The personal blog of Peter Attia, M.D.

What I actually eat, part III (circa Q1 2014)

What I actually eat, part III (circa Q1 2014)
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This week I had dinner at a great steakhouse in New York with a very good friend.  Like any two “normal” guys after a long day, all we could talk about was science, and on this particular night the topic du jour was NAFLD (non-alcoholic fatty liver disease for the non-cognoscenti).  We ate, we drank, and we shook our heads in disbelief at the thought of 7 million children in the United States being afflicted with NAFLD.  In the next few years NAFLD will become the number one indication for liver transplantation (not a typo).

After dinner, my friend, who I dine with almost every time I’m in NYC, made a comment about how many vegetables and how much fruit I consumed.

I had the following: a chopped salad, tuna tartare, a 12 oz filet; and we split an order of sautéed onions, brussels sprouts, and a bowl of berries.

He asked, “How are you able to stay in ketosis with all of those carbs?” I responded, basically, that for the past few months I have not been consistently in ketosis, and when I am it’s only following a long bike ride where my BHB levels may get back into the 2-3 mM range. Most days, however, I live in the 0.3 to 0.8 mM range, depending on the time of day. (In my mind, to reap the benefits of nutritional ketosis, one probably needs to consistently be in the 1-3 mM range, and for some “applications” 3-4 mM is probably ideal.)

So what gives, you may be thinking. Is Peter Attia not Mr. Ketosis? Well, my friend suggested it might be time for another one of the dreaded what-do-I-eat posts.

Anyone who knows me or who has read this blog for a while will appreciate the fact that I loathe talking about what I eat. Why? Because, it unfortunately gets interpreted by many as what they should eat. It’s like asking me what exercises I do, and inferring you should do the same. It doesn’t make sense.  I have specific genetic factors, epigenetic alterations, and goals.  These factors coalesce to shape my behavior – how I exercise, what I eat, what I supplement.

A little backstory first

In September of last year, for my wife’s birthday, we went to our favorite restaurant in San Diego, where we live. The day before I emailed the owner and general manager, both friends, and asked for them to have one of our favorite off-menu items on hand (the best sushi in San Diego).  They happily obliged and asked which of their desserts my wife would most like.  I said something to the effect of: well, they are all great, so you pick.

The next evening, after eating more sushi and sashimi than I could imagine (I ate 3 platters myself), they brought out a platter with a full size serving of each of their signature SIX desserts, each with a lit candle.  We sang Happy Birthday, blew out the candles, and my daughter and wife, themselves already stuffed, proceeded to have a small forkful of each of the six desserts.  My daughter said, “Daddy, these are so yummy! Why don’t you have a bite?” To which my wife echoed, “Yea, they really are ridiculous…”

And in that instant, I made a decision. I did something I had not done in 4 years (to the month, actually). The decision was this: about 3 or 4 times a year (I opted for my wife’s and daughter’s birthdays, Thanksgiving, and maybe something else), I would – for one meal – eat whatever the hell I wanted.

In the next 15 minutes I devoured the remaining 4/5-ths of EACH of the six culinary masterpieces in front of me.  From cheesecake, to carrot cake, to decadent ice cream, and stuff I didn’t even recognize, I ate it.  In an instant I felt both wonderful and horrible.  The look on my wife’s and daughter’s faces – alone – was worth it. Their jaws on the table the whole time. The taste was beyond what I remembered (actually, much sweeter than I remembered, probably because when you don’t eat sugar for 4 years, well, you know).

I could barely get up from the table. That night, when we got home, I had a horrible headache. 1,000 mg of Tylenol and 2 glasses of water later, I still couldn’t sleep. I eventually got a few winks of sleep. The next day I felt hung over – a feeling I had not experienced since my 26th birthday. My fasting glucose was 126 mg/dL and BHB was 0.2 mM. Clearly I was out of ketosis.

I decided to go out for a glycogen-depleting workout (multiple sets of 3 min all out intervals on the bike) and about 36 hours later, after resuming my normal diet, I was right back into ketosis and felt just fine.  I told my wife I was going to repeat this experience on Thanksgiving. As such, and despite how far in advance this was, I asked her to plan to make an extra bowl of my favorite Thanksgiving dish – candied sweet potatoes – baked sweet potatoes coated in melted marshmallows.

Thanksgiving came and went, and I repeated the same act of debauchery during the big feast. Sure enough, by the Sunday morning of Thanksgiving weekend, I felt back to my baseline.  I haven’t gone on a bender like that since, but I’m probably due for one.

I’m sure at least some of you are asking, “Does Peter still think sugar is metabolically deranging?” The answer is absolutely, at the levels it is consumed by most Americans.  If you want a refresher on my point of view on sugar, definitely give this post a re-read.

So what did I take away from this?

Somewhere between “every day” and “never” there is a tolerance I have developed to consume massive amounts of carbohydrates, and specifically sugar.  Now, there are two components to this: a purely physiologic one and a behavioral one (which I suspect is heavily influenced by my physiology).

Focusing just on the physiology, I would guess I could probably “tolerate” a binge like that every few weeks with little measurable or discernable adverse effect.  I won’t even attempt to argue whether it’s every 7 days, every 14 days, or every 30 days.  But, it’s probably somewhere in that vicinity.

What about the behavioral side? Well, I suspect there exists a different “frequency distribution function” that describes how often I could binge like this without resuming unhealthy eating habits in the long run.  If I had to guess, I think the threshold for recidivism is higher from the behavioral tipping point than it is for the physiologic one. In other words, habits matter. I can probably tolerate – physiologically – more sugar today than I can tolerate behaviorally.

One last point I’d be remiss to leave out. You should keep in mind that for a period of 4 years, my consumption of sugar (sucrose, HFCS, liquid fructose in the form of any beverage, etc.) has been less than about 5 grams per day.  The average American, depending on which stats you believe (I think they are all pretty weak), consumes somewhere in the neighborhood of 100 to 120 grams per day of sugar, NOT including the liquid fructose in juice!

So, I have to at least entertain the hypothesis that 4 years of avoiding sugar has been a sufficient enough period of time to offer me some sort of “metabolic reset.” Now, I have no intention of testing this. If I was once susceptible to insulin resistance, I’m pretty sure I will always be. But, an interesting Gedankenexperiment would have me going back to one of several different dietary patterns – vegan, but with no sugar; standard American diet with lots of sugar; modestly higher carb, but still sugar-restricted – all could offer insights into the physiology of adiposity and fuel partitioning in my metabolically reset condition. 

How has this shaped my current eating behavior?

Sometime early in the New Year, I started really craving more vegetables. I’ve always loved them. Even in ketosis I still ate one or two salads each day most days, but I was pretty restrictive about the quantity of vegetables that had much carbohydrate in them (e.g., tomatoes, carrots).  But now, I wanted even more.  Big heaping bowls of curry stir-fry. (I have to toot my horn on this one thing. I make a really good, creamy, spicy curry stir-fry.) I realized this would probably knock me out of ketosis, especially with the large amount of tofu I mix with it and the yogurt I use to make the sauce.

My lunchtime salads were getting bigger and bigger, and I was piling more and more “stuff” into them. Almost laughable by the standards of those around me.

And I noticed I was eating less meat. Not at all by “design,” but somehow by seemingly craving less.  It seemed an average week would have maybe 2 servings of red meat.  When a great steak is placed in front of me, believe me, I enjoy every bite, but I found I just wanted it less. I also started craving a bit more fruit, especially berries and even apples, the former I consumed in modest amounts in ketosis, the latter I did not at all. (Because I know someone will ask – do I think red meat is harmful? – the answer is no, I do not believe so. Certainly not based on evidence I’ve seen to date, including the recent story about protein. For those looking to brush up on the state of evidence implicating red meat, I’d recommend three posts – one I wrote many moons ago in response to one of the dozen epidemiology stories, one written by Chris Masterjohn in response to the TMAO data, and one recently by Zoe Harcombe in response to the protein epidemiology).

I don’t know what to make of this, of course, and it may be nothing at all, other than an evolution of preference. I’ve checked mineral levels in my body in search of a clue (none showed up). Maybe I’m over- or under-saturated in some key nutrient?

Now, since everyone seems to care how much carbohydrate I consume, here is my current framework.  I put carbohydrates into 5 essentially MECE categories:

  1. Those I consume daily – mostly salad stuff and other vegetables; about twice a week I make a curry stir fry with tofu, for example.
  2. Those I consume often – nuts, berries, almond butter (which I just spoon out of the jar), super starch (both as a meal replacement and post-workout drink).
  3. Those I consume intermittently – a couple spoons of rice here and there, especially when I make Indian food or when we have sushi; a piece of baked potato when it looks particularly appetizing. If my daughter “makes” spaghetti, which she loves, I’ll usually have a forkful to remind her that her dad is not a complete freak.
  4. Those I consume only on very special occasions – exceptional desserts, for example – about 2 or 3 times a year, like the ones I consumed on my wife’s birthday, or the candied yams. (NB: One thing I decided in an instant – if I’m going on a bender, it’s not going to be for “average” dessert like some lame birthday cake; it’s got to be best in class.)
  5. Those I still completely refrain from – I call these the “cheap” carbs – basically all else (including cookies, potato chips, cereals, and the candy bars they keep handing me on this flight as I type this), including any liquid form of fructose, such as juice or sports drinks.

Below is a “typical” 5 days of eating over the past few months. Keep in mind, I virtually never consume breakfast, maybe once a month (e.g., if I have a breakfast meeting). Essentially, I do all of my exercise (current routine, below) in a fasted state only consuming the BioSteel’s high performance sports drink (HPSD), which contains virtually no calories – maybe 8 kcal of BCAA per serving.  So, despite the dietary changes I’ve made, and the fact that I’m not in ketosis most of the time, I remain seemingly well fat adapted, though RQ is a bit higher than before.

I should point out that I spend much less time exercising than I have historically, due to time constraints. But, I still aim for the following schedule, which is interrupted by travel during at least 2 or 3 weeks each month. The schedule below amounts to about 14 to 16 hours per week of training.

Monday – high intensity lift, followed by swim

Tuesday – ride (tempo)

Wednesday – swim

Thursday – ride (TT practice or threshold)

Friday – high intensity lift

Saturday – ride (VO2 max intervals), followed by swim

Sunday – group ride or solo TT practice

 

I can’t believe I’m about to do this…I just have this horrible feeling someone is going to attempt to replicate this, bite-for-bite, for no good reason. Please refrain. Remember, this is what I eat because of how my body works.

Wednesday

Lunch – huge salad (bowl larger than my head) with romaine lettuce, kale, carrots, tomatoes, cucumbers, olives, mushrooms, chicken breast, 2 tbsp olive oil, 3 tbsp lemon juice, 1 tbsp white vinegar, 1 cup of almond slivers

Snack – a cup of macadamia nuts

Dinner – Another large salad, but no chicken or nuts in this one; 1 pound of salmon; bowl of berries to follow

Thursday

Lunch – huge salad (bowl larger than my head) with romaine lettuce, kale, carrots, tomatoes, cucumbers, olives, mushrooms, can of tuna, 2 tbsp olive oil, 3 tbsp lemon juice, 1 tbsp white vinegar, 1 cup of walnuts

Snack – 2 or 3 tbsp of almond butter (a zero sugar variety)

Dinner – Omelet made from 6 eggs (white + yellow), shredded cheddar, lots of other veggies; side of steamed broccoli in butter; 2 more spoons of almond butter after dinner

Friday

Lunch – same as Wednesday (I basically rotate salad back and forth about 3:1 in favor of chicken over tuna)

Snack – none

Dinner – Curry stir-fry containing tofu, carrots, broccoli, bell peppers, mushrooms, zucchini, and squash, in a sauce made from curry paste and Greek yogurt.  I typically consume two heaping plates of this.

Saturday (post ride and swim)

Lunch – 7 hardboiled eggs, an avocado, 2 oz of cheese

Snack – a Fuji apple covered in almond butter

Dinner – 8 oz of steak (fillet, rib-eye, or tri-tip), 8 oz of salmon, large salad (sans meat and nuts, which I only do with lunch salads).

Sunday (post longer ride)

Lunch – The “Peter Kaufman” super starch shake (heavy cream, zero-sugar almond milk, a package of chocolate super starch, 2 tbsp of almond butter, an extra 20 g of Biosteel whey protein, frozen strawberries, ice – blend to a thick shake); I’ll drink 2 liters of this. Literally.

Snack – none

Dinner – Family sushi night! I’ll have a seaweed salad or two, huge platter of sashimi, California roll, and another specialty roll.

Lastly, because I know someone will ask, the few times I now take to measure, record, and tabulate exactly what I consume, it works out to about 3,500 kcal per day.  But some days, especially when I travel, it can be as low as 2,000 kcal when I only consume one meal per day (dinner). Other days it can be as high as 5,000 kcal. But, 3,300 to 3,600 kcal per day is the typical range. 

So, there you have it – the most irrelevant information you’re likely to find on this blog (except for what’s below… this is actually valuable stuff!)

Fashion tip of the month

While in NYC I realized – about 15 minutes before leaving my hotel for a very important meeting – that I had forgotten to bring cufflinks. My heart sank. I’ve never made this mistake before. I immediately realized why.  While packing, and just about as I was going to grab a set, my phone rang and I was distracted.  But that was neither here nor there. What was I going to do?  I didn’t have time to buy a new set, and the hotel concierge didn’t have a set to lend me, so I grabbed some dental floss and tied the cuffs of my shirt together using precise surgical knots.  I was pretty self-conscious that someone would notice and ask or comment, especially on a day stacked with so many back-to-back important meetings. Amazingly, no one said anything, though I could see some people looking at them and doing the double-take. Over that lovely steak dinner I alluded to at the top of this post, I told this story to my friend (who snapped the picture, below).  His response?  “Yea, I noticed it right away. I thought it was a new style. Very cool, actually. Kind of European.” So there you have it.  Don’t say I never shared anything of value on this blog.

Cuff links

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About the Author:

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

Discussion

  1. Joey  March 17, 2014

    Love the dental-floss-links, they’re definitely on the gifts list for my bf’s next birthday!

    (reply)
    • Peter Attia  March 17, 2014

      Always a winner.

    • Park Firebaugh  March 19, 2014

      As a dentist, I can tell you that 10 out of 10 dentists approve of this hack.

    • Peter Attia  March 19, 2014

      Ha ha! That’s a higher approval rating than even Trident!

    • BR  June 11, 2015

      Zip ties work well, too.

  2. Jeremy Tyler  March 17, 2014

    Sounds more like primal/paleo diet now (not that there is anything wrong with it). A few questions.

    1. Previously you talked about ketones and carbs co-existing. So even with the amount of exercise you are doing (depleting your glycogen) you still find it hard to remain in ketosis eating the amount of carbs you eat?

    2. Do you feel the “low-carb flu” when going in and out of ketosis so often or only after having a heavy sugar meal?

    3. Has this had any effect on your lipid profile (or think it will if you have not tested yet)?

    Thanks for the great post.

    (reply)
    • Peter Attia  March 17, 2014

      1. I don’t exercise aerobically enough now. Maybe in the summer with more saddle time it will be enough.
      2. I don’t, and frankly am a bit surprised by it. The heavy sugar meal is an exception, but that’s only happened twice in 6 months.
      3. Yes, it’s actually deteriorated a bit! TG and LDL-P a bit higher; HDL a bit lower. All to be expected with more CHO in diet.

  3. Monique DiCarlo  March 17, 2014

    Great article…and no, I’ll not eat what you eat, because my body has other needs! 😉 I’ve been Primal since 2012, I do eat some rice and quinoa, dairy, and lately I went back to lentils (soaked they give no problems). My question is: why is the ketosis state such a big thing? Do we really need to have such a low intake of (healthy) carbs? Is it OK for the body to be in ketosis all the time? How does all this translate to an approach for children?

    Thanks for sharing your insights and thoughts!
    Mo

    (reply)
    • Peter Attia  March 17, 2014

      All addressed elsewhere on blog.

  4. Monique DiCarlo  March 17, 2014

    P.S. Going to steal your cufflink design, as I have the same problem with a business shirt!

    (reply)
  5. Duncan Lally  March 17, 2014

    Hi Peter – you say that you on average take in about 3k to 3.5 k calories. But the examples you give don’t seem that much….maybe almond butter gives you stacks of calories all at one go? I have measured “kind of” accurately my calories over the past few weeks and I have a hard time reaching 2k to 2.5k calories. I train a lot but my weight seems stuck at a plateau (20% body fact – amazing given the exercise I’ve done over several years now, no idea why…) Anyway, just wondered if you really have to try hard to get to 3k calories..Thanks.

    (reply)
    • Peter Attia  March 17, 2014

      Absolutely. Plus, I’ve had the “luxury” of testing myself with doubly-labeled water, which confirmed I was in energy balanced at 3,850 kcal/day. DLW is generally viewed as +/- 10% accurate and is the gold standard for free-living energy expenditure.

  6. Monique DiCarlo  March 17, 2014

    Oops, I can’t edit my post! I see now that you wrote multiple posts about ketosis/carbs…I guess I have some homework to do 😉

    (reply)
  7. Osama  March 17, 2014

    Hi Peter
    Seems to me, this is (still) Low in Fat?
    Do you cook your food with coconut oil?
    Almost no butter and Olive oil !!

    (reply)
    • Peter Attia  March 17, 2014

      Still cook in butter and/or coconut oil. Plenty of EVOO. Did you see the salads?!

  8. David Harley  March 17, 2014

    Glad to know I’m not alone in my ‘cheat’ nights. I will say though that after my initial weight loss (31KG), where I was very strict, I started with my ‘cheats’. The problem I found, was that once a month became twice a month and then weekly and then every few days until I got to a stage where I’d put back 21kg. So I think, much like any other drug, I need to be really strict on my cheats and recognize that I need to be careful (I fully realize this is just me and others can maintain their will power, but not me). Since the 1st of March I’ve gone back to a very strict diet, keeping it under 50g a day and I lost 9kg in 17 days. This has taught me a few things.

    1. Exercise is definitely not relevant to weight loss. I was doing massive amounts of swimming during my 1st weight loss window so I was never 100% certain it was the LCHF or the exercise that caused the weight loss however, I have been unable to exercise at all this month so the weight loss is purely down to diet, despite the fact that I’ve been eating 4000+ calories/day

    2. You do not have to be fully in ketosis to lose weight. I only measure every 2nd day but I haven’t gone above 0.4mM since I re-started. I do recognize that I could’ve lost more weight in this period had it been higher though.

    3. Having set yourself a goal and then achieving it, you need to have a back-up or secondary goal ready in place from the day you achieve your first goal. I set myself a goal of doing an English Channel relay in 2013 which I completed in Aug but had no secondary plan in place and that was definitely a contributing factor in my going back to my old diet.

    ps. When you had your carb-fest, did you feel ‘drunk’ afterwards… i definitely get the feeling like I’ve had a few too many beers if I do a carb-binge.

    (reply)
    • Peter Attia  March 17, 2014

      1. Maybe, but it depends on the exercise, I suspect. I’m on the fence for this.
      2. Agree completely
      3. Agree, also.

  9. Moti Halpert  March 17, 2014

    Hey Peter, is there already preliminary results of the experiments?
    http://nusi.org/the-science/current-science-in-progress/ #. UycGvPmSxRI

    (reply)
    • Peter Attia  March 17, 2014

      Not yet. Science takes a while.

  10. Edmund Brown  March 17, 2014

    Love the salad qualifiers!

    My wife and I eat truly enormous salads more days than not. I sort of lost perspective on just how big they are until last week when we went out to eat, which is not something we do very often. I got a “house salad”. When the food arrived I thought my salad was a garnish until I realized nothing else was coming to the table.

    (reply)
    • Peter Attia  March 17, 2014

      When I go out for salad for lunch, I order 2 entree salads.

  11. Emory  March 17, 2014

    I do low carb 50-100g per day but have yet to transition to complete LCHF. I have found over time, that I experience the same “hangover” when I overindulge in carbs. The first time or two, I thought it was simply lack of sleep or jet lag (since I will try something new on a trip and we stay up later when flying from FL to the west coast) so I decided to eat some simple carbs at home to see the effect.
    I found that a bowl of strawberries or peanut butter and banana sandwich on ezekial bread, had no effect the next day. Eating white rice, a few cookies, or similar, gave me that same hungover feeling that I’d experienced before. Full fat ice cream had no effect while a “diet ice cream” did.
    I find it revealing that one’s body will let you know what to eat and what to avoid…at least for me.

    (reply)
  12. John  March 17, 2014

    Peter:
    What is your current caloric ratio of Fat:Protein:Carb? Has that changed?

    (reply)
    • Peter Attia  March 17, 2014

      Yes, it’s changed greatly since NK. Roughly 25% PRO; 20% CHO; 55% Fat.

  13. Ben Greenfield  March 17, 2014

    For some reason, I couldn’t get this song out of my head the whole time I was reading this post: https://www.youtube.com/watch?v=VxjqPBP7cZg#aid=P-V3QFTLcb8

    Peter’s quarterly theme song, perhaps?

    (reply)
  14. Tom A  March 17, 2014

    Excellent post Peter. I couldn’t help to notice the massive amount of protein you consumed during Saturday’s dinner. Looks to be over a 100g of protein during that sitting. Was that by design or happenstance?

    (reply)
    • Peter Attia  March 17, 2014

      I never regulate it. I just eat what I want, but I’m definitely eating too much protein on most days to be in ketosis. So it’s not just the CHO content in my diet.

  15. N.Lockard  March 17, 2014

    Peter,
    Thanks for sharing. I definitely won’t try to copy you, but always enjoy these posts as I look for new ideas on healthy combinations. Do you have any other favorite meals that maybe didn’t show up?

    (reply)
    • Peter Attia  March 17, 2014

      Yes, but I only had time to list out 5 days of eating.

  16. Steve  March 17, 2014

    Do you recommend beans and what’s the maximal amount of eggs you should be eating on a daily basis?

    P.S. What’s your body fat percentage now? (if it’s not a secret)

    (reply)
    • Peter Attia  March 17, 2014

      Last DEXA was about 3 or 4 weeks ago (8.5%). BodyMetrix was 8.1% on the same day.

  17. Lynn Wright  March 17, 2014

    Tofu, really? Why not coconut milk in those curries?

    (reply)
    • Peter Attia  March 17, 2014

      I’ve done that plenty, but I actually prefer the taste and texture in the current form.

  18. Leslie Evans  March 17, 2014

    Hi Peter,

    I talked to your friend, Dr. Zubin Damania, for a good bit a few weeks ago while I was at Scripps for a conference. We both went on about how great your blog is! He talked me into getting a Precision ketone meter and pushing hard to stay in ketosis (still waiting for the strips to come in from Canada). I still have about 30-40 lbs of extra fat on me. I noticed that I eat too many low-carb veggies sometimes, which ends up stalling my fat loss. I think this post is very helpful and look forward to the time when I can add more back into my diet to maintain my weight.

    Thanks for doing what you do!

    (reply)
  19. Dan Walker  March 17, 2014

    Do you have any go to foods that you prefer when you are travelling? Possibly something you bring with you? I travel a lot for work and that really seems to be one of my biggest issues. At home I can stock, prepare, and eat whatever I want but on the road it can be a real challenge. I know I can try and pick and choose different foods from restaurants, and I’ve been able to work that out to a certain degree but it still seems almost impossible sometimes. Even if there is just a resource you use for travelling with good ideas that you like and have used in the past, that would be really helpful.

    Thanks!

    (reply)
    • Peter Attia  March 17, 2014

      I rely greatly on fasting when I travel. When I eat at restaurants, which I do often, I keep it pretty simple. On the road it’s often 1 meal a day, but sometimes 2. I used to carry nuts everywhere, but no longer. I take a reprieve from them now when I travel.

  20. Fred Forsyth  March 17, 2014

    Interesting cufflinks. I like brass-plated paper fasteners from an office supply store. They works great as studs or cufflinks – they look like gold, but are cheap and disposable.

    http://www.amazon.com/ACCO-Plated-Fastener-Fasteners-A7071710/dp/B004LWSFAK

    (reply)
  21. Yael  March 17, 2014

    Hi Peter
    I do very low carb..under 15g/day….
    I have a Mtb stage race coming up and I tried superstarch for the first time this weekend! Could u ofer some advise for eating for a stage race…ie..would u eat a high fat breakfast 2 hours before the start..then a sachet of superstarch at the start and every 2 hours then a superstarch added with protein as a recovery?? Would u eat fat while racing or not?…any advise would be great!

    (reply)
  22. LuckyMama  March 17, 2014

    Great post.

    I came to the same conclusions on my own – I felt so vindicated when I found your website!! I’ve devoured every page.

    My issue was putting it into practice – I’m a slow learner! But I’m in the saddle now and I’m down to less than 15 g sugar each day and less than 35 g carb total.

    My only criticism of your website? You don’t post often enough! 😉

    One question though. What do you do/use to accurately determine whether you’re in ketosis or not?

    (reply)
    • Peter Attia  March 17, 2014

      I’d like to post less…

  23. Rory  March 17, 2014

    You don’t really mention supplements. Do you still take all/any of the “Daily Supplements” listed in this prior post?
    http://eatingacademy.com/personal/what-i-actually-eat-part-ii-ifik-2

    I’m mostly curious if you have found that you don’t need to supplement electrolytes since you’ve increased carbs a bit. Also curious about MCT oil.

    (reply)
    • Peter Attia  March 17, 2014

      Some, and I’ve added others. I don’t take MCT, though. No need.

  24. Fredrick Hahn  March 17, 2014

    Peter –

    Have you been reading Dr. Art Ayers blogs? I have a new dis-appreciation for plants now. VERY enlightening information.

    Here’s a sample:

    http://coolinginflammation.blogspot.com/2014/03/health-diagrams-ii-curing-autoimmunity.html

    Keep up the great work.

    Best,
    Fred

    (PS – I’m a friend of Gary Taubes. He used to train at my gym when he lived in NYC).

    (reply)
    • Peter Attia  March 17, 2014

      Fred, I have not read this. Sadly, my blog reading these days has approached epsilon. I’m a big fan of you’re doing, and after speaking with Doug McGuff and a few others I have embarked on my own journey of slow lifting, though I “need” to do so twice a week with a split protocol. Really enjoying it.

  25. Tim Claason  March 17, 2014

    Thanks for sharing.

    I’ll have to try to add lemon juice to my salads. I’ve been trying to get away from putting Italian dressings on my salads, because the brands I like all use vegetable-based oils. I’m still warming up to EVOO+White Vinegar…it’s sort of new for me.

    (reply)
    • Bean  March 21, 2014

      If you are using olive oil and vinegar for a salad, make sure to use salt. Otherwise the vinegar is unbearably sour. Do it like the Italians would, entirely by taste and no measuring. You have your bowl full of salad leaves, etc. Start with salt and a sprinkle of vinegar first, toss, add more salt and vinegar, toss, then start adding olive oil, toss, taste a few leaves, add more oil, possibly more salt, etc. If it sits for 5+ minutes before you eat it, so much the better. (This fits into the Italian meal structure – toss the salad before you sit down – eat the “primo”, the first course – then the salad is eaten with the “secondo”, the second course, and it has sat just the right amount of time.)

      Having just written this – I haven’t done salad this way in AGES – my mouth is watering with the memory of it!

  26. Judy  March 17, 2014

    Yeah, I can understand why you hesitate to write out the detailed menus, but I still think sharing fully and honestly can have so many benefits.

    For instance, I read your very first “what I eat” post when I was struggling with a lot of metabolic and digestive issues, and when I read that one of the first things you had stopped was sugar, I decided to give it a try. I tried it for 2 weeks, tried other things also for two weeks, not all at the same time, and staying off sugars has been an important part of my eventually sustainable eating habits. I’m not skinny or particularly muscular but I am healthy and relatively fit.

    I would not recommend my own diet to ANYONE else, since it includes responses to lots of digestive issues, but reading your posts gave me ideas and helped me start thinking of things a bit more scientifically and taking restrictions less personally. And I found that staying off sugar meant, in my case, that I could eat a lot more other carbs than I had in the past.

    I got to my current dietary habits as a result of experimenting, but your sharing helped me do that experimenting, so… thanks!

    (reply)
    • Peter Attia  March 17, 2014

      I’m glad you appreciate the nuance of it. Hope it helps, Judy.

  27. Guillaume  March 17, 2014

    Hi Peter,
    This is almost exactly how I eat, in the guiding principles, except that consume about half the calories you do, and get about half of them from coconut oil in the form of milk and oil directly. However, there are two things that shocked me completely, and these are having a bowl of cherries or berries for desert after a big meal, and having an apple with almond butter. This is possibly the worse combination of them all: sugar and protein together in the stomach are completely incompatible.
    Sugar does not need to sit in the stomach and does not trigger HCl secretion: it needs to go straight through to the intestines where it is digested by the sugar degrading enzyme in an alkaline environment. Simple sugars, taken on an empty stomach, make their way through and into the blood in the order of minutes. Whereas protein in the stomach triggers the secretion of HCl needed to break it down. And as it is being broken down, the pH is adjusted by the secretion of as much HCl as is needed in order to bring the pH down to about 1-2. It is only at this stage, which would normally take between 2-5 hours depending on how large the meal was and how much protein it contained, that the valve will allow the chyme from the stomach to go into the intestine, together with the secretion of bicarbonate from the pancreas in order to neutralise the acid and make it alkaline for processing (further breakdown and then absorption) in the intestines. I’ve written about this in a few posts, but this one is particularly relevant: http://healthfully.wordpress.com/2013/08/03/understanding-digestion/
    So, if you allow me to suggest something, it would be to have you berries and any other fruit always on their own on an empty stomach and away from meals.

    (reply)
    • Elizabeth  December 11, 2015

      I wonder if anyone can comment on the pervasive use of proton pump inhibitors and the intake of protein in the diet. It seems to me that PPIs would be detrimental to the digestion of protein.
      I love your blog, Peter. Thank you for the fantastic work. Also loved the podcast with Tim Ferris – great stuff!

  28. james  March 17, 2014

    No worry Peter about imitating your eating habits, love my eggs and bacon and salad with sauerkraut and half avocado (share with my wife) in the morning too much. A bowl of home made yogurt (tbsp of RS) with cherries for lunch all through the winter. Your lunch looks a lot like our ‘work’ lunch through the summer. We are a bit more decadent maybe. Couldn’t skip the glass of Riesling or Chardonnay (own vineyard North of 401!) Thanks for another entertaining and informative post. Will share it again on Facebook

    (reply)
  29. Justin  March 17, 2014

    Dr. Peter,
    To (maybe) give this post some educational value :), could you do a follow up to John Kiefer’s idea/theory of carb-backloading? I have only listened to a few podcasts where he was interviewed about this and there is not a whole lot of info floating around out there (other than referencing him). Your thoughts?
    Regards,
    Justin

    (reply)
    • Peter Attia  March 17, 2014

      Maybe.

    • Billie  April 7, 2014

      Carb nite/carb back loading came to my mind when reading this latest post, too. Exciting stuff!

  30. Giselle  March 17, 2014

    My post will be a little blunt, but only because I am interested in this!

    The language of your post resembles addiction language in some regards, e.g. “bender”, “craving”.

    With, say, alcoholism, a relapse ends with a drink. That is, it tends to start with permission thoughts, and then some balanced reasoning along the lines of “special occasions only” and in time, maybe a week, maybe a year, alcoholism inveigles its way back in. Thus, for most, abstinence is the only way.

    I notice you also refer to eating whatever you “want”. Which might suggest a bit of resentment at ketosis?

    I intend no offence here. I ask because your post echoes my own issues. I am an ex alcoholic. I have not had alcohol for years for the very simple reason that I don’t want to. I don’t feel hard done-by, or tempted, or that I want to join in on special occasions. Abstinence is easy because I want it.

    I don’t feel the same about ketosis. I believe in it and I want the benefits (especially blood sugar control) but it feels like a straight jacket if I’m honest. It sounds as though you have opted for a bit of “moderation” and I wonder how that feels psychologically? I take the point of the 4 years’ abstinence having rebalanced the insulin resistance, and maybe balance is the better route anyway. But I’d welcome your thoughts on the mindset here.

    (reply)
    • Peter Attia  March 17, 2014

      Fair enough. No doubt being in ketosis was a compromise. I was not eating certain foods I would have liked to eat (and I still don’t), but the trade-off was worth it, given what I was optimizing for at that time. I don’t think the addiction model makes a perfect comparison, though there are some elements that carry over. Food is, I suspect, more complex, and I think many cravings are physiologically driven. Part of why I hate writing about what I eat (vs. discussing with a friend over dinner), is the nuance is too complicated to capture in a blog post, and I’m not interested enough in writing a 10,000 word treatise to explain it all. So in short, I don’t think of food they way you may be thinking of alcohol, but I appreciate your sentiments.

  31. Michele  March 17, 2014

    Hi Peter,
    Out of pure curiosity:
    1. I realize you have a bazillion things to do with NuSI and life in general but is the affect of gut flora on weight something you are looking into or are intersted in?
    2. Given that you are interested in gut flora, have you tested your own during your self-experimentation?
    As always, thank you so very much for all you do.

    (reply)
    • Peter Attia  March 17, 2014

      I am interested, and suspect it matters, but I have not seeing compelling and rigorously quantifiable, actionable metrics to track. Still a black box in my mind.

  32. Yossi Mandel  March 17, 2014

    I’m reading the title of this post as “Don’t eat like me, you fellow freak!” The message I got from your 3 eating posts is that no one should eat like anyone else. Test yourself and your eating, adjust it to your health needs (you needed to lose weight, I needed to reverse T2 diabetes which I did), and keep on going.

    I have to thank you for being able to adapt to holiday eating and being able to celebrate. Yesterday was Purim, big Jewish drinking festival (imagine being an Irish Jew yesterday?) and sharing gifts of sweets and bakery goods, and last year I couldn’t participate in any way. This year, I switched from vodka/scotch to dry red wine, had a couple of pieces of really good looking brownies and a challah roll smothered in butter, and today I’m back to normal. Thank you so much for leading the way!

    http://en.wikipedia.org/wiki/Purim#Purim_meal_.28se.27udah.29_and_festive_drinking

    (reply)
    • Peter Attia  March 17, 2014

      Glad you appreciate, Yossi.

