ratio.

    • KevinF  May 10, 2012

      Xiaolei — well, while we’re waiting for Dr. Attia to give us the full authoritative scoop on PUFA’s — I’ll just point out that IMHO there are two issues here: 1) you’re hung up on the RATIOS and not paying enough attention to the sheer quantity of Omega-6′s involved; and 2) the Omega-3 in Canola or any of these vegetable oils is the ALA type, which is usually seen as far less useful to you than the EPA/DHA found in fish — hence (possibly) you can’t really count on the Omega-3 in vegetable oil to do you much good. (Peter set me straight on that point a while back).

      So the trick with vegetable oil is to minimize the Omega-6 load. The ratio that is most useful at a glance is the Mono:PUFA, not the O3:O6.

      People like olive oil NOT because it has a great ratio of 3:6 (it doesn’t), but because it has little of either, since it has relatively little PUFA content, and is hence benign. Therefore you can use olive oil and not ingest too much Omega-6, which in turn means the Omega 3 fish oil supplements you’d take are not being wasted. A bit of canola oil on the other hand, you’ll be swamped with Omega-6.

      If you look at the sources you link to, notice that a tablespoon of olive oil has far fewer milligrams Omega-6 in it just about than any of the other mono or PUFA vegetable oils — despite whatever the ratio is. (An exception is the > 70% oleic sunflower, which is interesting).

      But, once Peter tells us some more no doubt I’ll have to restock my pantry. I heartily endorse coconut oil though.

    • Xiaolei  May 10, 2012

      Hi Peter,
      Thanks for responding; cannot wait for your article but do take your time. Wish you the best.

      Hi Kevin,

      Thanks for your reply. My post is driven by my concern over quantity rather than ratio. I was trying to say that there should be some factor that separates canola oil from olive oil. If not, 3 table spoon of olive oil is just as bad as 1 table spoon of canola oil in terms of amount of Omega 6. I agree with you that it is the quantity that matters, but following that logic and the assumption that there is no other variables at play, olive oil and avocado would be pretty bad choices if consumed without moderation.

      I suspect there might be other variables/pathways that affect inflammation process and I am anxiously waiting Peter to share his knowledge on it. In the meanwhile, I will go buy some salmon from Costco.

      Cheers,

      Xiaolei

  169. Mark  May 11, 2012

    Hey, Doc Peter.

    I’ve got gallstones and it turns out I’m gonna have to get my gallbladder yanked out in a couple of weeks. I’ve been in ketosis for over two months now, and I’m adapting really well to my training. Obviously, this is going to set the training back a little, but I would rather not have to re-adapt to ketosis.

    All of what I’ve read says foods to avoid post surgery are the very foods I would need to eat to stay in ketosis. Is eating fats that much of a problem after getting one’s gallbladder removed? Also, is this way of eating a problem for those without a gallbladder?

    (reply)
  170. Brad Hefta-Gaub  May 15, 2012

    Peter,

    First off. Thanks for putting together this amazing resource. I’ve only scratched the surface in reading your blog so far, there’s so much to “meat to digest”, I feel like I have to take long breaks so I don’t eat more than 150g of protein a day. :)

    Quick background on me: Fat kid, turned fat adult, never exercised a day in my life, ate some junk and some healthy food most of my life, but mostly I ate too much of what ever I was eating… ended up 5’4″ and well over 200lbs, 40% body fat, clinically obese by age 34. Then one day partly inspired by a doc telling me “I shouldn’t gain any more weight” and partly inspired by a bet I made with my wife that I WOULD go to the gym if we were just members of a 24 hour gym… I started on a quest to get healthy. I lost 50lbs in 3 months, by eating a VLC diet (~1200cals/day) and exercising at 1-2hours a day-7days/week. After losing the weight, I decided to see what my new body could do… I started cycling, and did my first double century ride a year later. Since then I’ve kept the weight off, and even lost another 15lbs, and now have completed 6 Ironman races, 7 one-day double centuries, 1 double-double century, 30+ marathons including 2 years in a row of running 4 marathons in 4 days, two 50 mile ultras, a several 50kms.

    I’m the healthiest person anyone of my friends know. (Which is, IMO, more of a sad commentary on the state of our nations health, than it is a commentary on my fitness.)

    However, I was recently diagnosed with osteoporosis (which was discovered accidentally thanks to me taking a DEXA scan to determine my body fat more accurately as I prep for my 7th Ironman). The current conclusion is that this likely resulted from several rounds of Acutane I was prescribed as a young teenager.

    I also recently discovered Bob Seebohar’s MET program, and for the last couple months have been working in his nutritional philosophy into my diet.

    At 61kg, my typical daily intake these days is: ~50g Fat (.83g/kg); ~150g Carbs (2.4g/kg); ~150g Protein (2.4g/kg) – ~1,650 cals/day

    As an Ironman triathlete, I exercise about 700hrs/yr or ~2hrs/day. (Although I’m including in that low effort practices like stretching and strength training.)

    One last bit of background: I don’t eat dairy or gluten, because I have found that when I consume these, I get a great deal of congestion and mucus build up.

    So… here are my questions….

    Getting to Seboohar’s MET 1:1 Carb:Protein was pretty easy, since I don’t eat gluten, it was actually pretty easy to just say “no more grains”. But I do like/LOVE my GREEN LEAFY vegetables!!! I really love them. I always have. And especially now with my diagnosis of Osteoporosis, I am eating more of them than before. A typical breakfast for me is to sauté up 3 cups of kale in olive oil toss in 2 eggs and/or a couple ounces of chicken.

    I can see myself eliminating fruits, starchy vegetables, and even beans… but I think I’d have a really hard time eliminating leafy greens. It looks like you still maintain leafy greens in your diet, so I guess that’s the path that worked for you.

    Q1: If I’m eliminating “sugars” — should I also be trying to eliminate any leafy green vegetable that has “sugar” in it. Examples: Swiss Chard, Broccoli, etc.

    Q2: I have picked up from your various articles that I should also be reducing my protein intake. You seem to suggest that there’s a magic number around 120g. I wonder, was that based on a g/kg ratio? What ratio are you shooting for? I think you mentioned 1.5g/kg elsewhere… but it seems like that would be an even lower amount of protein for you. What is the preferred g/kg ratio of protein.

    Q3: 50g Carbs + 120g Protein = 680 cals… so I guess that leaves only fat to make up the fuel we need. From what I can tell, you’re basically setting these Carb/Protein limits based on the metabolic conditions most conducive to stimulating and maintaining ketosis… and then you’re filling in the remainder of your caloric needs with fat. Do I have that right?

    Q4: Finally — do you know any nutritionists in the Seattle area that work with endurance athletes and believe in the concept of nutritional ketosis?

    Thanks

    -Brad

    (reply)
    • Peter Attia  May 15, 2012

      Brad, congratulations on an absolutely remarkable turnaround. Very inspiring. To your questions:
      1. The amount of sugar (i.e., fructose) in those veggies is really minor. Should not be an issue.
      2. This is only an issue if you’re trying to be in ketosis, if not, don’t sweat the extra protein. Your carb intake is well over ketosis, so protein is not an issue.
      3. Based on being in ketosis. If you’re going for a low-carb, but non-ketotic diet, these constraints disappear.
      4. I do not.

    • Brad Hefta-Gaub  May 15, 2012

      Thanks for the quick reply. I apologize if these next couple questions are answered elsewhere, I searched the site and didn’t quickly find answers to these.

      First of all, when I first read Bob Seebohar’s stuff I was immediately convinced that keeping insulin response down would be a massive advantage to me in my endurance racing. Which is why I jumped on the MET bandwagon without hesitation. Nutritional Ketosis sounds like a very logical extension to this exact same philosophy. So I’m equally intrigued by it. But I’ll admit, MET doesn’t sound nearly as extreme… and so I have some concerns about the “unknown” potential health risks of nutritional ketosis.

      Q1: If I chose to continue to move down the “low carb” spectrum… and decided to taking on nutritional ketosis what are the contraindications to be aware of before moving toward nutritional ketosis? Are these things I can get tests on without a MD’s prescription? What markers should I be tracking to make sure I’m not doing some other damage to my systems by being in ketosis?

      Q2: You mention ‘being in ketosis’ in your reply and in many of your posts. How do I determine if I am “in ketosis”? Is this something I can self-test without a MD’s prescription?

      Q3: A little bit of googling led me to some references that seem to suggest that “increased bone demineralization” is a potential side effect of ketogenic diet. Needless to say, with my recent diagnosis of Osteoporosis that would be baaaaad. Is bone demineralization indeed a contraindication of the ketogenic diet? OR… is this bone demineralization only linked to “high protein diets”?

      Q4: Am I confusing ketogenic diet with being in ketosis? Are these the same things?

      Q5: I’ve done the New Leaf metabolic tests and in my Zone 1/Zone 2, I’m pretty metabolically efficient at ~95% (running) and ~80% (cycling). I’m working on my Zone 2 work to help push those numbers up… And I believe that going MET has helped… and I’m also convinced that nutritional ketosis would help more… but…. I’m struggling to figure out the math on keeping Carbs under 50g for a long hard training or race effort. How are you still achieving carbs of <50g on days when you do long hard training efforts (3-4hrs)? Even using MET with 1:1 ratio I'm still getting much more carbs than that. I can't think of any "portable" nutrition that you could carry with you that can supply your needs. What are you using for your long/hard training efforts?

      Q6: You mention Generation UCAN. I've never tried it, but heard great things about it, and I'm planning on getting some to use during my long hard training efforts. But like Q5, I'm wondering how you keep your Carbs under 50g if you're using UCAN? One serving of UCAN has 28-30g of Carbs. I get that these are "good carbs" and even better than good carbs they're super carbs… but are you simply excluding these from your carb counts?

      Thanks again!

      -Brad

    • KevinF  May 16, 2012

      Brad, you may be overwhelming the poor guy with so many questions.

      Some easy ones —

      Ketosis is the process in which the body creates ketone bodies to utilize fat as a source of energy, rather than relying entirely on blood sugar. Your body truly burns fat for energy, in other words. There is always some of this going on at a low level, but being “in ketosis” means that it’s happening at a high rate througout the day. Peter has said that you’re in ketosis if a blood meter gives you a ketone reading (beta-hydroxybutyrate levels) of between about 0.5 and 3.0 mM.

      See Peter’s Ketosis post, which also speaks to health concerns (or lack thereof)…
      http://eatingacademy.com/nutrition/is-ketosis-dangerous

      Yes you can determine if you are in ketosis youself. Peter indicates that he uses a blood glucose & ketone meter, like diabetics use, wherein you prick youself in the finger and analyze the drop of blood for either glucose or ketones (there are also urine sticks such as Ketostix, but they are said not to be as reliable).

      If you look at Peter’s Books and Tools tab:
      http://eatingacademy.com/books-and-tools

      …scroll through that, and you see a bullet point about a ketone/glucose meter he uses, the Abbott Precision Xtra. In the comments someone also mentions a similar product, Novamax Plus. You can find these on Amazon, etc. (Very cheap).

      “Ketogenic” refers to the type of diet that enables you to enter into and stay in ketosis. Someone in ketosis is necessarily eating a ketogenic diet, or they wouldn’t be in ketosis. Kind of hard to do, you must severely restrict carbs (some say less than 50g a day, likely even less than that), and the tricky thing is you must ALSO limit protein, as too much protein also prevents ketosis. You necessarily get the majority of calories from fat.

  171. Corey  May 15, 2012

    Peter, love your site. Much like you, I’ve been eating very low carb for quite a while now. I’m concerned that this is inducing some level of hypothyroidism, as my free T3 values have been quite low over the last year and a half. My concern is that as a result of this, my LDL and total cholesterol values have gone up quite a bit (I do know all about the different types of lipoproteins, tests, etc., just simplifying here). I take the same amount of fish oil as you. And last year, while I was taking niacin, my HDL got up to 95; but I stopped the niacin for a while, and my profile worsened.

    So I guess the question is, is the low carb eating negatively impacting my thyroid/cholesterol profile, or could it be that my ratio of protein to fat is too high? Any opinion?

    (reply)
    • Peter Attia  May 16, 2012

      Too much going on here for me to guess or speculate without knowing a lot more.

  172. susan  May 17, 2012

    Your diet is not for people who react to salt is it? I’m sure you know a lot of about health and far more than I, but I would bloat up badly on cheese and salami and would look and feel horrible. I notice with the comments here if there is “too much going on” you decline to comment. therefore your personal diet is of little value to anyone else.

    (reply)
    • Peter Attia  May 17, 2012

      Really? All this work just for me, huh? Too bad I’m the only one who can benefit from this. Sorry for the sarcasm, but if this is what you think, you’ve missed the boat. Who said you need to eat cheese and salami just because I did during a week when I happened to record what I ate for readers?

    • Peggy Holloway  May 18, 2012

      Peter:
      I want to add that my partner and I are doing amazingly well on a ketogenic diet – he is 70 and I am 59 and we can bike rings around much younger cyclists. As I said in my other post, my diet is very much like yours in smaller quantities. I just had brunch (after a 1.5 hour bike ride with no breakfast except for a cup of coffee with heavy cream) of 1 piece of bacon, 2 eggs fried in the bacon fat with a pat of butter and some cheddar, and a cup of homemade beef broth. I won’t eat again until dinner which will be porterhouse steaks, asparagus in olive oil, and a salad with homemade dressing. I am never hungry and have amazing health and energy for someone with a horrendous family history of insulin-resistance and metabolic syndrome-related health problems.

    • Peter Attia  May 18, 2012

      Wonderful to hear.

  173. Peggy Holloway  May 17, 2012

    Peter:
    If you happen to get this comment/question:
    My daily diet is much like yours (though many fewer calories). I am a 59-year-old female who has been eating this way for 12 years. The past 5 years, I have been cycling, increasing my miles and speed each season. I am registered for a 6-day ride across my state and I’m really concerned about how finding appropriate food out in the rural areas of this state. This is an organized ride with communities providing the meals, and I fear that high-carb food will be the norm. Our luggage (limited to 2 40-pound bags max) is transported in large trucks and the weather will be very hot, so bringing food along is problematic. Any ideas on what I can take along that is non-perishable and easily portable for emergencies? I don’t ever eat during a ride, so that isn’t an issue. I just want to have something along in case the meal options aren’t suitable.
    I corresponded with Steve Phinney about this last summer, and he had some ideas that didn’t work all that well so I’m asking you in case you have better ideas.
    Thanks.

    (reply)
    • Peter Attia  May 17, 2012

      Hmmm. In such situations, I carry some of my own food (e.g., pre-packaged cream cheese, nuts, oils, super starch), and just rely on being very picky about what I eat from what is being provided. If you can at least get some eggs for breakfast, you should be ok.

    • Peggy Holloway  May 18, 2012

      Will the cream cheese do OK unrefrigerated in a hot truck for 6 days?

