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What I actually eat, part II – “IFIK” (circa Q3 2012)

What I actually eat, part II – “IFIK” (circa Q3 2012)
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Note to readers: This post was written in September of 2012.  PLEASE do not ask me why I eat ‘this’ or why I don’t eat ‘that’ — as what is shown here does not necessarily reflect what or how I eat today (or more importantly, how you should eat).  My diet evolves constantly, due to my constant tweaking and self-experimentation. Over time, I’ll share it here and there, but what I eat is not at all the focus of this blog.  I ask that you refrains for asking questions about what I eat your comments.

 

For reasons I don’t fully understand the most read post on this blog is one I wrote very quickly and with very little thought.  I wrote it in response to a question I’m asked all the time, “What do you actually eat?”  The post, aptly titled, What I actually eat, has more than twice the traffic of the next three most read posts combined. Go figure.

After a full year in “strict” (i.e., no “cheat” days) nutritional ketosis I wanted to experiment with other eating patterns.  I had been reading about intermittent fasting (IF), and had a few discussions and exchanges with Mark Sisson and Robb Wolf about it.  Though I don’t know Brad Pilon or Martin Berkhan personally, I’d also read a few interesting things they had written.

Why the change?

My curiosity was sufficiently piqued to break a golden rule – if it ain’t broke, don’t fix it.

I was very happy after a year of nutritional ketosis, but I did wonder if I could improve on a few things.  For starters, as my cycling season was about to ramp up, I wondered what it would be like to weigh 75 kg (165 pounds) instead of my steady-state weight of about 78 kg (172 pounds).  I know 3 kg does not sound like a lot, but it can make a huge difference when riding up Mount Palomar, assuming one can preserve power output. I also liked the idea of not spending so much time eating.  As you probably know, I’m pretty obsessive about how I utilize the 168 hours in each week and resent anything that takes me away from my family, my work, and my training.  (This includes sleep, which I wish I could figure out a way to thrive without.)

In the end, I think Mark Sisson finally just egged me on enough to agree to at least give it try – even just one day per week.  And with that, I embarked on the next phase of my nutritional odyssey.

I decided, in early May, to start with the following protocol: one meal per 24 hours, twice a week.  On the other 5 days I consumed my usual keto-diet.  On the two IF days I would just eat one meal at around dinner time.  I still consumed normal amounts of liquids (water, coffee, tea) and supplements (see list below), with one exception – on fasting days I doubled the amount of sodium I supplemented via bouillon from 2 gm per day to 4 gm per day.

Like all nutritional changes, this one took some getting used to.  Because I exercise in the mornings, on fasting days I would get pretty hungry by about 10 or 11 am.  Interestingly, though, by about 2 pm, as my blood glucose levels would be between 60 and 70 mg/dL, I would start to feel completely fine.  In fact, by about 5 or 6 pm, just before eating my meal, I found I wasn’t really hungry.  This may have been due to the fact that my B-OHB levels were usually above 3 mM by this time of day.

Why do I call it “IFIK?”

Not surprisingly, after eating 100 gm of protein and 40 gm of carbohydrates in one sitting, my B-OHB levels would fall, often below 0.5 mM, the practical threshold of nutritional ketosis.  Usually within 24 hours I’d be back to my normal levels, generally between about 1 and 2 mM. But, the cycling in and out of ketosis was new to me, hence the phrase “intermittent fasting, intermittent ketosis,” or “IFIK.”  I guess you can see why I didn’t end up in marketing – “if-ik” doesn’t really have a nice ring to it.

The purpose of this post is not to provide a detailed overview of IF or ketosis, but rather to address the following common questions I often get asked in response to the original post on what I ate:

  1. Question: Peter, why do you eat so much dairy?  Answer: I don’t.  That was a year ago.  I did eat a lot of dairy, and seemed to tolerate it quite well. I realize that’s not true for everyone. Regardless, I seem to eat much less today.
  2. Question: Peter, is ketosis for everyone? Answer: Of course not.  Besides oxygen and water, few things are.
  3. Question: Peter, why do you eat so much meat? Answer: I don’t.  In fact, some days I don’t eat any.  Other days I do. I obviously don’t think there is anything harmful with eating meat (read this post for a refresher), but I’m quite happy eating lots of non-meat items, too.
  4. Question: Peter, how can anyone possibly do anything athletic without carb loading? Answer: It’s easy.  Anyone can do it, if they are just patient and let their body adapt (refer to this post for a few examples).
  5. Question: Peter, you eat like a freak (ok, not really a question!) Response: And your point is?

What happened after several months of IFIK?

Interestingly, I did lose weight.  After briefly hitting 163 to 164 pounds, I settled out at where I am right now, about 165 to 166 pounds, right at my 75 kg target.  I have not yet repeated a DEXA scan to confirm, but I suspect I lost a bit of muscle, along with more fat, probably at about a 1:2 ratio.  My last DEXA measured a body fat of about 9%, and I suspect I’m about the same, though my waist is half an inch smaller than when I started, so I may be closer to 8%.

Why do I think this happened?

In the IF community there are really two (maybe more) theories on why I lost weight.  I won’t describe them here in any detail, but will do so in subsequent posts.  One hypothesis is that I’m simply consuming fewer of the same high quality calories than I did before.  The other hypothesis is that the physiologic response to IF (rather than the response to prolonged fasting) is to increase my REE during the period of IF, possibly through the up- and or down-regulation of various hormones.  Of course, it could be a combination of these, or something entirely different, too.

Drumroll….

Before getting to the part that folks who are still reading probably care about, let me point out a few differences between what I eat today and what I ate a year ago.

  1. I consume, on average, fewer calories per day.  I am also lighter, and we know TEE varies with body mass, so it’s not surprising that most days I am not eating over 4,000 kcal, as I used to. Of course, one might argue my body has become more metabolically efficient at utilizing substrate, and so my REE is lower than it was a year ago.  Finally, I do exercise less than last year.  Hence, there are many explanations for this difference.
  2. I consume less dairy. Don’t read too much into this.  There is nothing deliberate about it, just an observation of my behavior.
  3. I consume less meat of all varieties.  Again, don’t read too much into this.  I have no explanation except that I seem to crave it in lower amounts and less frequently.
  4. I consume more overall carbohydrates, though still virtually zero sugar or refined carbohydrates. Most of this additional carbohydrate is in the form of nuts and SuperStarch.
  5. I consume virtually zero sugar substitutes, except for the little bit in my SuperStarch and protein powder (sucralose).  I also drink, at most, about one diet soda per month.
  6. I spend less money on food.
  7. I spend less time eating.
  8. Currently I only eat three meals per day about once a week. I eat two meals per day probably 4 times per week, and one meal per day twice per week.

To calculate the nutritional content of my intake I use a piece of software called Nutritionist Pro, which is not for the faint of heart. It’s one step removed from a DOS prompt. In addition to costing about $600 a year, it’s not exactly user-friendly.  I’d probably describe it as “user-hostile,” actually.  But, it’s really accurate and has a database that is unrivaled.  The reports, once you learn how to generate them, are very good, also.

Three consecutive days of representative eating

Keep in mind, I don’t count my calories or weigh my food normally.  I do it periodically, such as at this time, when I’m curious as to what I’m actually eating.  I believe I’m able to do so without eliciting the Hawthorne Effect, but obviously one can never be positive.

Tuesday
  • 7 am — morning workout – flat intervals on bike (75 minutes).
  • 1 pm – Nicoise salad:
    2 cup butterhead lettuce, 1 tomato, 10 black olives, 8 oz tuna steak, 1 hard boiled egg, 0.5 cup red onion, 2 oz lemon juice, 4 tbsp olive oil, 1 tbsp mustard.
  • 7 pm – Chicken salad with nuts:
    2 cup romaine lettuce, 1 tomato, 0.5 cup cucumber, 2 oz cashews, 2 oz walnuts, 8 oz chicken breast, 6 tbsp olive oil, 2 tbsp balsamic vinegar.

Daily totals:

Carbohydrate – 89 gm

Protein – 131 gm

Fat – 218 gm (about 15% SFA, 70% MUFA, 15% PUFA)

Calories – 2,900

Wednesday
  • 6 am – morning workout – high intensity dry land (90 minutes).
  • 3 pm – The “Peter Kaufman shake” (named after my good friend, Peter Kaufman at Generation UCAN, who hooked me up with the recipe):
    4 oz heavy cream, 8 oz zero-sugar almond milk, 1 pack chocolate protein SuperStarch, 2 tablespoons almond butter, 8 gm additional glutamine, 1 tray of ice cubes (blended to smoothie consistency).
  • 7 pm – Chicken-nut omelet:
    4 eggs, 0.5 avocado, 3.5 oz cheddar, 3 oz red onion, 2 oz walnuts, 2 oz cashews, 4.5 oz chicken thigh, 2 tbsp butter

Daily totals:

Carbohydrate – 60 gm (30 gm of which is SuperStarch)

Protein – 151 gm

Fat – 226 gm (about 40% SFA, 35% MUFA, 25% PUFA)

Calories – 2,800

Thursday
  • 7 am — morning workout – hill intervals on bike (75 minutes).
  • 5 pm – Attia super salad:
    1.5 cup romaine lettuce, 0.5 cup cucumber, 0.25 cup mushroom, 1 tomato, 3 oz sliced T-bone steak, 2 oz cashews, 2 oz peanuts, 2 oz macadamia nuts, 8 tbsp olive oil, 2 tbsp balsamic vinegar.
  • Between 6 and 8 pm – after-dinner snack consisting of:
    3 oz cashews, 1 oz almonds, 2 oz peanuts, 1 oz macadamia nuts, 2 cups of coffee with a total of 6 tbsp heavy cream.

Daily totals:

Carbohydrate – 94 gm

Protein – 93 gm

Fat – 369 gm (about 20% SFA, 65% MUFA, 15% PUFA)

Calories – 3,800

My daily supplements

Note: I am only listing the products I use, and not trying to convince you that my brand of vitamin D is superior to another.  If I feel strongly about a product, I note it. But this is not a product pitch. I don’t make one penny off you buying any of these products.

Fish oil

1 tablespoon of Carlson’s Very Finest Fish Oil, providing 2,400 mg EPA and 1,500 mg DHA.  I do feel this is a superior product and I’ve had detailed toxicology analytics conducted on the product to confirm the absence of lead, arsenic, mercury, and other toxins.

Vitamin D

5,000 IU D3 in gel capsule, by NOW.

Magnesium

400 mg magnesium oxide by Nature Made.

Sodium

2,000 mg in the form of bouillon, typically by Knorr.

MCT oil

Either 2 or 3 tablespoons, depending on activity level, by NOW.

Probiotic

2 capsules of Mark Sisson’s Primal Flora, providing 60 billion CFU.  The reason I use Mark’s product is because I know and trust him, and I know how much homework he did in formulating this product.

One of the topics I’m currently getting steeped in is gut biota, and I’m hanging out a lot with a San Diego expert on the topic, UCSD Professor Larry Smarr, who has repeatedly sequenced his entire gut biome, with the help of Craig Venter at Synthetic Genomics and others at MIT.  As Larry points out, the challenge of “moving the needle” with probiotics is that they only provide the aerobic bacteria while, of course, most of our gut biome is anaerobic.  Stay tuned for much more on this topic.

Closing thoughts

  1. My performance, especially in light of my reduced training volume (or maybe because of it!) has not deteriorated.  In fact, this week I had 3 best times in 3 of the activities I do weekly (tire flipping/sledge hammer/plyometic routine (1:04); short sprint up 15-18% grade (0:39), and long sprint up 8% grade (3:29)).  It’s possible the added carbohydrate, relative to my constantly ketotic state, has facilitated this, despite consuming about 15% of the carbohydrate I used to consume on my “standard American diet” circa 2008.
  2. I will discuss the impact on my biomarkers in a separate post.
  3. The only drawback I’ve noticed of IFIK so far is that I’ve inadvertently turned my daughter off nuts.  About 4 months ago, after having three consecutive identical dinners (chicken-nut-salad), she called my wife into her room as she woke up and said, “Mommy…we need to talk.  We need to have something different for dinner tonight.  We can have steak…we can have sausage…we can even have regular salad without nuts…but I can’t have nuts in my salad anymore!”  Poor girl… So now I have to make my salads separately.

 

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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. Chris  September 30, 2012

    Hi Peter, this question doesn’t exactly relate to the above post, which I really enjoyed reading. My question regards the effects of anti-psychotic medications on insulin resistance and weight gain.

    The first 20 years of my life I was relatively lean and well-muscled, though I always had a small layer of extra adipose tissue. Around my 20th birthday I was put on Zyprexa and Depakote and promptly gained 20 pounds in one month. Over the next several years my weight slowly crept up until I began eating low carb. But even then it was a struggle.

    I’m wondering if my metabolism was permanently altered due to the effects of the Zyprexa, or if it just exacerbated a latent problem that would have inevitably emerged on its own. I’ve read studies regarding anti-psychotics and their effect on insulin sensitivity, and just wanted to hear your take on it.

    Thanks much!

    Chris

    (reply)
    • Peter Attia  September 30, 2012

      Hmmm, good question, Chris, but I don’t know the answer. I have heard others comment on this, but I don’t know enough to comment meaningfully. Perhaps others know?

    • RJ  December 25, 2013

      Chris, I took high doses of Seroquel for 5 years. i later tried Abilify, Risperdal, and Zyprexa ODT. I feel that the drugs have permanently affected my metabolism. I currently take lithium (dx is Bipolar-NOS and PTSD). I feel that he most important things are:
      1.) daily exercise. Try to get high-intensity interval training at least 3-4 days per week. This is important on multiple levels for staying well.
      2.) vegetables and focusing on your gut flora. I try to eat 5 servings of vegetables per day, OR MORE, plus probiotic-enhancing foods like a couple forkfuls of sauerkraut per day. This is very hard for me due to the taste/smell side effects of the lithium, but at least i don’t wake up destroying a jar of peanut butter in the middle of the night, like I used to do on Seroquel.
      3.) long-acting therapy modalities that will ensure long-term success, such as DBT and/or ACT (mindfulness is key)
      The most important thing is to continue treatment and commit to raising your standards for physical fitness and nutrition, as well as treatment using DBT or ACT.

  2. Matt  September 30, 2012

    Peter, have you tried any of your workouts without the superstarch since you have discovered it? If so, what were the major differences in how you felt?

    (reply)
    • Peter Attia  September 30, 2012

      I only use SS during workouts that last longer than about 3 hours, which I only do 1x per week. Otherwise, I’m using SS to replete glycogen (as I’m showing on these 3 days).

  3. Brian  September 30, 2012

    Peter, I had my first blood test with my doctor yesterday. It was very interesting trying to explain my diet to him. Needless to say I did not convince him, but he did walk away knowing I’ve done my homework and wasn’t just a nutcase who didn’t care what I eat. Believe it or not, he runs an NMR test standard so I’ll get to see my LDL-P count which I was surprised and very relieved to find out. He is excited to see the results. One thing that was interesting was that when I told him I expected my HDL to go up, Triglycerides to go down, and LDL-P to be in a healthy range, he agreed with me…. so I’m not sure what the issue was. He got a little defensive at one point and tried to tell me that fat is stored in arteries! He was grasping for straws of course and he quickly admitted he was wrong. Anyway, I should have the results by early next week.

    Oh and one more thing. I told him if he is smart and wants to stay a relevant doctor, he should check out NuSI right away. He wrote it down so hopefully he does the right thing and starts living in the now.

    Thanks for all you do!

    Brian

    (reply)
    • Peter Attia  September 30, 2012

      Great. Will be interesting to see.

    • khan  June 30, 2013

      I was curious to know about your blood test results, kindly post them. I am curious to know what is the effect of low carb and high fat diet

  4. lorraine  September 30, 2012

    What are your ketone levels on the higher carb days (over 60)? Aware of the slight insanity of referring to high carb as being higher than 60…….

    Glad your wife and daughter keep you a bit reigned in.

    (reply)
    • Peter Attia  September 30, 2012

      I’d be nowhere without them… It really depends on too many things to really give an accurate answer. Type of carb (e.g., SS has little effect on B-OHB), timing, amount of aerobic exercise, glycogen deficit…all seem to play a role. Of course, starting level of B-OHB matters too.

  5. John  September 30, 2012

    Peter excellent article as always. I have been living off a Keto diet for about 4 months. I think it’s interesting you bring up this article because I find myself eating the same way coincidently. I will be consistent through much of the week and in days I have long classes I usually eat 2 high fat low carb meals. The first couple months fat loss was effortless, but now it seems my body is starting to preserve fat stores. I think these 2 meal days sort of make my body tap a little further into stored adipose, because without a doubt my body has become an efficient fat utilizing machine. Just my 2 cents, keep up the great work.

    (reply)
    • Peter Attia  September 30, 2012

      Could be…I sure would like to see a few cleverly designed experiments address this question.

  6. David Nelsen  September 30, 2012

    Peter, glad to see you back posting! I’ve been stuck at my current weight for a while and might give IFIK a try to get over the hump. I think I can already see from you food logs that I’m eating a bit too much. I have a BBQ smoker/grill and make a lot of really tasty meat dishes that the whole family enjoys (I add hardwood smoke flavoring to the meat). What I use is like a Big Green Egg if you heard of that. I’ve been afraid of IF since I can’t remember ever skipping a meal in my life, but I think I’ll give it a try on an upcoming weekend. On the Gut Flora, what are you trying to accomplish? I have some gut issues and have to take Metamucil every night or there’s trouble the next day. This is the case even if I have a large salad for lunch and dinner. I never have indigestion or any other stomach issues, but I’m curious about the Gut Flora supplement. As far as your daughter is concerned you need to mix up your play (kind of like in Poker) – they go through phases and don’t want the same thing all the time. Then again, my daughters have eaten Nutella sandwiches for breakfast for more years than I want to count. Cheers, Dave

    (reply)
    • Peter Attia  September 30, 2012

      My interest in gut biota is pretty broad. I’ll definitely write about this in detail in the coming months, but it goes beyond regularity.

    • Vasco Névoa  October 1, 2012

      “One of the topics I’m currently getting steeped in is gut biota” – hooray!! :D
      This, Peter, is promising to be a lot greater in magnitude and importance than your cholesterol series. And quite interrelated, too.
      My personal situation of high LDL-c can be traced, I believe, to an exaggerated gut permeability, which in turn is definitely caused by a mutated/overgrown gut microbiota. So, in my view, it is probable that many SIBO sufferers will also suffer from high LDL counts as a consequence. I’m trying to verify this through N=1 experimentation.
      I’ve been trying a restricted FODMAP diet to kill down the critters while watching the lipid profile, but progress has been stalled by an overconsumption of heavy cream (apparently 2% lactose is still enough for stomach and small intestine bacteria to thrive, especially when we gulp down a pint of cream every day). So now cream is out, coconut milk is in. Now I just fear that such an extreme low-FODMAP/ketogenic diet will trigger mycotic overgrowth… Candida time? Hope not.
      I’ve come to consider the gut biota as possibly THE main force in body composition and metabolism… they control a LOT of what’s going on in us, whether through FIAF or neurotransmitters or immune modulation or who knows what else, and it is our chronic food habits that in the end dictate what kind of biota we maintain.
      It is also, I believe, a source of fundamental differences between individuals (why does that guy eat whatever he wants and not gain any weight?), being a mid-term “state” store of the body – can someone with a carb-specialized biota change their food habits and not feel like s**t for a looong time?
      Anyways… great to see this extremely important field come into your analytical attention. I’m looking forward to reading your thoughts and experiments, and learning more about it. Glad to be joining your input to the ones from Lucas Tafur and Art Ayers – one step closer to reaching critical mass on the subject.
      Cheers

  7. Richard Hanks  September 30, 2012

    Peter, great post! Am I reading this correctly that you are still in Ketosis most of the time (aside from short fluctuations after a post-fasting meal) even with carbohydrate intake in excess of 50g/day? Thanks!

    (reply)
    • Peter Attia  September 30, 2012

      Tough to say, Richard, because it would require me checking hourly for a few days and then doing an “area under the curve” analysis, which I have not done. I have done a few days of 5-6 checks per day, and my guess is on days with ~60 gm/day of carb (virtually all from nuts and SS), I’d be in ketosis about a third of the time. Even on days when my total is ~30 gm/day, if consumed in one sitting (along with ~100 gm of protein), I invariably fall “out” of ketosis for at least a few hours.

  8. Jared  September 30, 2012

    Hello Peter,

    Interesting to see you replenishing glycogen stores with Superstarch rather than fat. I assume this would top them off and allow for more explosive power in your land training rather than just relying on fat. Would you say you gained any muscle mass or strength compared to before? Any future thoughts on trying to add muscle mass in the future? I know your love for distance training so this may be counterproductive but just out of curiosity of such an experiment or thoughts on it.

    Thanks

    (reply)
    • Peter Attia  September 30, 2012

      Fat is a pretty inefficient way to replace glycogen, because each triglyceride only yields 3 carbons (glycerol backbone). Protein is better, but ultimately, nothing is better than a carb. The key, of course, is not overshooting, which is what most folks do.

  9. Mark  September 30, 2012

    Peter:

    I don’t understand the SuperStarch. I checked the nutrition facts and the first ingredient is corn starch. How is the UCAN product any different from the corn starch you’d find in any number of processed soups or baked goods? Seems hard to believe you could modify the properties of corn starch in such a way that it would no longer elicit an insulin response or suppress ketosis.

    (reply)
    • Peter Attia  September 30, 2012

      Great question, but requires a post of its own. Actually, to be technical, the ingredient is amylopectin, which is plant glycogen. What makes SS “super” is the 40 hour or so hydrothermal processing of amylopectin. More on this later…

  10. Von Packard  September 30, 2012

    Peter – I was happy to see your notes about UCAN – I purchased a small order of the vanilla protien product the other day after seeing you mention it & doing some research on it. It’s in the mail, and I’m excited to experiment. I’ve only seen you allude to it in your posts; could you share any thoughts or links to previous posts you’ve made about it? I’ve read their recommendations, but they aren’t geared towards those with a keto diet. I’ve been doing the insanity workout (1 hr long), and I was wondering if you would recommend using the SS before, during, or after for optimal effect (endurance & recovery). Last question – I’ve been on a keto diet for almost a month now, and combined w/ exercise I’ve gone from 203 to 179, but I still have about 10lb in my stomach that needs to go, and I haven’t changed weight (despite intense workouts!) in two weeks! What can/should I expect as far as change & is there anything specific I can do to target belly fat? Thanks!

    (reply)
    • Peter Attia  September 30, 2012

      I’ll definitely do a post on SuperStarch. I periodically give a talk on sports nutrition, and spend some time on SS. Maybe I’ll podcast it.

    • Jeff  October 2, 2012

      I would love to hear that podcast. I used the super starch and found it to be no better or worse than any other high quality drink mix such as endurox or skratchlabs secret drink mix, for competitive cycling, although it cost about twice as much . The vanilla recovery drink did taste pretty good.

    • Von Packard  October 14, 2012

      I went through my vanilla protein and found it to be not so tasty . . . :-( I had a 0 carb BCAA fruit punch mix that I would combine with it to make it palatable. Maybe I’m just too picky. I saw some recommendations for using the chocolate and mixing it with a variety of other things to make it tasty. I’ll try that out – any recommendations from the peanut gallery on favorite flavors of the non-protein flavors?

  11. Aviv  September 30, 2012

    Great post Peter
    Just a point regarding dairy, and it might be VERY important for many guys out there trying to get ketotic and can’t (like I was).
    3-4 weeks ago I stopped ANY dairy and after straggling for months, in a matter of 2 days, boom, I got in – finally!
    I am still experimenting with it and trying to find my sweet spot… didn’t want to say anything until I’ll see results, but hey might have found what stopped me and might be stopping many others!!!
    It is an awful place to be, knowing you doing everything right , yet you gaining wait and feel lousy – I was lost!
    That’s why I decided to write this comment, maybe others out there can learn from me.
    And I was consuming only good quality, highest fat dairy, by the last few months it was goat’s cheese only – yet only after I stopping it altogether I finally got in… seems like dairy getting me a high insulin response – and after learning so much from you and Phinney’s books, it’s one explanation to why I could’n get fully into fat oxidation, and even GAINED weight on a low carb diet! talking about frustration… this is something many low carb books, blogs, experts forget to mention – low carb is not the only thing, food sensitivities and intolerance is VERY important – I’m thanking Nora Gedgadous for teaching me this lesson.
    By the way, I’m too on IF together with being ketotic, I usually don’t eat breakfast and my first meal will be around 1-2 pm. keeping it simple.
    Anyway as I said, still trying to find my “sweet spot”, will drop a comment if I’ll get back to my 165 like last year – than we’ll see who climb these hills faster ;)
    Later

    (reply)
    • Peter Attia  September 30, 2012

      Absolutely brilliant and critical point, Aviv. Thanks for reiterating. I know I’m made this point in other comments, but it can never be overstated. Some folks have a pretty aggressive insulin response to dairy, while others (like me) don’t seem to at. I can drink a gallon of heavy cream and my B-OHB goes up!

      Whenever I’m working with someone who is “doing it all right” and unable to get into ketosis, step 1 is to visit protein timing/amounts…step 2 is dairy…

    • Natasha  October 1, 2012

      Aviv,
      When you say dairy – does it include butter? I find myself stuck despite doing everything right, yes. I use heavy cream in my coffee, eat some cheese, sour cream, and a lot of butter. I can see myself giving up the heavy cream, cheese and sour cream. But do I have to give up butter? What is your experience?

    • alan  October 3, 2012

      exactly the same. with dairy on 20 g of daily carbs,and 90/100 g protein i gained weight.

