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

Hey Peter, what does your daughter eat?

Hey Peter, what does your daughter eat?
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If there’s one question I get asked often, it’s this one.  And I understand why.  Anyone who knows me, and knows how obsessed I am with everything I do, knows there is one thing on earth I cherish more than anything else – my daughter.

Any of you reading this post who are parents know exactly what I’m talking about.  My daughter, and I know the same is true for Gary with his boys, is one of the greatest driving forces behind us founding NuSI.  Why?

Picture the United States as a cruise ship.  Overall, it’s a wonderful place to be.  We have so many things to be thankful for (as do many folks outside of the U.S.).  But, there are icebergs out there.  If we continue the course we’re on, our fate will be similar to that of the Titanic.  Unlike the Titanic, though, we actually have several icebergs in our path.  That is, there are many different forces in the world today that – if left unchecked – could easily disrupt our way of living.  I won’t go into detail about what I think the list of potential threats to our economic and social freedoms are – pension overhead, national security, energy security, structural problems with education – but I’ll assert my opinion on the first problem we need to get a handle on.  If we don’t figure out a way to curb the twin epidemics of obesity and diabetes, our healthcare spending alone will bankrupt us.  No one can pinpoint the day this will happen, but if not in my lifetime, I’d bet anything it will be in my daughter’s lifetime.  In other words, of all the icebergs we need to skirt past, this one is the closest to our vessel.

So, back to the question.  While we wait a decade or so for NuSI to fund the type of science that will unambiguously resolve the jugular question — What should people eat to maximize their chances for greatest health? — what do we do?  If you’ve been reading this blog, you’ll certainly have a great idea for what I do, based on my interpretation of the data currently at our fingertips.  But ambiguity remains, especially when asking an even more important question than what do I eat.  Since my daughter (and presumably your children, for those of you with children) is infinitely more important to me than anything else, including myself, how do I interpret current data around what she should eat?

 

Principle 1: Excess sugar is not conducive to good health for anyone

I don’t think I need to spend any additional time reviewing the harm of sugar (e.g., sucrose, high fructose corn syrup, beet sugar, cane sugar, brown sugar).  If you do want a quick refresher on this, you can read this post. If you can only make one intervention in the dietary pattern of your child, make it this one.  Based on our experience and the experience I’ve had with clients, friends, and family, a trend has emerged.  It seems the longer you wait to make changes in this area, the more difficult it can be.  Not always, but often.  Sugar is very habit forming, and from a neurochemical standpoint an addiction to sugar is not unlike an addiction to gambling, alcohol, or heroin.  Yes, they all have nuanced differences, but each of these addictive patterns or behaviors results in stimulation of the dopaminergic pathways of the brain.

How do we translate this intent into practice?  The easiest thing to do is to minimize the amount of sugar brought into the house.  This means we don’t have soda, cookies, candies, cakes, cupcakes, and other similar nutritional weapons of mass destruction lying around.  This doesn’t mean we never have them lying around.  Invariably, a grandparent or neighbor will bring over a lollipop or some cookies, but this is an exception, not a rule.

Furthermore, we don’t have any juice in our house.  Our daughter (who is 4) drinks whole milk and water.  That’s it.  Amazingly, she no longer finds sweet beverages enjoyable.  Recently, at a birthday party, she was given one of those Capri Sun sugar-syrup drinks.  She took one sip and asked for a bottle of water.  It was actually too sweet for her.

As I explain below, she still gets some sugar in her diet, but it’s probably about 20% of what the average kid her age is consuming.  And she gets plenty of fructose in the form of fruit.  But when she eats fruit, it’s usually lower fructose fruits (e.g., raspberries, blueberries, strawberries) rather than higher fructose fruits (e.g., watermelon, banana).

Principle 2: The less processed the food is, the better the food probably is

As an extension of the first principle, if you always make trade-offs in favor of cooking your food, rather than pulling it out of a box or jar, you’ll win many of these day-to-day battles.  At least half the week our daughter asks for cereal for breakfast (instead of bacon and eggs).  Rather than dump her a bowl of sugar-laden cereal, my wife or I will make her steel-cut oatmeal, to which she’ll add milk and a few raisins and walnuts.  Sure, it’s more carbs in one meal than I eat in 3 days, but it doesn’t contain sugar (beyond the fructose in the raisins).

When she wants spaghetti for dinner, we make her real sauce out of real tomatoes and garlic.  No added sugar, of course.

This requires extra work, as you can imagine. It’s much easier to dump cereal out of a box or pasta sauce out of a jar.  But if I need to sleep 15 minutes less or my wife needs to cut her run short 15 minutes to make it happen, is it worth it?  For us, the answer is yes. But, it is a choice – of both time and money – every parent needs to make.

Principle 3: Insulin and insulin-like-growth-factor (IGF) are important for childhood development

This topic is highly complex.  For anyone who has studied IGF-1, GH, IGF-BP3, STATb5, or any of the hundred other molecules involved in the highly regulated pathways of growth, don’t be offended.  It would take another series the lengths of the cholesterol series to give this topic its fair shake.  However, a few key points are worth noting.  There is sufficient evidence, for me at least, that a growing child needs a modest dose of insulin to capture their genetic (vertical) growth potential.  In fact, stunted growth is one of the documented side-effects of children on ketogenic diets, though there may be several factors accounting for that beyond the role of insulin and IGF (e.g., protein deficiency, caloric deficiency).

Ketogenic diets are a medically accepted treatment for recalcitrant seizures.  About half the children whose seizures don’t respond to any medications almost immediately stop seizure activity once they are in ketosis. Some investigators, including Dr. Elizabeth Thiele, Director of the pediatric epilepsy program at Harvard’s Mass General Hospital, are investigating this approach in adults.  I had breakfast with Dr. Thiele recently and had an amazing opportunity to learn from someone with enormous experience treating children with ketogenic diets (over bacon and eggs, of course).  According to Dr. Thiele, who described some really amazing in vivo and in vitro research, the reason for the effectiveness is not entirely clear.  That is, it’s not clear if the seizure activity is ameliorated by the presence of B-OHB (beta-hydroxyburyrate) or the stark reduction in glucose or the insulin, or some combination of these, or even something altogether different.

Of course, having too much insulin-like-growth factor is even worse.  There are numerous medical reports that describe the opposite “growth” scenario – too much IGF-1, for example, being associated with increased childhood malignancy.

Everyone wants to know if my (non-epileptic) daughter is on a ketogenic diet.  The answer is no.  If I had to guess, she probably gets 40% of total calories in the form of carbohydrates, and very few of them are sugar.  That said, she’s so used to seeing her daddy give himself “boo-boos” on his finger every day to check his ketone levels that I think she’s getting curious…but that will have to wait a long while.

Principle 4: Fat is fine

As much as you’ve heard me espouse the benefits of fat intake in adults, it’s equally or even more true in children.  As the Harvard anthropologist Daniel Lieberman points out, as we evolved from chimps to homo erectus about 1.5 million years ago, and to homo sapien about 200,000 years ago, we required an increase in our storage of body fat (from about 4-5% to 7-8% to 12-14%).  Why?  Most likely to support the requirements of our rapidly growing and developing brains.  At no point in our development is this more necessary than as children.

My daughter certainly consumes less fat than I do, but she still gets about 35-40% of her total caloric intake via fats – saturated, monounsaturated, and polyunsaturated.  Perhaps her favorite breakfast of all is bacon and eggs with cream cheese.  She likes to wrap a piece of cream cheese and scrambled eggs with a strip of bacon which she calls a “cooc-a-mooc.”  Don’t ask me how she thought of that, but she loves them.  She drinks whole milk (it’s always struck me as strange that the American College of Pediatrics recommends children switch from whole milk to skim milk abruptly at the age of 2), avocado by the truckload, and a wide variety of quality meats.

Principle 5: They are, after all, still children

My wife and I agreed a long time ago that we were not going to restrict our daughter’s eating when she was at birthday parties, on Easter egg hunts, out for Halloween, or on other “special” occasions.  A few weeks ago we took her to Disneyland for her 4th birthday.  (Anyone want to guess what it’s like for an ISTJ to spend 2 days at Disneyland?  Were it not for the look on her face, I’m not sure I could have survived.)  We decided, for these 2 days, she could eat whatever she wanted.  The day started with a bag of cotton candy larger than her head.  I couldn’t resist looking at the package to see that it contained 90 gm of sugar.  I did the quick math on converting that dose of sugar from her weight (35 pounds) to mine (165 pounds) and realized it was like me eating 450 gm of pure sugar in 20 minutes – the length of time it took her to inhale it!  That’s about 12 cans of soda.  She went on to have pretzles and cookies for lunch and, of course, a cake for dessert after dinner.

The entire time I was watching her mainline sugar – more in one day than I consume in a year – I couldn’t help but chuckle.  I sent pictures to my friends all day long.  In the end, she was pretty sick of all the junk she consumed and welcomed her usual meals. But, for a couple of days she ate just like most any other 4-year-old would on her birthday.

Principle 6: No two kids are the same

As you’re reading this keep in mind, this is an anecdotal account of my life and my child.  Yours will be different.  What works for our child may not work for your child or children.  Don’t worry about it!  In the end you’ll be the best judge of what the optimal zone is.  I really believe my daughter will live a healthier life because of the way she eats growing up.  One day, of course, she’ll have to make her own choices.  Will she completely rebel against everything we’ve tried to teach her?  Perhaps, but I don’t think so.  I really believe that kids are the product of the example set by their parents.

I used to always wonder where my tendencies came from.  Not surprisingly, much of who I am today is the result of the behaviors I observed in my parents.  It’s my belief that if my daughter grows up in an environment where an emphasis is placed on eating well, it will become a natural extension of her behavior, too.

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About the Author:

Peter Attia, M.D., is the co-founder and President of the Nutrition Science Initiative (NuSI), a non-profit based in San Diego, CA. He received his B.Sc. from Queen's University in Canada and his M.D. from Stanford Medical School in California. After his surgical residency in general surgery at Johns Hopkins he worked as a consultant at McKinsey & Company. He founded NuSI with scientific journalist Gary Taubes in 2012.

Discussion

  1. Ben Greenfield  August 23, 2012

    Ahem, I’ve got twins man. So principle 6 is a bit weird for me. ;)

    But great insight. When my 4 year old boys get back from Grandma’s, I just *try* to ignore the sugar stains on their teeth and food coloring on their lips…

    …but at home, the little beasts are already doing med ball slams and ladder sprints on the tennis court, eating liver for dinner and sardines for lunch. So the occasional cotton candy isn’t a big dent.

    (reply)
    • Peter Attia  August 23, 2012

      Ben, the only thing I worry about is that if you have twin 6-year-olds, does that mean in 4 years, they’ll be able to flip tires faster than me?

    • ChrisH  August 23, 2012

      Twins, eh?

      Ever tempted to use one as a control?

    • Jillm  August 23, 2012

      Delightful pics Peter. Thank you. I am the no sugar grandma trying to be a good example to three grandchildren. When they visit they are offered cheese, berries and sausage. I haven’t been able to encourage anyone to even look at a low carb lifestyle. A friend said yesterday they were planning to have fruit salad for dessert. I asked if she was going to put cream on top. Oh, NO!

    • Peter Attia  August 23, 2012

      As long as they whip the cream from scratch without sugar!

  2. Carlos C.  August 23, 2012

    What’s not to love about waiting 70 minutes in line for a 5 minute ride, overpriced food, crowds of sweaty, loud people, morbidly obese folks whizzing around you in motorized scooters, and that disc of torture in the sky beating on your back for a good 8 hours?

    (reply)
    • Peter Attia  August 23, 2012

      And…I got the TWO-DAY pass… As my wife said to me, “Peter, every time you want to kill yourself, just look at her face and see what she sees…” Sure enough, it worked.

  3. Tom Ramsey  August 23, 2012

    Mahalo for the personal stories! Because eating is so personal and the social environment challenging, the personal stories of “coping’ are a great boost to morale. Reading your blog helps greatly in keeping the main goal in mind. I was stuck at 180 pounds for a year (that was reduction from a horrible peak of 220+), and the self sabotage was usually in a social context. For example, I’d lose weight for 6 days and put it back on with one restaurant meal with friends. I’m now at 171 pounds after doing super-low-carb—the low-carb broke the stalemate.

    I seem to have elevated creatinine (23 or so, on some scale, with 3-20 as normal). I’m not alarmed about that. Due to a heavy travel schedule, I intend to follow up on it in about half a year. Perhaps due to heavy coffee drinking, I seem to get dehydrated more often.

    Mostly, I’m happy to have broken a yo-yo pattern that lasted about one year. Your web posts and Gary Taubes’s provide major moral support!

    (reply)
    • Peter Attia  August 23, 2012

      Tom, amazing story…thanks for sharing.

  4. Kumar  August 23, 2012

    Hi Peter,

    Great Blog. Very Informative.
    I’ve got twin boys. My wife and I follow almost all the Principles you’ve outlined.
    And yup, no 2 kids are the same, even if they’re twins.
    I’ve been following a low carb life-style (Paleo/Primal/Rosedale) for almost a year and half and
    lost about 20% of my weight, all of which were fat weight.
    I’ve always wondered should I go low carb with my kids but somehow stopped doing so, as I just didn’t feel right and there was no data saying it’s good for children.
    Thank you for explaining it.
    And I agree completely that kids observe what the parents do, in fact, my kids has been asking why I’m not eating rice (in this part of the world, it’s our staple food), and they were intending to follow but told them, that they needed the energy to grow!
    Keep up the great content.
    God Bless You And Yours!

    (reply)
    • Peter Attia  August 23, 2012

      Thanks so much, Kumar. I’d love to have parents chime in about what they find works for their kids.

  5. Anthony  August 23, 2012

    Hi Peter,
    Not much to say. 1 – I agree with you on all fronts. 2 – We are very similar to you in the way we treat our daughter when it comes to food. 3 – Your daughter is gorgeous. Beware of sugar fueled boys.

    (reply)
    • Peter Attia  August 23, 2012

      Oh boy…yes, I’m really worried about that. One problem at a time, I guess.

    • Vasco Névoa  September 11, 2012

      Peter, thanks so much for the candid exposure. This is the kind of story that touches people and makes connections between reality and scientific knowledge.

      “Beware of sugar-fueled boys”… ahahahaha!! Beautiful.
      Well if you teach her to strike and run, her keto-adapted body will be able to outrun any sugar-fuelled boy as long as she wishes. ;) This should take care of most kinds of assault (god forbid it from happening, but you never know).

      As to the influence of bad companies, I would place my faith in the good role model examples. After she’s experienced the truth, all else will pale in comparison.

      I’ve got a 6-and-a-half year old princess who loves to run and jump, and a 2-and-a-half year old thug who can already lift more than his weight with ease. I predict that my strength training and jujitsu practices may very well one day prove necessary when he gets to be a teenager and we “strongly disagree” about something… I’ll have to keep fit well past my fifties.
      So again, the role modelling is always absolutely required from birth, to avoid any fundamental conflict as much as possible. But differences will always emerge, I guess. Knowing that someday we have to cut them loose on the world and that this has always been true in the history of mankind doesn’t make it any easier. Oh, the anxiety. Breathe in, breathe out, count to one hundred. And by all means yes, look at their faces and see the world from their eyes. This can actually change the way YOU look at the world. Having kids… what a ride.

      But about the kids’ diet… I’ve been worrying about that for a long time, especially since my in-laws are a sugar and wheat fuelled bunch, suffering from all the classic problems of a SAD diet with “healthywholegrains” and such. And since my kids spend time with them every day, this can be a real problem. It’s taken a whole year and a half for the message to start sinking in, with me being seen as a total nutcase with a death wish who eats way too much fat and demands that the amount of trashy candy and liquid yoghurt the kids get is absolutely controlled. I let them have the occasional fries or white rice (they LOVE sushi), the infrequent bowl of pasta, and the very rare pizza, at least while I don’t see any signs of obesity or auto-immune attacks. And one or two squares of dark chocolate (>=70%) a day, as a treat after dinner. Slowly the kids are coming about. But the grandparents…

      The turning point came a few days ago, when someone I never even met came to my blog to thank me for having turned their life around (I write in Portuguese, translating the highlights and summarising and pointing back to the Paleo-leaders’ pages). When my inlaws heard the thank you message of someone who got rid of a bunch of auto-immune problems and undesired weight by dropping wheat after my advice, they finally started to think I was on to something. It was a hell of a year, constantly arguing about what is “healthy” for kids and what is not and why, trying to dispel all the food misconceptions our culture has and the general ignorance we all have, with them frequently sneaking behind my back to smuggle the kids some more candy and junk food.

      But finally, after much perseverance, we are starting to align. I can now relax and leave them all alone, trusting the grandparents to not go overboard with chocolate milk and flavoured liquid yoghurt. I hope. :) It is far easier to naturally interest my kids on the “weird” breakfasts me and my wife have every morning than it is to convince the adults that the problem is the sugar and cereal, NOT the fat. They enjoy eggs and cheese and bacon and are growing to like the salads too. Detoxification is a slow process, but it works. We just need to have faith and persevere.

      I sometimes stand in awe of how robust the human body is; my kids were both fed some crappy supplement formula in the very first day of their life, without us even being consulted. It’s just something that is done around here (were this the USA, and we’d been very busy throwing lawsuits around, but it’s not, so we just deal with it.) Adding this to the fact that both were born of C-section and the constipation and bloating problems both went through was to be predicted – had we known at that time what we know now. Live and learn…

      But sure, parties are parties, so go ahead and go wild on the sugar stuff. And in the end, they observe by themselves how sugar binging makes them feel bad, and start controlling it by themselves. At least the 6-year-old is doing fine; she starts primary school this week and she’s been asking for “real food” items more and more by herself, often even shunning the savoury junk food right in front of her. When the body isn’t drowned in garbage, it asks for the nutrition it needs. I hope she carries on even after she starts hanging out in the junk food cathedrals with the other kids.

      Sorry for the once more enormous comment, but that’s how real life is: complicated.

      Cheers Peter et alia.

    • Peter Attia  September 11, 2012

      Thanks for the kind words, Vasco. Sounds like you’ve given this a lot of thought, also. I’m still in denial that my little princess will one day grow up…

  6. TheFatNurse  August 23, 2012

    Dr. Attia I think most of your principles are spot on and can simply be described as “eat real food.” By the way, even tho your daughter has roughly a 40% carbohydrate diet, that would probably still be considered a low carb diet compared to what a majority of the country eats!

    (reply)
    • Peter Attia  August 23, 2012

      Oh, absolutely. I just wanted to clarify that she was not a VERY low carb diet or a ketogenic diet like her daddy.

  7. Melanie  August 23, 2012

    Very helpful information. Thanks, Peter. And your daughter is beautiful!!

    (reply)
    • Peter Attia  August 23, 2012

      Thanks so much. Takes after her mother.

  8. Trisha Gilkerson  August 23, 2012

    Very informative post and particularly interesting since I have four young boys. We have this far taken a similar approach: cut out wheat, most grains, sugar, and processed food while at home, but the boys get these things when with other family and friends. I’ve been unsure about how hard of a line to draw particularly with the wheat since we have several family members on my moms side with celiac disease. Thank you again for sharing how you handle food with your family!

    On another note, your daughter is absolutely adorable! Love the pictures :)

    (reply)
    • Peter Attia  August 23, 2012

      Thanks so much, Trisha.

    • Colleen  August 23, 2012

      Trish: We started our low carb (now more paleo plus dairy) journey in January. I have a 3 yo. In March, when my sister visited with family we all enjoyed a waffle breakfast (waffle, peanut butter with sugar and syrup). During her visit the last 2 weeks, we ate eggs every morning and her family pancakes/sugar peanut butter/syrup. I wouldn’t let my daughter eat the other grain based snacks/crap her cousins were eating. We did plan some treats (went to the ice cream shop one night). It was not an easy decision but I decided that I did not want my daughter to think it is okay to eat crap whenever we see family. In May we cut out grains and my daughter immediately looked different in her chest area (thinner) even though she was back to whole milk (was great for mommy too). It is a subject I had been worrying about b/c her 12 yo cousin is overweight and 10 yo cousin on the way.