  33. Cort  March 17, 2014

    It went unmentioned so I was wondering if you still have bullion daily? How about water consumption? I find that some cramping when I work out, and at night, is still a problem. The salt seems to help, and the water. I eat the same sort of things you do on your few carb days, but never high sugar–and here I thought I was in ketosis all this time! Hmmm–but less (1500-1800k/day) being a great deal older and more sedentary. The fat loss in the last 9 mos has been very encouraging–30 lbs–and my blood work has all improved, especially the “good cholesterol” which moved from 39 to 50 in that time.

    (reply)
    • Peter Attia  March 17, 2014

      No more bouillon except maybe once a week when I crave salt, typically on a weekend. p.s., remember there is no such thing as “good” cholesterol or “bad” cholesterol.

  34. Amy Wagner Bush  March 17, 2014

    Great post, as usual. SCARY stats on the NAFLD, especially as far as implications for children.

    Hope you don’t mind a nosy question – have you noticed any visual changes in your body composition/level of leanness since increasing your carbs and maintaining at a lower level of BHB? I know that you mentioned that your RQ has increased – has that translated into any changes in energy or performance levels during workouts?

    Thanks so much for sharing your experiences and thoughts!

    (reply)
    • Peter Attia  March 17, 2014

      Not really, but I do ask my wife if she thinks I look leaner or less lean. She just rolls her eyes and tells me to shut up. No plans to start posting shirtless pictures on the blog, though, so for now I guess the most I can say is, if there is a difference, it’s minor.

    • Janknitz  March 18, 2014

      “Do these carbs make me look fat?”

      (Sorry, I could not resist!).

  35. Beverly  March 17, 2014

    Forget about what you eat. What we really want to know is how did you tie those knots! 😉

    (reply)
    • Peter Attia  March 17, 2014

      Surgical residency… one of the few perks.

    • Sean  March 18, 2014

      If he did it while wearing the shirt I would be REALLY impressed.

  36. John Wilson  March 17, 2014

    Peter:

    Your food choices reminded me of two items you occasionally eat, but could be eaten more often with one slight change: Apples and Potatoes. ~80% of the nutrients and the flavor are in the skin. I peel apples, chop up the peel for a decided flavor booster and crunch in salads. The fructose laden inside goes in the trash. Baked potatoes get the same treatment. Scoop out all of that starch and trash it. The shell, filled with fat of your choice plus salt and pepper have kick-ass flavor and nutrients.

    (reply)
    • Peter Attia  March 17, 2014

      Interesting. Might have to try some time.

    • Carl Eduard  March 18, 2014

      Looking at a micronutrient comparison between a kilo of apple with skin to the same without skin, there doesn’t seem to be an outstanding difference:
      http://www.bitelog.com/mega-food-search.htm?q=apple+skin&q0=1000&btn=Update&f0=9003&u0=0&q1=1000&f1=9004&u1=0&p=100

      Also, a kilo of potatoes with flesh and skin compared to a kilo of potato skin:
      http://www.bitelog.com/mega-food-search.htm?q=potatoes+raw&q0=1000&f0=11354&u0=0&q1=1000&btn=Update&f1=11362&u1=0&p=100

      That website of gets its numbers from a database put together by the USDA (but, I find that other website displays the data in a more overviewable way):
      http://ndb.nal.usda.gov/ndb/search/list

      Browsing around the web I came across some reports of “beneficial phytochemicals” being concentrated in the apple skin, while on the other hand potential pesticides could be another consideration (though the effect of both of these things can be hard to quantify). I’ve also read that if you were to rely on potatoes as a staple food it might be a good idea to peel them to avoid a glycoalkaloid called solanine that’s mostly found in and near to the skin.

    • cmztrav  March 21, 2014

      Thanks for reminding me that one of my favorite snacks of all time is the leftover potato skins from cooking certain Indian food (samosas or koftas, anyone?), heated up with some butter and salt. Oh boy!

      Thanks for your interesting post, Peter. I love reading about all of the self-experiments.

    • Diana Duran  October 29, 2015

      Just curious on supplements…how do u feel about fat burners and those types of claims?

  37. AmitK  March 17, 2014

    Peter, Thanks for sharing changes in your diet, always makes interesting reading. I noticed there are no more “fasting” days, I remember you sharing about Intermittent Fasting. Do you still have fasting days ? ….Thanks, Amit

    (reply)
    • Peter Attia  March 17, 2014

      Depends how you define fasting. By one definition I fast every day. By another (24 hours with no food), I do not.

  38. Hans  March 17, 2014

    Great post, and well worth reading, as always. I have another question. I’m curious as to how it is going with NuSi.org? There has been no updates on the homepage. Have You raised enough money to start Your studies? Have they, in fact, already started? That is going to be really interesting when it comes along. Is there anywhere online where news about NuSi.org is posted?

    (reply)
    • Peter Attia  March 17, 2014

      Lots at NuSI. Unfortunately, website is not really up to date, though.

  39. Zach Morris  March 17, 2014

    Peter,
    As always, I love your insights. I’m in South America, so I don’t have the luxurie of eating almond butter milk/ all the fancy meals you do, but I’ve been able to maintain very healthy either way, and I attribute it totally to reading about intermittent fasting and training while fasted. Hasn’t cost me a cent but the benefits are huge. I go on these benders you speak about more often than you, but I can always go back to baseline based on my frequency of intermittent fasting/ carb reduction! Thanks for being a mentor in regards to health. I’m so excited to see what happens with NUSI!

    (reply)
  40. piotr  March 17, 2014

    Do you have any take on supplementing leucine instead of all BCAAs? Seems to a/ increase insulin b/ without converting to glucose like 2 other BCAAs. From what I read it converts to ketone bodies c/ It also seems to increase protein synthesis within muscles

    All the best,
    Piotr

    (reply)
    • Peter Attia  March 17, 2014

      The BioSteel HPSD is actually more than BCAA. An explanation of why I prefer it, inclusive of the few additional factors it includes and their ratios, is beyond the scope of a response. But what you’re addressing is that some AA are ketogenic vs. gluconeogenic.

  41. jeff  March 17, 2014

    Hi Peter
    With your BHB levels below 1 how has this affected your FTP?

    Despite trying twice to get to this range I’ve never been able to successfully get my BHB between 1-3. I can always tell when I’m in no mans land because intervals that should be easy 2×20 at 280 watts become impossible.

    I seem to exist happily at around 100g of carbs a day although I don’t get the endurance benefits that I had when eating no carbs, 3 hour rides on only water, my FTP is much better when eating some carbs, sweet potato, pasta, soup.

    I went full carb (at least for me) on a family ski trip last week and woke every morning with a headache. Not sure if it was from the carbs or the elevation in Big Sky.

    (reply)
    • Peter Attia  March 17, 2014

      My FTP is down 20 watts right now, but that’s for a reason unrelated to my diet. As far as I can tell, diet shift has not altered FTP.

  42. Christina  March 17, 2014

    Thank you for this long and informative post, including fashion tip 😉 And no I promise I will not try to duplicate your eating style as I know the needs of my body differ. I subscribed to your blog after stumbling across your very moving TED.com talk and expect to learn a lot as I review your archives. And thanks for your work to promote real health in our society.

    (reply)
  43. Naren  March 17, 2014

    “In my mind, to reap the benefits of nutritional ketosis, one probably needs to consistently be in the 1-3 mM range, and for some “applications” 3-4 mM is probably ideal”.

    By benefits in the 1-3mM range, are you referring just to the increased cognitive function experienced in NK? Or even steady improvements in body composition and biomarkers (specifically TG, HDL)? Trying to understand if the body comp/biomarker benefits might not be fully realized if one cruises in the 0.5-1 mM range.

    Also, could you share what some of these 3-4mM “applications” might be?

    Thanks, Peter.

    (reply)
    • Peter Attia  March 17, 2014

      Everything from cognitive, appetitive, aerobic. As far as other applications, cancer or AD would be foremost.

    • greensleeves  March 20, 2014

      @Naren

      “Trying to understand if the body comp/biomarker benefits might not be fully realized if one cruises in the 0.5-1 mM range.”

      Bingo. Most people won’t see serious body comp benefits until 2.0, if the low carb forums are to be believed. But YMMV. N=1. I live at 2.4 myself – but I did splurge & eat an apple at a party for the first time in 3 years. With brie. 😀

    • Naren  March 20, 2014

      @greensleeves

      Thank you for sharing your thoughts. That is intriguing, I barely cross 1.5 mM ketones and often am in the 0.5-1.0 mM range. That is after 3 tbsp of MCT each day (2 in the morning, 1 in the evening). Then again, I only test once a week (in the morning, fasted) for cost reasons, so I’m not sure if the numbers are representative of what the situation is throughout the week.

      I am stalled at around 15% bf, want to get to 10%. M/32 y.o./170 lbs/6′ tall/4 days per wk of resistance training. As much as Peter would like to not put himself on display, at 8.5% bf, we all know he qualifies to have his business card say Shredded, M.D.

      Lately been trying to ensure I don’t have too big of a calorie deficit resulting in low T3, which I understand could stall fat loss.

      Would you be comfortable sharing your body comp. figures, and what they were prior to achieving 2mM+ ketones for a sustained period of time? I’m wondering if you had a fat loss “whoosh” after hitting 2mM.

      Understand it will all be N=1/MMV.

      Thanks!

  44. MImi Mugler  March 17, 2014

    Hi, Peter,
    I’ve been reading and digesting (sorry, couldn’t resist) your blog for quite some time and really appreciate your thoroughness and expertise. (It’s also very cool that I became really interested in Gretchen Rubin’s work and then found out she was a board member of NUSI! You guys rock!) Can I ask how you test for ketosis (strip or blood test)? I ask because so many people seem to test with strips, yet Phinney and Volek seem to say that that the urine strips don’t measure BOHB, and that is the ketone more produced after keto-adaptation. Also, you seem to eat a lot of protein! Is this all being utilized by your body for repair due to your intense workout schedule or do you think you have gluconeogenesis going on there?

    (reply)
    • Peter Attia  March 17, 2014

      When I do I use Precision Xtra blood meter for BHB.

  45. Todd Williams  March 17, 2014

    Just wondering if you consider the time between your workouts and your lunches. Do you aim to “refuel” within a certain time frame? Thanks! And I won’t be eating quite like you; there’s no way I could choke down 7 hardboiled eggs in a sitting.

    (reply)
    • Peter Attia  March 17, 2014

      Sometimes I ingest 25 g of whey protein right after lifting. Sometimes not. Nothing for the others, typically.

  46. Nico Oud  March 17, 2014

    Hi Peter,
    Is there a reason for you to ‘not have breakfast’?

    (reply)
    • Peter Attia  March 17, 2014

      I like to work out fasted.

    • Nico Oud  March 17, 2014

      Does not having breakfast effects your insuline levels later that day? Some people believe that skipping breakfast causes insuline peeks.

    • Peter Attia  March 17, 2014

      Does not appear to.

  47. Jerry  March 17, 2014

    Well yogurt (from whole milk) is one thing I know how to make, and I “sneak” it onto a low carb diet, so I would really appreciate the recipe for your yogurt curry stir-fry.

    (reply)
  48. Kim  March 17, 2014

    Would you be willing to share the recipe for that curry sauce?

    (reply)
  49. Joshua Paquette  March 17, 2014

    Peter,

    Thanks for the update! It’s fascinating to see your evolution and understanding of diet. Also appreciated is your willingness to joke and make light of yourself.

    I myself have seen a similar pattern with my own process of ketosis, i.e. a gradual shift towards increasing quantities of vegetables, mostly fibrous, about the same amount of fat and a bit less meat.

    I had a thought the other day, remembering some information I gleamed from a book called “The Perfect Health Diet” by Jaminet and Jaminet. In the book the authors discuss the seemingly conserved mammalian trait, species-wide, of fatty acid/ketone metabolism. For instance, cows eat mostly grass (naturally) and the massive quantity of bacteria in their four stomachs churn out short- and medium-chain fatty acids from the cellulose and fiber in the grass they consume, making the net breakdown of their diet 60-70% fatty acid content. They systematically go on to show this in many other mammalian species. I don’t know how true all of that is, but still.

    My inquiry is…

    Might a changing gut bacterial milieu, over the long term, coupled with an increased metabolic flexibility associated with ketone adaptation, shift a persons diet preference to include more vegetables?

    Might this shift allow a person to stay in ketosis (1.5-3 mMol) while consuming larger quantities of vegetables? (A complex and multi-factorial question I know).

    I realize the study of gut biome is still in it’s infancy, but am wondering if you have and “hunches” about this in relation to your research or your own process?

    Thank you very much for all of your inspiring work,
    Joshua

    (reply)
    • Peter Attia  March 17, 2014

      No idea. I guess it’s possible, though.

    • Kevin  October 14, 2014

      I’d like to expand on this hypothesis.
      In light of the recently released research about artificial sweeteners changing the gut bacteria, I’m thinking of Dr. Attia’s comment that insulin resistance is a natural body reaction to something. If I’m not mistaken, aspartame and sucralose are both indigestible in the stomach and significantly sweeter than natural sugars. If the body has a natural, “STOP THE INSULIN ABSORPTION” reaction to gut bacteria being exposed to sweetness – whether as a result of a dose of natural sugars too big to be absorbed before getting to the large intestine or a dose of indigestible sweeteners – then perhaps the long term exposure to sweeteners is acting the same way chronic stress does on the body, both in terms of the chronic exposure and the hyper-sweetness turning the reaction up to 11.
      Stress is a perfectly healthy reaction and will give your body a boost to get away from a lion or some other short term threat, but chronically over the long term it damages the stomach, the brain, the arteries.
      What if insulin resistance is supposed to be a short term reaction to a big uptick in carbohydrate intake – as a result of a bumper crop or some other short lived situation that could arise as hunter-gatherers – and we are just suffering the consequences of experiencing it chronically?

  50. Lloyd James Powell  March 17, 2014

    So you ride fasted for 3 hours plus?

    Do you still have super starch during long rides or just after in the shake? I have been adapting and adjusting with good success on my rides. Feeling better not having gels etc

    (reply)
    • Peter Attia  March 17, 2014

      I only bring along SS for rides over about 4 hours, which I’m not really doing these days. But, yes, 3 hours at any intensity is easy for me on a fast.

  51. Debbie  March 17, 2014

    Your birthday cake binge brought back with horrific vivid immediacy my break-my-diet binges from years and years ago, when after losing a huge amount of weight and trying with all my might to maintain it, I’d finally let loose – and – destroy myself. I actually didn’t get past that paragraph yet – I had to post this. These kinds of foods are as addicting as any drug. Happily – for me – I know I cannot eat them at all.

    (reply)
  52. Debbie  March 17, 2014

    You tied those knots with one hand? Nice.

    (reply)
  53. Aven  March 17, 2014

    Hi Peter. Great blog. I’m inspired by your story.
    Just wanted to find out how long after consuming carbs can I resume a high fat regimen?
    I wouldn’t want the insulin spike to cause increased fat storage.

    (reply)
  54. R. E. Hunter  March 17, 2014

    About the carb craving, I get that every fall. I suspect, based on various bits of evidence, that it’s the shorter days. The farther north you go, the more body fat people carry on average. The Canadian military found that soldiers gained an average of 40 pounds when posted in the Arctic (sorry, I don’t have the reference for that). I use a seasonal affective disorder light, and it really reduces the craving. It makes sense that we have this “instinct” to fatten up for winter, when food traditionally could get scarce.

    (reply)
    • Peter Attia  March 17, 2014

      Interesting hypothesis.

    • Steve  March 23, 2014

      I’ve had that same theory this winter. After loosing 20# last spring/summer, I’ve gained back about 10-15# eating the same LCHF foods (I’ve probably been cheating a bit more this winter 🙁 ).
      I spend hours each day sitting on a snowmobile grooming XC ski trails in the cold and snow, then spend hours skiing on them afterwards, so I spend a lot of time out in the elements. Maybe the added weight is just my body’s natural way of providing fuel and protection from cold.
      I’d like to know more about the Canadian test.

  55. Butch Pornebo  March 17, 2014

    “I don’t know what to make of this, of course, and it may be nothing at all, other than an evolution of preference. I’ve checked mineral levels in my body in search of a clue (none showed up). Maybe I’m over- or under-saturated in some key nutrient?”

    Maybe your gut microbiome is sending you some feedback on what they need to thrive. Have you done any testing in regards to this ?

    (reply)
    • Peter Attia  March 17, 2014

      See previous comment on this re: black box.

  56. Caitlin  March 17, 2014

    A few thoughts/questions on this post…

    1. It seems like what is a more sustainable way to use ketosis is as a periodic state. It may be necessary to be strict and follow a long period of adaption for those who have developed insulin resistance, but after that the body’s insulin may become more reactive and sensitive. After a period of adaptation, “cheating” is not quite as harmful because your body is not overwhelmed with what it is processing. It is still beneficial to periodically go into ketosis however because it helps with inflammation that may have built up while consuming a non-keto diet. Periodic ketosis makes sense from an evolutionary standpoint (seasonally available fruit, etc.).

    2. Regarding your current diet… You say you do not crave meat, but it also seems like you crave less saturated fat. I don’t see any bacon, ground beef, butter, lard, etc. I guess you get a decent amount from the coconut oil, but I wonder if you try to keep your saturated fat within any sort of threshold? Do you still use the fatty parts of chicken on your salads or are you using the lean white meat stuff? The tofu really just confuses me (i.e., you simply enjoy it, or you find a health benefit from it?). Furthermore, while all those vegetables have a lot of nutrients, what about all the nutrients stored in fat by grass-fed animals? I’m curious that you don’t seem to attribute much value to the source of the meat you do eat. I suppose I am mainly curious about what is absent that used to present in your diet. The lack of breakfast is also a wonder to me, since eating in the morning generally gets your metabolism moving for the rest of the day. I also see less salt since you are not in ketosis, I am curious if you think (generally speaking) limiting salt is a good idea when not in ketosis?

    3. Do you drink? Does drinking a small amount of alcohol knock you out of ketosis? Particularly if you drink something like red wine with food?

    Personally, I eat a lot more meat and cheese. I have also noticed that the longer I’m in ketosis, the easier it is to get back in after I cheat. Going overboard on a cheat also gives me the symptoms you mentioned. The worst one for me is the headaches and not sleeping well. That’s enough to get me back on the ketosis wagon for awhile.

    (reply)
    • Peter Attia  March 17, 2014

      1. Perhaps
      2. I don’t know about craving, but I do consume less SFA. Seem more a consequence than a driver. I eat fatty meat and lean meat, alike.
      3. Maybe a glass of wine or two a week. Alcohol impacts different people in different ways with respect to ketosis. I’ve observed all “shapes and sizes” of responses.

  57. Margaret  March 17, 2014

    My diet has been evolving striking similar to yours since I started low-carbing 2 years ago. I crave fruit from time to time, and will occasionally have a bit of pineapple or melon. I love vegetables and tend to care less as time goes by whether they’re higher glycemic or not, I just load up as you do. I found that my weight has been very stable and I’ve been slowly putting on more muscle due to my workouts. My HbA1c is still good, improving since last year. I figure, if I can allow myself the monthly piece of rice sushi, and have a bite or two of local, fresh, in-season fruit, I can eat this way forever. Do you ever worry that over time you’ll begin to slowly, slowly slide back to how you were eating 5 years ago? I wonder that for myself sometimes.

    (reply)
  58. Cindy  March 17, 2014

    Just thanks, Peter. I’ve been reading your blog for a week. You’re a life saver.

    (reply)
    • Peter Attia  March 17, 2014

      I wouldn’t say that, but I’m glad you enjoy it.

  59. Justin  March 17, 2014

    I think the important part here is that you are finding what works for you and that is so important.

    Do you supplement with BCAAs or EAAs beyond the Bio-Steel?

    What about bouillon? Do you still take extra bouillon before and/or during workouts? Or another form of salt?

    (reply)
    • Peter Attia  March 17, 2014

      No, and almost never. I seem to get enough salt from food since not in raging ketosis.

  60. Birgit  March 17, 2014

    Thanks for the update on how you eat. I do learn from it (and not to copy you, LOL), primarily by giving my perspective and also that I need to be even more aware of what I eat. Carb creep is bad news for me. My body fat is still at 20% and my A1c is still at 5.8 and I hope to get the first one down to 16% and the second one down to 5.0 so cutting carbs down to 20 grams from 50 but also cutting protein down from 90 to 60 grams. I hope it’s going to work.

    (reply)
    • Peter Attia  March 17, 2014

      Completely agree with carb creep. I’ve seen it in so many people.

  61. Dan  March 17, 2014

    I like the “7 hardboiled eggs” meal. Perhaps this video is the next step in your evolution:

    https://www.youtube.com/watch?v=NhkdLHSKo9s

    (reply)
    • Peter Attia  March 17, 2014

      I’ve not had raw eggs in massive quantities since high school — inspired by Rocky, no less.

  62. Tony  March 17, 2014

    Hi Peter,
    You stated you perform VO2 max intervals in your bike. I assume that with your keto diet, you probably do not have stored glycogen in your muscles. Does the lack of glycogen impair your intervals performance? Or, is it unnecessary to have stored glycogen to perform intervals at full tilt?

    Thanks

    (reply)
    • Peter Attia  March 17, 2014

      You still have plenty of glycogen in muscles when in ketosis, about two-thirds a “normal” amount.

  63. Isaac  March 17, 2014

    Dear Peter,

    Great Post, as usual.

    You mentioned in this entry that you do not fully understand why you are eating more carbohydrates (e.g. your body is missing minerals, etc). Have you considered that maybe you are eating more carbohydrates because they are addictive and the reward center of your brain is telling you to do so?

    Take care,

    I.

    (reply)
    • Peter Attia  March 17, 2014

      Why now and not for the past 4 years, especially when I was most “addicted” to them?

    • Isaac  March 17, 2014

      Well, there might be some reasons as to why now and not before:

      1) Before you were really extremely careful/conscious with your diet, and avoided consciously carbs
      2) Maybe now you are relaxing a bit for various reasons: it takes a lot of self-discipline to be as close as possible to KT; family matters or work gets in the way and, let’s face it, the day only has 24 hours.
      3) then you relax a bit your diet -taking more carbs- and the brain is fooling you to talk more…

    • Peter Attia  March 17, 2014

      Appreciate your concern.

  64. Craig  March 17, 2014

    Thanks for sharing your nutrition/training info, always interesting to read what other LCHF/Paleo/Primal athletes are doing.
    Re dental floss cufflinks: Fantastic! I’ve ended up using paper clips when going to the opera… 😀

    (reply)
    • Peter Attia  March 18, 2014

      There could be an entire cottage industry of cufflink substitutes!

  65. Tuck  March 17, 2014

    I think it’s a bit misleading to include salad as 100% carbohydrates. Metabolically, the important thing is not what enters your mouth, but what enters your blood stream. So starch hits the blood as glucose. Lettuce hits the blood as short-chain fatty acids (butyrate & co). Very different effects on the body!

    I minimize carbs that digest to glucose, but eat unlimited carbs that digest to fats. Just another way of eating fat, effectively.

    And I also find myself craving salads on a regular basis. Given how nutritionally poor a salad is, I can only imagine that once the nutrient deficiencies of the Modern American Diet are made up, your body needs a less nutrient-dense diet and is looking more at maintenance nutrient loads plus fuel.

    (reply)
    • kuchenrolle  March 24, 2014

      Can you elaborate on that? Are you just talking about fibers vs. non-fiber carbs?

  66. Rob C  March 17, 2014

    I believe I have read (or heard) somewhere that one of your primary reasons for continuing with the ketogenic diet despite having already substantially achieved your body re-composition goals was due to the positive effect ketones have on your brain. Are you experiencing any adverse cognitive effects now that you are not regularly in ketosis (e.g. memory, focus, anxiety, stress etc.)?

    (reply)
    • Peter Attia  March 18, 2014

      I notice a difference when I’m hungry, which I find is a state I’m more often experiencing today than in full NK. So when I’m hungry, today, I feel much less “on” than the pseudo hungry times in NK, when BHB levels were rising, and I could feel paradoxically better.

  67. Al  March 17, 2014

    Hi Peter,

    First of all, I’d like to thank you for all the work you have done, I have learned a lot from you work over the years and truly appreciate you giving away all this information for free. However, I take exception to a few things in this post. First, you say you seem to have built up a tolerance to consuming large amounts of carbohydrates. However, feeling “hungover” and not yourself for a couple days after these binges hardly sounds like a tolerance to me. In fact, it sound like the opposite seeing as people who eat SAD day in and day out go on binges like this all the time and it hardly affects them. And as for the behavioral shift you noticed, this seems like standard conditioning to me, no need for fancy terms like “frequency distribution function”. You ate a ton of carbs, got sick, so your brain said don’t repeat that anytime soon, that wasn’t cool. I’ve noticed this in myself. I know pizza is good, and would love to have some, however since I’ve started eating in a non-SAD way I get sick everytime and just know its not worth it.

    (reply)
    • Peter Attia  March 18, 2014

      Sure, the 2 episodes of eating *massive* amounts aren’t really what I mean. What I’m wondering — not asserting — is if eating the odd baked potato or bowl of rice *today* would have the same effect on me metabolically that it would have pre-2009.

    • Naren  March 18, 2014

      HAD to chime in here.

      I have done both – a debaucherous, dirty carb refeed while in ketosis, and a “clean” – sweet potato and white rice refeed while in ketosis. The morning-after symptoms between the two were day and night apart, every single time (so it certainly wasn’t a one-off thing influenced by some third factor).

      Food consumed during the Dirty refeed (Kiefer’s Carb-Nite) in a 3-4 hr. period in the evening: 1 Chocolate Eclair, 1 Donut, 1 piece of Tres Leche cake, 1 medium deep dish pizza. Woke up in the middle of the night feeling dizzy and nauseous, had a pounding headache the next morning. Had no idea what was happening since I had never experienced a hangover before (I don’t drink). Did a dirty refeed a few weeks later, same thing happened again.

      Food consumed during the “clean” refeed in an 8 hr. period – 2 sweet potatoes, 1 yam, a few servings of white rice, some rice krispies cereal with skim milk. No hangover-like symptoms at night or the next day. Only adverse symptoms were the water retention and gassy-bloat from the sweet potatoes. Did this again the following week and results were identical minus the bloat as I reduced sweet potato quantity and upped rice and rice krispies.

      My brain absolutely sent me the “pls. don’t do this again” message with the dirty refeed and it didn’t with the “clean” refeed. So if I were to eat “clean” carbs in modest amounts (and not refeed amounts) occasionally, I certainly wouldn’t get the “pls. don’t do this again” msg. from my brain, and I am guessing it would probably be okay metabolically as well. Of course, the possibility of behavioral derangement / carb-creep is a different story, something I personally have to really watch out for.

  68. MJ Blanchette  March 17, 2014

    another thoughtful, generous post by the great Peter Attia. you’d think if i had something to say, it’d be about the post itself.

    but no, all i can think about is that luscious, naughty marshmallow concoction. my obsession with it is a bit startling, given that for about 13 months i’ve not eaten, nor been tempted by any kind of sugar, starch or grain. not a crumb; not a taste — i went cold turkey and that was that.

    but i’m sitting here, thinking longingly about those gooey yams. and while i’m no chef, i’d consider toasting the marshmallows before adding them to the dish. yeah. i’d toast the marshmallows. in fact, i’m considering to make a big batch of it, sit under the kitchen table and eat it all by myself.

    and bite anybody that comes near me.

    (reply)
    • Peter Attia  March 18, 2014

      Don’t do it! At least hold off until Thanksgiving….

  69. John P.  March 17, 2014

    Peter, Do you notice any body composition differences in days after the binge? After the excess water is again released back on my normal VLC diet, I do feel as if I’ve possibly renewed the VLC fat burning effectiveness and believe there is some truth to the above mentioned John Kiefer carbnite. I suppose I am vain for asking lol. Thanks for your great work.

    (reply)
    • Peter Attia  March 18, 2014

      I definitely gained weight, in the ballpark of 3-5 pounds overnight, due to water, both intravascular and via glycogen. I probably don’t have a discerning enough eye to notice a huge difference.

  70. Maryann  March 17, 2014

    Hi Peter,

    I always look forward to your monthy post! It would be fun to take a poll on your “coming soon” page (maybe let people choose their top 3) to see what people are most looking forward to you writing about. I checked, and I don’t see e Apo E or Cholesterol part X there, which you mentioned doing. I hope that you can do them some day. It looks like this post will not disappoint you as one of the most commented!

    (reply)
    • Peter Attia  March 18, 2014

      I’ll definitely get to a part X of that series. It’s just a post like that will take 20 hours to do correctly (vs. one like this which can be done in 4 hours). I haven’t had a spare 20 hours since early 2012…

  71. Michael  March 18, 2014

    I have a burning question: When you spoon almond butter straight out of the jar, do you double dip?

    (reply)
    • Peter Attia  March 18, 2014

      Yes, but I keep my own personal jar!

  72. Nelson S  March 18, 2014

    Dr. Attia,

    First off, excellent post as always. I have an interesting question for you that is actually pretty unrelated to the topic of this post. What are your thoughts about the similarity in structures between Beta-hydroxybutyrate and Gamma-hydroxybutyrate (GHB)? I came across an interesting medical hypothesis on pubmed (http://www.ncbi.nlm.nih.gov/pubmed/17011713) that speculates about the implications of their structural similarities. However, this lead me to another article (http://www.ncbi.nlm.nih.gov/pubmed/17011713) that demonstrates that a GHB-analogous receptor ligand synthetically constructed had anticonvulsant properties in the brain. As far as I know, the mechanism of the anticonvulsant nature of the Ketogenic state has not been fully quantified. Is it possible in your opinion that the structural isomerism between GHB and BHB could have a hand in the Ketogenic diet’s ability to treat seizures?

    Thank you for your time

    (reply)
    • Peter Attia  March 18, 2014

      I saw this recently. I have no idea, though. It’s at least a plausible hypothesis.

  73. Eric K  March 18, 2014

    Hi Dr. Attia,

    As always, thanks for posting – all I can say is “wow”. Should be a headline, “Peter Attia Out of Deep Ketosis, film at 11” I have to process this a little bit. I think you were our collective ketosis “wingman”. When the going got tough, we knew there was a dude down in San Diego that was just killing it so we should persevere. (Okay a little tongue in cheek but not completely) But of course your journey is not our journey and glad you’re still sharing what you’re up to.

    I’m curious about your comment regarding very deep ketosis, (3-4 mmol) which has some “applications”. Could you say what those applications might be?

    thx,
    Eric

    (reply)
    • Peter Attia  March 18, 2014

      Eric, I could still be “killing it” in ketosis if I wanted to, and I’m sure I will again when I fancy the time as right. But don’t use my being in ketosis or not as any barometer for you! There are countless people in ketosis. I’m just one idiot who is stupid enough to write about it.

  74. Julien  March 18, 2014

    Hi Mister Attia,

    I’m french and i Love your web site! I just would like to know if a low carb diet is better or worse for bodybuilding. Many people say to me “if you want to build muscle (and i want;) train but dont cut the carbs”. So i dont know what can i do? Stay lean without muscles or building muscle… And fat.

    If you could answer it could ne great! Again congratulations for your work!

    (reply)
    • Peter Attia  March 18, 2014

      I know little about BB, but I suspect a cyclic approach is best. The low carb AND low fat (i.e., highly calorie restricted) phase is probably best for show-time preparation. So BB is really about multiple phases.

    • Eric K  March 18, 2014

      Hi Julien,

      If you’re interested in cycling carbs as Peter suspects may be the right approach, you might consider visiting “body.io”, which is John Kiefer’s website. He has a couple of ways he recommends doing it which may or may not be useful to you.

      You might also consider Volek and Phinney’s latest book regarding low carb for athletes. In there they do agree that insulin can increase amino acid uptake into muscles. But they assert that only a relatively small amount of insulin is needed for a large effect. So pounding cherry turnovers after a workout to create a large insulin spike may not be needed or desirable.

      I bought some superstarch with protein to use after my weight workouts in the hopes I might get some “carb backloading” effect in the manner Kiefer recommends without interfering with ketosis. I haven’t tried it yet but was gratified to read that Peter says he often uses that product after lifting weights.

      Good luck,
      Eric

    • Julien  March 19, 2014

      Thank you Peter (or doctor as you wish) ! i don’t know if it’s a cliché but i love the state of mind of your country (i ask a question , the next day i have an answer even two;)

      Tank you Eric too, that’s very nice! But there something i dont understand with J.Volek. In his book “TNT diet” he says that the best thing to do for bodybuilding is low carb 5 days and high carbs 2 days (even pizza!). He calls those 2 days “the reloading time zone” but in his new book “the art science of low carb performance” if i understand well, he says that carbs are not necessary at all and could even getting things worse. So what can i do? And hear pur official”keto-boss” peter attia saying that low fat is good (!!) make me in trouble.

      Again Peter, congratulation for your work and what you’re doing on this wonderful web site

    • Peter Attia  March 20, 2014

      Best of luck in your pursuits, Julien.

  75. Bill  March 18, 2014

    “What I’m wondering — not asserting — is if eating the odd baked potato or bowl of rice *today* would have the same effect on me metabolically that it would have pre-2009.”

    I believe I experienced such a metabolic “reset.” After years of low-fat, high-carb vegetarianism a slightly alarming FBG (102) led to a pretty long period of VLC, but likely not ketogenic, eating. I lost quite a lot of weight became very lean—friends thought I might be seriously ill. Eventually I gradually reintroduced carbs, though I did continue to abstain from grains except for treats now and then. I eat white rice (in the way Asian cultures do), fruit, dark chocolate, even candy treats now and then.