    • Jessica  November 11, 2012

      Aviv,
      Have you noticed any improvement since taking out dairy? I’m struggling with weight gain when I am so diligent. Do you still use butter?? I’m looking forward to seeing how this turns out for you.
      Thanks!

    • Aviv  November 12, 2012

      Natasha, Alan and Jessica, just now saw your responds.
      To say I’m frustrated will be an understatement. I do not consume any dairy. There so many things I took off my diet, it’s seams as if nothing will agree with me anymore. I have a feeling dairy doesn’t work for me for other reasons other than weight gain (foot athlete seems to be gone when I stopped consuming dairy, no mucus, etc…)
      The only dairy I’m consuming now is ghee.
      All I know is that nothing seems to work with me. I will gain weight while being ketotic (testing always), my performance went down the drain since I started low carb, to get myself out to do a training ride or anything is close to impossible now (psychologically). Tried intermittent fasting (just got worst), calorie restriction while being ketotic, upped my fat intake, clean paleo, you name it I tried it. Dairy, no dairy, what’s the point, I will gain weight anyway…
      I started my own blog in Hebrew this Summer, since I know ALL the science behind this way of eating, I wanted folks in Israel to learn too. Needless to say, I stopped blogging… I never giving up in life, and I want to understand exactly how things works so I’m reading and trying – just like Dr. Attia did with his journey. Only that with me the story went the other direction – gaining weight and being frustrated. The problem now, after knowing so much, what am I going to do??? go back to low fat calorie restriction diet???
      I have my last 140 (!!!) keto stripes that I ordered from Canada, I’m giving it a last try while being the best I can – the cleanest, paleo, keto food until this supply is over and then I’m done.
      If it’s not working, I’m moving to some deserted place, living of the land by hunting… Any suggestions of a good warm climate place in the states anyone? Had enough from NY… :)

    • Donna  November 13, 2012

      Aviv,
      Before you began this part of your journey from which I glean that you were trying to improve athletic performance were you at your ‘normal’ weight? Did the weight gain begin because you were attempting to go into ketosis? It is possible (without knowing what your diet was before) that going low carb may not be the best answer for you. You may have been eating instinctively what your body needed. It is possible that your body cannot utilize the amount of fat that is consumed on a keto diet.
      What all the tests, all the studies, all the discussion cannot do is tell you exactly how YOUR body will react. You can only experiment with what you have. Take what works for you and discard the rest! Continue to read everything, talk to people about nutrition, take it all in but realize there is no single answer to health and fitness . There are levels of fitness just as there are levels of health. Now that you have experimented one way, experiment another. You’ve discovered dairy is a problem so you eliminated it. Maybe the next is to look at the protein consumed. Maybe enough, maybe not. Perhaps the ratio of types of fat. Does your blood work indicate any other problems such as low vitamin D or magnesium deficiency. Maybe a certain amount of carb needs to be added to your diet that is higher. Maybe you need to eliminate fruit altogether even the low carb variety. Your body like my body and all other bodies are all unique in how the components come together. The building blocks are the same in everyone but the way they come together are unique in every individual.
      What works for one person or even a group of people may not work for another. Does that mean failure. No. It just means you seek the way that gives you what you want.
      The low carb, keto way is a good way. It needs to stop being demonized as unhealthy but at the same time it needs to be understood that it is not the only way to go. As one works with the personal instrument (the body) the discovery is hopefully made about what works best for this instrument and that can only be done by the indvidual. If higher carb is the answer, go for it. If fat restriction is the answer to better health, go for it. If you land somwhere in between go for it. If a plant based diet works best for you, then go for it. In the end it all comes down to what works best for your instrument (body). Science can offer guidance through studies and research but it cannot tell you exactly how YOUR body will react or what it needs. Only YOU can discover that.
      You say you stopped blogging. I thought that was unfortunate. You have this marvelous experience. You can put out there what is happening to you, what you are discovering and you will realize that none of it is a failure. You have not failed. That is not possible. Your insight could be of great benefit to many so I hope you resume your blog if that is what you want to do.

    • Edward  December 7, 2012

      Hi Aviv,

      If you are truly desperate, try consuming nothing but raw meat for a month, preferably beef. I have been communicating with a gentleman named Lex Rooker over at the Raw Paleo Forum. You can read his story here: http://www.rawpaleodiet.com/testimonials/lex-rooker-usa. He has eaten nothing but raw meat for 8 years now, with one exception, that being the Irish butter that he blends into his morning beef broth. He takes no supplements.

      He mixes high fat ground beef with a so-called primal beef mix, which consists of large amounts of beef organs such as spleen, kidneys, liver, etc, adds ground suet (beef belly fat) to further raise the fat content and consumes around one and a half pounds of the resulting mix each day. He gets all this from his supplier in Texas, Slanker’s Grass Fed Meats,

      Reading about the diets of the Masai, the Samburu, the Inuit and the Sioux who eat no plants other than those they find in the digestive tracts of animals has convinced me that plants are not necessary to us other than our gut biota, and Lex is the n=1 proof. Unfortunately this raw meat diet costs him around $400 per month to feed one person and I can’t afford it. For him it was a matter of life and death, so it represents a real savings as it were.

  12. Mark  September 30, 2012

    Hey Peter,

    I’ve recently come across your blog and have truely enjoyed reading through all the information you have provided. With regards to the “exactly what do you eat?” post being the one that generates the lost traffic, I suspect that may be people repeatedly visiting that post for reference on their own choices.

    I’m curious what you thoughts are on omega 3 eggs and their stability when heated to high temperatures?

    (reply)
    • Peter Attia  September 30, 2012

      Great question about the eggs, Mark. I definitely owe the readers a post (or 2 or 3) on the entire omega-3/6 morass. Short answer, the n-3 in eggs is primary ALA, so it’s not really “relevant” for reasons you’ll see when I get around to it. Same for walnuts an other non-marine sources of “high” n-3. The key is EPA and DHA, not ALA.

  13. DavidM  September 30, 2012

    Hi Peter,

    Hopefully you’ve got more time for blogging now! Very interesting results.
    I wonder now if there is really an exercise benefit with ketosis. From what I gauge in the blog post, you are in ketosis fewer times a day compared to previously. And you’re still able to work out just as effectively, if not better.
    Maybe it has more to do with your weight loss? For every 1kg you lose you get 2mmHg decrease in BP. Wonders if anyone knows how much performance you gain for each Kg lost.

    To answer the zyprexa question, most atypical antipsychotics will cause weight gain and is a common side effect. Some less than others, aripripazole maybe have fewer weight gain side effects, but the weight gain is more centrally mediated (other hormones in the brain are also affected such as prolactin) and less to do with any more direct effects on the pancreas and insulin resistance.

    (reply)
    • Peter Attia  September 30, 2012

      Actually, David, I am busier at this moment that ever before, and don’t see any reprieve for at least 4 to 6 months. Doing what I can, though. Of all the elements of Met Syn, hypertension was never one. My BP has always been about 100-110 over 60-70, and has remained so. I suspect, without the extra sodium, it’s probably lower.

    • David Ma  September 30, 2012

      Knew it was wishful thinking… ;)

      The HTN comment was just an example of the profound effects of weight loss on different aspects of the metabolic syndrome. My main point was whether there is a stronger link connected with your weight loss and exercise performance, or whether it is a worthwhile confounder in the interpretation of your results. Like you said, I little weight lost on the bike makes a huge difference.

    • Peter Attia  September 30, 2012

      Certainly is on the bike. I have to lug 40 few pounds up the hills today, even though my absolute power output may be less. The biggest change I’ve noticed, though, is metabolic flexibility. It’s the ability to far better oxidize fat over glycogen for most (all but the most intense) periods of exercise.

    • David Ma  September 30, 2012

      Re efficiency with fat utilisation: I agree that is an advantage. Particularly as you’re exercising less than before

      Interesting to know about your blood pressure results actually. Not sure how that plays into all of this. Classical teaching was that BThal trait was somewhat protective against high BP. Not sure how applicable any such benefits were in your case considering your ‘disease-burden’ (for a better word) back in the day.

      Wish in the future a panel could be done, that would be able to identify all the significant markers of disease and performance! We’re prob getting closer.

  14. R?za  September 30, 2012

    Hi Peter, to tell the truth, I was a bit surprised seeing Vitamin D in the list of supplements. Based on where you live and your active lifestyle, I though you already had enough to surpass US IOM RDA for vitamin D (600 IU); 5000 IU daily is even higher than the recommended daily intake for people at high risk for vitamin D deficiency (1500-2000 IU), based on the guidelines of IOM and US Endocrine Society. In addition to that, there might be an upper limit for vitamin D intake, as suggest by this study: (https://www.ncbi.nlm.nih.gov/pubmed/22573406). Have you ever measured your serum 25(OH)D levels?

    (reply)
    • Peter Attia  September 30, 2012

      Yes, measured and consistently low without supplementation. While you might not know it based on my complexion, my dermatologist in San Diego has turned me into a hardcore sunscreen user. I wear a minimum of SFP 30 at all times (just day-to-day) and constantly reapply 50 with all outdoor activity. Years of 8 hour training swims in the oceans have really beat up my skin.

  15. Stuart Williams  September 30, 2012

    A few things…
    1) I believe one of your tags is misspelled ( but biota vs gut biota) on your post
    2) Did your VAP panels show a significant change (good or bad)? What about VO2 max? (closing thoughts 2)
    4) Have you considered replicating your results by going back to baseline (nutritional ketosis) to see if you can replicate your results? (closing thoughts 1)

    Does this indicate then that nutritional ketosis may not be as important on biomarkers/health as Dr. Phinney et al. believe? What effect does IFIK have on insulin and IGF and should science be studying IFIK instead of NK?

    BTW – I have found a potential anecdotal correlation in myself between diet side consumption (ounces) and B-OHB levels. I keep my diet and activity the same and found the amount of diet soda decreases my B-OHB the next day. I have found 2 20 ounce diet mtn dew can drop me from 3 to 1.6. And 20-40 additional ounces can drop me to .5 or below. Roughly each 20 ounce drink seems to decrease my B-OHB by .6 to .7 ( no p values yet).

    I plan on testing BS and B-OHB levels more rigorously (intra-day & next day) in the coming months.
    I would think as people stay in NK who are extremely IR they would tend to vary their diet and drink sodas, thus kicking them out of Ketosis without realizing by being complacent.

    (reply)
    • Stuart Williams  September 30, 2012

      Corrections…
      Diet side = diet soda
      BS should be BG Blood Glucose.

    • Peter Attia  September 30, 2012

      1) good catch!
      2) will detail in subsequent posts.
      3) have not planned on this, but it’s a good idea.
      Your experience with diet soda has been noted in others, too. You may have a cephalic insulin response to the aspartame.

    • David Ma  September 30, 2012

      Hi Stuart, very interesting you found that effect with diet soda.
      I used to have a diet soda with my meal on Mondays too, and I found that afterwards I would feel sleepy, almost a post-prandial dip type effect. Precisely one of the things I was hoping to avoid with the ketogenic diet.

      Interestestingly, Diet Doctor – Andreas Eenfeldt, MD has recently posted about this topic. Its on the side bar as one of the sites that Peter visits. Its an interesting read.

  16. Bob  September 30, 2012

    If you’re going to throw around terms like B-OHB, REE and TEE could you try to at least once per post let us know what these mean? We don’t all immerse ourselves completely in the culture, for your information (fyi). Thanks. :-)

    (reply)
    • Peter Attia  September 30, 2012

      Bob, I’m deliberately doing this! Any post I’ve written on ketosis will address what B-OHB is (start with “the interplay of exercise and ketosis”). For the other stuff — REE, TEF, TEE — check the post titled “good science, bad interpretation.” Fair point, though. I am in a bit of rush trying to get this post out before heading out on the road for the next month. Also, consider using the search feature on the blog. It may help.

    • Chris  October 3, 2012

      You can’t spare the ten seconds it takes to do a google search?

  17. Jason Williams  September 30, 2012

    I understand where your daughter is coming from. After turning on to ketosis, I started to eat a lot of eggs. If I so much as smell eggs now, I get gag reflex. I think I’ve traumatized myself for life.

    Great post by the way, and very helpful for those of us who struggle to plan our days/diets down to the detail.

    Regarding the sleep issue and psycho-energy, I for one would be thrilled if you were to ever divert a little bit of your time/mental energy from general nutrition towards nootropics (brain hacking). There are scientific-minded communities out there dedicated to mastering how to feed our brains in order to obtain maximum energy levels (full concentration for longer periods of time on less sleep). Ideally, this is done naturally, though there are plenty of artificial ways to do it as well via “smart drugs” such as adderall, modafinil, etc. The science is a bit sketchy though and we could definitely use people like you on the case.

    (reply)
    • Peter Attia  September 30, 2012

      For me, levels of B-OHB over 2 mM are a pretty amazing “drug” for mental acuity and focus. I’m pretty fascinated by this topic.

    • Jane  June 8, 2013

      Peter,
      I am fascinated by the notion of increased acuity and focus at B-OHB levels over 2mM.
      Is this a topic covered in more detail in the second Phinney & Volek book about performance?

      Thanks.

    • Peter Attia  June 9, 2013

      I have not read their 2nd book, but I think it may deal more with physical performance.

  18. Shareef  September 30, 2012

    Hi Dr Pete,
    You said, “This includes sleep, which I wish I could figure out a way to thrive without”
    Were you aware of Dave Asprey’s sleep hacking info over at Bullet Proof Exec? http://www.bulletproofexec.com/improve-your-sleep/

    (reply)
    • Peter Attia  September 30, 2012

      I do most of these, but my “issue” with sleep is not that I don’t sleep well. I do. It’s just I wish I didn’t need to. I’ve only got 50 years or so left on this earth. I hate the thought of sleeping for 15 or so of them.

    • Paul N  October 1, 2012

      For a really simple bio-hack on sleep, you might try a period of sleeping on the floor (!) (or on a rug, thin futon etc)

      http://www.paleodietandliving.com/paleo-living/sleep/sleep-which-surface-is-best/

      The common theme seems to be that people slept less but felt better! A Zeo would be able to make some quantitative measurements of this?

      After reading this article (and the linked story within) I gave it a try. Took a me a couple of days to get used to it, but, same thing, my energy upon waking up was noticeably better. Something I had always noticed when camping. I do like the “less tech is better” approach…

      I knew someone years ago whose “bed” was actually a sandbox, and they swore by it!

  19. Nina  September 30, 2012

    Hi Peter,
    Thank for another interesting & informative post – I really enjoyed reading it with my morning coffee & had to laugh out loud at “if-ik,” your user-hostile software, & your little daughter’s anti-nut comment!

    (reply)
  20. Anne  September 30, 2012

    Hi Peter
    Thanks again for another great post.
    I think that you are getting so many hits on this article is because there is not much practical, reliable information out there about day to day living and exercising while in ketosis and/or IF. Obviously there are the Volek and Phinney series and then Mark’s blog pages and books, and others, but I think (I could be wrong but this is just my personal view) that many people are muddling along and trying to string together information from all of the current resources and not finding anything really concrete that might necessarily apply to them.

    What you eat and your reasons for doing so are always interesting and helpful because you describe what and why you are doing it which gives us a few ideas to try things a little differently.

    (reply)
    • Peter Attia  September 30, 2012

      I just hope folks don’t read too much into what *I* or anyone else eats. The “key,” if there is one, is using the best available evidence out there, and then patiently experimenting till you find what works.

  21. Jim Georgopoulos  September 30, 2012

    Hi Peter,

    As far as gut flora and probiotics is concerned, have you considered fermented dairy and vegetables as a source?

    (reply)
    • Peter Attia  September 30, 2012

      Not there yet…more work needed.

  22. Dan V  September 30, 2012

    Hi Peter, thanks heaps for sharing. Your blogs are helping me alot.

    Just a quick couple of questions.

    I notice you regularly workout in the mornings but may not eat for 4-5hours after. Do you have your supplements after?

    Also what are your thoughts on young drinking coconuts? Are they high in carbs? Can they replenish glycogen? Can they keep you out of ketosis?

    And one more thing, I have changed my diet over the last 2-3 weeks to try and achieve ketosis, but I am getting quite constipated. In the past I took a product called Motion Potion to help with this, but stoped while trying to achieve ketosis because it contains wheat & barley grass. Can you recommend taking anything else that will not affect ketosis too much? Like maybe just plain pysillium husk and maybe some slippery elm powder etc?

    Thanks,
    Dan

    (reply)
    • Peter Attia  September 30, 2012

      The only workout I like to supplement right after is HIIT, where I always try to get 6 to 8 gm BCAA during the workout and about the same amount of glutamine post. MCT, magnesium, and bouillon seem to cure most bouts of irregularity.

    • Dan V  October 1, 2012

      Thanks for the reply Peter, but do you also know much about young coconuts? As in do they contain too much carbs etc for ketosis? Having 2 per day was really helping with regularity, but I think it was keeping me out of ketosis.
      They are one of my favourite foods though and seem to be good for exercise etc.

      Regards,
      Dan

    • Peter Attia  October 1, 2012

      Just that they are relatively higher in carbohydrate than fat or protein. Probably explains your ketosis issues.

  23. colby  September 30, 2012

    Really interesting to see you (kind of) adopt a couple of IF days in your week. IF works wonders for my (type1) diabetes. Really looking forward to your post on type 1 diabetes and ketosis! I hope that your frequency of posts means you’re getting to spend more time with family. Can’t wait for the next update!

    (reply)
  24. Evan  September 30, 2012

    Peter,

    Your story (in general) is similar to mine in most respects. Low carb for 22 mth nows, with a similar diet, with my favorite new addition post workout the fat shake (4 oz of heavy cream, 8 oz of unsweetened almond milk, scoop of chocolate whey protein)….and enjoyingly gulp it down with my supplements – as i hear fish oil and vit D, since fat soluable, should be taken with a fatty meal.

    My driver to the LC lifestyle was the avoidance of perscribed statin – not weight loss, as i only gained like 5-7 post in the 25 years post college.

    Lipid panel pre-LC was 262 total, 168 ldl, and 40 hdl, trig at 96
    After low carb, went to 282 total, 189 ldl and 75 hdl, trig at 95

    Very happy i reduced ratio of total/hdl from 5.1 to 3.9 and my trig/hdl ratio is quite favorable.
    I do want to get an NMR lipid test as well to calm my wife’s fears about my LDL

    i will toss in what i eat.

    Breakfast: post workout (20 min cardio, 25 min of intense weights – one body part a day)
    – fat shake (as i noted above), non-workout days (weekends) big omelet (4 eggs, bacon, cheese, cooked in bacon grease – so good!)
    Snack: 3 hardboiled eggs, or pork rinds, or almonds, plus 2 brazil nuts a day for selenium
    Lunch
    – chicken or steak ceaser salad, or just steak and broccoli, or check salad, or similar
    Dinner
    – hamburger patties, or steak, or tuna salad, or chicken salad (no bread of course in anything), broccoli, perhaps side salad, a block of whatever cheese is in the house, or an omelete (4 eggs min plus cheese and bacon)
    Snack
    – tablespoon of organic butter, or nuts or perhaps 85% dark chocolate (not too much), or rolled deli meat, or a few eggs

    Food cooked in butter, bacon grease (have 2 jars in fridge from when wife baked 3 lbs of nitrate free bacon, or coconut oil (this is a fantastic foo, which trader joe’s now carries at a great price!)

    Note: one thing i miss is crunchy food. Found microwaveable pork pellets (raw rinds), and fantastic replacement for chips in nacho supreme, or great to replace the bagel in a bagel and lox meal!!! Just $10 delivered for a 1 lb bags and just 2 min in the microwave makes them better than the store bought (who knows what oil) fried type – called Carolina Gold Nuggets Pork Rinds. sometimes i just load these chips with home made guacomole

    i have used the Fat Secret App on my smartphone to track everything i put in my mouth over a 2 week period (do this every now and them to measure or check carbs). Nice parts, it does running totals thru the day on total carbs, or even net carbs (of fiber), can track protein so i stay at less than 1 grm per lean body mass, and what i found out i have approx 72% of my calories from fat, 23% from protein, and 5%, or so, from carbs. PDF print out daily summary you can generate are cool _ and the app is free. Another great feature is you can just scan the barcode with your smartphone and it populate the food into your data, so cool.

    Like you i dont count calories, but just eat, but my intake seems to hover around 2500 a day. I don’t work out as much as you (- but i have trained for over 20 years and am in pretty decent shape – and if is a good feeling knowing i am more fit than the much younger guys at work! My past diet, for 20+ when i trained was low fat and all my friends are amazed by my 180 deg change on habits.

    As for results, i dropped perhaps 5 pounds, i never crave food, feel like i put on a few good pounds of lean mass. Had to redo my wardrobe as my waist dropped 2 inches, body fat prob down from 12% to 10% – feel great!!! Wife still nervous i am slowly killing myself – but she is accepting it – slowly.

    On a lighter side, what i have learned is to not go into this lifestyle (i don’t call it a diet) when out to dinner with others, or new friends – all it leads to is me ranting on our how saturated fat has never been linked to CHD, how for example eskimos never has incidence of diabetes or cancer, etc until they went from 70% fat diet to a western diet etc……..EVERYONE (99%) thinks i am a NUT, but i got about 6 people to attempt the life style change, of which 2 are on it for over 18 mths – and think i am a genius (thanks to you and Taubes, and all the other nice guys i read regularly online). Funny note: a common comment from others is “moderation is the key”. I bite my tongue every time and have learned to just nod my head yes.

    Anyway, enough ranting, now on to my question:

    Question: Why magnesium oxide? From what I read this is by far the least absorbed type. Better no to get a chelated form, ending in ‘ite’ or ‘ate’ like magnesium citrate? or magnesium aspertate? I take two types, GNC super magnesium (mag lactate, mag citrate, apertate) and a magnesium/potassium aspertate combo.

    Thanks for your time and letting me share your story.
    Your site is great and I am looking very forward to the things NUSI can do.

    Keep up the GREAT work,

    Evan

    (reply)
    • chris  October 3, 2012

      I had a bit of a chuckle with this one, a lot of overlap with my past 12 months.

      RE Mg, Morley Robbins has some interesting stuff to say on this topic:

      http://magnesiumman.com/

      He has also been interview by Jimmy Moore, Dr O (not Dr Oz!) and Sean Croxton

      Chris

    • Susie  October 3, 2012

      Just a thought on moderation: I know someone who was strictly paleo for several months – never cheated. At a New Year’s Eve party she was completely undone by a tray of cookies. She fell completely off the paleo bandwagon and was back to eating SAD for two years before I encouraged her to go back to paleo. In her case, I really think a little cheating would have gone a long way to keeping her on the right track in the long run.

      That’s great that you can avoid all the SAD stuff completely (I envy you, I really do) but I honestly don’t think that’s realistic for everyone.

    • Peter Attia  October 3, 2012

      I don’t recall saying it is.

  25. Crista  September 30, 2012

    awesome post! thanks for putting it out there. I’m still experimenting with nutritional ketosis on myself – can’t believe I lived my whole life thinking chronic fatigue was normal, feel like I’ve been freed from a cage. I expected the extra energy to dial down after a few weeks but nutritional ketosis (or at least low carb – I only have ketostix so I’m not really sure if I’m in nutritional ketosis) has allowed me seemingly boundless energy even after 5 weeks! I eat up all new information you post and I’m doing my part by putting my experience out there. I think it’s important.

    ps. I’m jealous of your nut consumption – I’m crazy allergic, but man, even the smell of a jar of mixed nuts makes me drool.

    (reply)
    • J  October 2, 2012

      Hi Crista!
      Could you post what you tend to eat over the course of a couple of days? I am trying to do it too with just ketostix (can’t afford the fancy stuff) and would love to feel more energy…have felt fatigued all my life, too. Thanks!

  26. aerobic1  September 30, 2012

    Peter: Excellent information. One question regarding the addition of SuperStarch to your shake; have you measured your 1-hour postprandial glucose level after drinking the shake, and, if so, what type of readings did you experience? I am somewhat skeptical of so called safe starches but am open minded to learning more about them. Thank you.

    (reply)
    • Peter Attia  September 30, 2012

      I have not done so in a controlled manner. Any postprandial measurements I do are confounded by other factors (e.g., exercise, other food intake). In a subsequent post, I’ll review the internal and external literature on this topic and others pertaining to SS.

  27. Maryann  September 30, 2012

    Thank you for the new post! Regarding the traffic, can you tell if someone is reading the actual post versus coming back to catch up on recent comments?

    (reply)
    • Peter Attia  September 30, 2012

      Maybe someone can, but not me. I’m doing it by unique visits.

  28. Diana Stanton  September 30, 2012

    Thank you for this post and for your very informative site. Do you still use heavy cream in your coffee even on IF days? Also, it seems many people are questioning the possible differences in men and women regarding IF as well as carbohydrate restriction. As a female I am wondering about the effects of IF and if long term carbohydrate restriction is somehow detrimental (thyroid problems?). I know you are tremendously busy, but if these topics ever interest you in terms of research, I would love to know your take. Thank you again for this very helpful site.

    (reply)
    • Peter Attia  September 30, 2012

      On a true fasting day, I drink my coffee or tea black in the no-eating zone.

  29. Chris  September 30, 2012

    Peter, are you concerned with higher levels of PUFA consumption from eating a lot of nuts? Thanks.

    (reply)
    • Peter Attia  September 30, 2012

      No, but you’ll have to stay tuned for my series on omega-3 and omega-6 to find out why…

    • Tim C  June 12, 2014

      Are you still planning on writing that post? I don’t think I’ve seen this article, and I see it’s still on your “Coming Soon” page. I know you’re incredibly busy, but I’d be extremely interested to read your thoughts on PUFAs, Omega 6 and Omega 3…even if it’s just a quick “High levels of omega 6 [are/are not] ok to eat because they [do/do not] stimulate inflammation in a really [bad/groovy] way.”