  9. David Nelsen  August 23, 2012

    I have 3 children who still live at home and it can be a struggle at times to get them to eat in a somewhat healthy manner. They still drink whole milk and we don’t keep juice in the house. My daughter’s do have a sweet tooth and do eat more carbs than I would like. None are overweight and are taller than average. I make real food and they eat it, but I wouldn’t say their nutrition is optimal. As time progresses I do think things are improving however. Do you recommend a ketogenic diet for a child that is obese? My daughter has a friend who is severely overweight and I often wonder if this would help her.

    (reply)
    • Peter Attia  August 24, 2012

      I’m not sure it’s necessary. I think getting all (and I mean all) sugar out of their diet automatically takes them to about 40% carbs.

  10. Jennifer  August 23, 2012

    What a great post! I always wonder what’s optimal for kids and I’m glad to see it addressed here. Because my daughter, who is about to turn 3, eats very well in general (I mean, she loves healthy food) I tend to give her what she asks for, and to assume she actually needs the carbohydrates. For instance, yesterday she ate 2 bananas with her breakfast, after eating 2 pieces of bacon, a bunch of raspberries, and some plain yogurt. Assuming she needs the concentrated carbohydrates I also let her eat crackers when she asks for them, though I do start to feel guilty when I read stuff about the evil properties of wheat. Her dad has a lot of doubts about the primal /paleo/ low-carb stuff so he occasionally asks me to make sure she’s not being forced to eat like I eat. She has always been very tall for her age and her weight has always been at a lower percentile than her height. At her 1 year check-up her height put her at the 98th %ile and her weight was at the 78th, and the pediatrician told me to switch her to skim milk (at age 1!) to reduce her risk of childhood obesity. Since the recommendation about full-fat until age 2 is to support brain development I didn’t think it made sense to switch early because of her height (presumably brain development isn’t accelerated just because a kid is taller than her peers), but because of everything I’ve read since then I have no intention of ever giving her skim milk. When she was first starting solid foods I wanted her to have healthy stuff and not that disgusting baby cereal, so her first foods were hard-boiled egg yolk mashed and mixed with water, mashed avocado, mashed banana, salmon, saag paneer and barbecued ribs She also liked to gnaw on big pieces of raw vegetables like red pepper. People around me were so sure she needed cereal that I started to doubt myself and got her some baby cereal, and she was so disgusted! She hated it and spit out the first bite and cried when she saw the box. I was proud of her. We also started giving her real food at 4 months even though the pediatrician said to wait until 6 months, because she was very interested and clearly wanted food. Ribs remain her favorite.

    Thank you, Peter, for the fascinating post! I was glad to read that you let your daughter eat what she wants at birthday parties, etc., too–sometimes I feel guilty about that, but if we were to restrict her choices it seems like that might lead to sugar acquiring the lure of the forbidden and maybe make it more likely that she will choose to eat unhealthy foods when she grows up.

    One thing I am concerned about for the future is nutrition is school. In our area, kids in elementary schools have cupcakes or candy during class time once or twice a week.

    (reply)
    • Peter Attia  August 24, 2012

      Jennifer, I share your concern on that front, also. Hopefully the parents with school kids can chime in about their strategies and successes.

  11. Christine Lilge  August 23, 2012

    Great post! As I travel on this nutritional journey myself, it is nice to hear how one differentiates the lifestyle for the growing needs of a child. Reduce sugar – good for everyone. Fat is fine-very cool. Real food -fantastic. Luckily my son had years of breastfeeding (whole milk of course) and then whole cows milk later till three. But after he turned three years, the Canadian nutritional authorities still had me brainwashed into the “low fat milk” mindset so I still feel regretful about ages 4-6 feeding him partly skimmed milk. All is good now with whole milk for him at age 7 but you can only do as good as what you know at the time I guess. I look forward to NuSI helping to fill in the informational gaps that have steered us so far off course.

    (reply)
  12. Erik  August 23, 2012

    Another excellent article.

    Child nutrition is a complex subject. I thought one of the better segments of HBO’s Weight of the Nation was the part about food marketing to children, though I think with a paradigm shift regarding what food are optimal, that this situation could be better.

    Tom Naughton had a very amusing post, thanking the USDA Guidelines Committee (and its food recommendations) for allowing his daughters to have an advantage.

    http://www.fathead-movie.com/index.php/2011/02/03/my-thanks-to-the-dietary-guidelines-committee/

    (reply)
    • Peter Attia  August 23, 2012

      Thanks for sharking link, Erik.

    • Erik  August 24, 2012

      Great interview on with Andreas on dietdoctor.com. It was very well-presented. Looking forward to the promised part 2.

    • Peter Attia  August 24, 2012

      Thanks, Erik. Part II should up when we launch NuSI in September.

  13. Zak Hendsch  August 23, 2012

    A great column and a nice perspective. A lot of my motivation for studying up on nutrition was to figure out where it’s most important to try to modify my kids diet (i.e. which battles are worth fighting).

    “No two kids are the same” and “I really believe that kids are the product of the example set by their parents” is tricky. After my first son was born, I believed both statements were true. Then my second son arrived. Very similar physically and raised in a similar environment but it’s hard to imagine kids who were more different in personality and behavior. The oldest will reliably follow my example and the youngest will reliably rebel against it.

    (reply)
    • Peter Attia  August 23, 2012

      I hear you… I know many folks who say the same thing. I’ll say this, he’s not yet grown. It will be interesting to see what your second does when he’s 30, and how much of that was grounded in what he’s observing now. Of course, I know little about this, so it would be wrong.

  14. mister worms  August 23, 2012

    I have a 3 year old and we do things much like you describe. After a run-in with pretty serious tooth decay on SHAD (the Standard ‘Healthy’ American Diet) at just over 1 year(!) we cut out all sugar and grains and limited fruit. We were able to forgo insanely expensive conventional treatment, not to mention the risks of GA, and the teeth are healthy as they can be today. And what do you know, my own lifelong problem with tooth decay also came to a halt. Outside of celebrations and some weekends with the grandparents, I’m strict about avoiding any sugary or flour-y food items.

    On the kid front, the biggest obstacle I’m running into is how relentless the stream of nutritionally lacking garbage is outside of our home. Once play group, play dates and now pre-K is in the picture, it seems like the only thing that parents and caregivers feed their kids is some variation on crackers or cake/muffin paired with fruit and juice for a beverage. I am SO relieved when snack time involves cheese or vegetables & hummus… but those days are rare. When it was our turn to bring in snacks I got whole milk and it was welcomed with surprise, like, oh we hadn’t thought of that!

    (reply)
  15. zack  August 23, 2012

    I have a 2.5 year old and I have been waiting for a post like this in the ancestral health community. Thank you for it.

    I am trying to keep him eating a paleo diet with some push back from my wife. I guess he’s pretty much there but eats a banana or apple every day which is higher sugar then other fruits, but it is dessert. Otherwise, it’s pretty much the same set up as your daughter except for a little orange juice mixed with water in the morning.

    (reply)
  16. Violeta  August 23, 2012

    Great post – thank you! I particularly like # 1 and # 2.

    My son is 16, 6’2” and “pure muscle”, and I can’t possibly force him to eat this way or that way. However, I don’t serve sugary/processed foods at home. And my son is fine with that.

    So, I control what I can, namely the food I serve at home, and I am sure that in that way I am helping my son make smarter food choices when he is eating out.

    When it comes to nutrition – and all other important things in life, I believe, parents are the key role models for their children.

    (reply)
  17. Amber  August 23, 2012

    I don’t draw the same conclusions. In particular, I disagree with that a ketogenic diet (KD) is likely to interfere with growth.

    I think the main problem with the argument is conflating calorie restriction or protein restriction effects with KD effects. The former two are detrimental to muscle and growth, but that doesn’t imply the latter is.

    First there is the fact that KDs spare lean mass. This means that there is some mechanism that protects KD dieters from losing muscle in the manner expected with calorie restriction, even when calories are restricted. This study has interesting measurements: Effects of Dietary Carbohydrate Restriction with High Protein Intake on Protein Metabolism and the Somatotropic Axis — http://jcem.endojournals.org/content/90/9/5175.full

    It says:

    “Results: Leucine Ra was increased (P = 0.03) after 2 and 7 d of LC/HP, and muscle fractional synthetic rate was approximately 2-fold higher (P < 0.01) after 7 d of LC/HP. Fat free mass was not altered by LC/HP. Average 24-h plasma insulin concentration was 50% lower (P 90% improvement (p = 0.004).”

    Another reason to be suspicious of claims that a KD impairs growth is that infants, who are growing tremendously, are naturally in ketosis most of the time. Relatedly, this study with infants on KDs –Experience With the Ketogenic Diet in Infants–http://www.pediatricsdigest.mobi/content/108/1/129.short reports that “96.4% maintained appropriate growth parameters”

    Finally, if KDs adversely affected growth, why would traditional Masai be some of the tallest people in the world?

    My take is that so long as protein and calories are adequate, we should not expect to find growth impairment on a KD.

    (reply)
    • Amber  August 23, 2012

      Here’s a rat study that shows this effect, though I can’t judge it very thoroughly without seeing the full text:

      Extreme ketogenic, but not moderate, low-carbohydrate/high fat diets lead to loss of lean body mass in rats due to impairments of the GH/IGF system — http://www.endocrine-abstracts.org/ea/0026/ea0026p129.htm

      “In conclusion, our data suggest that loss of LBM with LC–HF-1 was prevented by the rise in pituitary GH secretion, which might be triggered by low liver-derived IGF1 concentrations. With LC–HF-1, higher GH secretion resulted in increased muscle IGF1 activation of associated signalling pathways. In contrast, rats fed the ketogenic LC–HF-2 diet showed unchanged muscle IGF1 expression and loss of LBM, probably due to lower systemic IGF1 levels and normal pituitary GH output.”

      The difference in the diets, as far as I can tell from the abstract, was low protein in diet 1, and adequate protein in diet 2.

    • Peter Attia  August 24, 2012

      Of course the challenge here is that extrapolating from rats to humans is very difficult, especially with dietary intervention.

    • Amber  August 23, 2012

      Hmm. I mis-copied the quote from Effects of Dietary Carbohydrate Restriction with High Protein Intake on Protein Metabolism and the Somatotropic Axis. The part I meant to draw attention to was this:

      “Leucine Ra was increased (P = 0.03) after 2 and 7 d of LC/HP, and muscle fractional synthetic rate was approximately 2-fold higher (P < 0.01) after 7 d of LC/HP. Fat free mass was not altered by LC/HP. Average 24-h plasma insulin concentration was 50% lower (P < 0.001) after 2 and 7 d of LC/HP, whereas GH secretion and total plasma IGF-I concentrations were unchanged with LC/HP. However, plasma free IGF-I decreased by approximately 30% after 7 d of LC/HP (P = 0.002), whereas muscle IGF-I mRNA increased about 2-fold (P = 0.05). "

      That is, even though blood IGF-I decreased, muscle IGF-I mRNA increased. So, like you said, it's highly complex.

    • Peter Attia  August 24, 2012

      Very fair point, Amber. As I said, this is a very complex topic, and it’s possible, as you suggest, that the huge confounding variable is hypocaloric intake and/or insufficient protein and/or some other factor. For example, we know that most of the kids on KD for epilepsy use a largely liquid diet. Perhaps this is different than a KD from solid food? My point, however, is that I don’t think a KD is necessary in (most?) kids because most are still “clean metabolic slates.”

  18. Megan  August 23, 2012

    We have a few rules in our house: no fizzy drinks (except lemonade on special occasions); no biscuits, cakes, snacks or sweets kept in the house; a choice of sweets once a week after school, everything is made from scratch and always a dessert.

    the last rule is put in place by my husband as he cannot survive without a dessert. However we try to choose carefully and offer full fat ice cream or yoghurts. of course they contain sugar and I refuse to eat them – but I am not a child and I was the one with a weight problem.

    My kids are now getting to an age where they can make their own choices when outside the house. I can’t do anything about that – but I hope they have a good basis to base the choices on. They even complain that restaurant food isn’t as good as it is at home as it is often mass produced. Fast food is not something they would choose.

    My daughter also likes oats for breakfast with some dried fruit – but she likes apple juice on it….compared to cheerios, I think we are doing OK…

    Just educate them and offer good wholesome homemade food. the rest should take care of itself.

    (reply)
  19. Andrew  August 23, 2012

    Peter – I think you might’ve left an editing comment about cheerios in your post.

    I think your approach (specifically the focus on avoiding added sugars as much as possible) makes a world of sense for a child. Relatedly, when it comes to chatting with friends and peers about nutrition — especially when I’m forced to decline a sweet of some kind — my approach is to simply say that I’m watching my sugar intake. This seems to be about the only nutritional intervention for which there is nearly unanimous agreement, even if it is routinely undermined by fat-phobia.

    (reply)
    • Peter Attia  August 24, 2012

      Thanks Andrew. Good catch. Man I’m rushing around like crazy right now…

  20. Pete Spitellie  August 23, 2012

    Peter, your timing on this post is perfect. I’m about 8 weeks into my new eating life thanks to you. I’m 6′ 1″ and weigh 200lbs. When I began limiting carbs I weighed in at 240. When I found your blog, I was 220. Looking forward to getting below 190lbs. Having three kids, 4yo twin daughters and a 8yo son, I’ve started to wonder hmmmmmmm at what point should I consider tweeking their diets. Our son has started asking ” why am I pudgier than my friends”(poor little guy has inherited his daddy’s genes). We’re already pretty careful what they eat and are lucky they all like healthy food(except the smallest of the three, she loves her salad and fish, but would live on bread and rice and chocolate if we let her).

    When you say: “I really believe that kids are the product of the example set by their parents” I agree with you, but I think the whole “nature vs nuture” is, like most things a continuum. Fraternal twins are amazing to watch in this regard. Our daughters couldn’t have come out of the womb any more different; one is much bigger and “softer”, really uncoordinated and wakes at 05:00 everyday. The other could sleep forever, is tiny for her age, very thin, loves carbs and is the most coordinated member of the family. As far as temperments go, whew, from different planets.

    Lastly, the comedian Jim Gaffigan has a great bit about kids and going to Disney in his latest show(on netflix streaming).

    Thanks Peter, I’m on my way to being “former fit but fat”

    Pete

    (reply)
    • Peter Attia  August 24, 2012

      Oh, boy, don’t bet me started on Jim Gaffigan…have you seen his bit on Hot Pockets? I’ve watched it 30 times and I laugh out loud every time.

  21. Travis Koger  August 23, 2012

    Our three kids are all pretty low carb. They eat vegetables with the dinner and sometimes at lunch. Their breakfast is nearly always a bacon and egg frittata that might include feta or mushrooms. Sugar is an absolute no go in our house, but they will occasionally enjoy a sugar free sweet (Xylitol) or some carb free baking that may have Xylitol in it also.

    Generally they are becoming anti-sugar zealots like myself and my wife, but occasionally instinctively (or peered into it) reach for something with sugar in it without thinking about it. On the whole though they understand to avoid carbs and will instead grab some cheese or ham etc. They are doing pretty well at it though and it makes me very proud when I hear them tell some other kids or teacher etc that they don’t want something because it contains carbs or sugar.

    We have noticed a huge difference in them since we cut out the carbs, particularly in my son who was suffering from very low energy, anaemia, tiredness and bad mood swings. These are a distant memory now and we are convinced that getting rid of sugar and most carbs has been the key to it. They have great appetites and never shy away from eating the good foods.

    The main difference with how we bring them up and what you have written here Peter is that we do restrict foods when they are out and about…. where we have some level of control. If they are at parties etc, then they are more than likely to reject the standard kids party foods and we will either feed them up on the good stuff before they leave or take along food for them to eat. The inevitable candy bag that is handed out at the end of the party, they will end up throwing the rubbishy sweets into the bin when they get home and we will give them a sugar-free sweet in return. This is something they are now doing on their own also and there is no ‘expectation’ from them that they will be getting a swapped sweet.

    Most of our friends and family are fully aware of the special diet that the kids are on and will make a point of checking with us the types of food they can have. In the event where we do not have control over what they consume, we do not get angry/upset with the kids over it so that we do not make out like it is something they have done wrong… although I get pretty grumpy on my own time. :)

    Thanks for another insightful article Peter. Always good to see a new one come through and love the pics.

    (reply)
    • Peter Attia  August 24, 2012

      Thanks for piling on the good info. I think it’s awesome that other parents (most with far more experience than me) are sharing their stories, too. THANK YOU!

  22. Maryann  August 23, 2012

    She’s adorable, Peter! I think she looks like you with long hair. Hey, which of your parents flipped tires?

    Your approach makes perfect sense, and I love the fact that you and your wife let her have treats on special occasions. I don’t have kids…so I’m still staring at the scrambled egg and cream cheese sentence… I wonder what will happen when she goes to school. Do you remeber hearing how a child had the lunch her mother packed confiscated by the government inspector at school because it didn’t meet government nutrition standards? Wait til they see her lunchbox :)

    (reply)
    • Peter Attia  August 24, 2012

      She just got a bento box for school (pre-K), which starts next week. Should be hilarious. She’s already telling us what she wants in each section. In all seriousness I will need to update this post every year or so, based on our experience with her travels through the system. When I was in med school my sister was in grade school (we’re 13 years apart). I used to a heart dissection for her science class once a year. I have a feeling for my daughter they won’t be asking me to come in for a nutrition lecture…

    • Jacob  August 27, 2012

      Scrambled eggs and cream cheese isn’t just for kids, though! Beat the eggs with a respectable amount of heavy cream, pour them into a heated pan (heated with salt, butter, and olive oil). Then flatten some cream cheese and stick it on top. As you toss the eggs, the cream cheese gets really soft. The whole thing turns out fluffy and delicious. No toast required.

      This is especially good with tomatoes, hot peppers. or scallions (the signature breakfast at a joint down the street from me is the “SCC” Scallion-Cream Cheese scramble–and it’s not on the kids’ menu!).

      I’m 30, and I may just fix myself a cooc-a-mooc tomorrow morning.

  23. Adam  August 23, 2012

    Great article, Peter.

    While my wife and I don’t have any kids (thank god), my two nieces and nephews via my older sister are almost surrogate children. Unfortunately, I am watching my brother-in-law force his SAD and anti-fat, calories in-calories out beliefs on them. The oldest, 10, already has a weight problem that is beginning to stress her out. He continues to blame it on calories and fat, which makes the situation worse. When the boy, 8, comes to our house and has breakfast, he nearly assaults my wife and I for bacon. He looks like a crack-addict fiending for a fix… when he is really just an emaciated kid whose brain is literally STARVING for saturated fat and cholesterol. I brought this up to my sister who told me, “yea, he never gets bacon at home”. ‘You know who’ won’t allow it. instead it’s more fiber-packed cereals, skim milk, fruit, and oatmeal.

    to me this is borderline child abuse! i would love nothing more than to tell my brother-in-law that what he is doing (albeit out of love and desire to do what’s right) is having the opposite effect and hurting them in many different ways. Unfortunately, cognitive dissonance is a b*tch and he shuts down as soon as I bring up how good Gary Taubes WWGF book, Eating Academy, Paleo, Primal, or anything that tells him “what to do”. Even though he has watched me lose 25lbs over the course of a year blending grass-fed butter into my coffee, and happily devouring any lovely fat off the steak he meticulously cuts off. btw – his visceral pot belly continues to grow and i’d love to see his lipid profile!

    anyway, it’s more of a tough social/relationship question than anything else. food is such a personal topic to so many people. personal diet decisions are obviously personal, but when it comes to controlling what one’s kids eat, there’s a lot of room for mixed emotion and conflict.

    (reply)
    • Peter Attia  August 24, 2012

      Adam, is there any way you can get your brother-in-law to think about the issues for himself, first? Then, perhaps, for his kids?

  24. Charlotte  August 23, 2012

    Hi Peter

    Have you viewed the Recent BBC doc on you tube – Eat, Fast, live longer. It goes into depth about the effects of protein in IGF 1 and fasting as an antidote. It seems to suggest that reducing protein helps. Fasting also. Does ketones and higher fat counteract the effects of protein on IGF1 in your opinion?

    (reply)
    • Peter Attia  August 24, 2012

      Have not seen it, but it sounds like I should.