    I’d say I’m now LC, certainly compared to the SAD, but not VLC. I did gain back a few pounds, but I’m still very lean and I seem to be able to eat pretty much what I want now and stay that way. I’ve decided that’s a good trade-off for me, and with fasting TG of 20 and HDL of 160 I’m not too worried about IR.

    Sushi (and other Asian cuisines) are our favorite, too, and I’m very pleased to be able to eat them frequently now, with the rice! What I don’t know is whether I could go back to all the bread, grains, and pasta and stay lean. I have no intention of finding out, but my sense (just that, I can’t be certain) is that I am now much more metabolically flexible and resilient than I used to be. I suspect, but again can’t prove, that IF (eating in an 8-hour window) and Doug McGuff-style high intensity strength training has contributed as well, and allowed me to become more carb-tolerant.

    (reply)
    • Peter Attia  March 18, 2014

      All plausible ideas, Bill.

    • Julien  March 27, 2014

      Hi Peter,

      My personal case lead me to ask you a general question. I fallow a strict low carb diet since 18 months right now and and i’ve lost 15 kilos in 6 weeks but i’m still in overweight (about 3kilos, i can see very well my handles). So i’m on a plateau since a year. Do you think it is possible that the plateau is breakable after after few months/ years more, just the time for the body to readapt?

      Thank you very much.

  76. Martin  March 18, 2014

    Hi Peter,

    thank you so much for all the valuable work and information!

    After a few weeks of reducing carbs, I went ‘all-out keto’ two weeks ago, and I feel great! Only four days of transition were hard when I felt weak.

    Having been competing in a sport at national level (in my respective age group) for more than 20 years, I’ve seen quite a few ‘trends’ in sports nutrition, trying everything and eating my way through the whole variety of spots bars. Competition weekends were especially bad: loads of sugar, sugary drinks and only a proper dinner.
    Nutritional discipline with bouts of binging during the week were regular.

    So I mainly decided to go keto to stop the cravings for sweets, and it works.

    In 2009 I first tried the cream diet as developed by Götz Heine (Munich, Germany) and had amazing results, both in weight reduction as well as in performance. But you wouldn’t want to keep that up for an extended period of time.

    Being a sprinter, what might be the right time to switch back to more carbs before the main competitions? I’d be grateful for any thoughts on that.

    (reply)
    • Peter Attia  March 18, 2014

      I don’t know much about sprinting, but it’s probably more a function of creatine phosphate than glycogen during competition. Training, of course, will certainly require adequate glycogen stores.

  77. Gary Althiser  March 18, 2014

    Pete,

    A question I have been hoping to hear you answer (and maybe I’ve missed it) is one you allude to in this post:

    “I have specific genetic factors, epigenetic alterations”

    You say you don’t like it when people think what you eat is what they should eat, and of course we all have genetic and epigenetic factors that would lead us to different ways of eating.

    Here’s my question: what kind of blood tests should be doen to find those out so we aren’t spinning on the hamster wheel thinking all we need to do is lower our carbs? I’ve heard you talk in some podcasts about blood panels you order for your patients. I know you can’t give medical advice here, but can you give an example of what kind of blood tests you order for insulin sensative patients you see? It’s so frustrating trying to find out what’s going on sometimes when you get one size fits all advice from professionals.

    Thanks, Pete.

    (reply)
    • Peter Attia  March 18, 2014

      Maybe something to discuss at some point in a podcast.

    • Naren  March 18, 2014

      Maybe the Joe Rogan podcast?!

      Peter Attia on JRE would be the Sopranos Pine Barrens episode of the Podcast world.

    • Tom A  March 19, 2014

      The Joe Rogan podcast for sure!

  78. KarenE  March 18, 2014

    Forgive me, I am am new to this kind of food post, but while reading all the comments there are a number of abbreviations I just don’t understand. I poked around a bit in some previous posts but just got more confused. Sorry.. Is there a place where I can look them up?

    (reply)
    • Peter Attia  March 18, 2014

      Which ones?

    • Michele  June 8, 2014

      Yes, very frustrating for me also. Everyone seems to abbreviate things. All I know so far is LCHF (low carb high fat) and BMI (body mass index).

  79. mrvlad0  March 18, 2014

    Dr. Attia.
    I’m a big fan. Was curious about your current weight and waist circumference.

    (reply)
    • Peter Attia  March 18, 2014

      About 170; about 31″

    • mrvlad0  March 27, 2014

      Excellent. Your blog is a life saver. Found your site in October. I am 45 yrs old, started at 194lbs now at ~170. Was on cholesterol meds for over 10 yrs.. stopped taking the meds after 2 months of LCHF diet.
      Still on BP med. Do you have any recommendation that would improve my Blood Pressure?

  80. james  March 18, 2014

    After submitting the above comment I realized I hadn’t even asked the question that has me puzzled for quite a bit. We have eaten a sort of modified paleo -no gluten (wheat and other), no margarine or other Omega 6 loaded stuff, and basically nothing from the centre aisles of the grocery store-, lots of veggies, often stir fried in lard or butter.
    Felt great on it, but recently, because of some hype in the blog sphere started with adding a tbsp of resistant starch (potato starch) to the yogurt and before going to bed a little bit of yogurt with RS and a teaspoon of honey. Got the honey idea from Seth Roberts. Now I discovered a ‘spring’ in my step that wasn’t there before. I don’t know what else to call it. Feels like some ‘lightness’ in my muscles. I am 72. I know about the gut flora and how the commensals are happy. I also realize that there is increased serum acetate, which makes the brain happy. But the spring in my muscles?

    (reply)
  81. philm  March 19, 2014

    Recipe for curry stir fry would be greatly appreciated!

    (reply)
  82. Miriam  March 19, 2014

    Hi Peter, thanks for the interesting post. It sure must have been funny to see your wife and daughter’s reaction when you ate those cakes! I don’t think my hubby or daughters would bat an eyelash. Maybe that’s the litmus 🙂

    My question is: Are you now more insulin sensitive than you were 4 years ago? If so, how do you know that? Recently, one of my colleagues, a respected endocrinologist, told me that insulin sensitivity does not change and that those of us with lower innate insulin sensitivity just become symptomatic as we age due to age related islet loss. He said some other stuff which seemed kinda wrong to me. He treats his “pre-diabetics” aggressively with metformin and calorie restriction. He believes in “calories” because as long as you are making insulin you are not going to metabolize fat. When I asked him what would happen if you just ate fat, he was kind of stumped. Not my intention, but I enjoyed that.

    (reply)
    • Peter Attia  March 19, 2014

      I am, actually. In fact, I’ve been thinking of doing a post on exactly this topic: How do I measure and quantify insulin sensitivity? Maybe, if enough folks are interested, I could do this as part of series I’d like to write about the “science” of measuring things pertaining to metabolism.

    • Naren  March 19, 2014

      If you’re taking votes, I just submitted mine.

      YES! YES! YES!, would love to see this.

    • Peter Attia  March 19, 2014

      Noted.

    • greensleeves  March 20, 2014

      @Miriam:

      “Recently, one of my colleagues, a respected endocrinologist, told me that insulin sensitivity does not change and that those of us with lower innate insulin sensitivity just become symptomatic as we age due to age related islet loss.”

      Dr. Eric Westman, for one, would largely agree that this is correct, unless you have, as Peter notes, certain genetic factors. There are a very few people who can become insulin sensitive again – most cannot.

      Reading this comment stream makes me so sad – filled with people who long to use Peter’s experience to cheat, to return to stuffing themselves with cake, to drinking. . .unless, like Peter you exercise an enormous amount (and while it’s less than he used to, it’s still way more than most people in this thread do), you’ll gain all your weight and health problems back.

      Why would you want to do this? To return – as even Peter admits – to feeling hungry, to brain fog & mental slowness, to less-than-stellar blood markers, to those extra 5 pounds of water. Why? After fighting so hard to progress, why throw it all away?

      To each their own. 😀 Best wishes.

    • Jeremy Tyler  March 20, 2014

      I too am interested, as another vote!

    • Michele  March 21, 2014

      Hello Peter…yes please….that post would be appreciated. I’m also looking forward to the thyroid post. Thanks as usual, Michele

    • Peter Attia  March 21, 2014

      The votes are adding up!

  83. Mo  March 19, 2014

    Yes! Upvote for post re: insulin sensitivity. Perhaps you could also speak to the other related topics in Miriam’s post a bit more, too, e.g. innate/hereditary sensitivity, aging effects, etc.

    Unrelatedly, I just came across your blog, Peter, recently, and I have been absolutely devouring it, not calorie restricting myself at all, when it comes to your posts. I really appreciate how much work and thought you put into these topics, and especially how you encourage readers to consider the science and fully understanding the proper interpretations of experiments & data, etc. Honestly, this is the best blog I’ve seen for a layperson (perhaps a somewhat in-the-know-or-attempting-to-be-educated layperson, but a layperson nonetheless) trying to improve his understanding of what we actually know about the science of eating.

    (reply)
    • Peter Attia  March 19, 2014

      Ha ha, glad you’re not taking an IF or CR approach to the content!

  84. Bob West  March 19, 2014

    Peter,
    ” Maybe, if enough folks are interested, I could do this as part of series I’d like to write about the “science” of measuring things pertaining to metabolism.”

    I think the level of interest would be enormous.

    (reply)
    • Peter Attia  March 19, 2014

      Ok, I guess this is sufficient feedback to plan the next post around this topic.

    • steve  March 20, 2014

      Yes, would love to see a post on it as well. The question i have wondered about is this: Are the traditional markers of IR- BG, waist cirucm, weight and BP NMR score, A1c, low HDL( i think that is it?) sufficient to say a person is IR or not?

      Based on the foregoing I am not IR, but produce tons of LDLP whether on a carb restricted diet or not.

      I have no intention of emulating your diet, but enjoy your general thoughts. I have yogurt or Kefir with berries or an apple in the am if I do not go to the gym, and a baked or sweet potato for dinner. Eat a qsquare or two of 90-1–% dark chocolate most days. Never any junk like you, and never have any food cravings of any kind.
      Question: Do you no longer eat dark chocolate
      Thanks for your time and effort. Greatly appreciated by this 60+ year old reader.

    • Peter Attia  March 21, 2014

      Glad it’s helpful, Steve.

  85. Shawn  March 19, 2014

    Always good to read you posts as I’m basically you (insulin resistant) but with more hair (just kidding). Question, I ave been doing the LCHF for about two and 1/2 months right now. Lost about 16 lbs, feel great, tons of energy but my latest blood test cam eback and although my TG were ok (146) and my HDL was good (47), my LDL-C was elevated (225). I had them do an ApoB test and that came back high at 150. I’m less concerned about LDL-C as i agree it’s the particle size that matters most, but with ApoB being elevated, I was curios to see what your thought were on this being on a LCHF diet. Not looking for medical advice just your thoughts. BTW, my BP is now 105/55. It used to be 125/80. I’m meeting with a Lipid Specialist in May to get a better breakdown of my numbers.

    (reply)
    • Shawn  March 19, 2014

      Sorry, “moderation” should be “motivation” 🙂

  86. Qorimayu  March 19, 2014

    Peter, that’s a great idea. I and I’m sure many others would DEFINITELY be interested in a series relating to measuring insulin sensitivity and other parameters pertaining to metabolism

    Regards

    (reply)
    • Peter Attia  March 19, 2014

      Ok, I’ll bump it in the queue.

  87. Peggy Holloway  March 19, 2014

    My white knight has fallen off his horse. I’m so disappointed in you, Peter. Ah well, I continue to feel like a million bucks in continual ketosis and have energy to burn, so to speak, at age 61. I can do a century ride basically fasting (a mug of bullet-proof coffee before) and not have any hunger or need to eat en route. I have no cravings or desires to “binge” and find it hard to believe that the horrible after-effects are worth the brief moment of “mouth pleasure.” (Although to me the taste of sweet is is now unpleasant). I am inclined to agree with those that find your veering away from healthy eating to be akin to an addictive response. Just my humble opinion for what it’s worth.

    (reply)
    • Peter Attia  March 19, 2014

      Ah, yet another reminder why I rue the day I decided to do this. Hopefully I’ll exercise better judgment in the future and refrain from discussing what I eat ever again. That said, I’m happy you’re feeling well.

    • Naren  March 19, 2014

      The majority of the people here, I think greatly benefit from and enjoy/appreciate reading about your (Peter’s) personal experience and dietary tweaks/status whether it be full blown keto, low-carb with (4/365)% debauchery, or a third or fourth or fifth way of eating.

      I hope the sense of excitement in these comments continues to far outweigh the disappointment, and you continue to share your personal experiences with us.

    • Martin  March 19, 2014

      Peggy, have you read Peter’s post on his experiments in the metabolic chamber? Do you have any doubts that he knows very precisely what is best for his health and performance and that he is able to control his diet and every other aspect of his life to the smallest detail? We all know how he would be eating if top performance in endurance sports was his number one priority. And perhaps it is not at the moment, not a problem to me 🙂

    • Sean  March 19, 2014

      Peter,

      You are definitely NOT a disappointment, nor have you fallen or failed. You are a treasure for two reasons:

      1) You are one of the rare few who is actually qualified to speak on this topic
      2) In spite of being inclined toward introversion, you have put yourself on display for all to see (and judge)

      What others think matters very little. I know that you know this. Unfortunately some people treat this topic like religious doctrine and are quick to attack (usually subtly) anyone who blazes their own trail.

      Please know that most of us are only excited and happy for you.

      Sean

    • Peter Attia  March 20, 2014

      Sean, can I hire you to be my personal coach? A constant reminder of all things sane? I may print this comment for future reminder. Thank you.

    • Sean  March 20, 2014

      You’re welcome. I am actually a counsellor by trade, but no, I’m not trolling for business 🙂 Feel free to PM me if you need another dose (out of the spotlight).

    • Peter Attia  March 20, 2014

      Thank you, Sean.

    • David Harley  March 21, 2014

      How to create an argument on the net?

      Step 1: Express an opinion
      Step 2: Wait

      Peter, Had I not read your blog in late 2012, I would almost certainly have had diebeties right now and would’ve been at high risk of a heart attack or worse in the future. With the amount of dis-information out there, mainly from government sources, it is blogs like this that educate people. I know of at least 2 other people that have gone LCHF since I referred them to your blog and have last massive amounts of weight. So don’t you dare stop writing about your experiences. 🙂 As much as you don’t like the limelight, you are saving people lives!

    • Peter Attia  March 21, 2014

      I appreciate that, David. It’s hard to blog when you’re not a “blogger” (because you don’t want to be).

    • Brody  March 8, 2015

      Just wanted to echo Sean’s comments and add that it’s nice to know that Peter is human and does like to indulge in sushi etc. once in a while. I am just finishing up reading Good Calories, Bad Calories and am thinking about transitioning into a more LCHF diet – but I *know* I am going to be breaking the ‘rules’…

      Maybe a silly question Peter, do you feel hungry often? I’m guessing that if you’re not eating breakfast and exercising in a fasted state, then yes, but you’re somewhat used to it?

    • Peter Attia  March 8, 2015

      It depends on my eating regimen. These days I’m back to 1 or 2 meals per day. On 1 meal per day, I get hungry midday, but the hunger is actually gone by about 20-23 hours into “fast.”

  88. Rob C  March 19, 2014

    I think you should be commended for your honesty and openness in sharing your experiences with us, particularly this one. I think for many people you really are/were “Mr. Ketosis”. Someone that many looked up to in terms of what can be achieved with this diet and in the state of ketosis. One thing that I think some of us are wondering is whether you have made this change purely because you want to be more flexible with your eating habits and/or because you don’t really see significant benefits of being in full NK at this point in your life now that you don’t have metabolic syndrome.

    I am personally interested in this because I am very fit but have recently started the ketogenic diet because I am continually trying to optimize my mind and body. However, as you know, the diet is quite strict and I do love pastas and breads and fruits. Of course each person is different in terms of goals and biology, but I am wondering for someone like me, that is in pretty good physical and mental condition, whether this strict approach is worth it ?

    (reply)
    • Peter Attia  March 20, 2014

      Rob, the answer is a bit longer than what I address now, but it comes down to many things, not the least of which being the way I want to teach my daughter about food. This does not mean I won’t be back in NK at some point — I’m sure I will — but for this moment in time, I’m very happy consuming something off that path.

    • Michele  March 21, 2014

      Peter,…the last post you did about what your daughter eats was wonderful….actually ALL your posts are wonderful. I know you have close to ZERO time but I would love to know how you teach your daughter about food if that is something you would like to share….even just bullet points would be great. I apologize for making requests with so little to give back!

    • Peter Attia  March 21, 2014

      Yes, maybe another post one day about how I teach my daughter about food.

    • JB  April 18, 2014

      Peter,

      The early qualifiers in this post – you didn’t really want to do another what-I-eat post; people, I’m tellin’ ya, don’t eat like me – made me think you were being overly cautious. But holy yikes, I see what you meant now! I’ve followed your blog since the very beginning and have advanced my knowledge so much because of the excellence of your mind, and your unbelievable generosity to share the journey.

      I’ve never considered you the keto-guy or the _____________(name of dietary regimen) guy. IIRC, I don’t think you even lost the majority of your weight while technically in ketosis, and if people read carefully they’ll see that your diet has evolved constantly since you first began treating your IR. I see you firstly as a physician-scientist attempting to understand disease and healing; and secondly, a wonderful example of what the journey of adaptation looks like. Diet, exercise, aging, health, time management, relationships – life – it’s all a process of serial re-engineering and experimentation.

      I loved it when you said in your TED talk that we really don’t know what the perfect human diet is (paraphrasing). There are so many things that contribute to our health, some of which we can’t even measure, and our happiness is a big one. Sometimes we get happy by doing something a little outrageous, like making our family members drop jaws on table in fancy restaurant. Awesome. And as awesome is the demonstration of principle proposed by Volek and others that an improved insulin sensitivity allows for some CHO wiggle room. You bounce back, maintain a high exercise output, are in fact, Dr. Shredded. As you are a fanatic measurer, I’m sure your various numbers will continue to guide your dietary evolution.

      Anybody who expects you to be – or stay – any particular way doesn’t understand the concept of n=1. Nothing you can do about that. I really appreciate the insights gleaned from your personal journey.

    • Peter Attia  April 18, 2014

      JB, I definitely appreciate how much of the nuance you’re catching. Thanks for paraphrasing it nicely.

  89. Ein Brown  March 19, 2014

    Peter, I would like to see the “here is what I eat in a week” presented so we can see how much of your diet consists of each food instead of presenting it as meals. Would it be possible to list what percent of calories you consume (over a week’s worth of meals, not individual days) from each food category? Namely grouping foods as something like: vegetables, meats, nuts, eggs, fruits, “pure fats/oils/butter”, and other ingredients.

    The educational value would be much higher because the body doesn’t enormously care how that food is distributed into meals, and it’s hard to tell at a glance how those day to day variations smooth out. A percent figure also lets the reader account for what is (for most) a comparatively greater caloric intake.

    (reply)
    • Peter Attia  March 19, 2014

      Sorry, Ein, what you see is what you get. I have a job and such.

  90. David  March 19, 2014

    Peter, or anyone else who could help. I have been following the LCHF lifestyle for about 6 weeks and have already lost 4 kilos which is a lot and faster than I had imagined.
    About 2 weeks into the diet I approached my Dr and got a full lipid blood profile done. The LDL/HDL/TG I understand and am going to compare in about 6 months. My question is that I noticed that my liver Bilirubin level was at the maximum level of “normal” as was my Albumin. Do you think that this is due to my rapid weight loss putting stress on my liver? Or is there any evidence that producing ketones in a state of NK adds stress to the liver and therefore can lead to raised Bilirubin levels?
    Cheers and love the site.

    (reply)
    • Peter Attia  March 20, 2014

      You may have something called Gilbert’s syndrome (about 1 in 20 people have it), and it results in increase bili, but not to very high levels.

  91. Martin  March 19, 2014

    Peter, I wonder if you noticed any changes in appetite control. Whenever I try to relax my ketogenic way of earing (have followed it for over 2 years now) I cannot control my appetite and start to overeat. It could be just me, though. I am also very physically active, but at my age of 38, the exercise cannot outweigh excessive eating, something I easily managed when I was younger even on a crappy high carb diet. For me appetite control along with energy levels is a proxy for a good diet.

    (reply)
    • Peter Attia  March 20, 2014

      The only food that seems to have a “strange” effect on appetite is fruit. Even a large amount of fruit seems to provide little satiation (but lots of enjoyment). I’m pretty sure I know why, and I definitely plan to write a post on appetite, perhaps one of my favorite topics, though something I have written virtually nothing about on the blog.

    • Yossi Mandel  March 20, 2014

      Wasn’t the short version of this that fructose just sits in the liver, triggers nothing and goes nowhere? I thought you or someone you referenced mentioned it.

    • Carl  March 20, 2014

      Peter, that’s interesting. Reminds me of an experience I had last summer when my way of eating was somewhat carb-restricted. I mainly had huge salads with copious amounts of avocados, meat and vegetables etc.
      No sugary stuff. Not much fruit, except some semi-ripe bananas here and there. After some time of that, I was getting a bit bored of those kind of meals so I thought I’d branch-out to include some other foods.

      Then one day I bought some oranges as well as tangerines and thought they tasted simply amazing (like of an addictive quality). For the next week most of meals were mountains worth of oranges with yogurt on the side, and also otherwise I was eating less fat than what was usual for me. Gradually it came to a point were the oranges still tasted “good” and “sweet” but my desire for them had diminished (same thing went for other fruits like apples, or other things that contained sugar such as dark chocolate). So, then I noticed that I hadn’t had any avocados for a while and got the idea to eat some, after the first bite I remember thinking to myself: “Oh my god, this is the most creamy, delicious thing ever. I could just eat avocados for the rest of my life.”

      Weird experience. Since then I’ve stuck with more moderate, not-so-out-of-the-ordinary eating habits (as in not particularly excluding any food group) and haven’t felt that kind of a compulsively rewarding response to eating any food.

  92. Chris  March 19, 2014

    Haha, people seem to focus on your dental-floss trick! Really good one doc!

    Sorry to have lost you on the darker side of carbs! 😛

    I shall now walk the lonely path on my keto journey.

    (reply)
  93. Steve Bacall  March 19, 2014

    Peter,
    Love your blogs and your videos, thanks for what you’re doing. I’m a chiropractor who strongly advocates the low “cheap” carb lifestyle and your writings prompted me to crack open my physiology text (Guyton 8th Ed., page 858) where I read: “Especially dramatic is the long-term effect of insulin lack in causing extreme atherosclerosis, often leading to heart attacks, cerebral strokes, and other vascular accidents.” I’ll assume this is from release of large amounts of fatty acids into circulation, but I will also assume this situation is pathological only in the presence of insulin “lack” which I suppose is defined as no insulin at all or levels well below what would be present in a keto-adapted person. Just checking. Thanks again. By the way, have you checked out Standard Process for your supplement needs? (not a plug)

    (reply)
    • Peter Attia  March 20, 2014

      Hmm, that’s an interesting reference. I’m curious as to the source. What does it reference for that assertion?

    • Chris  March 20, 2014

      Yes Steve. For keto-adapted persons it is a bit different. I’m also reading Guyton’s Medical Physiology….but I do it just to get familiar with our physiologies. Even though it is very good resource, some concepts are a bit behind…it still directly correlates saturated fat with heart disease and it also promotes big amounts of carbohydrate intake

    • Steve Bacall  March 21, 2014

      On next page: “In the absence of insulin, all the effects of insulin noted above causing storage of fat are reversed. The most important effect is that the enzyme hormone-sensetive lipase in the fat cells becomes strongly activated. This causes hydrolysis of the stored triglycerides, releasing large quantities of fatty acids and glycerol into the circulating blood. Consequently, the plasma concentration of free fatty acids begins to rise within minutes. This free fatty acid then becomes the main energy substrate used by essentially all tissues of the body besides the brain.” It goes on to discuss how the fatty acid excess also promotes liver conversion of same into phospholipids and cholesterol. All of this, however, is in the presence of excess blood sugar in the diabetic patient. I assume in the non-diabetic individual, the fatty acids are converted in large part to ketones for the brain and this rise in plasma lipids is negated (as has been demonstrated with your own bloodwork as well as countless others on this type of eating regimen). Thoughts?

    • Peter Attia  March 21, 2014

      I explore this is great detail in the fat flux post, Steve.

  94. Eric K  March 19, 2014

    Hi Peter,

    Glad to hear you’re talking with Doug McGuff – I found his book on exercise a very stimulating read. He makes a strong case for the “work out briefer, work out more intensely” philosophy. Alas, I have started and quit Superslow three or four times. The scorching intensity of moving slowly under tremendous load and getting to failure in a relatively short time is not for the faint of heart. I guess I shouldn’t be surprised that you seem to enjoy it 🙂

    Best Regards,
    -Eric

    (reply)
    • Peter Attia  March 20, 2014

      I’m definitely digging it. And the pain is so upsetting in a way that’s even foreign to me. Quite lovely, actually.

    • Naren  March 20, 2014

      Back in 2005-06, for about 8 months or so, I trained in a way that was close to the Super Slow method. It was Mike & Ray Mentzer/Arthur Jones/Elliott Darden’s HIT method of training. My goals at the time were 1.) Hypertrophy (bodybuilding) and 2.) Strength gains, in that order. I was coming off of about 1 year of doing “bro-splits” with some deadlifts and “quarter-squats” thrown in. Unfortunately, training (mostly) slow negatives with high weights once a week or so just didn’t work for me and my training partner, we lost muscle and some strength. The intense pain during (and DOMs post every workout given how far apart the workouts were) weren’t really translating into gains in size or strength. Since then, I have gone back to a higher frequency doing traditional, “quality work” – mostly compound movements performed with strict form and that has worked best for us.

      That said, I would love to hear at some point Peter’s experience with it. Wish Mike Mentzer was around today, and I could learn the nuances of that method outside the basic template, which I probably missed.

      All the best, Peter!

    • Peter Attia  March 20, 2014

      Yes, I’m not clear on whether this will produce best results, but I’ve already deduced that one session per week of the “big 5” is not sufficient. I’m doing 2 days a week with a split routine. MUCH more volume than “traditionally” prescribed, but so far I’m pleased. Also, my goals are different. No interest in hypertrophy for strength for the same of that movement. Primary driver is the metabolic effect for strength on bike and in water.

  95. Miriam  March 20, 2014

    In terms of the insulin sensitivity thing. The hyperinsulinemic/euglycemic clamp comes to mind. When I was an intern, we had a family friend/possibly distant aunt who was an endo attending. I got to spend a week in her lab and did some of these on her subjects. Funny, I never thought I would ever care about that again. There has got to be an easier way.

    (reply)
    • Peter Attia  March 20, 2014

      Ah, yes, we’ll be talking all about my good friend the euglycemic clamp, and his big brother the insulin suppression test!

  96. Peter  March 20, 2014

    Do you have any concerns about soy consumption (thyroid function, phytoestrogens)? Is there a particular reason you include tofu besides the fact that you like the taste / texture?

    (reply)
    • Peter Attia  March 20, 2014

      As you note, I just love tofu when I cook it the way I do (I generally don’t when anyone else does). I do have some concern about phytoestorgens, but I take a few steps to mitigate that risk, which may or may not be real.

  97. Gabriele  March 20, 2014

    I’m Italian and so European. And I can assure you I’ve never seen anybody wearing those cufflinks in my continent. It sounds more Japanese style. ;-))

    (reply)
    • Peter Attia  March 20, 2014

      Good to know I’m trend setting!

  98. Peter  March 20, 2014

    Got it. Thanks for taking the time to write this blog – it’s been a great resource for me and I’m sure many others.

    (reply)
  99. Chris  March 20, 2014

    Hello,

    Thank you for all of your hard work.
    My wife sent me an article by Dr. Mercola who had posted a link to your video – An Advantaged Metabolic State: Human Performance, Resilience & Health. It was a life changer.
    I have since inundated myself with various information on low carb diets and am currently reading Grain Brain by David Perlmutter, MD. I have found it very intuitive as it echoes much of what you have already posted.
    You may have written about it, and if you did, I apologize for not doing my homework, but I was curious on your take about Glutten and its adverse effects on the body.

    (reply)
  100. Chris  March 20, 2014

    * Gluten, sorry.

    (reply)
  101. Christopher Lind  March 20, 2014

    It’s interesting to me that alot of the LCHF leaders are transiting to a more lax approach. I still remain in deep ketosis (for mental performance, I could stay very athletically built on the SAD diet easily). So besides social reasons, did you find out something that alarmed you with long-term ketosis?

    (reply)
    • Peter Attia  March 20, 2014

      Not at all, and it was really HARD to deviate from ketosis, but I the desire to try was strong enough.

  102. Mark  March 20, 2014

    Peter, fellow massive salad lover here. Hope you are well. You’re completely right about the vegetables; I was surprised how much I missed them while in ketosis – out of all things. It’s tough to beat a fresh, extra large bowl of veggies topped with some Kerrygold. 🙂

    It’s always so refreshing to see someone not obstinately tied to a particular way of doing things. It will be interesting to see how your anaerobic systems (both phosphagen & glycolytic) are impacted by the new diet.

    I was on a ketogenic diet for the last 90 days of 2013, and now I’m consuming slightly more carbs (~100-150/day) than you referenced here. There seems to be some definite benefit in my anaerobic work, but I don’t have any hard data.

    The spacing of my meals is similar; although, I have been eating breakfast (at least an hour after a fasted workout), a normal lunch and dinner and supplement with BCAAs between each meal instead of snacks. I’m curious. Do you consume BCAA’s only with workouts or also during periods of fasting?

    Keep up the good work!

    -mark

    (reply)
    • Peter Attia  March 20, 2014

      BCAA (plus other cofactors) consumed during each of my 3 types of workouts, but not other times. They would probably “help” during periods of longer (>16 hour) fasts, though.

  103. Evan  March 20, 2014

    Peter and All,
    I notice when I am strict with carbs, perhap less than 40 net carbs a day I have very vivid dreams.
    They occur each and every night. They are long/epic, quite strange or bizarre but not nightmares. I wake a bit puzzled and can remember the general concept. (but forgotten a few hours later). Wish I can figure out why. Serotonin issue?

    There must be others with similar experiences. Anyone?

    (reply)
    • Jeremiah  April 3, 2014

      I’m 3 weeks into a keto/paleo diet and experiencing the same thing, but hadn’t made the connection that a week in is about when they began. Could be coincidental, but maybe not… Anyone else?

    • Evan  May 13, 2014

      Low Carb Vivid Dreams
      Peter, have you experienced this. I notice many do (as per the web), but can’t explain.
      Any insight on if this negatively affects quality of sleep, serotonin, or growth hormone release etc?
      tx

    • Peter Attia  May 14, 2014

      Certainly heard about this, and even experienced it myself early on. But no real insight beyond the fact that it seems to occur for some folks for some period of time.

    • Boundless  May 15, 2014

      > I notice when I am strict with carbs, perhap less than
      > 40 net carbs a day I have very vivid dreams.

      Vivid dreams are being commonly reported by those experimenting with Resistant Starch (e.g. a few tablespoons per days of uncooked potato starch). The conjecture is that it’s due to what the gut bacteria are doing with the RS, which implies that it’s less about “low carb” or keto than about how much of what you eat is pre-biotic.

    • Peter Attia  May 15, 2014

      Not aware of this. Interesting to note.

  104. Ezra  March 21, 2014

    Quick question that came up after reading this and some earlier posts on NK: Are they any reason(s) why you would revert back to strict ketosis? Let’s say hypothetically you were training for an endurance cycling event; would you change your diet for a few weeks?
    Thanks!

    (reply)
    • Peter Attia  March 21, 2014

      I’m sure I will at some point. But to really reap the benefits, I’m not a few weeks would be sufficient to re-acclimate.

  105. Xiaolei  March 21, 2014

    Hi Peter,

    Your advice rocks. After losing close to 100lb with strict ketosis diet, I have added some carb (more vegi, steel cut oats, banana) back to my diet to help me progress in my O-lifting. For me, the value of strict ketosis diet is really psychological. It made me feel in control and live my life without the craving that has always been part of my life.

    Now I have gained almost 15 lb, some fat, some muscle. I did start to feel my old craving after getting off ketosis and it has its pros and cons. However, with the experience of strict ketosis, I find myself more confident in resisting the craving and experimenting with new diet to meet my goals. Knowing there is something I can fall back on brings confidence and this confidence is invaluable.

    I really believe in moderation now. However, I think one can only achieve balance if he has had a taste of both extremes.

    (reply)
    • Peter Attia  March 21, 2014

      I think you make a very good point. For many people one of the key benefits of NK is the “control” and absolute nature of it. Very little decision making. It’s black and white, so to speak. In addition, there is an amazing real-time feedback mechanism in the the form of measuring blood levels of BHB (for those who choose to do so). I think the reason some people experience complete recidivism when adding back “a little bit of carbohydrate” is that they lose this ability to be strict about intake and before long they are back to their pre-NK diet (or worse).
      While I appreciate the few who have railed on me for my “sins” of deviating from NK, I think what they don’t realize (about me, personally) is how my brain works. I’m a very cerebral person, and while a slave to my own physiology like any other animal, I think I have a few cerebral override systems in place that many do not.

      So while I loved being in NK, and will almost with 100% certainty go back for periods of time, I was confident I could add back the RIGHT kind of carbs without going all the way down the ladder to indulge in “cheap” carbs (5), and even when I did indulge in the *rare* treat (4), it would a few times a year.

      Last point, my birthday was 2 days ago. I had zero urge to eat cake or ice cream or other birthday trimmings. What did I have? Two heaping plates of curry stir-fry and a bowl of berries with homemade (zero sugar) whip cream!

  106. cmztrav  March 21, 2014

    I love your “what-do-I-eat” posts and I am sorry that they cause you so much distress. Of course you are going to stir people up. Didn’t you know that diet is religion?

    I, however, am an info-maniac and I really appreciate reading about the escapades of a modern-day explorer. Keep it coming!