  30. Rosalyn  September 30, 2012

    Hello, Peter. It’s been about a year since I’ve found your site and I am all the more healthier because of it. I am happy and excited that you have finally launched NuSi and that your vision and passion are alive and well! I see your eating plan has changed somewhat–well, quite a bit! When I discovered this site a year ago, I’d also discovered The Bulletproof Executive (http://www.bulletproofexec.com/) and have been incorporating both your science and ideals in with the ideals of Dave Asprey–particularly IF. I totally attribute the two “lifestyles” I’ve adapted to the fact that I have lost 15lbs and no longer require blood pressure medication! I’d asked you then if you were aware of Dave’s “teachings” and you said, then, that you were not familiar with the site at all. So I’m curious, again, as to whether you’ve come across the site/Dave Asprey and your thoughts, if any? Especially the Bulletproof coffee– :). Again, kudos, and here’s to living, healthily, until we’re 125 years old!

    (reply)
    • Peter Attia  September 30, 2012

      Yes, I have. Don’t know Dave, but would be cool to connect with him at some point.

  31. Steve  September 30, 2012

    Peter,
    I’m curious about the KNORR bullion. It’s got sugar and MSG in it. As do 98% of the bullion you find in supermarkets. Does the sugar and MSG worry you?

    (reply)
    • Peter Attia  September 30, 2012

      Yes, it does, but in very small amounts, especially given how I consume no sugar beyond it. I’m also note sure MSG is as “bad” as folks think. It’s quite likely a confounder may be present in those observations. Either way, my doses are pretty trivial. There are some great organic bouillons out there with no sugar or MSG, which I consume when I can find them.

    • Indy M.  October 2, 2012

      Whole Foods carries ‘Rapunzel’, Vegan, Organic Vegetable Bouillon, with Sea Salt and Herbs. Been using it for 3+ mos.; its nice, Swiss product, a little pricey, $3.19 for 8 cubes/16 Servings. My 2C.

      Thanks for all the hard work Dr. Attia.

      Quick question:

      In your teachings you have mentioned discordant & concordant LDL-C/LDL-P. Is there such a thing as totally random LDL-C/LDL-P relationship(or no relationship)?

      Many thanks in advance!

      Indy M.
      Sunnyvale, CA

    • Peter Attia  October 3, 2012

      If they predict the same thing, they are concordant. If they don’t they are discordant.

  32. Rick  September 30, 2012

    I don’t see how you’re getting that much protein. It seems a bit lower than you’re reporting.

    (reply)
    • Peter Attia  September 30, 2012

      You must know something Nutritionist Pro and my food scale do not…

  33. Craig  September 30, 2012

    Peter,
    Great post as usual!
    Do you subtract fiber from your carb count?

    (reply)
    • Peter Attia  September 30, 2012

      No subtractions. I’m just counting total. If you subtract out fiber and SuperStarch, I’m probably about half what I record.

  34. Mary Ann Delaney, RDH  September 30, 2012

    Hi Peter!

    Great post. I am so interested in all of this, especially since my Doc has suggested a probiotic and deglycerized licorice for what may be some acid reflux. I find this interesting as I have been eating in this manner for over 3 years with what seemed like no digestive problems whatsoever. As of late a bit of sleeping problems and have awakened with some indegestion. I will definately look into Primal Flora. Thanks for all the info.

    (reply)
  35. Birgit  September 30, 2012

    Peter,
    this was very interesting. Thanks for sharing what you do. I think people enjoy these particular posts because ultimately they want to know, regularly, that you practice what you preach, because so many others don’t. ;)
    I had bloodwork done for the first time after 7 months of low-carb (50-100grams/day) and Insulin was at 2.2, C-reactive protein at 0.9
    H A1c was elevated at 5.9 but doctor is testing hemoglobin to make sure it was normal before. I had never been diagnosed as pre-diabetic but as a previous sugar addict I’m wondering.
    The surprise was that my previous sky-high TSH (anywhere between 8 and 14) was closer to normal at 6.45 so I’m curious if you know whether a low-carb diet can positively affect thyroid function (non-Hashimoto’s, normal T4 and T3). I did not change any supplements.
    Also my doctor did an InBody 230 scan, supposedly close in accuracy to DEXA (I hope) and body fat had dropped from about 29% to23.6% with weight loss of only 10 lbs in the same time. I’m hoping I can get it down quite a bit more by adding an upper body strength training routine (which I now have the energy to do. :) )
    Thanks for all the great work you do.
    I hope at some point to read a post about superstarch and why you find it is better than natural food starches like potatoes or root veggies.

    (reply)
    • Peter Attia  September 30, 2012

      I will definitely write at length about what makes SuperStarch so unique. There is no food on earth like it, actually. The thyroid topic is also worthy of an entire post, but it will need to wait a while.

    • Amanda  October 9, 2012

      I too have a fairly hight A1c at 5.9. My iron count is on the low end of normal so my doctor put me on an iron suppliment to cancel the so called false high of my A1c.

  36. Scott Russell  September 30, 2012

    Interesting stuff! I too am a bit of a nerd when it comes to gut biota. Its kind of amusing to hear you mention it, because extremely low carb diets tend to starve the gut flora. Have you looked into FIAF (fasting induced adipose factor) at all? I’d be interested to hear your thoughts on ways to manipulate gut flora to our advantage.

    (reply)
  37. Lex  September 30, 2012

    Peter, interesting post, and thanks for the update. Now this might become your 1st or 2nd most-read post!
    Really, it’s not surprising; it can be difficult to determine what to eat for optimal health. I appreciate you taking the time to put your information here.
    Regarding your magnesium supplement: I took MagOx on the advice of my cardiologist, after he ruled out any pathology, for irregular rapid heart rate (during mild exercise, my HR would suddenly go up to around 200 bpm and then become irregular). The MagOx didn’t do anything for me. However, later on the advice of a chiropractor, I switched to magnesium citrate, and it absolutely cured the problem.
    I now take chelated magnesium glycinate (so that I can take more w/o the ill effects of mag citrate), as well as I use a little magnesium oil. I wanted to relate this because it was the chiro’s opinion that MagOx is not readily bio-available, and this seemed to be true in my experience. I think it was Dr. Eades where I first read about magnesium glycinate.

    (reply)
    • Peter Attia  September 30, 2012

      I’ve been following this discussion, and to date I haven’t convinced myself that one formulation is better than another, though it sounds like there are exceptions, as you’ve experience.

    • Lex  October 3, 2012

      Dr. A,
      Regarding magnesium, if one formulation is not better than another, then why not take one that may be better absorbed?
      I am going by my experience, as well as what I read from Mark Sisson (“The chelated magnesiums . . . tend to be the best absorbed. You can also apply magnesium oil topically for transdermal absorption.”) and other sources.

    • Peter Attia  October 3, 2012

      Could be true, but not sure how I’d validate it, as serum magnesium levels have little relation to total body levels (that which we care about). I take Mg to spare potassium. Since I never cramp, and my serum K levels are normal, I suspect whatever I’m doing is good enough, even if there are other/better options.

  38. Joel Ganor  September 30, 2012

    Hi Peter, are you aware of Arthur De Vany’s Evolutionary Fitness methodology? If yes, will you please comment on his nutrition and exercise approach. Thanks, Joel

    (reply)
  39. Julia Finn  September 30, 2012

    Hey Peter–as usual, great post. I always appreciate your candor and thoroughness. Like you, I have a fondness for nuts. Do you shell your own? I don’t, typically I buy raw cashews and such from the whole foods bulk bin. After reading about the dangers of mold in all types shelled nuts I’ve been reconsidering my consumption of them. You are probably aware of this…any thoughts? Thanks as always!!! Julia

    (reply)
    • Peter Attia  September 30, 2012

      Some yes, but mostly no. I’ve been dodging bullets so far, I guess, if mold is that much of a problem. I don’t know how much of a problem this is.

  40. Joe  September 30, 2012

    What are your thoughts on the use of a fermented sauerkraut to help provide some probiotics (anaerobic ones, I believe)?

    (reply)
    • Peter Attia  September 30, 2012

      Don’t know enough to comment.

  41. es  September 30, 2012

    I really do enjoy this blog, and appreciate all of the work that goes into it.

    But I remain mystified by some things. One is that you could be surprised by the popularity of your “What I actually eat” post. You run a blog that is now called the “Eating Academy.” Notwithstanding the provisos and disclaimers, you clearly are designing the blog to attract people who are interested in how they should eat–to learn at your “academy.” They want answers on what to eat in order to be healthy, not necessarily long treatises on cholesterol (rollicking as those can be). So naturally, your “what I actually eat” post appears to most to be the one time where you allow yourself to be specific, applying your rigorous thinking on the science to the daily reality of eating. I imagine many read that post as “what YOU should actually eat.” Not your intention (wink, wink, disclaimer), but everyone kind of knows that’s what’s going on. If you are genuinely surprised by that, then I think you are not being honest with yourself.

    But now we get this somewhat bizarre update, and to people who have relied on your most popular and specific post in the Eating Academy (in direct contravention of your instructions–wink, wink), you now say that you don’t really eat that way anymore. It’s all now, painfully, yet more complicated, with plenty of other provisos and things-you-will-write-about-later. For people wanting to learn how to eat well, this site can be immensely frustrating. Not because your readers are stupid, but because you have mismanaged expectations.

    All of this is fine so far as it goes. Of course, you are free to write whatever you want. But I think your decision to change this site to an “Eating Academy” was bizarre in light of the content you generate. Better to stick with the notion that it’s one man’s war on insulin and his assorted thoughts on food science (because that’s what it is!).

    (reply)
    • Peter Attia  September 30, 2012

      Interesting take, I guess. If you really think about an “academy,” though, it’s not about giving you the facts. Facts are the easy part. It’s about teaching you think. That’s actually what I aspire to do, regardless of the name of the blog. I’ve long since accepted there is no name that will make everyone happy. It’s a shame — and I hope you are wrong in your assertion — that folks read this post or it’s version 1 and assume I’m telling them what to eat. For the record, I am not. But I understand that not everyone is as “theoretically” bent as I am, and just want to know how I personally implement my interpretation of the data.

      If the title “Eating Academy” bothers you, read the subtitle. That’s probably a better reflection of what I try to do with this blog. Thanks for the feedback, though. I wonder how many others feel this way?

    • lorraine  October 2, 2012

      Yeah, I don’t get this at all as a blog giving instructions for eating, given that Peter has stated more times than I can count that he doesn’t want people to eat like him, he wants people to figure out what works for them. That’s the whole deal about the n=1 experiment. Moreso, it’s hard to miss that most of the content deals with the diseases of civilization. That everyone has been brainwashed to eat the same diet for the last 50 years, when you think about it, is exactly the problem that spawned NuSI!

      Really running a long-term self-experiment with careful data collection inevitably leads to eating and training evolution. Things change with adaptation and time. There should be no expectation that Peter always eat the same way, My perspective is that the way to any goal involves serial re-engineering of the process to account for the adaptation. That’s exactly what I’m observing here.

      There’s really no safety in the notion of concrete facts. Too much is unknown, information is constantly changing, and any single person’s physiology is dynamic and also always changing. Better to get comfortable with applying critical thinking and the process of experimentation and see what happens. I have found this blog a great example of doing just that.

      Btw, I’ve been more deeply experimenting with foods to feed the ol’ microbiome this summer. I’ve been fermenting vegetables, and sauerkraut, and making kefir from the raw organic milk I can get across the river in PA. And to my delight I discovered that salami is just fermented ground beef/pork! I have a LOT of pastured ground beef in my freezer and that’s my next project because it’s one of those foods that you always wonder what’s really in it when you buy it, but love it so much you buy it anyway! I’ve also been making salty bone marrow broths for the sodium and mineral benefits.

    • Peter Attia  October 3, 2012

      I couldn’t have said it better, Lorraine.

  42. Eric  September 30, 2012

    Great post Peter. What are your thoughts surrounding fish oil and it being ruined through the processing it goes through? I know others recommend just eating cold water fish vs supplementing with fish oil:

    “The trouble with this approach is that omega-3 fats are chemically fragile: their carbon double bonds are easily oxidized. EPA has 5 double bonds and DHA 6 double bonds, so they are the most vulnerable of all dietary fats. They easily become rancid.”

    The idea that the oil sit’s on a shelf for some time before consuming it doesn’t really sit well with me but I really dislike the taste of salmon and other cold water fish like sardines, etc.

    What are your thoughts on this particular brand of oil becoming rancid before we consume it?

    Thanks again!
    Eric

    (reply)
    • Peter Attia  September 30, 2012

      I prefer the oil be made from the smallest youngest fish, ideally bait fish. Let processing and less time to accumulate toxins.

  43. Michael  September 30, 2012

    Hi Peter, I’d like to ask about your cycling in and out of ketosis — usually within a 24h period as you state. I see many people stating the same with the exception of Phinney & Volek. They seem to claim — in their books as well as in many interviews I’ve heard — that once you go out of ketosis by eating higher carb/protein even just once that it can take weeks to become ‘keto adapted’ again. There also seems to be the implication that this is less than ideal somehow. Personally I don’t feel any the worse when I do as you do. The reason I ask is that they persistently state this position. What are your thoughts if you don’t mind me asking. Btw, thanks for you wonderful work.

    (reply)
    • Peter Attia  September 30, 2012

      In my experience, they are correct. If you’re trying to really optimize for ketosis, it’s best to stay in. Hence, I never really did “cheat days” (except for 2 or 3 days when I deliberately gorged on berries — like a bowl larger than my head) and “knowingly” knocked myself out of ketosis for a couple of days.

    • Jesse C  September 30, 2012

      Hi Peter,
      Thanks again for a really interesting post. With respect to going in and out of ketosis you wrote “In my experience, they [Phinney/Volek] are correct. If you’re trying to really optimize for ketosis, it’s best to stay in. Hence, I never really did “cheat days” (except for 2 or 3 days when I deliberately gorged on berries — like a bowl larger than my head) and “knowingly” knocked myself out of ketosis for a couple of days.”

      I’m still so curios about this. It sounds like you are now experimenting with eating a bit more carbs and kicking yourself out of ketosis, and it seems you perform better and feel fine. If your ketone levels drop for a spell but you feel fine then what does it matter? After about 6 months of being careful to eat below 50 gms of carbs per day (and zero starch or sugar), I finally started experimenting myself, and while I don’t measure my ketones (I only measure things subjectively, don’t have the gadgets), I have noticed that I seem to feel fine eating a few more carbs (mostly in the form of 50 gm or so in one sitting of fruit). I think I’m fairly insulin sensitive, so maybe I would need to eat even more carbs to cause a noticeable difference.

      Could you add any more to this discsussion like: does it feel bad to go in and out of ketosis? sometimes?
      never? And what does it feel like? Anyone else?

      Thank you,

      Jesse

    • Peter Attia  October 1, 2012

      I think there may be too many variables to draw a conclusion that strong (i.e., despite eating more carbs I feel and perform better). Remember the one variable we’re not controlling for…time. How do I know I wouldn’t be performing this way in ketosis (with another 4-5 months of adaptation)? Also, I wouldn’t say I feel better, and if anything, I think my mental energy was better in uninterrupted ketosis. Of course, there are many other confounders, also, not the least of which being the 5x increase in my stress level during the past 4 or 5 months.

      In the final analysis, what I like most about IFIK is the complete freedom I have from the “need” to eat if suitable food is not readily available. Tomorrow morning at 5 am I’m getting on a plane to go to France for a week (no, not a vacation…I haven’t had one of those since 2005). A year ago I would have been freaking out trying to figure out how to stay in ketosis for a week in another country. Now, I’m not even thinking about it. I’ll eat when I want and not eat when I don’t want to. Stress free.

  44. Jon Zimmerman  September 30, 2012

    Peter–thanks so much! I’ve been following your site for several months now. I’m running the twin cities marathon in one week (Oct 7th). I’ve been on a ketogenic diet for about 10 weeks while completing my marathon training. All is going well, I fell good, steady energy, etc. I’m not a fast runner but I have a goal time (under four hours)I’m hoping for and wondering what my best strategy is during the race (as it pertains to a ketogenic diet and the absence of carbs before and during the race). I have been integrating super-starch, and my current plan is to have one packet 1 hour prior, then maybe 1/2 a packet somewhere in the middle of the race, along with some salt, and maybe a handful or two of my favorite chocolate covered (sugar alcohol) low-carb almonds ( I love them, and they seem to go down well while running).

    Anyway, here’s my question. I’m 37 years old, and if I’m running at an easy “all-day” pace (say 9:30 pace for me), my heart rate is typically in the mid 130’s. This is the pace and effort I’ve done most of my “long runs” at. I’d really like to run a sub-4 hour marathon. I need to average 8:45’s to do this. Last week I did my long run at this pace, and my heart rate started at 145, averaged 150, and peaked at 160 when I ended at mile 20. I felt pretty good all things considered, but the last 6 miles of the TC Marathon are tough…some long steady climbs. I’ve never pushed it past 20 on a ketogenic diet, and wondering what to expect if I run at a harder intensity for most of the race… I know, tough question to answer, sorry. Just thought you (or someone) might have a tip for me. If I shoot for this pace, I know I will spend the last hour of the race at 90% of max hear rate (220-37=183 x .9 = 165). I don’t want to take sugar, gatorade, etc. I just don’t know what to expect at that point, and what I can do this week to be prepared.

    I sure appreciate all your effort. It blows my mind how the entire endurance world is “buried” in sugar.

    Jon

    (reply)
    • Peter Attia  September 30, 2012

      A sub-4 hour marathon, or even a sub-3 hour is entirely achievable on a ketogenic diet. Check out the work of Tim Noakes in South Africa.

    • Lex  October 1, 2012

      Jon, if I may, re your goal 4-hr marathon. It sounds to me like you are well-prepared (20 mile long run, tested race pace). If you properly taper and are well, you will not believe how easy a 4-hr pace will feel. It should actually feel like you are at a lower intensity and you will be; that is, until you get near the end, where it is normal to have the HR drift up. My warning, based on running a few of these (and at a similar pace) is to be sure to hold yourself back on the pace from the start. Don’t think that because it feels easy that you should push the pace in order to save time. It’s best to stay with a pace group, if offered. Also consider taking in some kind of fat for fuel around 3-hrs into it.
      Hope I’m not out of line here offering suggestions. I guess it’s vicarious for me (I miss running those). Really, from what you say here, you are doing great!
      (Also, you need to average 9:09’s actually.)

    • chris  October 3, 2012

      Also check out Ben Greenfield. Go to his website & ask him a question.

      chris

    • Jon Zimmerman  October 3, 2012

      noah was here

  45. Mark.  September 30, 2012

    I wonder whether that magnesium nitrate liquid laxative in doses too small for laxative effect would be absorbed better than the oxide. I use that but have no proof it’s better.

    (reply)
  46. tim  September 30, 2012

    Sort of off topic, but are you aware of studies showing vitamin c reducing cortisol levels post workout? I’ve become skeptical of any “study”.

    I’ve used IF successfully to break thru weight plateaus. However, I’ve also read that in some, there is an increase in cortisol levels, as the body is reacting to no food and the stress involved.

    Started to think added Vit c during IF might be beneficial.

    (reply)
    • Peter Attia  September 30, 2012

      Keep us posted on what you find.

  47. John Vogt  September 30, 2012

    Peter,
    I think people hear all kinds of seemingly reasonable and consistent theories about what to do about almost anything, but what is most convincing is what advocates actually do. I don’t find it at all surprising that your column on what you eat is by far the most popular. Practice trumps theory. I’m glad you’re continuing to fine tune this diet. I think it will help me to try some variations, since after losing 30 pounds I’ve been stuck on a plateau for most of the year.

    (reply)
    • Peter Attia  September 30, 2012

      I’m glad it’s helpful.

  48. Sean P.  September 30, 2012

    Have you intentionally reduced your consumption of SFA and increased your consumption of MUFAs or do the foods you happen to enjoy now just have lower levels of SFA and higher MUFAs compared to before? Put more simply: Did you purposely change the ratio of SFA to MUFA in your deit?

    (reply)
    • Peter Attia  October 1, 2012

      Not purposely, no, but you’re correct, I’m down from about 50% of my fat being SFA to about 25%, with MUFA making up the delta. In total amounts, I’m down also, since I consume less fat in aggregate.

  49. D  October 1, 2012

    “No, but you’ll have to stay tuned for my series on omega-3 and omega-6 to find out why…”

    REALLY looking forward to this one.

    (reply)
  50. Allen  October 1, 2012

    Another great post Dr. Pete! First off, I just want to say that your blog site is a gold mine. I have been following your posts since about February 2012 and I have learned so much from it. Thank you very much!
    A quick question though on your 3 consecutive days of representative eating. I noticed that you don’t consume any post-workout meal or supplements immediately after your workouts. Is this mainly to follow your IFIK protocol? Just wondering what your thoughts on this. Thanks again so much.

    (reply)
    • Peter Attia  October 1, 2012

      Thanks, Allen. Correct, on fasting days, the most I’ll consume post-workout is some glutamate (6-8 gm) and BCAA during the workout. What I didn’t show is my “long” workout days, which right now is one long ride per week (75-120 miles). For these rides, I rarely fast, though I have gone up to 90 miles on a fast.

  51. Carl Hays  October 1, 2012

    Hi Peter,
    I absolutely love your blog. Your principles are directly inline with what I believe and practice.

    Incidentally, I came across your blog while searching for a pre and post workout recovery solution. I see that you use Generation UCAN and my question is specific to that product. In reviewing the label, I see that one serving has between 26 to 31g of carbohydrates.

    From your audio interview, it would seem that ingesting that many carbohydrates along with other foods you eat daily would result in more than 50g of carbohydrates. Is that correct, or is the remainder of your diet so restricted that you never surpass that number?

    My diet is *very* similar to yours, and I’ve successfully lost a lot of weight. However, I’m still carrying a lot of fat around my abdominal area, but nowhere else. At one point I was 92 lbs overweight. I’m 68″ tall, currently weigh 160lbs and every other area of my body appears to be very lean, except for the fat still stuck in my abdominal area.

    I’ve been eating this way for awhile, and currently consume about 1g/lb of protein. I exercise daily, both by riding my bicycle 11 miles and another 1hr workout later. I’m beyond frustrated that I’m stuck not losing anymore fat.

    What would you suggest?

    Thanks so much in advance!

    (reply)
    • chris  October 3, 2012

      Try asking Ben Greenfield for some advice on this one.

      Chris

  52. Butch  October 1, 2012

    is there an advantage using bouillon as your source of sodium as opposed to Himalayan Salt which has 1980mg sodium per teaspoon.

    seems to me that Himalayan salt is a more natural choice.

    regards….

    (reply)
    • Peter Attia  October 1, 2012

      Convenience, especially as I love to drink “broth.” Nothing wrong with adding salt or using other sources of sodium.

  53. Carl Hays  October 1, 2012

    Peter,
    I thought of one other question. I noticed you consume heavy cream; that’s something I do not consume, but instead use full fat coconut milk. Is there a reason you favor heavy cream? And about how much per day?

    Thanks again.

    (reply)
    • Peter Attia  October 1, 2012

      I love the taste, but I do use coconut milk, also. Great substitute for those who don’t tolerate dairy.

  54. dennis  October 1, 2012

    Interesting post, and thanks for that.

    Glad to hear you’re doing something on omega’s. My wife and I are currently taking a tablespoon of chia seed daily. Our understanding is that one tablespoon has all of the daily omega 3 requirements a body needs. I’m hoping to get your opinion on chia seed as a source of omega 3.

    (reply)
  55. Guillaume  October 1, 2012

    Hi Peter,
    I am happy to see that you are coming around. I started doing 24 hour fasts some 4 years ago, first 1 day per week, and eventually 2 days. And although it took a little time to really get used to it, with time I felt that it was really one of the best things I had ever done for my overall health and physical and intellectual performance.
    Now the next phase, which I suppose you will also get to in time, is fasting everyday until about 15 or 16. Drinking lots of water and green drinks and eating salt all the way through. That’s even more effective at cleansing and healing the body from the inside out and increasing metabolic efficiency: consuming less calories but continuing to strengthen and build muscle.
    That’s what I’ve been doing for the past 6 months, and it is really amazing to see what happens: I’m down to 56 kg (super lean) from my initial 61 before cutting out simple and starchy carbs 5 years ago, I have probably at least 1 kg more of muscle, my strength has doubled in the sense that I used to bench press 20 kg each hand, and now I use 40 kg, I used to shoulder press with 15 kg each hand and now I use 30 kg, I used to seated upright row 30 kg and now I use 60 kg, and I use to leg press 100 kg, now I use 200 kg. This gain in strength over 6 months is partly due to the diet, but maybe mostly to the type of training: super slow, adapted from Doug McGuff (Body by Science; I don’t train only once per week like he suggests. Instead I do resistance training 3 times per week, but work a large muscle group only once per week). I highly recommend it, especially for you who is a training buff concerned with time efficiency.
    I invite you to browse my health blog: http://healthfully.wordpress.com, I’m pretty sure you’ll learn lots of stuff, and at the very least, find it interesting to read.

    (reply)
    • Peter Attia  October 1, 2012

      Ok, will check it out. Thank you.

  56. Ted  October 1, 2012

    I was keto/Paleo for a solid year and while I enjoyed it, I found myself looking for a change just to shake things up. For the last 7 weeks I have been doing a Leangains protocol where I do a 16/8 hour fast/feed and cycle my macros and calories on training versus non-training days. I do intense reverse pyramid strength training 3 days a week for 30-45 minutes. I’m just not into vengeance style aerobic activity. The biggest change in my macro intake has been the addition of rice on workout days. Anyway, I have dropped about 7 pounds and my strength is up significantly. I feel excellent and spend less time cooking, but I can sympathize with your daughter because the tendency to cook the same things over and over is strong for the sake of efficiency.