  25. Denise  August 23, 2012

    Dr. Attia,
    Thank you so much for this post (as well as your series on cholesterol). This year my husband and I have been transitioning our family (us and a three year old daughter) to a paleo/primal type of diet, with much success (my cholesterol numbers are greatly improved!). We have been questioning if it makes sense to restrict our daughter’s carbohydrate intake, and this article will be very helpful in our discussions. Like you, we restrict bread, sweets, and juice, but allow virtually unlimited fruit, vegetables, meat, and whole-fat dairy. Our daughter’s favorite meal right now is plain Greek yogurt with blueberries and a touch of honey.

    One challenge we face is from our caregivers, who ply her with doughnuts, fast food, and juice. At least she knows that when she’s home, she isn’t able to get that type of food from Mommy or Daddy!

    (reply)
    • Peter Attia  August 24, 2012

      Any chance you can ask said caregivers to play by your rules, instead?

    • Denise  August 28, 2012

      Ah, ha, we have asked for them to play by our rules, but its difficult when the biggest rule-breaker is Grandmom (her house is filled with junk foods)!

      My husband and I have decided to apply the 80/20 rule when it comes to this aspect of our daughter’s upbringing. As another poster has said, we believe that childrearing is about helping kids make good choices. We are heartened by the fact that she usually chooses spinach and broccoli over ice cream and cake (much to Grandmom’s shock), and that the teachers at her school always compliment us on how well she eats!

    • Peter Attia  August 28, 2012

      80/20 rules are a great way to be efficient.

  26. Avner Taieb  August 23, 2012

    H? Peter,
    My two cents for NuSi: If you refer to the rest of the world (non LCHF diets), institutions and regular people as kids. You can implement your smart principles on them. It will be easier to make a change this way; the first principle for instance is a consensus for the majority of diets, low carb and low fat types. By starting with it, it is possible to gain immediate success, and getting the leg in the door.

    (reply)
    • Peter Attia  August 24, 2012

      NuSI is actually about something much different that advancing any particular diet…it’s about getting the science right before anything else.

  27. Zooko Wilcox-O'Hearn  August 23, 2012

    Hello Peter Attia. Thank you for your posts and videos! I really appreciate the copious, factual, and clearly expressed information.

    The fact that epileptic kids who are treated with a ketogenic diet suffer stunted growth should really not make you worry about any keto diet your daughter might do in the future. The diet that those epileptic kids get is radically different from any diet that you would ever consider giving your daughter, starting with the fact that it is a semi-starvation diet!

    Almost all of the kids who are put on a ketogenic diet for epilepsy are also put on calorie restriction and protein restriction. The standard practice was (and is) to figure out what the child’s calorie needs are, by some combination of keeping a food diary before beginning the diet and using the USRDA of calories for that child’s height and weight, and then giving them only 75% of the calories they need! Similarly the child is deliberately supplied the child with only a bare minimum of protein (starting at 1 g/kg/day).

    See for example ¹, which mentions this as being standard practice. (They also often practice *water* restriction!)

    I’ve not yet found any research that even *attempts* to tease apart the impact of this calorie and protein restriction from the effects on IGF-1, insulin, ketosis, or other effects. If you have, please share. Citation ¹ looks at a correlation between stuntedness, reduced IGF-1, and ketonemia. My brilliant wife Amber pointed out to me that if the stuntedness is caused by protein deficiency, and if protein intake correlates inversely with ketonemia, then that might explain some of the observed correlation.

    [Please mentally insert here an outraged rant about how unhealthy and how unjustified this semi-starvation is and about the fact that experimentation with full-calorie alternatives (Modified Atkins Diet for epilepsy) has begun only in the last few years, e.g. ².]

    (By the way, the kids who suffer stunted growth while on the anti-epilepsy diet and then later go off of the diet experience catch-up growth and end up, on average, no shorter than their peers who didn’t do the diet.)

    Also, keep in mind that a standard component of a keto diet is KetoCal™. Check out the ingredients (from ³):

    “Water, Refined Vegetable Oil (High Oleic Sunflower, Soya, Palm Oil), Sodium Caseinate (Milk), Whey Protein Concentrate (Milk), Soy Fiber, Resistant Corn Starch, …”

    Those are probably unlike the ingredients your daughter would eat.

    Finally, the components of the typical epilepsy diet which are *not* KetoCal™ are still often things you wouldn’t put on your menu at home. Not the meat-oriented, natural approach that you and I would naturally imagine. I don’t have Kossoff’s “How To” book on keto for epilepsy at hand, but the “Suggested Menus” section of that book was kind of eye-opening. It looked like they tried to pack in as much sugar and artificial sweetener as they could within the macronutrient limits, presumably to increase compliance.

    In sum: of course it is possible that a healthy, full-fat, full-calorie, meaty keto diet would stunt the growth of a child, but the evidence from the epileptic kids can’t be used to prove it. Anyway, I kind of doubt that it would be a real problem. Our keto baby is 2 years, 10 months, he’s eaten very little carbohydrate in his life so far, and he’s built like a bull — a cute little fat, strong bull baby. I think he weighs about 40 lbs.

    Regards,

    Zooko

    ¹ Spulber-2009-“Growth dependence on insulin-like growth factor-1 during the ketogenic diet”
    http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.01769.x/pdf

    ² Porta-2009-“Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet”
    http://download.journals.elsevierhealth.com/pdfs/journals/1059-1311/PIIS1059131109000053.pdf

    ³ http://www.myketocal.com/product.html

    (reply)
    • Peter Attia  August 24, 2012

      Yes, great points Zooko. I sort of responded to this effect to a previous question, but you’ve done so much more eloquently. Thank you!

  28. Kim_S  August 23, 2012

    Great information, perfect for me – particularly Principle 3. I have been VLC for 8 months, down 20 lbs — and more importantly, feeling better than I have felt in years. Your website has been a great source of information and inspiration to me. My 12yo daughter is being treated with growth hormone for her short stature. We have had success with the GH treatment — so all her pediatric endocrinologist can worry about is that her BMI is too high (25.8). We have made changes to her diet this summer, no sugar (except for special occasions) and she has adopted many of my eating habits (she prefers the food I eat, she is a protein lover). Unlike her mother, though, she will still eat small portions of pasta, rice, and potatoes at dinner. I am always tempted to restrict those carbs further to see if we can get her BMI down, but this post is a great reminder that although she looks like a mini-me, she is not. She needs some carbs in her life. Thanks Peter.

    (reply)
    • Peter Attia  August 24, 2012

      Nice way of putting it! Fortunately, my daughter doesn’t look like a mini-me!

  29. lockard  August 23, 2012

    We have a 9 yr old boy and a soon to be 8 yr old boy – the 9 yr old does not handle grain well at all – so we keep him on a grain free diet and he gets his carbs from veggies and fruit – our younger son eats grain free at home but for lunch at school he gets the junk food they slop (pancake on a stick with a side of corn some fruit soaked in HFCS and a cookie becuz its america and heaven forbid we dont give the kids a dessert. ) I really want to start sending his lunch like his brother- i try to keep myself (T1 diabetic) in ketosis

    (reply)
  30. Holly  August 23, 2012

    Thank you! Thank you! Thank you for this awesome post. My husband and I love your blog (along with Gary Taubes’ books and Dr. Andreas Eenfeldt’s blog.) We have a 10 month old daughter and it has been difficult to find information about how we should feed her. It is especially hard when all you get from the pediatrician is to fill her full of rice cereal and other Moms trying to convince me she needs teething cookies (biscuits), lots of whole grains and goldfish. Instead she gets an egg yolk and yogurt (full fat) smoothie with strawberries and blueberries and a bit of banana for breakfast and meat or fish source with a bit of fruit and veggies (with grass-fed butter) for lunch and dinner. And she is still breast-fed. Your post makes me feel better about how we are feeding her and I really appreciate you sharing. Thanks for doing what you do and good luck with NuSI!! I cannot wait to see what information you guys come up with over the years to come!

    (reply)
    • Peter Attia  August 24, 2012

      Holly, so glad you found it helpful. By the way (and completely unrelated) I did an interview with Andreas in Boston last week and I think he posted it today.

    • Holly  August 24, 2012

      Yes! I saw that earlier today and was very excited to watch it. Great Interview Dr. Attia!! As a triathlete and marathon runner I am very curious to see how my winter marathon season goes with this new diet so I loved what you had to say about that. I also saw the guy who won the Western States 100 earlier this year is low-carb. He beat the record by like 21 minutes. All very exciting and interesting stuff. 24 hours and a 6 hour bike ride on water and sodium…impressive!! My goal is to do a marathon on the same in December so you have piqued my interest on the self-experimentation. Thank you!!

  31. steve  August 23, 2012

    very nice post! The years of peer pressure are yet to come, as well as the dreaded Freshman 15lb. At least you wiil have provided her with the tools to make her own decisions as she gets older- that is what parenting is suppose to be about, not control.

    (reply)
    • Peter Attia  August 23, 2012

      I guess it’s the best I can do for now.

  32. George Henderson  August 23, 2012

    We don’t keep wheat from our kids, though I’d like to, but I can limit the amount they eat by always preparing potatoes for meals (they’ve stopped asking for pasta), cooking bacon or black pudding for breakfast, and making dinners rich enough (stroganoff, lamb chops) that they’re not hungry afterwards. Any desert, rarely needed, is based around fruit and cream. But usually they are happy with a whole-milk cocoa. Water, milk, no juice in the fridge. Cheese and fruit always available for snacks as well as bread/toast and spreads, which are not usually big movers. In fact, not a lot of snacking goes on, and they often skip breakfast or lunch. No more than one spoonful of sugar per hot drink and only two of those a day.
    So when family or holidays do dump rubbish on us, its effect is soon shaken off. I might get some multivitamins or kids probiotics at these times, but not usually. I recognise all the principles you have set out here as sound and sustainable. Since feeding them a higher-fat diet (and cooking with dripping and butter rather than oil) we see far fewer colds and allergies.
    You might like this book: I know I did. It’s a very funny, very British take on Taubes, WAP, low-carb and Paleo.
    http://www.dailymail.co.uk/femail/article-2105132/Damn-low-fat-diet-How-reformed-vegan-John-Nicholson-gorges-foods-granny-enjoyed–felt-better.html

    (reply)
    • Peter Attia  August 24, 2012

      Thanks very much for sharing, George.

  33. Pierre  August 23, 2012

    Thanks again for the post Peter! Daughter is beautiful! Boys will be the death of me, I have 2 daughters! The 15 year old is going to her first high-school football game.

    For adults moderating IGF-1 is a good idea?

    (reply)
    • Peter Attia  August 23, 2012

      I don’t think so, Pierre.

  34. Jeff Hay  August 24, 2012

    Peter,
    Awesome post; I follow each & every one and this is my favorite. I am an ISTJ and agree completely (which explains why we haven’t been to Disney yet with our 11, 9, 7 y/o). Our trip this summer was to Wash D.C.
    We allow some of the “bad” food options in our home; however our kids are very aware of carbs/sugar and will often ask if a choice is good or bad… We give plenty of room for kids to make the easy choice and do our best to keep healthy options readily available (veggie platter for after school snacking). One of my proudest moments was listening to my son tell his friends that our pantry only had “healthy food”.

    Another thank you! I just read this blog with my 11 year old and it sparked a good conversation. Keep sharing your experience; it’s making a difference!

    Jeff

    (reply)
    • Peter Attia  August 24, 2012

      Jeff, thanks so much and thanks for the great pics of your family. That’s a beautiful family you have.

  35. Shirley Chirch  August 24, 2012

    We are having a “weight of the state ” obesity conference in Virginia in the spring. I sure would like to submit you or Gary’s name as speakers.
    What say you?
    Yoda

    (reply)
    • Peter Attia  August 24, 2012

      Shirley, I can’t speak for Gary, but please contact us (separately) via our contact forms.

  36. Mom  August 24, 2012

    I’m posting under a different ID than usual, to protect the anonymity of my junior high-age son. He’s great with food in many ways- never has been a sugar hound, unlike many of his friends, and didn’t even like chocolate until he was probably 9 or 10?! He’s always been slim- higher on the height than weight growth curve, and naturally active… so I feel lucky. I switched him from low-fat to full-fat milk last year, after I discovered LCHF for myself, and he’s fine with that. I do give him more starch than I eat, for example I’ll stir-fry veggies and meat, and give him rice with it. My main dietary issue with him is that he kind of has a beef phobia. When he was in preschool, well-meaning parents of one of his best buddies told him about Mad Cow disease, and he really took it to heart. We’ve done desensitization (is that the correct term?), so now he can be around other people eating beef without freaking out, but he still doesn’t want to eat it. In the big scheme of life, it doesn’t seem worth it to try and battle and force him to eat beef, but it does limit my meal-planning choices more than I’d like. He’s a very logical, science-minded child in most ways, so if anyone has a good argument r.e. Mad Cow not being a huge worry, please let me know! I have told him that he’s probably much more likely to get struck by lightening, or to get salmonella from salad, than he is to get Mad Cow, but he’s still concerned. I will say that I do wish we had the option of purchasing beef from cows that were tested after slaughter and found to be negative for Mad Cow. My understanding is that the government has actually forbidden such testing from being used in marketing meat, which seems an unnecessary restriction.

    Oh, about school, we were lucky in that his preschool forbid kids to bring any sweets (cookies, candy) in their lunches. He was there for 3 years, and when he started elementary school, he himself maintained the idea that he shouldn’t bring sweets in his lunch, even though other kids did. He also refused to eat the school lunches, as he found them disgusting! :) On the other hand, especially in the earlier grades, some teachers used sweets as behavior incentives- i.e. behave well, get candy on Friday- which was annoying, but didn’t seem worth arguing about at the time- and of course in a class of 32 kids (California class size nowadays), birthdays with cupcakes etc are constantly happening!

    (reply)
    • Peter Attia  August 24, 2012

      Thanks so much for sharing.

    • Elenor  August 24, 2012

      You might find some good information about how to … lead … your son into reconsidering beef here: http://www.psandman.com/search/search.php?zoom_query=mad+cow

      Peter Sandman and his wife (Dr. Jody Lanard) have done a lot of work on *communicating* about risk and cows and beef and health (among many many other hazards). Finding a source of ‘healthily-raised’ beef cows isn’t that hard; convincing your young fellow to re-address/reconsider the fright those parents gave him is probably harder. (Perhaps a discussion about SAD vs. healthy diets and how the impetus for them differs so dramatically? i.e., why you choose the healthy way…) (And letting him help FIND healthily raised beef — *doing* something to address the hazard — would help!)

      Sandman’s ‘thing’ is that merely addressing “risk” (what he calls “hazard”: i.e., what the actual odds are that a hamburger might be contaminated) won’t suffice. A communicator must also address “outrage” — the feelings ABOUT the ‘hazard.’ His motto is “Risk equals Hazard plus outrage.” I love his stuff — eye-opening!

    • Colleen  August 24, 2012

      Maybe do some research together on mad cow. From a table I just glanced at it reported 3 cases of the disease in humans from the US (total not per year). He’s more likely to die this year from an auto accident (is he still going to ride in a car) or getting the flu virus.

      Grass fed beef? Healthier animals with no animal by products reduces any miniscule risk.

      Good luck!

    • Lp johnson  August 24, 2012

      I’ve been researching all of the “infectious prion encephalopathies” (mad cow,scrapie,cjd,chronic wasting) it seems the governments if UK & US lead us astray. The infectious proteins may not be so infectious (more like fictitious). All recent research points to a mineral imbalance in nervous tissue, specifically low copper & iron, and elevated manganese. Search pubmed.gov
      May just give you one more reason to be mad at Gov’t.

    • Jennifer  August 26, 2012

      Hi California mom,
      Your son sounds very bright! Maybe you and he could do some research together about mad cow disease and visit a farm with grass-fed cattle? As somebody who’s pretty anxious myself, I would advise you to steer clear of comparing that risk to salmonella in salad or riding in cars…it might just encourage him to start thinking too much about the fragility of life. I didn’t eat commercially processed ground beef because of the mad cow disease. It’s my understanding that there really shouldn’t be risk from 100% grass-fed cattle–the problem was that cattle were being fed meat from cattle. Also the risk of a prion being in a hamburger is greater when the meat from so many individual animals is mixed together. Our local sources say that there’s likely to be meat from just one animal in a burger because of the way they process and package the beef. Because the neural tissue is where the danger is, pieces of meat like a pot roast or steaks–muscle tissue–aren’t risky. Automated gadgets that are used in extracting tissue from carcasses take some neural tissue (even though they aren’t supposed to) that gets mixed in to ground beef.

    • Jennifer  August 26, 2012

      And I should have said, the neural tissue that has the prions that cause the mad cow disease is tissue from the central nervous system, the brain and spinal cord. Not all over the body. Anyway, maybe if you and he read about it together he would feel okay about eating steak or a roast. Or maybe the little guy would just get freaked out about animals being slaughtered and stop eating chicken & pork, too…you know him best!
      That is so cool that he won’t eat the school lunches! Good luck with the beef!

    • Mom  September 2, 2012

      Hi Elenor, Colleen, LP, and Jennifer,
      Thanks for all the suggestions. We’re working on it!

  37. Michael Dufty  August 24, 2012

    Really interesting post. I’m pleased to see your approach to kids is similar to my own, I occasionally wonder if I should be more strict with them.
    My wife is not as convinced as I am on low carbs, and is of the opinion that a short life with rice and noodles is better than a long one without, which would make it difficult to go lower carb anyway.
    I try to minimise their sugar at home (get enough from grandparents and birthday parties). While I don’t stop them eating carbs, I don’t insist on it and try to offer options without carbs. My two sons (6 and 8) have very different preferences. The 6 year old loves rice and will happily eat a huge bowl of chicken rice for breakfast every day. The 8yo is quite happy to give rice a miss completely like me. Unfortunately the 8yo seems to be naturally very skinny and could probably get away with eating the carbs. The 6 yo has always had a large tummy and round face and I suspect takes after me and may have to watch what he eats more in future.

    (reply)
    • Peter Attia  August 24, 2012

      Another great example of individual variation. The good news is rice noodles are much easier to tolerate in a metabolically “fit” person than the opposite. So if rice noodles are essential, it’s that much important to avoid sugar.

  38. Mark  August 24, 2012

    Thanks for the post, Peter. Sometimes I feel I’m the only one around “forcing” my 2 daughters to eat whole foods as much as possible (continually swimming upstream against conventional wisdom).

    However, I started studying the whole diet thing when my youngest developed asthma at 18 months old. At 3.5 years old now, on real food, and no asthma for a year. That’s some motivation.

    I seem to be following pretty much the same principles as you do. What is your take on the wheat/gluten story? Do you allow foods containing these?

    (reply)
    • Peter Attia  August 24, 2012

      You’re not alone, Mark, though I know *exactly* how you feel when I take my daughter to pre-school lunches with other parents and watch what they let their kids eat. The tragedy, of course, is that each of these parents — I am 100% sure — wishes only the best for their children. But they are misled and highly confused. This is why NuSI needs to exist. We’ve got to put an end to this. What parent, even if they smoke, would encourage their child to do so? It’s a silly question. Not because it’s silly to smoke. Tobacco is addictive and for many it’s a coping strategy. But because we always want more for our children than we want for ourselves.

  39. Stipetic  August 24, 2012

    I love feedback from other parents as well. I’m trying to find a comfortable range for my kids, so great to see your approach. Thanks.

    I have 3 and 7 year old daughters. The eldest loves pasta and the youngest has a sweet tooth. We’ve eliminated pasta from the house–it was too easy of a meal option when time was short–so that problem is gone now. The little one, though, is constantly bombarded with sweets (in Greece, the Grandparents see it as their life goal to stuff kids with sweets and they hand it out at daycare too!). So, she’s constantly looking/asking for her sugar fix in between meals. I’ve noticed that if I leave bowls of olives or macadamias or fruit or cheese lying around her usual haunts (or bring some outside when she and her sister are playing), she usually stuffs herself with those and that seems to take care of “the shakes.” LOL I’ve also included both of them in helping me cook and making treats. For example, they were going through a “popsicle” stage made with fruit juice.So instead I had them make popsicles with Greek yogurt, strawberries and a bit of honey (I slipped in some coconut cream for good measure too). They absolutely love them–either from the taste or from making them themselves. They also helped me make paleo pancakes over the weekend.