    (reply)
  107. Maryann  March 21, 2014

    Happy birthday Peter! Celebrate all week and thanks so much for all you do! Maryann

    (reply)
    • Peter Attia  March 21, 2014

      Three straight days of curry stir fry!

  108. John Vogt  March 21, 2014

    Do you think there is any validity to the idea that the carbohydrate level of yogurt should be considerably less than the milk it is made from because the lactose has been fermented into lactic acid? I believe I read somewhere that the carb level of fermented milk products has been overstated because of the way carb levels are measured.

    (reply)
    • Peter Attia  March 21, 2014

      I haven’t put many clock cycles into this, but Steve Phinney told me once that lactose as a form of CHO contributes about 50% the insulin effect on ketosis. But I have no idea. Empirically, Steve seems correct.

  109. Marco  March 21, 2014

    Always good to read your blog and have a good laugh on what you expect people will do with all that “irrelevant” info.. i guess you know well your audience. cheers

    (reply)
  110. John Vogt  March 21, 2014

    Do you think there is any validity to the idea of inflammatory foods? (Monica Reinagel, Barry Sears, etc.) The nutrition website I use (Self Nutrition Data) has Inflammation Factors listed and I wondered if I should consider that in developing my diet. Thanks for all your efforts. They are much appreciated.

    (reply)
    • Peter Attia  March 21, 2014

      Maybe, but I’m not sure.

  111. Kathleen  March 22, 2014

    I just saw your presentation on TedTalks. You not only apologized to your lady patient, but lo to me. Dr.’s do have a condescending attitude toward fat people like me, I can feel it. It is so disturbing I won’t go to the Dr unless I have no other choice because I’m getting better. I have recently been advised 9by 3 doctors to have bariatric surgery. It seems like an answer to prayer, but on the other hand, I feel like a failure because I couldn’t do it myself. Monitary issues have tossed this possibility right out the window, again.

    I plan to read all I can on this site. I do have some concerns. I have gout and it’s getting worse all the time. Will these new eating habits have a negative impact on that? Secondly, I take depression meds. I know my weight depresses me, but could it be a result of a poor diet as well? I am 65 years old and been overweight for 50 years. I feel hopeless. My father was an alcoholic and tho’ I don’t drink, it’s the same rollercoaster ride. I’ve about given up and that won’t bode well for my scale. Thank you for listening. k

    (reply)
    • Peter Attia  March 22, 2014

      Kathleen, first of all, I’m so sorry to hear what you’ve been through and continue to go through. I think you’ll find some helpful info on this site. As for gout, I typically see TWO dietary patterns that make it worse, one pertaining specifically to fructose (the sugar in fruit, and that which makes up about half of table sugar and high fructose corn syrup) and excessive meat (through an entirely different mechanism from fructose, largely due the breakdown of protein). So one thing to consider is if you could first reduce fructose intake as much as possible. If that has no effect, maybe reduce protein.

  112. Junior  March 22, 2014

    I see sushi in your picture! How often do you eat it? I want to eat it but ‘m worried about the white rice.
    By the way, is it better to eat high carbs right after exercise as I’ve heard elsewhere?

    (reply)
  113. Tony D.  March 22, 2014

    I recently found out that by limiting carbs you can reduce your BG numbers.(duh) Always had trouble keeping the tests in the proper range. So after seeing and watching your videos I tried cutting carbs. Now my numbers are in a controlled range. Also weight loss has been a nice side affect. Thank you so much for the info. You opened my eyes and helped me turn my life around.

    (reply)
  114. Vito  March 22, 2014

    Hi Peter-
    Been lurking on your site for awhile now, my wife and I are 3 months into NK and the change has been remarkable. Through our journey, it has changed our bodies, minds, and made us much more aware of society in general. It is incredible to see now how the exact wrong choices are absolutely everywhere, on TV, Internet, and the advice circulating from the medical establishment is often conflicting and full of confusing partial truths.

    Anyways, kudo’s to you with your site- it is a great resource for people! We are all lucky to be in the internet age and able to learn from each other- As an engineer, I appreciate your data driven approach and rare ability to question your formal MD training. Looking forward to future topics- Cheers, Vito

    (reply)
    • Peter Attia  March 22, 2014

      Thank you, Vito. I’m glad it helps, and feedback like yours keeps me “limping” along with the blog. Otherwise, I think I would have stopped months ago.

  115. Michael  March 22, 2014

    Hey Peter-

    Keep up the occasional personal blog posts. I am a Family Practitioner with 27 yrs experience and also a natural introvert. I find it is good to let out something personal to relate to people . I try not to overdo it because the office visit is NOT about me, but it can help to make that real connection. I realize you are NOT practicing medicine but your blog is important to many of us out in the trenches.

    I find your blog very educational . It is inspiring to see someone work so hard to communicate an important idea. I also admire your habit of looking at both sides of a controversy (e.g. why does the Ornish diet work for some)

    I use some of your talking/teaching points daily .

    BTW, I am a math geek (unusual for an FP I know) so I love the review of statistical significance , discordance and such. Keep it coming!
    And here’s another vote to continue exploration of the clinical use of various metabolic markers. It can be confusing at times. I get some folks with low LDL – P but very high IR .

    How reliably can I utilize the TG/HDL-C ratio when I cannot get NMR or other LDL-P data? ( a real world issue b/c of insurance and cost limitations)

    Again, many thanks for your efforts,

    Michael

    (reply)
    • Peter Attia  March 22, 2014

      Michael, thanks for the kind words. I’m very happy that the blog helps the front line practitioners. I’ve got a great case study from a client that will address your question. I’ll likely incorporate it into Part X of the cholesterol series, though I think I’ll end up doing the IR post first.

  116. Giselle  March 22, 2014

    Just want to be clear that even though I have queried your latest experience, I am so glad you’ve posted about it. It’s enormously helpful. It’s great to have you say, ‘hey, this is what is working for me just now,’ in a take it or leave it kind of a way!

    I wondered about increasing carbs – someone somewhere said that the brain alone needs about 150 grams of carbs just to be a brain, unless of course we switch to ketosis and get fuel from ketones/fat. So if I raise carbs from my current 30 grams to say, 60 would I just be in no-man’s land? Not getting enough fuel from either source?

    Apologies if this is a dumb question!

    (reply)
    • Peter Attia  March 22, 2014

      Definitely not a dumb question. In theory, the answer would appear to be “yes,” however, in practice, I have not found this to be true *universally* especially on the way “up” (i.e., adding CHO back in), though it seems to sometimes be the case on the way “down” (i.e., reducing CHO).

  117. Juliet  March 22, 2014

    Bottom Line: Advice needed for those of us who are “small-framed” WOMEN who are just trying to lose about10 lbs of fat (while working out Crossfit), potentially adding muscle weight) while living on KETO diet?

    Do we need to “alter” the diet in order to shed/burn body fat?

    I ask because i have read every article on this blog — and read comments by others — and most folks who have “done well” seem to be self-described as moderately heavy individuals (mostly men) who have adopted the KETO lifestyle and shed body fat quickly.

    I am envious — in 1.5 months of carefully eating KETO (consuming less than 25g fat per day, less than 1400 total calories, per day, less than 70 g. fat per day — appropriate for a 120 lb 5’4″ woman), while working out 5x week (HIIT – Crossfit), i have not lost a single pound – in fact i’ve now gained 1 lb.

    True, i’ve lost 2″ from my waist – but i still would like to lose another 2 ” to get down from 27% body fat to under 20% body fat. All the while, i’ve consumed a lot of FAT — Coconut oil, Butter, Animal Fat on meat/fish, EEOV, and some cream in coffee. I am religiously weighing food, measuring portions, etc., so i know no extra carbs/protein are sneaking in…and i only eat 2 meals per day usually.

    But is this too much fat for a small woman to eat? Should i eat less fat – and fewer calories? I can’t eat more carbs or protein and stay KETO.

    I am wondering if eating all this fat is causing my body not to burn body fat because it is getting too much from my diet.

    Or should i just be patient and be content to only very slowly shed body fat? Why am i not losing as fast as others — with dramatic reports of losing 2 lbs per week?

    Please advise….does a smaller person (like me) need to adjust anything — or just be patient to realize body fat loss?

    (reply)
    • Peter Attia  March 22, 2014

      Impossible for me to know/troubleshoot. True, for some people, the process is trivial, but don’t fall prey to ‘survivor bias’ — there may be many people, of all genders/shapes/sizes, who share your experience. So I don’t think it’s about being a small women, etc. I’ve had clients with the body habitus you describe have an “easy” time and others not. Bottom line, if I can borrow your “lede,” I don’t know the answer without doing some detective work, which almost always involves elaborate blood-work and study of food logs.

    • Boundless  March 22, 2014

      Dr. Davis (Wheat Belly) has a useful checklist at:
      http://www.wheatbellyblog.com/2012/10/i-lost-the-wheat-but-didnt-lose-weight-2/
      and a 3-part video update of that topic in his blog’s Feb 2014 archives. If you’re not familiar with it, the WB recommendations amount to a borderline keto LCHF (obviously grain-free) diet that is easily adapted to full keto.

      You’re probably on top of item 1 on the checklist (net carbs), but two carbs need to be zeroed out entirely, as they are fat magnets: modern gluten-bearing grains and added fructose (i.e. fructose not part of whole fruits).

      Even with an ideal diet, a non-trivial fraction of the population has confounding factors that impede weight loss, and if it’s thyroid (#4), getting a useful test panel, correct diagnosis, and sane treatment is a challenge.

    • Martin  March 24, 2014

      Juliet, here’s what I found about myself that may help you: I do very well on a low-carb ketogenic diet, and I can easily maintain very consistent energy levels and body composition, but only if I pay attention to one small detail: I am well able to overeat on butter and cream and will gain body fat doing so. For me the only way to go down with body fat is to stop adding extra fats (other than those naturally contained in fatty meats, eggs, fish, cheese or avocado) with the exception of coconut oil. As a result I can easily control my appetite and naturally eat less and lose body fat very quickly. If I indulge in butter, my appetite control stops working. I often drink coffee with coconut oil and feel great afterwards but if I add butter, I will be… hungry for more within an hour or two.

    • Perry  March 25, 2014

      You might try cutting out the coffee with cream. I seem to pretty easily gain some weight if I have coffee with cream, even while in ketosis.

    • JB  April 18, 2014

      I’m a small female and what jumped out at me is that you’ve lost 2″ from your waist in 1.5 months – a sure sign that you’re losing body fat – and you seem to be blowing that off as insignificant. Pounds on the scale is an inferior method of gauging changes in body fat because of fluctuations in water weight and the possibility that you’ve gain lean mass from ketosis and exercise. Your waist change is a more reliable indicator of your success, IMO.

  118. Juliet  March 22, 2014

    oops… i meant to say — that i am eating about 70g of PROTEIN per day, or less – i am actually eating a lot more fat per day… about 120g of Dietary Fat

    (reply)
  119. Carmen  March 22, 2014

    A recently published study found that a long-term KD caused glucose intolerance (in mice). http://www.ncbi.nlm.nih.gov/pubmed/24398402

    Is it possible that your reaction after sugar- and carbohydrate- heavy meals is glucose intolerance? Have you had a glucose tolerance test after being in ketosis for a long period?

    (reply)
    • Peter Attia  March 22, 2014

      I’m not going to say mouse studies are universally useless, but when it comes to understanding how HUMANS metabolize FAT, well, they pretty much are. *ESPECIALLY* since they such studies virtually all use a combination of high sugar and fat (so the mice will eat the “high fat” food).

  120. Ted Naiman  March 23, 2014

    Hi Dr. Attia! I’m a fellow physician (oh and mechanical engineer) here in Seattle and I’ve been using low-carb and ketogenic diets personally and professionally for about 15 years now so obviously I really appreciate all of your work and you are one of my heroes! I created a free iPad app, ‘Diet And Exercise 2.0’, out of equal parts guilt for all of the horrible nutritional advice given by most of my other peers plus laziness as I wanted to educate all of my patients simultaneously and save a bunch of time! Anyway the point is, I use you and your YouTube videos and your website in my list of helpful references and I wanted to make sure that was ok with you? [let me know if there is something in there you don’t like or don’t agree with!]

    Keep up the good work, I for one highly appreciate it!!! =)

    https://itunes.apple.com/us/app/diet-and-exercise-2.0/id836080709?mt=8

    (reply)
    • Peter Attia  March 23, 2014

      Very cool. Thanks for sharing.

  121. Tony  March 23, 2014

    Hi Peter, id really like to see more you tube videos. You really inspired me and my partner.
    I wanted to know your thoughts on sweet potato.

    Tony

    (reply)
  122. Amy B.  March 24, 2014

    Peter,

    I completely understand your reluctance to post details about your diet. You knew only too well that there would be people trying to imitate/emulate your intake when their individual metabolisms and physiologic needs are so vastly different from yours. That said, put me in the camp that truly appreciates your willingness to put it out here anyway. Even if none of us should take it and run with it for ourselves, reading about other people’s experiences (especially ones like yours, because you measure and document everything so meticulously) helps me learn *so much* about human physiology and gives me an ever-expanding appreciation for how different one person can be from the next. As a nutritionist, I love “geeking out” on this stuff, and even though your personal experiences can’t be extrapolated to any populations at large, they contribute so much to the conversation and the *education* of us all.

    Beyond that, I want to bring up an issue because I’m getting the sense that a lot of folks think ketosis is black or white, in or out. I might be somewhat oversimplifying things here, but please correct me if I’m overtly wrong about something:

    Is there not a difference between “deep ketosis” and being *fat adapted*? (With “deep ketosis” meaning significantly elevated B-OHB levels, and “fat adapted” meaning having been on a lower-carb, insulin-sensitizing diet for long enough that the metabolic and mitochondrial machinery are in place for a person to be running on fat [and small amounts of ketones] most of the time.) I’m asking because it sounds like there’s some confusion (and possibly unwarranted fear) about a one-off high-carb meal causing someone to get “kicked out of ketosis” — as measured on urine and/or blood test strips. Am I wrong in thinking that yes, ketone levels will be lower (and possibly not register at all) in an acute time period after an increased carb intake, but that does NOT reverse months and sometimes years of fat adaptation. The quantity and quality of mitochondria–and specifically, their flexibility to transition relatively easily between burning glucose and burning fat–have not been destroyed because John Doe decided to have pasta and a piece of cheesecake.

    J. Stanton over at Gnolls had a freaking excellent piece about this — it was his presentation at the 2013 Ancestral Health Symposium: http://www.gnolls.org/3637/what-is-metabolic-flexibility-and-why-is-it-important-j-stantons-ahs-2013-presentation-including-slides/

    In reading through all the comments here, I can’t believe people are giving you flak for literally three or four days out of *an entire year* wherein you allow yourself to have a few things you wouldn’t normally. And if you’ve upped your CHO intake so as not to be in heavy ketosis all the time, so what? I don’t think these people have any idea how demanding your research, lecture, and exercise, schedule is, physically, intellectually, and all other ways. You probably get more done before 10am than I accomplish in a week. 😉

    And for people to focus on semantics is…well, I’m not sure it’s helpful. I don’t think using words like “splurge” or “bender” implies an unhealthy addiction or relationship with food — especially if, like I said before, it happens 3-4 times a YEAR, rather than 3-4 times a week or month, like it probably does for millions eating the SAD.

    Someone used the word “splurge” regarding the first apple they’d had in 3 years. I certainly recognize that some people might *need* to be at extremely low levels of CHO for the duration, but for the sake of reason, I thank you so much for injecting a little “relaxation” into the discussion. I understand that even an apple could be a “splurge” for someone — I really do. But it’s also very refreshing to see you take a step back, especially as it regards how your actions might be shaping your daughter’s view about healthy eating — or a healthy philosophy toward food.

    I don’t remember where I saw this, but this is one of the most insightful things I’ve read in a while on all this: “You should follow the most restrictive diet you can *enjoy,* not the most restrictive one you can tolerate.” Will anyone feel more righteous on their deathbed if they can say they went 50 years without tasting a single sweet summer strawberry?

    (No tomato throwing from the peanut gallery, please. I wrote my thesis on Alzheimer’s as Type 3 diabetes. I am well aware of CHO intake, ketones, and brain function. I’m just pointing out that complete and total inflexibility at *either* extreme might not be the best way to go. [Either all keto all the time, or everybody eat as much sugar as they can cram down their piehole.)

    (reply)
    • Amy B.  March 24, 2014

      Meant to be more clear above:
      If long-time low-carber John Doe eats whatever he wants a couple times a year, he’ll be “knocked out of ketosis” and will feel like arse in the short term, but the reason he’ll be back to normal in just a coupe of days is because his *fat adaptation* hasn’t gone anywhere. (Especially if exercise is involved in the interim and all that glucose & glycogen gets disposed of relatively quickly.)

      I guess what I’m trying to say is, for someone who’s well fat adapted, the very–very–occasional day of throwing caution to the wind (or “kicking your heels up,” as Robb Wolf would say) just isn’t going to mean the difference between good health and a raging case of metabolic syndrome. Maybe–just maybe–the blood markers might move a teeny, tiny bit unfavorably, but again, if a once-a-year honking piece of carrot cake (or whatever) means the difference between trigs of 35 vs 40, or HDL of 85 vs 79, people need to weigh that against their quality of life and the simple pleasure we sometimes experience from good food and good company.

    • Peter Attia  March 24, 2014

      Agree. Sometimes people forget which function we’re most optimizing. In my view, it’s the “happiness function” more than any other. The “health function” is just one of the higher order terms that serves an an excellent — but incomplete — proxy.

    • Peter Attia  March 24, 2014

      Lots of words of wisdom in here.

    • Eric K  March 28, 2014

      Hi Peter,

      The article cited in this post makes some interesting assertions regarding fat metabolism. Namely, that degrading fat metabolism may be a significant contributor to the metabolic problems people can have.

      I haven’t seen that before – usually it’s all about too much sugar and the inability of some people to process it.

      I’m curious if NuSI is looking at fat metabolism problems as well as sugar issues. (i.e. insulin resistance)

      Thx,
      Eric

  123. Joe Pug  March 24, 2014

    Hello Dr. Attia

    Do you still consume the same types, amounts, and brands of “daily supplements” as you did in part II circa Q# 2012?

    (reply)
  124. Joe Pug  March 24, 2014

    Will you comment on what changes you have made?

    (reply)
  125. KM  March 25, 2014

    Dear Peter,

    Being an excellent Dad to your beloved daughter is clearly your Attia#1 priority. Let the blog go, if needs must. You’ll teach her to have a friendly relationship with food, and help her cultivate a healthy body image. Throw in the art of a quick wardrobe fix for good measure, and she’s well on her way! Kind regards, KM

    (reply)
    • Peter Attia  March 25, 2014

      Thanks, KM, I couldn’t agree more!

  126. Andrew  March 25, 2014

    Peter i do landscaping & painting both very physically demanding jobs and still very low carb only from green veggies i have lost alot of weight in 3 months from being in a ketogenic state but im also worried that not getting enough carbs from alot of physical activity so should i up my calories in fat or add in some more carbs from say sweet potatoes and carrots on the days i work and remain high fat on my non work days

    (reply)
  127. Eduardo G.  March 25, 2014

    Hi Peter,

    I do the “big five” workout once a week and I love it but I feel that maybe the big five are not enough to cover all the muscles (like the back side of the legs, abs or lower back). What exercices do you ad to the “big five”?
    It would be nice to know also what your split routine consist of.

    Thanks for your time.

    (reply)
    • Peter Attia  March 25, 2014

      Maybe another time. I can only handle so much “sharing” of my life at any point in time.

    • Eduardo G.  March 26, 2014

      It´s ok Peter, when you want. I understand that we are a lot of people asking and we want to know every little detail. So no worries. The good work you are doing here is invaluable.

      Gretings

  128. bjjcaveman  March 27, 2014

    Having a cheat day 4 times a year seems pretty reasonable to me….

    (reply)
  129. Stipetic  March 27, 2014

    Hi Peter,

    I always appreciate these types of posts, especially when you seem to have tempered you dietary regimen to maybe be a more effective role model for your young daughter (I have two of them, so I may know where you are coming from).

    Since a lot of folks come to low carb (keto) from paleo, I’m curious if you have any “foods” that you absolutely do not eat or eat very infrequently (like sugar-laden desserts 4 times a year, or so). For me, it’s wheat and sugar to a large extent (and anything soya!). I’ve lessened my objections to legumes somewhat as they are a great vehicle for olive oil and feta cheese (hey, I live in Greece). Just curious.

    Thanks for your time.

    (reply)
  130. Perry  March 27, 2014

    Hi Peter,

    I’d like to add another vote to the requests for a post on insulin sensitivity. I’d really like to understand insulin sensitivity/resistance better.

    I was overweight and on the blood sugar high-low roller coaster most of my life. I started reading and learning about low carb diets 3 years ago. For my initial transition to low carb, I used “Life without Bread” as a guide. For the last year I’ve been in ketosis; which has been a real benefit…stable energy, better memory, and cogitative function. Through the whole process I lost 60 pounds, and have been weight stable for the last year.

    I think I’ve read every post & comment on your web site. You have a rare ability to understand the science, analyze the data, make sense of it; and communicate clearly. I know you are very busy, but I really appreciate you taking the time to share your knowledge. You are helping a lot of people!

    Perry

    (reply)
    • Peter Attia  March 27, 2014

      Ok, hope to get it to it next month.

  131. Dominick  March 27, 2014

    Peter,

    I just started reading your blog this week, and I am blow away. I have learned more in the last few days about nutrition than I have learned in my entire lifetime (I am 44 years old). I had always heard of the benefits of a restricted carb diet, but I never knew why. I am starting to look at food completely differently, as I recently began my journey to losing 50 lbs.

    Thank you for opening my eyes and giving me the opportunity to learn from you.

    Regards,
    Dominick

    (reply)
    • Peter Attia  March 27, 2014

      Hope you find what you’re looking for, Dominick.

  132. Norm  March 27, 2014

    I guess there have been lot more wait and the votes for the part X of cholesterol…so first I would like to repeat my vote for the part X of cholesterol and then vote for the insulin post as well.

    (reply)
  133. David Harley  March 28, 2014

    Hi Peter,

    I was wondering if you had read Prof Tim Noakes’ new book ‘The Real Meal Revolution’ yet? And if so, what you thought of it?

    (reply)
  134. adrian  March 28, 2014

    Thank you Peter for generously posting great information.

    Second go at low carbs for me, and I find myself eating a big fry-up every morning after my run. Lots of Bacon, Sausage, eggs, etc. I am also eating alot of red meat. Are Fry-ups ok, or should I curb them somewhat, and replace with a nice tuna salad every now and again? I don’t have a weight issue, but I do have a bodyfat issue in terms of marathon performance.

    (reply)
  135. mrvlad0  March 28, 2014

    Your blog is a life saver. Found your site in October. I am 45 yrs old, started at 194 lbs now ~170. Was on cholesterol meds for close to 15 yrs.. stopped taking the meds after 2 months of LCHF diet.
    Still on BP med. Do you have any recommendation for improving my Blood Pressure?

    (reply)
  136. Mark  March 30, 2014

    I like your blog. As an engineer, I really appreciate the math references that make their way into your posts, as well as the clear logic you use to boil complex topics down to something digestible for “biological laypersons.” Keep fighting the good fight, and I’ll try to do the same.

    (reply)
  137. newbie  March 30, 2014

    Hi Peter,
    First off in case you don’t want to read the rest of the post, I want to add my vote for the two proposed posts – the IR one sounds great, especially if you address both pathological and physiological IR. The metabolic parameters post would be informative too. It was through your blog that I first truly learned and understood about cholesterol, despite being a family doc for over 30 years.

    You are made of tougher stuff than I would have thought, but then, you have always shown steadfast resolve in your choices. I cannot imagine how it must be to put yourself out there for everybody to judge. Ultimately we can only judge ourselves. If you have been true to yourself and are comfortable with your choices, then “cheating” (dietary or exercise, or whatever) is something you will be less likely to do because it just doesn’t feel good. It’s not the way you structure your life. You sound very comfortable with your choices.

    I started on my educational journey 2 years ago, I was never convinced that long term ketosis was an advantageous metabolic milieu. I have this nagging suspicion that any process that your body will summarily terminate , given a choice, cannot be the preferred environment. I’ve currently settled on a non grain, non legume diet (ie protein/fat, fermented dairy, veggie, minimum fruit/nut), along with IF/HIIT/HIT(love McGuff – training to failure makes sense) with a recent leaning toward consciously supporting the microbiome (increased pre and probiotic intake).

    I’ll continue to modify my choices as new research emerges. Stagnating educationally is not an option. You should be very proud to have educated so many, helping them to make their own more informed choices. I thank you from the bottom of my heart.

    (reply)
    • Peter Attia  March 31, 2014

      Happy the blog has helped you with your patients, and really appreciate the encouragement. Sounds like your journey is going very well!

  138. David Jackson  March 30, 2014

    Hi Peter,
    I was wondering whether sweet potato starch powder is similar to Superstarch? I read that 100g of sweet potato. starch has 0g sugar.
    I have an inkling that I am wishing for too much.
    Any response would be much appreciated. Thanks.
    (following a 18/6 one meal a day keto diet.)

    (reply)
  139. Paloma  March 31, 2014

    Dear Dr. Attia,
    I must congratulate you for your personal journey and the wonderful job you are doing here in terms of explaining what a Ketogenic diet is and all the advantages and disadvantage (just one) it has. It is very difficult to find a doctor with such broadmindedness, specially today.
    It has been a very busy weekend trying to read up all your posts, they are all so interesting and mind blowing!
    I feel that this blog comes at the right time. I was already on the path: Switched 2 years ago from high carb almost vegetarian diet to a paleo diet, trying to fix a candida gut infection and mild depression. After that I gradually increased fats and protein, and reduced fruits realizing that I felt better than ever.
    After this weekend readings, it feels even sadder to see so many relatives and loved ones insisting on poison themselves, eating all that “healthy whole bread and fruit”, searching low fat dairies and complaining about joint pain (elders) or fat bellies (youngsters) and lack of energy. Yesterday I went to the cinema and felt depressed about all the fast food restaurants there were and all the families eating there. And that was a rich area.
    Your blog and the NuSI initiative are truly laudable, keep spreading and demonstrating the facts!
    I wish you get all the strength in the world to undertake this task.

    (reply)
  140. Patti  April 1, 2014

    For me a LCHF diet works, but periodically I will eat those high carb foods for three reason: I can’t stop myself, I feel like a normal person again, and it freakin taste good. Good to know you are human Peter.

    (reply)
    • Peter Attia  April 1, 2014

      Well…I think my wife would disagree with you…she thinks I’m a freak beyond words, but I guess it’s relative.

  141. Greg Capron  April 1, 2014

    As usual very interesting. Not wanting to copy your entire week but wondering….

    Would you share you Curry stir-fry recipe?

    Love the blog!

    (reply)
    • Peter Attia  April 1, 2014

      It would take too long to explain, maybe I’ll video tape it one day and post the video.

    • Greg Capron  April 1, 2014

      Super, would love to see it!

      Thanks

  142. Grant  April 1, 2014

    Peter,

    Long time listener, first time caller…

    Couple of questions:
    1) Is there any research/papers that describe the rate of ketone & glucose decay after exercise? As an example, I finished a 300k bike ride with ketones/glucose readings of 3.3 mmol/L & 71mg/dL, but 12 hours later the readings were 0.7 mmol/L & 102 mg/dL. The only thing I ate between the readings was 3 oz cashews, 1 quest bar & 20 oz diet Mt. Dew.

    2) Since I think of nutritional ketosis as a tool in a tool box, Is there any research/papers that quantify the ranges of NT and the associated time cost for getting back into NT once you’re no longer in NT (nice graphs that show time since in NT vs the time to get back into NT). For example, Dr. Phinney states 0.5 mmol/L as start of NT, but you’re more stringent on your definition. Also, Dr. Phinney stated that leaving NT would likely cost 1 week to get back into NT. But you currently think it would take about a month-ish and previously it took you 2 days to get back to NT.

    Thanks

    (reply)
    • Peter Attia  April 1, 2014

      Grant, surprising results given such little intake. I’ve done similar things many times and I experience the opposite — BHB goes up and up. I could speculate all day what was different in your case, but it would be just that.
      Not sure what NT is, but if you mean NK, I think 0.5 mM is the beginning of “flirting” with NK. The real changes in metabolism don’t seem to occur until you’re consistently in the 1 to 2 mM range (AM fasting level — levels throughout the day will fluctuate by intake and activity). The in and out situation is very complicated and depends on how adapted you were to begin with. Too long to explain in comment section.

    • Grant  April 1, 2014

      Peter, This typical dose/response for me. I’ll do intervals, or long hilly rides get my ketones up, but the next morning, they’re back down. C’est la vie. I wasn’t looking for you to explain it to me, but only if you knew of any papers that might bring some insights. Not that you couldn’t explain it, but that behavior doesn’t scale well…

      Thanks for the time you put into the blog, and into getting NUSI. Hopefully, you’ll either get to answer alot of these questions, or you’ll fund the answers. Which does scale well, and that’s a good thing.

    • Peter Attia  April 1, 2014

      Indeed.

  143. laro  April 1, 2014

    Hi Peter,

    Your reticence in regards to these type of posts is understandble. Somewhere on this world someone is copying this 1 on 1, no doubt about it. But for every one of them at least 10 others probably find their own way, only using your post for some new tips, tricks (and not just nutritional ones apparently!) and adjustments.

    I am not in NK. Right now, as a student, I found this to influence my social life to much for my tast (I might go NK again someday though). But I do use some of your tips, changing my meals for the better. Not everyone is a sheep. Besides.. as long as they are happy with it, why bother? 🙂

    What I would like to see though is a guiding post on helping us finding our own way in the nutritional research. Where to start, what to mind (as you already pointed out in one of your previous posts), etc. If you really loath these What I Actually Eat posts, why not help us find our own way in literature?

    (reply)
    • Peter Attia  April 1, 2014

      I’ve got several posts that (should) help folks navigate these waters.

    • laro  April 18, 2014

      Thank you for your response Peter! I’ve read all of your posts and they do help me out a lot. I can understand this has no further priority, but I do wonder through what channels you keep yourself updated on the latest articles. I mean I assume there isn’t some sort of a RSS feed or is there? 😉

  144. Nico Ritschel  April 1, 2014

    As far as I can tell, it looks like you should still remain in ketosis the majority of the time if you time your carb intake like you do, yes? Well, that’s what I could gather based off your blog post redgarding the coexistance of ketones and carbohydrates.

    (reply)
    • Peter Attia  April 1, 2014

      No, too much protein and too much carbohydrate. Hence, only intermittent ketosis, as sub-threshold exercise permits.

  145. Jason  April 1, 2014

    Any information that you have found on the effects on TNF (Tumor necrosis factors)

    Thank you

    (reply)
  146. Jeff Johnson  April 1, 2014

    Insulin Over-Sensitivity
    Is it possible to be overly sensitive to Insulin ? – : those mechanisms that store injested fat reacting to strongly to Insulin ?

    If so – this would present somewhat of a double edged sword – excess carbs and perhaps Insulin resistance producing excess Insulin and a condition of injested fat being overly-sensitive to this Insulin produced – regarding those mechanisms that store injested fat

    If this is correct – a low carb diet would certainly improve things but result in a body weight set point far higher than ideal because of even normal or small Insulin amounts affecting those overly-sensitve to Insulin in regards to those mechanisms – that store injested fat

    If so – this would require that all three macronutrients be carefully controlled to acheive a decent body composition

    In such a person there would be a tendency of eating slightly to many carbs in relation to fat intake

    The over-sensitivty to Insulin in those mechanisms that store injested fat driving or forcing the process

    (reply)
    • Peter Attia  April 2, 2014

      Good question, Jeff, and it really illustrates the elephant in the room: what the hell does insulin resistance *really* mean? I’ll explore in the post on this topic.

    • Norm  April 3, 2014

      Very good question Jeff indeed. It got me thinking: in lean people who tolerate carbs very well, is it possible that their fat cells are actually resistant to insulin? In obese, is their insulin too sensitive with regards to carbs? Is insulin the key factor in deciding whether to store energy as fat or oxidize it? Is it the amount of insulin secreted which is the problem or its sensitivity or resistance to food and different cells? Apart from carbs/protein what other things could be affecting insulin?

    • Vicente  April 3, 2014

      Hi,
      I don’t understand the question. Does not “insuline sensitive” mean that you need LESS insuline released in your body to achieve the same effect? Otherwise I just found I understand nothing about insuline resistance/sentivity.

    • JB  April 18, 2014

      Yes, what does insulin resistance really mean, and what does insulin sensitivity really mean? I think, as with all things physiologic, one has to place desired outcomes in the context of the state variables of the person we’re talking about – older, diabetic, competitive athlete etc. When we speak about improving insulin sensitivity in someone with MetSyn, for example, do we really want to increase whole body insulin sensitivity (that is to say, fat and muscle), or just increase muscle sensitivity? And if we want to do just the later, which I think we’d probably all agree we do, then are diabetic medications more of a problem than a help? There’s the whole relative nature of what resistance or sensitivity means in a person who’s healthy and one who’s not, which can be confusing I think. I also believe it’s a similar confusion in terminology when we speak of sensitivity and resistance for leptin.

  147. Jennifer Utterback  April 2, 2014

    Hi Peter,

    I have been reading about NK and trying different things in myself to see how I feel and what happens. I had some blood work done to check out all of my markers and Cholesterol, HDL and LDL all cameback within optimal markers. Yet, the BUN was higher than desired and the BUN to- Creatine ratio came back higher. I Have been adhering to less than 50mg of carbs per day since the end of Oct, have lost some weight, about 12 lbs and about 5% of bf, from 32% total bf. I have also kept strictly to no more than 10mg of sugar a day, yet my fasting glucose level came back at 99 and my triglycirides at 39. My Dr suggests that I up my sugar and or carb intake bc those levels of triglycirirdes could be harmful after a certain time.
    I also had what I consider a “fainting” spell and felt Like was I was going to faint and pass out. I am not looking for a diagnosis, but would be helpful if you could give me your opinion on what is happeing with triglycirides. I have since increased my fat intake, even more, and carbs to 100g. Thank you.