    • Peter Attia  May 18, 2012

      Not sure about that…I would try an experiment before the trip with the same conditions and see if it lasts. For me, it easily lasts a few days at room temp, but I’ve never subjected it to those conditions. Another option to buy some really high quality pemmican, carry your own coconut oil, coconut butter, nuts, etc. All of that stuff will easily be preserved.

    • Edward  May 19, 2012

      You might try making pemmican. It is mostly fat and keeps very well.

  174. jack  May 18, 2012

    Great article. What kind of salami? Applegate? Trying to find passtured salami.

    thanks

    (reply)
    • Peter Attia  May 18, 2012

      I generally go with an organic variant from whole foods. Mostly just looking to avoid the added sugar and abx.

  175. jack  May 18, 2012

    Thanks!

    (reply)
  176. Edward  May 19, 2012

    Peter, I believe you said that you had to keep your protein consumption at around 150 grams per day or below in order to stay in ketosis. How does protein interfere with the development or maintenance of ketosis? Is it metabolized to glycogen or something?

    (reply)
    • Peter Attia  May 19, 2012

      Correct, gluconeogensis.

    • KevinF  May 19, 2012

      OK let me sneak in a question here that’s been bothering me. I’ve read that ingestion of protein stimulates insulin release – just not to the degree & with the glycemic impact that carbs do. (Though I believe i recall in Reaven’s ‘Syndrome X’ book that he summarily dismissed dietary protein because it stimulates insulin).

      Question: does protein itself *directly* cause insulin release, or is it only when excess protein is converted into glucose that the body reacts to the glucose with insulin release? Thanks!

    • Peter Attia  May 19, 2012

      Both. In the case of the latter, it take place as hepatic glycogen is converted to glucose and exported.

  177. Jeff G  May 19, 2012

    What about those of us that are lactose intolerant?

    What are some alternatives?

    (reply)
    • KevinF  May 20, 2012

      To butt in with anecdotal stuff Jeff, have you gone very-low-carb yet and made sure you’re still lactose intolerant? I’d thought I was increasingly lactose intolerant for nigh on 15 years. Spent a fortune on Lactaid. Then when I went low-carb/high-fat I almost immediately realized that, whatever else had been going on, I wasn’t lactose intolerant. In the relative absence of carbs, I can eat cheese, whipping cream, sour cream, butter, yogurt, and there is nothing like lactose intolerance in my life. I even drank a glass of regular milk to check this.

      To requote something I saw from another low-carber, I never even fart anymore…

  178. oriana  May 21, 2012

    Is there some way you could show what your wife eats on this diet? I am a highly active marathon woman and would like to see what a woman would eat like on this if possible? Would it still be 4000 calories like you? I run 20 miles on weekends and about 10 miles a day.

    (reply)
    • Peter Attia  May 21, 2012

      Yes, I’ll do that at some point. She eats less than me, both in absolute quantities and in fat intake.

  179. Susan Boyd Reilly  May 21, 2012

    Hi Dr Attia,
    How do you fuel your long endurance sessions such as your swims? While training for IM Texas I lost virtually no weight despite 4x the weekly volume of my normal exercise regimen. I discovered your site 6 weeks before the race and lost 10 lbs in 2 weeks by simply removing the engineered nutrition (all fructose, glucose or maltodextrin based) from my diet. My coach went ballistic at this point and told me that I would cause myself great harm if I continued. So I went into the race fit but fat and ended up DNFing due to nutrition issues anyway. Any advice you can give would be greatly appreciated as even books that I have found that are supposedly low carb nutrition plans for endurance athletes recommend eating sugars during long traing sessions and races.

    (reply)
    • Peter Attia  May 21, 2012

      Susan, sorry to hear about your DNF, but don’t be too hard on yourself – it takes much longer than a few weeks to train your nutrition for an IM. I rely pretty heavily on nuts, cream cheese, and super starch. Check out my posts on the interplay of exercise and ketosis.

  180. Susan Boyd Reilly  May 22, 2012

    Thank you so much for your answer and I apologize that I didn’t find the posts myself despite spending hours on your site. It is exactly the information I was seeking. My plan is to only use my coach’s training plan but follow your nutritional strategies until IMTX 2013. Thanks again!

    (reply)
  181. oriana  May 22, 2012

    Any suggetions on what to eat pre marathon(26.2 miles) and post? In the past on my fruitarian diet I would have fruit or fruit juice. Since converting to high fat I don’t know what to eat before a big race.I would be so weak and starving after eating all fruit before that I would pigout on about everything after a marathon and I would always gain weight while everyone else lost!

    (reply)
    • Peter Attia  May 22, 2012

      See previous comment about interplay of exercise and ketosis.

  182. Brian  May 23, 2012

    Hi Peter, I’ve been very low carb for 8 weeks now, without any problems. I guess I’m one of the lucky ones that transfers into ketosis without any major issues.
    My questions are :
    1) when is the best time to measure bloodglucose after a meal, my aim is to see what impact different foods have on my body and how well I tolerate carbs in different form. Thinking of doing a selfexperiment on UCAN superstarch during my long runs.
    2) to ensure a correct fasting value bloodglucose, how many days do I need to measure my fasting bloodglucose to get a fairly accurate number?

    (reply)
    • Peter Attia  May 23, 2012

      1. Probably within 1-2 hours, but be consistent.
      2. Very tough to say, as it depends on duration of fasting, and last meal, etc. A week probably gives you a good range.

  183. Garry  May 24, 2012

    Peter,

    I’ve been reading up on MCT and it’s role in everything from fat oxidation to its support of ketosis to the possible benefits for exercise performance. (I’d like to give a nod to AJCN.org for being such a fantastic resource). Would you mind sharing literature references for the reasons you use it as a supplement? Also could you tell us what MCT product you use? Thank you very much.

    (reply)
    • Peter Attia  May 24, 2012

      Lots out there Garry. Just search Pubmed. I use the brand “NOW.”

  184. DavidM  May 28, 2012

    Hi,

    I was wondering about supplementing potassium and magnesium. I get tired easily, and have to sleep quite a bit more whilst being ketogenic.
    I noted you mentioned you no longer supplement potassium in a comment in the books and tools section – why is this the case?

    (reply)
    • Peter Attia  May 28, 2012

      For me, with enough sodium and magnesium, my potassium levels remain normal. If I started get cramps I would add it back.

  185. Gill  May 28, 2012

    Hi Peter
    I am really enjoying the benefits of being low carb having survived the transition which was miserable! Since going “no carb” a lasting problem i have is a foul taste in my mouth! Food and drink has lost all taste.Is this usual? is there something i am missing or should be adding..zinc??

    (reply)
    • Peter Attia  May 28, 2012

      Hmmm. I don’t know. I’m curious as to whether it will pass, in time?

  186. Mark Jacobs  May 29, 2012

    Peter,
    I have lost 30 pound since starting VLCHF and really enjoy all the food you shared in this post. My wife is very interested and started by eliminating sugar. She wants to loose weight and likes the way she feels eating lower carb but she does not like the bacon, sausage, and other fatty meats like I do.

    The problem for her is constipation, and a feeling of hunger since she is not getting enough fat and salt in her diet. (I remember from one of your othe posts how salt, water, and fat are needed to keep things moving along) what “good fats” can I try to introduce her to? Extra olive oil on her salad? She is adamant about staying low fat, turkey bacon, skinless chicken…. I don’t want her to give up when she sees she is not lloosing weight as quickly and goes back to lean cuisines for lunch since she will not satisfied without more fat in her diet.

    Please share any web sites or very low carb high fat foods that I can cook for her.

    (reply)
    • Peter Attia  May 29, 2012

      Mineral oil and MCT oil can really get things moving.

    • KevinF  May 29, 2012

      Mark, in addition to what Peter says, authorities like Volek, Phinney and Eades recommend plenty of water through the day, as well as supplemental bullion (I use paste in a jar called “Better than Bullion”, which makes all the cube bullion seem totally nasty to me).

      A helpful thing I’ve found is to add flax meal (ground flax seed), and a great way to eat it is it to take a couple tablespoonfuls and prepare it like hot cereal with hot water and just a bit of cream and butter. It’s a small volume of stuff but high in fiber, all fiber-carbs and no net carbs. In fact, this may work too well. You might want to ease that in gradually.

      As to recipes, you might try acquainting yourself with following, and of course there are tons of other websites and books if you do a bit of Googling:
      http://everydaypaleo.com/
      http://yourlighterside.com/your-lighter-side-cookbook/

    • Mark Jacobs  May 29, 2012

      Thank you Dr. Peter and Kevin! That is exactly what I needed. I am simple when it comes to food, eggs & bacon or sausage for breakfast, ham & cheese with celery of cucumber to munch on for lunch, salad with some fatty steak or chicken thighs for supper and I’m good to go. My wife needs something more than that.

      I look forward to looking into the resources you gave. Thanks again to you both!

  187. Judy  May 29, 2012

    Peter, first, thx so much for answering a zillion questions.
    Do you worry at all about processed meats, salami, etc.?
    I read recently where AMA warning about nitrites, nitrates.
    You are an inspiration.

    (reply)
    • Peter Attia  May 29, 2012

      Judy, it’s not really clear such foods are actually “bad for you,” as the “data” implicating them are observational and not experimental in nature. It’s probably more likely that folks who tend to eat a lot of these foods also eat other foods, and it’s the other foods (e.g., sugars, highly processed grains) that cause the trouble. That said, I don’t think I eat nearly as much of these foods as people assume. Remember, you’re looking at a small snapshot of my eating patterns.

  188. asil  May 29, 2012

    HI, Great info here! I am struggling with weight loss on low carb diet. I am keeping the CHOs to around 50-60/day after slowly decreasing them. Energy was low so i upped the total fat and am a bit better. Protein and fat are around 85g/day. I am exercising 4-5x/wk. In the past month i have lost about 2.5#. I am eating around 1400 kcals/day, not that the number matters from what i am reading. have been dizzy over the weekend and bumped up the sodium to aourn 2400 mg/day. It helped a little. How much sodium is recommended for female 160# on this plan, roughly? Any other tips would be appreciated. Since there is no rule of thumb and we are all different, do i play around with adjusting amounts of pro/fat/carb? Thanks for any help! Asil

    (reply)
    • Peter Attia  May 30, 2012

      You’re definitely on the right track with your approach to experimenting with things. Keep the following point in mind: it can easily take about 4 or 5 days for any change you make to take effect. I’d recommend few simultaneous changes, so when you make a change or two, try to hold everything else the same for a week, then modify again, based on the result. For what it’s worth, I consume about 4-6 gm of sodium per day, depending on activity level.

  189. Miss C  June 1, 2012

    Hi Peter, thanks for sharing this info. I’m 27, female, competitive cyclist. After reading your blog and the books of Taubes and Phinney/Volek, I’ve decided I want to give keto adaptation a try. My goal is to lose 7-8 pounds that I absolutely can’t get off using conventional diet.
    My question – I’ve been on a LCHF (< 50g carbs) diet for 8 weeks, no fat loss and blood ketones are 0.2 according to my meter (Precision Xtra). What gives ? The carbs I eat are from nuts and dairy. From your experience, what could possibly had gone wrong? Any suggestions to what I should do? I do experience some benefits as decreased hunger but not a single gram of fat was lost. I'm 5'7, 140 pounds
    Thanks!

    (reply)
    • Peter Attia  June 2, 2012

      Two thoughts: 1) protein might be too high, and/or 2) you’re quite sensitive to dairy and might want to reduce it.

    • Aviv  June 2, 2012

      Ahhh finally another road racer, please keep me update at how it goes for you here on the blog, I’m on the same quest like you, yet still experimenting, still in and out of the “misery zone”. I am recording all power files and data, so I would be able to share my results as for the before and after when I finally get fully keto-adapted.

    • Scott M.  June 11, 2012

      Miss C, I’m 49, male, non-competitive on the elliptical trainer. Like you, I started LCHF after I read Taubes and Dr. Attia, for I wanted to lose 20 lbs. I went to low, Atkins-induction-like levels of carbs for 2 months, saw the ketone level slowly increase, and, for my efforts, lost precious little fat. 4 mos. in to this LCHF business, I’m back to my starting weight. I’m not ketotic, but I’m still very low-carb. “This sucks,” I lamented. I gave up pizza and ice cream for what reason, exactly?
      I asked Dr. Peter essentially same question you asked: what gives? Dr. Peter suggested my protein intake could be high.
      My unsolicited response to you and to Dr. Peter? First of all, frustration at the short-term inability to reach lofty goals does not constitute persuasive grounds to return to carbs, at least for me. What does one do, go back to eating donuts? No chance. Like you, I’ve exp’d decreased hunger since going LCHF. That benefit alone provides sufficient cause not to return to high-carb ways. Seemingly paradoxically, my energy level has increased while my appetite has diminished. A second point, really an extension of the first, is that perhaps a couple or even a few months stand as only a brief period of normalcy in a long history of HC binging. LCHF is the new normal, yet some bodies, mine certainly, are slower to respond to the new normal. (Though I admit, I still wonder at how effect has not quickly followed cause here. How can the ketotic body NOT burn fat? As Taubes writes, some bodies are really really insulin resistant.) I counsel patience. I don’t understand the chemical processes which will make up/are making up the transition to normalcy, but I’m willing to bet that years of abuse can’t be undone in a few months.
      Thirdly, I’ve only very recently, despite Dr. Peter’s word of caution, decreased protein. I think it was societal conditioning–years of colorful, cheery advertisements preaching the low-fat route to good health, the “received wisdom” of LFHC and consequent invective of everyman, e.g., “OMG, look how much butter is on that!”–which dissuaded me from increasing fat intake to compensante for decreasing protein consumption. I couldn’t help but cringe at the thought of eating another fat-laden piece of bacon, lifting spinach & onions out of a buttery pool, or letting that olive oil pour plentifully over the greens. In the past two weeks, though, I’ve gone higher fat, higher leafy-veg, and lower protein. The results have been satisfying. Maybe I’ve turned a corner, or, consistent w/my above comment on timing, maybe it’s too early to say. In any event, I’m pleased, it seems to be working, and I’ll stay w/this modification to see what happens. I would encourage everyone to self-experiment, while remaining LCHF, to find out what works best for him/her.
      Other people have benefitted more noticeably from LCHF than have I. Perhaps their success also inspires me to stay the course, logic here being that if it worked for them, and we’re all made of the same stuff, it has to work for me, eventually. But I have already benefitted from LCHF, and I see no good reason now to abandon the course.

  190. Edward  June 4, 2012

    Hi Peter,

    Exactly how is alcohol, as in hard alcohol, not wine or other drinks that contain some carbohydrates themselves metabolized by the liver in terms of how it affects attempts to gain the benefits that reducing carbohydrates in one’s diet bring? I don’t mean “is it okay to drink?”

    Rather, I’m thinking about how one low carbohydrate diet historically was known as the “drinking man’s diet” as you already know, and the idea was more or less, “to lose weight, have a martini, a steak by itself (no baked potato) and watch the weight fall off.” It seems like drinkers hit a bottom in their weight loss that seems suspiciously like it might be due to the alcohol, even hard alcohol.