    It’s a slow process, but it’s getting easier.

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  40. Conflicted  August 24, 2012

    Thank you so much for the insight into how you handle your daughter’s diet! I also have enjoyed reading all the responses from other parents and getting multiple points of view. I have a 3 year old and have been slowly trying to wean him of his sugar/carb addiction since switching to the Paleo diet in February. I didn’t have the knowledge when he was younger that I do now, but have been making slow progress. Of course, I wish I had known about the Paleo diet when he was a baby and subsequently would not have progressed on the SAD way of eating, but as I cannot change the past I can certainly start my next child in a much healthier pattern of eating…

    Which brings me to a question that has been burning in my mind since switching to a Paleo diet: What do you eat when you are pregnant?

    My son had colic and would scream for about 3 hours a day for the first 4 months of his life and all I was ever told is that he would grow out of it. Since I began reading about diet and how it affects every aspect of our health, I firmly believe that my diet while pregnant played an unfortunate role in his early health! I didn’t eat poorly by conventional wisdom, of course, but I certainly followed the SAD, ate whole grains, the occasional fast food when I craved french fries and the usual over-processed non-foods. I didn’t gain much weight and I was looked at as very “healthy” compared with my other friends who were pregnant and used it as an excuse to eat what ever they wanted when ever they wanted it. I sorely wish I could go back and do it all over again, but as there’s no point in wishing for the impossible, I can certainly change what I do during my next pregnancy!

    Which brings me back to: what do I eat? I will certainly stick to my current healthy way of eating, no processed foods, healthy oils and fats, no legumes, gluten-free, etc… but what about carbs and gluten-free grains?? I don’t want to unnecessarily cause harm to my growing child by eating less than 50g of carbs per day (what I currently eat). Any advise you can share will be greatly appreciated! I am not pregnant now, but hope to be in the next few months and I want to be on the right path from the get go!

    (reply)
    • Peter Attia  August 24, 2012

      Ahhh…important question, and one I plan to address in a separate post.

    • Cindy C.  September 2, 2012

      Hi,

      I have read in Jay Wortman site, that his wife was on the diet he was on while she was pregnant. The latest blog is about that child, and what that child now eats.

      http://www.drjaywortman.com/

    • Peter Attia  September 2, 2012

      Great find. I know Jay and think very highly of his work and insight.

  41. Andrew  August 24, 2012

    My wife and I have been Paleo/Primal for about 14 months, and have gotten increasingly stricter with it for ourselves in the past few months (we’re currently doing a Whole30).

    Starting about 8 months ago, give or take, we cut the grains and sugar out of our daughter’s diet (she’s currently just over 2 years old.) She is a great eater and her diet currently consists of some whole milk dairy (milk, cheese, cottage cheese), eggs, a wide variety of vegetables and tubers (sweet potatoes, peas, green beans, lima beans, spinach, mushrooms, onions, peppers. tomatoes, artichokes, carrots, avocado), nuts, meat, fish, and fowl, and fruit (blueberries are her favorite). We give her the bare minimum of processed food (as little as possible, organic and no-added-sugar when in a pinch). Basically, she eats like we do (although we, the adults, are now dairy-free). We try to have as many meals together as possible, so she sees what we eat, and always wants to eat off our plates. Since we don’t eat grains, sugars, or processed junk, she never asks for it.

    We’re bracing ourselves for what will happen as she gets older and out into the world, but for the time being, this is all going great.

    And I have a personal theory regarding kids and veggies (based on really not much buy my own thinking about it): I think that if more palatable foods (highly processed, highly sugared, etc.) are in a kid’s diet, those become distracting from more whole foods. This is why I think you see kids get away from veggies as they get older – they’ve been exposed to more things like pancakes and cookies and so on. As the sweeter stuff comes into play, and the grainy stuff, the veggies become less appealing. If you don’t introduce the “distracting” stuff, they stay with the healthy stuff.

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  42. Guillaume Belanger  August 24, 2012

    Hi Peter,
    It’s very good to see that there is no clash between what you believe, practice and preach about diet, and what you are feeding your daughter: integrity and honesty is highly important.
    I am very happy to report that my now-almost-14-year-old son eats almost exactly as we do, my wife and I. And this means close to zero insulin-stimulating carbs, and he is already almost 6 feet tall, strong, muscular, a fast runner with great endurance for his age, handsome with nice skin and exceptionally good digestion, and only gets colds when he doesn’t sleep enough for several days in a row, which happens maybe once per year.
    Here (http://healthfully.files.wordpress.com/2012/08/dietanalysis.pdf) is a diet analysis poster he did for math class, (he got the best grade; I helped a bit), where he was looking specifically at protein requirements and intake, but all the info about the other macronutrients is there. We used a very typical day in the winter. His total calorie intake was 3063, and I am very happy to report that 61% (207 g) was from fat, 13.5% (103 g) from protein, and 24% (182 g) from carbs, but almost all fibrous and thus not insulin-stimulating. This was a while ago, and we are eating even more fat now!
    But there is something that I haven’t noticed you mentioning (maybe you haven’t at all), and this is the importance of keeping the body alkaline to avoid chronic acidosis from excess uric acid, either from production or insufficient excretion. This is of great importance for health, both from the purely theoretical physiological perspective, as well as from the very real experience of perception of health through our performance in day to day activities. Any thoughts on that?

    (reply)
    • Peter Attia  August 24, 2012

      Guillaume, this is so cool! Thanks for sharing. I really feel hope when I see that 14-year-olds doing this kind of thinking.

    • Guillaume Belanger  August 25, 2012

      I forgot to mention that he did the poster two years ago, and we’ve all been eating an organic/local, mostly raw, vegetarian version of LCHFMP for almost 5 years now, fine tuning as we go along. And we all feel better and better with every month.
      Most exceptional is that my wife who suffered from asthma rather seriously since she was a kid, that’s about 40 years, is almost completely free of it. My guess is that within another couple of years, asthma and the continual stress it brings about, especially during the spring and summer, but really throughout the year, (because it takes a couple of months to recover from the spring/summer, and then the cold air is really bad for the chronically inflamed lung tissues, and then every cold used to take her a couple couple of months to completely purge the mucus), will all just be bad memories of a past life.
      I have to say that although there were remarkable improvements that came about from the elimination of simple and starchy carbs, the two most recently added elements that have made a marked difference in her getting better over that last year, are: 1) a lot more water—always on an empty stomach—together with more salt (unrefined), and 2) the excretion of accumulated acid by the alkalisation of body tissues through green drinks and an alkaline diet. These two have brought about an enormous improvement.

  43. Vicki  August 24, 2012

    It really is nice to read what other parents are doing in regards to LCHF approaches in there own lives (especially an MD that gets LCHF) and how they implement it in their kid’s lives. I wrote a post about how I approach food choices and health with my 8 year old daughter – http://www.health-seeker.blogspot.com. I’m “just a stay-at-home-mom” with a passion to understand health (thank God for Gary Taubes, Tom Naughton and Jimmy Moore or I would still be 233 lbs instead of 5’10” and 140) and why the SAD diet failed me. I wondered what your thoughts are on wheat? We try to limit it as much as possible but she eats fermented wheat and ancient wheat on limited occassions. I have been learning about Dr. Davis research. Our approach is very similar to yours. Sugar is totally limited but we follow a whole, real food approach of traditional nutrient-dense foods with the principles of Weston A Price for het even though I am LCHF and strive for Ketogenic for both my husband and myself.

    (reply)
    • Colleen  August 24, 2012

      Re Wheat you may be interested in this interview:

      http://chriskresser.com/pioneering-researcher-alessio-fasano-m-d-on-gluten-autoimmunity-leaky-gut

      Fasano researches gluten. My lay understanding of what he said is that eating gluten, even in a normal healthy person, causes tight junctions in the intestine to open (briefly) and allow things to pass through that should not. The immune system will respond. The point was not really followed up with regard to any negative consequences, but left me wondering that in some, there may be effects we do not yet understand/appreciate.

      We have basically cut wheat out, but may have a hamburger bun or pita eating out once a month and our 3 yo will also.

      After going low carb (and later more paleo/grain free except for the cheats) I had some minor aches and pains go away which I attributed to being in my 40s but could be attributable to what Fasano terms as gluten sensivity.

    • mhikl  February 14, 2013

      I suspect you are correct regarding a higher level of carbohydrates for children. Vilhjalmur Stefansson in his studies and time spent with the Inuit noticed that the young were given the prime cut of their raw Primal fair, the fish heads, sweet meets and other organ foods. It might not have been candy floss :), but it was the closest they had. I wonder if the Inuit would have been taller had there been a little more carbs for the diets of their children.

      I did a search for the oldest human remains (homo sapiens sapiens-us), larger than thumb bones and the such, and the two oldest were from the same area in Iran. One was 34000 years ago and the later 27000 years. The average height of the adult males in the earlier site was six foot seven inches and from the second site, five foot seven inches. Either they were from two diverse groups or their diet was different. I speculated that the tall group may have been heavier meat and fat eaters but also partook of local figs and other carbohydrates and the shorter ones may have had to rely more on the available carbs. Just speculating.

      However, I have also read that strict vegan and vegetarian children are smaller in stature than their more carnivorous classmates.

  44. Lp johnson  August 24, 2012

    Peter,
    Did you noticed any change in behavior after the Disney Binge? I have a 4 yo son, had a major meltdown after eating a small blueberry bagel. We eliminated most wheat several months ago, someone my husband works with stuck that bagel in his lunch bag to be funny ( they give him a terrible time about his wife’s packed lunches and think we are lunatics for the way we eat). Anyway, do you think the loss of mental and emotional capacity after a bagel is more likely related to carb load or wheat? Thanks a ton!

    (reply)
    • Peter Attia  August 25, 2012

      Funny you should ask. Gary asked me the exact same thing. As much as I want to say it turned her into a hell-child…it didn’t. She continued to be her usual, profoundly sweet self. And believe, she ate pretty poorly for 2 straight days. I do recall on Easter, though, after she inhaled a lot of chocolate eggs, she was a bit out of sorts.

  45. Alice  August 24, 2012

    I chuckle thinking back to when my daughter was 2. She would grab the butter stick off the butter plate and chow down. We would grab it out of her hand because we thought at the time that that was unhealthy. If we had to do it again, we would let her dig in. She has always drunk whole milk, eaten our home cooked food with plenty of butter, and had very few sweets. She is 11 now and doesn’t care much for sweets. We try to make sure she gets plenty of sleep. She’s extremely healthy, smart, and fun. What more could a parent want?

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  46. Alexandra M  August 25, 2012

    I am becoming more concerned about the kids around me – especially the rapidly ballooning children of close friends and relatives. I’ve begun to seriously consider going for a certification program in nutrition so that their parents will at least give me a hearing. People will believe something if it comes from someone with the title “nutritionist.” Last week, the CSA (Community Supported Agriculture) farm we have a share in, sent out their weekly newsletter with this gem in it, written by a nutritionist (it was the week potatoes were going to be in the share):

    “Carbohydrates are sugars and are all converted into Glucose in our system. Glucose is the preferred energy source of the brain and for our muscles. If we do not get adequate glucose/carbohydrates, our body starts to break down proteins from our muscles and organs to convert to glucose. ”

    My husband is convinced that I could never get certification unless I’m prepared to grit my teeth and toe the party line until the end – but I really don’t know if that’s the case. I know it would be nearly impossible for me not to challenge things that I know are not true.

    (BTW, I sent a reply to the CSA citing Volek and Westman: “We recently used dual-energy x-ray absorptiometry to examine the change in body composition in subjects who switched from their habitual diet (48% carbohydrate, 32% fat) to a very-low-carbohydrate diet (8% carbohydrate, 61% fat) for 6 weeks. Surprisingly, fat mass decreased significantly (–3.3 kg) and lean body mass increased significantly (+1.1 kg), despite no change in physical activity. There were no significant changes in the control group. These results suggest that a very-low-carbohydrate diet favors loss of fat. Water may account for some of the initial rapid weight loss, but it appears that fat loss accelerates and lean tissue is preserved over longer periods, ” but never got a response.)

    (reply)
    • Peter Attia  August 25, 2012

      It’s tough to hear these things without wanting to respond. I used to be on various nutritionist discussion boards, but I had to quit. Too painful to read and I’d much rather focus my energy on other things, like trying to advance the science.

    • Alexandra M  August 26, 2012

      I took this from the other thread where Dr. Cahill’s obituary was quoted:

      “A crucial finding was that in the first few days without food, the liver starts breaking down protein to make glucose to feed the brain. But using protein as fuel can be perilous, because it is the stuff of vital organs and muscle.”

      The current state of nutritional “expertise” is like a game of Whisper-Down-the-Lane. Dr. Cahill makes a crucial discovery about the body’s response to starvation, and 50 years later nutritionists like Ms. CSAconsultant are saying it’s a response to a lack of whole grain bagels…

  47. Birgit  August 25, 2012

    Thanks for sharing this personal story and pictures. It is so nice to see this very personal side of the scientist you are. :)
    My daughter (who is 15 and a swimmer) will be reading it as she is contemplating a ketogenic diet (currently at about 80grams carbs/day).
    I did have one question. After reading William Davis’ book “Wheatbelly” and learning that wheat will raise insulin levels much more than sugar, not to mention the other toxic effects, what type of pasta do you serve your daughter with the homemade spaghetti sauce? Are there some grains you avoid completely? Why or why not?

    Looking forward to reading more from you about nutrition in children.

    Birgit

    (reply)
    • Peter Attia  August 25, 2012

      Just by the nature of what we have at home, she does consume relatively minor amounts of gluten.

  48. K  August 25, 2012

    Hello, Peter!

    Congratulations on raising such a happy, healthy child!

    We are hoping to have children soon, so I was very interested to read this post today. I’ve given a lot of thought to how I might handle the carb situation, if my partner and I should be lucky enough to have kids. He and I are both prone to insulin resistance and have been since we were little, so we’re keen to avoid the same fate for our kids. I’ve been thinking that I will do for my children what I wish my parents had known to do for me–recognize excessive hunger as a signal that there are too many carbs in the diet.

    When I was little (5 or 6 onwards), I started to get chubby, and would constantly ask my naturally thin parents for snacks, etc. They didn’t believe me that I felt hungry, and would say things like, “You just THINK you’re hungry! You just like the way it tastes!” They did their best to keep me on a “healthy” diet–one dessert per week, whole grains, no saturated fat, tofu instead of red meat, no soda, only fruit for snacks, no fast food or junk food–but of course it didn’t work. I turned into a fat grownup, and I always tried to ignore my hunger and follow the food pyramid guidelines! In my mid-20’s I finally figured out for myself what was going on when I was sent for a diabetes test as part of a medical clearance for some work in a remote location. I’d eaten my usual “healthy” breakfast at 8:30, which was steel-cut oatmeal made with water, a stewed apple (no sugar) and a handful of slivered almonds. By 10:00, I was starting to feel the typical hunger that I always tried to resist until lunch, because I “couldn’t be” hungry yet! At 10:30 I had the blood glucose test and my results showed a blood glucose of 80 (units?). The nurse asked me if I’d had breakfast, and when I said yes, replied incredulously, “Was it a donut?? Because you look like you’re having a sugar crash!” That’s the first time I made the link between low blood sugar and that constant plaguing hunger, and of course that’s gone away now that I keep my daily carbs below 20g. I just wish my parents had known that that’s what I was feeling when I was little and constantly complaining of hunger, and could have responded in a way that would have helped me not get so fat!

    So, when I have kids, knowing that their bodies will be different than their parents’, I don’t want to keep them on as strict a low-carb diet as myself or my partner, but I will try to keep my eye out for excessive / non-stop hunger as a sign that they might be getting too many carbs.

    One more thing, Peter–given that you’re planning to write on the topic of low carb pregnancies at some point… Here in the UK they have started treating overweight pregnant women with meteor in, even if they don’t have gestational diabetes, to prevent the fetus from experiencing high blood sugar and thus becoming predisposed towards obesity later in life. I’ve been wondering if there is any evidence surrounding the effects of ketosis vs. metformin

    (reply)
    • K  August 25, 2012

      Sorry, cursed autocorrect! I meant they treat overweight pregnant women with metformin, not “meteor in”!

  49. Marilyn  August 25, 2012

    @Zak Hendsch: “Very similar physically and raised in a similar environment. . .” I once remarked in a casual conversation that two siblings were brought up in the same environment. A psychologist among us said, no they weren’t brought up in the same environment; they had different siblings. :-)

    (reply)
  50. Dorian  August 25, 2012

    Peter

    What is your view on bacon? In particular, it being processed,the nitrites and nitrates, etc.

    Thanks!

    (reply)
    • Peter Attia  August 25, 2012

      I’m a fan. I try to buy organic, which minimizes additives.

    • Alexandra M  August 26, 2012

      I had looked into this. Apparently ALL bacon contains nitrates and nitrites – the better ones just don’t contain “added” nitrates and nitrites. From the Applegate website:

      “Q: Do Applegate Products Contain Nitrites or Nitrates?

      A: The short answer is yes, but with another longer story. Nothing is ever simple, is it?

      All animal proteins are made up of amino acids that contain naturally occurring nitrites and nitrates. And so Applegate products made with animal protein will have levels of naturally occurring nitrites and nitrates.
      In addition, the celery juice and sea salt used to cure our meats also contain naturally occurring nitrates.
      For these reasons, the USDA does not allow animal protein products to state “nitrate/nitrite free” on their labels. So, being law-abiding citizens, we don’t state that.
      Packages for our products are required to say “no added nitrites” since they contain the naturally occurring variety, but were cured without the addition of chemical sodium nitrate.”

      Some good info here, but the author also thinks saturated fat clogs arteries. GAAAH! Will it ever end???

      http://www.coopfoodstore.coop/content/good-or-bad-nitrates-and-nitrites-food

      Or you could make your own:

      http://www.nytimes.com/2012/03/28/dining/home-cured-bacon-recipe.html

      Apparently lamb belly makes a very good bacon, too!

    • bill  August 28, 2012

      Here’s a great link re: Nitrates in food.

      http://www.efsa.europa.eu/en/efsajournal/pub/689.htm

      After you read this, you’ll never worry about them in your meat again.

      Stop the fear mongering.

    • Peter Attia  August 28, 2012

      Nice. Looks like it will take a while to read this!

  51. Obee  August 26, 2012

    Now that you’ve tackled the youngsters, I’d love to see you address the other end of the age spectrum. I’m turning 60 next year and have essentially been on a low carb diet, at least most of the time, for at least 20 years. When I originally did the Atkins diet I discovered that all my pollen allergies disappeared. Experimentation revealed that eliminating the wheat made the difference. I used to be on two different inhalers but today barely even get a runny nose during the height of the pollen season, which can be brutal here in Tennessee. What I have discovered, however, is that it is increasingly difficult to maintain my weight even at very low carb levels. I eat almost no processed foods. I can go on what might be described as the Atkins induction and my weight will barely budge. However, I plan to stay low carb forever because I believe research is eventually going to show a strong relationship between excess insulin and Alzheimer’s disease. So what might be the ideal diet for many of us nearing Medicare age?

    (reply)
  52. Mia  August 27, 2012

    This is really interesting! I am from Sweden were LCHF is huge (as you know) but we live in Australia and has been for 6 years. I have been low carbing for the past 7-8 years or so and of course that has spilled over to our son who turns 13 in a couple of weeks. He is the tallest in his class and his endurance is spectacular, if its running or doing home works-there is no difference.

    Here in Australia we have to provide lunch boxes and it’s gone to the extent where kids in his class offer him money for his lunches…! Which he of course never accept :) The standard lunch for Aussie kids consists of white bread, margarin and vegemite, for recess a lot of kids have donughts and ice coffee, a sports drink or one of those energy drinks.
    My son? He has chicken drumsticks or wings marinated in spice mixes I make myself. It is so easy and you don’t get all the sugars and anti -caking crap. To go with the chicken he’s got home made mayo as well as home made ketchup. That also is very easy and I know exactly what he gets. Another day I just boil some eggs, roll up some ham and cheese slices, cut up cucumber and bell peppers, mayo to go with it. Again so easy and apparently very enviable :)

    We are not being fanatic about his diet (even some people would disagree) but as long as I can control what he eats at home I’m happy.
    He feels that they are teaching the kids the wrong things in school when they talk about that margarin is better then butter, cream is bad for you but “here have a processed meat pie, It’s good for you”- kind of talk.