    (reply)
  148. Maximilian  April 2, 2014

    Hallo Peter,

    what data are you using as benchmark for your oral glucose tolerance test (OGTT)?
    I bought a Glucose/Ketone-meter and a ready made 75g Glc solution and performed an OGTT.

    However most of the reference values are for venous blood rather than capillary blood. I just found out that venous blood and capillary blood are not comparable (sometimes lower, sometimes higher values http://www.ncbi.nlm.nih.gov/pubmed/14632723). My values are way below the WHO Diabetes and IGT anyway, but I would be interested to see if there is some benchmark for healthy people.

    When it comes down to “non-diabetic subjects” this paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430037/) is the best which I found. Intrestingly it shows that increased blood-glucose levels after 40 min are irrelevant to mortality (RR = 1,0), but fasting ( RR = 1,34 ) and 2h ( RR = 1,22 ) are highly correlated with increased mortality. I mean a relative risk of 20-30% per “increased Glucose (mmol / L)” is similar to smoking and lung cancer. Anyway, my question number two:

    Since the most meaningful value is the fasting glucose, does it relly make sense to perfrom an OGTT?
    I mean 75g of sugar is quite some stress for the body and the result does not really matter, so why shouldn’t I just stick to fasting glucose measurement?

    Thank you so much for your blog, and thanks in advance for the answer,
    kind regards from Germany,
    Maximilian

    (reply)
    • Peter Attia  April 2, 2014

      I’ll discuss OGTT in the post on measuring insulin resistance.

    • eric johnson  April 9, 2015

      hi maximillian,

      have you been able to find the post on measuring insulin resistance? i cannot.

      you question is very insightful. i know of coaches who are recommending people doing the test at home and this could cause issues with interpretation.

      i’m very interested in dr attia’s answer.

      thanks, eric

    • Merrilyn Boyd-Jones  December 21, 2015

      As an ex- hospital cientist and a newly diagnosed diabetic I am sort of qualified to answer this. My doctors focussed on requesting fasting bloo tests all the time. My fasting glucose remained “just normal” always until 2 months ago,when my specialist decided that I was an impaired fasting diabetic ( fasting Glucose 6.1 mmol/L). I was sent to the GP for management who said that I did not fit the guide lines for the government run diabetic program so he decided that i needed a OGTT to rule out diabetes as it will come out normal. Well guess what. Definitely not normal with sugar up to 14.4 mmol/L. This was totally missed with all the focus on fasting tests. Doctors need to request the occasional random test eg. yearly so they can diagnose properly. He was under the impression that I had no symptoms of diabetes but he had never asked. Pet favourite of mine is a GTT if you have raised triglycerides as they go hand in hand. Had one patient who was on tablets to lower trigs for 18 months and they didn’t work. I had to lie to the GP that I was doing research to save him ego when I rang up to explain the very high glucose level i got on the patient that he had not requested

  149. Anthony  April 2, 2014

    Hello Dr. Attia,

    First your complement: I have great admiration for what you have done/do and how you go about doing it. I appreciate your ability to be humble and change your opinion as the science evolves and leads you to different conclusions, this is not a perspective I have found in many doctors/clinicians. I have been reading various parts of your blog for several hours over the course of a week or so and want to make a change, however I have a few questions that I haven’t seen asked to you yet. Forgive me if you have already answered them and I didn’t discover them.

    1. Social Norms: One of the most difficult challenges I have found when I change my eating habits away from the “norm” is that it is very challenging to deal with the social aspect of eating differently than others. How do the logistics of your current eating habits work? (Does your family have a different meal from you at dinner, what do you eat if anything when you go to events like birthdays or parties where only one type of food is served?)

    2. The other 30-20%: In one of your posts (How can I lose weight) you stated that this approach works for 70 to 80 percent of people (i understand this is only an estimate). Is this due to physiological/genetic reasons or other circumstances where individuals cannot make it work in their lives? And if it were physiological/genetic, what would it look like when this approach is not working, would the results (weight loss, low TG, high HDL) be mediocre or non-existent?

    3. Evolution: From an evolutionary perspective, how do you view your current eating habits and those expressed on your blog? I would like to eat in a way (the proportions of fat, protein, carbs) that our ancestors ate for 190k + years, before McDonalds.

    4. Carb Continuum: I have viewed on your videos and read that your decrease of carbs has been on a continuum to where you are now, do you believe that it is possible to reverse the continuum slightly (increase carbs) and still maintain your current health outcomes (i understand that individuals will have different results based on their genes), or do these outcomes exist on a continuum that goes hand and hand? (ie. slight increase in carbs and/or sucrose will increase the various outcomes)

    Thank you for all of your positive work and research. As well as the time you take to answer questions.

    (reply)
  150. Cathy  April 2, 2014

    Reading your blog this week with fascination. I too am a doctor and have difficulty losing weight, despite being relatively fit and very active in a busy job treading the wards of a large hospital. Will ease myself into HFLC and see what transpires.

    Thank you for sharing your knowledge with us and summarising the literature, even though I cant understand all the chemistry! My question is: What is the effect of alcohol on insulin and why does alcohol reduce low blood sugar?

    (reply)
    • Peter Attia  April 2, 2014

      Depends on type of alcohol, so not a simple question. Dry red wine, for example, entirely different from beer, entirely different from vodka.

  151. Tony  April 2, 2014

    Peter,
    How, and how often do you measure your blood BHB levels. As a corollary has that data given you a more complete picture of your own metabolic process? Thanks!

    (reply)
    • Peter Attia  April 2, 2014

      Addressed countless times elsewhere, Tony.

    • Tony  April 2, 2014

      I found out about the meter you use in a previous post, turns out the ‘search’ button works 🙂

  152. Art  April 2, 2014

    Peter,

    Thank you for sharing your research, thoughts, and experiences on nutrition and training. I love the intensity and focus. Fair winds on your rides and smooth seas on your swims.

    (reply)
  153. Bob Iafelice  April 2, 2014

    Hi Dr. Attia,

    I would just like to say that it’s so refreshing to find a medical professional who understands the truth about cholesterol, saturated fat, carbs, etc., and yet doesn’t ‘jump on the bandwagon’ with regard to aspartame. Somewhere in your blog you speak the simple truth about this dipeptide, i.e, it’s harmless. I love your airplane analogy!

    As you know, so many integrative/holistic/alternative docs ( not to mention Mercola) make it out to be the most poisonous substance on earth. Case in point: I work with a functional med doc who, upon being asked by an obese patient with metabolic syndrome whether she should drink a can of diet pop or regular pop (because she absolutely had to have just one a day), the doc strongly recommeded the regular pop. Unbelievable!!

    While, for the most part, the food industry doesn’t have our health in their best interests, they got lucky with aspartame. If I discovered it, I would surely run with it! All these docs recommend gram quantites of individual aminos, but are frightened of miniscule amounts of aspartic acid and phenyalanine. Absolutely ridiculous!!

    Love your blog! I’m a new fan!!

    Regards,
    Bob Iafelice, MS, RD, LD

    (reply)
    • Peter Attia  April 2, 2014

      Glad you’re finding something helpful here, Bob.

  154. Martin  April 3, 2014

    Peter, I wonder if you are familiar with the carb cycling protocol(s) by John Kiefer and if you have specific opinions about it.

    What I find particularly interesting is that while Kiefer basically adocates ketogenic diet and agrees with Phinney and Volek that high-carb and chronically elevated insuline are bad things he claims that periodic insuline spikes are beneficial for health and fat loss.

    (reply)
    • Peter Attia  April 3, 2014

      There may be anywhere from some to complete truth to this. I just have no data to evaluate it, nor have done sufficient work with myself or my patients/clients to comment. Still an unknown to me, but certainly seems plausible and worth experimenting with. The drawback, vs sustained NK, is that you’ll give up many of the metabolic adaptations of long-term ketosis, such as extreme fat adaption. However, it’s not clear if one is only giving up, say, 10% of this benefit in exchange for a whole new world of benefits. Tricky, huh?

    • Martin  April 4, 2014

      Tricky indeed, thanks!

  155. Greg  April 3, 2014

    Peter,

    Thanks for all your research and insight. It’s incredibly helpful! Do you think Red Blood Cell Distribution Width is a useful diagnostic marker for MetS? And if so, what’s a realistic range? Is this topic worth expanding or including other markers that relate directly to RBCDW.

    Thanks,
    Greg

    (reply)
    • Peter Attia  April 3, 2014

      I’m unfamiliar with this metric and more specifically, where and how it provides diagnostic clarity over the standard measurements. If you have a paper you particularly like, please post link.

  156. Greg  April 3, 2014

    Peter,

    http://care.diabetesjournals.org/content/33/3/e40.full

    Not suggesting this is important, I’m just a layman, a patient trying to get well.

    Our local lab range is 11.5-14.5%. My recent result was 14.7 after 8 weeks of LCHF eating. My last 10 years has been 13.5-14.4, so below range. Which is like my fasting glucose, A1C, etc, just slightly below range or border line so no one pursued it, not for 10 years, ugh. Not sure if this means anything in relation to MetS. My Dr doesn’t seem very interested in MetS so I’m operating on my own. This nutrition strategy is solving a lot of issues for me, but I still have lots of joint pain, adding some magnesium now. But able to exercise again after 10 years, so I’ll take a little pain.

    No need to comment if this doesn’t mean anything.

    Thanks,
    Greg

    (reply)
    • Greg  April 3, 2014

      Sorry, I ment to say below upper range, not below range…

  157. Patrick  April 3, 2014

    Every once in a while I’ll go out for an evening and drink ten to twelve beers, half a dozen shots of whiskey, and smoke a pack of reds. It’s cool tho, because I don’t do it very often, and even though I feel like absolute hell afterwards, I’m back to my usual self within a few days.

    Given lots of people drink and smoke a LOT more than this, it must be a sane and relatively healthy thing to do. In fact, looking at society in general, it would seem NOT sane to never drink or smoke! I mean, back in college I used to be surrounded with people who drank and smoked every day and I did the same and I was in pretty damn good shape back then!

    The real problem isn’t the binging itself, it’s the fact that these binges make me want to drink and smoke more often. But I’m not a raging carb– I mean, alcoholic, (even though many of the people I drink and smoke with are), I only do these things socially. So it’s all good!

    (reply)
  158. Eric  April 3, 2014

    Peter, i have heard you state in one of your videos that fiber isn’t needed whereas Dr.Lustig puts a premium on fiber. Why the difference? Is it more of opinion and preference than facts? I am a huge fan of him like yourself.

    Thanks, E

    (reply)
    • Peter Attia  April 4, 2014

      My point was with respect to “health,” such as cancer prevention.

  159. Nan  April 5, 2014

    I keep wondering if it is good to stay in nk for long periods of time (after excess body fat is lost), if we evolved from hunter gathers who would have gone in and out of ketosis during the year?

    (reply)
    • Peter Attia  April 5, 2014

      Good question. I don’t have an answer.

  160. D  April 6, 2014

    Great blog

    Even if the brainy stuff goes way over my head. Well at least it makes me stop and think.
    Your IHMC lecture on metabolic state is really interesting.

    I have gone Keto as last resort. I am fairly healthy – daily exercise and Mediterranean diet, no junk food, no refined sugar but my cholesterol is high, even the good one. My GP was ok with that, its the only thing “ wrong with me”, down to genetics ( heart attacks father’s side – digestive and liver cancers on mother’s) but now I am getting pressure to get statins. People on pills are much easier to manage it seems.

    I have had a couple of very stressful years and my waist line has expanded – just my waistline which I knew meant high cortisol ( it has happened before and got confirmed by my endocrinologist who follows me for hormonal problems). I am one of those people who cope but are only chilled when they are asleep ( I slept through a hurricane once) and grow fat when under stress ( like my dad). Nobody mentions Tai Chi to chill, I tried it – too slow for me. I must be the only fidgety person who manages to put on weight with the condition. I was told to lose visceral fat or my hormone imbalance would get worse.

    I decided not to do a high protein diet – I hate the sluggish way my body feels with too much meat and I am lactose intolerant. The first month of Keto was hell, hell, hell for me and my loved one, who is a mesomorph and bloody lives on pasta and race with no problems. I had brain fog and constipation, I was dead to the world by 9 pm. I moved to pooping green from all the green vegetables with coconut oil . Then something funny happened at the end of the first month – I noticed my elbows were as soft as a baby’s bottom – I don’t use body cream because of the crap in them.
    Once the head fog cleared, I realised I no longer had digestive problems ( a genetic thing as well that runs in my family ). Also, I am mentally alert when I wake up – very, very scary – I am making lists with my expresso these days as opposed to wait for the caffeine to hit me into life.

    One question – I am on my third month and need to have my cholesterol tested again, how long to I wait, 6 months ? Or until I can get into my 30 inch no-lycra jeans?

    (reply)
    • Peter Attia  April 6, 2014

      Changes in lipoproteins can be seen in as little a month. 6-8 weeks is often good to assess a response.

  161. Louise  April 6, 2014

    I have been following your website for less than a year and wanted to put to test being in ketosis, I am Canadian so nice to talk to another Canadian and I am in my menopausal years, always keen to learn new methods to reduce body fat. I cut back all complex carbs and added coconut fats, my sugar levels were between 90-95 and my ketones were .1 upon my first measurement. I was at least 4 weeks on this diet before I tried to test my ketones. I was a little disapointed that I could not achieve better numbers, I thought perhaps it was my fruit intake which included oranges. After 6 or 8 weeks of the diet I gained body fat in my legs and abdomen……………not the results I was looking for, I have since removed myself from this diet and am going through some Medical detox and medical food to address my metabolic syndrome issues. Perhaps when I loose the weight that I gained I’ll rethink your method. Concerns are age and menopause hormone, any suggestions for the next go round

    Louise

    (reply)
    • Peter Attia  April 6, 2014

      Lots of possibilities, but glad you’ve abandoned if not get results you were looking for. Impossible to troubleshoot via blog, though.

  162. Eric  April 7, 2014

    I thought i would contribute this podcast in the overwhelming mix of information out there. Peter if you hear this or have heard this could you comment on it. It largely speaks to saturated fats in the diet based on a meta analysis. I know that a meta analysis is not an experimental design however I found that the majority of the experts on the show used correlation to infer causation citing other studies they knew of. They seem to bash butter quite hard, implying that there is a fatty acid (palmetic acid steric acid) in butter that is “known” to be bad for the heart. I appreciate and try my best to understand the science, but the back and forth of the science and “experts” out there make it difficult to choose a best course of action for my own diet.

    http://onpoint.wbur.org/2014/03/31/saturated-fat-healthy-diet-fat

    (reply)
    • Vicente  April 8, 2014

      If you really want to understand why low-carb diets are, in general, healthier than low-fat ones, read “The Art and Science of Low Carbohydrate Living” by Volek and Phinney. They don’t use epidemiological studies to fool you.

  163. D  April 7, 2014

    Hi Peter,

    Thank you very much for your answer.
    I will give get the free – prick your finger – cholesterol test at the chemist, see the number before I get my proper triglycerides test, just to be on the safe side.

    In the UK, statins are now pushed on patients deemed at 10% risk of heart attack, 10 years ago it was 30%. Last time checked, my risk level was 2%. It’s crazy.

    I belong to a big NHS GP practice in the UK with a few doctors. My endocrinologist is private. My GP is not overly worried but my high cholesterol flags on the computer whenever I see any doctor. So, with a non-diabetic-sugar level, an ideal blood pressure, fit and physically active, an ok thyroid, eating more than my 5 a day, not drinking or smoking, rarely sick, I am still not being responsible with my health! Even treatment for a severe allergic reaction to exotic gnat bites got me a lecture on the power of statins and the wonders of a low fat diet, but strangely not on the nefarious effect of sugar on the body.

    Kind regards

    D

    (reply)
  164. Dannielle  April 9, 2014

    Dear Peter,

    I am a 56 year old women, extremely obese, have Graves/Hyperthyroidism, a combo of Osteo/Rhum arthritis in my knees and most joints of my body. I am on disability now and am feeling quite helpless. I have taken med’s for my arthritis for over 20 years and I just gain more weight every time I put another medication in my body. I went off all med’s 4 years ago and lost about 80 pounds. Then I got Graves and the side effects I have had with this and med’s is horrible. So much so that I can not swim anymore and that was the only exercise my doctor would let me do. Subsequently, I have gained back All and More! I don’t even know where to start…. my doctor was useless and I am looking for another doctor but they are very hard to find now. Most aren’t taking new patients or they have gone to the States to work now. I do not know where to start now. I use a walker to get around but not much anymore. I want to turn this around. Do you have any words of wisdom in regards to starting this? I really need to change my life.

    (reply)
    • Peter Attia  April 10, 2014

      I’m sorry to hear about your condition. The most important thing is really to get the hyperthyroidism condition under control, which of course requires an excellent endocrinologist. Maybe consider finding a functional expert in thyroid disease (but understand most specialize in hypothyroidism).

  165. Lisa Gundry  April 11, 2014

    Peter,

    I want to take a moment to thank you for being so perfectly you! Your TED talk brought me to tears; as a nurse I have had the same experience you shared with some of my patients. I’ve also had those thoughts about myself- the gradual weight increase despite a “healthy diet” and exercise lead to feelings of inadequacy, hopelessness, doubt and anger. I felt like I had no discipline or will power. With diabetes, Alzheimer’s and hypertension in family, I know that it’s only a matter of time before I find myself on the same cocktail of medications and list of specialists monitoring and managing my diseases. As a result of your TED talk, I found your blog, Gary Taubes books and several other experts via Youtube discussing LCHF. With Gary’s prodding (“You don’t have to believe a word I say, just do it for 30 days and see what happens!”) I’ve been LCHF for 9 weeks now. Your blog and both of his books as well as the Youtube lectures have guided me, encouraged me and supported me the entire time. I feel like a different person in every way- my thinking, joint mobility, digestion, appetite, body aches, skin, body awareness, mood stabilization, etc. have all changed. As a result of these changes, I’m seeing everything in my life very differently. Your courage in putting yourself “out here” has helped me tremendously. I appreciate your integrity, your clear communication and your boundaries- I’m learning just as much from the simple and steadfast approach in your comments as I am from your blog posts. Thank you for sharing yourself; it is giving me the confidence to do the same and the belief that it can make a difference. I look forward to seeing what comes out of NuSI. I have great faith in it’s mission and the methods you are using to study this complex topic. Blessings to you in your life and your work!

    (reply)
    • Peter Attia  April 12, 2014

      Lisa, I’m so glad you shared this with me. And I’m even more delighted to hear that you’re feeling so much better. Weight, of course, is just the tip of the iceberg. Sounds like you’re reaping many benefits of improving your diet. And you will be a much better nurse for your patients, also.

  166. Norm  April 11, 2014

    Hi Peter,

    For me it makes sense that most of the people will not respond well to carbs after being on very low carb for a long period of time but how to interpret this phenomenon? Is this good thing or bad thing? How does adding carbs and becoming tolerant to them after a while should be taken (like some people add starches back and lose weight and their fasting blood glucose improves):

    1. My metabolism is working well as I can tolerate carbs without gaining weight?
    2. Although I’m tolerating carbs but what would be the long term effects in terms of my insulin sensitivity and other factors? ( for example carbs tend to increase LDL-P and frequent spikes in insulin over the years can make one insulin resistant).
    3. By adding carbs if one gets better glucose tolerance, how it can be good if it is achieved by secreting more insulin?

    As an analogy, if you add back nicotine and caffeine they affect the body more but then regular use of them makes you tolerant towards them and now you need more of them to get the same effect which is no good, how far does this apply to adding carbs back?

    (reply)
    • Peter Attia  April 12, 2014

      I’m not sure this is true. The mechanisms of nicotine and caffeine are very different than glucose.

  167. Stefan  April 11, 2014

    Dear Peter,

    I really enjoy reading your blog. After reading your latest post above I accidentally read about Norm Robillard’s Fast Tract Digestion diet. Basically some kind of low carb diet to treat and prevent acid reflux.
    Are you familiar with this diet and waht do you think about it?

    Kind regards, Stefan

    (reply)
  168. Matteo  April 11, 2014

    Hi Peter,

    First of all, thank you for your dedication and generosity in sharing your knowledge and experience on the web.

    I would like to have your opinion on some rather interesting (in my opinion) findings of an experiment I conducted on myself (with two more friends). Being healthy and fit (training 12-15hrs weekly, around 10% body fat for the past 2yrs) with a normally balanced diet rich in non-processed foods, I tried a 5-day “detox diet” of raw-vegan juices only (just for the fun of it), that the company was marketing “for athletes”. Among other data, I took my lipid particle profile (spectracell) before and after the diet. The data I would like your opinion on (all data are in my blog if you have time and interest), are my LDL-C, LDL-P, LDL-IV, HDL-C and HDL-P. Firstly, my LDL-IV before the diet was 162 nmol/L. I understood from your posts (hope I’m right here…) that it is not relevant considering my low LDL-C (78mg/dL) and LDL-P (653nmol/L) and their concordance, but was still surprised why it was so high… Would you suggest any idea? After the 5-day diet, I saw a reduction in pretty much every value (LDL-C to 55, LDL-P to 547 and LDL-IV to a still high 158). Would that (maybe, possibly, just a single 5-day case study on a healthy subject does not make science) suggest that a short period on a similar program might help controlling blood lipids? As it is almost the opposite approach of the LCHF diet, how would you explain so similar body adaptations? Interestingly, also my HDL-C went from 104 to 101 mg/dL and my HDL-P from 9558 to 8064 nmol/L…

    I would really like to know your thoughts (also on the short-timed changes) and if that was something you would expect. And in case you want to read the whole experiment and see the result, I would be immensely honored.

    Again, thank you for your posts and attention,

    (reply)
    • Peter Attia  April 12, 2014

      Not sure anything can be inferred from such a short test. I’ve checked lipids as many as 9 times in 3 days and seen 10-20% variation, even with NMR.

  169. jackson  April 11, 2014

    U said you take probiotic and other supplements as well. There is so much talk when it comes to vitamins… I wanted to ask if you had any input on supplements when someone is on a ketogenic diet.

    Thank you

    (reply)
  170. Michael  April 12, 2014

    Dr Peter Attia,

    Love you work very much I’m confident this change will be massive for my coming year of sport 25yrs old ( Rugby Player) i can’t seem to find very much on side effects. I have been paleo for a year and just switching to Ketosis I’m having liquid bowels terribly for over 2 weeks. Do you have a post or any comment on trying to diagnose or process of illumination for this issue. Thank you. Ketosis feel so good quitting is not an option.

    (reply)
    • Peter Attia  April 12, 2014

      Usually people complain, initially at least, about the opposite. If you’re ingesting MCT I would stop. If I had to guess, you have steatorrhea. Even if not consuming straight MCT, you may have too much MCT in your diet (or even other SFA).

  171. Carol  April 12, 2014

    Frankly you should not be surprised when some of your readers attempt to replicate your diet. You call your blog the eating academy, and you teach about diet and health. Naturally some will follow the lead of a mentor., and why not. Everyone must find their own way, and your guidance may be helpful to some.

    (reply)
  172. Norm  April 13, 2014

    Hi Peter,
    Do you think caffeine can affect cholesterol levels in a low carb environement? If quitting coffee with cream just for two weeks reduces total cholesterol by 40mg/dl, what is more likely: coffee or cream (10 grams saturated fat per day) or both?

    (reply)
    • Peter Attia  April 13, 2014

      Assuming measurement error is not issue, could be both for different reasons.

  173. Sol  April 13, 2014

    I’ve recently started the Ketogenic diet a week ago and lost about 10 lbs, I keep my calories under 2000 I’m 5″10″ 230lbs. Can anyone give me the ideal numbers or percentage for each…Carbs? Fat? Protein?

    (reply)
    • David Harley  April 15, 2014

      This is my opinion based on my own experience… It might or might not work for you. I don’t count calories or rather, I don’t limit my calories. There is no point. When I’m in proper NK, I tend to be under 40g/day of carbs… that’s what works for me.. some ppl need to be under 20g some can manage it at higher levels. I try to eat 80/15/5 as fat/protein/carbs and limit protein to 1-1.5g a day per kg of lean body mass. I generally eat about 3500-4000 calories/day and I feel that to limit yourself to 2000 calories will probably mean you have to limit your fat intake which would be detrimental to staying in NK… In fact, when my weight loss stalled, I figured out that this was because my calorie intake had dropped and I wasn’t eating enough fat. As soon as I upped my fat intake, I started losing weight again.
      Again, just my opinion, but it worked for me.

  174. Chris  April 14, 2014

    Do you find after a heavy carb binge that your face feels puffy and itchy for a couple of days?

    (reply)
    • Peter Attia  April 14, 2014

      No, but I do get a bit bloated.

  175. Mindy  April 14, 2014

    I just found your site and I love it! Thank you. I spent some time searching, but couldn’t find some info on my issue. I have been on very low carbs for 16 days. I have periods of rapid heartrate w/o exercise. I am wondering if it is low sodium or dehydration (?) Any thoughts? Thank you!

    (reply)
  176. Evan  April 15, 2014

    Are vivid dreams on low carb diets due to cortisol or lack of glucose to the brain?

    (reply)
  177. Henry  April 15, 2014

    Peter,

    First off, thank you for all the information, both public and personal that you have written on this site. I’d hate to see that go as it’s invaluable to someone like me, who like you, wants the best from their body.
    I’m a bit conflicted as to the ‘eat all the fats you want’ statement most keto-advocates advocate, yet cannot ignore the laws of thermodynamics.. It seems almost stupid to ask but, despite eating a low carb diet and feeling keto-adapted, will I still store fat?
    I can’t help feel like a bit of a dunce, but that’s why you’re the doctor and I’m not!

    Many thanks

    (reply)
    • Peter Attia  April 16, 2014

      Henry, the post I did a while back on “fat flux” addresses this point exactly.

    • Vicente  April 16, 2014

      Hi Henry,
      I would say “eat all the fats you want until you are not hungry any more”. Nobody says you have to eat like a lion even if you are not hungry.

      You say we “cannot ignore the laws of thermodynamics”. You cannot “ignore” the law of gravity either, but it doesn’t mean that gravity is important when talking about health and weight. To focus on the amount of calories you eat is a mistake. Not all the calories are the same: when I ate carbs my liver was warning me (NAFLD) and I was fat. Now I eat low-carb and I am healthier. What says the first law of thermodynamics about that?

      You ask about storing fat when being keto-adapted. I don’t know if I am in ketosis (I just eat low-carb and I don’t measure my ketone levels), but my body fat is under 10% (I can’t believe it). If I store fat I must be burning the same amount (give or take) of stored fat for energy.

    • N  April 18, 2014

      @Vicente,

      10%bf is very impressive. Congratulations.

      Would you mind sharing what %bf you were at before ketosis, and how many months of being in ketosis it took to get to 10%bf? What is your current macro split and calorie intake approximately.

      Thanks.

    • Vicente  April 18, 2014

      Hi N,
      I don’t know if I am in ketosis. I eat low-carb but I don’t measure my ketone levels.
      I don’t know either what my body fat percentage (BF%) was before low-carbing. I didn’t have a caliper back then as I wasn’t thinking about making a before-after comparison. I don’t even know how much waist I have lost (I could have a hint if I compared my trousers from before with my trousers after). If someone thinks the skin caliper is not accurate, I really don’t care if it is not: I can clearly see my muscles in legs and arms and I can see I barely have any fat. I don’t care if my BF% is really 11% or 7% instead of the measured 9%.

      I am 175cm tall and my weight was 95Kg (209 pounds) last summer. Today my weight has been 70Kg (154 pounds).
      It took me 6 months to lose those 25Kg. My weight has been more or less stable for the last 4 months.

      I don’t have a six-pack (I wish I had one) but my belly is completely flat. I love my body now. May be a side effect of this way of eating is that you become a little gay, watching your body and loving it (it’s a joke but also a little truth).

    • Vicente  April 18, 2014

      Hi N,
      sorry, I forgot to answer your question about macro-split and calorie intake. I don’t count calories any more. I did while losing weight (I was controlling carb intake) but I stopped a couple of months ago. I eat avocado, salmon, meat, eggs, bacon, cheese, sobrasada (spanish kind of sausage), all kinds of nuts, salad vegetables, yogur, butter, flax seeds, 85% chocolate (once a week may be), etc. May be one piece of fruit per day (some days none). I also drink coffee and kefir but no milk (no special reason for that as I like both). I don’t eat wheat, not even in small quantities, grains, bread, pasta, sugar, potatoes, rice, etc.

    • N  April 19, 2014

      Thanks for sharing, Vicente. That’s excellent, happy to hear how well it has worked out for you.

      I think I’m right around 15% bf (Visual estimate) and am using low carb methods to get to 10%. My eating is pretty similar to yours. I don’t count calories or measure macros either anymore but suspect my caloric intake is around 2500 kcal. I am 6 ft. tall, weigh 175 lbs. and resistance train 4 days a week and could possibly do with a few more calories.

      Gracias,
      N

    • Naren  April 23, 2014

      Vicente,

      While you might not be in nutritional ketosis, I am guessing your daily carb intake isn’t more than 100 grams or so. Do you ever find yourself suffering from the low-carb flu?

      If one is not in NK but still doing low-carb, I wonder how many grams of carbs per day one would need to ensure the brain has sufficient glucose in the absence of ketones.

      Currently, I too am hanging out in this purgatory. No breakfast, Big Ass Salad for lunch (with lots of olive oil, boiled eggs, sositch), a fat-shake post-workout, and dinner is a no-carb hot meal (fat + animal protein) + ~60 grams of carbs from either white rice or sweet potato. I am curious if dropping the rice/sweet potato will throw me into the low-carb flu zone.

    • Vicente  April 23, 2014

      Hi Naren,
      I believe I eat less than 100g carbs/day. I am quite sure about that: 1/2 liter kefir, salad, a few nuts, and eventually a piece of fruit or a yogur doesn’ t seem enough to reach 100g. But I will track my carb intake for a week so I can tell you for sure.

      I also had the same doubt: what will my body do if I don’t eat a lot of carbs but I don’t have enough ketones either? No problem so far:
      1) my brain works ok (at least I think it does). I am not sure I believe your brain is going to have problems because of the diet (pure speculation).
      2) now I can play a 2 hour tennis game without signs of tiredness. Before low-carbing I could only play for more than 20min because of deep exhaustion. No joke there: it is just like that. Friends of mine say it is because I am 25Kg lighter now but I always replay: “true, I am lighter, but now I play for hours with no carbs at all: something has changed”.

      Just one day I had terrible cramps in my legs. Since that unpleasant experience happened I try to have more sodium (drinking broth) regularly.

      You eat potato and rice. When I started low-carbing I wasn’t only fat: I was taking medication for my GERD (I was diagnosed a hiatal hernia) and I had NAFLD. Now my liver is perfect (or at least my liver transaminases are) and my GERD has disappeared. Moreover, my brother was diabetic until his kidney failed and he received a new pancreas and a new kidney. When I watch the big picture, I can’t see carbs in my diet. I have no choice.

    • Naren  April 23, 2014

      Vicente,

      As always, thanks for sharing. I am delighted every time I hear how well low-carb has worked for you.

      Out of curiosity, in a person who might consume alcohol with some regularity and also be insulin resistant, how is it determined if the fatty liver is NAFLD or Alcohol related, do you know?

      Also, I looked up Plain Kefir available in America and it contains 12 grams of carbs/sugar per 240 ml. Is the sugar content similar in the kefir available in Spain? And I wonder if like yogurt, Kefir too is less insulinogenic compared to 12 gms of sugar from say fruit juice or ice cream. Do you consume it for its probiotic properties?

      While I am currently young (32) and physically active, I have insulin resistance in my genes and wouldn’t mind getting an early start avoiding rice, potatoes, etc. My reason for including them was because I started noticing some low thyroid like symptoms while in NK (not verified through TSH, T3 blood tests though so I could be wrong in my “how I felt”-based assessment). Although including them hasn’t necessarily caused a complete 180 on those symptoms, and has introduced some bloating/water retention.

      I have not noticed any carb flu symptoms in the 100 – 120 gms carb range. I have noticed carb flu symptoms in the <50 gms carb range (NK). I wonder if I could find my carb sweet spot in the following,
      -Copious amounts of veggies
      -Moderate amount of fermented dairy (yogurt/kefir)
      -Berries occasionally
      – Glycogen replenishment through SuperStarch, as needed for my athletic needs (hehe vanity more than athletic needs, I gots to look swole afterall!)

      And I could keep hormonal issues in check through regular consumption of organ meats. Chicken liver and hearts start to taste good after some time.

      May the power of the Universe be with you, mi amigo.

    • Vicente  April 23, 2014

      Hi Naren,
      no, i don’t know about alcohol-related liver disease. I don’t drink alcohol so in my case there is no doubt. A medical doctor is needed here to answer that question.

      My kefir is home-made so it has the carbs of the milk I use: 12g /250ml is right. The bad news is that kefir has an insulinotropic effect that makes the insulin release bigger than that predicted by its carb-count (read “Effects of kefirs on glycemic, insulinemic and satiety responses”). That sounds bad for a low-carber (we all want our insulin levels low, don’t we?). So yes, I drink it because it’s probiotic (and I like it) but may be it is a mistake. I am no nutrition expert so please don’t think I have a good reason to drink kefir. I don’t have it.

      I also don’t know what is the best carb-count for me. Is 40g carbs/day better than 75g carbs/day? I don’t know so I don’t count carbs. In your case, if you feel you need more carbs than others, just do it!

      Thanks for the good wishes 🙂

    • Vicente  May 1, 2014

      Hi Naren,
      the days I could weight my food I can tell you I eat a mean of 60g total carbs/day. When I ate out, I can’t tell for sure but I always eat low-carb (no cheating). Of course my numbers are not a valid reference for anybody.