    For anybody who is looking for something different, this has been a great way to go for me. Note: I have done this with a coach, which has been key.

    (reply)
  57. Chuck  October 1, 2012

    Peter,

    I have a question about ketosis and the percentage of fat / protein / carbs. Should the goal be to eat each meal with the fat ratio of 85-87% or by the end of the day reach that ratio?

    Thanks, Chuck

    (reply)
    • Peter Attia  October 1, 2012

      Absolutes matter, not ratios. Generally carb < 40-50; protein < 120-130 max.

  58. Troy Wynn  October 1, 2012

    Hi Peter,

    what is your end game? where is this going? Are you trying to gain an edge? Improve your total muscle mass to body weight ratio and you will perform better, yes? Not putting down your N=1. Just curious that’s all.

    (reply)
    • Peter Attia  October 1, 2012

      Facilitating world peace, I guess :) My goals change over the course of the year. What I’m trying to do athletically in the fall is very different from the spring, for example, so performance goals change. Health is always at the top of this list, especially given my family history. Mental acuity and energy levels, also.

  59. Marilyn  October 1, 2012

    Thank you, Peter. I always enjoy seeing a new post.

    I can see that for your work with NuSci, the $6000 database you’ve described will be very useful. For myself, a $6000 database wouldn’t be any improvement over the $65 one I had on my computer and finally abandoned. Assuming one is eating real food, every duck egg, every pound of ground beef, every head of cauliflower, has different “nutrition facts.” There were just too many unknowns to fill in all the blanks on the database. Checking other databases simply compounded the problem; for the same portion of the same food, the values often varied widely from one source to another. After spending more of my life than I care to think about trying to keep track of all the details of my diet, I’ve finally just made a list of foods I eat on a Word document, picked a set of values for fats/carbs/protein for each that seemed most reasonable and gone with that — when I keep track at all. :-)

    (reply)
    • Peter Attia  October 1, 2012

      It’s only $600, but it’s not a NuSI-related expense. All personal.

  60. steve  October 1, 2012

    I must be among the few who are more interested in the cholesterol posts than your dietary intake! Learned much there, and use NMR test results as a guide to how i am doing diet wise. I do not follow a ketogenic diet, and will eat a potato at dinner several times a week. Trgs very low( 26) at last testing so i guess i am not getting to much carb matter in my diet. I take Carlsons fish oil, and had both an Omega 3 index done and absolute level of O3 measured. Results: O6:O3 ratio of 1:1, and O3 level at 9.3%. Only issue which from your series highlights it not to be an issue is the level of small LDL-P which can be 50% of total LDL-P which is well under 1,000. Must take meds to get there.
    Be interested to see final installment(s) of the cholesterol series. thanks for the great work. Us older guys appreciate it!

    (reply)
    • Peter Attia  October 1, 2012

      Yes, I’ve got a few things to say in the yet-to-be-completed part X of that series.

    • chris  October 3, 2012

      hi steve,

      if you haven’t already seen the following post you will find it interesting:

      http://azsunfm.blogspot.com.au/2012/09/font-definitions-font-face-font-family.html?showComment=1348701001328

      chris

    • Joe  June 11, 2013

      Hello Peter,

      Your blog has been an immense help to me as well as my wife in thinking through actions we can take together to improve our health and for that we are both extremely grateful. As for my more immediate situation, according to my NMR and coronary calcium scan results, there is, unfortunately, a lot of “opportunity” to lower my CV risk..

      The cardiologist I am consulting with remotely has made some recommendations and one is to begin fish oil supplementation. A recent blog posting by Dr. William Davis at his trackyourplaque site recommends that to get the best health benefits of DHA, you should either eat fish and/or supplement with fish oil in the triglyceride, as opposed to ethyl ester form. Dr. Davis further states in his posting that many leading and popular brands, some of which I was considering trying, were ethyl ester formulations.

      http://blog.trackyourplaque.com/2013/05/dha-the-crucial-omega-3.html

      I would be very interested in your thoughts regarding the differences in the two different formulations of DHA, as this is all new territory for me.

      Best regards,

    • Peter Attia  June 11, 2013

      I am not really an expert in this but have tested (for contamination, not bioavailability) the Carlson’s brand.

  61. BruceF  October 1, 2012

    Hi Peter,

    I am a 57 year old recreational cyclist who likes to ride several century events throughout the season that we have here in the UK. Earlier in the year three of us went to the Alps for a week and climbed a lot of the famous Tour de France climbs like l‘Alpe d’Huez, Col du Galibier and Mont Ventoux. In addition my riding buddies and me also do a fair bit of mountain biking to mix things up a bit. I don’t have a weight problem and no significant health issues either and as far as I know am not insulin resistant.

    A couple of recent TV programs on the BBC switched me on to the dangers of sugar and via Dr Robert Lustig’s “The Bitter Truth” and the wonders of web searching I eventually ended up at your brilliant website. Along the way I also discovered Gary Taubes, Steve Phinney and Jeff Volek and downloaded and devoured their books in record time (not many carbs in an ebook!).

    As a committed cyclist riding many miles each week I had become concerned about the amount of sugary energy products that I needed to consume just to allow me to pursue my sport. As you know, on longer rides it becomes a logistical nightmare to carry and manage your carbohydrate replacement in order for you to make it to the finish in decent condition especially on very arduous terrain.

    As such, when I found out about the wonders of ketosis it seemed like the answer to all my problems. The fact that it also turned conventional nutritional wisdom on its head and actually had very beneficial effects on heart disease and strokes seemed almost too much to believe. Having said that apart from the sugar consumption on the bike I always felt like I ate a healthy, low-fat diet but couldn’t understand why my cholesterol seemed high whenever I had a blood test. Now I know why!

    I decided to go completely cold turkey and just see how things might pan out – my wife thought I was nuts by the way. All processed sugar of any kind went out the diet from Day 1 and pretty much every other kind of carbohydrate too. The first week was a struggle to accustom my palate to all the cream etc. I had switched to and my first couple of 30-40 mile training rides on the bike were also lacklustre affairs. My legs just didn’t seem to have any power from almost the first pedal stroke. Then I tried to do a 70 mile ride at the weekend with only water in my drinks bottles and no food on the ride. Boy did I hit the wall at 40 miles big time! I really don’t know how I made it home I was hallucinating so badly.

    Subsequent rides I followed your advice and took some cheese and nuts out with me and although leg strength was still way down, at least I made it round the rides without drama. At this point after two weeks on the diet I was still assuming (due to my lack of strength) that I hadn’t reached ketosis yet. I was determined to stick with it though and by now I was actually enjoying the diet and lot more and things were at least getting easier on that front as I was organising my meals a lot better and learning what sort of things suited my tastes better.

    Then in the middle of my third week I got on the bike for a training ride with a friend and as soon as I turned the pedals over I knew my “legs” were back. Not 100% yet but at least I was able to push a lot harder than I had been able to since starting the diet especially on hilly rides. I have been following the ketogenic lifestyle for about six weeks now and things have been getting steadily better over the last few weeks and I think I am pretty much back to where I started performance-wise before I started the diet.

    Now I seem to be really reaping the benefits that I had hoped that a ketogenic diet would provide. I have done several 70 mile plus rides only eating a handful of cashew nuts and drinking electrolyte fortified water as well as taking salt tablets. Incidentally the salt intake is one of the things that I have really struggled with. I drink what you call bouillon (we call stock) occasionally but I don’t really like it that much. I have increased the salt in and on my food as far as possible and take salt tablets if I think I need to but still find it a bit wearing to keep supplementing with the salt. I don’t suffer with hypertension by the way so am not especially worried about salt intake levels, especially after reading Gary Taubes take on it as well.

    One comment I would like to make about your website is that it’s a pity that you don’t have a forum. I think others have made this observation too. The problem with your comments after a blog posting format is that a variety of threads get started about things which may or may not be related to the blog topic. This makes it very hard to follow a train of thought effectively and especially relate back to some piece of advice that you may have given someone but is buried halfway down on of your blogs. The length of the blog also becomes very unwieldy especially for newcomers like me having to wade down each one!

    Apologies for the length of my post but I hope some people might find parts of it helpful to know where others are coming from and going to. I can only say that your website has literally been life changing for me and obviously for many others as well. I look forward to many other interesting articles that you have in the pipeline.

    Regards,

    Bruce

    (reply)
    • Peter Attia  October 1, 2012

      Bruce, thanks for your story. I’m so jealous about the ease with which you can take a quick trip to France to climb Alpe d’Huez! It breaks my heart that I’ll be in France for a week and I don’t get to ride my bike at all…

  62. Bill  October 1, 2012

    Whirled peas? Are those OK to eat?

    (reply)
  63. Rob  October 1, 2012

    Peter:

    Any health / science based reason for the reduction – or elimination – of artificial sweetners from your current intake? Or just a preference?

    (reply)
    • Peter Attia  October 1, 2012

      For some, not sure if I’m in this camp, but suspect I’m not, they are still “treated” as sugar by the body/brain. Any time someone is looking to up their eating game, I always suggest a trial without them.

  64. John Vogt  October 1, 2012

    Do you agree with the idea that we are genetically built for the diet that we ate as we first became homo sapiens a couple of hundred thousand years ago? The so called Paleo ideal. Do you think we know what those first humans ate? It seems we are clearly omnivorous, but do you think there is some other dietary ideal that would work best, independent of individual differences, if we could figure out what it was?

    (reply)
    • Peter Attia  October 1, 2012

      I think it points us in the right direction, but I don’t necessarily subscribe the notion, wholesale. It’s a complex question, but worth of discussion at some point. Our ancestors ate out of necessity and their eating patterns were largely determined by survival and availability.

  65. Isaac  October 1, 2012

    Peter, as so many have mentioned, thank you for your time and commitment to this website and the posts. I have been following this website for about 2 months and I’ll say that my mind has been completely blown by the information and I love it! I have tried to get completely changed over to a VLC diet and it has been pretty good so far but I wonder what your recommendation would be like for a person like me (and I’m sure that there are at least some people out there that this may pertain to). I want to preface this question with the complete sincerity that I am not trying to brag or boast about my physical condition/status whatsoever. I love hearing people’s testimonials of how certain goals were achieved and I am just falling into the same boat as someone who is wanting to achieve physical goals, and at the same time, hoping I can do it while still being on a VLC/Ketotic diet. So I have been skinny/scrawny my whole life, and have been on a constant (since 10th grade) effort to gain muscle mass and get “bigger”. Now at age 28 I have made modest gains but still would like to gain more. My goals are not for any major athletic event, but is just for overall health, moderate physical hobbies (rock climbing, basketball, surfing), and the aesthetics are obviously a bonus. I love the way you have got me to think (re-think actually) about what is healthy and have made appropriate lifestyle changes (mainly in diet). This change in my diet, however have made my gains VERY difficult. I am still eating as many, if not more, calories on this diet/lifestyle. I have lost some weight, but that really wasn’t my goal. It is nice knowing that I am contributing to my health but I would also like to still move forward in my goals. I have read all your posts (maybe not all the comments/responses) but I can’t remember if you have talked about achieving the types of goals I am looking toward while being keto adabted. I feel like if I am not trying to actively gain weight, I am loosing weight (which for me is the opposite direction from MY goals). I appreciate the fact that I may have lost some fat% but that really hasn’t been a concern either. I know there is a lot of rambling here but do you have any thoughts about someone who has no goal of loosing weight but is trying to gain weight (and by that I mean muscle mass) while still trying to being in ketosis? Thanks, Isaac

    (reply)
    • Bill  October 3, 2012

      As a fellow ‘skinny’ person, I have to chime in here with the concept that a lot of body-build is genetic. In college, I went on an intense weight lifting schedule; at the end of a year, I weighed only 5 pounds more. However, I looked like Michael Phelps; is that so bad? One’s build has a lot to do with your natural levels of circulating hormones and a lot of other built-in factors. A friend in college looked like a pumped-up Arnold, and never worked out a day in his life. Don’t worry about it, just work out for health and conditioning.

    • Peter Attia  October 3, 2012

      More than any other genetic factor passed on from generation to generation, body habitus is profoundly conserved. Clearly genetics plays a role in obesity. However, it’s the epigenetic factors we need to be worried out. Genetics aren’t driving the obesity epidemics. Epigenetics are driving it. Obviously, it’s my hypothesis that the most important epigenetic factor is the quality (rather than quantity) of food we now consume.

  66. Joshua  October 1, 2012

    Thanks for the post Dr. Attia. I haven’t done anything particularly consistently this year, but I’m keeping things like IF & other tricks up my sleeve for if/when I hit a plateau.

    I’ve lost 85 lbs this year (from 372, 6ft, 36yo), and I count your blog as one of my inspirations. Because of your signal to noise ratio, you’re at the top of my fitness blog list.

    I know it’s a work trip, but I hope you have a {little} bit of fun in France.

    (reply)
  67. John Nelson  October 2, 2012

    I think I remember you saying in your first “what I eat” post that you had maybe 1 diet soda every once in a while…but in this post you seem to make a point that you had like no artificial sweeteners the whole year except for what’s in the SS…was this deliberate? I’ve read your post on artificial sweeteners where I believe the gist of it is that “we don’t know yet if they’re bad for you, so just observe moderation and if you’re intolerant then cut it out” But is there something you found out since then that made you want to purposely avoid artificial sweeteners altogether? I mean, did you not have any of your famous ice cream this whole year? Or am I misreading what you’re saying altogether?

    (reply)
    • Peter Attia  October 3, 2012

      Correct, I’ve noticed that less AS in my diet makes it even easier for me to ignore anything sweet. I also do see that a non-trivial segment of folks I work with, removing them may accelerate fat loss, though the reasons aren’t entirely clear.

  68. Bjarte Bakke  October 2, 2012

    Peter,

    First things first; my question is: Is there enough research out there to identify the key drivers of our health? If yes, what are these key drivers (I assume LDL particle number will be one key driver in your opinion)? If no, what do you personally believe our key health drivers are?

    I’m a Norwegian management consultant and the author of http://www.rethinkingtruth.com. I highly respect your work and admire your approach to finding the “truth” and accepting that sometimes you have been/will be wrong. Keep it up. Also, I’ve read most of the books you recommend and I especially like Doug Newburg’s. I started my own “who am I, what do I feel, and what’s important to me” journey about five years ago and it’s been a very challenging but excellent process.

    Some more details about my question:
    Life & health is my main interest and I strongly believe in the importance of identifying key drivers and how to measure these. One of the life & health topics I have studied is how to measure health from the perspective of answering the question: How healthy am I currently and what are my disease risk levels. Unfortunately, I’ve been frustrated in my quest for identifying such key health markers. Having spoken to dozen of doctors, nutritionists, paleo/LCHF experts and blood work guys my conclusion is that no-one knows what the key health markers are (say the 10-15 most important ones).

    Would you be able to provide a break down of how you view the key health markers for a human being, to provide some data on why you have picked these markers and how certain/uncertain you are about these being the most important ones?

    Thanks a lot and regards from Norway!

    (reply)
    • Peter Attia  October 3, 2012

      Great question — sort of like the “unifying theory of life.” Short answer is I don’t think I know and even if I did, I suspect the “weighting” of the variables would be far more relevant to an individual. If you think of this as a Taylor polynomial, it’s like figuring out what the coefficients are — they will differ for different people. I do think about your question a lot, but I think it deserves a more thoughtful response than I can muster right now. Let me put some real thinking into this and take a crack at writing it up.

  69. tooticky  October 2, 2012

    Thank you for your informative post again.

    I don’t normally comment but anything related to gut flora is close to my heart. Hippocrates reportedly said “All disease begins in the gut.” Apparently our gut holds the same type of neurons found in brain so the gut is indeed our second brain.

    Unless you already own a copy, get hold of Sally Fallon’s Nourishing Traditions. It’s full of great recipes and soon you’ll be cooking your own stock. It may sound time consuming and initially it may be the case. However, when you have fresh stock in your fridge/freezer, cooking is faster. You make nourishing soups in no time. My personal favourite for Vitamin D is Green Pastures fermented cod-liver oil. It’s produced in the USA and bit difficult to get hold of here in Europe. I treat it like a gold dust :)

    (reply)
    • Peter Attia  October 3, 2012

      Sounds interesting. Thank you.

  70. Wilt  October 2, 2012

    I’m curious as to why you double your sodium supplementation on fast days. Could you expand on that a bit?

    (reply)
    • Peter Attia  October 3, 2012

      Not getting as much sodium out of food.

  71. John R  October 2, 2012

    As always, a very interesting and informative post. I am much looking forward to your Part X of your cholesterol series! I do have a question regarding your experience as your diet has “evolved” — have you noticed any changes in your LDL-P?

    (reply)
    • Peter Attia  October 2, 2012

      I didn’t do NMR until I was already keto-adapted, so no way to know for sure where I started.

  72. Eric K.  October 2, 2012

    Hi Peter, Great post as always. I tried various IF schemes awhile back. In addition to weight loss, I was interested in any health benefits it might bring. One obvious question when it comes to fasting is whether lots of short fast or less frequent, but longer fasts are more beneficial. One person who has a strong opinion on that is Dr. Thomas Seyfried – I wonder if you’re familiar with his work. Rob Wolff and Jimmy Moore have interviewed him and have material on their websites. Dr. Seyfried uses fasting and ketogenenic diets in his mouse models to control cancer and epilepsy. According to him, many cancer cells cannot burn fat and are inefficient users of sugar (the Warburg Effect). The most powerful anti-cancer therapy he knows is to undertake a 7-10 day fast once a year (distilled water only) to put any cancer or neo-cancer cell in your body under extreme metabolic stress, and hopefully kill it. So that’s what I do.

    (reply)
  73. John  October 2, 2012

    Will your gut biota entry include discussion of kefir and yoghurt? I have seen comments elsewhere, suggesting that kefir has fewer carbs than are listed on the label, due to fermentation consuming the sugars. Do you know if this is true? Or should one just consider the carbs to be consistent with what is listed on the label?

    Also, for food items, I find that baking some thin slices of pepperoni makes a great substitute for chips and that adding a touch of vanilla or dark cocoa powder to whipped cream makes it very tasty without adding sugars. I wish someone would sell whipped cream that is full fat with no sugar though; it would be convenient to have around for times when I don’t have time or inclination to whip up a batch myself…

    Re the popularity of the food article, I would add that it seems always to be the top item in the “Top Ten Posts” sidebar, which I suspect helps it to stay in that place.

    Thanks for your hard work on this site. It has been very helpful to me.

    (reply)
  74. John R  October 2, 2012

    Sorry, I should have been clearer in my question about LDL-P. I meant if you had seen any changes as you transitioned from your full keto diet to the IFIK diet that you described in this post.

    (reply)
  75. alan  October 3, 2012

    the question was “what do you eat”? i think you have so much traffic on this because at times it is hard to find alternatives when you eat low, very low – carb.
    when one eats a type of nutrition full of carbs, the choice is immense, but once one goes into a differrent lifestyle nutrition, it is difficult to figure out how to get your fat quota up especially if one does not eat dairy. very low carb without diary is hard to put together in the long run i think. and too many nuts may contain too many O6 oils.
    great blog by the way.

    (reply)
  76. Howard N  October 3, 2012

    “I wish someone would sell whipped cream that is full fat with no sugar though; it would be convenient to have around for times when I don’t have time or inclination to whip up a batch myself…”

    I can help with this — i use an ISI whipper ( http://www.amazon.com/iSi-1-Pint-White-Cream-Whipper/dp/B0039B3YD2/ref=pd_sim_k_3 ) . It uses N2O cartridges — you just add your cream (+ flavoring if you like) and voila — instant whipped cream! Just keep it in the fridge like redi-whip. Works great!

    hn

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  77. John Dawson  October 3, 2012

    I’m looking at Primal Flora. A couple of questions — what benefits have you personally seen? And I see you’re taking 2 daily vs. the recommended one. Why did you go to 2?

    (reply)
    • Peter Attia  October 3, 2012

      Bowel regularity and better diggestion. Trial and error for the dosage.

  78. Marcus Wolford  October 3, 2012

    Supplement Questions:
    – Why Magnesium Oxide vs. Citrate or Glycinate?
    – Have you tried Green Pastures fermented Cod liver oil? Not only for the fish oil, but especially for the natural Vitamin D & A.
    – Why the Vitamin D Pills vs. liquid drops?
    – When you do take BCAA’s during or post, how much do you take and what ratio of Leucine to valine/isoluecine?
    – Should someone who is trying to stay ketotic be concerned about too much BCAA supplementation in the same sense of too much protein via gluconeogensis. I add 3-5x more leucine to my BCAA supplement b/c of this concern based on the fact that leucine is a ketogenic amino acid.

    Off topic question: Have you seen any research or anecdotal evidence that nicotine patches may be an effective means for woman to lose hip/thigh fat?

    Thank You!

    (reply)
    • Peter Attia  October 3, 2012

      1. Not clear there is a difference.
      2. Have not.
      3. I take gel/liquid, not tabs.
      4. 5-6 gm.
      5. No, amount is small (see above).
      6. Some evidence this could be true, probably through downregulation of LPL on adipose tissue (ergo, more TG breakdown).

    • lorraine  October 4, 2012

      Magnesium oxide tends to pull more water into the intestines and causes looser stools, and it’s believed to be less absorbable than other forms. I used to do consulting work for the company that makes (or actually, originally made) MagOx, and they reformulated it to address both these above issues, claiming a 40% improvement in bioavailability over other Mag oxide formulas. I can’t speak to that claim, but it does seem to get decently absorbed as I did a pilot study for them with diabetic clients and all had significant reductions in BP.

      Nicotine patches for thigh fat – what an awesome idea!!

  79. Tina  October 3, 2012

    Hello Peter,
    just a quick question on Vitamin D supplementation: as you take 5000 I.U. per day (plus what’s in the cod liver oil) please let me know why you aren’t supplementing Vitamin K2 at the same time in order to prevent calcification of organs/arteries, etc which is one of the risks when taking high D3 doses. Thanks a lot and kind regards from Germany, Tina

    (reply)
    • Peter Attia  October 3, 2012

      I haven’t seen evidence that compels me to worry about my vit D contributing to atherosclerosis. Maybe I need to learn more, but my serum levels are normal, not high/normal. No vit D in my fish oil, just some vit E.

  80. Lucy  October 3, 2012

    Hi Peter,

    I recently stumbled upon your site. I am a 22 year old female and even when I was running for an hour daily and doing several hours at the gym working out (I was a kickboxer), I always had fat on my body that just wouldn’t go away, no matter how much I worked and how strict I was with my diet.

    Now that I’m nearing the end of my degree, I’ve become sedentary as my study demands increased. I’ve maintained a low fat diet to no avail, I’m heavier now than I ever have been.

    A fellow student directed me here, after a discussion about ketosis and the health risks and benefits that arise from it. I was interested that he thought ketosis was risk-free and may even be beneficial, and when I asked him for his resources his answer was your website.

    I’m trying to exercise again by including my hourly run each day, but I would like to attempt to keep myself in ketosis to see if it will finally rid me of these fat patches that never go away (my upper thighs, knees and belly). But I’m very short, female and presumably may need to consume far less calories than what you’ve described as making up your own diet. How should I start so I can determine how much is too much or too little for me? Should I be making a slow transition into ketosis, or should I start immediately? Should I consult my physician and have tests run first, and if so, what tests?

    Thanks!

    (reply)
    • Peter Attia  October 3, 2012

      Lucy, glad you’re willing to give a shot to new approach. I can’t really provide the kind of help you’re looking for in this response, but the good news is (if you have the time to read the blog and the comments), most of your questions have been addressed. Also, pick up a copy of “The art and science of low carb living” by Phinney and Volek.

  81. John Vogt  October 3, 2012

    For those of us who are not engaged in high level athletic performance, what is the advantage of using SuperStarch? What does SuperStarch add to any already low carb diet? I’ve plateaued with my weight loss so I’m willing to try something more but I don’t understand why low carb with SuperStarch would be better than just low carb.

    (reply)
    • Peter Attia  October 5, 2012

      Will address all SS-related questions in a subsequent post.

  82. George Henderson  October 4, 2012

    I can’t wait till you blog about commensals! My favourite subject and one complex enough that I’m sure you’ll do it justice and turn up something new.
    Interesting that you source extra fish oil – I suspect this might be wise on VLC.
    “Low thyroid/ high LDL” if and when it exists might just demonstrate an increased requirement for DHA.

    (reply)
  83. jess  October 4, 2012

    Peter,

    You obviously eat a lot of fat (400g’s/day some days). As you know with low carb, fasting triglycerides tend to go down and HDL goes up leading to the new all important Triglycerides/HDL ratio as a predictor for heart disease. With low carb, fasting triglycerides clearly go down but what about postprandial triglycerides. Do you ever worry about your non-fasting triglyceride numbers? On 400g/day of fat will these numbers stay high and potentially change your risk profile for heart disease? You seem like the one person who might be able to answer this question. thanks!!

    (reply)
    • Peter Attia  October 5, 2012

      Great question. I’ll address this in a subsequent post based on the lab data I gathered during this time period.

  84. Deb (SmoothieGirlEatsToo)  October 4, 2012

    Palomar! Fun! We have a cabin in Julian and just love that whole area.

    I WISH I could get really sick of nuts like your daughter. They are just too good to break up with, but I know that I’d be better off with fewer. I know I need to break up with cheese or nuts to lose ‘those last’ pounds but I’m not ready.