    (reply)
    • Peter Attia  June 4, 2012

      Ethanol is metabolized in the liver in a manner very similar to fructose. Excess is typically exported in VLDL particles as triglycerides.

    • Edward  June 5, 2012

      So this similar metabolic pathway for ethanol and fructose indicates that ethanol consumption obstructs attempts to enter or maintain a state of ketosis just as fructose does?

    • Peter Attia  June 5, 2012

      It’s entirely clear. I don’t think I’ve seen this exact question studied, though it’s plausible.

    • Robin  February 13, 2014

      Interestingly I have heard that alcohol tolerance seems to be reduced when in ketosis (this is all anecdotal but it seems to be a common complaint).

      I also understand that ethanol is metabolized via the same pathway that is the primary pathway for gluconeogensis. Is it possible that drinking in excess while in ketosis could inhibit glucose production leading to hypoglycemia over a period of several hours? This could explain the increased intoxication?

    • Peter Attia  February 14, 2014

      Anecdotally, I’ve observed the same. I actually consider this a benefit of ketosis, rather than a detriment. Same buzz (if that’s what one is looking for); half the liver toxicity, assuming this effect is real.

  191. Amy Phillips  June 4, 2012

    Thank you for all your work :) I’ve read your blogs and watched some interviews where you talk about being an endurance athlete and how you fuel without carbs. I am an ultramarathon runner who persisted on mostly carbs and sugar until May 18th of this year where I cut out sugar and tried to limit carbs to 20-40 daily. I quickly have become the black sheep amongst my friends and running community. I’m following Atkins induction basically, eating meat, cheese, spinach, broccoli. I ran a half marathon 2 days into the change and it was painful which I expected so took it slow. I’ve been laying off exercise since then, I have done a couple of 5ks here and there. I’m drinking powerade zero to get electrolytes. I started the change because I’m tired of being addicted to sugar and I look like your before picture. I only have like 15lbs to lose. I want to know how your information carries over to me? I can’t be in ketosis all the time, it’s a delicate state as you said. Are you advocating being in ketosis for other people? If I’m not in ketosis, is my body going to be relying on carbs to fuel my workouts? I have a 50k Saturday June 9th, I am not ready but I signed up with friends so I’m going to try to do it. What can I do to fuel my body? Should I go back to gel and gatorade for a day? I’m being pressured to carbo load and I read about super starch, could I take a packet of super starch the day of? I don’t get how to train my body to run off of fat if I’m not in ketosis or have undetectable level of insulin like you. So I know what you do to fuel your workout, but how about me or other athletes who have some carbs like veggies in their system? Will this stall the access to fat stores?

    (reply)
  192. JK  June 4, 2012

    Hi,

    I’m wondering what your take is on goat’s milk. I have avoided dairy for a long time, but I recently added goat cheese to my diet and really enjoy it. I realize that goat’s milk has more carbs, but am wondering if you think it is fine as long as carbs are below 40g a day in total. I remember you saying somewhere that a glass of milk will bump you out of ketosis, so I’m just wondering if that holds true for goat’s milk…

    Thanks!

    (reply)
    • Peter Attia  June 4, 2012

      I don’t know enough about goat milk, specifically, to comment.

  193. Alex  June 5, 2012

    Hi Dr. Attia,

    Very interesting info and makes a lot of sense to me. I would like to try it but have one problem.

    I had my gall bladder removed last year. Is high fat diet still suitable for me? Thank you.

    (reply)
    • Peter Attia  June 5, 2012

      Not having a gallbladder will not prevent you from removing most carbs from your diet. You may need to ease into your fat intake, but this should not be a long-term issue. Start easy.

  194. Jack  June 6, 2012

    Thanks for your efforts and your approach. I’ve lost 40 lbs over the past year on various LC diets. I feel great,but I’ve stalled. Not too disappointed because I haven’t gained the weight back. I’m implementing your suggestions to try and take off the last 20 lbs. I’m curious of your views on cold thermogenesis. You’ve spent a lot of time in cold water and this is a hot topic these days.

    (reply)
    • Peter Attia  June 6, 2012

      Jack, while it’s true that I’ve spent more time in sub-60 degree F water than most humans, I actually *thought* it had the opposite NET effect. In other words, I probably generated more heat due to the cold, but my body seemed to “want” more than anything to store fat to protect me. I often wonder if this is part of what drove me to be such a carbaholic. My body NEEDED to be fat to survive what I was doing to it.

  195. Eric  June 6, 2012

    Thanks for all the great work yu are doing with the site as well as NuSI. I’ve got a backpacking trip planned for this summer and I was wondering if you had some suggestions for some calorie dense, high fat, non-perishable foods to keep my daily calorie intake above 5000 while I’m at high altitude. So far I’m thinking lots of nuts and pemmican. Any suggestions? Thanks

    (reply)
    • Peter Attia  June 6, 2012

      Those are exactly the things I’d bring.

    • Jack  June 6, 2012

      Thanks for responding. I’m trying to figure it all out. It’s not easy to know who to listen to. Your words ring true. Please keep it up – you’re appreciated.

  196. Kathleen Turner  June 9, 2012

    Hi Dr. Attia -

    I am truly enjoying reading all of your blogs. I read “why we get fat” a year ago and was on the low(er) carb wagon for about 6 months. I kept my carb intake to 50g-100g a day. Most days were right around 75g. I did not lose the massive amounts of weight that I’ve read about people losing but I also wasn’t checking to see if I was in ketosis.

    My question is, is it possible to be low carb and achieve weight loss without being in ketosis, or is ketosis essential to the weight loss process? I should mention that I am an insulin dependent diabetic, so I know that low carb is good for my health and to reduce my insulin requirements, but I would also like to lose some of the weight too.

    Thanks for doing your part to legitimize the low carb lifestyle through your meticulous calculations/formulas/graphs, etc. As an economist, I appreciate all of these things!

    (reply)
    • Peter Attia  June 9, 2012

      Ketosis is not necessary at all to achieve weight loss. For some, like me, ketosis is an easier place to be for several reasons (e.g., more efficient utilization of fat for energy, psychologically easier to have a limit on carbs, freedom for brain from obligate glucose dependency).

  197. David  June 12, 2012

    I’ve been feeling quite tired whilst on the diet, usually cant last the whole day without getting a real urge to sleep and snooze. I’m around a month and a half into ketosis (been keeping track with urine dipsticks only) and it says I’m in ketosis.

    I take fiber, approx 20grams in the form of chia seeds with each meal. Is the fiber affecting the absorption of fats contained in my meal? most of the fats in my diet is coming from olive oil. I think I’m doing something wrong, because I don’t feel energetic, and still quite lethargic despite being in ketosis for >6weeks.

    Thanks for taking the time.

    (reply)
    • Peter Attia  June 12, 2012

      David, lots of comments on the blog addressing this concern. Check through old comments in the section and other pertaining to ketosis.

    • KevinF  June 12, 2012

      David, I’m not going to pretend to give dietary advice, but I can’t imagine what you’re eating. Seems to me 20 grams of fiber each meal from chia seeds is crazy. That may be too much fiber supplementation and a massive dose of ALA Omega 3. And if you get “most” of your fat from olive oil I can’t imagine what you’re eating. Nothing but salads and olives? For most people a ketogenic diet implies some veggies but a good dose of things like eggs and meat, & usually some nuts and cheese.

    • David  June 12, 2012

      Hi thanks for your reply, I tried before posting to search the forum for the word ‘fiber’ using the tool and didn’t come up with comments directly addressing this. I do however get the impression from the comments that too much fiber can be a bad thing.
      I cant really find much evidence on this topic, only anecdotal evidence that it may reduces fat absorption. But then its also good in the sense it slows down carb absorption and reduces insulin spikes.

      some would call my dietary style unpalatable, I’m trying to reduce the diet down to the most basic elements.
      I have olive oil, including shots. 3 spoonfuls of chia seeds each meal. in the morning i do have 3 raw eggs, bit of milk and cinnamon. a protein shake here and there (keeping total protein below 120g) and for dinner either a steak, poached or roasted chicken. Oh and so more olive oil. I supplement with Ca, Mg, fish oil, sodium with salt and beef stock.

      still feel terrible, and its not a function of my relatively bland diet!

    • KevinF  June 13, 2012

      OK David, I don’t know why you’re assuming your problem is NOT your diet, one glance at that and my non-professional opinion is *OF COURSE* the problem is your weird diet. Why not try eating actual food three times a day and see how you feel then? Food being something you have to bite into and chew, so let’s say olive oil and chia seeds don’t really count as food, those are more like things you might put ON food. Click on Peter’s “What I actually Eat” link if you need ideas.

    • David  June 13, 2012

      Thanks again for you comment KevinF, I may have misled you with the breakdown of my diet.

      Breakfast: 2 shots of olive oil, 3 raw eggs, milk and cinnamon shake with a teaspoon of salt. MCT oil and black coffee
      Lunch: Protein shake, two shots of olive oil, 2tblspoons of chia seeds. I’m doing an Emergency shift in hospital atm, and there isn’t much time to go and find a low carb or prepare a low carb solution.
      Get home: Another 2 shots of olive oil. MCT oil and coffee.
      Dinner: 1/2 a poached chicken with a bit of soy and sesame oil. 2 more shots of olive oil, 2 tblspoons of chia seeds. 500ml of beef stock.
      Suppertime: Green salad with balsamic and olive oil (little bit), cheese and 50grams of Wagyu smoked beef slices. 2 more shots of olive oil, 2tblspoons of chia seeds

      And fish oil, magnesium, multivitamin, Calcium and vitD supplement when I can spaces throughout the day.

      I wouldn’t say there was anything particularly out of the ordinary except for the additional shots of olive oil and the chia seeds. I just cant physically consume that much, so liquid calories are a better option for me.
      I get a low amount of saturated fats in a day, is that the issue? I need more saturated fats and less poly and monounsaturated?

    • Nina  June 13, 2012

      I agree with Kevin, David. You need to eat real food, take away the chia seeds & drinking olive oil.

    • KevinF  June 13, 2012

      You may have reasons for eating that way that you haven’t fully explained, but it’s still an abnormal diet so it’s no surprise you’d feel suboptimal. Maybe your problem is not your diet — but seems to me common sense that that’s the first thing you should alter to see how it works. I’m not a dietician but that is clearly a strange diet. People don’t drink shots of olive oil — much less EIGHT shots of olive oil a day. I daresay olive tree farmers in Greece don’t take shots of olive oil.

      Some people might have a teaspoon or two of chia, but you’re downing a multiple of that. That much chia seeds are delivering a huge dose of like 10,000 – 12,000 mg of ALA Omega 3 polyunsaturated fat (as well as unnecessary amounts of fiber) — far in excess of any recommendation I’ve ever seen for supplementing. The Tarahumara Indians would think you’re a crazy gringo. And then you take fish oil supplements on top of that. I’d guess all that chia oil is drowning out any fish oil you take.

      I’m not sure how you poach a chicken but beware that you’re not draining away the nutrients. (Old dictum, if you boil meat, you need to drink the broth). If I were you I’d much prefer at breakfast to scramble up some eggs in coconut oil. That won’t take much longer than setting up a blender to make a shake. If you need more calories, you can use more oil, more eggs, and pour in cream, also pour in heavy whipping cream into coffee. For lunch maybe you could tow along a bag of lucnhmeat and cheese.

      BTW, aside from diet, if you have problems getting sleepy is it possible you have sleep apnia? Do you snore? I used to have a real problam dozing off in the afternoons, then eventually I discovered my problem was sleep apnia.

    • David  June 15, 2012

      Thanks again for the replies. I’m actually a medical doctor myself, and I do not have any medical conditions that I know of.

      my diet may not have much variety, but I really dont see what the issues here.
      The ketogenic diet is more or less 90% fat. Does it really matter where this is coming from? If its coming from a single source or multiple sources. At the end of the day it is all fat. As long as you can absorb it, your body will use it. The only distinction is the type of fat. I consume much less saturated fats than other people on the diet, and more of the good fats.

      Fiber is unnecessary? Some argue that Inuits never needed fiber and they’re ok. Well they have a life-expectancy of around 67, and so that is generally considered young in terms of cancer. and fiber prevents colorectal cancer. Not something that the Inuits would have gotten since most would have died of other causes.

      The amount of ALA I consume may sound like a lot, but its all ALA, and not much will be converted to EPA and DHA. and so should it not count as any other fat? I also supplement with this amount to try to keep my omega 3 to 6 ratio as close to 1 as possible (with the amount of olive i consume).

      To me, this is an experiment, and so the taste really does not matter to me. I see my body as a machine and trying for a way to run it more efficiently. This means that focusing down on a few food sources is more ideal for my goals. I do not eat for enjoyment or taste, I do it simply because I have to fuel my body and brain, and do other more interesting things in life :)
      How you can appreciate that.

    • Peter Attia  June 15, 2012

      The amount of fat in the diet is highly dependent on the number of calories. For most folks, it’s actually closer to 70-75% fat. In fact, for me, these days, fat is about 75% (about 50% MUFA, 30% SFA, 20% PUFA). I’ll be writing about fiber at some point. All the “evidence” implying we needed is pretty weak epidemiology, actually.

  198. Tina  June 12, 2012

    Hi Peter,

    unfortunately I have severe problems with lightheadedness, probably due to my ketosis?!
    I even fainted a few weeks ago, although I always make sure to be well hydrated. I’m a bit worried now that ketosis is not the right thing for me. By the way, after an initial weight loss of 18kg with the help of a high protein, no carb, little fat diet, I’ve been in ketosis for about 6 weeks in order to maintain which works flawlessly ;-) Please let me know whether my lightheadedness might be gone as soon as I’m ketoadapted?! Thanks a lot.

    (reply)
    • Peter Attia  June 12, 2012

      Tina, as I’ve suggested to others with your symptoms, sounds like a combination of dehydration and low sodium intake. How much sodium do you supplement per day (beyond what you get in your food)?

  199. Tina  June 12, 2012

    When I was in hospital (because of that unconsciousness) they checked my blood and didn’t find any lack. (NA was 136 mval/l which seems to be fine?)
    I supplement 1 gram sodium per day and make sure I salt everything.
    I drink about 3 litres per day as well.
    Just to make sure I understood it correctly: I thought lightheadedness only occurs during transition to ketosis but once you are in ketosis most people don’t have symptoms like that anymore?!

    (reply)
    • Peter Attia  June 12, 2012

      Serum sodium levels are an insensitive way to assess. I would like to try to help you troubleshoot this more, but I can’t do so responsibly in this fashion. I’m hopeful others will chime in.

  200. Bob Jenson  June 14, 2012

    Hi Peter,

    I’ve read your stuff on thermodynamics and weight loss but I’m still confused as to this question: Can I eat an unlimited number of calories from dietary fat and not get fat?

    (reply)
    • Peter Attia  June 14, 2012

      Unlikely. At some point your body, even in a low insulin environment, can’t expend of the excess energy quickly enough and you’ll be forced to store it.