    • Naren  May 2, 2014

      Hi Vicente,

      Thanks for sharing that. Do you do any sort of intermittent fasting or just eat high fat, moderate protein, ~60 grams carbs without worrying how many meals it’s spread over?

      I am currently working towards getting to ~100 gms of carbs on weight training days and 50-60 gms on non-training days.
      The extra 50 gms of carbs on training days come from rice and/or sweet potatoes. I do eat fruit but only berries and in very modest amounts. Have to admit, reintroducing carbs hasn’t been smooth sailing for me. Going from ketosis to 150 gms of carbs (rice/potatoes) gave me the symptoms described in this article, http://robbwolf.com/2014/03/21/carb-reloading/. So a few weeks ago, I dialed it back and am now slowly adding the carbs in until I get to 100 gms on training days. Would like to live in the sweet spot described here. http://i247.photobucket.com/albums/gg158/MDA2008/MDA%202011/Carb_Curve_color.jpg

    • Vicente  May 3, 2014

      Hi Naren,
      no, I have no experience with intermittent fasting (nor carb reloads). As long as I keep my weight stable (I am already 5 months stable) I don’t see the point of trying. Nevertheless, in the book “Grain Brain” Dr. Perlmutter recommends intermittent fasting as a way of keeping your brain healthy (he also says we should take probiotics).

      You are right, I do not care if I do 3 or 5 meals. A few months ago I tried to eat 5 or more meals/day because I thought it was good for my liver. But I really don’t know that for sure so I don’t care any more about how much meals I have. If I am hungry I eat a little.

      I want a six-pack like Sarah’s (from the first link you posted)…

  178. Dare  April 17, 2014

    Peter, my diet and eating scheduele is pretty similar to yours. I fast for 16 hours, skip breakfast and eat big meals, carbs only post wokout with a goal to quickly replenish glycogen. But lately Ive up my exercise routine as I want to improve both my strength and conditioning and also build muscle. I did some adjustements and increase my calorie intake but often I find myself hungry during the night. Im sure this is because I ate too little during the day, but untill I find out how much my body needs based on trial and error….what would you advise me to do in this cases? When Im hungry during the night (3-5 am)? I usually just have a glass of warm milk.

    (reply)
  179. David Harley  April 17, 2014

    Slightly unrelated to this post but thought I’d ask anyway. I do quite a bit of cold water swimming. When I started on this journey I had a horrific BFP of 40%… Even with that amount of ‘Bioprene’ I struggled with the cold water. Since I’ve been on a keto diet, I’ve dropped 15% BFP (another 10 to go) but am much more comfortable even in single digit (Celsius) water. Would you say that this is solely due to acclimatisation or is there some part of the fat burning/ketone production that raises your inner core temp beyond what would be normally for those on a high carb diet?

    (reply)
    • Peter Attia  April 17, 2014

      Not sure, but don’t discount acclimation.

  180. Josh Smith  April 17, 2014

    Hi Peter,

    I would love to hear more of your thoughts on NAFLD. Perhaps this is a future blog post??? (fingers crossed) My son was diagnosed with this Dec 2012 and I have been looking for dietary answers ever since. This is quickly becoming a major issue in the US and I don’t think people realize how wide spread this is. Thank you.

    Best regards,

    Josh

    (reply)
  181. larry  April 18, 2014

    Peter, there’s an interesting article by Dr. Daniel Gwartney M.D. in the May 2014 issue of Fitness Rx titled The True Low- Carb Ketogenic Diet what went wrong? Basically he explains that VLCD diets will not be ketogenic if there is a significant protein load in the diet such as often consumed by bodybuilders and cross fit enthusiasts. Therefore, the argument goes,VLCD diets may produce very little fat loss effect for such folks ( or presumably anyone eating a relatively high protein diet) because (1) protein is insulinogenic ( resulting in inhibition of fat release) and (2) in the absence of carbs will stimulate release of glucagon,thereby triggering gluconeogenesis .

    My question is whether there is really evidence that gluconeogenesis is significant. You cited to studies (Hellerstein ?) that show de novo lipogenesis from carb loads isn’t favored in humans. Do you know if it’s similar for gluconeogenesis? I found a website that raises this question http://www.ketotic.org. Do you have any insight? I’m not so concerned with ketogenic diet but am wondering if low carb and higher protein is counterproductive. thanks

    (reply)
    • Peter Attia  April 18, 2014

      In the case of ketosis the issue of high protein may be less about GNG and more about the actual insulin response of protein.

  182. Barbara  April 19, 2014

    An apology from Dr Oz — Wow — Kudos to you an Mr. Taubes!

    (reply)
  183. JC  April 19, 2014

    Hi Peter,
    Thank you so much for the breadth and quality of information you are providing. After many years of on/off low carb (which I know is ultimately the best way to eat for me) I finally understand the science behind it. One issue that I am struggling with as a woman is the intense PMS cravings for carbs. I view cravings in two ways: i) those you have to “get through” at the early stages of a low carb program until the body no longer asks for sugar and simple carbs, and ii) those that mean your body really needs something you are not giving it. I have read there is a connection between low serotonin levels and PMS, and have also read that a high carb, low protein/low fat snack (glucose carbs not fructose) is the way to boost those levels. There are 10 days out of every month, for me, when the carb cravings are tough to ignore, and I’m starting to think I shouldn’t. The research out there is scattered and filled with myths (ladies love chocolate am I right?) and bad science. For me the biggest question, if what I am reading is correct, is how to differentiate these cravings and satisfy the valid ones nutritionally without blowing the whole low carb program. I’m starting to think though that for women there could (or should) be an alternative plan that is healthy and doesn’t involving giving in to cravings for bad snacks which for some of us leads to a downward spiral. Would you consider a post about the serotonin and tryptophan connection, and how controlled introduction of glucose-based carbs might play into that?

    (reply)
    • Peter Attia  April 19, 2014

      Not sure I know enough to be helpful or thoughtful at this point, but I’ll keep my eyes open for some research.

    • Tom Bunnell  April 20, 2014

      It’s your carbohydrate addiction pulling you back.

    • Jeff Johnson  April 21, 2014

      I’m with You

      I add 4 heaping teaspoons of dark bakers chocolate to my coffee when I make it – 24 grams carb – and eat two squares of solid bakers chocalate a day too – which I chew with my whey protein – about 8 grams carb

      A slice raw potatoe – slice onion – a slice tomatoe – a slice pickle – a slice carot – a 1/4 inch slice frozen bannana – one frozen cherrie – a slice frozen strawberry

      I also eat eat 1 teaspoon mixed beans and grains (dry) and a couple teaspoons soaked – and I’m happy with this –

      This amount of veggies and fruit is the cat’s meow for – me – that 1/4 inch slice of frozen bannana with peel – is as every bit as good as eating two whole bannana’s

      I’m not giving this up for any reason – if I want to lose weight I just cut back on other stuff that I am willing to cut back on – a little less whey protein and other fats – non fat sour cream really isn’t all that bad or low fat cream cheese

      The salient point being – it.s possible to satisfy yourself and be responsible at the same time –

  184. N  April 20, 2014

    Peter,
    You’ve mentioned in the past that you would take ~ 8 gms. of glutamine post-workout. I am a resistance training athlete (compound oly. lifts) and recently started taking Biosteel HPSD during my workouts. Was wondering if Glutamine post workout might help me (objective is to get strong and swole), and are there any brands you think are good? I know you don’t like to talk about the products you use so people don’t mistake it as a plug, but I am tempted to ask as it would really help me avoid the low-quality (crushed bird-feathers) stuff.

    Gratitude!

    (reply)
    • Peter Attia  April 21, 2014

      I no longer do this, given that I’ve found what I perceive to be an excellent source of BCAA for in-workout and whey for post-workout. So like you I use the HPSD in every workout (bike, swim, life), and the biosteel whey (which tastes pretty bad IMO) post lifting.

    • N  April 21, 2014

      Thanks for the reply, Peter.

      I was going to order some Biosteel Whey along with the pink sizzurp but then decided not to when I saw that it had Stevia in it. I am so used to the unsweetened taste of my fat shakes (a variation of your Peter Kaufman shake) that I dread adding stevia-containing whey to them.

      In your opinion, would a source of whole food animal protein consumed post-workout be just as effective as whey (assuming equivalent protein content in both)?

    • Peter Attia  April 21, 2014

      Likely, but logistically tougher for those of us on the go.

    • Naren  July 28, 2014

      Peter,

      Biosteel HPSD is my supplement of choice for BCAAs during workouts.

      I’m now considering a zero-carb Whey Isolate for post-workout nutrition. In trying to find a quality product, I was wondering whether the difference in quality between Biosteel Whey Isolate and other popular brands (one that rhymes with Wow and another with Isocure) might be as great as the difference between HPSD and other BCAAs (bird feathers).

      Would greatly appreciate your thoughts, many thanks.

    • Peter Attia  July 28, 2014

      Straight whey is “easier” to make than BCAA, so hopefully there are more choices. But only chemical analysis can definitely address.

    • Naren  July 29, 2014

      Is this chemical analysis something people could obtain for reasonable $, or is it typically out of the reach of the average consumer?

      Would you consider this a perhaps incomplete (it’s missing Biosteel) but credible source for chemical analysis of supplements?
      https://labdoor.com/rankings/protein

      It’s a privilege for us to have such direct access to you, and it is greatly appreciated. Thank you, Dr. Attia.

  185. Paul Arena  April 21, 2014

    Peter,
    I was wondering if after a long bike ride, say 2 or more hours, do you come home and later in the day experience a bad headache? I’ve been LCHF for about a year and feel great. Is it just indicative of depleting glycogen stores? Because even when I was High Carb I would experience headaches after my long rides. Usually I have to take 3-4 Advil just to get rid of it and I hate doing that, but it helps. I’ve also tried broth but doesn’t seem to help.
    Thanks
    Paul
    P.S. Did Dr OZ apologize to you and Taubes?

    (reply)
    • Peter Attia  April 21, 2014

      I don’t experience this. Maybe hydration?

  186. Victoria Smith  April 21, 2014

    I am curious if you have ever read the book “The 80/10/10 Diet” by Douglas Graham. This stands for 80% carbohydrates, 10% fat, 10% protein and is the diet I consume. It seems like the opposite of what you do. The basic premise is that as long as you don’t eat fat along with your carbohydrates, you can eat as much carbohydrates as you want. Therefore, my diet consists mainly of fruit (for example a smoothie containing 10 bananas and some frozen cherries and water, or 2 cantaloupes or 6 mangoes for a meal) I stick with fruit and greens for breakfast and lunch and dinner could be rice or potatoes along with steamed veggies and spices and a huge salad. I record my food in Cronometer to make sure I get enough calories (at least 2500 per day but often 3000+) and that I keep my fat and protein under 10%. If I want overt fat (avocados, nuts, seeds) I eat them with a salad and no fruit at that meal. There are many people eating this way and very thin and healthy. Some who had diabetes have cured it along with other diseases. Have you looked into the theory that diabetes is not caused by too much carbohydrates, but rather too much fat? Many of the foods people think of as “high-carb” actually have a lot of fat – cookies, cake and other baked goods, chips, fatty toppings on potatoes, etc.

    (reply)
    • Peter Attia  April 21, 2014

      Anecdotally, folks who are insulin sensitive do appear able to tolerate this provided, as you say, fat intake is kept low. But for folks with hyperinsulemia/IR, this strategy does not appear to work in my clinical experience and that of others I speak with.

    • wukang  April 22, 2014

      Victoria,

      I am a T2 diabetic, and I did try something similar to what you are suggesting, no, not working after 2.5 weeks.

      What worked for me is the low carb diet.

      Diabetes might /might not be caused by carbs, but once you have it, I believe low carb is the only way to reverse it.

  187. Evan  April 21, 2014

    Peter,

    If someone is on the standared american diet (SAD) and then eats “healthy” once a week, with healthy meaning no sugars or processed foods and low carb, etc…..it obviously doesn’t give the benefits that are talked about here.

    But what about the reverse, eating low card etc, and then once a week hitting the chinese buffet – but just once a week. We know straying 4 times a year isn’t gonig to mess anything up, but where do you think is the inflection pioont?

    Also, how do you rate ice cream cake as a general desert, much better than yellow cakes? pastries etc, …that is with respect to insulin etc

    And one final question, do you think you will revert back to the fat shakes (boy to i love those!), supplements and the diet you had a yr ago.

    thanks in advance.

    PS – looking foward to Part X of the Cholesterol Series.

    (reply)
  188. Anthony  April 21, 2014

    Peter I noticed that you have restricted both sugar and carbs in your diet. Do you have any idea how much of the positive changes in your health profile (lipid profile, bmi, bp) are due to your reduction in carbs and how much are due to your reduction in sugar (fuctose, HFCS)? Are there any clinical studies that you know of that seek to answer this question in human physiology? I understand that both seem to impact health, however I would like to know the independent impacts of each on health. How otherwise would we know that 75% of the effects are due to carbs and 25% to sugar or vice versa? Seems like a question worthy of investigation, that i haven’t heard many speak of with the exception or Dr.Lustig.

    (reply)
    • Peter Attia  April 21, 2014

      Yes, all addressed in other posts and presentations.

  189. Lynn  April 22, 2014

    Hi Peter,
    About a year ago, I watched your Ted talk and cried. I was fat and I ate well (or so I thought) and I exercised HARD 4 times a week. Why was I fat?

    I read what you ate and while I didn’t replicate it, I used it to create what *I* eat. I’ve lost 43 pounds in the last year, because of YOU. This information is also VERY valuable to me. I just returned from a vacation, where I took a NK vacation and went right back into ketosis. Lost the 10 pounds I gained and am losing again. It was easy for me to go back to NK because I feel great!

    I appreciate your commitment to us “readers.” I know you’re busy, but you should know that to me, you’ve made an immeasurable difference in my life. I really appreciate you.

    Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

    Lynn

    (reply)
    • Peter Attia  April 22, 2014

      Lynn, I’m so happy for you. Thank YOU for sharing this. I can’t take the credit, but your story definitely makes it easier to do my job. You made my day.

  190. Suzanne Kitt  April 23, 2014

    I just watched your Ted Talk and cried too. Love your humility. Is it possible to share a female version of your diet so that I can try it? I was like you: I’ve worked out for 20+ years religiously (am 43) and have been eating clean. To be honest, I’ve been trying to lose the last 10 pounds for the past 15 years. I’ve been a fitness instructor, personal trainer and even competed in bodybuilding one year, I’ve never found a diet that gets rid of fat. I always have a layer of fat covering my hard earned muscle. Should I eat what you are eating but just tone it down a bit? I’ve noticed you never eat breakfast? Why? More time for fasting……….
    You cried in your video feeling bad about the lack of care and compassion to that lady, but I want to thank you today for the care and compassion you are showing to all of us, so that finally we know what to eat to better our health. I’ve been waiting for you to come along for 20+ years. Thank you for helping us by telling us the truth about food.
    Suzanne

    (reply)
  191. Jason  April 23, 2014

    Ever thought of doing an Ironman triathlon?

    (reply)
    • Peter Attia  April 23, 2014

      Sure, but I enjoy what I do now too much to change plans.

  192. Justin  April 23, 2014

    Dr. Attia,

    Thank you so much for your dedication to this project (ie, blogging/responding to comments/sharing research etc.) A dear friend of mine is in medschool in Buffalo, and on a recent visit to see me in Boston she got pretty fired up about the deficits (her opinion, not mine) that keto presents. Mainly, she was concerned that I was not getting enough vitamins and minerals, and most of all, fiber. After listening to her regurgitate what sounded like a hybrid of lectures and textbook jargon, I have since added a flax/chia supplement to what is otherwise a pretty simple keto routine. While I don’t have access to the tools you do, my amature approximations have made for what I consider outstanding anecdotal results. I have never felt, performed, or looked better (no more blood sugar crashes, increased endurance). I do not want to change lifestyles again, as the past 5 months have been always improving. My question is this: how can I get the 40g/day of fiber that the internet says I need, without exceeding my current levels (30-50g/day CHO)? Most of my CHO gets taken by salads/roughage, and residual grams in almond milk etc. I searched the site to no avail (and some of the internet as well), so if this is repetitive, just say so and please point me in the right direction.

    Thanks,
    JG

    (reply)
    • Peter Attia  April 23, 2014

      Start by finding out where the EVIDENCE is that 40 g of fiber per day is necessary for X? (You’ll also need to define X) Maybe have your med school friend do the research for you. By the way, read the NYTimes story I tweeted yesterday about “an apple a day” regarding fiber.

  193. Brent  April 25, 2014

    Peter,

    I’ve been following your blog since “The War on insulin” days. In that time I’ve gotten married, been on and off a healthy LCHF diet, lost weight dramatically gained 30 lbs over 6 months.. a lot of this is due to very different bodily responses to carbs, especially refined carbs, between my wife and I. I remember you saying your wife is similar to mine in that she can eat pasta every day and have dessert and not have it adversely effect her, whereas you are like me and even when you had done what was “healthy” as an athlete you were becoming pre diabetic. My question is 3 parts:
    1. How do you and your wife reconcile the differences in your bodies responses to foods? Do you prepare separate meals or do you just not have “family” meals.
    2. In your experience, someone who eats the way my wife does, literally most food is refined carbohydrates, and she is at 15% body fat, have that kind of eating catch up to them in the long run even though it seems to make no difference now. (it definitely seemed to catch up to here twin sister after pregnancy)
    3. Lastly this is unrelated, but I’ve noticed in times when I eat refined carbs, my body gets swollen, very swollen. At first I attributed this to the inflammatory effects of gluten, but it happens if I have potatoes, or something sugary. Is this possibly just water retention, or something psychosomatic, are is there typically a strong inflammatory response to heavy carbs after not having much other than a little veg and cheese daily.

    (reply)
    • Peter Attia  April 25, 2014

      Often we just make a meal and I selectively consume.

  194. Surfdocsteve Shapiro  April 26, 2014

    Peter,
    Just want to say I really enjoy your posts. I like you was hitting my mid 40’s and running 100 mile races only to discover that I had gained over 10 lbs. Unlike you I was never in a metabolic syndrome state, but your self testing got me to test my kids and they were. Anyway I would love to swap stories one day but that is not why I am writing. My question is if you have progressed out of a metabolic syndrome state then why after one transgression would your FBS be 126. If you are insulin sensitive, less than 2 on the HOMA IR, then should you not be able to consume sugar and store it either in muscle, if not full, or into fat in a rapid manner due to your insulin sensitivity? A FBS of 126 would be concerning to most people that diabetes is near.

    (reply)
    • Peter Attia  April 27, 2014

      One FBG offers little insight. Need to look at glucose challenge, which is why I use OGTT in my patients to identify IR.

  195. Tom Field  April 27, 2014

    Peter,
    You mention following your detosis with BHB blood levels. Where do you have these done? Is there a finger stick system similar to blood glucose?

    BTW we’re following eachother around. I went to medical school at Johns Hopkins and did my surgery residency in San Diego

    Tom

    (reply)
    • Peter Attia  April 27, 2014

      POC device — Precision Xtra by Abbott.

  196. Anthony  April 28, 2014

    Dr. Attia, you need to make a post in your media section for your appearance on Dr.Oz. I found it by chance on Dr.Oz’s youtube channel, i will post the link here because i know alot of folks like me read this post daily. You did a great job! I wish he would have went more in depth about the way of eating as a whole and explained how these fats are good for you, but I am just thrilled to see that this vital information is going mainstream. PS: I could tell that you were amused (as was I) in his elaborate illustration of cholesterol in the arteries and all over the floor.
    https://www.youtube.com/watch?v=6t6T0l14-n4

    (reply)
    • Peter Attia  April 28, 2014

      I didn’t consider it worthy of sharing.

    • Jane  May 1, 2014

      Dr Attia is my hero. Dr Oz, not so much!

  197. K  April 28, 2014

    Dear Peter,

    I’ll give you another reason to keep doing these posts, despite the flack you get and the risk that some people will take it as prescriptive and try and duplicate it.

    For many of us who read and found Gary Taub’s book convincing and want to change what we eat, we’ve got a couple of options. Option one: Very prescriptive eat this day one, eat this day two diet books like Dukaine. Option two vague lists like the ones at the end of Gary’s book. The overplanned version makes me feel punished, With just guidelines, it’s easy to get stuck in a Don’t-think-about-elephants mode were you spend more time thinking about what you can’t eat, or you get chased in to the arms of time consuming fake pastas and cauliflower pizza.

    So every once in the while you need to hear from what works for someone who’s got it together. The fact that what you eat has evolved over time, just provides more options. It think of it as a way to shake up my own stuck ideas.

    My own experience with bingeing has been different than yours, but that’s more psychological than anything. I appreciate hearing from another person who’s thought this through and has something that works for them, and I can use your experimentation to figure out what does work for me.

    (reply)
  198. John  April 28, 2014

    Just found your site and have been reading everything I can find, but I havent yet seen anything on fiber. Ive read that when counting carbs you subtract the fiber. Do you agree with that?

    Example I eat Quest bars. They have around 25g carbs listed with 18g Fiber so I consider that 7 carbs. Thoughts?

    (reply)
    • JohnK  April 29, 2014

      In early posts, Peter states that he counts all carbs, including fiber.

  199. Mthusi  April 29, 2014

    Hi Doc,
    Thank you very much for all your posts. One quick question though:
    For a very active 25year old male (6x week at the gym, mostly doing cardio and core exercises) what would you say is a ‘safe’ amount of protein to consume daily to stay in ketosis. I’ve been on High Fat Low carb for a very long time now, but worried about my consumption of cheese. I eat a lot of cheese, sometimes 500g of hard cheeses/day.
    In the morning before gym:
    – 4 eggs + boerewors (a type of sausage popular in South African cuisine ++Table spoon of coconut oil+ Olive oil)
    -Coffee with whipping cream (3 cups a day)
    In the evening:
    (Something similar to my breakfast. Or Eggs with chicken livers)
    Not a fan of vegies though

    Interms of my protein intake, am I not eatigning a lot of protein to stay in ketosis?

    Many Thanks,
    Mthusi (Cape Town, South Africa)

    (reply)
  200. raqi  April 30, 2014

    Hi Peter,

    A friend of mine sent me the Dr. Oz show clip…….. no comment.

    My question: What is your input on antiangiogenic therapy?

    Thank you.

    (reply)
  201. Sarah J  May 1, 2014

    Hi Peter: Would you be able to do a post or video on vitamin K2, its role and relationship with insulin? Add it to your long list of topics! 🙂

    (reply)
  202. Norm  May 1, 2014

    Peter, what do you think about resistant starch making insulin sensitive, wouldn’t any fiber do that by slowing the absorption?

    (reply)
  203. Jason  May 5, 2014

    “I can’t believe I’m about to do this…I just have this horrible feeling someone is going to attempt to replicate this, bite-for-bite, for no good reason.”

    LOL

    (reply)
  204. Hemming  May 5, 2014

    Hi Peter,

    I just saw part on of the BBC documentary The Men Who Made Us Thin. In it they interview a former CFO of Weight Watchers and ask him how they can be in business when only 16% of their clients is at a lower weight five years after they started the programme, he replies with ‘because 84% come back’. This is not a rant against Weight Watchers but just an observation of the industry (because if the diets really worked there wouldn’t be any industry).

    (reply)
  205. Chris  May 5, 2014

    Peter,

    I have been in nutritional ketosis for more than a month (BHB 1.7 – 4.0 mM), and I do an endurance workout almost every day. Lately, after my workout I have been feeling nauseous and have chills, and today I got very sick. I measured my glucose, and it was 52 mg/dL. As far as I can tell, I was hypoglycemic. I ate a few tablespoons of honey, and the problem corrected itself within an hour (feeling better, glucose back up to high 70s). I don’t count my carbs down to grams and percentage, but I too average two “salads as big as my head” a day, and I eat a lot of gluconeogenic protein and plenty of carb-containing nuts. I do, however, try to rigorously minimize carbs.

    So my questions for you are:

    1. Have you come across any evidence that there is a lower limit to the amount of carbs one should eat?

    2. Is it possible that hard endurance workouts can have the effect I experienced, regardless of diet?

    I am not looking for medical advice, merely bioichemical explanations for the questions above. Thanks in advance, Chris

    (reply)
    • Peter Attia  May 8, 2014

      Chris, carb need is dependent on glycogen demand. See the post on carbs and ketones “co-existing.” To your second question, I’d need to understand what’s really happening to answer the question with any meaning, but I can’t know that without assessing in great detail.

  206. Deanna  May 7, 2014

    This is by far the BEST site that I have found on health, nutrition, etc. So THANK YOU!

    My question is whether or not eating what I consider a surplus (e.g., 10-12oz) of low carb veggies (e.g., cauliflower, broccolini, cabbage, etc) 2-3 times a day will knock one out of ketosis. (assuming a 1400 cal/ day diet and assuming any other carbs are trace carbs)

    Thank you

    (reply)
  207. Chris  May 7, 2014

    Hi Peter,

    Not sure if you’ve addressed this topic before, but what are your thoughts on the “big breakfast/small dinner” concept? As far as I can tell the logic is, if you eat most of your calories in the morning you “burn them off” through your daily activities, but if you eat a large portion of your calories at night, they’re turned directly into fat tissue due to the inactive nature of sleeping.

    This always seemed very suspect to me (partially due to wishful thinking, since I’m never hungry in the morning). The reason I bring it up, is that according to this post you seem to not be eating breakfast lately.

    Thanks,

    Chris

    (reply)
    • tanya  May 9, 2014

      jarvis-

      this happens to me periodically, but more in the rear end and hips. i like to call it “nut butt.” i think it’s just because i’m eating too much and too many calories that my body doesn’t need then. nuts and nut butters are great (one of my favorite things,) but if you overeat them, it’s just like eating junk food (albeit, a little better for you…)

      tanya.

  208. Jarvis  May 8, 2014

    Has anyone else noticed their weight go up if they eat a ton of nuts. I am pretty lean, and have been experimenting with LCHF for over a year, so its been easy to notice the few times where there is extra pudge around my stomach and love handle region. I mindlessly consumed a jar of (sugar free) peanut butter, and probably six or seven packs of almonds over the last couple of days (studying for finals), and notice some gravy around the stomach. Obviously there are a lot of other variables that could have caused the fluctuation in the past, but the peanut binging seems to be number one suspect. If nuts make anyone else gain weight I would like to know. I’ll probably cut them out for about six weeks and see what happens when I squat in front of the mirror (this is the most objective measurement I do).

    (reply)
    • Vicente  May 9, 2014

      Hi,
      I haven’t noticed that with nuts. In my case, after reaching my weight-goal a few months ago I started eating a few grams of bread (a couple of “wasa fiber” crackers per day) and my weight started to rise (slowly but consistently). I stopped eating bread and my weight returned to my goal value. May be it was chance but I believe wheat/gluten was causing the weight gain, even in small quantities. After reading “Wheat belly” I am determined to avoid wheat forever. By the way William Davis recommends nuts (eat as much as you like category).

    • Alice  May 12, 2014

      Peanuts are not strictly speaking a nut; they are a legume. That would be in the carb category for sure. If you switch to other nuts, you could try the same experiment and see what happens. I love cashew butter, but it’s pretty pricey these days!

  209. Eric  May 9, 2014

    Hi Dr. Attia,

    Hope all is well with you and the family.

    I’ve been pondering a question.

    I believe you (and others) are linking insulin resistance to heart disease. (Liver converts persistently high sugar to fat – fat gets tucked into VLDL particle as a triglyceride and dumps in the particle in the blood – TG gets burnt by some tissue in the body and the VLDL particular becomes an LDL particle – and high LDL-P is the best predictor of heart disease)

    If that (simplified) narrative is accurate, and if we live in a society that is becoming increasingly insensitive to the effects of insulin (and that seems a sure thing giving increasing Type 2 diabetes rates) then heart disease would also have to be on the rise. Is it? I thought death by heart disease in this country was holding steady. (Maybe statins, and all the stents, bypasses, etc. are holding back the increase?)

    Best Regards,
    -Eric

    (reply)
    • Peter Attia  May 10, 2014

      A bit over-simplified, but directionally correct, Eric.

  210. Razwell  May 10, 2014

    Hi Dr. Attia,

    Both you and Gary Taubes are good people. You both put in honest effort to understand this subject. I am glad you guys collaborate. I saw your Dr. Oz show just recently. You come across to the public very good. You have that humble, curious , scientific attitude that Richard Feynman and other great scientists ( Filippenko etc.) had/have. And you use words such as “probably” and ” likely ” etc. which shows excellent understanding. 🙂

    I also respect the strong art factor part of medicine. The great doctors have that element down- and it is difficult to do. You have the best of both worlds.

    Best wishes,
    Raz

    (reply)
    • Peter Attia  May 10, 2014

      Thank you, Raz. Very kind words of support. Interestingly, some people criticize me for saying I should be more “firm” on my views, as it looks like I’m unsure of everything. I think they are missing the point–I don’t know everything.

  211. larry  May 10, 2014

    Peter, in his 2014 youtube lecture to MIT club, Dr.Lustig does a thought experiment where a person eats 2000cal and burns 2000 and is in a steady state re her weight. He then follows her and injects her with insulin every time she eats. He says that would cause 500cal of the 2000 to go straight to fat. Can you explain the mechanism by which that would happen? I’d ask him but I don’t think he has a blog. I’m confused on this. Is he perhaps assuming roughly 500 cal of her consumption is fat calories that will be shunted to adipose cells as a result of the elevated insulin?

    (reply)
    • Peter Attia  May 12, 2014

      See my post on fat flux, though I don’t know the answer to his assertion. You should ask him.

  212. E  May 10, 2014

    Hey Pete–

    Have you heard of Soylent (http://soylent.me/)? It’s an interesting concept, and it might make experimentation with diet easier (taking out some variables, uniformity of meals and proportions of fats, carbs, etc). There is apparently a whole DIY movement connected to it, some with low carb recipes. All of which is to say, I think you should design something like this.

    (reply)
    • Peter Attia  May 12, 2014

      I have and I have a friend who has tried it and will do so again.

    • Greg Hanssen  May 22, 2015

      I’ve been on Soylent 1.4 (40% fat) and a modified DIY variant (also 40% fat) for 6 months with great results. I’m 48 and a marathon runner/Ironman with my latest lipids at 85 HDL, 81 LDL, 44 Triglycerides. I’ve lost a few pounds and my 5k time is getting down near 20 minutes. I’m starting to tweak the Soylent with a tad more protein and a lot more fat (heading towards 55% fat)

  213. Patti  May 10, 2014

    Peter,

    Just wondering if you have come across information regarding the following question: In respect of CAD, if you have a non-modifiable risk factor such as family history, how much does a low carb/high fat diet affect life expectancy?

    Thank you,
    Patti

    (reply)
    • Peter Attia  May 12, 2014

      Case by case basis and most studies on CAD are too general to draw specific conclusions. Also, non-modifiable risk is very broad. Could be apoE, could be Lp(a)-P, could be a lot of things.

  214. Stacey  May 11, 2014

    Thanks for all the great information Peter. I preach this stuff and am also raising 2 kids one of which is a carb-aholic. While his eating habits are far better than his peers and he is at a healthy weight I feel I am constantly harping on him. How do you balance your knowledge of what keeps a body healthy with the independent minds of your children?

    (reply)
    • Peter Attia  May 12, 2014

      You may find the post I did on kids helpful.

  215. Alice  May 12, 2014

    You’ve likely addressed this elsewhere, but over a year ago, after stopping eating wheat and then 6 months on a very low carb diet, I felt myself kind of flattening out, less energy, less appetite, still bloated and losing very little weight. I went back to high-carb diet (the Peat approach, essentially), and now 40 pounds heavier and my leg joints more painful than ever in my life. No energy to exericse, fuzzy head (I have fibromyalgia, which got a bit better at first on paleo template but then seemed to worsen again), easily over 40% body fat I would guess. I’m what I consider a very young 57-year-old woman, but can see that changing quickly. I suspect one problem was that I was simply not getting enough calories (I tried the Dr. Mark Fuhrman approach, and I think that guy may simply be selling an eating disorder). Anyway, going back to unlimited carbohydrates has clearly been a bad choice. I would appreciate your thoughts for how to begin again to reduce carbohydrates so that one feels full, is getting enough energy, and doesn’t risk what some have called the thyroid burnout that can come with switching over to low carb (I know I am far from the only person who has had this reaction). Oh, and I have two or three of the five markers for metabolic syndrome, but waistline is about the first thing to improve, which I consider must be a good sign.

    (reply)
    • Alice  May 13, 2014

      Really, if you have time to address this I would be most grateful. It seems like the big mystery, or some piece missing, and oddly most paleo people don’t seem to want to talk about it, and the anti- or non-paleo (paleo of course is shorthand for the kind of way of eating you’re talking about) say, “Aha! We told you they were wrong” And in the meantime, like a lot of good patients, the ones with the problem or the “bad” question continue on in distress. (This is not a joke or an exaggeration–I read a blog post on Rob Wolff’s site, for example, whose conclusion was, “Suck it up, buttercup, quit complaining, and keep doing what you’re doing. I’m not kidding. I could not for the life of me tell how that was materially different from hearing the same thing in a medical doctor’s office when diagnosis or treatment did not seem to be “working.”) In this case I’d be most grateful for any insights you might have–not treatment suggestions, of course.

    • Tom Bunnell  May 13, 2014

      Your answer is two fold.

      Buying and cooking and eating meat that has lots and lots of good healthy fat, gobs and gobs of fat, inches of fat, answers the satiation question fully.

      Cooked to perfection.

      Delicious.

      Out of this world delicious.

      Most people can’t and won’t do it even though it’s far the best for weight loss and health, that along with very large portions everyday.

      You will never have felt better and will lose weight beautifully and live to be a hundred.

      The second question of boredom is your addiction’s way of bringing you back into the fold and it works every time.

      Your addiction has a thousand tricks.

      Put all the way to rest, no problem.

      Let your guard down ever so slightly and in it comes every time.

      Some of thousand’s of ways.

      -TB

    • Vicente  May 13, 2014

      Hi Alice,
      can you point me to peer-reviewed scientific studies that show the development of a thyroid-related health problem caused by low-carbing?