    I recently started to blog about how to cook easy low carb, and my son helps out since he loves to play around in the kitchen and always make his own after -school -snack. Please have look if your interested at aswedishsmorgasbord.com

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  53. Gary  August 27, 2012

    Hey Pete, a couple of off topic questions:

    1.) what do you think of the High fat, low protein, very low carb diets? Jimmy Moore is doing one and is losing weight after 10 years on a LC diet that saw him lose 200 pounds then gain 80 back even though he kept under 20 carbs a day. He goes 85% fat, 12% protein, 3% carbs. When I started reading his blog posts, I immediately thought that he must have been in the ‘Zone of Misery’ you talked about 6 months or so ago (Still patiently waiting on that blog post by the way). Do you think that could have been Jimmy’s problem, too much protein?

    2.) How is life as a first time dad in your mid 30’s? Looks like I’ll be the in the same situation and know no one else who is a first time father at that age. Just curious on your thoughts.

    (reply)
    • Peter Attia  August 27, 2012

      1. Hard to say what’s going on. I’ve learned to stop guessing without a detailed analysis of exactly what someone eats. Too many variables (dairy, protein, artificial sweeteners, others).

      2. Greatest thing in my life. If you think I care about nutrition, you’ve seen one tenth of how much I care about that little girl.

  54. Gunhild (Denmark)  August 27, 2012

    Thank you for a great blog and blog post, dr. Attia!
    My 2 1/2 year old son was diagnosed type 1 diabetic 1 1/2 months ago, and on top of that we just entered a research project which investigates whether a gluten free diet will benefit his active beta cell count. So naturally we are restricting his carb and gluten intake. His day care is great at handling all this, but they sure do eat lots of bread, so though I prefer he ate other things like veggies and meat, he will problably end up getting his fair share of gluten free bread and the like.
    I myself got interrested in the kegogenic/paleo-sort of eating about three months ago (though I have normal-low BMI), and I think of the diabetes diagnose as a knife-to-the-throat kind of encouragement to eat more low carb and low/no grains. Thank you so much for writing about your take on food and kids!

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  55. dave in Vancouver  August 27, 2012

    Another “Thank You” to the long list for your time/effort here. The last pic (at the desk) pretty much screams it’s great to be alive: I hope one day science can up with a blood test measuring the health benefits of being surrounded by people who love us.

    A question for you or your readers. I apologize if it’s been answered already. I bought the blood meter you use. Can I make a correlation between glucose and ketone levels? The ketone strips cost 4x as much as the glucose where I am.

    (reply)
    • Peter Attia  August 27, 2012

      I’ve been trying to do so for a year, but the correlation is too weak to justify. Too many factors involved. Ketone strips in Canada are about a third the price (relative to U.S.).

  56. Birgit  August 27, 2012

    Peter,
    as usual you inspired me with this post. I decided to write my own blog post about kids and low-carb eating on Sparkpeople and wanted to share the link:
    http://www.sparkpeople.com/mypage_public_journal.asp?id=HOUNDLOVER1
    Birgit

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    • Peter Attia  August 27, 2012

      Thanks so much, Birgit.

  57. Liz  August 27, 2012

    Hi Peter,

    This is on a tangent from the topic, but I wonder if you have an opinion.
    Every now and then I would read articles about how vaccines are bad for your children. I would roll my eyes and think, “duh, why on earth would government do something that would harm our children? “. The CDC are, afterall staffed with doctors and researchers and whotnot, and obviously they know what they are talking about.

    My daughter is almost 5, and have been vaccinated to the nines (we lived in Vanuatu for a while, so hep C was also added to a long list of stuff). My son is 9 months, and he has also been vaccinated according to schedule.

    Since starting eating Primal I have started to wonder if government is pushing something as clearly harmful as grains, why would vaccines be any different.

    I am hesitant to do a google search, as it can be ridiculously difficult to distinguish the proper sites from the crack-pot ones.

    I understand that it is not really the scope of your blog or this post, but having just read another article about it (http://www.mommypotamus.com/vaccines-and-sudden-infant-death-syndrome) , I figured that I need to ask someone.

    Thank you

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    • Peter Attia  August 27, 2012

      The data suggesting vaccines are harmful is pretty weak.

    • Acacia Aggarwal  August 28, 2012

      To learn more about the safety of vaccines, look at the Vaccines course on Coursera taught by Paul Offit, MD (University of Pennsylvania):
      https://class.coursera.org/vaccines-2012-001/class/index

      I took this course and it really helped to fill in the gaps about similar questions that you have.

  58. Charles Lee  August 28, 2012

    “That said, she’s so used to seeing her daddy give himself “boo-boos” on his finger every day to check his ketone levels that I think she’s getting curious…but that will have to wait a long while”.

    Hi Peter
    Great post. Can you please elaborate a bit on how you measure your ketone levels?

    Thanks,

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    • Peter Attia  August 28, 2012

      Described in detail elsewhere on blog.

  59. David Ma  August 29, 2012

    Hi Dr. Attia,

    I’ve been ketogenic for around 3months now. Always limiting carbs to <50g (more like 30-40g) and never consuming more than 20g of carb in a single meal. I take approximately 1.5g/kg of protein each day.
    However, I noticed that I've lost muscle mass, and have been laying down fat. Before the start I had little body fat around 8-9%, now its more like 14%?
    What could be going on? I do take a casein and a WPI shake from time to time, could it be that?

    (reply)
    • Peter Attia  August 29, 2012

      Not sure. Very difficult to troubleshoot without enormous amounts of info.

  60. Bobby  August 30, 2012

    Peter: A lot off the topic. This afternoon I got talking with a friend of mine and I mentioned a high fat diet. As our conversation continued, I brought up your name. My friend, is Pedro Mendez-Tellez and it turns out you and he know each other well. I even mentioned the book you wrote while at Hopkins, and he pulled out his I Phone to show it to me. It is still used.
    We are running buddies and have run together for years. Pedro mentioned that he had thought of doing a high fat diet, but believed he should have certain test taken prior to taking that step to determine his insulin sensitivity such as a glucose 2 hour test along with tracking insulin. We speculated that would help determine whether a high fat diet would be beneficial. He mentioned, as you have, that your wife is thin. I noted that you have mentioned that she can eat carbs without the negative effects.
    So our questions is what blood tests can we take to determine our insulin sensitivity? Clearly, if we are more like your wife, carbs may be no big deal. If we are more like you, carbs are really a problem.
    I own a running speciality store and before Pedro left he bought some UCAN and said to send his best wishes. Regards, Bobby

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    • Peter Attia  August 30, 2012

      Wow! PLEASE say hi to Pedro for me. Man, I miss that guy. He was one of my favorite attendings from Hopkins. The gold-standard for determining IR is something called a euglycemic clamp, but it’s not a realistic option, so I opt for 3 other measures: OGTT with HOMA-IR, ratio of TG/HDL-C, and lipid IR score based on NMR. The combination of these tests gives a very good impression of how insulin resistant one is. Please have Pedro email me!

  61. Joe  August 30, 2012

    Probably the coolest t-shirt I have ever seen in the Disneyland photo. Got to love the bacon!

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    • Peter Attia  August 30, 2012

      You should see my “Bacon is meat candy” shirt…

  62. Pixelfairy Devnull  August 30, 2012

    wish i could get my sisters to feed their kids healthy. i see what happens to most kids, and just feel helpless knowing these things will happen to them. they think “normal” is healthy and that all the problems im mysteriously not getting are normal too.

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  63. Ellen Urciola  August 31, 2012

    Hi Peter,

    Gorgeous photos. You have a beautiful family. If I may indulge my excitement on the eve of the first day of September ( actually, the day before the eve of September), I was wondering if we could have a sneak-peak, or if perhaps you could tell us what to expect when you and Gary roll out NuSci? For instance, will this academy be an online venture where you will continue with this blog? Will NuSci, along with promoting the advancement of “right” research, offer in person consulting? Please pardon my excitement, and I will understand if you need to keep things under wrap a little while longer. I do want to take this opportunity to thank you for your unselfish time, commitment and unwavering hard work keeping your readers informed, not to mention the the personal out-of-pocket expense involved in running this blog.

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    • Peter Attia  August 31, 2012

      Thanks so much, Ellen. Everything you want to know about NuSI will be out in the open shortly. Please stay tuned.

  64. Janet  August 31, 2012

    Thank you, Peter, for sharing here. Found the “Primal Way” about a year ago; and have never looked back…

    How about morning supplementation with 7keto for the primal set? The resulting IGF-1uptick would seem to be a boon for adult neurological health.

    Any thoughts?

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  65. Shelly  September 1, 2012

    Love your website and your dedication to truth in dietary science. Your work is important and significant.

    I limit carbs and eat almost no sugar. I hike and do resistance training. I feed my family mostly whole foods—lots of meats, full fat cheeses, eggs, butter, olive and coconut oils, loads of vegetables, nuts, berries. A recent triumph is getting my kids to eat salads with homemade olive oil/lemon dressing, or just plain—no ranch crap in my house! My kids are lean and healthy. I am tall and lean and suspect with proper modeling and a little luck, my kids will be, too (although my husband has quite a belly, 25 lbs. overweight and resistant to limiting carbs). My real concern is how sugar affects health, not just weight. My dad was lean his whole life but died in June of leukemia at only 69 (his father died last year of pneumonia at 94). Dad had a real sweet tooth. My mother has been obese for years and was diagnosed with early onset dementia at 65. She is now 69 and in a nursing home. The only way I can maybe increase my chances of NOT getting either of these horrible disease is limiting sugar and exercise (from what I’ve read) . Gary’s NYT article last year, especially the last few paragraphs, gave me chills —the part about the doctors/researchers that choose not to consume sugar not because of weight concerns but because they don’t want to get cancer. I can’t changes my genes, but I can say no to dessert …

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    • Peter Attia  September 1, 2012

      Shelly, I applaud your insight into a complex problem. It’s all about knowing what you can and can’t change and focusing on the former, while resisting the urge to awful-ize about the latter.

  66. Maryann  September 2, 2012

    Hi Peter, I was wondering how you handle Halloween. What do you give the neighborhood kids and what do you let your daughter have as a treat, if you don’t mind? Imagine if I gave out hard boiled eggs :)

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    • Peter Attia  September 2, 2012

      She eats what she collects on that day. It’s trash the next day.

  67. Patrick Timpone  September 2, 2012

    Hey Peter great post. I like your point on how they are all just children. Because in reality we can’t control everything they’re going to eat right? Probiotics would be good since they will eat sugar. Keep up the great work and awesome website.

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  68. Matt  September 3, 2012

    This was a great post. I started reading it with anxiety, because I expected you would have your daughter on a lower-carb regimen and I would end up feeling guilty. But my wife and I are pretty much doing the exact same thing with our girl. So that feels good. You’re lucky not to see mood changes when your daughter goes off her regular eating pattern. My guess is that that’s unusual. We can usually count on some kind of crash/meltdown at the end of a day when our little girl has special occasion treats. She’s younger though, so maybe that’s a factor. Anyway, thanks for the post! We had a cooc-a-moocs for breakfast. My daughter’s a big fan.

    (reply)
    • Peter Attia  September 3, 2012

      Probably, and sometimes we don’t get so lucky…like last Easter, after she ate her half her body weight in chocolate…

  69. Maria Jallow  September 5, 2012

    You already wrote what I have been thinking about for the last year. I also react towards the gropus at FB wich is about LCHF (LowCarbHighFat/The swedish part) where ppl put out wonderfull recepies of food they are eating and adds that the kids ate something else with pasta/potatoes or rice. They eat LCHF because of the healthissue but the kids…?
    Can’t really get that!
    I been blogging in swedish but decided to start in english also because I got friends outside Sweden who asks me about this “Nordic diet”. I will put your blog on my favourites because you are awsome! <3
    http://www.myfattystory.blogspot.com

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  70. Gary  September 5, 2012

    Peter: It appears from the pictures that your daughter has the nice, broad dental arch that Dr. Price found in the exceptionally healthy people he studied, no doubt due to the excellent diet you and your wife followed prior to conception and during pregnancy. What a gift to a very lucky, lovely young lady. My daughter is now 25, and eating well now, but she didn’t have the benefit of a good early start, nutritionally speaking, for we were ignorant, and tended to believe the governent and media. I’m a retired educator, so I bend the ears of anyone and everyone I come across about proper nutrition whether they like it or not. Thanks for the good work! The cholesterol (my favorite food group) series is fascinating.

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    • Peter Attia  September 6, 2012

      Thanks so much, Gary.

  71. Jere Krischel  September 6, 2012

    Although it probably seems a bit cruel to her, for my 7 year old, I just can’t let her go wild on sugar, even on special occasions. Perhaps she’ll get a tiny 1cm cube of whatever cake or treat is going around, just for taste, but the idea of letting her be “normal” and overloading on the typical sugars and starches everyone else seems to take for granted as benign – I just can’t do it, not even some of the time. Heck, when I get high-carb presents from people who can’t quite grok I’m not eating starch and sugar, I can’t even bring myself to regift, because I don’t want to hurt my friends!

    I wish my daughter had enough low-carb friends to put together a birthday party where nobody would expect cake, juice, or sugary ice-cream, but perhaps that will happen in the next generation :)

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  72. David LaPlante  September 6, 2012

    Great post! Principle #5 awesome! It is certainly hard to stand back and let them live and learn…but it seems that the only way kids truly learn is through experience. Recent experience: Our friends thought we were cruel when we laughed and laughed hearing that our older son ate two hot dogs at summer camp, got sick, and puked them up. It was the first processed/nitrate meat he’d ingested in years. He learned more of a lesson than any food censorship and cognitive reasoning promulgated my Mom’n’Dad could have ever produced.

    Now that our kids are older (10/12) it’s been wonderful to note how much of an influence they’re having on what their friends eat. Unfortunately it can get expensive for us because their friends love to eat at our house. Grass-fed beef ain’t cheap! But that’s better than the opposite – when a kid comes over for dinner and has no desire to eat anything unprocessed.

    Again – great post. Way to play to the parents. 8-)

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  73. Tracy  September 7, 2012

    I love this post. My son is 19 months old and basically eats what I eat – meat, fish, eggs, veggies, fruit, berries, nuts, goat yogourt, water. Oh, and breastmilk but I don’t eat that :) His grandparents, at first, thought he wasn’t getting his vitamins because he wasn’t eating fortified foods like cereal and milk….but I keep repeating that he doesn’t need fortified foods because he eats real food. And he has treats once in awhile – cake at parties, we shared an ice cream cone on the first hot day of summer. I figure as long as I have control over what he eats I’ll make sure he eats lots of good food, trusting that when I have less control he’ll gravitate to what he knows.

    He’s full of energy, sleeps well, laughs all the time, and is a healthy boy. Some of that must be from how much we enjoy eating good food together!

    Thanks again for the post – so nice to read!

    (reply)
    • Peter Attia  September 8, 2012

      Amazing idea, huh? Somehow kids were ok long before sugar-filled formula became the norm.

  74. Christa Crawford  September 8, 2012

    I love this! I teach second grade, and I’m always trying to find ways to gently nudge the parents to cut down on the sugar they’re feeding their kids. It’s hard to do this without offending the parents. I’ve found the best way is to teach the kids why I bring the foods that I bring. They, in turn, go home and request healthier choices.

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    • Peter Attia  September 8, 2012

      Christa, you’re really on the front lines. Wow. I wish you all the success possible to help parents better understand the importance of giving their kids a nudge in the right direction. Hopefully this post can be an efficient way to pass along the info.

    • dave in Van  September 9, 2012

      My wife teaches grades 1-3. The past few years she’s forbidden sugar treats in her class (supportive mangement); changes their behaviour considerably, she claims. This year she’s at a new school with new management and parents, so they’ll eat the standard fare. Should be an interesting experiment.

    • Peter Attia  September 9, 2012

      Absolutely. Too bad the parents didn’t know better to make the decision for themselves.

  75. Adam Hauptman  September 8, 2012

    Totally off-topic but I think totally post-worthy question that has been bugging me for a while and I can’t find any research on…

    The standard answer to “how many calories do you have to burn to burn 1 pound of fat” is “453 grams in a pound times 8 calories in a gram of fat equals about 3600 calories.”

    While this is technically chemically true (or at least the numbers I’m using are close enough to illustrate the point), I’ve also always been told that the human body is ~75% water regardless of shape or composition.

    Here’s the conjecture part that I have been unable to corroborate by looking for medical or internet research: So, to keep a constant 75% water ratio one would lose 12 oz of water (that had “supported”) every 4 oz of fat burned off. So, really one needs to burn about 900 calories to lose 1 pound of fat (as measured in fat composition tests or similar), not 3600 calories.

    To take an illustrative example, take one of those 500 pound guys on Biggest Loser. Say he loses 100 pounds of “fat”. He wouuld need to lose 25 pounds of fat, ~90k calories (note lack of quotation marks) and 75 pounds of water to stay at 75% water composition. If he lost 100 pounds of pure fat, ~360k calories (and no water), then his water composition would jump from 75% to 93.75%.

    (reply)
    • Peter Attia  September 8, 2012

      The estimate of 75% of TBW (total body weight) being water is too high. Closer to about 50-60% for a lean individual. The less lean someone is, the less of their weight/mass is made up by water, as fat is anhydrous. The folks on BL are probably less than 30% water. To lose a pound of fat does, in fact, require a net reduction in about 3,500 kcal. The point I think you’re making is that this is rarely a static event. It is very hard to just lose fat mass without giving up some other mass (e.g., extracellular water, glycogen, lean tissue).

  76. George Henderson  September 9, 2012

    Even high-normal blood sugar is not good for the brain: http://www.neurology.org/content/79/10/1019

    The aim of this study was to investigate the association between plasma glucose levels and hippocampal and amygdalar atrophy in a sample of 266 cognitively healthy individuals free of T2D, aged 60–64 years, taking part in a longitudinal study of aging.

    Methods: Fasting plasma glucose was assessed at wave 1. Hippocampal and amygdalar volumes were manually traced on 1.5 T MRI scans collected at wave 1 and at wave 2 4 years later. General linear model analyses were used to assess the relationship between plasma glucose and incident medial temporal lobe atrophy after controlling for a range of sociodemographic and health variables.

    Results: Plasma glucose levels were found to be significantly associated with hippocampal and amygdalar atrophy and accounted for 6%–10% in volume change after controlling for age, sex, body mass index, hypertension, alcohol, and smoking.

    Conclusions: High plasma glucose levels within the normal range (<6.1 mmol/L) were associated with greater atrophy of structures relevant to aging and neurodegenerative processes, the hippocampus and amygdala. These findings suggest that even in the subclinical range and in the absence of diabetes, monitoring and management of plasma glucose levels could have an impact on cerebral health.

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  77. Dan  September 11, 2012

    Great balanced approach. Thanks for a great post Peter.

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  78. Leslie  September 15, 2012

    My question is about breastfeeding. I switched to a HFLC diet right after the birth of our fifth child. I’m going with the assumption that what is healthier for me is healthier for my baby, but I can definitely tell the difference in the baby’s stools (different color, smell, and texture than the previous 4 children’s). Otherwise no difference — all 5 have been healthy, happy babies to various degrees.

    Not as much success switching the other 4 children and husband to a HFLC diet! Still working on them…

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  79. Susan  September 26, 2012

    Disneyland? I LOVE Disneyland! But then again, I’m an ENFP. Lots of people, voices and other stimuli is heaven for me.

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  80. Sooz  September 30, 2012

    My daughter, 23 now and living away from home, ate slightly higher carb than I did from baby to teens with very little processed food. Once a month we had “treat night” where we’d go to the supermarket and pick whatever she wanted or go to McDonalds. Kids don’t want to be different, and I get that. As a teen, she was vegetarian for a very long time, but anaemia forced her to choose between iron tablets and eating a bit of red meat. She chose the meat. I’ve taught her all the things you teach – animal fat is ok etc etc, but most of her friends are still on the low-fat/higher carb thing, so it’s often difficult for her. It’s also difficult for me to buy nicely marbled meat – everyone is still does low-fat around these parts. She’s very slim, active and eats very healthy for someone her age. I think I’ve done a reasonable job to set her up for lifetime eating.