    I know that you said that your dairy-reduction in the past year was more based on taste, but it seems that you would have been cutting out a lot of calories from your wife’s ice cream, cheese, yogurt etc and that could definitely help with your weight loss. So a few questions:

    1. Do you feel that your weight (fat) loss is as much a matter of shaving off some of these calories as it is just having a much more limited eating window- hence lowering the opportunity for consuming as many calories as before?
    2. Are you concerned with getting as much protein in one sitting as you are getting?
    3. Did I understand you correctly in saying that Volek & Phinney are correct in that it can take weeks to get back into ketosis, but that you aren’t blowing so far out of ketosis (like with a bowl of berries the size of your head) that it is in fact easier for you to slip back into ketosis?

    Thanks and I hope that you can enjoy a little bit of down-time in France! (PS I was just there too and people could not believe that I was not even a little bit tempted by the bread…the cheese on the other hand….um) ;-)

    (reply)
    • Peter Attia  October 5, 2012

      1. Quite possible, as I note in post.
      2. Whenever I seem to quantify it, it seems to be comparable to what I used to consume over 3 meals.
      3. Seems that way, probably due the fact that it’s protein overload that throws me out, rather than sugar or simple carb consumption.

  85. Daryl Broussard  October 4, 2012

    Doc, do you have any idea how a type 2 diabetic, or someone with severe insulin resistance, would react to SuperStarch? Looking forward to you writing about the product, I know Volek is very favorable towards it.

    (reply)
    • Peter Attia  October 5, 2012

      Preliminary data look promising, but this is not fully tested in a RCT.

  86. Sam  October 4, 2012

    Granted you were experimenting with IF for this post, but your meals do seem markedly different from the first edition of What I Actually Eat. Along with the aforementioned reduction in dairy you seem to be eating fewer eggs and (maybe it’s just my reading) less meat generally. Would you agree with this statement or is this food log not representative of the time when you are not IF? If there was a change in how you eat was it more related to seeking stronger athletic performance or has your opinion changed with regards to the healthfulness of anything you were eating before?

    Thanks

    (reply)
    • Peter Attia  October 6, 2012

      I’m not sure it’s accurate to say that based on what I’ve shown you, though my current intake is certainly different from before.

  87. Tina  October 4, 2012

    Concerning supplementing Vitamin D without additional supplementation of Vitamin K2 : it would be great if you could look into that ;-) As far as I understood it it seems to be essential to have an optimal intake of Vitamin K2 when supplementing Vitamin D as the body’s ability to absorb calcium is greatly enhanced when supplementing Vitamin D: http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-cofactors/vitamin-k/

    (reply)
  88. Brian Packowski  October 4, 2012

    Hi Peter,

    I am avid fan of your blog and think you are doing something truly great here. I’ve taken alot of advice from you and how you eat and have achieved significant weight loss the past month (196 to 187). It would be safe to say i am keto-adapted as my blood levels of B-OHB are around 1-1.5 and can cycle continuously for approximately 1.5-2 hrs. However, as I am younger (24 yrs old), i enjoy going out with co-coworkers to happy hours about once per week. I typically have 3-4 drinks consisting of 1 Michelob Ultra (2.4g Carb) and a the rest Rum+Diet. How does this affect my keto-adaptation? Does this have a similar effect to eating over 50-60g/carb and falling out of ketosis? I know that the body processes alcohol before any other source of energy and temporarily “kicks” you out of ketosis and causes me to wonder.

    Thank you in advance for your response, Peter! Keep up the good work, you have changed my life for the better!

    (reply)
    • Peter Attia  October 6, 2012

      Check with you ketone meter and less us know.

  89. xz123  October 5, 2012

    Just a quick question that is a bit off topic: If you can’t get an NMR test but only get apoB tested – what is the “preferable range” here? (My apoB is getting lower since taking l-thyroxine, last time I checked it it was at 135 mg/dl)

    And a bit more on topic: Great and interesting post. Since a few month I do all my training fasted (16h fast, 8h feeding windows) and in ketosis with “paleo” foods only, and it works surprisingly great.

    (reply)
    • Peter Attia  October 5, 2012

      Depends on the lab. They should provide a range.

  90. Gonçalo  October 5, 2012

    Very nice post!
    I wonder if my symptoms might be helped by a diet like this. I have chronic anxiety, acne, hair loss, cold hands and feet in the winter, gas, constipation, eczema, dandruff, muscle pains and mites allergy. I don’t know if there is some autoimmune condition (or other) that is causing all this (maybe you have an idea) but maybe this diet could help?

    (reply)
  91. Raffaello  October 5, 2012

    I hope you meant 70mg/dL of glucose not gm/dL!!

    (reply)
  92. Indy M.  October 5, 2012

    Dr. Attia –

    Is there one of your writings that indicate ways to normalize LDL-P please? Or is that forthcoming?

    Many Thanks in advance!

    Indy M.

    (reply)
  93. Alex Li  October 6, 2012

    Hi Peter, I learned a lot from your blog and have practiced LCHF for about four months even though I had my gall bladder removed a year ago. My surgery doctor recommended low-fat and I searched on-line for proper diet (before finding EatingAcademy.com) and mostly confirmed what my doctor said. Some gave their own experience that after their gall bladder removed: they always had diarrhea if they had fat n the diet…

    But after I read your post here, I started to add fat slowly to my diet and my stool got better and better. I am not kidding, it is now better than before I had the surgery. My current diet include organic green leaf vegetables and lot of fat,: sour cream, eggs, rib-eye steak, clarified butter, and once in while coconut oil ( I can’t take too much coconut oil because my body seems to still react to it). My carb intake gradually reduced to two bowls of rice for the entire day ( U used to have three bowls per meal) . The main thing is I have more energy and feels warm and good every day. I knew the benefit of exercise for long time. But when I was on mostly plant diet, I was weak and felt no energy and when I force my self to exercise I did not enjoy it. Now I feel differently, it sort of feels like the more you exercise, the more you want to exercise. Although I am not in Kenton yet (at least I don’t think so) I am feeling GOOD. I thank you for your advice. You the best.

    (reply)
    • Peter Attia  October 7, 2012

      Alex, great to hear your story. Glad to see you’re gradually experimenting to find out what works best for your body.

  94. Ilaine  October 7, 2012

    Hi Dr. Attia,

    I think you are awesome and appreciate your work, but don’t think you are eating enough vegetables.

    Some suggestions: dark greens braised with either olive oil, chicken fat, or bacon fat. Collard greens, mustard greens, turnip greens, chard, kale, bok choi, escarole, spinach, dandelion, cabbage, red cabbage, broccoli, brussels sprouts. Drizzle liberally with high phenolic olive oil.

    Dark colored salad greens: arugala, radiccio, spring mix, basil, parsley, dill, oregano, thyme, celery, fennel, again dandelion, spinach, cabbage, red cabbage, bok choi. Again, drizzle liberally with high phenolic olive oil.

    I buy the most amazing celery from a local farmer’s market that is dark green and tastes more like parsley than celery. Yow!

    I believe that dark greens are the real secret to the Mediterranean diet. The braised greens the Greeks and Cretans eat every day, they call them “horta” and say that’s why they live a long time.

    Full of minerals and vitamins, not out of a bottle. If you want to branch out, you can pick wild greens, too.

    Anyway, I am a mother, and as mothers say, “eat your greens.” Lettuce is not enough, and neither is broccoli.

    (reply)
    • Peter Attia  October 7, 2012

      Ilaine, I certainly appreciate your sentiments, but I’d ask the question, what is the scientific proof that such foods are necessary? They may well be, but I have never come across convincing evidence that tells me I must be consuming them to be healthy.

  95. Craig  October 7, 2012

    A previous poster indicated that they had been able to adapt to the high fat diet even after gall bladder removal. Is that generally the case, or an uncommon outcome? (My wife had her gall bladder removed a number of years ago, and tends to feel ill & suffer digestive upset after high fat meals.)

    (reply)
    • Peter Attia  October 8, 2012

      Interesting, but of course food availability isn’t as informative as consumption.

  96. Javier  October 8, 2012

    Peter:
    Great information here!!! I’ve been following the blog for about 2 months now. I’m also a physician, (pathologist) and also a triathlete. I’ve been frustrated with the never ending feelings of doom from bonking issues. So, I decided to start a a ketogenic diet. I am now in my 5th week and all has work out great except for an issue with heart rate. It just doesn’t seem to come down, specially in long sessions. This has obviously limit my endurance. Also, I get a prolonged effect after 2.5 hours sessions where my HR will not go down until maybe 4 hours later. In a couple of occasions I had to take propranolol to help with the heart rate, palpitations and blood pressure. Blood pressure seems to follow a similar path where I would be in the pre hypertensive zone for a couple of hours. The palpitations are really annoying. I thought these would be transient but I am still getting these issues after 5 weeks. Also, my heart rate is always in the 80s during the morning, where it used to be in the low 60s. Would you recommend me someone who could coach me in these regards? I have tried all mineral supplementation, hydration, etc to no avail. I’m aware of a probable medical issue that may not allow you to give advice in the blog, but any recommendations will be appreciated. Keep the good work rolling. I am coming up with a presentation (about obesity) to a local group here in Puerto Rico. I will definitely reference you blog as well as NUSI.

    (reply)
    • Peter Attia  October 8, 2012

      Just request a work-up. Find out if it’s being driven by catecholamines, electrolytes, whatever. I can’t really comment beyond that, unfortunately.

    • Jared  October 9, 2012

      Have you tried dramatically increasing your salt and magnesium? Try cutting out coffee or other dehydrating drinks

    • lorraine  October 12, 2012

      Also Javier, have you considered you might be over training? Lack of recovery HR and BP, and first morning elevated HR is a common symptom of over training.

  97. Count Bananas  October 8, 2012

    Greetings Peter. I’m interested in trying Ketamine after the Yale findings. Do you know which pharmaceutical companies have a monopoly on it, if any, and does it matter which drug store you buy it from once you have a prescription?

    Any thoughts on depression now that it’s been cured? Would you say this is a major event in human history, or just another excuse to get high?

    (reply)
  98. palo  October 8, 2012

    Great article! I have some questions on the keto diet:

    1. Is there an age on which a person should not adopt this diet?

    2. What happens if your daily < 50 grams of carbs include sugar and grains? Does the diet still work?

    (reply)
    • Peter Attia  October 9, 2012

      1. Not that I can tell.
      2. Becomes less effective, especially with really simple sugars and grains (e.g., candy bars and potato chips).

    • palo  October 9, 2012

      Thank you for your prompt response!

      Another question: Since the Japanese are the slimmest, and they consume 49 grams of sugar daily, is this a good amount to shoot for? Any suggestions?

      By the way, I just discovered your website and you got me all fired up in my pursuit of the keto diet.

  99. Matt  October 9, 2012

    Hi Peter,
    I don’t work well with dairy products but I love walnuts and have no problem eating the same thing all the time every day if that’s what it takes to feel great. Do you believe it would work to eat about a cup of walnuts a day which would come out to around 75 grams of fat and 16 grams of carbs? It makes sense mathematically but are healthy fats healthy fats? What I mean is should I be diversifying my fats or can I get it from one source?

    High fat items I could tolerate daily:
    Avocado
    Any type of Nut
    Animal Fat
    Coconut Oil

    Could I do this diet on these items alone? I’m open minded to any suggestions. PS: I appreciate your logical, honest, no BS or artificial hype blog.

    (reply)
    • Peter Attia  October 10, 2012

      Plenty of non-dairy fats to make up a healthy diet, as you’ve listed.

  100. Julia Finn  October 9, 2012

    Hey Peter,
    I really enjoy your site and I’m very excited about the prospect of new, better research in the realm of nutrition with the advent of NuSI. I am currently experimenting with a low carb diet. I was raw vegan for over a year some improvements and then hit a plateau. Not yet sure what diet is best for me

    I am wondering what your views are regarding metabolic typing. Are some folks born to be high carb and others high fat? Can we test for this? It’s confusing to me that quite a few masters athletes I admire can thrive on a high carb-raw vegan diet (check out Tim Van Orden or Rich Roll) while others like yourself do very well low-carb paleo. It seems the common denominator is getting rid of wheat and processed foods in general. I would love to get your feedback!

    (reply)
    • Peter Attia  October 10, 2012

      Interesting area of study, but I’d like to see more research. I’ve definitely heard of some positive anecdotal experiences. As you say, though, hard to make a great case that lots of sugar, wheat, and processed foods are helpful.

    • Martin  October 13, 2012

      My take at it would be all of the athletes like Scott Jurek, Anton Krupicka (high carb ultra runners) on the one hand and Tim Olsen and Stu Mittleman (low carb ultra runners) on the other are… outliers. The point is that we won’t learn much from looking at them.

  101. Evan  October 11, 2012

    Peter,

    Question 1: What about chopped liver (store bought, say Shop-rite deli as i am too lazy to make it)? I figured it would be good source of Copper. They printed out a list of ingredients for me – wow, long. I was shocked, and i presume it must have a flavoring mix added to it, ingredients includes: chicken livers, onions, eggs, enrichd wheat flour, flour, malted barely flour, reduced iron, niacin, thiamin mononitrate, vitamin b1, riboflayin, vitamin b2, folic acid, water, HIGH FRUCTOSE CORN SYRUP (…..those Bastages!!!….) yeast, salt, soybean oil, butter, ……..list goes on.

    I guess (from what i can find for other chop liver spreads on the web, perhaps, 2-4 carbs per 2 oz? Typing it all makes me want to toss the container……

    Question 2: late at night when i am hungry, i take a tablespoon of organic (grass fed cows) butter (trader joes) and just let it melt in my mouth. Its good for K2 supplementation (yes i sound like a freak, especially since my post workout food is a Fat Shake). See my post from up above with my typical food list – for those who want to make fun of me).

    Question 3: I added 2-3 brazil nuts a day for selenium, do you have thoughts on these? I am sure you already know they are super high in selenium.

    Question 4: When is NUSI going to start a study or publish some results?

    thanks in advance,
    Evan

    (reply)
  102. Matt  October 11, 2012

    I’ve looked through the site FAQ, in depth FAQ and coming soon but didn’t see this, apologies if it’s been posted:

    1. Why is it s that once we become fully keto-adapted (nutritional ketosis) and our body is using our fat for energy that it’s still necessary for us to consume a large amount of healthy fat in a day? Is it simply to not to lose too much weight?

    2. Doesn’t our body store vitamins/nutritents within it that will replenish us if we’re low making it almost only necessary to eat once every 2-3 days and still feel fantastic? I have done a 2 week water-only fast (i’m a very big self experimenter as well) and felt fine which would make me believe this is the case.

    Thanks for your time and dedication and sharing your experiments.

    (reply)
  103. Tim  October 13, 2012

    Peter, I came across your name from listening to your interview with the great Lew Rockwell. I was very intrigued by what you had to say, so I checked out your website. I’d like to hear your opinion on Dr. Caldwell Esselstyn, author of Prevent and Reverse Heart Disease. In his book, he advocates no meat or dairy whatsoever. He forbids his patients from any oils as well. His plan in a nutshell is a plant based diet, it’s that simple (although not easy to adhere to). He says all the fat that your body needs can come from plants. What do you think about this? I’m so confused about what is best for my health. Even though we are all wired differently as individuals, I feel like there has to be some universal laws regarding human nutrition, whether its no sugar, no dairy, no meat, or all of the above. Thanks for your time.

    (reply)
    • Peter Attia  October 13, 2012

      His data is based on epidimiology and experiments in mice and rats. Interesting, sure, but not subject to the rigors of experimental clinical trials in humans that delineate cause and effect. Someone may do very well on his diet, if they were formerly eating a standard American diet. The question is WHY. What it the elimination of sugar? Flour? Processed food? Meat? Dairy? You see the problem? When you change 13 variables, then assign cause to 1, you’re not really doing science.

  104. martha  October 13, 2012

    Dear Dr. Peter… I just heard you this morning on LRC and literally ran right out to my local market to buy some “Knorr” bouillon…. i was horrified to see the list of ingredients! Salt is fine… but second was MSG… and after that (only going by memory, since I did not purchase it) … was hydrolyzed protein, and sugar, and …. whatever… Things that send up a red flag for me. You recommend neurotoxins? and artificially created substances? Thanks, but I’ll make my own… or simply put some high quality sea salt in my water!

    And then, later on in your posts, I find out that you use sunscreen???
    Boy… have you lost a reader!!!

    (reply)
  105. martha  October 13, 2012

    Dr. Peter….. I listened to you this morning on LRC. I then read your blog and checked out your website.. Attention to “what I eat”…Then, I literally ran right out to my local grocery to buy some bouillon. I read the ingredients on the Knorr brand… and was totally mystified how you could be recommending this garbage. OK… first ingredient is salt… no problem with that… But next was MSG ( you are recommending neurotoxins??) Going from memory, as I did not purchase it, were hydrolyzed protein, sugar, and a long list of artificially created ingredients.
    Guess I’ll just go back to making my own.
    OR, adding some high quality sea salt to my water.
    You have certainly lost one potential reader here.
    Check out Dr. Batmanghelidj…. water with salt.

    (reply)
    • Peter Attia  October 14, 2012

      I’m surprised you didn’t bring up nitrates, too, since I eat bacon. Wait, they may not actually be harmful at all: http://chriskresser.com/the-nitrate-and-nitrite-myth-another-reason-not-to-fear-bacon

      Keep one thing in mind with your comment: “dose response.” I do agree, of course, that if one has the time to make homemade broth and the luxury of not traveling 200 days per year, it’s probably better than store-bought bouillon. But to dismiss what I’m saying because of sunscreen (?) or store-bought bouillon is missing the forest for the trees.

    • Dave Nelsen  October 14, 2012

      Whenever I hear someone going off the rails about MSG I thing about this article:

      http://www.guardian.co.uk/lifeandstyle/2005/jul/10/foodanddrink.features3

      The headline is: If MSG is so bad for you why doesn’t everyone in Asia have headache!

      Even if it is potentially bad as some consumption level the amount you get in a Bouillon cube has to be pretty small. I don’t travel 200 days per year and find it challenging sometimes to eat right all the time. The overall message which bears repeating is not to over emphasize something that is way down the Pareto chart of concerns.

    • Peter Attia  October 15, 2012

      Thank you…

    • Matt  October 14, 2012

      Ever heard someone say “eat Chinese food and you’ll be hungry again in 20 minutes”? This is because for a long time it contained MSG which is an excitotoxin that can cause someone to overeat or to become hungry again very soon, which is why companies add it to food; as a cost effective way to make it taste great and to keep the people coming back for more. There are plenty of studies for people to read if they want to find them that at least leave a reasonable doubt about the safety of long term use of MSG (and its many hidden forms) to just simply leave it out of their diet whenever possible.

      Unfortunately for Martha there aren’t any studies that indicate how to effectively communicate a new idea to another person in a logical, non-emotional way so that we can all help each other to get better. My guess is that she’s making this statement in a rude way because it feels good to be able to tell someone who is seen as an authority in a given subject matter that they did something they think is wrong.

      PS I won’t be responding to any replies to this message.

  106. martha  October 14, 2012

    Dr. Peter… I did not mention anything about nitrates, or nitrites… Don’t Straw Man me.. or get off subject.
    If you need to replenish your sodium, drink some sea salt in water. Your advice to drink Knorr bouillon is way off target…and undermines your reliability on any other topic, especially since your “excuse” is that you are away from home so often,but are not addressing of the issue of very nasty ingredients.
    PS I am old, and have been “in ketosis” for a couple of years… but I would NOT buy that Knorr crap. But I eat bacon … lots of bacon.

    (reply)
    • Peter Attia  October 14, 2012

      Please share the data implicating the dose of MSG as a neurotoxin. My credibility, if I have any, comes from providing data when it exists, acknowledging it, when it does not, and changing my mind in the presence of new information. If mg of MSG are indeed neurotoxic, I’ll be first to stop in favor of something else.

  107. martha  October 14, 2012

    Dr. Attia…. This will be my last post. I do not intend to be contentious. I am simply responding as a member of your potential “Nutrition Science Initiative”, which I was interested in reading about after I heard you on Lew Rockwell, (who has, as you know, ‘Gone Primal’).
    I discovered Mark Sisson’s philosophy over three years ago, and have been following a Fat based-NO grain diet ever since. I am 65 years old and pretty thin to begin with, and I initially lost about 6 pounds…. but all of it was bloated belly. No more symptoms of digestive disorder in any sense. And NO medications of any sort.
    Things have come to a point that I can breeze through the supermarket on the outside aisles, purchasing meats and vegetables, because almost all of everything else has something “hurtful” in it.
    So…. I then read your “personal blog” about the first article you have posted, “What I Eat”, and read through it. That’s why I wrote to you in the first place…. your recommendation of Knorr bouilon blew me away.

    I just got back from the supermarket with a package of it so that I could share with you the list of what I consider ‘distasteful’, or ‘harmful’, ingredients:
    1) after “salt” is Monosodium Glutamate
    2) Palm oil (no so bad)
    3) Hydrogenated beef fat (hydrogenated?)
    4) corn starch (not only GMO, but glycemic)
    5) soybean oil (90% chance GMO)
    6) sugar (enough said)
    7) dried beef (fine… and finally)
    8) Hydrolyzed corn protein (a “code word” for MSG
    9) Maltodextrin ( another MSG “code word”)
    10) Natural Flavor (often another “code word” for MSG)
    11) Yeast extract (definitely a “code word” for MSG
    12) caramel color (artificial or not?.. I don’t know…)
    13) dehydrated parsley and turmeric (fine with me)
    14) Disodium Inosinate (?)
    15) Disodium Guanylate (?)

    There you have it.
    I studied Anatomy and Physiology in college over 40 years ago. Blood typing was a new idea. There hadn’t been a heart transplant yet, or Dialysis. No one had ever heard of Leptin, or m-Tor…. I do not pretend to be able to discuss with you… or anyone… the science behind the studies… or “prove” anything to you. (that’s what I am hoping YOU and Dr. Taubes will do…) But if articles on the Internet state that MSG coaxes the pancreas to raise insulin levels (see today’s: http://www.naturalhealth365.com/food/msg-2.html ), and I personally get shaky when I ingest MSG, and all I read says it is considered a Neurotoxin, (excitotoxin at least), don’t you think I might be a tiny bit disappointed to hear a fellow who is going to do Big Scientific Research promote this stuff?
    PS. About my suggestion to drop a bit of high quality Sea Salt into some water if you feel the need to replenish (or stock up on ) Sodium, pleas check Dr. Batmanghelidj’s website: http://www.watercure.com/
    The same information he presents is mirrored on The Kahn Academy website about sodium ions and cell valves.
    AND, there is always Dr. Pollack’s lecture on Water… http://www.uwtv.org/video/player.aspx?mediaid=16213809

    If you intend to do some Great Research on Nutritional issues (and I heard you say in your interview that you “hate to be wrong”, please understand that I am NOT writing this to you to ‘prove you are wrong’…. I want you to be a bit more enlightened…. even from a Pleb.

    (reply)
    • Peter Attia  October 15, 2012

      I appreciate your insight, but I still think my point about dose response is relevant. Eating 25 gm of MSG per day in a typical fast food diet is probably a lot different than getting 1 gm in some bouillon. Thanks for your suggestions.

    • Whitefox  December 3, 2012

      FTFY:http://jn.nutrition.org/content/130/4/1049S.full

      Perhaps the package you picked up contains hydrogenated fats, aka trans fats, but I do not believe all Knorr products do. There are approximately 0g fat and 0g carbs in a cube, therefore your argument of glycemic corn starch is meaningless, and I doubt .1g of GMO corn is going to harm the human body as much as a bruise from falling off his bike might. Same applies to sugar (which is harmless in and of itself – a piece of fruit contains way more sugar than a bouillon cube). Same applies to soybean oil. Also, maltodextrin is distinct from MSG, however the process of making maltodextrin can create glutamate. In any case, if he was promoting 20g trans fats and 10g GMO corn with every meal, yes it’d be an issue. In terms of the principle of the matter, the principle is science and science says the human body is stronger than you think in response to low-dosage and/or infrequent stressors (see: hormesis).

      Also see: http://ajpendo.physiology.org/content/278/1/E83.full
      TL;DR – Eating MSG can spike glutamate, because they’re, you know, the same thing – MSG is the sodium salt of glutamate, the amino acid that is in many proteins/enzymes in your body. Glutamate is an excitatory neurotransmitter, not an excitotoxin… just like insulin is a hormone, but at extra high levels can be toxic. Note the part where the safety evaluation stated that voluntary ingestion of MSG cannot possibly exceed 60mg/kg dose whereas 500mg/kg was required to cause lesions in the mice due to excitotoxicity. “Intake levels associated with the use of MSG as a food additive and natural levels of glutamic acid in foods, therefore, do not raise toxicologic concerns even at high peak levels of intake because the mechanism of toxicity appears to be related to the peak plasma level achieved rather than the area under the curve”.

      MSG may also spike insulin, so diabetics take note not to ingest huge amounts of MSG-containing foods. Other than that, only sub-populations respond to MSG, and even those in large doses as Dr. Attia indicated (if they’re eating that much MSG, they’re eating the wrong stuff anyways and probably have metabolic syndrome anyways).

      I know others have already addressed this, but I wanted to make sure to reference the studies in question. Also, Martha, I understand how it could feel to be betrayed by authority or w/e, but you must try and give people the benefit of the doubt before going off on a rant wherein you presume many incorrect assumptions and use the word “enlightenment”. You sounded like somebody lecturing about the dangers of saturated fat.

  108. Jim  October 14, 2012

    Any idea if the superstarch affects triglyceride levels adversely?

    (reply)
    • Peter Attia  October 15, 2012

      Has not been studied in a RCT yet, but mechanistic and indirect work would suggest very little.