      Please note that: 1) a change in the thyroid function is not the same as a health problem. May be we don’t need the same hormones when we change our diet. 2) Only a serious scientific study could prove that thyroid problems have been created by and are not a condition that already existed (before the diet change).

      Please excuse my disbelief, but people out there tend to lie (or make up stuff) when they write about nutrition.

  216. JJ Bell  May 13, 2014

    Slow of the mark with comment on this one (sorry) but taken an age to read through wealth of information in comments above, thanks to all for contributing (except that one guy who criticised Peter, jeez you could not pick on a more self-deprecating yet brilliant mind, shame on you).
    Peter, a huge Thank you! and word of encouragement for sharing more intimate details of your eating habits and self-experimentation. Please pay heed to this brief reminder of why this is important and valued (selfishly) by people like me.

    – By printing your n=1 you hand out the tools to allow people to take control of their own health (you are a muse for others designing their own self-experiments)

    Take my case in point.

    – You responded to one of my comments about my (former) insomnia which made me feel like I was losing control of my life (everything seems 10 x tougher without sleep even dumb stuff) suggesting I check out vitamin D levels.

    ?-> Tested myself for Vitamin D, severely deficient. Supplemented and continued working on sleep habits. Result = best sleep of my life (including quality, now have the ability to feel better with less sleep if I want to as more bang for buck per hour)

    – Lost around 70 pounds via restriction years ago and maintained by continual starvation, using ‘complex, slow burning’ carbs to ‘control’ blood sugar and obsess about eating for around 8 years. Also completely relied on caffeine for wakefulness especially mid-afternoon where no matter how much coffee I drank or I slept the night before, I would crash sometimes dangerously so whilst driving. Plus symptoms of low T (though not tested).

    -> After reading your blog, experimented with LCHF (can’t believe this is official policy in Sweden now!). Oh my god. Without tracking accurately, must average between 500 – 1000 more calories per day & no impact on weight. Eating no longer takes up 80% of attention. Some unexplainable mental states reached. Afternoon dips are now the rare exception instead of being the rule. (Anecdotally also felt more like a man).

    Because you print your experience/results no matter what they are, people trust them which gives them confidence to try their own self-experiments (where relevant).

    Finally, because you have integrity and honesty I doubt you have the ability to post something without it being insightful, as you take so much time and attention over the details. I have mentioned before, I am an info junkie and have read widely from the ancestral/biohacking/bodybuilding community. If you strung your existing articles together with barely any editing you would have a book which (in my opinion) has more value, quality and insight than anything I have read on ‘the subject’.

    In summary, thank you thank you thank you, you are far too kind (& damn generous)! If you can spare the precious time, please keep on doing this (though readers like me will understand if you can’t).

    (reply)
  217. Emanuil Tomov  May 13, 2014

    Hey, Alice,

    Not sure if Mr. Attia will chime in or not, but still – without really knowing the specifics of your low-carb eating during those 6 months, anyone would be hard put to give you an explanation. But! Here are some of the general problems of people experiencing “carb flu”, described by people like Vollek and Phinney, as well as Eric Westman, and the solution:

    1. People cut carbs but don’t make up for it with fat. (In other words, your “not enough calories” suspicion may well have been correct.) Solution: Get rid of your reservations toward fat.

    2. People don’t remember to supplement more sodium. Solution: Do it. Salt your food, drink bouillons, so you get to something like 1.5 teaspoons of salt/day. Also, drink more water.

    3. People underestimate minerals, in particular magnesium and potassium. Solution: Get more of them, via food or supplementation. Potassium powerhouses: parsley, spinach, tomatoes. For magnesium, I personally go with supplementation. Nuts are high in it, but they shouldn’t be the cornerstone of your diet.

    Of course, you may have tried this and it may not have worked; in that case I’m useless to you, since I’m just a guy that has read the books and some of the research, but my interest is far from professional and neither is it backed by any sort of academic degree in the field.

    (reply)
    • Alice  May 14, 2014

      Thanks, everyone, this is actually quite helpful. I’m also not a doctor (not a medical doctor, anyway), and I’m not at all familiar with peer-reviewed studies related to my question, but it did have to do with, as Emanuil said, what’s commonly called “carb flu.” My guess is that all of the points he addressed might have been at play, most especially likely calorie restriction and not enough salt.

      What I do know is that returning to unlimited carb eating has taken a toll on my health like I would not have imagined, but just want to make sure that I’m not veering headlong into the opposite direction with the result of yet another set of difficult to manage health problems.

      Thank you, everyone, for such kind and generous advice and responses! Much appreciated!

  218. jack  May 14, 2014

    Hi Peter,

    I have been on a Keto diet for the pat 8 months. I just started working out (5’10 165 lbs). My goal is to stay at this weight and get more muscular, but it seems that I am still loosing weight. I eat, I’m never hungry, but I would like to add a few pounds and I cannot eat anymore. Im thinking protein shakes but I thought I’d pick your brain first and see if you have any input.

    Thank you

    (reply)
    • Peter Attia  May 14, 2014

      Maybe. Also, might be that keto is not ideal for you during an anabolic phase of your training.

  219. David Harley  May 14, 2014

    Hi Peter,

    As an avid follower of your blog, I am always amazed at the number of comments your posts generate. There is an immense wealth of information in the comments but short of reading all the comments in every post, there is no way of organising the info. Also, replies are sometimes lost in the massive amounts of comments. I wonder if you have considered a forum attached to your blog where questions and answers could be more easily organised and found? Just a thought, not a critism at all 🙂

    (reply)
    • Peter Attia  May 14, 2014

      If I could wave a wand and make it happen, I’d be happy to do so. But I can barely keep up with writing posts and trying to respond to the odd comment to put any more time into blog.

    • Boundless  May 15, 2014

      > … but short of reading all the comments in every
      > post, there is no way of organising the info.

      A couple of tips:

      1. Bookmark your own replies as soon as you post them – it’s a deep link. It otherwise requires some skill with HTML to figure out how to deep link directly to your response to follow further replies.

      2. Use an external search engine, usually the Advanced page, such as:
      http://www.google.com/advanced_search
      to find things. The key thing to do is set:
      site or domain: [ eatingacademy.com ]

  220. Jack  May 15, 2014

    Hi Peter,

    Not sure if you have seen this, but figured I’d share.

    http://www.kare11.com/story/news/health/2014/05/14/mayo-clinic-trial-measles-vaccine-multiple-myeloma/9101893/

    (reply)
    • Peter Attia  May 15, 2014

      Had not seen. The vaccine trial I’m *really* interested in is the GBM one. Seems too good to be true.

  221. JJ Bell  May 15, 2014

    Re above, agree – need to get maximum bang for your buck with time makes sense to writing excellent posts and comments rather than editing the ramblings of commenters.

    In the spirit of self-experimentation, I wondered if you would be willing to jot down an ultra brief description of some of the exercise protocols you are currently experimenting with. As a life-long couch king, am playing around with some ideas at the moment and have been (positively) surprised with the results (though have a long way to go).

    Am particularly interested in the slow lifting approach and how one might try to do this with higher volume. When I switched from John Kiefer’s shockwave to a Body by Science type protocol I felt good but lost some muscle tone. To be clear I AM NOT asking you to tell me what to do but am being nosey and am interested in some of the things you might have been trying to inspire my own experiments. Am in need of a body building muse.

    ps Have you ever tried supersets? Am a bit of a duck out of water with all this stuff but it feels amazing.

    JJ

    (reply)
    • Peter Attia  May 15, 2014

      I (think) have tried it all since the age of 13. I’m just wrapping up a 12 week “experiment” with a modified super slow protocol via Doug McGuff. Next experiment, which I’m the planning stages of now with Ryan Flaherty, will be the boldest of them all. Should know results by Fall.

  222. Ron Webb  May 15, 2014

    Peter, I just watched a video on vegan diet(or why not to be), and was wondering if you have ever seen this.
    http://www.youtube.com/watch?v=WKRREBwvaV4

    (reply)
  223. Claire  May 16, 2014

    This is an interesting blog! I’m 5′ 6″ and weigh about 123 (very small boned.) I had gestational diabetes when I was pregnant with my son. While I was pregnant, I was able to control the diabetes through diet (did not need to take insulin.) It was a very low-carb diet and I checked my blood sugar 4 times per day & had to keep a food journal, as instructed by my OB-GYN.

    I learned so much from the experience. Afterwards, it was possible to lose the pregnancy weight (about 20 pounds) and I have been keeping it off pretty well… Now I understand how carbohydrates always have a big effect on insulin. Nowadays I usually only have small amounts of bread, like maybe one piece of buttered toast in the morning… and I never put sugar in my coffee, the toast is enough!! I almost can’t imagine having pancakes for breakfast ever again in my life. It just seems like that would be a weird thing to do… and there’s no protein in a meal like that.

    When I was pregnant, and constantly checking my blood sugar, I found that fruit was O.K. (even a bit of pineapple.) Potatoes were O.K. (again, a small serving.) But bread was really the killer! It’s the refined quality of bread–the fact that there somehow doesn’t seem to be any “real” fiber even in whole wheat bread. Once I cheated, and had a big bran muffin, and my blood sugar spiked. Any kind of sugary baked good is really going to have a big impact and make you fat.

    This way of thinking is a part of me now, and it has helped so much. I usually eat carbs only in small amounts. I don’t want to be in ketosis because I don’t think it’s necessary for me… But I think it is probably true that carbs are the big problem for lots of Americans. Especially the wheat, corn and corn syrup.

    (reply)
  224. H. Carney  May 20, 2014

    Hi Peter — love your blog & TED talk.

    My husband is Type 1 Diabetic in excellent (apparent) physical condition, running 4-5X per week and lifting fairly heavy (rotations) those days as well. Diagnosed at age 30 (he’s 50 now) he hasn’t shown any noticeable complications of the T1D yet, but his A1Cs have been above 8 for at least the last 9 years (when I began watching them), and most recently above 9. He won’t use a pump (dislikes the idea of a permanent thing stuck in his body) and has an extremely high-stress job.

    Long story short, I’m doing what I can to help him (bought Bernstein’s book and I went Paleo last year, cooking that way him and our daughter) and he even tried going about 80% Paleo for 6 months, and “only” saw his A1C go from 9.2 to 8.5. He thought that wasn’t worth giving up morning muffins, night time pretzels, crackers, etc (I’m certain that was because he wasn’t 100% and remained on the rollercoaster, never feeling satisfied). I’ve been working on Nutritional Ketosis for myself for about a month now (via Maria Emmerich for weight that wouldn’t come off, aches, etc.) and feel VERY happy with it.

    Here’s my question: Can you direct me to some inspirational people/athletes that I could show my husband that may compel him take the step toward drastically reducing his carb intake? We have an 8-year-old daughter, and I’m fully aware, at those A1Cs, it’s only a matter of time before bad things happen. His doctor (not an endocrinologist) cautioned that “ketoacidosis” is a danger for him… which is tough when only your wife (I’m no doctor, after all) makes the point that it would be, ONLY if he stops taking insulin. He currently takes 18 units Lantus & (approx) 30 units Humalog per day. Thanks in advance for your reply!

    (reply)
    • Peter Attia  May 20, 2014

      I do know just the person. If you contact me via the contact page on the blog, I’ll introduce you. But, I gotta warn you, if the horse doesn’t want to drink, not a lot of good it does dragging him to even the most beautiful water basin.

  225. Jennifer  May 20, 2014

    What are your thoughts on the “Blue Zones”? They’ve found that centenarians eat primarily a plant based diet, including lots of legumes, with 5 or less servings of meat per month. Eating primarily plant based also gives the body the essential fiber and antioxidants it needs to fight the disease (especially cancer) that so many Americans unnecessarily suffer with.

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  226. Usha Rajagopal  May 21, 2014

    Great post. I have never seen any post where the amount of food consumption is such well gelled with work.

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  227. Jack  May 22, 2014

    Hi Peter,

    I wanted to ask if you have any knowledge or theories when it comes to psoriasis.I know it’s not part of the subject, but just wondering with your background (medical and reading the “right” research/medical information out there )if you have come across anything that’s slightly “interesting”.

    Thank you.

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    • Peter Attia  May 22, 2014

      Jack, I’ve heard anecdotally that some folks experience resolution of psoriasis with diet change.

  228. Ferruccio  May 23, 2014

    Can the absence of carbs cause migraine after a high intensity workout (cross fit)? I cut carbs for two weeks and often finish the workout session exhausted and sometimes I feel some nausea which one day led to a migraine crisis (which I never have) with a brief moment of aphasia. Could that be due to a sudden hypoglycemic state?

    (reply)
    • Peter Attia  May 23, 2014

      Possible, though hypoglycemia is less likely. Low sodium is more likely.

  229. Doug  May 23, 2014

    Dr. Peter,
    I see you have been mostly ketogenic for 4 yrs; I have been for 1 year. I also have a similar pattern where I occasionally go out of ketosis for the sake of a birthday or good restaurant (probably a little more than you do). Overall, I like this way of eating because I feel much better and I can eat an appropriate number of calories without feeling hungry all the time. Because I like data, I got a ketone meter and started tracking glucose and BHB. Ketones were pretty much what I expected but I noticed that my fasting glucose is always on the high side when in ketosis (100-130) as compared to a “regular” diet (80-90). After doing some research, it looked like I have some degree of physiological insulin resistance (PIR), though I also read that its a benign condition, not to worry. Then I came across a piece that is essentially saying long term ketosis is bad. First you get PIR, which leads to high serum free fatty acids and super low triglycierides (<20), which sets the stage for various autoimmune conditions like Hashimotos…. Clearly, you haven't experienced any of this, and I don't think I have either aside from the elevated glucose. Would like to hear your thoughts on this. Link with a good summary is below, though I think some of this originates with the "Perfect Health Diet" (the claim being that eliminating your dietary source of glucose puts the liver under too much stress).

    http://freetheanimal.com/2014/02/ketogenic-diets-news.html

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    • Peter Attia  May 23, 2014

      These are interesting ideas, but I have no way of knowing if they are correct or not.

    • calvin  July 20, 2014

      hello Peter

      about the same blog … did you see this?
      http://freetheanimal.com/2014/03/disrupting-carbs-prebiotics.html
      Although what you eat has nothing to do with what is described, I noticed that your 25%/20%/55% PRO/CHO/FAT looks funnily similar to the numbers given as Inuit nutrition ratios as calculated there.

      I have no idea if that way of computing the breakdown of components in the Inuit food is correct or not. I guess you know better than me.

  230. Fred Roh  May 26, 2014

    Peter – I work with youth athletes and active adults and have believed in the principles you promote for years. My question is this: Your measuring tools are very sophisticated and elaborate, not available to many practitioners or consumers. I also understand you take months to know your patients so that your treatment is personalized. Accepting that your approach is the gold standard, are you willing to offer any guidelines for nutrition that you believe will be universally beneficial? If so, what would they be or where might i find some that you support? Most of my clients are not in some disease state but rather are looking for higher levels of wellness and performance. Thank you.

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    • Peter Attia  May 27, 2014

      Million dollar question. I will definitely let you know when I find out.

  231. Andy  May 26, 2014

    Hi Peter,

    Love your stuff. Been eating pretty low carb (not ketotic, though) for a long time, and generally things are very good. But, on a whim I’ve signed up for ORAMM (Off road assault on mount mitchell) – 62 miles and 11000 feet of elevation gain on a mountain bike. For this ride I’m guessing 8-9 hours in the saddle for me, and I think it’s almost impossible for me to ride in a glycogen-sparing way doing all that climbing. I’m trying hard to maintain as much reliance on the tanker (fat) rather than the gas tank (priceless analogy, BTW), but it is getting tough in practice.
    I find that I usually can ride about 2.5 hours or a bit more at a moderate + pace (a bit longer if I take it very easy on the climbs.) I can tell when I’m in a nice fat-burning mode, everything feels very easy and smooth. But, mountain biking demands a lot of heavy exertion, and after that amount of time my legs are just spent for heavy exertion, which I interpret as total glycogen depletion. I’ve experimented with super starch, but have found generally that it is not a miracle worker. (I think a pack is only 110 calories, which isn’t a lot in the context of this kind of workout) Obviously all the guys I ride with are in the goo/gatorade/sugar camp, and right now I’m in panic mode and thinking of joining them. Or I’ve been thinking about spiking super starch with a bit of the sugary stuff. In my reading, you seem to be able to avoid the hard stuff altogether and still exercise at pretty high levels. Am I missing something? Is sugar going to wreck my fat metabolism and turn me into a crazed insulin spiked mess? Recommendations?

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    • Peter Attia  May 27, 2014

      Just seems to take time. The guys I ride with mainline goo and traditional sports drinks. I don’t have any problem keeping up and riding away with just BCAA +/- some super starch, as needed. But initially I really took a hit at zone 4/5/6.

    • David Harley  May 28, 2014

      FYI – Using any carbo load with Superstarch effectively renders Superstarch useless… Don’t be fooled by the low caloric count… You will be using fat so the calories don’t mean that much..

  232. John G  May 29, 2014

    Hi Peter,

    Long time reader, first time commenter here. First, I really appreciate the time you put into your blog and responding to the comments. I understand the dangers of emulating your diet without nutritional due diligence and understanding your own body. I have found your “what I eat posts” most helpful for new ideas on how to stay LCHF and maintain athletic performance.

    That being said…. I would liken this latest post to when my mom dictates to me one of my favorite childhood recipes. She gives me the key ingredient list, but the recipe never tastes as good. Turns out, she never measures anything and always puts in more butter and salt than called for in the recipe. She is not holding back on purpose, this is just the way she cooks. I think you have, in essence, done the same thing. You provided the key ingredients of your diet, without a few critical ingredients/strategies that make it all work.

    For Example: I too am a big salad eater. However, greens and veggies themselves create issues for me. In order to reach my caloric intake goals, I find myself ladling 3-4 Tablespoons of olive oil onto my salads (along with several ounces of cheese, hard boiled eggs, uncured bacon bits, etc).

    I suspect after reading your calorie targets above there is fat (and maybe salt) finding its way into your diet that is difficult to discern, especially if you take this post out of context of all of the others. I must admit that I am missing the venti whipping cream latte drinker in the “Praise the Lard” t-shirt. If you have had either a subtle or wholesale philosophy change on fats, please share.

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    • Peter Attia  May 29, 2014

      I don’t exercise as much as I did for most of life–the problem with too many jobs. So, yes, total caloric intake averages less than 2 years ago. Also, not being particularly ketogenic, I eat more protein and carbs, and less fat. I believe I’ve alluded to this in the post and comments.
      There is a reason, as you can imagine, I don’t go into great detail of the “recipe” for my intake. See most recent post…

  233. larry  May 30, 2014

    Peter,have you ever shared your LDL-p number on this blog either when ketogenic or subsequent? Just wondering whether you think diet is actually a main driver. I eat roughly a one third percentage of each macro and lift/cardio regularly and intensively for my age ( relatively low body fat 15% at age 65) . My latest results from Accesa lab NMR analysis: HS CRP.4;Trig 60; HDL-C 54:LDL- C 118; but LDL-p 1450 (borderline high) Not sure what to make of that. Any thoughts?

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    • Peter Attia  May 30, 2014

      Last LDL-P was in the 800’s with concordant LDL-C (in the 80’s).

  234. Michael  May 30, 2014

    Peter –

    Do you ever utilize Glycomark (1,5 – Anhydroglucitol) in lieu of OGTT?
    If so , how well does it correlate with LP-IR? Now that I ask that , how well does OGTT correlate with LP-IR?
    OGTT is a lab hassle – most labs do not want to do it any longer.

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    • Peter Attia  May 30, 2014

      Never, not even close. Glycomark is an ok sub for A1C, but not OGTT with insulin+glucose and 60 and 120 min check points.

  235. Jane  May 31, 2014

    Peter,

    Thanks again for your work.

    I find your blog posts, as opposed to these forum answers, to be best for me to understand the science underlying the nutritional questions that we are all so interested in. So I do hope, fervently, that you choose to focus on generating another one! And my vote for your next substantive post is for the Part X of the cholesterol series.

    That said, I do have questions, and hope you have time and inclination to answer.

    1. Did your LDL-P change significantly after your diet evolution to the pattern you describe here? What about OGTT and insulin response to the glucose challenge? A1C?

    I think we are all following your personal story with interest, you are a role model for each of us trying to figure out how best to modify our diet and exercise habits.

    2. I also look forward to what you have to report about the effects of the slow strength training you tried.
    That looks like a safe way to add muscle. Does that ring true to you?

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    • Peter Attia  May 31, 2014

      Jane these are important questions. Glib answers in the comments sections don’t do them justice, but unfortunately, that’s all I have time for these days. So it will have to wait.

  236. Phil  June 1, 2014

    Hello Peter, I have been on a ketogenic diet for about 10 weeks now and everything is going well, however I have been experiencing more migraines since starting the diet then ever before. Is there any reason why someone would begin having more migraines after starting a ketogenic diet? I have read that this diet is supposed to help reduce migraines. Could it be that I’m not fully adapted and that things will improve, or is there something I need to change in my diet. I currently take in under 50 grams of carbs a day and have no more then 100 or so grams of protein each day.

    Thank you for any advice you have.

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  237. larry  June 2, 2014

    Peter in one of your posts about the AHS meeting you mentioned learning about the possible perils of exercising as much as you were. Are you going to get to that or can you at least drop a hint? Does it have to do with endurance exercise specifically and resulting biomarkers of heart and endocrine stress etc.? Also in that post you mentioned Stephan Guyenet who clearly doesn’t buy the carbohydrate/insulin hypothesis of obesity. Ever going to explain why you think he is incorrect? I know you have only limited time but these are fascinating topics( at least to me) and I’d rather get back to them than have commenters off on a tangent debating the evolution of why we don’t generally think scientifically( which we don’t). By the way your cholesterol series is one of the best posts I’ve read( several times)!

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  238. Colt  June 5, 2014

    Hi Peter,

    I know you’re busy so I’ll keep it short. I’ve been on Keto for about a year and half, and it seems like my beta hydroxybutyrate levels very rarely go higher than 0.3 mM when measured with a finger prick. I know this is the very low end of ketosis, and you often talk about how full blown Keto readings are much higher than this (1.0 to even nearly 5 mM you mention in your Andreas Eenfeldt interview). How the heck do I get this number up, and does it even matter in my ongoing weight loss struggle? Thank you in advance. (PS I’m excited to see what NuSI has in store for us)

    (reply)
    • Peter Attia  June 5, 2014

      Not eating what I describe in this post!

    • Norm  June 5, 2014

      Hi Colt,

      With regards to getting BHB numbers up you will find Peter’s series on ketosis very helpful and for weightloss issues and ketosis have a read of Peter’s post on fat flux.

  239. Margaret Ruesch  June 6, 2014

    Hello Peter,

    I came across your work in March when my brother was dying of pancreatic cancer age 65, I am a year younger. I found some amazing explanations for my own conditions too, and I am very grateful for your work. I have been diabetic since 1992 and on insulin for over 10 years. I would chase my sugars with insulin keeping in “control” by basically self dosing. Never was I able to get my triglycerides under control, nor did I keep my weight anywhere near normal. As long as I chased my sugars, I felt I was OK. After listening to you wonderful explanations, and others, I stopped taking my statins, but more important, went sugar free and wheat free with a high fat low carb diet. I really loved the bacon and got the results you see below in March – very early in the diet change and had stopped statins completely for about 2 weeks before the test. Doctor highly chastised me and said I was the type of person who needed statins and with that high cholesterol I was convinced to continue my 40 mg crestor and fenofibrate micronized 200 MG getting the following results in May which surprised every one but me , along with a never before reached 6.5 A1C. Another milestone I reached were triglyceride levels below 400 – NEVER before accomplished in 22 years! My first numbers back then were 3000!

    May 20, 2014
    CHOLESTEROL 115 – 200 mg/dL 140
    TRIGLYCERIDE 10 – 149 mg/dL 395
    HDL 40 – 60 mg/dL 23
    LDL, CALCULATED 50 – 130 mg/dL 38

    March 21, 2014
    CHOLESTEROL 115 – 200 mg/dL 423
    TRIGLYCERIDE 10 – 149 mg/dL 1596
    HDL 40 – 60 mg/dL 21
    LDL, CALCULATED 50 – 130 mg/dL see below
    Calculation not performed, Triglyceride >400 mg/dL.

    My doctor now wants me to reduce my crestor to 10 mg because of a danger — with low HDL or LDL — not quite sure of the details, but I am tempted to cut out the crestor all together. Can you elaborate on the dangers of too much crestor? or give me a good reference to follow up with. I really wish you could be my doctor, but I know you can’t. So I thought you might like to know about my successes.
    Other things achieved.
    Ultra sound of neck does not reveal any blockage over 50% (don’t know if or how much may be there)
    Blood pressure remains low Upper 135 – 150 lower 60 – 65 (I’m disturbed with the wide range between the two numbers)
    Lost some weight – but have to eat more vegies and cut down on the delicious fats.
    Never hungary.
    I have bad hip which cuts down my exercise – but weight loss does help with this.

    Your tears and apology on your Ted Talk really touched me where I live, and I have felt that distain in a doctors office from the time I was 16 years old. You have allowed me to learn, and now talk turkey to the doctors and they listen to me. Health care has changed so much over 60 years, my goal for my later years it to talk to as many people as possible about the effects of food on your medical bill. Also the effects of industrial agriculture and it’s effect on the future of the US health care system.

    I will be reading along with you, and hope perhaps we will cross paths some day.. Do take care.

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  240. Michele2  June 8, 2014

    I am not trying to be on a ketogenic diet and do not want to go into ketosis. I went on low carb and gave up wheat -sugar-milk and doing this got rid of gut issues, sinus infection, and lost 13 pounds–3 pounds more than I would have liked due to lack of hunger. I am searching all over to find out what I am doing wrong that I can only sleep 3-4 hours a night which is running me down. But am curious to know if a urinalysis Sieman’s I had in March where it listed Ketones – Moderate (40) means that I was in ketosis?

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  241. Cap'n Jan  June 18, 2014

    Hello Peter,

    Have been following your blog now, limited commenting, for at least 3 years now. I follow a carb restricted diet, off and on for the past 15 years, mostly off recently due to family issues. The last 4 months I have been back on a very low carb diet, probably too much protein, however. Couldn’t get ketosticks to register anything, so that is my guess.

    This past weekend I decided to try a 3 day fast to see if that could kick start me off of this weight plateau.

    Days 1 and 2 were pretty good, energy enough to do my yearly trail clearing (cutting, hauling and grinding wood on my property) pretty intense.

    Day 3, however found me totally fagged out! I measured my blood sugar at various times during the day and it was down to 43 with one reading. I did NOT want to give up on the last day, so I just lay on the couch reading, drinking lots of water

    Day 4, woke up exhausted blood glucose on waking is 39.
    1 hour after breakfast 52
    1 hour after lunch 56
    2 hours after dinner 83 – pretty normal for me, I stay below 100 most of the time. Energy levels seem fine now.

    My question: Is that reading of 39 dangerously low during a fast? I felt clear headed, just physically beat up. Keto-strips showed very high ketone levels (urine).

    I could not find any information on the web concerning glucose levels I should expect on a 3 day fast, but figured if you had done something like that, you would have measured everything 3 ways from Sunday.

    If you don’t have time for this, I will understand. I may stick to 18 hour fasts, once a week or every two weeks!!

    Love the blog, and especially the videos. There is a sea change coming in diet, and you and Gary have really lead the vanguard. Thanks so much!

    Cap’n Jan

    (reply)
    • Peter Attia  June 18, 2014

      Did you have BHB measurements along side the glucose measurements?

  242. Cap'n Jan  June 18, 2014

    Hi Peter,

    No, I haven’t been to a doc’s for any blood tests (but probably, at some point should do this), as I have not found a single ‘low-carb’ doc in the area that doesn’t have his/her own brand of ‘supplements/diet’ that you have to buy. My experience is that asking for ANYTHING from an M.D. is met with stalwart resistance. (You are a doc, you don’t have this problem us ‘mortals’ have ;->)

    (Quick detour on why I am reluctant to go to docs: I worked for a Big Multinational. They had a health day and everyone had to go. When they measured my body mass (weight/height on a chart, sheesh!) I was overweight. (My caliper measurement was a consistent 17% at the gym- not bad for a female, but I was also a serious weight trainer, heavy weights, no froo-froo girl weights.) It was put in my personnel file that I was ‘uncooperative’ with the health professionals when I refused dietary counseling. Every doc I have had to go to in the last few years has given me the same song and dance. YOU are an anomaly in the profession. I note you are no longer in the profession ;-> )

    So, no I have no idea what the BHB measurements are. Just the measurements I took with my home test glucometer. I also test with ketostrips, (definitely in ketosis! even after starting to eat again after 3 day fast). Fasting blood glucose this morning was 83, which as I said, is pretty much average for me. I don’t seem to have any blood-glucose regulation problems while eating low-carb. It doesn’t swing hard in any direction, pretty much goes up to 110 or lower if I ‘pork out’ a bit, then back down to the 80’s.

    I might have been feeling some eurphoria from GHB production, but I didn’t feel all happy-face, more than usual (My husband says I can have fun in a paper bag), not more talkative than usual either.

    I WISH that the labs would get off their kiesters and do some lobbying so that they, too, can do tests and send results to patients without the intermediary. They would probably make a bundle on that.

    The other issue I have is we are on a (very) high deductible medical plan, currently between jobs, so funds are somewhat limited and I don’t want to experiment with docs and keep wasting money on dogmatists, if you see what I mean. We have looked hard for someone who understands very low carb dieting, to no avail. Austin, TX area. If you know someone that would be deluxe.

    Normally I wouldn’t post here, Peter, I know you are up to your neck in work. But I thought I’d give it a try. The 39 glucose reading was kind of scary (that low, I read, can cause convulsions and other really not fun things). I just wonder if I was in trouble, or if this is not uncommon when someone fasts from the platform of a very low carbohydrate diet. It would seem likely that blood sugar would drop, but that surprised me!

    (reply)
  243. M Bertler  June 26, 2014

    Hi Peter-
    Very basic question- I see a lot of discussion of macro caloric percentages allocated to “fat”. Detail on specific proportions of fat consumed seems lacking (%’s of fat allocated to Saturated, MUFA, PUFA). Understanding dietary choices and results are individual and no one answer is correct, do you have an opinion on a starting point for healthy fat percentages on a low carb diet? Could you advise on the fat percentages used on your NuSi “high fat” diet experiments? The percentages you average given your current diet? Thx for any insight!

    (reply)
  244. Tim C  June 28, 2014

    Thanks Peter – Your work has totally changed the way I eat, and train, and live – thank you. One thing I’ve never been able to work out from your writing is: when you talk about carbohydrate intake, do you include fibre? A 150 gram serve of broccoli will have about 11 grams of total carbohydrate but nearly half of that is fibre, so I’m wondering if it counts as 6 grams of carbs, or as 11… I’m just wondering which part of the label I should be reading to try and work out what I’m actually eating. (and yes, I thought about spelling ‘fiber’, but I’m an Australian, and I just… can’t)

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  245. JD  July 2, 2014

    Love your blog. Thank you again for all your work. Wondering if you have reviewed the new research paper “Long-term ketogenic diet causes glucose intolerance and reduced ?- and ?-cell mass but no weight loss in mice” http://ajpendo.physiology.org/content/306/5/E552.abstract . Well aware the vast difference between research using mice and humans (additionally, the study used a high Omega 6 ratio – not good). Nevertheless, becoming increasingly insulin resistant in the long run after most people have such spectacular short term results using a KD might be worth noting. Any thoughts on the implied rebound effect?

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  246. Mark M  July 13, 2014

    Hi Peter.

    I have been doing Dr. Joel Fuhrman’s “Eat to Live” nutritarian diet style and have lost about 64 pounds in a 3-month timeframe. I have plateaued but continued to lose at a slow rate (down from 270 lbs to 206 now). I just wanted to get your opinion about this eating style. It is very low in calories, but high in fiber and micronutrients with most food coming from unrefined whole plant foods (fruits, green vegetables, non-starchy vegetables, beans, nuts/seeds/avocado). Dr. Fuhrman advocates food with a high micronutrient-per-calorie density. I don’t know the exact mechanism for how weight loss occurs on this type of plan, but I would imagine it would be due to 1) a reduction in calories and 2) a stabilization of blood sugar and decreased insulin response at mealtime using low-GI vegetables, fruits, and beans. There is a lot of research to be done though, as it may be possible that the phytochemicals might also play a key role in inducing lipolysis.

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  247. Gaby  July 28, 2014

    Hi, Peter!

    I love your blog!

    I’m following a ketogenic diet since July 4th and I have noticed that I no longer crave sugar! I have a compulsive relashionship with sugar since early childhood but now I have no desire to eat any kind of sugar. It’s like a miracle! It’s so good!
    I have a question: I love cheese. What kind of cheese have a low glycemic index?

    (reply)
  248. Gudmundur Johannsson  August 8, 2014

    Hi.
    I am a fellow MD working in Iceland.
    Firstly I want to congratulate you on your work, truly amazing and groundbreaking stuff.
    Like yourself, I have shedded about 20-25kg by gradually cutting out carbs (your intro in the
    video-lecture on RQ could have just as easily been about myself) and for the past year
    I have been on an LCHF diet.
    I was more into endurance training before but now I’m doing almost exclusively HIIT (cross-fit/boot camp, 1hr training sessions) and sometimes olympic weight lifting.
    However, on the low carb diet I have had problems keeping my performance level up, especially the last 15-20min. So I came across John Kiefer’s book about carb backloading and I found his theory very interesting, exploiting the exercise induced translocation of GLUT receptors in muscles and just jam in refined carbohydrates right after exercising. I’ve tried it and certainly find that I feel more energetic when working out and after 3 weeks I haven’t noticed any increase in body fat (his claims are that it is nearly impossible to put on body fat with carbohydrates consumed within the first 1-2 hours after heavy resistance weight training).
    However I wonder what your experience is on how many grams of carbohydrates an average person can consume after exercise and still keep optimal/near optimal ketosis, and whether you agree with Kiefer that it is better to have a large but short-lived insulin spike post exercise than a lower, but longer elevation of insulin in your blood stream?
    Keep up the good work!