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  81. cameron  October 10, 2012

    Peter

    Asked you about swim training in Boston and have since seen you weren’t kidding when you said you are a swimmer. My daughter is 13 and trains 5-6 days per week. The team just held a nutrition session and……(wait for it)……suggested chocolate milk!

    I believe you said you worked some with Matt Grevers. Since I KNOW Chocolate Milk and pancakes are wrong–what should she be eating? The workouts are about an hour and half. I ordered some super starch just to try it but are the 1 1/2/ hour workouts even long enough to worry about pre and post diet outside of regular paleo eating habits? Do you have suggestions outside of Super Starch? Are 2 minute “all out” races even conducive to SuperStartch? Is there a resource you can point me to if you don’t have time to write a big long response to this?

    Thanks

    Cameron

    (reply)
    • Peter Attia  October 14, 2012

      I have not worked with Matt, but have worked with others at his level. You’re correct to point out that such swimmers race in a purely glycolytic state (i.e., their races are all-out exertions less than 2 minutes). However, as you know, their training is typically north of 4 hours per day, and much of it is aerobic in nature. So in my experience, even athletes “only” working out a few hours to compete in very short bursts, still find benefit (performance and health) in substituting SS for the typical sports drinks and products.

  82. Chris Meenach  October 13, 2012

    I ask my daughter, ‘what would you like for dinner?’

    Elsa (6): ‘what are my choices?’

    me: ‘pig, elk, or fish’

    elsa: ‘what kind of fish? one we caught or from a farm?’

    me: ‘farm. but not the one you’ve been to’

    elsa: ‘ummmm, . . . . pig! . . . wait! pig from aunt Jaime or the store?!’

    me: ‘aunt Jaime’

    elsa: ‘yeah! lets have pig!!’

    (the pig in question is ground meat from a 1/2 berkshire, 1/2 landrace, killed at 180lbs, fed barley and canola, no corn – sausage is loaded with fresh fennel)

    Kids are natural foodies. They have a wonderful response to what is good and what is not. I’ll back Peter up on the Capri Sun antidote as I’ve experienced quite exactly the same thing – and several dozen other processed food aversions.

    If YOU want to eat better, go out of the way to cook some better stuff for your kids, their resistance to the triple bleached, ultra-processed FDA-approved gruel will motivate you to feed yourself better. You go to McDonalds because your kids want to and it is too much effort to fight them . . . why not make that the case for beet chips, Berkshire pork, Criollo beef, and pumpkin curry?

    All cheaper than fast food. As if that matters.

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  83. JD Mumma  October 30, 2012

    Dr Attia,
    I agree with several of the arguments/statements you make.
    I understand you to be a professional who focuses on evidence based medical science and cognizant and capable of being able fulfill the burden-of-proof to validate your advocacy/arguments/statements/hypothesis with objective scientific proof.
    Would you also be willing to share with us your daughters medical health test records?

    (reply)
    • Peter Attia  October 30, 2012

      1. There are no lab tests to share on a 4-year-old.
      2. If there were, I would not share them. That’s going a bit too far in my opinion.

  84. nicole  November 2, 2012

    We eliminated all sugar and grains from my 5 year olds diet 3.5 years ago. She used to have to take miralax everyday. Poor thing would get so constipated. No more crap food, no more miralax, just like that. To this day if she spends too much time with grandma she comes back constipated and we have learned she can absolutely have no more than one treat (grains, desserts, binding starches) at most a day. So i ended up with a 5 year old who eats mostly meat, fish, raw veggies, fruit, full fat dairy and nuts, in the end she and her younger sister are healthier for it and i feel like a good mom. Question: do you have any ideas about supplementing fish oil for kids? I used to put chocolate flavored fish oil in her full fat greek yogurt when she was smaller, but i was always slightly concerned that I could be giving her too much as it was very very concentrated. I’ve never found any guidelines about this for children….

    (reply)
    • Peter Attia  November 2, 2012

      I read a pretty good study in the journal Pediatrics that showed benefit in children when supplementing omega-3. BUT you need to be very careful and not do so without measurements of EPA and DHA levels in the blood, to ensure you’re not giving too much. Too much can actually lead to easy bruising and even bleeding, which is easier to happen in children because of their size. I am not familiar with Pediatric guidelines and would only suggest doing so under the careful eye of your pediatrician.

  85. nicole  November 2, 2012

    Thanks!

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  86. Trisha  December 6, 2012

    I realize this might not be the right place to ask the question, but not sure where the right place would be. I teach a high school Biology class for home schooled students. We only meet once a week for an hour for class (they have an hour with another teacher for lab), but we use moodle during the week to communicate and I give them assignments etc this way. Anyhow, we’ve gotten to the “Nutrition and Digestive System” chapter. EEK! It’s making me crazy. It’s based on the food pyramid and extols the virtues of canola oil, corn oil, and a grain based diet. Because I have such a limited time, I really won’t be able to dispel all of this nonsense. Last week (while talking about the nervous system) we already got into a conversation about some of this as I was talking about how essential good fats were for proper nervous system functioning – some of the girls were freaking out about the “saturated fats” I was talking about. I was also explaining about how sugar can cause problems with the nervous system and one very athletic male student said he’s prediabetic and has a very fast metabolism so has to eat sugar and carbs because of his metabolism. I tried to explain that he could avoid the prediabetes progressing to type2 diabetes with dietary changes. Anyhow, all of this to say I want these kids to learn more about nutrition than what I can pack into next weeks lecture, most of which needs to cover the digestive system.

    Do you know of any resources, articles or online movies/clips, on good nutrition that would be appropriate for a high schooler? Thanks for taking the time to read this long comment!

    (reply)
    • Peter Attia  December 7, 2012

      I don’t off hand, but perhaps someone else does.

    • Michele  December 7, 2012

      Hi Trisha,

      Would approaching it from another angle – i.e. carbohydrate intolerance, be helpful? Perhaps it is more straightforward explaining why/how many people are carb intolerant instead of explaining why saturated fat is good and how sugar can cause problems with the nervous system???

      In any case, there is a short presentation I put together for my aging parents on what carb-intolerance is given that my father was recently diagnosed as a Typ II. It is floating around in this blog somewhere but I cannot seem to fish it out with the search….it is on a file sharing site called “The Box” and if you search for “Carbohydrate Intolerance” I’m sure you’ll find it.
      Good luck! Michele

    • Trisha Gilkerson  December 10, 2012

      Thank you Michelle! I will look for it :)

  87. Joe  December 18, 2012

    Hi Peter

    Great post, i think its nice to see that everyone online is in fact human and live ordinary lives too!
    For sure your daughter is eating much better than I did at that age.
    Just wondering what your thoughts are on why it seems to be an innate response in us to seek out sugary, high-carb foods if in fact we need relatively minimal amounts to survive at an optimal level of function (ie your diet of <50g/day carbs). Why did we evolve to seek/enjoy sweet foods, which are typically high sugar and thus a food not necessary for survival?
    It seems humans are programmed to seek and thoroughly enjoy high-carb foods from a very early age.? (which the food industry has identified and milked). I only thought of this as it seems your daughter who rarely eats much sugar still enjoyed copious amounts in a short space of time.
    And I know I was the same, numerous fillings at the dentist!

    (reply)
    • Peter Attia  December 18, 2012

      Joe, this is a question that would require a great length of time to respond to properly and many others have written about it. Stephan Guyent has written a lot about this idea of certain food (e.g., sugar) being “hyperpalatable” and addictive. There is a lot of neuroscience evidence supporting this. Of course, this area is debated for reasons I won’t go into here, but I do think there is a growing body of evidence to suggest that sugars may be doubly bad.

  88. Kristin  December 28, 2012

    Peter,

    My husband and I have been following a ketogenic diet since discovering your website and the wealth of knowledge contained within. I might add that we’ve both met with great success with this type of diet, but we’re about to embark on a totally new journey together – parenthood. I’m 6 weeks pregnant with our first child and it seems that the literature is pointing against a ketogenic diet for me. I would assume that you and your wife follow a similar eating regimen – perhaps you could shed some light on my options for maintaining some kind of consistency throughout the next 8 months while still giving the growing baby all the nutrients needed for proper development.

    (reply)
    • Peter Attia  December 28, 2012

      Congratulations, Kristin, to you and your husband. The literature on ketosis and pregnancy is so spotty I would just assume there is none. I can’t really tell you what to heat, but if my wife were pregnant, should we consume a modest-carb, very low sugar diet. The carbs would be low GI carbs, and she’s get appropriate amounts of SFA, MUFA, and PUFA. Normal protein. Only really limit, therefore, would be sugar and high GI carbs. Fats would fill the gap, but not ketotic.

  89. leslie  January 10, 2013

    Hi! I´ve been reading your articles and find them really interesting as I´m also very concerned on giving my children a healthy diet. I´ve been reading a lot on how terrible milk is and how after the age of 2 we dont need it (this would include dairy). What´s your opinion on this? I stopped giving milk (not cheese ) to my children after 2 and give them rice milk, but now reading all this on carbs and sugars I´m not sure anymore!
    Thanks!

    (reply)
    • Peter Attia  January 10, 2013

      I think it’s best to scrutinize the research on how bad milk is.

  90. Jenny  January 11, 2013

    Thanks for your good work. I just came across low carb diets in the past month through triathlon podcasts, and have now read all I can get my hands on (including Gary Taubes, Lustig, Phinney and Volek). I have a 9 year old son, who is a bit chubby. After reading all that I have, I suspect that he is very sensitive to carbohydrates. I have a history of obesity in my family, and he has always loved sugary, starchy foods more than the average kid. (And obviously all kids seem to – but observing him and my daughter around other kids – he has a super sized sweet tooth. She is much more typical). We have always fed whole foods, healthy diets, but every chance he has to eat sugar, he eats as much as he can. (We tried to manage it rationally, as you have with your daughter. But he’s been really drawn to the sweets.) Grade school has been extremely challenging. It seems that every other day that is some event deserving of sweet treats in the classroom. The school discourages it, but the other parents all want “special days” for kids birthdays or think “kids should be kids.” It’s frustrating.

    Since reading these books, I’ve switched to whole milk, and encouraging higher fat meals and further reducing carbs. But with the outside opportunities for junk in grade school, it is a real challenge.

    (reply)
    • Peter Attia  January 12, 2013

      I can not imagine. I guess you do what you can and hope a change at home offsets the horror of school feeding. Even if you could eliminate sugar, without worrying about non-sugar carbs, it would likely help.

  91. Amy  February 17, 2013

    Hi,
    I just started the low carb high fat diet 2 months ago. I limit myself to 20-21 carbs a day. I check my ketones but am rarely in ketosis. I try to be more and more precise in checking the number of carbs but think I must be off somehow.

    I eat as dessert of pecans and Calif walnuts, missed with cinnamon with whipping cream or sour cream.

    I love the steak with butter salt and pepper.

    I have been having colds and lung infections (allergy? asthma?) ever since I started this diet. I had not had a cold in years. So I’m taking inhalers, phlegm looseners and Benadryl a lot. Even supersweet Nyquil once.

    I did cheat yesterday. Had a croissant from the new local French bakery. It tasted like super sweet paper.

    (reply)
  92. chris kimpton  February 18, 2013

    Hi Peter, having recently realised that my previous low carb attempts were simply not keto enough and that now i’m doing it right it’s totally amazing, i want to get better information when looking to put family members on the diet. My son is autistic and epileptic, i think that putting him on a keto diet could be very helpful in quieting down the ‘noise’ in his head. My wife is quite against this but is slowly coming around to it. when we do try i don’t want any errors in approach to allow those against the idea to decide that it’s not worth the effort, otherwise we may never see a result.
    So my question, can you recommend anyone or any resouce to help us plant this transition in advance?

    (reply)
    • Peter Attia  February 19, 2013

      I would first start by looking at the data for epilepsy in children. Look at the work coming out of Hopkins and Boston Children’s Hospital (the 2 leading centers).

  93. Jill  February 26, 2013

    Hi, thank you for a fantastic blog, I just found it! I am an MD in Sweden, just discovering low-carb, or actually LCHF as we call it here, low-carb-high-fat, (much like what you are eating it seems) and I am going through a lot of great benefits for my health and are having all those “aha!” moments that other MD’s describe when the pieces are finally falling into the right place. One of the things that motivated me to look into LCHF was the things my daughter chose to eat from the time she was introduced to food at 6-12 months. I have always tried to be guided by her reactions to food, when deciding what to serve, and not to “push” anything. She ate meat very early, and loved butter (but licked it off the bread and left the bread), ate cheese and a lot of vegetables and fruits gradually but also pasta (and a lot of juice and gradually lemonade). She didn’t even like candy until 3-4 yrs old. She refused to eat processed “jar-food” so we had to make our own pasta sauce on mostly ground beef ourselves from the beginning.
    So now she is 4,5 and my husband and I started cutting down on carbs a few months ago, but are now down pretty low. We reasoned much like you and your wife and decided to just start serving water or whole-milk for our daughter (which we did a lot earlier too) and serve the things that were pretty LCHF that she liked already, cheese, ham, butter on thin slices of bread with bell pepper or cucumber (she still mostly eats the butter :D) and just leave out sweetened yoghurt, juices etc. She asked for yoghurt the first morning, but we said we ran out. Then, amazingly enough, she has not asked for it any more! At dinner she eats what we eat (eg meat, fish, poultry, salad, vegetables low in carbs, butter- or cream (40% fat)- based sauce etc) but additionally some pasta or rice. She asks for an ice cream occasionally and then she gets one. But it is interesting how she is starting to ask questions spontaneously now, like -Why don’t you eat pasta anymore? and so on, and I simply answer that I found it was making me feel bad in some ways so I think I am better off without it. Then, of course, she wants to know if it is dangerous to her and I just say no, you are growing. But when she asked about candy, I answered that I think it is ok if children eat it sometimes but that it is not at all good for “your body to work well” (health is a concept she cannot yet understand of course) and she seems to take that in and has only asked for candy once or twice the past 3 weeks. So I totally agree with you that being an example, eating and feeling well, enjoying food, and not “banning” foods for the kids, might be a good way if you start early. If they are older I guess it is much more complicated for them to find their “way back” to more healthy and, perhaps, instinctually prefered foods.
    I think this will be a life-changer for me (in ketosis now and had the most chocking experience with dramatic increase in performance yesterday when out walking) hopefully I can work with LCHF in the future, I wish you all the best with the NuSI!

    (reply)
    • Peter Attia  February 27, 2013

      Jill, I’m sure by now you’ve also discovered Andreas. No doubt, you’ll want to connect with him also as one your peers!

  94. Amelia  February 28, 2013

    Hi Peter,
    This is a great blog and an important post. I just read through all 197 comments and it was a breath of fresh air to be amongst so many like minded parents. I’m an acupuncturist, specializing in treating infertility and one of my professional goals has been to educate my patients about the importance of a truly healthy diet before conceiving their baby. Once they’re pregnant, I send them home with books and information on feeding their baby.

    I have a 9 year old son and a 1 year old baby and I’ve always viewed how I fed my family as one of my most important jobs as a parent. Many parents have shared how they feed their kids and educate them about food here and I enjoyed everyones’ posts. Thank you! Since my older son was a baby, I’ve talked to him about food and why we don’t eat junk. Somehow he absorbed that information and has made good decisions on his own since he was 3 years old in preschool.

    Unfortunately, I couldn’t trust my son’s teachers to prevent him from eating junky snacks brought in by the parent helper of the day, so I had to train my son. If a mom brought in cupcakes, he would ask her if she made them. He didn’t eat store bought cupcakes. He refused the juice and asked for water. I was most proud of him for refusing Goldfish. The teachers were shocked and were sure to tell me that he opted for the alternative snack that day.

    At a birthday party, they had a Thomas the Train store bought cake when my son was about 4 years old. He chose to have some cake and when he pooped blue poo, he freaked out. I’ve always told him and showed him the artificial colors used in candy and sweets and described it like a kind of paint. He came running out of the bathroom and told me that the blue paint from the cake was in his body. He was horrified.

    We’re not purists, but we try to be conscious. Most importantly, I want my son to understand what is truly healthy food and what’s not, so that he can make his own decisions. My husband is a chef and we cook his school lunches. One of the lunch monitors is always commenting on my son’s healthy, gourmet lunches. We eat real organic, pasture raised food, consume raw full fat dairy, cook with coconut oil and palm kernal oil, and avoid grains and beans (mostly). We don’t consume sugar or wheat. My husband and I don’t consume bread, pasta, potatoes or rice. We give the kids non-wheat based starches. We love all fat!

    I have started using Xylitol when baking with soaked, non-wheat flours and I wonder if anyone has experience or information on the use of Xylitol. I don’t do it often, but when I want to bake a treat occasionally, I’ll use it. I don’t use it in anything else really, as I want us to be able to appreciate the taste of Earl Grey tea or hot cocoa without needing it to be sweet. I try to keep the baked goods from being too sweet, of course. When I was a kid, I used to bake a lot with my grandma, so I love baking for my boys, and I appreciate the challenge of using the soaked, non-wheat flours.

    Another thing that we do is make kombucha, milk kefir and water kefir for the beneficial flora. I try to let them ferment for ages, so use up the sugar, but I’m still concerned that we’re probably getting too much sugar from these drinks, even though they aren’t really sweet. Does anyone have experience with kombucha or water kefir? The sugar issue is really bothering me with these, but I like the other health benefits.

    We went to Disneyworld for my oldest son’s 7th birthday and that was crazy! It was the worst food selection that I’d seen in a long time. We stayed at a Disney resort, so we were eating in the main cafeteria in the morning. We ate scrambled eggs. Next time, we’ll stay in a condo and cook breakfast and bring some food with us into the park. What a carb fest!

    In terms of letting our son be a kid, we let him make his own choices to a certain extent. He eats the crap at birthday parties if he wants to or at other social functions. Sometimes we go out for an ice cream or some other treat. He gives his Halloween candy to the Halloween witch in exchange for a gift (kind of like the Easter Bunny.) The Easter Bunny generally brings a nice chocolate treat and he usually takes a month or two to consume the 4 oz of chocolate.

    I don’t believe in subscribing to super strict diets like a religion. I think that each person has to find what works best for them. I like that my son thinks about his food and he understands the direct connection to his health. He’s not perfect and neither am I, but we both know when we’re eating something that’s not good for us. I think that being informed and proactive regarding food and health is crucial in today’s world.

    Thank you Peter for starting this very important conversation. It’s my dream to be able to host some of the great food films that are out at my son’s school and encourage a dialogue similar to what has happened here. I look forward to learning more from you in the future. Warmest regards.

    (reply)
    • Peter Attia  February 28, 2013

      Amelia, thanks very kindly for taking the time to share your experience.

  95. Jill  March 4, 2013

    Yes, definitely! Thank you also for sharing your story about back-pain, very important, and I also know how much one learns from such experiences as an MD. All the best to you and your family!

    (reply)
  96. Michelle  March 18, 2013

    I really enjoyed your take on LCHF, even for children. I have been eating LCHF for 2+ years for health reasons( ie losing weight). I have been very successful so far. I have been told by many not to have children eating this way, that they need these carbs for nutrients and growth. But I have read you blog and two others stating the opposite. It is a relief to me. My son is short in stature but he is only 10 so I am sure he will grow a bunch when he starts puberty, as that is how his dad and one of his half brothers grew. Both 6′ Tall as adults. My only concern is what is a good amount of protein for kids in general eating this way? I know how much I should be eating, but not sure how much protein is a good rance to start with. Or what percentage of their diet should be protein and fats. I just want to do it right the first time. We have started to reduce the carbs down in general already. To 1-2 servings daily( starchy). Eventually would like it to be once a week, and the rest of the week carbs from fruits and veggies. And by once a week I don’t mean a binge day, just a regular portion. I just want them to eat healthier and grow up with a healthy attitude towards food and be able to make healthy choices. I used to eat very horribly over processed food. I hated veggies, didn’t eat fruit barely ever, and had non celiac gluten intolerance since a child I never knew why I was ill all the time until 2 years ago until I went on atkins. Because all the stomach aches, gas, and frequent bathroom trips went away. My daughter has the same issue with gluten, so the kids eat brown rice noodles when they have pasta. So if you know of a general percentage range that might be good for a preteen and a teen for protein that would be awesome if you could let me know….or if you have a link to another source that explains it. I know how to do low carb…I have read lots of bookss on it and have put it into practice for me. But they aren’t adults, and I just want to be safe. Great info on your site! I really appreciate it. It was just what I needed to read today!