    • Michele  June 15, 2012

      Hi Peter, I know you have A LOT on your plate at the moment – my assumption would be that to get to the point where your body is forced to store the excess energy even in a low insulin evironment you would have to probably consume inhuman amounts of fat? (I’m not talking about protein because I know this does provoke an insulin response at a certain level.) Because otherwise you’d have to be bedridden (= no exercise, no daily activity), plus be hypothyroid (= low basal expenditure) for this to happen? (I’m not sure what to think about digestion in terms of “energy out”)

    • Peter Attia  June 15, 2012

      Digestion accounts for “energy out” in 2 ways: 1) it requires energy to break down food (some more than others), 2) undigested food can leave the body in stool.

  201. fiona  June 15, 2012

    Hi Peter, Great information on your website. Thank you. My husband and I have recently started eating low carb. Neither of us is overweight but we are interested in the health benefits of LCHF. During my first week I had one “hot flash” but none since. He gets hot flashes several times a day and never had them before the low carb diet. I am curious to see if you know what might be causing this. He does supplement with broth at least twice a day.

    (reply)
    • Peter Attia  June 15, 2012

      Interesting. This is not a side-effect I’m familiar with. Anyone else?

    • Michele  June 15, 2012

      I somtimes get “hot flashes” during meals but then again, I have known thyroid issues and the flashes happened when my thyroid replacement was dosed to high.

    • fiona  June 15, 2012

      Thanks for the input, Peter. It may be unrelated. It is helpful to know that you are not familiar with this as a side effect of low carb diets.

  202. Lucas  June 18, 2012

    Peter,

    When you chose to eat dairy, I am assuming since you are going to Starbucks that pasteurized dairy is not a concern for you? I am curious, as to you thoughts of raw dairy over pasteurized.

    Thanks again.

    (reply)
    • Peter Attia  June 18, 2012

      When I do, I ask them for the behind-the-counter stash of heavy cream.

  203. kb  June 20, 2012

    Thanks for the info. I just started a cyclical ketogenic diet and I discovered your site and found the info in line with other data that I have been absorbing. A former triathlete from the late 1970′s, I was a victim of too much carbo loading and ended up with Chronic Fatigue Syndrome. I am now 61 and normally on paleo diet keeping up my activity level with Mountain biking and a bit of lifting. I have read many articles about how the eskimos had a high fat diet and no heart/artery disease, tooth decay, cancer. In contrast the mummies of ancient Egypt show heart/ artery problems similar to our current society and they ate a diet high in complex carbohydrates with some vegetables and little fat. I have also read about the misaligned Campbell reviews of the China Study.

    I am hoping to soon be able to buy the upcoming Denise Minger book “Death by Food Pyramid”

    Just saying HI, keep up the good work.

    (reply)
    • Peter Attia  June 21, 2012

      Yes, I’m also looking forward to Denise’s book.

  204. John Kobeck  June 23, 2012

    Hi Peter;

    What is your take on statins? Is there a place for statins I this lifestyle, in your opinion?
    I ask this because I was on Crestor which I recently stopped taking. I feel much better without it. My memory has improved and less fatigue and muscle aches. My “good” LDL cholesterol is persistently low hovering around 30, while my “bad” cholesterol is usually in the 150 range with my carbs generally around 150. When I was doing a Paleo diet my carbs dropped to about 100, however the other cholesterol markers remained unchanged. I was in ketosis for about a month as evidenced by urinalysis. I dropped 20 pounds which was pleasing. Eventually I succumbed to carbs again after terrible brain fog. Thankfully I haven’t gained back the 20 pounds though.
    I’m now going back to a modified version of that diet, basically eliminating all sugars and most carbs.
    I am resistant to going back on the statins though, but I wish I could improve the lipid ratios. Any advice would be much appreciated. By the way, I’m 47, 6′ tall and currently weigh about 220. I was 245 before the one month Paleo. I would love to get south of 200. I haven’t been there since my teens :)

    (reply)
    • Peter Attia  June 23, 2012

      Statins are like hammers. Really good if you want to hit a nail. Not so good if you want to wash your car or put together a doll house. If used for a very specific purpose, they are helpful, but as you note, not without a cost in some people.

  205. john  June 24, 2012

    Hi Peter, glad i found the blog. I especially enjoyed the cholesterol explanations. My question is in relation to those (like me) who have familial hyperlipdemia. I am intolerant of statins due to sky high CPK numbers and the only way I lose weight is by low carb. Never seem to be able to last on it because I creep into the low fat version of it. I have read Ravsnkov’s book as well as Malcom Kendrick’s and they seem to leave a caveat in there for people with FH. My unmedicated numbers are in the 400′s and I hesitate to go with the high fat version of the low carb diet. Thanks for your thoughts and efforts.

    (reply)
    • Peter Attia  June 25, 2012

      I wonder if a sterol analysis would shed some light on other (non-statin) approaches you can try? A very good lipidologist should be able to help with this.

  206. Michael Altose  June 25, 2012

    Dear Peter,

    I am an anesthesiologist and a PhD in biochemistry, and learning about LCHF (thru Good Calories Bad Calories) a few years ago an epiphany for me – it was the first time nutrition/diet/metabolism all “made sense.” I’m looking forward to following your blog and reaping the benefits of your hard work reading, analyzing and (hopefully) contributing to the literature. I am truly appreciative and (almost) feel guilty exploiting your generosity in answering so many comments individually.

    I never had much weight to lose, maybe 10-15 lb (but switching to LCHF certainly helped me drop that quickly) and my serum lipids were decent (but switching made my HDL rise and my TGs drop by more than 50%). I did it because I had a feeling I was insulin resistant and wanted to live a long and healthy life. But recently I have found that even with relatively low carb intake (~50g/day, maybe less) and modest caloric intake (2000-2500 cal/day) in a 5’11″ 80kg male who does HIIT a few times a week, I easily gain weight – in the belly, of course! But if I significantly CALORIE RESTRICT (!!), the weight starts to come off (but with little if any hunger). And when I eat, I am then ravenous and need to keep a close eye on portion control. Your comments are welcome, but I am not asking you “solve the problem” over the internet, and of course I am experimenting with different variables as you would probably suggest.

    Here is my question: What is the meaning (metabolically) of a low-carb, high-fat diet in the ABSENCE of significant nutritional ketosis? Does a “middle ground” exist, where your carb intake is sufficiently low that your metabolism and caloric intake / loss are self-regulated within reasonable limits? Or maybe (as I am starting to suspect) if you’re on a LCHF diet (with appropriate protein intake) without ketosis, then maybe calories DO need to be “counted.” That is, you reap the benefits of low insulin levels, serum lipids are favorable, etc etc. But the fat burning just isn’t going to happen in the “low carb” way until ketosis occurs.

    Thank you again,
    Michael Altose

    PS I had also had the “hot flashes” mentioned above – I felt they were a sign of my increased metabolism when I went low carb.

    PPS If you added color to the Eating Academy logo, then maybe if the wreath were green then it wouldn’t look like wheat. Just a thought.

    (reply)
    • Peter Attia  June 26, 2012

      Michael, there is actually a paper coming in JAMA tomorrow by David Ludwig at Harvard (embargo ends at 4 pm ET today, so I can’t share copy) that looks at the metabolic adaptation of low-carb to low-GI carb to low-fat diet in obese subjects who lost weight. There is a clear difference between the 3 groups, so the switch is not purely binary. What probably is binary is the level of ketosis (and B-OHB production) required to “feel good” on a very low-carb diet. I, and others, have noted that unless B-OHB > 0.5 mM, very low carb (i.e., below about a 100 gm/day) can be pretty miserable.

  207. JK  June 26, 2012

    Hi,
    I’m doing fairly well on my ketogenic journey since I started adding MCT oil. The only issue I’m still having is with some bloating/constipation issues. I’m thinking of trying a magnesium supplement… I know that you use one and am wondering if you have any specific recommendations. What type and/or brands do you think are of high quality?

    Thanks in advance! And, of course, thanks for all your hard work.

    (reply)
    • Peter Attia  June 26, 2012

      Magnesium can certainly help with that when taken in liquid form. I find MCT oil and bouillon to be important, also.

  208. KL  June 27, 2012

    This is such an amazing and very educational blog.

    2 questions:
    1.Are you not eating way too much cholestrol?
    2. I’m in investment banking at the junior level. How is this lifestyle attainable given the hours (banking/consulting)?

    Thanks for this!

    (reply)
    • Peter Attia  June 27, 2012

      1. Read the series on cholesterol, starting at part 1
      2. I bet I work more than you do :)

  209. Joe  June 27, 2012

    Peter:
    You mentioned taking Carlson’s fish oil. I assume that you take in liquid form. However, it doesn’t keep while traveling, as it need to be refrigerated once opened. Do you take fish oil pills while traveling? If so, what brand do you use/recommend?
    Thanks,
    Joe

    (reply)
    • Peter Attia  June 27, 2012

      When I travel I use the same amount of gel capsules.

  210. Bill  June 27, 2012

    Peter,
    Great stuff, love it. Couple of questions with regard to protein and feeling lousy.

    Is the threshold to too much protein similar to not enough in that the body will utilize gluconeogenesis and take you partially out of ketosis?

    In the beginning wouldn’t it be wise when starting ketosis, for the first few weeks to avoid strenuous exercise and limit the breakdown of lean tissue via gluconeogenesis? Also, doesn’t it take a bit to really ramp up the metabolic machinery of efficiently utilizing ketonic bodies for fuel?

    When you talk about a protein threshold what is the most straightforward way for the average person to come up with that range of protein consumption that allows them to remain in ketosis?

    thanks
    Bill

    (reply)
    • Peter Attia  June 27, 2012

      Absolutely. Both amount and timing. For most folks staying in ketosis requires daily protein intake less than 120-150 gm.

  211. Ric  June 27, 2012

    Hi
    Would your wife share her recipe for sugar free coffee ice cream?
    I have been making my own ice creams for a few weeks but have not been able to get the consistency to come out right – Meaning when I freeze it it is hard as a rock –
    Thank You
    Ric

    (reply)
    • Peter Attia  June 27, 2012

      It’s embedded somewhere in these comments.

  212. Mo  June 28, 2012

    Hi Peter,
    I am in the transition period, considering ketosis. I have upped my fat intake and significantly reduced carbohydrate intake, trying to cut out sugars (sounds a bit like Atkins, but its not really). In effect my overall consumption has increased, and I find I become more hungry at the moment, having cut out the carbs. I am afraid that my increased consumption will end up leading to weight gain, especially as my fat intake has increased (I understand that fat does not make one fat, but culture has banged this into me). I am fairly active but by nothing excessive. As such, I do not know if this will be productive.

    I have only been on my second day of the process, so nothing to report. My aim is to lose weight. I am a trader, with high stress and an inability to leave the office during the day, and often working past 8pm, starting at 6am.

    In order to lose weight, will the simple transiion suffice? I have read a fair deal of your blogs and have tried to understand the approach on a theoretical level. As an example, I had scrambled eggs, spinach, tomatoes and chillies for breakfast (8am), some yoghurt with blueberries and macadamia nuts at 10am, lunch is chicken breast with cheese (1230pm), more yoghurt with berries at 4pm, and dinner of fish with vegetables at 8pm.

    I usually have porridge in the morning, with a few apples and carrots during the day, lunch of chicken breast and dinner of potatos.

    Your advice would be very much appreciated.

    Thanks very much!

    (reply)
    • Peter Attia  June 28, 2012

      Once I finish the cholesterol series and a few other things I’m planning a SHORT series on everything I’ve learned in 1+ year of ketosis. I think you, and many others, will find this post/series very helpful.

  213. Mo  June 28, 2012

    Just to be clear, the porridge etc is what I was having, but am now transitioning away from it into more protein and fat.

    (reply)
  214. Mo  June 28, 2012

    Thanks, Peter. I guess the main concern for me is my limited excerise regimen while at work… Would I need to reduce my consumption or is it irrelevant?

    You talk about insulin production and how the reduction of glucose and increase in fat and protein would decrease insulin production, which in turn causes the body from fat-storage to fat-burning, reducing fat oxidation.

    Can you please expand if you have a moment, in terms of whether diet alone, and levels of consumption (not particularly calorie counting) are enough?

    I look forward to your series on ketosis.

    All the best,
    M

    (reply)
    • Peter Attia  June 29, 2012

      For most people, a reduction in exercise or “deliberate” activity results in a natural decrease in appetite and consumption. If you’re eating the right foods, appetite is a very good guide to eating.

  215. Ellen Urcilola  June 29, 2012

    Hi Peter,

    Thanks for your wonderful posts. This past year has been quite a roller coaster ride for me and my weight problem.

    I have faithfully read Gary Taubes and you for the past 18 months. I have completely given up the sugar and flour with amazing results (lowering my blood sugar level and even managed to drop from 237 to 220).

    Then back in March I started eating more fat and tried to and add back some healthy food like nuts and Greek yogurt.
    I gained 7 pounds. My doctor (skeptical and a calories in/calories out guy) pointed to my weight and told me the only way to lose weight was to count calories and to eat way less. He then pointed out that my creatinine
    Level was high (1.13) and increased my lisinapril to 20 mg. Initially, I was devastated, however I truly feel I am on the right track. I just need to figure out what I am doing wrong. I think one of the most important lessons I learned is, I have to pay extra careful attention to when I am no longer hungry and stop eating. I also have to realize I fill up very quickly with little food. I think that is most of my problem. I was having a high fat snack (cheese and sopresetta) Then I would have dinner even though I was not hungry.
    Lastly, even though I love and crave the heavy cream and cheese, I am not sure my body can process them like everyone else here. Bottom line is I need to get the weight off so I can get off the darn blood pressure meds.

    So, when everyone talks about how easy it is, they don’t seem to mention that you still need to work really hard at it (at Least that has been my take). Thanks for allowing me to vent.

    Still a faithful follower

    Ellen
    posts) I can’t eat eat the quantities I would like.

    (reply)
    • Peter Attia  June 29, 2012

      Ellen, there is no doubt about it — the dietary changes are of variable difficulty for different people. It depends a lot on your genetics, the length of time you’ve been eating a higher carb diet prior to switching, your incoming metabolic limitations, and other factors. I am surprised that your doctor wanted to *increase* your lisinopril in the face of a rising Cr.

    • Jeff Johnson  June 29, 2012

      Dear Ellen – How to start -

      !. Your RMR(resting metabolic rate) is probabally something like 1800 calories – your BMR(maybe 2100 Max)

      2.Cutting these two numbers in half – 900 to 1050 calories is where your weight loss should start abd these two numbers will go down too 700 – 900 if ? and when ? you start to reach goal weight

      3. Protein should remain constant at 120-140 grams – thats a minimun of 750 to 875 calories from protein (whey Protein) – (meat protein will have much higher calories due to fat) alone (you can subtract 20% from these numbers due to protein wasting) -So –

      600 to 700 calories from protein

      4. That leaves 300 calories for fat or carbs – 200 for fat – 100 calories for carbs(25 grams)

      5. 70% protein – 20% fat – 10% carbs

      6. Ignore any and all advice about fat percentages – if you don’t – you will still weigh 230 pounds 20 years from now

      7. Buy a year’s and a half supply of Whey Protein – 54 – 5 pound jugs -

      8. I’m just a little bit concerned Peter hasn’t spelled this out – he knows this is what’s needed

      Fond Whishes – Jeff

  216. Mo  June 29, 2012

    Hi Peter,

    Thanks for your post. You are absolutely spot on. Since cutting out carbohydrates and sugars, my appetite during and after work has significantly reduced. This is pretty cool. I will continue to explore your posts as I find it intriguing.