  109. Avner Taieb  October 15, 2012

    Hi Peter,
    Just felt the need to share with you, that I have completed a 100 miles ultra-marathon race successfully . I am on a ketogenic diet. I read carefully all your tips regarding sport and low carb diet, thanks to you I read Dr Phinney and Dr Volek’s book on low carb and performance and implemented every guideline from it.
    During the race I consumed only water, electrolytic drink (zero calories) , Vespa and generation UCAN.
    It was amazing to me to see all the competitors eating dates, bananas, pretzels, gels… while me only drinking UCAN (2 packets) every 4 hours. Never in the race I had a GI issue or drop of energy, I even had the power to speed up in the last 4 miles.

    Thank you so much.

    (reply)
    • Peter Attia  October 16, 2012

      Wow, very very impressive. 2 packets is barely 70 gm per 4 hours, or about 70 kcal/hour of ingested carbohydrate to replace glycogen. I bet your RQ was below 0.80 the whole time. Very cool!

  110. Evan  October 15, 2012

    Hello again Peter,

    I know you are busy so I will just add a few more questions on ‘eating’ to you to the ones i posted in a comment above.

    Q1-4: my post post above from several days ago – curious on your thoughts.
    Q5: Your general thoughts on cheese? Okay to have 6-8 oz of hard cheeses a day?
    Q6: Any thoughts on the importance of Iodine supplementation?
    Q7: Did you ad safe starches for some fear of staying low carb and possible increased in cortisol or thyroid issues?

    thanks,
    Evan

    (reply)
    • Peter Attia  October 15, 2012

      Evan, I hope you understand between comments on the blog and comments/questions through email, I get about 40 requests per day. I do the best I can, but there are only 168 hours in each week and most are spoken for. Please check out this post for a better understanding of my situation: http://eatingacademy.com/nutrition/welcome-to-the-eating-academy (actually, I request that anyone who has not read this post please do so before posting a question on the blog or sending me a personal message). It breaks my heart to not be able to respond personally to every concerned person out there. It really does, but it breaks my heart more when my daughter thinks I don’t live with her any more because I work 100 hours a week. NuSI is my top priority, and I try to do what I can with the blog. I hope you can respect this. Finally, most of your questions are addressed in responses to other questions, so hopefully you’ll find help there. Thanks for your understanding.

  111. martha  October 15, 2012

    This response is to “Matt”, who said he would not be responding to any replies to his post…. because I told Dr. Attia that I also would not be making any more repiles….
    Matt: You stated that I am making a statement in a “rude way”, basically because I don’t like authority. Well, you are partially correct. I definitely do not agree with “authority” if it is telling me to do, or be, something I do not agree with.
    Dr. Attia continues to focus in his responses to me about “dose tolerance” of MSG, which was not quite the point I was attempting to make in my posts. I am being portrayed as ‘hysterical’ about the neurotoxin effects of MSG, when the entire question needs some rigorous Scientific study (Dr. Attia’s position).
    What I take offense with is the idea, as an example of Logic, that Knorr bouillon is “not too bad”. It all depends on “dose tolerance”.
    Ok… follow that line of reasoning: How many Chemtrails are within acceptable limits? How much Flouride? How much, and which types, of pesticides are acceptible? How many, and which, vaccines? Do they have a cumulative effect? These questions seem to constitute a Scientific Line of Questioning unto themselves.
    For Dr. Attia to adhere to this line of reasoning, in my opinion, steers him away from a principled and coherent stand on ANY issue…. Therefore, I do not consider him to be an “authority” I would wish to follow.
    PS You get like this when you’re old. Some folks may see it as “rude”.

    (reply)
  112. Maryann  October 15, 2012

    Herb-Ox bullion is gluten-free with no added MSG.

    (reply)
    • Peter Attia  October 15, 2012

      Perfect, I’m more than happy to switch brands. Hope it’s widely available.

    • Nicholas L.  October 15, 2012

      Peter, just for what it’s worth, there is still plenty of glutamate in Herb-Ox brand boullion. It says so on their site—”Contains Naturally Occurring Glutamates.” I would recommend sticking with the knowledge that was contributed in the wonderful link from the Guardian that Dave Nelson graciously linked to (http://www.guardian.co.uk/lifeandstyle/2005/jul/10/foodanddrink.features3).

      You already said it right—it’s about dose. The MSG-induced obesity in rats was on diets of 2-4g/kg per day (or two) of weight. That is on the order of 100 times what a normal person would eat, whether they’re on a diet with lots of tomatoes and cheese or on a fast food diet. How many other foods that we eat would cause huge problems if we upped our dose 100 times?

      Glutamate makes things delicious. It’s a huge part of why we prefer seared meat to raw or boiled meat (it is a product of Maillard reactions that make meat so much more delicious). It is a frankly unavoidable amino acid, as mentioned in the article Dave shared. The whole MSG scare is based on pseudo-science and bears little interest for people looking to keep themselves in good health, as you must well-know already. You eat MSG every day, and pile on top of it a lot of extra glutamate in your walnuts, cooked meat, cheese, tomatoes, etc. You’ve measured your insulin levels, your blood sugar, your body fat, with utmost care. Are you fat? Do you have a problem with excessive insulin production or high/low blood sugar? Does your boullion drink make you ravenously hungry 20 minutes later or give you headaches? I assume no.

      Losing your credibility among people who think glutamate is bad for you seems about as bad a blow as losing your credibility with the alkaline diet advocates. You can’t please everyone. At least, that’s my take. And speaking of that, I wanted to thank you for sharing your knowledge and experience on this blog. You’ve had a profound impact (for the better!) on my lifestyle and health since I discovered your blog through Gary Taubes, and I appreciate it. Keep up the great work.

    • Peter Attia  October 15, 2012

      I have many flaws, and near the top of the list is some horrible desire to make everyone happy…clearly I’ll need to cure that if I’m going to have a blog. Thanks for another balanced approach to this question. And, of course, my bouillon drink neither gives me headaches nor makes me hungry.

    • Dave Nelsen  October 16, 2012

      Nicholas, thanks for the kind words. My line of thinking is that if roughly 2 billion Asians eat MSG like is going out of style and don’t appear to be suffering any obvious side affects (that we know of) then it’s probably not a neuro toxin. Granted that is observational data and not a RCT. That said I wil stipulate that there are no doubt individuals who are sensitive to MSG. Just not nearly as many that have been led to believe they have a sensitivity. Which is why I think it is way down the list of potential issues people might have. I’m watching TV right now and a commercial for Pregresso Soup just came on. It said it’s low sodium, low fat soup couple with vegetables/fiber helps lower cholesterol. Apparently they haven’t read Peter’s 9 part series on Cholesterol! Heck Cheerioes has that same Heart Healthy label – (saying it lowers cholesterol). With all the mis-information out there it is no wonder the public thinks everything is unhealthy – and then gives up and decides to eat anything. If you look (and not very hard) you can find people will tell you that carbs are bad, protein from animals is bad, fat is bad. Cue a NuSi to the rescue. I think a NuSi logo like the Bat signal is in order in cases like this. As Tom Petty says “The waiting is the hardest part”, and for Peter the words of the late great Ricky Nelson from Garden Party – “You can’t please everyone, so you’ve got please yourself”.

    • Peter Attia  October 16, 2012

      Dave, maybe I can retain you as my sanity coach…love the Tom Petty reference…

  113. Julia  October 15, 2012

    Hi Peter,
    I’m wondering what your thoughts are on the protocol (ala Tim Ferriss and Jack Kruse) that recommends a high protein meal within 30 minutes of waking to promote better metabolism (and, I believe ketogenisis).

    As always, thank you for what you do—I have been impressed by your openness and patience with all of the comments posted thus far!

    (reply)
    • Peter Attia  October 15, 2012

      Historically I’ve always done this, but during the IFIK I would not always do so. I’m not really 100% sure of the data on this, though, so I don’t know if it’s true that failure to do so results in catabolism.

  114. Joey  October 15, 2012

    Hi Peter!

    I started low carb eating and have lost 40 lbs. in nine moths with 30 to go. But I have some problems that you may have encountered and can tell me what to do,

    Suppose I go into a social setting (i.e. a wedding) where I’m expected to eat carbs and drink. How do you handle it!

    Suppose I take a trip to a foreign country and the cuisine (i.e. Italy) is predominantly carbs. How do you handle it!

    Thanks!

    (reply)
    • Peter Attia  October 15, 2012

      Plan ahead, even if it means eating a meal before (the wedding) or carrying some of your snacks. Travel is actually one of the best reasons to consider IF.

  115. Donna  October 16, 2012

    I have been reading this blog with much interest since it began under its old title. Recent postings have me dismayed by the veiled hostility expressed by some individuals. The recent one on glutatmate brings this to the front.

    Studies of glutamate that were compiled in 1995 for the FDA led to inconclusive results. Anecdotal evidence of headaches, muscle twitches, etc prompted the studies. Certainly if you experience a sensitivity or allergic reaction to the substance then don’t consume it. However, to dictate to the rest of us that we should not consume it is as wrong as it is to ‘scold’ Dr. Attia for using it. It appears not to bother him. It doesn’t bother me. In order for it to be truly toxic (which has been demonstrated only in rats) you need to eat (quoting from memory) about 18 grams which is more than three times what rats normally consume and far more than what we humans consume.

    I see why Dr. Attia reacted to your comment, Martha, with his nitrate comment. Your attacked his credibility without reason to. This blog is to share information. As Dr. Attia has said (paraphrasing) you need to make your own choices about what you are going to do. He has access to many individuals and studies that many of us do not have access to and he’s willing to take the time to inform us. It is still our responsibility to decide what we will do. To dismiss him because he does not fit perfectly is not helpful to the rest of us who may benefit from your insight.

    He did ask for studies which you did not provide him with. I wish you had. I find that because of his tutelage I am more critical of the studies I read and what conclusions are drawn. Thank you, Peter.

    To the gentleman who insisted that a plant based diet was the only way to go. Did he not notice that the flour and sugar and other ‘toxic’ elements were eliminated from the diet. Some people will do well on plant based, others on meat. As I said earlier each of us must decide through our own personal experimentation which way we are going to fall.

    There is no perfect diet. There are things we can do that help or ‘hurt’. Can we prevent certain ailments? Perhaps. We don’t know. All the studies in the world cannot predict what will happen to you on a personal level. All you can do is take what seems to work well for you and enjoy the ride of life.

    (reply)
    • Peter Attia  October 16, 2012

      Thank you, Donna. Sometimes, getting hit with so many hostile/rude and misinformed comments, it’s easy to lose sight of the fact that folks like you (and many other amazing readers) are out there, hopefully getting something positive from this blog.
      I really appreciate your comments.

  116. Susie  October 16, 2012

    Peter, I have been searching for how I can get a paid consultation. I read much of your post on cholesterol and heart disease and would like some help. I am ApoE3/4. I have been on a grain-free, sugar-free, high sat fat diet for several years. LDL particle number is high, I am assuming because of the ApoE4. I do not know how to lower this risk factor in a healthy way. Do you do long-distance consults?

    (reply)
    • Peter Attia  October 16, 2012

      Susie, for this very specific request, I would recommend you reach out an understanding lipidologist. I don’t think Dr. Dayspring is taking new patients, but Dr. Tara Dall may be, and she also works remotely with patients. I’m sure you can find her contact info online.

  117. Mark  October 16, 2012

    Dr. Attia,

    Thanks so much for all of the work you do on this blog and with NuSI. It is obvious you are passionate about making a difference with your work, and I am excited about the future of NuSI.

    I wanted to share with you a bit of my story. I’m about 6 feet tall, and two years ago I peaked at 240 lbs. I experimented with a number of diets (low-carb high-protein, semi-starvation with diet shakes, The Zone, etc.) and lost about 30 lbs over the course of a year. I was miserable, tired, and had intense cravings almost all the time. The thought of living like that for the rest of my life was truly depressing. I started to add a “cheat meal” once a week for my sanity. That evolved into a cheat day, then cheat weekend, and well, Friday is pretty much part of the weekend so throw that in too. The results were predictable, and I added back 15 lbs over 6 months.

    Then I read Why We Get Fat, stumbled upon your blog, and that led me to The Art and Science of Low Carbohydrate Living. I have been eating LCHF for about 6 months, and have dropped another 30 lbs. This time, I feel great. It turns out my previous attempts at low-carb had actually been extremely high in protein and relatively low in fat, hence the misery. As a bonus, my blood lipids are much improved, and my BP (which was borderline high) is now on the low end of normal.

    The most important thing, however, is how all of this new knowledge and understanding affects the way I look at food. Before, a diet was just a set of rules. I didn’t really know why I was doing what I was doing. Now, I look at a cheeseburger and fries and think “those refined carbs are going to flood my bloodstream with insulin and turn all of my fat cells into calorie vacuum cleaners and I’m going to feel like crap for three hours.” For me that has been a game changer, and picking the right foods is becoming second nature.

    Thanks again for all that you do.

    (reply)
    • Peter Attia  October 16, 2012

      Mark, your story is *exactly* why I continue to blog. It’s not about rules. It’s about understanding. With understanding — which includes accepting the fact that people are different and works for me might or might not work for you — you can be empowered and confident to carry out your own nutritional journey. The tragedy, as you allude to, is that many folks trying to reduce carb intake do so with the best of intentions, but make a few “physiologic mistakes” (e.g., too much protein, too little sodium). So glad you were able to sort it out.

    • Jacob  October 16, 2012

      Add me, my sister, my wife, and my good friend to the pile — cumulatively, nearly 150 pounds lost over the summer, and we all feel great! (I’d love to know cumulative fat loss — I calculated a few weeks back that I’ve lost 15 cups of fat.) For us, the low-carb idea started with GCBC and took shape through my reading your blog, which is such an important resource precisely BECAUSE you provide the evidence — and accordingly, freedom of reader interpretation and self-experimentation. Now, when people ask me what “rules” they should follow, I say “1.) stop drinking regular soda (the only absolute, as I see it); 2.) read Taubes and Attia and start experimenting!”

    • Peter Attia  October 16, 2012

      Jacob, thanks so much for the kind words and for sharing your story.

  118. Maryann  October 16, 2012

    Peter, I am definitely one of those readers who is grateful for all you teach and how hard you work…thank you! Here are a couple of resources with search features for finding a certified lipidologist: lipidboard.org/lookup and learnyourlipids.com.

    (reply)
    • Peter Attia  October 16, 2012

      Thanks so much, Maryann.

  119. Susie  October 16, 2012

    What a coincidence. I got my blood work and have had one appointment with Dr. Dall. I am being told to cut my saturated fats. I recalled reading something on your cholesterol series where you were talking about certain recs you make for ApoE4, though nothing specific.

    (reply)
    • Peter Attia  October 16, 2012

      Having 2 copies of the E4 allele (quite rare — about 1-2% of the population) pretty much always requires medical intervention to minimize CV risk. One copy of 4 and one of 3 or 2, less so, but still needs to be in the hands of a competent provider.

    • Indy M.  October 23, 2012

      Susie –

      I have had similar experience, where LDL-P went very high on high fat/low carb diet. It came down some
      on cutting down on SFA(all pasture Chicken sans skin, low carb) but not enough. I am now on my 3rd iteration with only oily fish and <=50gm carbs. If this fails to lower LDL-P(I am concordant) then it has to be genetic and I will have to be medicated, I believe.

      I will be interested in your followup experience with Dr. Dall, if you will share.

      Thanks.

      Indy M.
      Sunnyvale, CA

  120. Joanna  October 16, 2012

    Peter, the amount of information you share on your blog is amazing – I learn something new every time I come here and reading your posts and replies and your helpfulness and patience with your readers is truly inspiring. So maybe my question is kind of dumb but here it is – with all of this new information about cholesterol and the advance testing that is now available why is it that members of the medical profession (and I am here referring to cardiologists at excellent hospitals with highly rated heart programs I have recently had personal experience with) still only rely on the standard lipid profile? What can a patient say in response to these doctors when it was already obvious that the standard profile had Not predicted a recent cardiac event?

    A separate thank you to Maryann for the information regarding certified lipidologists!

    (reply)
    • Peter Attia  October 16, 2012

      That’s a great question, Joanna, and I can only speculate (which I hate to do, with respect to other people’s behavior). My guess is cognitive dissonance. Read the book “Mistakes were made (but not by me)” and you’ll have — I believe — a good idea of what may be going on.

    • Maryann  October 17, 2012

      Thank you Joanna, that is so nice of you! I hope it helps!

    • Donna  October 17, 2012

      Joanna,
      Besides the enormous amount of new information that may be overwhelming the vast majority of our doctors and hospitals to absorb it all and put into practice, there is another factor that may drive the use of only the standard lipid panel and that is insurance companies and perhaps, Medicare and Medicaid. It may be difficult to get insurance companies to agree to pay for the newer tests. Many people may balk at paying out of pocket additional costs because they may not understand that the newer tests may give them better information . It is also possible that the person who does all the coding now a necessity before anything is actually done ( that happens now where I live, may not be true elsewhere) may miss the correct code and you may end up with the other test being performed. There are thousands and thousands of different codes and though the coders make every effort to code correctly, it still ends ups with costly mistakes being made by all from the medical staff, doctors and hospitals.

      You might want to check with your insurance company about getting the newer tests, cost invovled and the coding and take that with you on your visit. An you just may have to be gently persistent to get what you want.

  121. John Dawson  October 17, 2012

    Peter, thank you so much for this blog.

    You have said that you plan to address APO E in your cholesterol series. In the meantime, generally, what is the state of knowledge about the recommended diet for someone with the APOE4 allele? Can you provide links or references for information?

    And a question for Susie, were you saying that Dr. Dall recommends a low saturated fat diet for APOE4? That would say the low carb approach is contraindicated for APOE4?

    (reply)
    • Peter Attia  October 18, 2012

      I’m looking into this at this moment. Perhaps the more important question is the role of dietary fat, especially SFA, based on apoA-II genotype.

  122. CJ  October 18, 2012

    I “fully understand” why this is the most popular post. Despite what you represent and what differentiates you and your nutrition project (critical thinking, science, unwavering pursuit of truth amidst the noise of fads, media, pop culture, politics…), the very things that draw readers to admire and respect you cannot drown our desire for both some concrete or quick answers (if we should wish to adopt or try out what is working for a clearly outstanding individual), and our psychological curiosity to simply get a somewhat intimate snapshot of a personality. I think it’s also the “testimonial appeal” of it. It’s an example of one of the strong pulls that fad diets are either subject to or whose proponents purposely and cynically employ. It’s ironic and unintentioned, but illustrative, I think.

    Thanks you so much for being you and working with Gary and others to change the world in a positive way.

    (reply)
    • Peter Attia  October 18, 2012

      I think you’re right, CJ. I guess I should embrace it.

  123. Jordan  October 18, 2012

    what i’ve eaten today, trying to get into nutritional ketosis state. I was hoping someone would comment on it? Give me ideas on where to look online for more meal ideas perhaps? Anything helps, I’m completely new to eating all this fat. I used to avoid it like the plague.

    1 tsp coconut oil & 1 1/2 tbsp coconut manna
    black coffee, water

    walking carrying 40lb child ~30min

    3 1/2 oz blk fst ham
    65g macadamia nuts
    water

    walking again carrying child ~20 min

    3 eggs in 1 tsp coc oil with
    2 oz feta & 1 oz fromage frais

    Now I have a headache and feel a bit sick to my stomach. I’m drinking peppermint yerba mate tea…

    It seems I’m already at 40g carbs and close to 60g protein. What can I possibly eat for dinner that will be basically pure fat? I was going to cook the rest of my ground beef in coconut milk and red curry with spinach and lettuce (its my new favourite dish) but that would put me way over carbs from the veg.

    I’m aiming for no more than 40g carbs, should be lower I bet and protein based on weight around 80g tops. The rest being fat. Considering what I ate today, I’m stumped on limiting carbs further. I feel like eating a head of lettuce AND a head of celery – I want that watery juicy crunchy greenery!

    This is an AMAZING site/blog which I just found 2 days ago, and I, personally for body recomposition and also my brain (mental health, energy, focus) have decided to experiment with a keto diet. I just don’t know how much cheesy eggs I can eat. I’ll need to research variety :)

    Thanks for putting all this out there. I’m fascinated by nutrition and it’s effects on the body & mind. I’ve had great success with raw vegan in the past, who knows, I might return to that – but my body is loving the red meat after 8 years vegan.

    (reply)
    • Pedro  October 19, 2012

      I have been on the LCHF now for the last 4 months and lost 25 lbs and as Jordan above, I have all my family following this with great success and well being. I am a physician in the Bay area, and finding this diet and the information we can get from doing NMR, is incredible. But more incredible is that nobody talks about or teach in the residency programs. Now, I do it in all my patients, and for sure in my diabetic patients, obese, or metabolic syndrome. Even when the other day refer a patient to a cardiologist with NMR results, he was surprise that I knew about this test. He even asked me “How do you know that”. I think still a lot of ignorance in the medical comunity and laboratories. One of my patients went to the UCSF laboratory and they did not know what NMR was.
      But I want to tank you for all the information, time and education you are giving to this your community of high fat low carb dieters.

    • Peter Attia  October 19, 2012

      Pedro, there are a lot of readers in the Bay Area in need of a good doctor. If you’re willing, it might be worth posting your office info in this thread for such patients.

  124. Aleisha  October 19, 2012

    Thanks for the great information. I’m looking forward to your blog on superstarch as I’m a big fan of it. I’m curious if you have tried Vespa and if so how would you combine the two for running a marathon?

    (reply)
    • Peter Attia  October 19, 2012

      Stay tuned…that’s the next topic coming up. No, I have not tried Vespa. How is it different than some honey-flavored water? I’m sure it’s more, but I can’t tell by looking at the ingredient list.

  125. Rob  October 20, 2012

    I am a 59 year old female with osteoporosis (t score -2.7). I was told that a high protein diet should be avoided since it makes the body more acidic. I was wondering how your method of eating will affect bone health. Can you give me some guide lines. I am not taking any prescription meds (e.g. Actonel,etc.). I am Caucasian , 5’5″. 137 lbs. I walk 4 miles 3x/ week, am a Pilates and water aerobics instructor. I am very small boned.

    (reply)
    • Peter Attia  October 21, 2012

      I recommend your doctor set you up for a 24 hour urine test and some other lab tests (e.g., vit D). If there is an electrolyte problem, this is the best way to identify it. Very difficult to know just based on standard blood tests.

  126. yuma  October 20, 2012

    Dr. Attia, there is no doubt your diet works because you look great.

    What are your splits in the Olympic Triathlon (1.5K swim, 40K bike, 10K run)?

    (reply)
    • Peter Attia  October 21, 2012

      yuma, just because someone “looks good” doesn’t mean what they are saying has any merit, and vice versa. Don’t fall for this logic, or you will forever be chasing your tail and listening to charlatans. Don’t believe what I say because of how I look. Believe it because you can reason through it, and check it.
      As for Olympic tri’s (or any tri’s) I don’t run…just swim and bike (but never together).

    • yuma  October 21, 2012

      Dr. Attia, I was flabbergasted by your response.

      My celebration of your physical condition was meant as a compliment on your achievements. I’m not looking for diet exercise gurus to follow blindly. Of course I’ll review all available facts before I decide to follow what anybody represents and decide accordingly. What do you think I am? Some kind of a stooge?

      However, I will discard any guru that looks the opposite of what they preach no matter their “qualifications.”. That’s why I don’t pay attention to my doctor’s dietary recommendations. He tells me to go high carb low fat but it’s obvious to me that with his “beer” belly, it doesn’t work for him.

      I’ve started low carb, not as low as you. So far I’ve lost 16 lb. in three weeks merely reducing carbs to about a hundred per day.

      When I was young I was a competitive swimmer. With my additional energy and on going weight loss I want to start competing again in master races.

      Since you and I are about the same height – although you have less weight and body fat than I – I figured that I could use your swimming time in the 1,500 meters free, the event I plan to resume competing at, as an achievable goal after I adopt your ketosis diet, which I plan to do.

      However, if your swimming times are secret to prevent your competitors from gaining an unfair advantage on you, I’ll understand your silence.

    • Peter Attia  October 21, 2012

      Hope I didn’t offend you! Remember, the best coach is not necessarily the best athlete. Everyone has different genes and susceptibilities, so I’m not a fan of the approach that someone much look great to be right, or that someone who doesn’t look great can’t be right. As far as my times, there are no secrets to keep. 1500 free was never my thing. My best is about 21 minutes. Nothing to write home about. My sweet spot in swimming much much longer than 1500, or shorter non-freestyle events, primarily breaststroke and IM.

  127. Hemming  October 21, 2012

    Hi Dr. Attia

    I’ve for a period of around 6 months been doing a morning run of 10-11k for three of the five weekdays and some interval sessions during the weekends. In the same period I have reduced my carb intake while having a (too) low fat intake. I’ve gone from 139lbs (64kg) to 121lbs (55kg) at a height of 5’10”.
    I would run at 5am, have breakast at 6am, a piece of fruit/carrots at 10am, lunch at 12pm, dinner at around 7pm and finally a very small meal around 9pm. The thing is now that I came to a back a couple of weeks ago where I had stop running after being very tired all the time, having some form of leg cramps, nosebleeds and a general lack of concentration. I’ve even been ordered by my doctor to not do any exercise an just start eating all the things I could (including cinnamon rolls etc.).
    My thinking is that I’ve done some minor IF and at the same become more fat burning. Since I haven’t consumed enough fat the body has used what I had stored already. In addition, I think that I haven’t been aware that I’ve cut some of the regular sources for potassium and calcium, which would explain my symptoms. My point is that it’s not as much my weight which is the problem, it’s more the lack of fat and other nutrients in the diet which has made it come this far. Up until maybe just two to three weeks before I stopped running my times were still improving marginally and in the mornings I would feel pretty rested and ready to go for a run.
    I know it’s difficult for you to give a good answer, but when I saw this post it simply reminded me so much of my own situation that I had to ask if this line of thinking makes sense to you?