    (reply)
    • Peter Attia  March 19, 2013

      Michelle, it sounds like you’ve found a great balance for your kids. In my limited experience, children start out a bit more insulin sensitive than adults. I think if you can just keep their consumption of sugar and highly refined carbs to a minimum, the rest will take care of itself.

  97. Nicole  March 20, 2013

    Hello Peter,

    I am a pediatric speech-language therapist in private practice in San Diego that works with lots of children who have significant neurological impairments, many of them also have significant emotional regulation issues (e.g., anxiety, attention difficulties). I believe for many of these children their diets have a dramatic impact on the severity of these symptoms. I am amazed and very concerned by the lack of recognition that parents have about how their child’s diet impacts their behavior. As a parent myself who recognizes the huge impact my kids’ diets have on their health and behavior, I also know how difficult it is to have your child stick to the type of diet you know is best once they enter school. It is truly astonishing to see what children eat at school. It is also incredibly frustrating to watch my children make poor food choices offered to them by their friends. I am passionate about the need to educate children about the importance of choosing healthy foods for themselves.

    Do you have any recommendations for an experienced, pediatric dietician/nutritionist that we can recommend to the families we see?

    Thanks for sharing your insight and information!

    (reply)
    • Peter Attia  March 20, 2013

      Nicole, unfortunately, I don’t. I wish I did, because I would also ask that person to spend time at my daughter’s school, where apparently sugar in the form of candies, juices, and cookies are part of the official food groups. I’m sure such entities exist, but I’m not sure where they are, especially locally.

  98. beth  March 27, 2013

    Hello Peter and readers–

    Great blog and I really appreciate that you find time in your obviously crammed life to do this. Thanks! It’s truly important work. I have a seven year old and three year old twins, all girls. My husband and I are LCHF eaters with an emphasis on local, grass-fed animal products whenever possible. I used to be a whole-grains, low-fat vegetarian but I came to this way of eating after having gestational diabetes with the twins and never truly pulling out of it (still very glucose-intolerant– having children in your 40s is hard on your body but that’s another story).

    Anyway: It is REALLY hard to get the kids to eat this way since they all seem predisposed to crave pasta, bread, and sugar and that’s what surrounds them in this world. But we’re trying and I guess my mantra is “baby steps”. I too am extremely curious if anyone– Peter or a commenter– has information on whether or not low carb baking fits in this regime. I have been making some cakes, cookies, etc using almond and coconut flours, butter, eggs, and using stevia and erythritol as sweeteners. They have been well-received and seem like a way to wean the kids away from sugar-laden treats. Good idea or not? Opinions? Data? Thanks so much!

    And finally, yes, the school food system sucks on so many levels and in so many ways that we simply must change it!

    (reply)
    • Peter Attia  March 27, 2013

      My wife has found a way to use almond flour with a tough of xylitol to make astonishing stuff that I nibble on from time to time and our daughter seems to like. I still think if you can keep sucrose and HFCS out of your house, the steel cut oats with raisins and the pasta with homemade sauce is fine. Hopefully you’re catching them before it’s too late.

  99. Nancy  April 12, 2013

    I read your article but did not read through all the comments. So I apologize if I am repeating anyone. My daughters are 18 and 21. I eat low carbs but have not converted them. My older daugher is more open to eating more good fats, avocados, olive oil, bacon. But my younger daughter is overweight, in college, and her eating habits are atrocious! They will both be home this summer. Any suggestions on how to convert and convince?

    (reply)
    • Peter Attia  April 13, 2013

      Start with the convince part. Unless they want to change… They’re not kids any more, as you know.

    • JohnK  April 14, 2013

      I agree with Peter’s comment – you can’t force change on your adult children. I have two sons about the same ages living at home, and I make it a point to always have a lot of high-fat meat and eggs around, and since that’s about all I eat, and losing a lot of weight and feeling great in the process, they’re learning the benefits of eating that way. Also, they’re now eating more of that kind of food since it’s generally readily at hand, so their consumption of, say, pizza and pasta had declined considerably.

  100. Roshni  June 26, 2013

    Hey Peter,

    I just watched your TedMed talk. It was beautiful, and I’m not
    even talking about the science.
    I’m a product of Hopkins myself, but have never seen such
    humility anywhere, in or around Hopkins. Kudos to you, for
    being able to change your outlook towards your patients.
    I’m guilty of the same. I come from a family of overweight
    people. When I started gaining weight without any change
    in my diet is when I started to feel terrible about the notions
    I had harbored about my family members.

    Anyway, I’m a vegetarian by choice now. Although my staple is
    rice, I have desisted it and shifted to whole grains – Quinoa,
    Oatmeal, barley etc. when I do have rice, I eat only brown rice.
    I have been able to cut down on fat a lot, using only spray oils.
    I have totally cut down my salt intake. My sources of protein are
    eggs and legumes(beans and lentils, And off course quinoa!) I
    eat a lot of fruits, including bananas (with my old fashioned
    oatmeal and raisins, every morning), apples, pears, peaches,
    all berries, plums.
    Being from India I know the high sugar content of mangoes.
    So, I try to have it only a few times in summer. I eat loads of
    veggies in salads and curries.

    Despite all these changes to my diet I do not seem to be
    losing weight. Any insight ???

    Do you have any suggestions I need to make in my diet
    as a vegetarian. I need to lose about 40 pounds to reach my
    desired weight of 130 lbs. I also want to participate in a
    marathon. So, any suggestions you are giving should allow
    me to train for this too.

    (reply)
    • Peter Attia  June 26, 2013

      There is a lot of compassion there, I know it, but sometimes it’s hard to find, in any hospital. I worked with a number of amazing and compassionate people there. As for your question, it’s tough (for some) to find the right balance on a vegetarian diet. Though for others, it seems to work very well. There is at least one study going on right now that is looking at genetic and epigenetic markers to help understand this phenomenon.

  101. Devona  June 27, 2013

    Great post, thanks.
    I pretty much agree with all you say, but we do take it a bit further with our 2 girls (almost 4 and almost 6). Some of it is necessity for my health (being Celiac triggering from gluten and corn), we keep the house almost totally grain free — with the exception of organic frozen corn (fresh when available) and very rarely rice noodles for the girls. When it comes to birthday parties I bring the girls their own cupcakes and grain free pizza (yay for Against the Grain frozen pizzas!). I also bring along 2 organic lolipops in case a sugar treat is given. I’ve been talking to the girls about bad/toxic chemicals in our food for so long that they typically take it in stride. We have gone to Disney many times (we lived in FL) and I would bring lots of food in a cooler for them to eat plus bring a bit of organic lolipops, or organic gummies — but only very special occasions do they get this junk (as even the organic is junk, just w/o the chemical food colorings and GM sugar!). We do full fat raw milk, and farm sourced pastured meats. However, it isn’t all rosey, my little one is definitely a sugar/carb addict and only wants the junk; it is also about impossible to get her to eat meat and she’s just given up the milk too! So, we just keep trying, offering and explaining that she must eat her meat and veges to be strong, healthy and happy. Happily raw milk yogurt smoothies (where I can hide egg yolks, soaked nuts/seeds, and more) are a hit — my Vitamix was so worth it!
    Thanks for the great work!

    (reply)
  102. Joyce  June 28, 2013

    What a great post! This has now become my very favorite website. Thank you so much for your contributions.

    I was slim all my life until I bought into the low fat dogma in the early 1980’s, leading to OBESITY. But I kept doing it because my doctor and every diet book out there at the time told me to eat low fat, high carb. And man, I counted every fat gram.

    And they say the definition of insanity is doing the same thing over and over again and getting the same results.

    Thank goodness I came to my senses. I will be 60 this year, but better late than never. So grateful for Dr. Rob Thompson, Gary Taubes, and numerous others for waking me up and helping me regain my health. And my husband’s triglycerides have fallen into a normal level ever since abandoning high carb/low fat, and sugars!

    Keep up this great website! Thanks!

    (reply)
  103. Jehefinner  June 29, 2013

    I also recently saw the TED video, and m now devouring the blog, it’s brilliant, and I’m loving it. I’ve been Low Carb for several months and the change in my weight and energy is obvious, people are commenting on it! (I wasn’t actually very overweight before, but my body shape has changed, I’ve lost my “middle aged spread”)

    I am gently tweaking my childrens eating habits, I’m coeliac so our we rarely have wheat in the house anyway, but I’ve consciously reduced their consumption even further. Our only failing is my baking. I bake killer (gluten free) cakes and cookies, and I’m now reducing this to special occasions, rather than a regular weekend activity.

    So, now that you’ve started this ball rolling, when are you going to take on the Baby Formula industry? And puréed weaning foods? Our Western eating habits need to be re-written from birth, how we expect our children to grow into healthy adults when they are fed on modified cows milk and slops as babies is beyond me!

    (reply)
    • Peter Attia  June 29, 2013

      It breaks my heart… 6 months old babies, whose parents have the best intentions, can easily give their children 50 gm of sugar a day via formula and pureed food. Fat phobia has some pretty tough consequences.

  104. Jehefinner  June 30, 2013

    Hey Peter,

    Thanks for the speedy reply! When it comes to baby formula and pureed foods the sugar content isn’t the only issue. Breast milk is very sweet, with high levels of lactose, but a baby that’s nursing on demand will tend to eat little and often, rather than the huge volumes at 3-4 hourly intervals you see formula fed babies being given. This raises the issue of appetite control. An 8oz bottle of formula will stretch the stomach of a 5 month old baby, but it’s quite common to see babies as young as 3 or 4 months being coaxed into finishing this amount of milk from a bottle. Feeding pureed weaning foods also over-rides appetite control, a baby will eat far more pureed food when spoon fed than if they are given whole foods and allowed to feed themselves. ( http://www.rapleyweaning.com/ ) Add to this the fact that most pre-prepared “jars” are bulked out with various carbs and you are setting a child up for over-eating and carb-cravings.

    I look at this stuff from both a scientific and common sense point of view. I ask; What did our ancestors eat? The answer to this is simple, meats, vegetables, nuts, seeds, fruits, and very little if any grains. Cave men didn’t feed their babies on the milk from another species, or mush up baby food (very few magimix blenders have been found in archaeological sites!) yet their children grew into adults and they had healthy teeth, the research done by Brian Palmer ( http://www.brianpalmerdds.com/ ) shows this. If we think about what evolution designed us to eat, and add our modern scientific thinking to the concept, we won’t go far wrong.

    Keep up the good work….

    (reply)
  105. Idil  July 8, 2013

    Hi Peter,

    Thanks for the candid post. It’s heartwarming to read about the wisdom of sugar reduction from kids’ diets. I have 2 young ones (7 and 5). Our family is working on some of the same dietary challenges.

    My question [bluntly] is “how low-carb is your wife’s diet”? I was recently on a very carb restricted regimen after having gained about 15 pounds with a back injury. My hormonal cycles went haywire. I was told it was probably because of all the estrogen being released from my fat cells and that it was temporary, but things got bad enough that I ended up adding fruits to my diet while still restricting grains. All is well now, but the experience left me wondering whether the female body responds differently to extreme carbohydrate restriction.

    Any ideas?

    (reply)
    • Peter Attia  July 9, 2013

      My wife (and daughter) probably get 30-40% of their calories from carbohydrates, though very few are what I call “cheap” carbs. Lots of fruit, vegetables, limited grains.

  106. Jessica  July 10, 2013

    Dr. Attia,

    I’m so excited I found your site. I have thought for years that obesity is the result of insulin resistance. I am insulin resistant and was diagnosed with PCOS when I was 23. (I am 39) I try try try to eat clean and sans grains at least Mon-Fri – it is very hard, but I’m pretty good at it. Lost about 10 pounds this year and I must say I started Metformin – 500 mg per day and it has helped me – really control that need to eat more. I am VERY resistant. (I’ve tried to up it to 1000mg and my stomach can’t handle it) Very sensitive to carbs. My BP and cholesterol are all very good though. Just need to lose 20 pounds. I digress. My post is actually a question about nitrates. I have 2 small kids and have read negatives about nitrates and children in particular…linking them to cancer. I started buying uncured nitrate free deli meats and bacon. My hubby is from Italy and my kids could eat salami all day long. It freaks me out with the nitrates and was just wondering if you could address that. Do you buy nitrate free or do you not worry so much about that? Especially when it comes to your daughter?

    (reply)
    • Peter Attia  July 10, 2013

      Jessica, the evidence implicating nitrates is pretty weak in my opinion, but it’s always reasonable to invoke the “precautionary principle” — what is the risk of avoiding X? In the case of dietary fat, for example, this has shown to be problematic, as one tends to substitute simple carbs for fat (a la the U.S. population since the 1970’s). In the case of nitrates, though, it seem reasonable if you can afford to be the more expensive stuff.

  107. chris kimpton  July 10, 2013

    Hi Peter,

    i didn’t see your response until today, thanks. i wanted to update you and anyone else in this world. Oliver has done amazingly well on a keto diet. I cannot describe the change in his development and people would really need to understand him to see what has happen on the autistic front. for the epilepsy we have dropped his meds slowly and are currently at 1 third of the levels and due to drop again next week (we make a small change and wait a month to see if there are negative affects, when we tried this before changing his diet he had a 150 minute seizure, few can imagine what it feels like as a parent to watch you child have a fit to two and a half hours)

    Anyway, the cost saving to us in medication is over $300 a month.

    He has also put on weight and bulked up with muscle. this was a very interesting side effect as our biggest worry was he would get too skinny (after all most people here including myself went keto to lose weight). He is incredibly healthy. i just wish my wife would let the other kids eat like this.

    thanks peter and keep up the good work.

    Chris.

    (reply)
    • Peter Attia  July 10, 2013

      Wow, Chris. Very interesting. Thanks for following up.

  108. M. Fourticq  July 11, 2013

    Once sugar is introduced to your body it starts to become an addiction like drugs.

    (reply)
  109. Nina Winkler  July 12, 2013

    Hi Peter, thanks for your talk on TED, very moving. I was wondering what you are thinking of the China study and veganism? Thank you, all the best to you! Nina

    (reply)
    • Peter Attia  July 12, 2013

      Nina, I’ve commented on this a few times throughout the blog, both on comments and directly (see the post on red meat, for example).

  110. Sarah Balfour  July 29, 2013

    Hiya Peter,

    How I WISH we had somebody like you here in the UK! Our ‘healthcare’ system is… Well, it isn’t – and I’m suffering because of it!

    I lost 22.5st (315lb) eating LCHF. Prior to that, I was 30 stone (420lb) and before THAT, 24 stone (336). Why the 6 stone (84) difference…? Simple. Before I learnt ‘The Truth’ as I call it, I was sent to a diabetes dietician (I have PCOS and, probably because of that, I was MO and diabetic). She had me on a strict 1,200kcal/day diet, of which around 80% was carbs (and you know the rest…). She also insisted I swap cows’ dairy for Alpro (probably the UK equivalent of your Silk) because, she assured me, it would “vastly increase and speed up” my weight loss. Not only was I to drink soy milk, I was to eat soy ‘yoghurt’ and eat soy ‘cheese’ (it’s DISGUSTING stuff!). I quit it the nanosecond I learnt what it was doing to my body, but it was obviously FAR TOO LATE as I’m now suffering from hyperthyroidism.

    Three years ago, I was admitted to hospital with severe abdominal pain; as I don’t have an appendix anymore, there was only one thing it could be: – gallstones! I was ordered to eat a VLF diet which, obviously, I flatly refused to do. Anyway, they seemed to settle down again, and I went on my merry way eating as I have done for the past 8 or so years.

    Last year, I began passing out after I’d eaten, and my pee looked like very strong tea, so I surmised I’d got one stuck in my common bile duct. I went to my GP and told her what I believed the problem to be. Now, stupidly, I made the mistake of telling her how I’d lost weight (it’s an all-female practice and they are ALL pushing obese, or obese!) so the first thing she said to me was “I’m not surprised! You’d not be suffering like this if you’d done what you were told to do!” She was right about that – I’d probably be suffering far, far, FAR worse!

    I’ve been told that I CANNOT have any further treatment UNLESS – AND UNTIL – I’ve been adhering to a VLFD for “at LEAST 6 months” which, obviously is something I won’t be doing not now – not EVER!

    So, I’ve spent the last 2 years (almost) confined to bed. My diet sucks because I’m in too much pain to repeatedly climb the stairs (if I do have to go downstairs, I’m crawling down backwards and vice versa). I’ve been forced to live of things in tins (tuna, sardines, mackerel, salmon mostly) and I can manage to eat goats’ double cream (48% fat) and sheep’s yoghurt (4.8% carb/5.8% fat) but by far the worst thing I eat is mayo (it’s made with rapeseed and EVOO, but it’s still not good…).

    I’ve had to watch the muscle I spent YEARS acquiring melt away, I’m losing my hair, I’m permanently exhausted (not fatigued, but lethargic), I’m living in the bathroom, I’m constantly hungry (everything I eat just just goes straight through me – I look permanently 6 months pregnant!)

    If all that wasn’t bad enough, I’m also severely autistic, and I get NO SUPPORT from ANYONE – and especially not from my folks (they’ve made it quite clear they’d really rather I didn’t exist). Despite the fact that they WATCHED me lose weight eating LCHF, they STILL refuse to believe it’s healthy (so concerned was my dear mama about it that she asked her GP whether it was healthy – and you can guess what her response was!). My folks believe EVERYTHING their GP tells them – they don’t question ANYTHING (without being too graphic, I’m sure if she told them that drinking their own pee was healthy, they’d do it!).

    So, because they’ve been told by their doctor that what I’m doing is basically going to kill me, they refuse to support me (“You can go ahead and kill yourself if you want, but we’re not going to be party to it!”) which I guess, in a backwards kind of way shows they care, I guess – well, either that, or they don’t want to be held responsible for my untimely demise…

    They blame my diet because, to quote my mother again “We don’t eat like you do and we’re perfectly healthy!” “Perfectly healthy” is relative; my father is on 80mg Lipitor and is extremely overweight (no doubt in no small measure due to the statins) and he’s DEFINITELY beginning to suffer from what I call ‘statin syndrome’ – arthritis, memory failure, definite mood changes (he’s always been his father’s son – his father was as irascible as they come! He’s also got this permanent dry hacking cough and I don’t know what else to attribute it to BUT the statins.

    Their diet is terrible; grains, starches and sugars at every meal (cereal, pasta, plenty of cakes, biscuits, granola bars, etc) and my mother is addicted to these yoghurt-coated puffed rice, dried apricot and almond bars; 50g each, around 40g carb. My father will easily eat an entire tube of Pringles in one sitting (my mother thinks she’s being ‘kind’ by fuelling his addiction). I’ve given up on them; I once asked my mother why she was so terrified of fat “I just don’t like to eat a lot of fat, alright…?!” When pushed, I get “It’s just the way I grew up, we didn’t eat much when I was little (she’s 65) and I can’t eat a lot, it makes me feel ill!” So they continue to shove junk down their throats (but, provided it’s low-fat/fat-free, it’s healthy).