    I will return in a couple of weeks with some observations on my own progress and on questions I will inevitably have. I apologise for taking so much of your time, but I thank you for your patience and the time you give each person on this blog.

    Thank you!
    Mo

    (reply)
  217. CanuckCrossfitter  June 29, 2012

    Hi Peter,

    Your website is absolutely fantastic – thanks so much for doing this. I always look forward to reading your new articles!

    I wanted to ask a question about your fat shakes. I notice that you use hydrolyzed whey protein. I was under the impression that this type of whey protein is less effective because the proteins are denatured during the hydrolyzing process. I was wondering if you wouldn’t mind sharing your reasons for choosing hydrolyzed whey over other types of whey.

    Thanks so much!

    (reply)
    • Peter Attia  June 29, 2012

      It has less to do with the fact that the protein his hydrolyzed and more to do with the fact that it’s a brand I can find with zero sugar or maltodextrin in it.

  218. Ellen Urcilola  June 29, 2012

    Hi Jeff, thanks for your input, but I thought It was suppose to be higher fat then protein. I am confused.

    (reply)
    • Ellen Urcilola  July 14, 2012

      Dear Dr. Attia, Scott M.

      Dr. Attia, many thanks to your wife for suggesting less technical jargon, or a separate posting for those of us who majored in, “other than biology.”. Not that I mind the jargon, it just takes a while to reference, and re-reference this valuable information. What are your thoughts on experimenting with whey protein (120g or less as a way to kick start weight loss? Have tried fasting, increasing fat intake, perhaps I need a different form of protein? Is there an increased risk of creatinine levels rising?

      Scott M.,
      Beautiful reflection on your weight experiences. I too am committed to staying the course and finding the combination that works for me. Continued success.

      Ellen U

    • Peter Attia  July 14, 2012

      It’s possible, but if you can get the same amount of protein from food, I’m not sure this particular source offers an advantage.

  219. Mo  July 4, 2012

    Hey Peter,

    I have often been told of the harms of salt intake. I have had nutritionists who have had me completely remove salt from my diet. What is interesting about this approach is that you seem to promote supplementing salt. Can you please explain the benefits of including it / drawbacks of not?
    I have now been into the process for a week. I feel much better during the day, more energy, lighter, sharper, happier. But I find I am more groggy in the morning and I wake up during the night. Is this a common issue?
    Thanks again for your time and all your thoughts and advice. My understanding of nutrition has been completely turned on its head… in a wonderful way!

    Mo

    (reply)
  220. Mo  July 4, 2012

    wow! Perfect. Thank you so very much!

    Favourite quote of the week:

    MODERATION — the only thing worth doing in moderation!

    It will be my mantra when training.

    (reply)
  221. Sean  July 5, 2012

    Hi Dr. Attia,

    First, I just wanted to say this is by far the best Low-carb blog on the entirety of the internet in my opinion. Keep up the amazing work!

    Now, as for my question: Is there a safe daily upper-intake level for omega-3s? I currently consume about 5-7g per day from marine sources (whole-foods like salmon, not supplements). Is this amount too high? My omega-6 intake is around 22g per day (I know I need to work on reducing this amount over time), SFA around 65g per day and MUFA around 85g per day (I’m providing this information just in-case it’s relevant to answering my question, as a deficiency in one of these might cause the body to utilize excess omega-3s in a detrimental manor).

    Looking forward to your answer and I greatly appreciate you taking the time to answer these questions.

    (reply)
    • Peter Attia  July 6, 2012

      Sean, I’ll be doing a series on omega-3 and 6 PUFA. Short answers:

      1. It’s less about the amount of n-3 (ALA), and more about the amount of EPA and DHA.
      2. Yes, you can overdo it.

  222. Mark  July 6, 2012

    Hi Peter,

    Thank you very much for your blog. It’s extremely informative and has helped me change my eating habits.

    Two questions:

    Please could you tell me if a LCHF diet, such as the one you’re on, would help men with benign prostatic hyperplasia (BPH)?

    What brand of fish oil do you take every evening?

    Thank you again.

    (reply)
    • Peter Attia  July 6, 2012

      I am not aware of a relationship with BPH. The fish oil I use is under my “Books & Tools” section.

  223. David Guerra  July 7, 2012

    What Probiotic do you take to help in the breakdown of the meat that you ingest? Thank you for your quest of knowledge in ideal health!

    (reply)
    • Peter Attia  July 8, 2012

      I do not currently supplement, and just rely on what I get in other foods. I’m thinking of giving Mark’s product a try, though.

  224. Mo  July 10, 2012

    Hey Peter,

    I have begun frying food more frequenty using butter and coconut oil. While you mention that these are the best approaches for frying, would it still be fair to say that frying itself is not particularly healthy? Should I still try to avoid frying as a general rule?

    Thanks for your time.
    Mo

    (reply)
    • Peter Attia  July 10, 2012

      No I wouldn’t say that.

  225. Mo  July 12, 2012

    Peter,
    Sorry for my persistent questions. I’ve been reading all the comments, articles, and I also watched ‘Sugar: The bitter truth’, which I found to be a brilliant piece. But that presentation brought me to a simple question as he mentions that he gets his patients to only drink water and milk. The problem with milk, I find, is that it is high in sugar. I have always been lactose intolerant, and since shifting my consumption to low carb/0 sugar, high fat, it no longer seems to bother me.
    But by drinking milk, I do not feel as if I am shifting the weight quite as well. Could the sugar in the milk be a barrier? I cannot otherwise see what it causing the problem.
    My diet is composed mainly of high fat yoghurt, nuts, a handful of berries, and either fish or red meat.
    Milk is in my coffee, and also alone between lunch and dinner.

    Thanksf or your advice.
    Mo

    (reply)
  226. Mike Lucas  July 12, 2012

    Don’t you wish we could get “double cream”, in North America like they have in the UK? 50%+ fat content. Lucky bastards.

    (reply)
  227. Eric  July 12, 2012

    Hi Dr. Attia,

    When I went VERY low carb earlier this year my eye’s became very bloodshoot, dried out and irritated. When I added back in a some sweet potatoes that all went away. Have you had any experience with this? I’d love to be in nutritional ketosis but with that eye issue I do not see how I could.

    Awesome blog. Thanks for putting it all together.

    Eric

    (reply)
    • Peter Attia  July 13, 2012

      Hmmm. Have not heard that one before.

  228. Ruslan Farutdinov  July 12, 2012

    Hello Dr. Attia,

    Love your blog! Will get straight to the questions I have:

    1. Looking at the blogs you visit, I am assuming that you are familiar with Tim Ferriss’-Slow Carb diet, which has 1 day/week to binge on whatever you want (with techniques that he provides in his book- The 4 Hour Body- to “minimize the damage”). I am now starting to follow a modified version of that diet: 6 days Ketogenic diet (with no dairy & fruits) and 1 day binge with the use of techniques to “minimize the damage”.
    Here is my question: Do you think that I will constantly feel in the state of “induction”, because every week I break the ketogenic diet? Or will my body adapt to this?

    2. I contemplated on this issue & here is another question: If you would follow this type of structure in your diet, would you use a Ketogenic diet 6 days/week or would you use something like the Slow-Carb Diet (which essentially is veggies, meat and BEANS/LEGUMES every meal)? Reason I am asking this is because of the issue of how I will feel. On the Slow-Carb diet there will be no shifts in terms of what the brain will use for energy, therefore even “binge day” shouldn’t affect how I feel.
    So again: which protocol would you use? One with ketogenic diet or one with beans/legumes?

    *I am on this diet to optimize my physical appearance (get as lean as I can), however I do want to have the option of eating whatever I want once a week- to me this seems like a good balance between good nutrition and following your desires. However, I also don’t want to feel lousy during the 6 days that I strictly follow the diet. This should give you the context within which to answer the questions.

    Thank you very much in advance for your time! I appreciate your help.
    Ruslan

    (reply)
    • Peter Attia  July 13, 2012

      1. If this is a way to increase “compliance,” I’m all for it, but it serves no metabolic or physiologic benefit. I gave up the “cheat” day or “cheat” meal a long time and it’s never felt better.
      2. Highly variable. Do the self-experiment and find out if it’s working for you (which assumes, a priori, that you define your goal).

  229. David Ma  July 13, 2012

    Hi,
    I noticed you take whey protein, do you still take this?

    I was doing a bit of reading, and came across some discussion on the internet about whey protein and how it can cause an ‘insulin spike’. Apparently it is quite a documented and studied phenomenon.
    I was wondering how this would affect ketosis and whether it will push you out of keotsis temporarily with the insulin spike.
    Also if it does, would a slower-release protein like casein work?

    (reply)
    • Peter Attia  July 13, 2012

      Yes, I take whey immediately post weight training mixed with glutamine. It doesn’t seem to impact ketosis, but I take a small amount. Large amounts of protein typically do take you out.

  230. CanuckCrossfitter  July 13, 2012

    Hi Peter,

    It’s been really great reading through all the reader questions and your responses. I had a couple questions which haven’t been raised yet.

    1. I noticed you tend to eat three meals a day. Is there a health benefit to doing this over eating a higher number of smaller meals a day (e.g. 5 smaller meals), or is this decision more logistically based?

    2. I notice that your meals don’t always have the same ratio of fat to protein (e.g. your ‘fat lattes’ are almost 100% fat, while other meals could be more 1:1 fat to protein). Is there a benefit to trying to keep this ratio consistent in every meal of the day, and if not, is there a guideline to how ‘relaxed’ one can be (i.e. don’t fall under a 1:1 ratio of fat to protein

    3. I’ve been doing a lot of reading on ketosis, and I’m not yet clear how much fat I should be shooting for in my diet. My approach is to use a BMR calculator to determine my daily caloric needs, eat 0.7 grams of protein per pound of body weight, and then fill the rest with fat. Is this correct?

    Thanks!

    (reply)
    • Peter Attia  July 14, 2012

      Actually, for the past 2 months I’ve only eaten one meal per day, in the evenings. As far as fat content, think of fat as the “plug” in this equation: Total intake = Fat + Protein (try to keep below about 120-140 gm) + Carb (try to keep below about 40 gm). Total intake should be governed by appetite. Hence, you’re physiologically “back-solving” for fat intake.

  231. Eric  July 14, 2012

    Hey Peter,

    Just for my own sanity. Did one meal a day ever seem just insane to you? I am really trying to embrace this strategy/truth but when people start saying they are eating just one meal a day I start to fall off the wagon. Just for my mental health can you elaborate on that? I mean, I eat the majority of my calories from fat currently. I’m not keto adapted but I eat a high fat diet. I’m not sure what my body fat percentage is but I’m skinnier than almost everyone around me. However, I HAVE to eat regularly. People talk about intermittent fasting….I tried skipping lunch once and by dinner I was about ready to eat my arm. I also snack in between meals. Mostly almonds (I know….high Omega 6….I just don’t know what else to do), cheese and coconut oil mix with unsweetened cocoa and then put in the fridge.

    Anywho…..I just need to be “real” for a minute and ask if that ever sounded crazy to you? I just don’t see myself being able to do that ever and I’m not sure what the disconnect is.

    Thanks man.

    Eric

    (reply)
    • Peter Attia  July 14, 2012

      Eric, all great questions. I’ll certainly address them all when we get there. In the mean time, ponder this, though: Would it be in our evolutionary advantage to not do well in a setting of intermittent fasting?

  232. PeterT  July 16, 2012

    This site is fascinating and incredibly informative. Thank you for your efforts putting it all together.

    I looked into the ketone meter — am I correct that it lists for about $2K?

    Would love to understand more about the sodium /kidney processing issue from a biological standpoint — I don’t understand what it is precisely that makes the kidneys process salt differently on a very low carb diet. Having found myself quite hypoglycemic, I found myself naturally on this diet (and made the same mistake with too much protien). Lately, I have been struggling with the dizzyness, even while adding salt to my food during the day. When I supplement with sodium I wind up overshooting into 130/90 territory. Nice to not feel dizzy but…not optimal. I’ve read all the commentary on this page and much of the rest of the site so if I missed it my apologies and would love if any of the commentators or Dr. A. might provide a link if this has already been addressed.

    Many thanks!

    (reply)
    • Peter Attia  July 16, 2012

      No! The Abbott Precision Xtra meter is essentially free (i.e., you typically just pay for the shipping). It’s the ketone strips that get expensive, depending on where you get them.
      It’s not clear exactly why the kidneys dump more sodium during ketosis, though it may be asking the wrong question. In other words, it may be our natural state to dump more sodium, and our current state to retain more sodium. Either way, the mechanism is thought to involve a change in membrane composition of some of the cells in the kidney, probably in the renal tubules and directly in the glomerulous.

    • David Nelsen  July 17, 2012

      PeterT, just a bit more on the meter. Mine cost $13 plus shipping. Ketone strips cost $50 for 10. Don’t make the mistake I made when using them however. You need a decent sized drop of blood to take the measurement. If you don’t it will try to make a reading and fail and you’ve just wasted $5. I learned to massage my fingertip before drawing blood, then squeeze it a bit more after causing it to bleed. My blood drops were about 4mm in diameter when they were large enough to get a good reading. Hope this helps. Dave

    • PeterT  July 22, 2012

      Thanks so much for the helpful tip, David. Had ordered but still awaiting delivery on the testing kit. I’m sure this will be helpful to others as well.

  233. PeterT  July 16, 2012

    Stunning to have you respond so quickly, again my deep thanks.

    I must have been looking at the hospital version of the meter. Now I see the right one on Amazon.

    I also in the last hour had downloaded the Art and Science of Low Carb Living book and found a paragraph on page 20 dealing with the sodium issue. I was just coming back here to post “never mind” and I saw you had already replied!

    On another topic, it might be interesting (I know I’d be interested) if you shared your blood glucose numbers over the course of a day or two? Do you have a range you shoot for? My fasting (morning) tend to be in the high 70′s low 80′s, but rarely go over 110 throughout the day. I know this is ok for VLC diet and I don’t have any of the hypoglycemic issues I did several months ago. Now that I have read your site it is clear my fat intake is still far too low. My main guide so far has been Bernstein’s diabetes book. But I don’t know how my glucose readings compare to someone in full ketosis.

    Just a suggestion to add to the mix here as was described above, there is also the option of Coconut Kefir, or “cultured coconut milk,” which I believe has lower sugar content due to fermentation. So Delicioous unflavored (original version) has the 65% Medium Chain Fatty Acids and low sugar. Plus the enzymes and live cultures for digestion.