    Thank you for all the very good and easy-to-understand posts on this site!

    (reply)
    • Peter Attia  October 22, 2012

      Sounds like you’re a pretty lean and metabolically flexible person to begin with. Even more so now.

    • Patrick  October 22, 2012

      Hemming,

      FWIW, I saw your post and thought I’d chime in. First off, in my opinion, you are doing a ton of cardio…basically 18 miles per week give or take; not including the interval work on the weekends. I used to be in that camp, running basically a marathon per week (usually 5 days per week at 5+ miles per clip). I lost alot of weight but was experiencing muscle weakness, lack of concentration, was tired, and not really losing much in the way of bodyfat. Not sure about your nosebleeds, but that can’t be good. Do you have high blood pressure? Sounds like you’re clearly pushing yourself to hard. That said, what I came to realize about the running, was that the chronic running is actually bad for you. When you exercise that way, you elevate your cortisol levels to the point that it starts to break down your muscle, which is converted to glucose which elevates your insulin levels which makes you store more fat. Cortisol is a catabolic hormone, not an anabolic one. Cortisol is useful in that it is integral to helping you get going in the morning; which is when it should be at its highest. It should be at its lowest in the evenings. But when your body is put under stress, cortisol rises. And if you think about, what happens when you’re really stressed out? You can’t focus on more than a few things; if at all, because your body is under stress and needs to focus on what is directly in front of it, so as to eliminate the stressor. Pretty cool how that works. Anyway, this clearly will impair your cognitive function, impair your long term memory, etc. Between the nosebleeds and the “chronic cardio” I would guess you are doing too much. In my opinion, I would cut out the weekly runs, and substitute them with walks, but keep the weekend interval training. Throw in some weight training 2-3 times per week and I’d bet you would start to feel a lot better.

    • Hemming  October 23, 2012

      Peter and Patrick, thank you for the replies.

      My blood pressure is at the bottom of the normal range. I assume the nosebleeds has to do with lack of potassium, I have noticed it for around a week now.

      I was definitely doing too much. Not only the cardio, but also working/commuting. As I said I’m now seeing my doctor at regular intervals where she takes blood samples and I have more or less stopped running.

      My overall consideration was more that my doctor is focusing too much on my weight, when its actually more a matter of vitamin defiency (I think), I just wanted a second opinion on that. Do any of you agree with that? I know it’s hard (impossible) to tell over the internet, but I think you get my line of thinking. Anyway, I was just sort of looking for a second opinion as I feel I’m being accused of ‘eating disorder’

      All the best,

      Hemming

  128. Sean  October 21, 2012

    Peter, I’ve commented in the past on the old site and I’m back again. At the top of this post you express surprise that your “what I actually eat” post is so popular. I think I can answer that question. From my perspective this site, while a great technical resource is too complex for the average person looking for answers on how to eat healthy. After spending hours pouring through all the technical minutia you get exasperated and jut throw up your hands. The “what I actually eat” is a way to cut through all that and get to a real world translation.
    I’ve read your ten posts on cholesterol but for the life of me I can’t figure out what cholesterol tests I should be having done. Or how I might try to explain to my physician why the standard cholesterol test is not helpful.
    I see way down on the list of ‘coming soon” this subject: What tests to get done if you want to track your health.
    I’m wondering if I’ll have already slipped into type 2 diabetes before you get to that. Put in terms of this post, how about a “What tests I actually get to track my health” post? I bet it would also be one of your most popular.
    I get that this is not your full time job but if you are really interested in helping people that would be a good subject to tackle sooner rather than later.

    (reply)
    • Peter Attia  October 22, 2012

      Sean, I’d be happy to walk through all the tests I get on myself (I’m going to have my wife draw 10 tubes of blood tomorrow morning, as a matter of fact), but I’m not sure that’s going to help folks. If folks are struggling to understand the value of NMR for lipids after I dedicated 9 posts to the topic, how will one post on all the labs I do have much help? I worry it will only create confusion for people as they try to rationalize to their doctors why they need test X or test Y because “crazy” guy on his blog suggests it. What do you think?

  129. carolyn  October 21, 2012

    yesterday my son the MD talked me into a KFC ‘double down’ which can be described as a low-carb perfect storm in the fast food world, at least the grilled version. only 460 calories (deep fried version is 560 i think). it was really good and very filling for its size: bacon, cheese, “12 herbs and spices”, 2 chicken fillets in lieu of a bun. it sounds and tasted like wretched excess, i.e. yummy.

    it must have been dreamed up by some madman in the KFC marketing department and the idea somehow got green lighted when his colleagues were asleep at the wheel. OR it could be that the low-carb concept is finally penetrating the corporate types in the fast food world. OR, i dunno, it’s just a gimmick like deep-fried snickers bars to get attention.

    have you had one and if so what’s your take.

    (reply)
    • Peter Attia  October 21, 2012

      I have not had one, but it does sound pretty good!

  130. Julia  October 21, 2012

    Hey Peter,
    I have read some arguments that a prolonged period of Ketosis detrimental to liver function. Given what little I know about physiology and the Krebs cycle it seems as though this arguement carries enough weight that it
    must be something you have looked into. Can you share what information you may have. I ve been looking for research on this to no avail.

    Please excuse me if you’ve covered this before,
    Julia

    (reply)
    • Peter Attia  October 22, 2012

      I am not aware of any credible information suggesting this.

  131. Chris  October 22, 2012

    Hello Peter,

    Thank you for all the time and effort that you put into this blog. I thoroughly enjoy reading it! I am wondering what your opinion is on the big push for annual flu shots. I am a 43 yr old male. Do you think that they are a necessity? Do you get one?

    Thank you!

    Chris

    (reply)
    • Peter Attia  October 22, 2012

      Depends on your risk factors and exposures. Speak with your doctor. I get one, but I have enough risks to justify it.

  132. C  October 22, 2012

    Dear Dr. Attia,
    I very much appreciate this site and all the hours of your thought and time to maintain it.
    I am a physician in the Bay Area, and have been recommending VLCD for weight loss for my patients for years along with an NMR profile before embarking on this regimen. (I use specific labs when I request NMR, LP-IR etc) (I also recommend NMR for patients with Metabolic Syndrome, diabetes, those prescribed statins by another physician, and those who I am trying not to put on statins.) I strongly believe that nutrition and exercise are the basis for optimal health and any physician who knows nothing about these is sadly lacking and cannot possibly be providing the best care for their patients.
    Thank you, again, for your commitment, passion and dedication to inform and educate.
    I would be very interested in contributing to NuSI, not only fiscally, but also professionally.
    Bonnes vacances!

    (reply)
    • Peter Attia  October 23, 2012

      C, I hope you can make patients in the Bay Area aware of your practice.

    • Mark  November 6, 2012

      C,

      I am located in the Bay Area and have been looking for a physician. I’ll echo Peter’s request to provide more information on your practice.

      Peter,

      I can’t begin to put into words my appreciation for the education you have provided me.

      Thanks!

      Mark

  133. steve  October 22, 2012

    While I believe carb restriction is the way to go, I have yet to see any data or test measurements( ie NMR) that show that nutritional ketosis is better than a max carb intake of around 150. If for example your NMR results are at goal(LDL-P,etc as you have discussed) at an upper level of carbs of 150( via fruit, veggies, tubers) than why bother with nutritional ketosis? I am assuming all other health markers-weight,etc are fine. Additionally, I have not seen any benefit for health to mega hours of exercise. Of course if one is doing so for enjoyment, and has not developed an addiction then it is ok. But to much exercise not only creates wear and tear, but increases oxidation and possibly inflammation. There is a huge difference between health and fitness.
    As a math guy, you certainly know about marginal and diminishing returns

    (reply)
    • Peter Attia  October 22, 2012

      Oh too well…Great question and we certainly don’t know the answer yet.

  134. Harvey  October 23, 2012

    Great post. I am a 63 year old male who started following your dietary recommendations 2 weeks ago. I am going for a physical soon and would welcome suggestions about additional testing to complement the usual blood tests physicians order.

    Thanks!

    (reply)
    • Peter Attia  October 23, 2012

      Check out some of the tests I’ve ordered on myself, which I’ve commented on throughout the various posts, including the cholesterol series.

  135. alan  October 25, 2012

    hi peter,
    i have been following a vlc nutrition for many weeks now, eating around 30 g of cho. i can’t afford to measure blood ketones, but i am a fat burner for sure. i tried out IF fasting too and i find it very useful especially in the way that it lets me organize my day not around meals times and i discovered that i can manage my hunger much better with the increase of ketones given from the fasted state.
    there i something that does not add up though and i find no answer anywhere:
    adding intermittent fasting to daily nutrition diminishes total calories intake naturally (fat amount intake dependent), which diminishes total protein intake. say that i need 90 g protein daily, if i have one or two meals per day, i am unable to reach that number with two moderate portions of 30 g. but…if i want to get to my requirement, i need to have a larger portion, which is likely to start a gluconeogenesis process that is likely to kick me out of ketosis.
    what is your point of view?

    (reply)
    • Peter Attia  October 25, 2012

      That’s why it’s called IFIK.

  136. jesse  October 27, 2012

    HI Peter and all,
    After about 6 months in ketosis I too have branched out and upped the carbs a bit. I’m now at about 50 to 100 per day. I just wanted to try this to see what happened, and wanted to have a bit more flexibility in my diet. I feel fine. I was surprised to find that I feel about the same when I work out as when in ketosis (i suspect this would not be the case with more endurance stuff like bike rides of a few hours–have not done those yet). I thought that at 75 gms per day I might have a lack of carbs that would leave me suffering in my workouts, but this is not the case at all. I typically get up in the morning, have a bit of coffee with just some cream, and then play basketball for and hour and a half or so.

    However, I do feel different. As soon as I upped the carbs I started having feelings of hunger at various times in the day that had disappeared when in Ketosis. And, related to this I think, the Mindbody stability (still looking for the right way to describe this feeling) that I had in ketosis diminished.

    I’ve stopped supplementing with sodium and potassium as well. I guess I just have one question: As you bumped up your carbs a bit in your latest chapter of experimentation, it looks like you continued supplementing with Sodium and Magnesium, but cut out the potassium? can you please explain why?

    Thanks!

    (reply)
    • Peter Attia  October 28, 2012

      With enough sodium and magnesium I’m not having any issues with potassium.

  137. Terrence  October 29, 2012

    Hi Peter – thanks for another great post. I wanted to ask a question of you. I’m a college senior, and while I have eliminated carbs from my diet entirely, I do still like to enjoy myself on weekends, and consume alcohol. Do you have any thoughts on how alcohol intake affects ketosis and fat metabolism? I don’t drink beer or sugary mixers, so I’m wondering what the impact of the alcohol itself would be, but at a rather high number of drinks.

    (reply)
    • Peter Attia  October 29, 2012

      Yes, check my responses to questions about alcohol in part I of this post. You may need to search, as my responses were in the comments section.

  138. Canuck  October 30, 2012

    Hi Peter! Just wanted to follow up with one quick question. I noticed that you supplement with sodium. I have been low/no carb for almost a year now and have not been supplementing with sodium. I suppose this means that I am ‘deficient’ in my sodium intake. But, I don’t feel ‘unwell’ in any way, but maybe I should consider supplementing sodium as well. What are the short & long term consequences of being deficient in sodium intake?

    (reply)
    • Peter Attia  October 30, 2012

      If you don’t feel lousy and you’re not suffering any consequences of hyponatremia, you may not need to supplement.

    • Canuck  October 31, 2012

      Thanks for the reply Peter!

      I suppose – as per your philosophy – it’s worth doing a self-experiment. Perhaps I’ve been in a ‘chronic’ hyponatremia and just adapted to the symptoms,

      Quick question – how do you drink/eat your bouillon? I can’t seem to stomach it! (taking it with 250ml of water). Is there another sodium supplement you’d recommend for people who can’t deal with bouillon?

    • Peter Attia  October 31, 2012

      Mix it to a concentration you find palatable.

  139. Jim Q  October 31, 2012

    Peter – thanks for all you’ve done with your website and trying to get good information out there. I have a question on the carbohydrate counts on your meals described above. In your Tuesday food intake, for example, I can’t find more than 10 g of carbs there, but you have 89 g listed. Am I missing something?

    (reply)
    • Peter Attia  November 1, 2012

      Mostly the nuts and olives.

  140. Edward  November 16, 2012

    Personally, I really enjoy poached eggs, but I stopped eating them, due to not having anything like toast to sop up the remaining eggy goodness from the plate. But no longer. I found some egg poaching cups called “Fusionbrands Silicone Poach Pods.” They basically just float on top of boiling water and after about 4 minutes or so have firm whites and liquid yolks. I transfer the cups to a plate and eat the eggs right out of the cups. If you are feeling generous, please click on my name and go to my Amazon portal before going to Amazon itself and I will get a small affiliate commission, but however you get there, enjoy your poached eggs!

    (reply)
  141. Brian  November 21, 2012

    Hi Peter, love your angle on todays nutrition and the selfexperimenting is so awesome.

    I have a question regarding the sodium intake, I try to get all I can from natural sources but it’s not possible to cook broth on a daily basis:)
    I thougt of doing like you with the bouillon cubes from Knorr but I’m a bit conserned about the content. They have a very large % of flavour enhancers in them, mononatriumglucamat (MSG) is ingredient number 2 on the list, followed by two other enhancers.
    How is your perspective on this ingredient ?? should it be considered safe or not, up until now I’ve used the cubes a lot when cooking but that is a lot different to taking them on a daily basis like you are…
    Appriciate your thougths on the subject

    Thanks for the blog :)

    (reply)
    • Peter Attia  November 21, 2012

      Fair question, Brian. There is — somewhere in this blog — a long thread in the Q&A on this exact topic. Possibly under Part I of ‘what I eat.’ Here’s the long and short of it: There are organic cubes of bouillon that have far fewer ingredients, if you’re worried about the ingredients. Important to keep ‘dose response’ in mind when looking at these. A cube of bouillon has really small absolute amounts of most things (besides sodium). Lastly, despite the demonization of ‘evil’ thinks like MSG, it’s still not clear that MSG, for example, is the problem, versus the food it serves as a marker for.

  142. Brian  November 23, 2012

    Fair answer and please don’t get me wrong, I have no problem wih the MSG as I haven’t seen any compelling evicence that the MSG is the problem as you also points out.
    My idea is just to eliminate the things from my diet that are not strictly nessesary – I will look into the organic segment-
    Thanks again for your time

    (reply)
  143. Marla  November 26, 2012

    I am confused by your posts about what you eat and do. Do you only eat once or twice a day really? Doesn’t that play with your blood sugar and what about hunger?

    Also, I read your blog, and then I followed the link you have about Ketogenic diets, and it talks about high fat low carb to help lose weight. How come when I did this diet in several different forms I didn’t lose ANY weight at all? I didn’t lose with any other diet either, but the ketogenic ones are supposed to be guaranteed right? So, other than being pregnant, what will help me lose weight? (I know, I’m strange, but I actually lose weight when pregnant and then go back to my prepregnancy weight afterward). I also do water aerobics at least 3 times a week and chase 2 toddlers. But, I don’t lose weight.

    I know that when I did do the low carb diets I got very dizzy, ill, and generally lethargic, but I didn’t lose any pounds. I am willing to take any and all help you can offer. I am working with my doctor to look into the lap band or gastric bypass surgeries, but if I can’t lose weight and then gain it back, the insurance company won’t pay for them either. Do you have any advice?

    (reply)
    • Peter Attia  November 27, 2012

      Marla, I think some folks on this blog will have some advice for you.

  144. Donna  November 29, 2012

    Perhaps people coming across this post can benefit from my story about finding what works for you.

    I have been watching what I eat my whole life. I am 47 years old and practice super intense yoga about two hours a day. My goals are to feel good, have good digestion and yes, i will admit it, be light. Being light is way better than being heavy. I can THINK clearer when my clothes fit well.

    What I am interested in at this point in my life is minimal suffering:) and and optimum performance. What works for me is I eat protein and veggies. The fat seems to take care of itself with a bit of olive oil and avocado. I stay far away from nuts as I tend to eat pounds at a time. A bit of dairy if I am craving a full fat dressing.

    The holidays are never a problem. I eat all the turkey and prime rib while the family takes on the stuffing and pie. There are ALWAYS comments on how much meat I eat. I have heard my father in law say for the past 5 years ” I would be sick if I ate that much meat”. I am the only one (besides my 2 year old daughter) NOT overweight at the table.

    I run into trouble when I add fruit in. Fruit and artificial sweeteners. For me (and this is all finding out about what works for each individual) they are the gateway to excessive binging—I tend to crave sweeter and sweeter stuff when I add them in.

    I will eat a bit of rice or potatoes. That is never a problem, as long as I stay aways from processed foods like bread. If I eat a pastry, and of course I do on occasion….I can tell the difference immediately. . The worst is the next day I want that pastry again. Better yet two.

    Thank you for all you do.

    (reply)
  145. JS  November 29, 2012

    Coming at this way of eating as a long distance triathlete eating a very clean plant based diet, but unable to lose some unwanted visceral abdominal fat. Since it has been drilled into me to eat small meals every 2-3 hours, I’m curious how you as an athlete found the transition to less meals. I read you said you weren’t hungry during the day but do you attribute that to being so fat-adapted, or is there another reason I’m not seeing. None of these new concepts concern me, save for the intermittent fasting being a plus. Thanks for all this work you do.

    (reply)
    • Peter Attia  November 30, 2012

      Hunger is a pretty complex topic, and I’m not sure we really understand it. But I suspect insulin and leptin play a major role and resistance to them can exacerbate the issues of “inappropriate” hunger. So I suspect that correcting these defects plays some role, but I can tell you…I used to need to eat ALL the time.

  146. Sharon  December 6, 2012

    Hi Peter
    I’ve used the Atkins type diet that you describe many times in my life to get rid of unwanted weight, after pregnancies and winter periods. Its the only way of eating that makes me feel in control as my cravings dissapear, the weight falls off and I feel great. I’m also a runner and find my running improves alot too. What I wanted to know is if I want to try and do this long term instead of twice a year when I need to loose, am I allowed to have a “cheat day”? And what are the consequences of this? For instance going to movies on a Sat eve without popcorn and sweeties is just completely unfathomable for me, so I tend to find I avoid “fun” things like this when I’m on strict Atkins. By cheat day I don’t mean a bowl of berries, I mean be able to eat simple carbs freely for 24hours. So is it possible to do HFLC 6 days a week and have one cheat day and still loose weight or maintain and what will the physical consequences be?

    (reply)
    • Peter Attia  December 6, 2012

      “Cheating” needs to be evaluated through at least 2 lenses: 1) physiologic and 2) behavioral. The 2 may overlap, also. One eat-anything-you-want meal every week may not do much to number 1. It probably does for number 2. For some, it’s a needed break and something to look forward to. For others (like me), it prevents a new pattern of behavior. So, for me (or for most smokers or alcoholics), it’s easier not to re-introduce regular “cheating.”

  147. Paul M  December 18, 2012

    Hi Peter,

    I love your site! Great insights and I’m learning a lot. I’ve been eating virtually no sugar, low carb diet for the past 3 months. I’m down 20 pounds and feel great!

    One quick question; I still experience quite a bit of light headedness when I stand up. I wouldn’t say only when I stand too quickly, but rather if I don’t stand up slowly. Is this something that will change over time, or something I need to learn to live with?

    Thanks!

    (reply)
    • Peter Attia  December 18, 2012

      Are you supplementing with sodium (e.g., bouillon)?

    • J  December 18, 2012

      Also, you’re not on blood pressure medicines, are you?

  148. Jenn  December 28, 2012

    Thank you for the conversation about the bouillon. I had the same questions and originally planned to just accept that you use it and move on, but I was curious to know WHY you thought it was ok. Thank you for the explanation! I will now sip guilt- and concern-free. :)

    (reply)
  149. Canuck  January 2, 2013

    Hi Peter,

    Happy new year to you!

    I wanted to ask a quick question about MCT oil, and other fats like coconut oil. I understand that due to the length of these fatty acid chains, the body cannot store them in adipose tissue, hence the reason that people supplement with MCT oil.

    So then, what would happen if one consumed only MCT oil, in excess of their body’s ability to burn in a given day (e.g. ingesting 3,000 cal of MCT oil, when one’s BMR is 2,000 cal/day). Does the oil then get converted to adipose tissue, or does it just ‘hang out’ until it can be burned?

    Thanks!

    (reply)
    • Peter Attia  January 3, 2013

      Probably explosive diarrhea. What you can’t convert to B-OHB or oxidize immediately must be excreted.

  150. Gaia  January 8, 2013

    Hi, I´m a woman from sweden reading your website. I would like to hear what You think about intermittent fasting and planning a pregnancy. I have too loose 11 more kilos from 76 to 65 and have had really good results eating lots less carbs no sugar absolutely no alcohol and more fat. I have lost 6kg in 6 weeks and feel so proud and happy. I am planning to have one more month to loose more weight before starting trying to get pregnant. Do you think it is a bad idea to eat just between 12 and 20 during daytime. To loose some more kilos under this month? Maybe its better to train more and skip the intermittent fasting. The body must feel safe and stable to become pregnant. Any ideas?

    (reply)
    • Peter Attia  January 9, 2013

      I can’t give medical advice, but have no idea about IF pre-pregnancy.

  151. Sam  January 12, 2013

    Peter, I just read a fascinating book by nassim taleb –“Antifragile.” It’s not about nutrition but he talks about how biological entities are Antifragile (a word here which means the exact opposite of fragile), and, as such, improve with intermittent stress (eg, growth via resistance training). He makes an interesting point that intermittent fasting stresses the body and in doing so strengthens it. In other words, a little randomness is good. This is an interesting thought. The book is pure genius and seems like it would appeal to your rational mind. Cheers. Sam

    (reply)
    • Peter Attia  January 12, 2013

      Yes, I have it, but have not yet read it.

  152. Martin  January 12, 2013

    Hi Peter,
    I just discoverd your site and think it is very helpful, thanks for that!

    I just have one question regarding weight loss: what’s your opinion on veganism? Don’t be scared i am not vegan nor am i considering to follow such a diet ;). I just wondered because your daily intake of veggies seems very small. The reason i am asking is that because in the ‘world of nutrition’ many guru’s like Joel fuhrman are pretty big on micronutrients. Also veggies aren’t too caloriedense, so from a laymens perspective i could understand one would consider a diet like that. How do you value veggies and what place do they have in your diet? And how do you view a vegan diet?

    Thanks!

    (reply)
    • Peter Attia  January 12, 2013

      Can’t address this question quickly, but you should check out Denise Minger.

    • Sam  January 14, 2013

      Martin, in response to Peter’s suggestion that you review Denise Minger’s work, here’s a link to a video of Denise’s presentation at last year’s “low carb cruise.” Her work is also posted on her own website, which you can find via google. The video might be a good way to get exposed to her work re the claims made in “The China Study.” (She was a vegan and talks about how her health suffered). BTW, I don’t know anything about the website in the link. I attended Denise’s LCC presentation and simply found it on this site. Phinney and Volek’s “Art and Science…” book is also a great source that may address your question.

      http://www.makeitfunanditwillgetdone.com/need-to-lose-weight/the-mouth-trap-videos/low-carb-experts-denise-minger/

  153. Jared  January 30, 2013

    Hello Peter,

    As a tennis player (explosive athlete) who cannot afford superstarch, I was wondering what carbohydrates you would recommend me eating or would tell other explosive athletes to eat. I currently am eating potatoes and rice. Just curious.

    Thanks alot,
    Jared

    (reply)
    • Peter Attia  January 30, 2013

      Low GI carbs. I favor nuts a lot while riding, since I get salt with with.

  154. Ruth Burke  February 11, 2013

    I just spent two weeks on a juice and raw vegetable diet. I stepped on the scale yesterday and lost ….. NOT ONE POUND! I had good luck losing my post baby weight each time with a carb controlled diet. But I noticed something extraordinary …. in re-reading Gabriel Cousens Tree of Life book (he is an MD turned holistic doctor who has been an advocate of raw foods since the late 70’s) I noticed that he recommends that you start your journey in raw foods on “Phase I and Phase I.5 before going to Phases 2 and 2.5. At his Tree of Life clinic he counsels patients to stay on Phase I for 3 months.. I did the math … Phase I is a KETOGENIC DIET! I was stunned. He used spirulina for the protein content, includes non starchy vegetables, nuts and seeds, healthy fats, ‘salad fruits’ like tomato, avocado and cucumber, and NO fruit and no juicing. Phase I.5 includes low glycemic berries. About 20 years ago he found that his patients became ‘less toxic’ and lost more weight following his Phase 1 Routine. As they get ‘less toxic’ and flip their metabolism around they can increase the amount of fruits and sprouted grains. Doesn’t this sound like Taubes? I just read Taubes’ book Why we get fat and that is the best piece of investigative journalism I’ve seen in a long time. The jury is in … for those of us who have gotten caught in middle age (I’m 59 and starting to gain weight around the middle) his answer is right – it’s ALL about controlling insulin levels. And juice/smoothie fasting is like crack to someone who is as carb sensitive as I am. I thought you’d enjoy the irony that one of the most famous raw food therapists has been recommending an essentially ketogenic diet for years and there is not one juicing recipe in his raw foods cookbook that is otherwise filled with great recipes. So I’m switching over to a South Beach Phase I this morning only I’m going to include all my lovely raw veggie salads along with raw nut and seed crackers with appropriate amounts of meat and fat and continue sugar free. But … two weeks of hunger on a juice fast and no weight loss – still bloated and a pudgy middle. Sigh. I did know better. :-)

    (reply)
    • Peter Attia  February 12, 2013

      Interesting. Remember, the scale is a very crude measure of progress.