    (reply)
    • Peter Attia  August 10, 2014

      You may find the post on carbs and ketones “co-existing” helpful on this question.

    • Gudmundur Johannsson  August 10, 2014

      Brilliant! Thank you.

  249. Megan  August 13, 2014

    Hi Peter,

    I just found your blog via Dr. Jonny Bowden’s site and I’m loving it so far. You mention your reactions from your family about your diet, which is something I am still struggling with as I transition from “eating what ever I want” to eating what I want because I know it’s better for me. I am in the stage of cutting out most sugar all together, most carbs, etc.

    When I’m making meals for just myself, I love it and feel great all day. However, I find myself out or even at home with friends and family often that do not share my restraint or even my opinion on eating habits. Do you have any suggestions or advice on how to, or how you, handle that? I know the ideal and possibly even “adult” think to do would be to ignore any negative comments and do what is right for me. But I find my family feeling hurt or calling me rude for turning down meals or baked goods (to name a few) made specially for me. So unfortunately, this is still something to overcome as I evolve my diet to where I want it to be.

    Thanks in advance and I look forward to reading and learning more!

    (reply)
    • Peter Attia  August 14, 2014

      Maybe others will have ideas. I’m too selfish to eat something just because it will make someone feel better, with the exception of my daughter.

    • Boundless  August 14, 2014

      > … turning down meals or baked goods …

      I suspect that if they offer you a cigarette, you have no problem declining that. 🙂

      You could get a Cyrex Array 3 test run. Odds are about 40% you’d test positive for wheat-related toxins. Then you’d have a piece of paper to display (and having this can be very useful for dealing with government schools, nursing homes and hospital stays).

      We just tell hosts, in advance, that we have a severe wheat reactivity issue in the family, confirmed by inadvertent challenge testing.

      If they are politically independent thinkers to the least degree, you can also tell them “You do know that the official government diet advice, the USDA MyPlateOfMetabolicSyndrome, is an utter political disaster, entirely unsupported by science, and very nearly completely the inverse diet of what human beings need to eat?”

  250. Kelly H.  August 16, 2014

    I see that you have enough admirers, but here’s one more love letter, so to speak. As a PA student, I am head over heels in love with your blog. Just starting ketogenic “stuff” for my narcolepsy, and I have directed nearly everyone I know here for cholesterol info. Thank you THANK YOU for making a science blog that doesn’t cater to the lowest common denominator. It’s hard to find something for people with a strong science background.

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  251. Richard B.  August 21, 2014

    The results of my last physical and blood tests suggest that I am pre-diabetic (high triglycerides, high fasting glucose and a glucose tolerance test that says I am not processing sugar fast enough). I came across an interview with you on YouTube and your story compelled me to subscribe to this site. I have enjoyed reading your articles and look forward to the emails.

    IMHO: The temptation to “Eat what you eat” or “Do what you do” comes from a lack of understanding of the process involved in deciding what is right for me. I see two paths in most things in life. 1) Acquire what you need/want that is ready-made (do what someone else has already figured out) or 2) Create it for yourself.

    I would like to create my own regimen. You are doing a good job of conveying the knowledge, now all I need is the process that tells us how to make adjustments in our diet and exercise. I would like to get my blood tests back in the normal range. Most of us don’t have access to frequent blood tests, so we need to know how to tailor what we eat and what we do that will achieve the desired result.

    Thank you so much for this site and your willingness to share what you know and understand.

    Richard

    (reply)
    • Peter Attia  August 21, 2014

      I hear you Richard. Though I don’t plan to write any books out there about eating strategies, fortunately others have done a great job. Jenny Ruhl, Jeff Volek, Steve Phinney, Eric Westman, and others.

  252. Ron  August 29, 2014

    Peter – I found your blog through the sweet life as I am a T1 Diabetic that has taken on endurance running. I am not sure exactly where this fits in and this looks like as good a place as any. I am just looking for general guidance nothing specific. I have a pending 1/2 marathon (my first) on Sept 20th followed by a full marathon (also my first) on December 6th. As my per run mileage increases it has become obvious to me that on my more conventional diet that my level of consumption of gels, sportsdrink, and other things laced with sugar must increase as well for a number of reasons. I recently had the realization that if I consume the anticipated amount of gel packs during the marathon I will need to bring a backpack along to bring all of my fuel. This, along with the fact that a diabetic ingesting so much sugar seems very counter intuitive, are what lead me to try to find a different way.

    My main question and my issue is with the timing of the switch from my current diet to a ketogenic diet. I currently am following many of the ketogenic diet guidelines (no sugar other than when I get when I need “fuel” for running, flour, corn, white rice, grains etc) which was part of a Dr Oz cleanse that I have kept doing for about 8 months. I will have no withdrawal or effects of cutting carbohydrates from my diet because other than a small amount of fruit, considerable vegetables, Greek yogurt and legumes there are none in my diet.

    With a 1/2 marathon in less than a month (September 20th), I am concerned about changing over now and messing up my ability to do the final part of my training. I am confident that I can do the switch and would like to convert to the Ketogenic Diet so that I can reap the benefits for the full marathon on December 6th. I am wondering what your thoughts are about the timing of a switch like this. What are the potential issues in the short term. I know the long term benefits and those are what I strive for.

    If there are any books or guides that would help me to determine the best course of action, I am open to suggestions, but short of just jumping in I see minimal information about thoughts on these subjects (though I am still searching for the answers). Your thoughts anecdotal or personal on these subjects would be helpful to me in figuring out my best course of action. Thanks in advance.

    (reply)
    • Peter Attia  August 30, 2014

      Richard Bernstein and Jenny Ruhl are very thoughtful on this.

  253. Ron  August 30, 2014

    To give you a second less drawn out option if you would prefer.:

    Peter,

    What are your thoughts on starting a ketogenic program as far as timing goes? I can find no real guide or help in when is a good time to do this switch. I am a diabetic who is training for endurance runs and one is close the other a little further off. I do not want to completely upset the closer race but would love to slip the ketogenic diet in as soon as possible because of the benefits. There is plenty on what it is and how to do it but as far as athletics is concerned, when is a good time to introduce these things. I already eat a very low carb diet with no sugar (other than goo for training), flour, corn…… so there i would be none of that withdrawal. Like I said, I can find no help but will keep looking. Any recommendations for reference material would be great.

    (reply)
  254. Jo  September 2, 2014

    How do you feel about diet in regards to women, do you think it could be (or should be) significantly different, especially if it could be different from person to person? I have yet to find a diet that works, I have tried vegan, vegetarian, atkins, paleo – the only thing that has enabled me to lose a significant amount of weight was green juice reboot diet – drinking green juice for 60 days. I lost around 50lbs but it all came back once I resumed eating and developed an insatiable food obsession. I don’t think I would want to do that again. Now I mainly eat fruit, meat and vegetables (in that order) and I do eat the occasional cake/bread/takeaway. I’m still huge and yet I eat nothing like I used to (chocolate everyday, cereal, bread, pasta, cheese).

    (reply)
  255. Sorin  September 8, 2014

    There is a documentary on BBC or Discovery science called something like “Did Cooking Make Us Human” where they show an experiment that show that cooked food gives 30%-40% energy so stomach needs less energy to break the food and so the brain has more energy to function..
    So eating so much raw food isn’t affecting how much energy the brain gets?

    (reply)
  256. John  September 9, 2014

    I mean no disrespect, but I’m sure you’re well aware of our propensity to deceive ourselves. What advice would you give to an alcoholic who found that after several years of sobriety, he could drink four times a year without giving in at other times? Thanks for the great web site!

    (reply)
    • Peter Attia  September 10, 2014

      In speaking with real experts on the topic of ‘substance abuse’ I don’t think the term alcoholic is particularly helpful. That said, I’m not sure why I’d be in the position of offering advice to anyone about alcohol.

    • Ron  September 10, 2014

      I believe that he is comparing an alcoholic to a person with who had previously has had issues with carbohydrates. Their ability to stay on the proverbial wagon might be compromised by allowing themselves the ability to fall off every now and then. By doing this someone runs the risk of not being able to get back on it. There is a part of me that agrees with both sides.

      You have to ask yourself if you can trust your will enough to let 4 meals out of the almost 1100 you eat annually allow you to be sidetracked then you probably should not do that. Peter does not have a problem with that. I might not have an issue with eating that but I can tell you it would throw my bloodsugar completely out of whack and it would be very difficult for me to deal with.

    • John  September 10, 2014

      I apologize. Again, thanks for the great web site.

    • John  September 10, 2014

      I was trying to put my thoughts in a way that were not offensive, but after re-reading my post, I seem to come across as a little know it all that is trying to point out the obvious to someone less intelligent than myself. This was not my intention. I am just socially awkward at times. The reason I wrote is because your post brought to mind the times that I have compromised on my intentions and ended up failing at my goal. I guess I felt a sense of empathy, and wanted to help. Again, I apologize if I gave offense.

    • Peter Attia  September 11, 2014

      John, I certainly wasn’t offended at all by your comment. No apology necessary. I just thing the question you ask is very complicated–and a very good one! It is, however, outside of my area of expertise.

  257. Matthew Duhamel  September 9, 2014

    I’ve recently started on this journey to weight loss (28 years old, 350lb starting) and am down to 325 in the past couple months. I’ve been reading through your blog and it has been helpful to see your thinking evolve. What I’m curious about is whether you’ve noticed your weight and cholesterol LDL-P (particle count) levels going up with your new, veggie-heavy, diet or if things have stayed the same.

    I’m recently unemployed so my variety of vegetables is fairly limited, but I’ve found success by eating salads as often as I can and eating a combination of tofu and chicken for protein. I’ve thought about upping my carbs since steamed potatoes are so cheap (and my food budget right now is about $35/mo) but I’m worried that might hurt my cardiac numbers.

    (reply)
    • Peter Attia  September 11, 2014

      I’m in the camp (not sure the size of said camp) of people who is at their absolute leanest and “best” in terms of biomarkers in strict ketosis. Hence, today, my LDL-P is about 10% higher and my weight about 3-4 pounds heavier and body fat perhaps 1-2% more. That all may be splitting hairs, of course. I’m infinitely healthier than I was on a standard American diet.

  258. Ron  September 11, 2014

    I have to say thank you very much for all of the information that you are providing. I am working my way month by month through your posts (from 2012 forward). The comments take more time than the blogs themselves. The one thing that has totally hit home with me is the role that insulin plays. For years as a diabetic I chased my blood sugar reacting to what I had done rather than being proactive and taking control of my diet and insulin. For the last almost 9 months I have been on a carb restrictive diet (not exactly Keto but close) and my insulin usage has dropped considerably. I use a Novolog Pen which was at that time 10-14 days worth of insulin. That equals 21-30 units a day plus lantus. The same pen now lasts about a month which is about 10 units a day. My hemoglobin A1C is much improved and I have lost almost 60 lbs since January. I will be starting the Ketogenic Diet in about 10 days after I run my first Half Marathon. I look forward to the improvements that this will help me to make. Once again thanks for everything. I look forward to reading all of your content. I intend on learning what I can to attempt to prolong my life and improve my quality of life in that time. That is what prompted me to initially change my lifestyle back in late January.

    (reply)
  259. jack  September 13, 2014

    Hi Peter,

    What are your thoughts on food tolerance tests?

    Thank you

    (reply)
  260. Lee Kelly  October 1, 2014

    I went from about 232 to a low of 187 on medifast. I stabilized at around 193. By this, I mean that I really didn’t have to pay much attention to what I was eating. I had changed my eating habits and had become accustomed to eating much healthier. That was about 3 years ago. During that time I had ordered medifast for two months. I am currently at around 205 and would like to go back down to where I was and even further. I would really like to be 180. I am married now and drifted a little in my eating habits. Perhaps that is what caused the weight gain. According to ketostix I have been in ketosis numerous times, sometimes for a couple weeks before I screw it up and drop out. After a few days I’m back in the game. It was easy to lose while on a ‘plan’ like medifast. However, I really don’t want to do that again. It is expensive and i’m not so sure it really teaches good eating habits. I would like to achieve these goals by eating what I readily available here. What I am doing now is 4 strips of side pork (un-curred bacon) and about 110 g of mushrooms for breakfast. For lunch I eat a hard boiled egg and an oz of nuts. For Dinner I either do around 8oz of talipia or a can of Tuna and another hard boiled egg. I know some would get tired of this but I really don’t mind doing this for a period of time to get to where I need to be. The problem is, I’m not really losing. I have been aiming for about 5% carbs, 20% Protein and 75% Fat. I am not hungry at all, but i’m also not losing. My calorie intake is around 1200 daily. Also, forgot to mention, for breakfast I cook the pork with 2 tbsp of coconut oil and I also have 4 tbsp of heavy cream daily in tea or coffee. Has anyone else hit a wall in trying to lose fat via ketogenic diet? Any suggestions?

    (reply)
  261. Matthew Gittelson  October 7, 2014

    I can’t believe I have actually asked you “so…what do you generally eat?” This was a great piece Peter! It really opened my eyes; I had no idea. See you soon.

    (reply)
  262. Jasmine  October 19, 2014

    The picture at the top of your post has UCAN in it. Do you use UCAN during longer/harder workouts?

    (reply)
  263. Div  October 22, 2014

    Hi Peter,

    Thank you for sharing valuable knowledge about nutrition and health on this website.
    I recently read an article about your NuSi initiative on Wired, and came to know about you. I am delighted!

    I wanted to point your attention to an Ayurvedic herb: Guggulu (http://en.wikipedia.org/wiki/Commiphora_wightii) that is so often prescribed by the Ayurvedic doctors in India to regulate cholestrol. It would be great if you already know about it and could point to trustworthy research on this.

    I thought it could benefit if “rigorous” experiments could be planned around Guggulu (also specifically for people with Indian food habits and genes – 1/6th of the world population is Indian!).

    My regards to you,
    Div
    Div

    (reply)
  264. Martha  October 23, 2014

    Dear Dr. Attia,

    I just discovered you and I am thrilled, devouring every blog as I can. You remind me of my son who has basically done the same thing since he was in high school, but not a doctor. I am trying to do something similar on my own. I just wanted to know if you and Gary Taub might consider a cookbook. Your curry sounds so interesting, but I wouldn’t know where to begin with it. I am happy I discovered you. Thank you for your work.

    Best,

    Martha Munters

    (reply)
    • Peter Attia  October 24, 2014

      Ha ha, thanks Martha. No cookbook from me any time soon. But there are lots of great resources out there.

  265. Barb  October 24, 2014

    What about the sucralose in the BioSteel and Superstarch? Does this concern you?

    (reply)
  266. veronica  November 1, 2014

    Peter! I am a triathlete and three months ago I’m doing the diet! I’ve only dropped two kilos my ketone levels vary constantly going from 0.5 to 4.7, I am currently preparing the ironman cozumel is the November 30, 2014, x various reasons I decided to follow this diet, I would have but it’s complicated, I can write some email address, just drop two kilos, and have not exceeded 25gr.de carbs! Thank you very much!Peter!
    Soy triatleta y hace tres meses que estoy haciendo la dieta! Sólo he perdido dos kilos mis niveles de cetonas varían constantemente que van desde 0,5 hasta 4,7, Actualmente estoy preparando el Ironman de Cozumel es 30 de noviembre de 2014, X Algunas razones por las que decidí seguir esta dieta, es difícil explicar, puede escribirte a alguna dirección de correo electrónico, no he superado los 25 gr de carbohidratos! Muchas gracias!

    (reply)
  267. Norm  November 3, 2014

    Hi Peter,

    What vitamin D levels do you aim for personally?

    Thanks

    (reply)
  268. Lisa  November 6, 2014

    Dear Peter:
    I listen to your Ted talk with facination because I been fighting something that defies my doctors. Like everyone who is overweight they tried to tell me I eat too much. I am a healthy person, except for my obesity and my fasting blood sugar goes from 90 to 99. They tell me my thyroid is normal. I recently was going to have bariatric surgery because of my weight and I had stage 0 breast cancer a few years ago and a knee replacement. I am 5’7″ tall and weigh about 235. Up until about 20 years ago my weight was normal. I never even gained the freshman 15. If I gained a few pounds I worked out and ate more carefully and the pounds would come off as expected. Then I went throught the trauma of a big divorce and a life reset. Life is good but I gained from 140 pounds to 215 in 10 months for no reason. I always was active and I always ate healthy. I do not snack or binge. I have done crazy amounts of exercise and 1200 and 1000 calorie diets and lose very little. With the bariatric program I was on 1000 cal of high protein diet, two shakes a day of a low carb protein. Salads, meats veges no sugar or wheat. I had 80 grams of protein and about 100 carbs and in 3 months only lost 12 pounds, I qualified for the surgery but got slammed with a job change and needed a hysterectomy…and that was enough to deal with. I have seen N doctors and had N tests they all tell me I am normal. But I remain obese. The only factor that I know of that caused this was the stress of divorce. None of the “normal” activities to lose weight work. I do not drink diet soda. I do not snack or binge. I know how to eat. i work out. So, I think you are on to something. If skinny people looked at how little some fat people eat and how healthy we eat they would be less to judge. 1000 cal is not much. I was on Phen fen for over a year and lost down to 175, but that got banned and the weight came back. I would love to diet this off but diets do not appear to help me. Forget about Weight Watchers…I lose nothing. What I would love someday is a path out of obesity and I wish it was not through another major surgery. There is something going on and I wondered if my body reacts to the hormones they been putting in meat and milk…or that GMO changes to our grains…or maybe drinking water from plastic bottles…something changed in the last 20 or so years and it affect me I think because there is something in my genetic makeup that is sensitive to something…anyway…I wish you the best in your research…

    (reply)
  269. Moose  November 8, 2014

    Steak? Fresh salmon? Nuts? I wonder how much your monthly food bill is.

    There’s a reason why poor people are sometimes obese. It seems unlikely – if you have no money for food you should be thin, right? Poor people food is crap. Cheap pasta. Rice. Potatoes. Cheap cheese. It’s dull. It’s boring. It’s crap.

    When you have $100/month for groceries, you don’t waste it on potato chips or trips to Mickey D’s. I’m lucky enough to have a functioning car so I can get to an actual grocery store. Produce? If it’s the middle of the year and they get farm-fresh stuff. If it has to come from another state (or country) it’s going to be more expensive. Not everyone lives in a sunny, warm place. Meats? No chance. Sometimes I’d get an on-sale $1.50 thing of bacon bits and make it last the month.

    I’m in a better place now. My monthly food budget is more like $300/month. $100 of that is dedicated just to produce. There’s a company near me that delivers a big box of fresh, ‘organic’ produce for under $25/week. Even though I can now have salads 3-4 times a week (and, like you, I only eat once or twice a day) I’m still struggling to be able to eat lower carb. It’s a diet for those who can afford it.

    (reply)
    • Peter Attia  November 8, 2014

      Couldn’t agree with you more. One day I’ll unleash my manifesto on this topic, which I’ve been honing for a few months. There is a solution, but it will take some work.

  270. Mary  November 11, 2014

    Hello Peter! Thanks for your blog!

    Stanford grad here…Wondering what your take is on how much protein to eat on Keto diet? What calculator or guidelines do you use. There is a great deal of controversy online as to whether to eat mostly fat [around 70%] with mod protein, very low carbs OR higher levels of protein, low carbs but lower levels of fat.

    Regarding this issue: The controversy seems to be raging regarding whether in fact the body turns protein into glucose readily. I believe you have stated that the body does….can’t find that here.

    Thanks so much!

    (reply)
    • Peter Attia  November 12, 2014

      It probably varies by person, activity, and a few other things. If the goal is ketosis, then be empirical about (i.e., use a meter to get the answer).

  271. rick  November 12, 2014

    Love your posts
    People usually say I am to intense, so your blog is right up my alley.

    For years I have eaten mostly high protein, mod cars , and low fat.
    Trying the ketogenic diet for 5 weeks now, and despite low carbs 30 grams a day, and low protein 50-70 gms a day ( i am 70 kg) , I am having trouble getting my ketones up above the 1- 1.2 range. Some day I literally have 2 cups of coffee, each with 2 TBSP of butter , and 1 TBSP of coconut oil, and still my ketones are 0.6-0.8 ( although BS @60-65) . I have lost 10 lbs of fat ( now 10% BF) , but surprised ketones not higher.

    thoughts ??

    (reply)
    • rick  November 15, 2014

      further,
      I realize I can raise my ketones just by loading up on coconut oil.

      There would seem physiologically to be a difference in energy regulation bt say me eating moderate carbs and elevating ketone levels with coconut oil vs. me on VL carbs with the same ketone level.
      Does the ketone level per se have any relevance ?

    • Sam  November 15, 2014

      Rick, I have had a similar experience. I find that exercise makes a difference in increasing ketones. (I assume this burns off “excess” liver glycogen). I also do a 24 hour fast one day a week and this seems to help.

  272. jack  November 13, 2014

    Hi Peter,

    Why try to prove carbs/sugar (and whatever else) are bad? Why take that strategy? Why not get 100,000 (possibly more for better data) people, healthy/ not so healthy. Get their blood work done and other tests. Get the data, compare the results of healthy people with the rest. Come up with an average of what is considered healthy. Once that is figured out, shouldn’t the healthy eating be the effect of trying to reach the healthy average numbers? Just thinking out loud.

    Let me know your thoughts.
    Thank you.

    (reply)
    • Peter Attia  November 15, 2014

      That’s basically epidemiology. Been tried…doesn’t work.

  273. Hemming  November 14, 2014

    Hi Peter,

    I was wondering if you’ve had regular DEXA scans done since the ones from 2011? I would be really curious to see how your body composition has changed over time (and since then) on a low carb diet. Sorry for posting the question here, I couldn’t comment on the other post.

    Best,

    Thomas Hemming

    (reply)
    • Peter Attia  November 15, 2014

      Yes, but now that I use BodyMetrix, which I’ve validated to be with 0.5% of DEXA, I only use it (since I can do it myself). Last DEXA was Feb 2014 at 8.1% (or maybe 8.4% I can’t remember). My body fat seems to vary between 7.5% and 10% or so.

    • Hemming  November 15, 2014

      Thanks Peter. I’m surprised its that accurate compared to DEXA. Do you use the Professional of Personal?

    • Peter Attia  November 16, 2014

      Professional. Plus, I had the person who developed it train me.

    • Hemming  November 18, 2014

      Thanks Peter, appreciate it. I figured that the device would take some practice to be useful.

  274. larry  November 20, 2014

    Peter, does the BodyMetrix use a formula based on age? I have used calipers and impedence devices, both of which use age based formulas to calculate BF. I’m 65 and muscular due to lifting very regularly and eating clean. If I plug in my actual age I’ll get 17-20 % BF. If I plug in age 30 I’ll get 10% etc. Does BodyMetrix give a true reading?

    (reply)
  275. Sherry  November 20, 2014

    Peter I saw you tonight for the first time on TedTalks and was very moved by your tender heart, compassion and sincerity about the obese problem people have. You are real!!! I looked you up on the internet and found your Blog. I’ve got alot of reading to do. I thank you for this. I am going to start following this.
    I have been well over 200 lbs. most of my life, even as a teenager. I’m now 60. My three daughters are all between 200 -300 lbs. My mother and grandmother were thin, but my great grandma and two of her sisters were all heavy. They didn”t have all the junk food and fast food like today, but still struggled with obesity. I’ve tried every diet, every gimmick, no success.
    I’ve always hated my body, hated being fat. Am disciplined in every area but my weight. I don’t like myself because of that. I love me, just hate my body. Guess you could say I have a Love/Hate relationship! Haha! I’ve prayed for years to find the answer, cure or whatever to win this battle.I hope you are the answer to my prayers with this.
    Time will tell. Be blessed Peter. I’ll be praying for breakthrough in your science & studies you and your team are doing. Thank you so much, again for your passion in this battle and your compassion.
    Sincerely yours, Sherry Smith

    (reply)
    • Peter Attia  November 26, 2014

      Sherry, thank you for your note. I’m sorry to hear about all you, and your daughters, have been through. I can imagine that many folks might imagine your weight is a result from eating “too much,” but I’m convinced there is something else going on, between your genes and genetic susceptibilities, along with perhaps some component of eating the “wrong” foods as a result of being told they were “right.” I hope we can find some better answers for you.

  276. Ben  November 26, 2014

    Hi Peter,

    Just wondering what your thougts are on whether it is advantageous to only eat fruit immediately after exercise sessions vs as a desert following a meal?

    (reply)
    • Peter Attia  November 26, 2014

      I have no insight. Not sure it matters, though I know some feel it does.

  277. Ed  November 29, 2014

    Hi Peter –
    thanks for all the info!
    As an IM triathlete, I’ve been using UCAN for a year and moving to ketogenic diet to see impact on LDL and BP. I am correct that I would not include the carbs from UCAN in the total daily carb count?

    You probably have answered this – but what’s a good post exercise recovery meal, e.g., long bike, etc.
    thanks
    Ed

    (reply)
    • Peter Attia  November 30, 2014

      Not sure what a daily carb count is, but they are carbs. Obviously not all carbs are equal.

  278. OT  December 1, 2014

    Hi Dr. Attia,

    Excellent blog and work, thanks for all you do for all of us, the readers and followers.

    I play racquetball, which requires quick bursts of energy and high energy responses. I have been in Ketosis for the last 8-10 weeks. About 3 weeks ago, I purchased UCAN SS and have had excellent results with it, when playing day-long racquetball tournaments. Before SS, I was struggling with my performance in the court after some time playing.

    Now, I am planning on trying the Biosteel HPSD as well, specially for muscle recovery / BCAAs / electrolytes. Since I want to maintain my NK levels, is it safe to assume that drinking both SS and Biosteel would not hinder my BHB levels? Obviously, I would have to test it on myself and draw a definite conclusion, but wanted to know your perspective.

    Thanks a lot, and please excuse if you already addressed this topic.

    OT

    (reply)
  279. Hemming  December 12, 2014

    Hi Peter,

    This might be a silly question, but do you ever find it difficult to eat >3000kcals/day on those foods? I can easily get to 2500-3000kcals/days but beyond that becomes quite uncomfortable.

    (reply)
    • Peter Attia  December 12, 2014

      I’ve never found it difficult to eat >3k kcal of anything unfortunately…

  280. Norm  December 12, 2014

    Hi Peter,

    Does protein insuced rise in insulin shuts off FFAs/lipolysis to the same extent as a carb induced rise in insulin would do assuming the rise in insulin is same?

    (reply)
    • Peter Attia  December 18, 2014

      Highly dependent on the protein and carb in question, but yes, protein does trigger insulin release.

  281. Anna  December 15, 2014

    Hi Dr. Attia.

    I appreciate your blog so much, and it is helping me to understand ketosis so much better than anything I have found. I am in month 3, have lost 21 lbs, and am in a bit of a plateau. But I am committed to staying in it for the long haul for both weight loss and overall health. My questions for you, that I have not seen asked or answered per se is this:

    (1) With you now being out of NK, but still eating more protein than carbs and 55% fat, is your body back to being a “sugar” burner? I thought I had understood that you need to be a ketone burner or a carb/sugar burner, and not teeter in and out of ketosis.

    (2) Do you feel that the state you are in now is a worse state than if you were staying in ketosis, but still good enough to reap the benefits of the insulin sensitivity you have come to have after being in ketosis so long? Any idea how the low carb, higher protein, higher fat is impacting all the other health markers compared to a fully ketogenic state?

    (3) I know we should not necessarily follow what you are choosing to do diet wise, since everyone is different and there is more to diet than health (i.e., enjoyment, family, etc.). I am just curious about whether the important take away from a purely health related standpoint is that perhaps long term, having lower carbs and regulating insulin is MORE important than staying in ketosis in and of itself once good health has been reestablished.

    Thanks so much for your consideration in answering my question.

    Anna

    (reply)
    • Peter Attia  December 18, 2014

      All fair questions, Anna, but truthfully, to give the responses their due I would need an hour, which sadly I don’t have. Perhaps I’ll do a podcast one day where I can address such questions.

  282. Scott  December 16, 2014

    Hi Peter,
    You provide so much information, trying to take it in is like drinking from a firehose!
    Thanks for the huge effort you put in to educate so many.
    I thrive as a carnivore, but my performance on the bike is certainly down during high-intensity efforts.
    It’s probably a carryover from traditional high carb/low fat thinking, but I try to keep down the amount of fat I eat.
    Do you think taking in as much (or more) fat as protein is necessary for high intensity performance?

    Thanks again for the tireless work,
    Scott

    (reply)
    • Peter Attia  December 16, 2014

      If the efforts are really anaerobic (say, at or above FTP), you’ve got to increase carbohydrate content.

    • Scott  December 22, 2014

      Peter,

      Thanks so much for your advice!
      Since your advice, I’ve kept carbs low and training rides below FTP, and felt great.
      Today I ate some oatmeal before the group ride hammerfest on a fixed gear(!), and had a superb ride.
      In fact, it was over an hour into the ride before I even had time to realize I was riding as well (and felt as great) as the best I ever did on the typical sugar-heavy athlete’s diet.

      Now I can ride my best, and still enjoy feeling so much better while off the bike, too.

      Thanks again for taking the time to help me out!

      Scott

  283. Dr. Tim  December 16, 2014

    Peter,
    Just “found” you on youtube while searching for information on the ketogenic diet. I’m an avid cyclist, and have found myself slowly increasing my body weight over the years, even though I am riding about 5000 miles a year. Your story, your interviews and presentations, and lastly… just watching this high-intensity land training video has gotten me motivated to switch my carb-eating/metabolism self to a fat-burning machine. If you can do THAT with the amount of carbs you are injesting, then I think I can ride a one hour crit at high intensity. Keep up the good work!

    (reply)
    • Peter Attia  December 18, 2014

      Two points to consider Tim. First, don’t discount the period of time I needed to adapt to that dietary change; second, there is no doubt you can “ride” it at high intensity, but can you win it (or do your best)? That’s another question. I’m a 20 km TT guy and I’m not convinced ketosis produces superior results at a distance so short.

  284. cal  December 17, 2014

    Hi Peter,

    I have been avid exerciser and interested in nutritional habits for some time now. Fortunately, I have been lucky and to this point in my life have had no weight, or body fat problems. Regardless, I am still very conscious of what I eat. Reducing the amount of dietary related diseases is utterly paramount and a huge (western) societal concern, with physical, social, economic, and environmental implications. And after doing much research on the topic, I agree with your assessment and own research on diets that can combat some of these concerns.

    However, I have to ask. Do you see the diets you have eaten over the past few years and seemingly similar diets (paleo, other low carb, high fat, high animal product diets) as a sustainable solution? My own academic background would suggest that while these dietary shifts are feasible and possible to many in developed countries where these specific health concerns are growing, suggesting a diet removing simple carbohydrates, starches, and grains as the way to create a healthy society has some seriously dire implications for the well-being and future of many communities. The more animal products we consume (myself included) has huge environmental and social consequences that maybe the western world doesn’t feel yet.

    I am curious if you have considered that the solutions you offer, which many have the luxury of following, could potentially shift the burden of one semi-global concern (dietary related illness) to a potentially long term global one (food security, global well-being, environmental sustainability)? If these are the only solutions, then i fear that we are doing what we do best: create problems elsewhere and for future generations.

    Anyway, I enjoy reading your blog. It is very informative and you clearly dedicate your life to this and helping people. I hope for some more posts.

    (reply)
    • Peter Attia  December 18, 2014

      Cal, great question, and not one I will pretend to know the answer to. I would posit that what we are doing today (diet-wise) is not sustainable, primarily in terms of our health. To be clear, I don’t think the world needs to eat more meat or animal products and I think/worry that this impression is a distraction from the argument. Question 1 is: what are the dietary triggers of metabolic disease? Question 2: how do we create a food environment to promote eating that way as the “default,” rather than the exception?

    • Boundless  December 20, 2014

      re: The more animal products we consume … has huge environmental and social consequences …

      That’s true if your apparent choices are artificially limited to industrialized grain agriculture vs. CAFO meat. More CAFO is definitely not the answer for those ditching grains and dialing down carbs generally.

      My impression is that we can produce more healthy food per acre than either of the above, quite sustainably, by using a model like Joel Salatin’s Polyface Farms.

      Population pressure on whatever food system, however, is a separate problem.

  285. Steve  December 18, 2014

    I would love to hear your opinion on the methods in the book “The 4 Hour Body”.

    (reply)
  286. Anna  December 19, 2014

    Thank you so much for taking the time to answer Dr. Attia. A podcast would be great! I am thankful that you continue to post as you can, given all that is on your plate!

    (reply)
    • Peter Attia  December 19, 2014

      Anna, I just agreed to do a Q&A podcast with Tim Ferris. Not sure when, but probably within the next month or so.

  287. David Jackson  December 19, 2014

    Hello Dr Attia,
    I follow your work on ketogenic diets, and am confused slightly by what another Professor states regarding ketosis. He claims it take months to achieve true ketosis and that you must never take a break from eating a keto diet, otherwise you have to start all over again. I find that hard to believe as it sounds so extreme and radical. Can I ask you your thoughts on his opinion, thank you.

    (reply)
    • Peter Attia  December 30, 2014

      The *complete* adaptation may take months, but biochemically entering ketosis can take days.

  288. Eduardo  December 19, 2014

    Hi Peter – I will try to make this short: I have read and followed a great deal of this site and am still vexed by the following problem: I am following an extremely strict keto diet, for about three months now, and after having lost about 10 pounds (starting weight, around 195), I am not losing any more weight. I am doing everything that I am supposed to do: I am keeping my fat consumption high, about 60-70% of total calories (I am measuring); my carbs are lower than 20 per day; I am consuming coconut/MCT oil every day; I am eating no artificial sweeteners; I am limiting my dairy; I am hyper-aware of food quality, I cook all (yes,