    (reply)
  234. Ruslan Farutdinov  July 17, 2012

    Hello again Dr. Attia,

    I have two more questions:

    1) Given the variety of foods that you consume, how do you make sure you stay bellow 120-140g of protein? Do you research how much protein is in the foods that you’re consuming or do you rely on specific portions, or do you use another method?

    2) You mentioned that after workouts you consume whey protein. On these workout days, is the whey protein that you consume after training, part of the total 120-140g of protein/day? Or do you allow protein to go higher on these specific days?

    Thanks very much for your time Dr. Attia,
    Ruslan

    (reply)
  235. Ruslan Farutdinov  July 17, 2012

    Dr. Attia,

    One more question that I just remembered:

    How do you check if certain foods (for example dairy) don’t stimulate insulin enough to kick you out of ketosis? I am assuming you eat the food and check your blood for ketones about an hour later?

    Thank you very much again for your time,

    Ruslan

    (reply)
  236. Susie  July 17, 2012

    Dear Dr. Attia,

    I am just wondering about your protein sources – do you practice the eating of grass fed meats, free range, etc. or are you purchasing at the local supermarkets. I have spent a lot of time at Mark’s site (but have discovered yours just recently) and this is the one area of my diet that I have not changed yet but am interested in exploring.

    I guess the same question would be true for organic vegetables and wild fish.

    I look forward to your response. Thank you much.
    Susie

    (reply)
    • Peter Attia  July 17, 2012

      I think this may be important, but less so than the actual food. For example, I’d eat a grain-fed piece of meat before I’d smell a piece of organic whole wheat bread. The data on this topic are even murkier than the stuff I tend to write about. I think it’s safe to say the following: Pick the right macro foods…if you can afford to eat organic/grass-fed/etc….great. If not, I wouldn’t lose much sleep over it.

  237. GT  July 18, 2012

    Peter,

    I would be interested in your thoughts on comments below from Chris Kresser’s web site regarding low carb diets and increased fasting blood glucose readings. Do you think this contributes to the so called “dawn phenomenon” when fasting glucose levels are elevated while post meal, casual, and A1c readings are normal?

    “One caveat here is that very low-carb diets will produce elevated fasting blood glucose levels. Why? Because low-carb diets induce insulin resistance. Restricting carbohydrates produces a natural drop in insulin levels, which in turn activates hormone sensitive lipase. Fat tissue is then broken down, and non-esterified fatty acids (a.k.a. “free fatty acids” or NEFA) are released into the bloodstream. These NEFA are taken up by the muscles, which use them as fuel. And since the muscle’s needs for fuel has been met, it decreases sensitivity to insulin. You can read more about this at Hyperlipid. So, if you eat a low-carb diet and have borderline high FBG (i.e. 90-105), it may not be cause for concern. Your post-meal blood sugars and A1c levels are more important.”

    Thanks,
    Glen

    (reply)
    • Peter Attia  July 18, 2012

      Yes, I’ve seen this argument before and it makes sense. It really speaks to the broader theme we’ve been discussing: how should we interpret biomarkers in people on a LC diet vs. those on a standard diet? I’ve also noticed (personally) that there has been only modest changes in BG levels, despite enormous changes in other markers, such as TG. That said, I still notice great variance in these measurements as a function of meal timing, meal composition, and activity level.

  238. Leilah Haddad  July 19, 2012

    Hi Peter!

    I’m really excited I found this blog I commend you it’s very informative.

    But I do have a few questions based off of my own personal experience and would love any feedback you can offer.

    I’ve been low carbing for about 3 weeks now. I would not say my body is keto-adapted as of now but soon hopefully. I’m 21 and unfortunately I’ve gained my “freshman 15″ plus 5 extra pounds. I would like to blame that pitfall on college. I’m currently a med student at NU and no matter how many people I try to explain the benefits of becoming keto-adapted I find very few professionals here agreeing with me. Matter of fact they are preaching the exact opposite.

    But my concerns are more personal. I’m trying to loose this last 20 pounds and overall make a lifestyle change.

    Before I started low carbing I was working out 3 times a day. I would be up at the gym by 4:30am and I would do fasted cardio usually 50 mins on the elliptical. I would have breakfast and then before lunch I would do my Insanity workout (not sure if your familiar with the dvds). Then I would have lunch and before dinner I would either take a 10 mile run or do every other day do strength training at the gym.

    Needless to say I did loose the 20lbs but I couldn’t maintain it. I was eating so few calories. I’m 5’7 and consuming 900 to 1200 calories I was basically starving myself and that’s when I crashed. I dropped my diet and just started eating whatever I want.

    Though I did keep up with the exact workout as previously mentioned because it became a habit and I truly enjoyed doing it. <~~~ Never thought I'd say that.

    Now I'm low carbing and I'm trying to stay at 20g of carbs or less and trying to keep my calorie intake no more than 1500 a day.

    But I'm noticing though that I can't workout like I did before. I don't have the energy. I get dizzy. I have to stop and take so many breaks. If I do manage to push myself through out my workout I have completely no energy. I'm exhausted. Normally getting up and doing fasted cardio in the morning was nothing now it such a struggle.

    I really don't want to cut down on my workout because like I said I look forward to doing it and I enjoy it but I don't know if I can handle it.

    On an average day my diet is 65% fat 30% protein and 5% carbs so I feel my body should be keto-adapted but its just not there.

    I'm also noticing that I'm not losing as much weight as I thought I would. Prior to starting low carb I thought the pounds would shed off… Not only would I be eating low carb but I would be working out on top of that and I thought that would be the key to shedding fat. But of the 3 weeks I've been eating low carb and working out I haven't loss a total pound which is driving me insane…

    So I'm starting to wonder if perhaps if losing weight is your main prerogative if you should ditch working out? I've read on many low carb blogs before that working out was not a big deal and if you decided to work out it should be very low intensity.

    But I refuse to believe this seeing how your work out schedule seems to be very intense. Clearly you're walking proof.

    Which then makes me start thinking that maybe not every "body" can function as well on a low carb way of eating.

    So now I'm at a dead end. Any feedback like would be greatly appreciated. Sorry for such a long post…

    Leilah

    (reply)
    • David Nelsen  July 20, 2012

      Leilah, are you supplementing your salt with Boulion cubes like Peter recommends? That can explain some of the problem with dizzyness. Also, read an article online by Gary Taubes titled, “The scientist and the stairmaster”. Also, if you can measure yourself with a tapemeasure and measure your body fat. I recently went through a period where I didn’t lose any weight but lost inches as I was turning fat into muscle. Once your body learns how to burn Ketones for fuel you should be ok. I would taper your excercise back a bit while you transition. Cheers, Dave

    • Jeff  July 24, 2012

      Leilah – I’ve thought about responding to your post for a week or so – I hesitated because my idea’s probabaly differ from Peter’s – so – that said – I will comment but understanding I’m not trying to undercut peter’s idea’s if possible -

      My own sit – u – ation is somewhat the same – so I’ll just state what has worked for me -

      If I lower my total fat intake as low as possible (200-300 calories) – keep carbs 50 – 100 – and not overeat protein – on a 1000 calorie per day diet I lose weight (my RMR is only like 1800 calories) – and I’m 58 – 6′ 3″ and male – 172 pounds -

      So -that leaves about 700-800 calorioes left for Protein and Carbs –

      147 GR whey protein + one egg 7 gr is 154 gr protein – ( which inculuding 20% protein wasting comes to about 700 calories and leaves 100 calories from carbs – I can vary from 133 to 175 gr protein if I wan’t too –

      Yes – at 1000 calories a day I do get hungry at times – all the time sometimes – but to go from from 15% body tat o 10% body fat apparently requires some hunger -

      I’ve thought about lowering protein some thing like 80 gr(400 calories)( and increasing my fat to 500 calories) -
      but realy -the difference between the 300 calories fat I am using and increasing it too 500 calories -

      The 160 gr protein may not keep me always full – but it’s a lot better than 80 grams -

      Basically – lowering fat total and closely watching protein and 50 -100 calories carbs works – the 160 grams protein at least keeps me somewhat full -

      Leilah – your own RMR-BMR must be around 1400 – 1900 calories per day – cutting them in half to 700 to 950 – you will lose fat – and you will be tired and hungry at times – but anything under god’s sun is better than being fat -

    • Peter Attia  July 24, 2012

      Jeff, thanks for sharing your experience. There is no reason to believe every one of us is the same, which is exactly why it’s worth tweaking and experimenting.

  239. Leilah Haddad  July 19, 2012

    Hmmm now that I reread my post (which I probably should have done first) I’m starting to think that perhaps I’m taking on too much too soon without giving enough time for my body to adapt.

    Maybe thinking I would be able to jump in to low carbing right off the back at 20g of carbs a day with keeping up my workout routine was a little far fetched. I’m so use to the whole “go big or go home” motto that I might be sabotaging my own plan.

    I’m young and I still trying to understand the whole concept of “limitations” and “over doing it”.

    (reply)
  240. Rima  July 20, 2012

    Hi Peter,

    So I’m confused about the whole omega-6 thing. Sorry I’m a little slow…lol

    Right now I supplement CLA/ GLA which the gla is a good source of omega-6…

    So I’m confused should we moderate our omega-6 intake? Is there something wrong with consuming too much?
    Maybe you can break it down further for me…

    Thanks

    (reply)
    • Peter Attia  July 20, 2012

      I will definitely be addressing this entire topic in a subsequent series.

  241. Tom  July 22, 2012

    Peter,
    I’ve recently become a frequent browser of your blog. While reading articles here, I discovered and began to explore lecture pad. It was there that i watched a lecture on the topic of the omega 6:3 ratio, presented by William S Harris. The conclusions he reached in the presentation were that increasing consumption of o6 fats was not detrimental, rather it was beneficial, that intake of EPA/DHA was also beneficial, and focusing on the ratio was “a distraction” i think he called it, from the fact that most people don’t consume enough EPA/DHA. I was wondering how you felt about this, specifically the first portion of his conclusion, and if you had covered this or plan on doing so.

    (reply)
    • Peter Attia  July 22, 2012

      This is an enormous topic of interest for me. In fact, Bill Harris has also become a pretty wonderful mentor and teacher of mine. Some time soon, I plan to do a series on the omega-3, omega-6 “story” and I hope to bring some clarity to this confusing situation.

  242. lorraine  July 22, 2012

    Doc, not sure where to ask this, but this seems as good a place as any. I read somewhere along the way that you’ve done some self-experimentation with IF. I’ve been doing the same, but limited to eating “within a window”. I usually wait 16-17 hours after last meal to start the new day’s eating. and eat two meals within that 7 or 8 hours. I really like eating this way, but I have found that it kicks me out of ketosis. Not so if I do fasted exercise. It seems to me, theoretically anyway, that if I’m running on ketones I shouldn’t have to turn on too much gluconeogenesis, but it doesn’t appear to be working out that way. I get kicked out of ketosis especially in the morning of the fast. Have you experienced anything like this? At least with me, it seems I need to pick one or the other. Thanks for any input.

    (reply)
    • Peter Attia  July 22, 2012

      You’re spot on. IF makes a steady-state of ketosis almost impossible, because of the bolus of protein in one meal. I’ll detail all of this when I get the post (or short series, more likely) on this topic.

    • lorraine  July 22, 2012

      Thanks. Yeah, the bolus protein meal makes sense. For me, it seems to most notably kick me out when I’m most fasted…….at the 12-17 hour mark of the fast. The take home in any event, though, is that the two of them mixed disallow the ketosis. Thanks again.

      Not to pepper you with more questions (but of course, here it comes), do you find you have a time of day that your ketosis is strongest; i.e, postprandial, before bed, first thing in the morning? I don’t have a particular trend (except getting kicked out with IF), and would love to save the money on test strips with less testing, by seeing where others are getting their most consistent readings. It would be helpful to know when the best time is to test. Thank you again so much.

    • Peter Attia  July 23, 2012

      I’ll get there.

  243. Andrew  July 23, 2012

    Peter

    I’m a 41 y.o. male, 5’10 152lbs and at about 9-11% bf (based on visual assessment and tape measure/on line calculations). I’ve been following Mark Sisson’s The Primal Blueprint, as well as doing a leangains-style IF for about a year. My weight has been almost perfectly consistent for the year I’ve been doing this, I feel great, etc. etc.

    I’ve hit probably 100g of CHO per day, on average, over the last year. Added sugars of any kind are gone from my diet, as are all grains and legumes.

    I am interested in trying to drop down into ketosis to see if I can knock a couple more lbs of fat out of my body. I suspect it would be pretty easy for my psychologically to go to <50g of CHO a day since that's a pretty short hop from where I am now and I'm not facing any cravings for carbs.

    That said, I really like the way I'm eating now, and definitely like my current diet as a long-term approach, and so if I do go into ketosis, it would be only for the short-term, with the express goal of seeing what it did to my body comp.

    My question is: if lose a couple more pounds of body fat and get myself into the 7-8% bf range, will I pop back up to 10% if I leave the ketotic state after loosing that weight and return to 100g CHO +/-?

    Another way to ask this question might be: in order to keep a very low BF % do I have to STAY in ketosis, or I can I use that as a tool to get to the lower % and then increase my CHO intake a bit without adding fat?

    Thanks!

    (reply)
    • Peter Attia  July 24, 2012

      Impossible (for me, at least) to predict. Lots of anecdotal evidence on either side, suggesting host factors matter a great deal. One way to find out. Please tell us what happened.

  244. PT  July 23, 2012

    On the sodium question — how do you monitory and moderate your sodium dosage? Do you monitor your BP at all or just wing it? Having had some significant dizzy issues over the past few weeks of making this VLC transition, and since finding your site and reading the Art and Science of Low Carb Living I had begun eating salted butter instead of unsalted, and eating jerky once or twice a day (high Celtic Salt content — I figured out 14g of jerky is roughly equivalent to the 1-2g of broth you eat). The dizziness is gone, and for a week I felt better, but in the past three days that has been replaced by racing pulse when standing and markedly higher BP readings. Trying to figure out how best to hit a happy medium. Reading Art and Science of LCL, they sound like the amount you excrete in ketosis means you are easily getting rid of any excess on a daily basis.

    Thanks for any suggestions on how you do this yourself.

    (reply)
    • Peter Attia  July 23, 2012

      BP is not a great marker. Symptoms are better. If I don’t get enough sodium, I get light-headed. It’s almost impossible in a ketotic state to get enough sodium from food unless you’re an Inuit drinking brackish water or a Maasi drinking/cooking with the whole blood of your meat.

    • PT  July 23, 2012

      Thanks for the very helpful response. Perhaps I’m still in the adjustment period and these sensations are related to other biological shifts. I’ll keep playing with the sodium and see what happens.

  245. dino  July 24, 2012

    Peter, shocked to see fage! 16g sugar. 18 carbs!? 18g protein. dino

    (reply)
    • Peter Attia  July 25, 2012

      Not in the whole fat version. 20 gm fat, 6 gm carb (of which only 3 gm is metabolized as a “sugar”), 16 gm protein.