    The last time I saw my own GP, she had a LighterLife shaker on the windowsill in her office; now I don’t know if you have LighterLife in the US, but it’s one of those evil MRP diets – and they’ve adopted that stupid ‘5:2′ protocol now (LL STILL refer to the 2 half-cal days as ‘fasts’). If your BMI is more than 30, then on the non-fast days, you have 4 sachets of their artificially coloured, flavoured, and sweetened gunk (containing no less than FOUR types of soy, aspartame, sodium saccharin, and sucralose) or 3 and a bar (the bars are pure junk) and on the fast days, you’re only allowed 2 sachets. Each sachet and bar is just 200kcal. So my GP is, evidently, attempting to do her job on 800kcal a day! 800, nutrient-free, calories at that! I know they claim to contain “all the vitamins and minerals of a healthy, balanced meal – but without all the calories!” but how good the quality of the vitamins and minerals is, I’ve no idea, but I’d suggest it ain’t THAT good…

    The NHS blames just about EVERYTHING on (saturated) fat and/or cholesterol: – CHD/CVD, stroke, type 2 and 3 diabetes, most cancers, liver disease, kidney disease, gallstones – you name it, eating fat caused it. Their dietary advice states that “at LEAST a third of your calories must come from whole grains, and starchy carbs. Yes, “at LEAST”, just as I’ve typed it – in other words, more is definitely better…

    NOBODY believes I’m telling the truth (what’s that Mark Twain quote…? “It is easier to fool a man, than to convince him he has been fooled…” They trot it out in relation to other things, but won’t believe it when it comes to diet!). I’ve FB friends being poisoned with statins, and NOTHING I say will convince them they ARE poison. “Cholesterol is evil and must be eliminated” is the NHS’s mantra.

    I know you can’t really help me, matey-dude, but I’m at the end of my rope – I’m SERIOUSLY considering giving up; 2 years ago, I was a fit, healthy, active 38-year-old – now I’m confined to bed! If I cold afford it, I’d GP private, but I can’t (I’m on disability benefits (welfare)). I’m at the mercy of a system which won’t help me because I refuse to conform (one of my mother’s favourite words). But I’m NOT going to compromise my health further by taking advice which I know damn well would not only increase the size of the stones, but cause me to pile on the pounds again!

    I know of private GPs who used to work in the NHS, but were hounded out for refusing to a) stop advocating LCHF and b) refusing to script statins. You are NOT free to practise, you MUST stick to the rules!

    Right, I need to attempt sleep again now (my parents have a couple staying who have a 6-month-old son – and that kid has a scream like a foghorn!).

    Thanks for reading, I know you can’t help me though…

    Sarah X?X

    (reply)
  111. DareV  August 9, 2013

    Peter,

    how come human milk is made of so much carbs, if carb is bad for us? One could assume that human milk have everything a “young” human needs and that it is ideal for growth and “performance” of a young body. Yet, it have a lot of carbs, speaking in % compare to fat or protein.

    (reply)
    • Peter Attia  August 9, 2013

      1. The needs of a baby are probably different than the needs of an adult. Do you sleep 20 hours per day, for example?
      2. The quality of carbs is the issue. The sugar in milk, for example, is not the same as the sugar in, say, a soda.
      3. Who said milk is bad? If you want to be in ketosis (as an adult), milk can’t be a large part of your diet, but that says nothing about the merit or harm of milk.

  112. Kristin  August 14, 2013

    Great blog! Love all the information you provide here. I am just starting to get really strict with low carbing for myself after losing 36 pounds over the last year by doing around 100g of carbs a day. My husband and I have two boys ages 4 & 6. I must admit, since they have been eating “regular food” (non baby food), they have had a fairly high intake of carbs (my oldest LOVES goldfish lol). They are both fairly picky eaters and while I do try to cut sugar where I can (sugar free syrup, sugar free jelly, natural peanut butter, no juice except on special occasions etc), I feel like I have hit a wall with them and food. They love peanut butter & jelly sandwiches, and my youngest loves fruit snacks and crackers. Any advice on getting two picky eaters to eat more eggs, cheese, meat, veggies, etc? They do love fruit (apples especially, and oranges) but not so much vegetables. Do you know of any sugar free kid friendly food? Like sugar free fruit snacks for example? I greatly appreciate your feedback. Keep doing good things, hopefully the mainstream medicine/weightless industry will come around. Thank you again!!

    (reply)
    • Peter Attia  August 14, 2013

      With kids I suspect the most important rule is this: if it comes in a package, minimize it. More carrot sticks, fruit, snap peas, celery sticks with almond butter, real cheese, etc.

  113. Craig Castanet, D.C.  August 27, 2013

    I have to say, this website has been the most exciting forum I’ve encountered in some time. Dr. Attia, your efforts in personal research, literature review, analysis and writing are so enriching. I get the benefit of a bright, passionate man who spends hours of his time and mind, then distills it all in such an original, objective manner. It is truly appreciated. I’m glad to hear my shared concern over the destiny of this once great republic. We threaten to collapse history’s greatest nation over our pie-hole choices. You may help avert this tragedy; I sure don’t see any other entity who can. We need an informed, valid consensus on our physiologic diet. Though I hope we’ll make these changes voluntarily, with the information. I’d hate to think a government would impose the ideas of whatever most powerful lobby may prevail in coercing their views upon the public. Seems unlikely now, but as we become subjects of the nanny state, government guidelines could evolve so. I always wonder how long before the socialist democracies outlaw cigarette smoking and the like, in the interest of cost savings. Thanks again, Craig.

    (reply)
    • Peter Attia  August 27, 2013

      Thank you, Craig. I’m not sure we ever need to outright remove these harmful agents (e.g., cigarettes), but we sure as hell shouldn’t make them the default. Today, tobacco is no longer the default. I long for the day when we can say the same thing about our food choices.

  114. Tyler  August 30, 2013

    Reading Principle 4, it reminds me of when I switched to high fat, low carb, a little over a year ago. I was speaking with a Dietician about my son, who was 1 at the time. She was asking me what I fed him and I responded that he drank lots of whole milk, which she agreed was good because the (saturated) fat was good for brain development. Then I got to the fact that he consumed coconut oil in the smoothies I made him, and all of a sudden that(saturated) fat was the fat that would give him heart disease. When I asked what the difference was between the fat in whole milk compared to the fat in coconut oil, she didn’t have an answer. Just makes me laugh and even more sad, because unfortunately we have doctors and dieticians making dietary recommendations that tend to contradict each other.

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  115. Matt Carter  September 17, 2013

    Hi Peter
    Your Blog is a tomb of useful information for which I am very grateful.

    My question relates to children with ADD. Andreas posted this http://www.dietdoctor.com/why-20-percent-of-boys-in-america-get-adhd which suggests a link between diet and cognitive function. There was also an article in Psycology Today http://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones which hints at neuro toxicity which is reduced with NK.

    I have a 10 yr old son who is distracted at school and we as parents have seen all the professionals and spent the money and ended up where we started. Our son has been on Ritalin without much success and I don’t believe it results in a healthy balanced child. He is now off the drug and is marginally behind his peers in the classroom. I will be trying to reduce his carbohydrates and follow a NK diet for him testing his vitals and making sure he doesn’t flag in other areas. If you have any opinion on this or any insights I would love to hear them.

    (reply)
    • Peter Attia  September 18, 2013

      Matt, I can imagine this is frustrating. I don’t think we have enough evidence to say that NK is the ideal (or even necessary) treatment in this setting. I do wonder what would happen if you tried something less draconian (though still very difficult in a 10 year old boy) — what about just eliminating sugar and refined carbs? Let him eat steel cut oats, fruits, veggies, rice, potatoes, but none of the “cheap” carbs and added sugars. I wonder if this would improve things in more (dietary) sustainable way? It might be the case that ketones, per se, make a difference. But I am not sure.

  116. Matt Carter  September 18, 2013

    Thanks for your comments, yes for sure that is a great place to start. I have started a blog to document the process, partly to motivate myself and partly to keep track of progress or regress… I have a friend who does a lot of research into fetal alcohol syndrome (common here in Cape Town) who will hopefully help keep track from a neurological standpoint.

    I will start with the sugar, carbs and get a higher % protein and fat into his diet and see where that takes us. Will post a link to the blog once there is something useful to read, thanks again.

    (reply)
    • Peter Attia  September 19, 2013

      Very good to hear, Matt.

  117. Nancy  November 5, 2013

    I just found your blog, and have spent hours reading through various posts. Thank you, thank you, thank you!!!

    My son is 13, 155 lbs, but 5’11 and very muscular now.

    Last November, he was sent home a “fat letter” from the nurse at school, and stated that he had acanthosis nigrans. Now, this child has been swimming 6 days a week for years, but still very chubby. I think he weighed the same as now. We didn’t know better, and spouted the whole carbs etc. that is so prevalent in the swimming world. His pediatrician had never really commented on his height/weight except to say he was off the charts in height for his age, but high in weight. After much panic and another visit to the pediatrician -this time he told us to stop anything “white” flour, sugar, rice etc, and add some sort of conditioning/weight program. He had read “Wheat Belly” by Dr. Davis, and suggested it to me. It was the beginning of a huge life change. Fast forward to this July- last visit showed no acanthosis nigrans. The Dr. almost cried, and said in 20 years of seeing patients, my son was the first patient, to show such a abrupt change. I have searched high and low about how low carb to go with kids, obviously don’t want to slow down his height growth, but have found very little. Reading this post, and all the wonderful comments, just warmed my heart. My friends all think I am nuts, but can’t quite fathom how his body has changed either. Now, the boy isn’t perfect, but he has seen the change food makes in his own body, and performance in the pool. Husband not quite on board, keeps wanting to give him bananas etc., but all I can do is try and educate (and send him a link to this blog!!)

    (reply)
    • Peter Attia  November 5, 2013

      Nancy, your son will be just fine with a mom like you who clearly cares so much about finding out what works best for her son.

  118. Miriam  December 21, 2013

    Hi Peter,
    I am a fellow doc and parent of two little girls 8 and 2. I really appreciated this post because highlights the reality of what we as parents go through and the daily choices that we make that truly matter. I have always struggled with an excess 20 -30 pounds or so. When I had my first daughter (during residency) I felt a deep responsibility to give her the best shot I could at health so she would not have to struggle they way I did. I didn’t quite understand how I should be looking at macronutrient composition at all (despite several graduate courses in nutrition) but I had a few pretty good ideas: 1. keep her naive to sugar as long as possible. (I managed this until about 3 years of age) 2. provide an appealing variety of home cooked-from-scratch- food. 3. When she got old enough, have lots of talks about why we make certain choices.

    I never eliminated foods from the home like chocolate or candy, I wanted her to learn to make the good choices herself and not just make the choices for her all the time. This is a bit of an art and quite an effort but is proving worthwhile. The other day someone offered her hot chocolate and she said “I better not, I had a popsicle yesterday.” I think this was my best ammunition against the onslaught of sugar in school and camp.

    Today she is 8 and has lost all her baby fat :(
    She has a lean and strong body and never stops moving. She loves my lunches (we do a bento box too) and won’t touch school lunch. Today in fact she asked me to pack her a snack to go to a birthday party because “They won’t have any food there that I like.” That was a proud moment. She has had her share of cupcakes, but she is not addicted the way I think I was at her age.

    But before I can declare victory, in walks my 2 year old. She, thanks to big sis, has been introduced to sugar for a year or so already. When she hears the crinkling of wrappers she shouts “CHOCKY!” (chocolate) Most veggies are promptly catapulted from her highchair at whomever had the nerve to present her with them. I was so cocky and I guess this kid had to set me straight. Nevertheless, since reading your blog and a few other things, I have shifted my thinking from fat phobia to embracing fat. I realize that I have a secret weapon. FAT! A hungry 2 year old at breakfast gobbles up eggs with cream. Whipped cream and strawberries anyone? Even cauliflower mashed with cream, butter and cheese at dinner. There is no room/desire for CHOCKY on most nights!

    Life is so hectic and so busy. It’s such a relief to know that my own health issues were not some sort of moral failure. That it wasn’t just a matter of trying harder, running more and eating less. It’s so empowering to know that I can do quite a lot to prevent myself from becoming another example of metabolic disease. My dad has been diabetic for 25 years and I have experienced the toll it has taken. It feels great to know that I can do something for my girls not to have to worry for me the way that I do for him.

    Anyway, that was a long aside. I am grateful to you for your work. As another aside, my area of interest is in cognitive function. I would be remiss If I didn’t mention how many fascinating things could be studied. On a somewhat subjective note, I have found that when in ketosis, my working memory (measured by simple digit span) and processing speed are much better. I think my attention is somewhat better and short term memory is about the same. Neat stuff!

    (reply)
    • Peter Attia  December 22, 2013

      Miriam, I feel your pain. Every time my daughter comes home from school having eaten cupcakes she was given at school…I just want to scream.

  119. Suki  January 4, 2014

    Peter,

    Thank you for your analysis of ketosis related scientific literature. I am devouring it as quickly as I can. Given my specific area of concern, this seemed like the best post to begin asking questions.

    My children (3 and 5 years old) have multiple polysaccharidase deficiencies and, thusly, are on a very low carbohydrate diet. We have eliminated all sucrose and lactose and severely restrict starch. We suspect a potential fructose malabsorption or HFI and are restricting (but not eliminating) fructose accordingly. As you can imagine…they are very carb restricted and will be for the foreseable future. Whike they are carb deprived, I am starving for information.

    I have bookmarked some of the links in the comments above, but am hopeful that you might be able to direct me to appropriate resources, as well. I really want to explore the available research (if any) on nutritional ketosis in children in relation to cognitive and physical development. Much of it (excluding the Inuits) won’t likely address diets that are as restricted as my guys’, but a jumping off point would be invaluable. I should add that I’ve read a bit about ketogenic diets in relation to epilepsy control, but briefly abandoned that for more pressing concerns when I saw their formulas. It didn’t seem particularly relevant at the time, but I intend to revisit it now that I’ve exhausted the body building forums and have run the gamut with Paleo, Primal, SCD, and GAPS.

    I’m not a biochemis (my background is developmental psychology), but I am able to follow (to some extent…once I dust off my A&P and Chem memories) your scientific descriptions in your keto series.

    Thank you, again, for all of the invaluable information and analysis you provide! If your goal is to help people make nutritional decisions…

    You are a very succesful man, indeed.

    Suki

    (reply)
    • Peter Attia  January 4, 2014

      You’re definitely, right, Suki. The formulations in the typical epilepsy protocols are pretty bad, and not at all representative of what a well-formulated KD can look like. Unfortunately, we don’t have great (any?) data on long-term use of KD in kids. My gut says, restriction of sugar and simple (e.g., high GI) CHO may be sufficient without the need for ketosis.

  120. Leanne  February 15, 2014

    Hi Peter:

    I started eating low carb just over 7 months ago and am really doing well with the new lifestyle. I’m losing weight slowly but steadily, so I can’t complain. But that’s not interesting. What’s interesting about me is my family. I have a 14 year old boy and 8 year old twin boys. The 14 year old and one of the twins are Type 1 diabetic (my eldest was diagnosed at 27 months old) so we have been “doing” diabetes and carb counting for over 12 years. There isn’t a lot of sugar in our household (we have NEVER done juice or pop and we don’t do desserts) but we don’t restrict the boys’ carb intake (I tease them that there isn’t a “flour and water product” out there that they don’t love!) One of the main reasons that I decided to start and stick to a low carb lifestyle was that I wanted to model low-carb eating for my diabetic boys. They are all lean and healthy, but as I’m sure you know, injected insulin is not a fun drug to mess around with and the less you have to inject, frankly, the safer and healthier you’re likely to be in the long run. We have just started using low carb as a method for allowing more independence for my teenager (with the idea again that the less injected insulin there is while he is away from us – overnight for example – reduces the risks of adverse side effects). So far so good – I really like the fact that all of my boys regularly remark about the differences between what’s on my plate and what’s on theirs, and they understand that I’m carb restricting and why (of course – my boys have known about carb and carb factors practically since birth – we are an odd family). My question, however, is about my husband. He’s an amazing athlete, 51 years old, VERY lean. He believes in the principles of low carb, but he just CAN’T do it. When he reduces his carbs, he starts to disappear (and he’s already a very small guy – think Tour de France mountain specialist type guy). He needs to eat very regularly throughout the day, and while exercising, or he bonks. He probably works out (hard) 1-2 hours per day, with 3-6 hours on weekend days. So – I guess I’m interested in what your wife eats? I believe you said in your Ted talk that she is a lean athlete as well. Do some people simply need carbs? Is there still metabolic damage being done?

    (reply)
    • Peter Attia  February 17, 2014

      My wife probably gets 40% of her calories from carbs, but probably consumes about 25% of the sugar of an “average” American. He sugar comes in dark chocolate and probably some in the bread she eats. She’s obviously nowhere near ketosis, but eats very well.
      I’d be curious how your boys would do on Generation UCAN’s super starch.

  121. Martin  May 26, 2014

    Hi,
    I want to ask about your record which you mentioned in interview with Andreas Eenfeldt. You have fasted 24 hours and then 6 hours rode. My question is, what pace you went in? 60% VO2 max or more or less?
    Thanks

    (reply)
    • Peter Attia  May 26, 2014

      “Record” isn’t the right word, as they don’t keep records for this sort of thing. I don’t recall exactly, but the ride was hilly and so average power (about 175 watts) is less relevant than normalized power (about 230 watts).

  122. Whitney  May 27, 2014

    Hi Peter!

    I have been following your blog for a good year now and just am so very thankful for the information. I have had personal struggles with inflammation driven illnesses such as rheumatoid arthritis and even a bout of infertility, all of which I believe were cured (I am sure a more comfortable word would be “remission”, but I have to believe I am cured) due to the food I stopped eating (processed carbs, sugar, bad meat, carbs, sugar) and started eating (real food, bacon, raw milk, butter, very little carbs, greens, bacon).

    Anyways, I just had my first child almost 9 months ago and make all of his solid food from scratch and it has occurred to me that no good food options are available for mothers and fathers who do not have the time or perhaps even knowledge of the importance of doing so for their children. I would really like to create a whole food option for babies and toddlers embarking on their first foods that is not a 45 gram of sugar pouched assault on their fragile digestive systems, and I was wondering if I could perhaps treat you to bacon and eggs, or a buttered coffee some day to discuss my idea a bit. Perhaps you would be interested in advising? Or if you could maybe point me in the direction of a pediatrician who shares your belief system that could help advise the creation of such nourishment for the babes? I live in San Diego and would be tickled with even 3 minutes of your time.

    I realize this is a far fetch, but I truly admire and idolize the work you do at both your institute and this blog. I hope we someday can connect. Thank you for your work. It will and is making a difference.

    With love,
    Whitney

    (reply)
  123. Amy  July 15, 2014

    Am reading all the old blog posts & comments as fast as I can trying to learn enough to make good decisions for my insulin resistant 10 year old daughter. We’ve been no sugar and low carb 50ishg/day for a year, but insulin symtoms persisted. Endocrynologist recommended metformin and that seems to be “working” — weight is coming off. Problem is the endo & his nutritionist seem to be hung up on typical whole grain/balanced plate diet. They are “concerned” about our low carb and resulting high(er) fat intake. Is there a good source for nutrition info for insulin reaistant kids that I’m just not finding? I’m piecing things together here and here (as it seems many of your readers are) but wanted to make sure I’m not missing some obvious (or not so obvious) source for info for/about children.
    Thank you.

    (reply)
    • Peter Attia  July 15, 2014

      Metformin is an ideal way to “break through” when hyperinsulinemia persists. Sounds like you need to stick to your dietary thoughts, and let the endo handle the medication. A child, in my opinion, does not need to be severely carb restricted. But sugar–in call forms, solid and liquid–and refined carbs should be out if they are pre-T2D, T2D, or have NASH/NAFLD. We don’t have data to confirm this (yet), but this is best hypothesis.

  124. Claudia  October 23, 2014

    This was very interesting. I eat a KD and before that I was Paleo. My daughter, who is 11, loves to make keto recipes, and she is not strict keto but I never considered that would be a problem for her. I would describe her more as Paleo but she does have occasional grains (pizza at a party but she actually prefers “Fathead” pizza made with a cheese crust) or rice in sushi rolls (she really loves that). The grain treats are limited to occasionally. But, I would absolutely never allow cotton candy, not only for the extreme sugar content, but also because of the coloring. Yikes! I’m surprised that you would ok that one at all. My kids have never had candy before, except for dark chocolate 85% or greater (so low sugar). On Halloween, they are happy to go trick or treating, collect lots of candy, and trade it in for cash at the dentist’s office. Then, they can buy something like a toy. I buy them little toys and dark chocolate bars and we’re good. Just sharing my experience. And no cereal boxes here ever, almost everything cooked from scratch. Challenging for sure but doable.

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