  246. Lex  July 25, 2012

    Dr. A, thought you might get a chuckle out of this. Inspired by your ground beef/onion/broccoli saute dinner, I prepared a version last night (besides your list, it included roasted red bell pepper strips and broth from a braised chuck roast; and for the cheese, cheddar and parmesan). My twins (9 years old) kept asking “what’s for dinner” and I told them it doesn’t have a name. We all liked it btw. This morning one of my boys said we should call it “Attia” after you. We then came up with this: “Beef Attia” (BeeFATtia for the pun-challenged).

    (reply)
    • Peter Attia  July 26, 2012

      That is *hilarious*… I’ve finally done something worthy in life. Thanks for sharing.

  247. Olga  July 26, 2012

    I am a regular blood donor.
    Since I eat Low Carb (less than 50 grams per day)- High Fat – Moderate Protein, the glass of orange juice that the hospital usually provides after I donate blood is totaly out of the question. What you you suggest I replace the OJ with??? I was thinking about Starbucks with full fat cream (yum … )

    BTW, I first heard about you from Ben Greenfiled’s podcast … and I REALLY enjoy your site. I do come from a scientist background and so I appreciate very much both your explanations (biochemistry and stuff) AND your take on scientific papers …

    (reply)
    • Peter Attia  July 26, 2012

      Bouillon. Replace the plasma volume and the sodium loss.

  248. Rima  July 28, 2012

    Hi Peter…. Just a random question….

    Have you heard or tried “Upgraded Coffee” here is a link http://www.bulletproofexec.com/coffee/
    I believe the creator of this is Dave Asprey. He also has a protocol for “Bullet Proof Coffee” http://www.bulletproofexec.com/bulletproof-fasting/ Which is basically coffee, 2 tbsp of MCT oil, and butter blended up together for the ultimate IF weight loss tool. I know you stand behind MCT oil but I’m just curious is there really any science behind picking a quality coffee opposed to an average brand you can pick up at walmart?

    (reply)
    • Peter Attia  July 29, 2012

      No clue if this coffee is special. Anyone else? If there’s magic coffee out there, I want some!

    • michael  June 14, 2013

      The coffee itself is purported to be lower in mycotoxins which make you feel bad. I think most of the benefits are from the grass fed butter and mct oil. They seem to also have a synergistic effect at transporting the brain stimulating properties of coffee to the brain? Just paraphrasing what I’ve read here …

  249. susi  July 29, 2012

    Hi Peter ,

    I stumbled upon your blog when i was researching about low carb.Great Blog !
    Please help me if you can.I am 5’7 and around 265 lbs.I have been trying to reduce weight for a long time (ever since i remember ), but even though i reduced 60 lbs , i gain it back if i dont exercise.I reduced those 60 lbs with lot of extreme exercising for 5 hrs daily.It was excruciating…I am hypo thyroid for the past 10 years and am on synthyroid

    Last year i tried Tim Ferris Low carb diet.I felt great for 2 weeks and i lost 13 pounds.But after 2 weeks i was feeling too weak even to walk and was totally in the bed.I had low BP and was feeling dizzy.Many time i would go to the gym and come back home or rather lie down in gym for half an hour and come back.I lost a lot of hair too and was feeling very weak for a month.My bad i had reduced my thyroid medication also as i was feeling hyper due to birth control which i had started.Since too many variables i dont know which one to blame

    But after careful study and trying to understand my body i feel i am very insulin resistant.My fasting insulin is low but my post prandial insulin is way too high..I know low carb is the way to go.But my body is in very bad shape any time i start with low carb i feel very low and not enough engery right after 2-3 meals and i am not able to stick with it.I am not sure how to slowly adapt my body to low carb without meltdown.

    Another important factor i learned is that i should have supplemented sodium and other electrolytes as going low carb too drastically may be too hard on the adrenals.I work with a metabolic typing advisor who says i am very parasympathetic dominant.I sometimes feel its so not right for me to suffer like this.I have to workout so much , that my legs and muscles hurt so badly , only then i can get my body to be sympathetic dominant .I was an athlete and i didnt have weight issues till my school and after which i stopped exercising and started putting on weight…

    I know you cant give any medical suggestion.But out of your experience can you give me some suggestions how to overcome and gradually move my body out of insulin resistance without meltdown with the low carb diet.Do you think if carb cycling (suggested by cate shanahan , chris powell ) will help me…

    (reply)
    • Peter Attia  July 30, 2012

      Susi, as you can imagine it’s impossible for me to troubleshoot such complex issues like this. I’m sorry I can’t provide helpful advice at this level.

  250. Maryann  July 29, 2012

    Hi Peter,

    I am sorry if this comment is in the wrong place. (I just read a comment on MCT oil and I can’t find where it is now.) In the comment, you mentioned that it is sometimes used to prevent alzheimers and cancer. I was trying to find information on the type and amount to take for this purpose. Is there a recommendation? I used your search feature (I put in “MCT oil”); although it lists many comments, it does not access them…it merely brings you to the top of the appropriate post.

    Also, I miss the comments that were on your personal journey section. There were many informative discussions on the post about your improvement in cardiac risk factors; but, these were all taken down when the blog recntly changed.

    Thanks again for all you do!
    Maryann

    (reply)
    • Peter Attia  July 29, 2012

      Maryann, I’ll be doing some posts on this topic. At this time, I can’t speak with any authority on the doses.

  251. Brandon Taylor  July 31, 2012

    Dr. Attia, as one who has also been doing intense exercise while intending to be in ketosis I was wondering if you could clear something up for me about refueling after exercise.After following the comments on this post I thought this would be the best place to put it because of the discussion on protein intake while ketotic. It may be best to tell you an illustration of what happened to me yesterday.
    I did a very intense HIIT workout on an elliptical machine mid-morning to afternoon. I was actually surprised that I was able to do about 90 sprints of 30 seconds total with a few rests after numbers 40 and 65. (On a side note, I think I’ve read somewhere that Volek has said that fatty acids can flood the blood stream to be used as energy if enough time is given to allow for oxidation during rest and that’s what I thought happened: hence my assumptiion of being in ketosis)
    My morning/preworkout meal was entirely fat and wasn’t very high in calories: a bit of coconut milk and sour cream were the main energy sources, along with black coffee.
    After the workout I wasn’t particularly hungry (never am because I assume my body is in ketone burning mode), so I didn’t eat until dinner. Now here’s where the question lies: At dinner my meal had more protein than fat and I ate a good amount because I was finally hungry. I didn’t go overboardbut I’m not sure how many grams I consumed. So I was wondering if my body would “snap back” into ketosis after this spike in protein after it digested the food because I was in a calorie deficit, am already lean and fairly muscular, and would assume any products of gluconeogensis would go into my muscles.
    To put it all together: Do I have slightly more wiggle room with amount of protein/fat:protein ratio after exercise because the body will use up whatever form of energy it gets to make up for the calrie deficit? If not, is there a max amount of protein my body can process in one meal even in these circumstances?
    Thanks,
    Brandon

    (reply)
    • Peter Attia  August 5, 2012

      Brandon, the short answer is yes, but it’s a bit more nuanced and worthy of a dedicated post, which I hope to get to in the next few months.

  252. Oxboy  August 2, 2012

    Peter,

    You eat 4k-4.5k calories a day, but you workout 2-3 hrs a day, right? If you ever found yourself with the inability to workout — say hypothetically you went extremely sedentary for a month — do you think you’d have to go down to a 2.5k range per day? Would you make any adjustments to the daily fat/carb/protein proportions in your daily diet?

    Thanks for the great blog.

    (reply)
    • Peter Attia  August 2, 2012

      When I’m not working out much (e.g., when I’m traveling) my appetite reduces to the point where I only eat about 3,000 kcal/day.

  253. Oxboy  August 3, 2012

    Couple of questions:

    Should we be using salted or unsalted butter in our diet?

    Also, I’m a total newb when it comes to boullion. Assuming somebody decides to use it for sodium intake, do you eat it? Drink it? Sorry, I don’t cook at all and have no experience with its preparation.

    Thanks.

    (reply)
    • Peter Attia  August 4, 2012

      Whatever tastes better. I like salt. Lots of comments in this thread about how to take bouillon.

    • Maryann  August 4, 2012

      You can find bullion in the soup aisle; it can be in powder or cube form. All you need to do is take one cube (or one teaspoon of powder) and dissolve in boiling water. If you have a Keurig brewer, just put the bullion in the cup below and brew with plain hot water. Herb-ox brand has no gluten and no msg. No cooking :)

  254. Robert  August 11, 2012

    Dear Dr. Attia,

    I’ve been in and out of ketosis for a few months and find that if I eat virtually any animal protein for dinner I have insomnia and cannot fall asleep for a few hours. I feel like I have restless leg syndrome and chest tightness and my mind is wired until midnight. This occurs even with consuming only small amounts of animal protein after 5-6pm at night.

    Conversely, a low protein, high fat dinner makes me incredibly exhausted by 9pm – I literally cannot keep my eyes open past 8:30pm, which is unusual for me. I do sleep exceptionally well, however.

    Is this common with ketosis and do you have any suggestions as to how might I find a middle-ground between insomnia and being comatose by 9pm every night? Thank you very much for your time.

    (reply)
    • Peter Attia  August 12, 2012

      I have not heard this specific complaint, but have heard other complain of sleep disruptions. Hard to imagine it’s not a result of something you’re doing (vs. a coincidence), but I don’t know. All the more reason to experiment a bit, as it sounds like you’re already doing.

  255. Mark Hoheisel  August 12, 2012

    Do you think there is any metabolic basis for Tim Ferriss’s suggestion of taking one day a week or one meal a week off from low carb and indulging in whatever otherwise forbidden high carb foods you please?

    I can see there may be a psychological reason to plan cheating so it may be less likely to lead to a general reversal, but is there any physiological reason?

    (reply)
    • Peter Attia  August 12, 2012

      Psychological – perhaps for some; not so for others. Physiologic – doubtful.

  256. Emory  August 13, 2012

    Peter, I just stumbled on your website and find it the most thorough nutritional site yet.
    I’ve done low carb since I was a 240 lb (80 lbs overweight) firefighter in the seventies. Using Atkins and strength training principals, I went from 240 to 160 lbs…11% bodyfat at my peak.
    Over the years, Iet my weight creep up to 170 before I decided that I’d had enough and started my low carb lifestyle again. I’ve been keeping complex carbs at 100 g per day, protein levels at 150 and fat at 90 (all approximate amounts per day…using Fitday diary). My exercise regimen compromises 2-3 HIT strength training sessions per week, and a one hour bike ride 3 days per week (15-18 mph).
    My question concerns sodium intake.
    I have moderate Meniere’s on one side and have experienced BPV once per year or so for a few years. My last visit to an “Ear doctor” was about one year ago and on that visit, she advised strongly, that I keep my sodium levels down to 2 g per day…which I have successfully done and have had no problems with vertigo.
    I’m wondering how important your salt supplementation is in the context of fat loss. I’m still at around 13-14% with a 33″ waist. I’d love to lose that last one or two inches of layered fat around the waist and am considering upping my fats and lowering my carb levels to do so.
    Can you give some insight on the sodium problem?

    (reply)
    • Peter Attia  August 14, 2012

      Emory, lots of discussion on sodium in the Q&A of this thread. It’s not about weight loss, it’s about supplement sodium lost through renal means, which often occurs in the setting of ketosis or VLC diet.

  257. Patrick  August 13, 2012

    Dr Attia,

    I’ve recently come across your work and this site and am a huge fan! Over the last week I have modified my generally high protein, low carb diet, to include much more fat (olive and coconut oil, heavy cream, butter, etc). I am amazed after just a single week of eating much more fat, how my body composition and energy levels are beginning to change for the better. That said, I do have one area of concern that I did not anticipate would occur. I have noticed, that I am generally hungrier, especially after consuming coconut oil. I am eating everything I was eating before, but adding some heavy cream (reduction sauce) to my steak and chicken, olive oil to my avocados, etc. My exercise routine has not changed. Everything is the same in my life except that I am adding a lot more fat to my diet. Why am I hungrier? I have read that consumption of saturated fat can block the leptin signal to the brain and thus inducing more hunger. I have also noticed that at times during the day, I feel like I now have bouts of low blood sugar and feel lightheaded. I never had this issue before. This has only occurred in the past week. Everything I eat is of very high quality as well. If I feel lightheaded, I’ll have a banana and it goes away. A bit confused. Can you enlighten me? Appreciate your time.

    (reply)
    • Peter Attia  August 14, 2012

      Really hard to say, Patrick. It would take a lot of Q&A to sort this out, which I can’t really do in this setting. Perhaps others have some suggestions based on their experience.

    • Bill Vincent  August 18, 2012

      One thought: Be certain that you are hydrating sufficiently. Sometimes thirst feels like hunger. Plus dehydration can make one feel lightheaded. The banana contains high levels of potassium, which would help with dehydration (in addition to providing some carbs.) Adequate hydration is not as easy as everyone assumes, so make an extra effort to hydrate well. In my experience, magnesium supplements are quite helpful.

  258. Claudia  August 13, 2012

    first of all; I love, love love your blog!

    While waiting for my blood ketone testing device I am trying my best to getting into nutritional ketosis (trying for 3 days so far). I’m 5’4 and 138 lb (165 cm, 63kg). I eat 60-63g protein from fatty meat and 18-22g carbs and the rest is fat (around 180-200g) 12% 4% 85%. My question is, I’m “right” compared to my weight / height? I eat 2000 and 2400 kcal but it feels like could eat a horse! I’m still hungry and if I increase the fat I fear that I will gain weight. Is there someone else who has experienced this insatiable hunger?
    I feel better than I have in 3 months (on LCHF) and I feel like I finally crawled out of a dark cave :) but I just want to know that I am in ketosis now before I can make my own measurements. What is your perception based on how I eat?
    btw – I wrote this yesterday and this morning I´ve gained 1 Ib -its not much but it sucks!

    (reply)
    • Peter Attia  August 14, 2012

      With that breakdown of input, Claudia, I’d bet you are in ketosis, but remember, ketosis doesn’t imply a negative energy balance (i.e., automatic weight loss). Don’t fixate on day-to-day weight changes and don’t force-feed yourself to “get more fat” in. Stick to an intervention for a few weeks and see if it works. If not, change a variable.

  259. Emory  August 14, 2012

    Peter,
    Can you advise how important the extra sodium intake is? I’ve been doing low carb for years, coupled with HIT strength training and biking. At 63, my bodyfat percentage is around 13% and waist is 33 at 5’10, 150 lbs. I currently do 100 to 125 carbs per day, with a high amount of fat and protein (40 fat/30pr/30 carbs) and would like to experiment with much lower carbs, higher fat and less protein.
    My challenge is that I have menier’s and dizziness which my ENT is exacerbated by my formerly high sodium intake. I’ve since, for the last year, cut down to 2g of sodium per day and have great results. How important is it to supplement with higher doses? Is there an alternative? I don’t want to upset the balance of fluid in my inner ear so I’m extremely hesitant to increase sodium.

    (reply)
    • Peter Attia  August 14, 2012

      It really depends how much sodium your kidneys are secreting. Most people on a carb-reduced, and especially on a ketogenic, diet require supplemental sodium. If you’re not having any symptoms, probably not necessary to change anything.

  260. Adam T.  August 15, 2012

    First of all, thank you for this blog. I have been pouring over the articles for a few weeks now, and enjoy every one of them so far.
    I was curious to know if this style of eating could be modified into an intermittent fasting protocol?
    (Intermittent fasting = 18 hours under eating, 6 hours overeating)

    (reply)
    • Peter Attia  August 15, 2012

      Absolutely. I’ve been doing IF for almost 3 months now. Will be writing about in the coming months.

  261. scott  August 17, 2012

    Hi Peter,

    Great blog and thank you for devoting your efforts for us – your audience.

    About 10 years ago I was living in UK and Atkins became very popular – I tried it but couldnt hack it. They suggested an “eat anything you want except carbs” and so I was protein heavy. I lost about 8 kg over the 6 weeks I was on it, but I was miserable.

    Now, I live in Singapore. It is hot, humid and inhospitable for someone weighing in at 125kg.

    Anyway, I stumbled on your blog and liked what I read. I started following your suggestions only 5 days ago. I’ve lost 5kg, and I ran my first sub 30 minute 5km in 2 years (trust me, for a 120 kg, 33% body fat man – I was impressed)

    I’m interested to see what results I will achieve over the next few months.

    Anyway, I do actually have a serious question and some words of wisdom from your kind self would be much appreciated.

    About 3 years ago I was sufferrring incredible abdominal pains. I went to the doctor and he checked me out and dignosed gallstones. The ultrasound showed a single round stone, roughly 1.5 cm in diameter. He immediately suggested surgery and gallbladder removal. I disagreed and sought an alternative, which was essentially to cut out animal fats which was the trigger. I havent suffered any symptoms since.

    Presumably, a high fat diet will cause bile purging from the gallbladder so I would like to know what your risk assessment would be for someone like myself. Am I tempting fate following this diet.

    On another note, other fats such as butter and cheese dis not cause symptoms, it was always animal fats (my first gallbladder attack was after a festive meal – the cuplprit was potatoes roasted in goose fat). WIth this in mind, can I still achieve the benefits of this without eating the animal and instead opt for things like walnuts, olive oil, butter and cheese ?

    Thanks in advance for your response and thank you once again for your great work – you really are making a difference !!!

    Cheers,
    Scott

    (reply)
    • Peter Attia  August 17, 2012

      Scott, the gallstone formation is probably less about the amount of fat consumed and more about other complex factors (many of which we don’t yet understand). It’s an oversimplification of the medical establishment to just dismiss it as fat eating. That said, if what you’re doing is working — I’d be hard pressed to suggest changing it! If you do experiment, remember the rule: one variable at a time.

  262. Oxboy  August 17, 2012

    Doc, have you ever seen cases of people who are low carb (sub 75g) eaters but maintain elevated 120+ fasting glucose numbers? I thought less sugar necessarily means less glucose/less insulin in the system, thus no choice but to pull you away from a diabetic trajectory.

    (reply)
    • Peter Attia  August 18, 2012

      Yes. Many reason this can happen, including too much protein intake.

  263. Mary Ann Delaney, RDH  August 19, 2012

    Hi Peter,
    New to your blog. I have been eating this way for the past 3 years after my pain Dr. suggested a lo-glycemic, anti-inflammatory way of eating. I have not looked back. I have lost a great deal of weight, blood work including lipids are “excellent.” Hard to argue with the results. I feel really good and eating this way I know keeps my systemic pain at bay. I read Gary’s book and felt he could’ve used me for a proto-type.

    I am a strong supporter of this and encourage all my patients to become aware of what they put in their mouths truly effects their well being.

    (reply)
    • Peter Attia  August 19, 2012

      Mary Ann, thanks so much for sharing your story. Really glad to hear you’ve found an approach that is working for you.

  264. Elsa  August 20, 2012

    Hi dr.
    Does it make any difference whether I take for example 2 g carbs 5 times per day or 20 g once per day? I’m assuming that 2 g carbs per meal/snack x 5 will cause less (even no) insulin spike than 20 g once per day, in which case, can the 2 g carbs per time even count as part of the “allowed” carbs per day?

    (reply)
    • Peter Attia  August 20, 2012

      At those levels, no. At higher levels, yes.

  265. ad ligtvoet  August 20, 2012

    Hi Peter,
    Some days I do a 16/8 hour IF(2-3 meals) and other days I eat only when I’m hungry(can be 1or2 meals during waking hours).I eat about 40 gr.of protein per meal to make sure that my intake doesn’t increase the insulin level per meal.Carb intake max.15 gr.per meal.When eating only one meal a day for a longer period , how does this influence loss or keeping of lean mass? Is building of lean mass possible under these circumstances?Protein intake is always stated by intake per day , but is a regular(as one’s or twice a day) intake of a certain amount per meal not a better and healthier way ?
    My current bodyweight is about 74 kg ,lenght 174cm waist circ.78cm at age48.My goal is to be a tad leaner and stay that way without much calculating ,timing etc.,thus more by hunger.
    Thanks at forehand for your answer,
    ad ligtvoet

    (reply)
    • Peter Attia  August 21, 2012

      I’m in the middle of a 3 month self-experiment with IF. I’ve been working on 3 protocols in rotation: 1 meal/24 hours; 2 meals in 6 hours; 1 meal post morning workout, plus dinner. I’ll be reporting on it in the coming months.

  266. Xiaolei  August 22, 2012

    Hi Peter,

    I have been in full Ketosis for about 2 months now and the result has been amazing: I have lost another 20 lbs and improved my weight lifting and swimming performance along the way. The weight loss does slow down a bit after I started lifting weights but I am stronger, more energetic and sleep better now. The best part is, I love the food I eat and I got totally used to the food preparation and carb/protein calculation. Everything becomes automatic.

    Ever since I started reducing sugar/carb intake, I have lost close to 100 lbs in total (first 50-60 lbs without much exercise at all) and my waist has shrink from 42 to 36. I have lost some of muscle but I am in a process of gaining them back. I am even lighter than the grade 9-self (yes, I had been overweight since I have memory). When I was young, I always wanted to bring my BMI down to 25 and 10 years later, I finally achieved this goal. I feel great both psychologically and physiologically and my family members have been stunned and some of them are trying out the new fatty diet now.

    The only draw back is that my doctor is not too fond of my diet. I have experienced muscle cramp that wake me up during the night so I went to see her to get some potassium. She ordered a blood test and amazingly, my LDL, and total Cholesterol count increased significantly to almost double the higher limit. The ratio between HDL and total Cholesterol also decreased. This is amazing since I have lost so much weight yet along the way, my Cholesterol has been rising and now it shoots out of the roof.

    My glucose and triglycerides are at the low end of the normal range so my doctor is amazed. She ordered further testing and it is revealed that my WBC, RBC, Hemoglobin, Platelet and Neutrophils are lower than normal. They were fine before I started the full ketosis and I wonder If the elevated Cholesterol and lower blood cell counts are normal or have been documented for ketosis diet? Am I starving myself due to my lack of hunger?

    I really enjoy this diet and the result it has brought me. My doctor is super concerned now and I am a little bit scared by the recent test results. I would be really grateful if you could point out my potential mistakes or possible explanations to the shocking results. Thanks for your time!

    Cheers,

    Xiaolei

    (reply)
    • Patrick  August 24, 2012

      Xiaolei,

      I’m no doctor and fairly new to the high fat diet “method”, but I’ll take a shot at your issue. First of all, congratulations on your impressive weight loss and what appears to be a better quality of life (energy, sleep, etc). With respect to you cholesterol numbers, I too experienced a similar situation in that my “headline” numbers (Total Cholesterol and LDL) are far higher that the “desired level” and have been rising further since I started the higher fat diet. That said, my Triglycerides are at the low end of the range and most importantly, my NMR (particle test) revealed a low particle count and thus a very low probability of a cardiac event. Dr. Attia has written about this at length. You should expect your “headline” LDL number to rise when consuming more fat but that is not what matters. It is your particle test (NMR) that you should be paying attention to. It appears that you may not have had this test done, but you probably should to alleviate any concerns you and your doctor may be having. I’m not saying I know the what the results will be, but before you change anything, I would think that you should get the complete picture of your situation and the NMR test will provide that for you. With respect to your lower than normal WBC, RBC, etc counts, I can’t say I’ve ever heard this occur as a result of adding more fat to the diet but here are a few things that can cause low counts: For low WBC (diseased liver or spleen and bone marrow failure due to an infection, radiation or tumor); For low RBC (anemia, leukemia, malnutrition, hemorrhage, bone marrow failure, pregnancy and overhydration); For low Hemoglobin (aplastic anemia, cancer, cirrhosis, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, leukemia, multiple myeloma and vitamin deficiency anemia); For low Platelets (leukemia, low production of platelets by the bone marrow, lymphomas and HIV, or human immunodeficiency virus infection. Anticoagulant medications, such as heparin, can cause a low platelet count). I would think through these possible causes first.

  267. ad ligtvoet  August 22, 2012

    Peter,
    Looking foreward to the outcome of your experiment.
    I don’t have a ketone meter but did until recently measure my BG level .It stays around a average of 4.2 mmol with once 5.4 (after awakening) and 6.1(after a workout,strenght training) .Measurements done during the day and 3 times within 2 hours after eating.As I stated I eat around 40gr of protein a meal.As far as I can tell this amount had no meaningfull influence on my BG. and probably also not my ketone production. This includes eating 3 times within 8 hours. Do you think that eating 3 times within 8 hours(still thinking that about 120 gr a day is necessary) a 40 gr of protein portion leaves enough time to metabolize it?Is it possible that any amount not metabolized will be so during the fast so nothing will be ‘wasted’?In general there is always the advice to consume about 1,5 gr per kg of body weight of protein per day. But that is calculated on say 12-14 hours over which the meals are spread.Also will these meals be higher in carbs.Since a lowcarb diet spares protein I tend to believe that spreading the meals more apart on a low carb diet leaves enough time for metabolizing the protein before the next meal comes and still stay in positive nitrogen balans. Plays hunger a role in the timing of protein intake from a body’s perspective?With this in mind would a be a good idea to consume a bit more protein per meal since we would then only eat once or twice a day.
    Pff.. a lot of questions .I hope you can answer them from a metabolism theory not necessarely as a result of your experiment.
    ad

    (reply)
  268. Oxboy  August 23, 2012

    Doctor Attia, what brand of Magnesium supplement do you take? Carlsons?

    (reply)
    • Peter Attia  August 23, 2012

      I just use generic Mg oxide.

    • Oxboy  August 23, 2012

      Peter, what led you to the oxide format as opposed to the other Mg forms (citrate etc)?

    • Peter Attia  August 23, 2012

      Not sure there is a difference, despite mass hysteria.

  269. GT  August 25, 2012

    Hi Peter,

    I have a question regarding weight gain on a low carb / high fat diet. Going low carb allowed me to lose all the weight I wanted, to the point where sometimes I would like to add back 5-10 pounds. However, I can’t seem to do this by increasing my food/fat intake with my current diet. So I’m guessing my body has reached its weight plateau and I would need to add back some complex carbs to gain extra weight. But I saw in another post where you mentioned it is possible to gain weight on a LC/HF diet. Could you expand on how you would do this? I exercise every day but not to the point where I would need UCANN or Creatine for recovery. And like you, I find that I actually lose weight when I don’t excercise.

    Thanks

    (reply)
  270. Kypros  August 26, 2012

    Hi Peter,

    I will say it again. Thank you for the time and effort you put into this blog!

    It seems that there is evidence that although ketones created from the liver can replace glucose in a lot of pathways, this may also ncrease cortisol. Any views on whether this can be a problem for those of us on long term ketogenic diets? Perhaps this problem goes away after a period of keto-adaptation? Any available data?

    (reply)
    • Peter Attia  August 26, 2012

      Worth a post of its own…

  271. Adam T.  August 27, 2012

    Quick question regarding “Regularity”.
    I have been following a ketogenic diet for about 3 months now, and love it. The only problem I am having is being “regular”. I have increased my sodium intake to about 4-6gram per day, and drink 3-4 liters of water a day, but still pass small amounts of “pellets” every other day, a clear sign of constipation. Am I doing something wrong? I apologize if this has been discussed previously.

    (reply)
    • Peter Attia  August 27, 2012

      MCT oil, bouillon make a huge difference.

    • David Nelsen  August 28, 2012

      Adam, have you tried sugar free metamucil? I have issues whether I’m eating low carb or not. I take my dose after dinner at night and there are no issues.

    • SusanneL  September 1, 2012

      Adding magnesium does tend to solve the problem. Been there myself!….

  272. Brian C  August 27, 2012

    Hey Peter,

    Thanks for this blog and abundance of information. I stumbled upon your site last night and literally read through blog posts for 3 hours straight.

    What would be your advice for a male ectomorph looking to gain lean muscle mass? I’m about six feet tall and 160 pounds. If I plan on gaining lean muscle mass by consuming 3500-4000 calories, what breakdown in fat, protein, and carbs would you recommend? I’ve followed a Scrawny to Brawny program through John Berardi’s Precision Nutrition in the past and had success, but wonder what you would recommend. Any feedback would be greatly appreciated.

    Thanks again for the site and keep up the great work! – Brian

    (reply)
    • Peter Attia  August 27, 2012

      Not really my area of expertise, Brian. I suspect it’s at least as dependent on your training regimen. Be thankful you’re an ectomorph…

  273. Butch  August 27, 2012

    sorry if this question has been answered already but did not have time to read all of the comments.

    Anyway, can you name exactly the Fish Oil brand you are using ?

    Is Omega-3 considered as PUFA ?

    I know Omega-6 is PUFA. And this is what I’m concern about. Because the Omega-3 supplement, Purified Fish Oil (molecularly distilled), I’m using listed in the supplement facts is POLYUNSATURATED FAT but did not mention if it was Omega-6. I’m trying really hard NOT to consume any Omega-6 or at the very least limit the intake of Omega-6.

    Should I be concern about this ?

    (reply)
  274. Crista  August 28, 2012

    I am really interested in the idea of living in a ketotic state. I am a huge sugar burner – used to be vegan I find I get most of my energy from dried fruit and I am hungry all the time. I’m active but would like to be more active. I’m a professional dancer and performer, often doing strength work for a living (stunts and aerial work) and I workout moderately 5-6 days a week (5 mile runs once or twice, resistance training and HIIT circuits). But I am always tired. If I don’t eat often my energy plummets where it seems hard to even move normally or carry on conversations. I have read a bit about changing to a fat-burning state. In your opinion, would this seem feasible for someone with my activity level? It’s important I have good energy and strength. I am interested in any advice you could give me.

    (reply)
    • Peter Attia  August 28, 2012

      Crista, this blog constitutes my advice. Lots to read.