  155. Neil  February 11, 2013

    Hi Peter,

    Great Blog! Not sure if you’ll read this because it’s an older post, but worth a shot.

    I’m currently trying to gain muscle (5’9/150lbs), but am finding it really hard to get enough calories and protein per day.

    The calories: Are proving hard since I’ve cut back on carbs. (Have slightly high blood glucose – a1c of 5.5, post-prandial ranges of 120-145 depending on what I eat).

    The extra restrictions: Dairy seems to cause breakouts for me, so this eliminated whey protein, which was both a huge source of protein and calories in the past. Additionally, my allergen panel showed the following:
    High reaction – wheat
    Medium reaction – dairy, egg whites
    Low reaction – peanuts, soy, egg yolks

    I’m guessing that I’m probably only eating around 2000-2200 calories per day. Any suggestions on increasing my amount of protein and calories without whey protein?

    (reply)
    • Neil  February 11, 2013

      Also, it’s worth noting what I’m currently eating:
      – Meals: Mostly just consist of 8oz of a protein + some vegetables and olive oil (usually spinach, broccoli, asparagus, brussel sprouts, etc) + an avocado
      – Snacks: TONS of nuts (almonds, cashews, macadamias)

      Given the above, I never seem to easily get past 2200 calories, when I want to be at 3000.

      Should I just load up on more olive oil? Last time I calculated it I think I was getting ~ 3/4 of my calories from fat already.

      My current workout routine is 3x per week at the gym doing 3×5 squats, 3×5 bench, 3×5 pullups+dips, and 3×5 lat pulldown. Cardio is just a quick 3mile ride on a stationary bike. Despite this lifting, I don’t think I’ve made a huge dent in my metabolism.

  156. Micah  February 12, 2013

    Hi Peter,

    I was wondering if you have any thoughts on the phytic acid content of nuts. I know many people in the low-carb/paleo community such as Mark Sisson don’t think you should eat a significant amount of nuts because of the phytic acid.

    I personally include a lot of nuts in my diet and it would appear you do as well. I sometimes worry about the “anti-nutrient” quality phytic acid is supposed to have, though. Should I be concerned and is there a limit to how much I should consume?

    Thanks

    (reply)
    • Peter Attia  February 13, 2013

      It probably matters at some point, but I’m not sure how to quantify the harm.

  157. Gareth  February 18, 2013

    Hi Peter, Fantastic site. Good to know you’re running NuSi too. My question concerns Carlson’s Very Finest Fish Oil liquid, which I use daily, do you have any information concerning the stabilty of the EPA and DHA once the bottle is opened? .. as I understand it the fragile EPA and DHA will slowly oxidise until they all become rancid, for how long is it good to consume it? Gareth

    (reply)
    • Peter Attia  February 18, 2013

      I don’t, but refrigeration helps. Check with them.

  158. Joseph  February 23, 2013

    Do you find that ketone production is higher during fasted periods (without exercise) or after a high fat meal?

    (reply)
    • Peter Attia  February 23, 2013

      Good question. Not all fats appear equal in me (or person to person). Not all forms of exercise appear equal, either.

  159. Joseph  February 23, 2013

    Such interesting anecdotal evidence. A relentless self experimenter indeed, your website is an invaluable resource.

    One of the most interesting things is the way your BMR increased with respect to the dietary change. I certainly don’t know the mechanics of such a health benefit, but I’m sure you have solid theories. I understand that the reduced insulin response purportedly curbs lipolysis (though I haven’t seen specific research) but doesn’t ASP ensure that fat is stored in the absence of insulin? Maybe I’m over-simplifying it; I just can’t grasp the increase in BMR, though clearly you’ve documented it. Here’s a study that documents ASP to an oral fat load: http://www.jlr.org/content/30/11/1727. I’d love to hear your take on it.

    (reply)
    • Peter Attia  February 23, 2013

      My BRM appears to have increased by about 400 kcal/day. Many possible reasons for this, but I don’t know which. FGF21 production? B-OHB production (see discussion on Gibbs free energy)? Increased fat flux through adipose cells?

  160. anne  February 24, 2013

    I’m an ultramarathoner and have been eating low carb for a year because it helps my GERD. On days when I am running 5 to 6 hours it is very difficult to stay under my normal 60 grams of carbs. Is it possible to increase carbs on days with extensive exercise to 100 or even 150 grams while maintaining ketosis? Have you found that with your long bike rides?

    I’ve read the blogs of low carb distance runners. Some runners maintain they are in ketosis but also state they consume multipe GUs or similar carb source (30 grams carbs per shot) during an event. Have you experienced anything similar? I’m skeptical and reluctant to return to such a sugary source. I’m using Super Starch. Thanks much.

    (reply)
    • Peter Attia  February 24, 2013

      Yes. On days when I’m riding >3-4 hours, especially around threshold, I can maintain B-OHB levels > 3 mM with > 100 gm/day carbs. That said, I never use goos or stuff like that. My 100+ gm is nuts, fruit, and super starch.

    • Hemming  February 24, 2013

      Would you then have to eat those carbs during exercise or can you, to some extent, spread them out throughout the day too? I would guess that 3x30g of carbs vs. 5-80-5g (with the 80 consumed during exercise) would yield very different results also subject to individual differences.

    • Peter Attia  February 25, 2013

      A bit of both. As crazy as it sounds, I can titrate them in to replenish glycogen stores, depending on blood sugar levels.

    • Hemming  February 25, 2013

      Very interesting observation. Have you found the same to be true for protein? Do you adjust your protein intake to your carb intake, I’m thinking that a lower carb intake would allow for a higher protein intake? Or do you always consume 1.6g protein/kg?

    • Peter Attia  February 26, 2013

      If for me, no. Mostly consistent in protein consumption.

  161. Jeff Johnson  February 26, 2013

    Mediterranean diet Study

    Another pile of reporting crap – the 30% reduction qouted for the heart event reduction is total nonsense –

    for anyone who can do third grade math – the actual reduction is less the 1%

    Why would any half sane person change their diet for a 1% improvment – they wonld not – apparently people in this country can’t do simple third grade math – which makes one wonder ?

    (reply)
    • Peter Attia  February 26, 2013

      Working on a post right now. Not quite as bad as you think, Jeff.

    • Colleen  February 26, 2013

      I don’t see this study as any validation of “the Mediterranean Diet” rather if any benefit is shown, it is from eating more fat and fewer carbs. Imagine the results by taking those diabetics and eliminating sugar, grains, and fruit juice from the diet? Even if science demonstrated this beyond proof tomorrow, the problem, I fear, is that a great many would rather take a pill then make any serious effort to eliminate such foods from their life.

  162. Sara  February 27, 2013

    Hi Peter! Have you ever heard of “Pinole?” It’s a corn flour drink with about the same nutritional profile and calorie density as UCAN (at least it appears so). Allegedly, it’s the refueling drink if the ancient running tribe, the Tarahumara Indians. It’s mentioned in the book Born to Run and in other realms of the Internet.

    http://www.amazon.com/Pinole-Ground-Corn-5-Oz/dp/B0000GKVUS

    Thoughts?

    (reply)
    • Peter Attia  February 27, 2013

      I have not, but it’s not the ingredients (i.e., waxy maize) that makes SS unique, it’s the hydroghtermal process of making it.

  163. Ron  March 2, 2013

    Hi Peter, About salt,new studies show that hi intakes of sea salt with natural minerals actually lower incidence of heart attack stroke and high blood pressure verses intake of deminerized ionized salt with anti caking agents. Dr Gerald Polick University of Washington has studied water and found what he calls EZ water the fourth state of water. I think I will live to see him get a Nobel prize for this work. Listen to his interview with Ben Greenfield.It seems that if you add good salt to your daily water it will help structure it so your body makes more EZ water in your cells for energy and mineralized them in the process.I make a Sole’ with Hemalayn salt and add a 1/4 teaspoon to ever liter of water I drink . This concentration gives me enough salt content ao that when I perspire I can taste the excess salt on my arms being expelled . Would this not be a better way to intake salt than a boullion cube? Getting a constant supply of mineralized salt throughout the day instead of big spikes form boullion cubes. I respect and admire your work and look forward to your comment.

    (reply)
    • Peter Attia  March 2, 2013

      Sounds interesting. Are there any recent papers from Polick you can direct me to?

  164. Shanna  March 4, 2013

    I was doing a Google search on high fat/ketogenic diets and came across an interesting point. This person was discussing avocados as being a good source of fat, but because it also had carbs, they excluded it from a ketogenic diet. Someone commented that avocados are also high in fiber so it would reduce the carbs and to use net carb when determining carb intake for ketosis.

    According to NutritionData.com – Avocado (150 g) = 240 calories, 22 g of fat, 13 g of carbs, 10 g fiber.

    What are your thoughts on this? Do we use net carbs or gross carbs when moving to a ketogenic diet?

    (reply)
    • Peter Attia  March 4, 2013

      Addressed several times in various comment threads.

  165. mg  March 6, 2013

    Peter, do you have a good source on Leucine’s impact on insulin and ketosis? Phinney and Volek write in the Carb. Performance that “the primary driver of muscle protein synthesis is not insulin, but the availability of essential amino acids, especially leucine.”…. and say that availability of leucine in blood increases under ketosis due to lower leucine oxidation… but stop short of recommending leucine supplements. I am considering taking leucine for weight training (and potentially also for cardio), but have seen data that claims that leucine has >2x the insulinogenic effect of glucose, which would likely make it very adverse to ketosis. I know you take it for your high intensity training. have you observed the negative impact on ketosis? can you point to any good data on how to think about it? thanks

    (reply)
    • Peter Attia  March 7, 2013

      Check with Jeff Volek or Steve Phinney directly. I do not. I take such small amounts, that it seems to have no measurable impact.

  166. Joseph  March 13, 2013

    Would it be accurate to say that low carb caused your weight-loss and fat loss because of an increase in BMR, naturally decreased appetite and less metabolic need for food, and perhaps aided athletics performance?
    Thanks Peter

    (reply)
    • Peter Attia  March 13, 2013

      It’s certainly possible that some combination of all played a role.

  167. Andy  March 13, 2013

    If one is able to maintain ketosis while keeping dairy as part of their diet, then is there any reason to reduce/eliminate it?

    Could dairy, even while in a constant state of ketosis, have negative effects such as hindering fat loss?

    (reply)
    • Peter Attia  March 14, 2013

      I think that is possible.

  168. Fabio  March 20, 2013

    Hi Peter,

    I have started my keto-adaptation two weeks ago and I’m still looking for what to eat. One thing that I’m not sure if I should is linseed. Altough it has 29g of carb per 100g, it has 28g of fiber per 100g.

    What do you think?

    (reply)
    • Peter Attia  March 20, 2013

      That’s why they make ketone meters.

  169. AMP  March 20, 2013

    After doing much research on a Keto diet, I decided to embrace it and see what impact it would have.
    First of all let me start by saying I am a fellow Canadian living in Berkeley CA.
    I am a personal trainer and also a hockey player.
    I have been strict Keto for about three weeks.
    I have dropped weight, cancelled my afternoon nap, have much energy walking hills, am not hungry, and extremely alert!
    I have experienced brain fog but not anymore…
    Cons,
    I did experience some toe cramping and calf cramping, that has since decreased.
    I did notice that my muscle tissue got a little soft( i’m doing some resistance to try and bring that back and also am putting more salt in my diet
    I did notice dry skin but i’m hoping the addition of extra salt and drinking more water will help in this area.
    All in all , it’s been a very positive experience for me.
    Thank you Peter for all of your work !

    (reply)
    • Peter Attia  March 21, 2013

      Great to hear your experience. I’m sure readers will have many suggestions.

  170. Jeff  March 21, 2013

    This is all fascinating. My body chemistry is similar to yours and I used to exercise intensely 6 days a week, eat ‘athletically,’ and was strong and fat-ish.

    I’ve since started eating way more fat, less carbs (always in the form of green vegetables and maybe 1 orange or a few berries per day) BUT ALSO

    I’ve cut my working out down dramatically, while upping the intensity dramatically. I do resistance training for only 30 minutes (no real stopping, eccentric, DEEP burn) 1x per week, and high intensity interval training 30 second sprint at highest resistance on elliptical followed by 2 minute slow jog a total of 8 times. It’s torture and my heart rate is at a maximum based on the monitor I wear.

    I’ve gone from a 36 waist to a 33, although my weight is still around 200 but my shoulders are around a 44. I’d love to hear your thoughts on this. I’m thinking of lowering carbs and protein even more and upping fat, but keeping my workouts the same. I eat about 2400 calories/day and am thinking of going to 2200.

    Thanks,

    Jeff

    (reply)
  171. Ryan Edwards  April 1, 2013

    I suppose I have two questions. Relationship of Vitamin D to Insulin, is there any? Live in Oregon and have a severe deficiency. I’ve called several clinics near my location for DEXA and most only do hips and spinal scan. I’ve been told that OHSU has a full body DEXA. Some background on these questions, I’m 5’10” at Christmas i weighed 307lb’s, I’m 27 years old. I found out about this Blog in Feb. Since then i have lost 30lbs so far, I train extremely hard when it comes to weights. Also I play pickup-ball 2-3 times a week. (no one ever believes me when I tell them I weigh as much as I do, I carry it well idk?). After losing this weight i would really like to see a full DEXA. Is there a specific approach to get my general Dr. to provide me with a referral? Goal, 12 months = <200lbs. genetically I've been dealt the cards. this is unfortunate.

    (reply)
    • Peter Attia  April 4, 2013

      Hmmm, I am not sure, Ryan. You can get a DEXA without a Dr. referral. I recommend looking for a university, which usually offer them cheaper than private facilities.

  172. Patrick  April 2, 2013

    Peter,

    Almost a year later, do you still follow this (or another) IFIK protocol?

    If so, what do you observe?

    Thanks,

    Patrick

    (reply)
    • Peter Attia  April 3, 2013

      I’m mostly back in “regular” ketosis, only doing fasting when I’m traveling and good food is scarce.

  173. Adam  April 4, 2013

    Any weight gain since fasting less?

    (reply)
    • Peter Attia  April 4, 2013

      Yes, but there’s a big confounder…I lift weights more now. So the 6 pounds or so I’ve put on 5 months is probably at least partially by increased lean mass.

  174. Ian  April 18, 2013

    Peter, are you calculating Protein requirements based on total body weight or on LBM. On your data by the end of your N=1 it is about the same (from 0.764 to 0.717). But when I enter those values (due to being 23% BF) there is a variance range from using 89g to 108g/day for me. I am keen to get started on my n=1 but want to set it up correctly. Can you tell me if you went by total weight or LBM please.
    Cheers Ian
    ps, in regard to GTT from memory the lab suggest eating carbs for the preceding couple of days. Do you do that or do you get the GTT done while still in ketosis.
    Ian

    (reply)
  175. Ian  April 18, 2013

    ahh found the answer to the how much protein question in the
    ‘Can you build muscle by eating fat?” Post.
    “As a general rule, consuming 1 to 1.5 grams of protein per kg of body weight is more than adequate to build muscle.”
    Ian

    (reply)
  176. Shawn Lamb  April 30, 2013

    Hi Peter,

    Last night I watched a documentary called ‘Forkes over Knives’ – as the title somewhat alludes to, the takeaway message was advocating a high plant whole food, low fat and no animal meat diet.

    I have seen similar websites like yours based on such eating habits, with similar enthusiasm and claims of fantastic health benefits.

    I was wondering if you’ve seen this documentary, and what your opinions are on this science? If you haven’t seen the documentary, substantial evidence based cases are provided to show a high correlation between animal-meat and various ailments (i.e. cancer, coronary heart disease etc.).

    Thanks, and thanks again for the amazing wealth of knowledge your website has provided.
    ~S

    (reply)
    • Peter Attia  April 30, 2013

      Actually, if I understood it correctly, I think the title of this film was to indicate that forks (i.e., eating) could be more effective that surgery, or medical intervention (i.e., “knives”), though I know it’s also interpreted as not needing a knife if you don’t eat meat.
      You’ve hit the nail on the head, though, with the term “correlation” rather than cause. A thoughtful response to this film or the book it’s based on, is well beyond the scope of short response here. Much has been written about it, and if you’re interested, you may want to look here:
      http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/

      I’ve also indirectly touched on this topic in this post:
      http://eatingacademy.com/nutrition/is-red-meat-killing-us

      Last point I’ll leave you with, when trying to unwind the relationship between correlation and cause. It’s widely reported that a home with a fancy alarm system is 3x less likely to be broken in to. This is clearly and association. But does it contain causal information? In other words, is this true BECAUSE they have the alarm system, or is it possible that some other factor (i.e., “a confounding variable”) accounts for the lower break-in rate? I don’t know the answer, of course, but I can think of many such variables, including socioeconomic status — that is, those who can afford fancy home alarms also live in neighborhoods that don’t suffer as mean break-ins. So we can’t possibly know without doing an experiment.

  177. Eduardo G.  May 15, 2013

    Hi Peter,

    Last days, after I found your web, I have been extensively reading all your articles. I have to say they are awesome. Wonderfull information and very well explained. Thank you very much for your work.

    I have been 3 months doing a LC diet (20 grams), not hig fat and high protein with bad results (trying to treat my reactive hypoglycemia). But I discovered your web and I learned that moderate protein and high fat were the keys. So I started a proper Ketogenic LCHF diet. After 10 days on Ketogenic diet my hypoglycemic simptoms were really improving but I was feeling quite bad (tiredness, light headedness and headache) and then you give me the answer, sodium. I have augmented my daily intake of sodium and just after 1 day I really feel great again. Thanks to you!!!

    Just one question about the sodium intake. In other article you said that in this tipe of diet you excrete more sodium than normal so your daily intake was around 5 grams + 2 grams in hard workout days. It´s still that the right amount for you? How could I know the right amount for me if it varies from one individual to another?

    Thank you in advance and greetings from Spain!

    (reply)
    • Peter Attia  May 16, 2013

      You would best determine it empirically, with lightheadedness and sluggishness being the biggest symptoms.

  178. Lindsey  May 19, 2013

    Hi there,
    First, a question:
    For sodium intake, would you consider taking Celtic sea salt dissolved in water? It’s full of minerals. When I drink it, I can just feel my body’s relief. The reason I ask you this is my gluten-free lifestyle doesn’t allow the use of many bullion products because they usually have wheat in them, so when I see bullion, my mind thinks of alternatives.
    In fact, my next response has to do with alternatives. I have chosen to feed myself and my family by going against the grain…almost quite literally. By way of some research I did on my own in college, I started to minimize gluten in my diet. With terrible asthma growing up, limiting gluten allowed me to go to the gym and exercise without needing my inhaler. It’s been 11 years since I’ve had gluten, and not eating gluten, I believe, has saved my life. When it contaminates my food, I immediately can’t breathe. I have an instant auto-immune response. Other changes I’ve seen: no more fatigue, clearer skin, weight loss (I had always been a slim gal, but I quickly gained weight my first two years of college–guess what I mostly ate? Grains. I’m now back to a healthy weight and I know it’s because I don’t eat gluten).
    My children are young, and I’ve made all of their baby food. We do a variety of fruits and vegetables, nuts, nut butters and milks, (no soy anything), seeds (especially sesame/tahini and flaxseed), nutritional yeast, kelp salt, eggs, some meat, and goat dairy products (check out my blog http://www.mishmashmusing.wordpress.com for why I do goat dairy and not cow dairy). I do not introduce any grains until after their first birthday. Please check out my blog and read my post under September 2012 “Mish Mash Beginnings” where I talk about the book “Infant Nutrition” by Mark Percival. You can find it on Amazon. I think you would find it VERY interesting for your learning and research…It talks about gut ecology and how nutrients in our gut are absorbed and especially how a baby’s gut works.) Speak of gut ecology, my mom just learned from her thyroid doctor that healthy gut flora can lead to better weight loss. Growing up, I was always told, “Your gut is the brain of your body. If it is not functioning well, everything else will be off.” In my personal journey, I have found this to be true. I am SO passionate about health, about how I feed my children, about all that I’ve learned. Food truly heals. I could keep talking and end up writing a book here. My blog just scratches the surface if you’re interested in checking it out, so I’ll stop to save room for others to comment here. Thanks for listening. Thank you for sharing your story and research. This is the best reading I’ve found in a long time.

    (reply)
  179. Olivier Ramirez-hernan  May 23, 2013

    That’s pretty interesting, i discover Martin Berkhan thanks to you, and his point on IF and low carb, keto and the alternative hypothesis.
    You probably know that he’s strongly against it, his article “low carb talibans” was interesting but he gave the impression to misunderstood, insulin resistance and insulin sensitivity. i gone through the 256 comments and some times i thought he gave arguments against his own faith and couldn’t counter others, do you have a thought about him and did you read the article?

    (reply)
    • Peter Attia  May 24, 2013

      I’ve read some really thoughtful things he’s written, but also some not-too-thoughtful things.

  180. Olivier Ramirez-hernan  May 24, 2013

    Thanks for the answer :)

    (reply)
  181. Aaron B  May 30, 2013

    Hey Peter,

    Great articles man. I’m an 18 year old headed to college with a big weight loss story, over 55 lbs lost since February. My mother and I are big into the “ketosis” thing right now and we’re trying to eat fat like it’s going out of style. I find it hard to get my fat in without eating high-fat meats, which skyrockets my protein quickly. I see you eat a lot of eggs, are there any other high-fat products that are good for meals that aren’t loaded with protein? Also, we use a lot of real mayo at our house. No carbs, high in fat, tastes good – I haven’t found where you’ve eaten any at all. Is there a particular reason or do you just not like it?

    (reply)
    • Peter Attia  May 31, 2013

      I’m not a big mayo guy, but never have been, even when I was a carbivore. I just find the taste of vegetable oils unappealing. You can try making scrambled eggs without the whites (and fluff them with whole cream) to increase fat content relative to protein.

  182. Mike  June 5, 2013

    Peter,

    Can I achieve the ability to mainly burn fat for fuel without ever going to full on ketosis?
    Will the body adapt to mainly burning fat if I am eating only leafy greens, nuts and occasional berries for carbs?

    I would be aiming for an intake of say 75 g – 100g a day from only natural fibrous carbs. No sugars, perhaps an occasional diet soda (which I think the body treats as sugar).

    I would like to retain lean mass and lose about 35 pounds+ of body fat. I will have a Dexa scan done soon, so I can track future progress. I do high intensity resistance training once weekly and also mountain bike (medium pace) and walk/hike.

    Mike

    (reply)
    • Peter Attia  June 5, 2013

      Yes, ketosis is not essential to shift substrate utilization from glycogen to fat.

  183. Will E  June 9, 2013

    Regarding the Primal Flora probiotic, the one thing I can say it is is REALLY expensive against a straightforward acidophilus probiotic such as this one:

    http://www.amazon.com/gp/product/B001GAOGKS/ref=wms_ohs_product?ie=UTF8&psc=1

    The one I link on Amazon costs you about 9 cents per tablet, whereas Primal Flora sets you back over $1.11 per tablet.

    Do we really have any evidence that suggests Primal Flora is that much better?

    (reply)
    • Peter Attia  June 9, 2013

      No, just anecdote and self-experimentation. Which, of course, means one can’t get eliminate the placebo effect.

    • Christoph Dollis  April 16, 2014

      Well to start with, that product has 3 billion bacteria per capsule vs. 30 billion. So that makes it 90 cents vs. $1.11 for the same amount of bacteria.

      Second, only one strain of perhaps a less important species. Mark’s product, on the surface at least, looks like a better value if you think about it rationally.

  184. Will E  June 10, 2013

    Maybe you should consider opening up a discussion forum as a companion to your blog? You have enough high-quality users to justify that and it would keep unrelated discussions outside of each blog post. It would also give a place to grow a discussion around particular topics over time, instead of people accidentally discovering those within an article discussion. A very good one is hosted by Invision: http://www.invisionpower.com/

    (reply)
    • Peter Attia  June 10, 2013

      It’s a great point, Will. Maybe I should consider it. My fear, I guess, is that it turns into a forum for a few nasty people to run amok.

    • Will E  June 11, 2013

      I believe Invision has anti-spammer technology that catches some of that. But the rest you can just moderate out. Probably there is still an option to not post anything new until it has been moderated.

  185. Will E  June 10, 2013

    I tried out MCT Oil recently (2 tablespoons with lunch and 2 tablespoons with dinner) and I noticed a very unpleasant side effect that it dramatically increased my heart rate. I could literally feel my heart beating strongly, and it wasn’t a pleasant experience. I repeat this result on different days, and it stops if I do not take the MCT Oil. Since a known effect of this oil is its thermogenic property and ability to increase metabolism, that seems somewhat consistent with my result. I do wonder about the safety of this oil if it is increasing heart rate or intensity beyond baseline. Has it been studied for that?

    (reply)
    • Peter Attia  June 10, 2013

      GI side effects are far and away the most common, but your thesis for tachycardia does make sense and at least seem plausible if your liver is rapidly converting MCT to ATP and the only disposal is heat.

  186. Charlie  June 10, 2013

    Hi Peter,

    Great post. I have lost almost 100 lbs (most fat, some muscle) over the last year thanks to the ketosis diet. My doctor finally become supportive to what I eat after so many blood tests.

    I am on a daily cardio,3 workouts per week schedule and feels amazing as long as I get enough sleep. Interestingly enough, I have noticed the similar patterns with what you described: my dairy and meat consumption went down quite a lot a couple months after my weight has stabilized and I no longer restrict my carb intake to strictly below 50g per day and enjoy eating more nuts.

    I have stopped my bacon and salami routine after reading this newly published article:
    http://www.biomedcentral.com/1741-7015/11/63 but my I still consume plenty read meat and butter. Looking back, I think the most valuable thing I have gained from Ketosis and this site is the ability to differentiate physiological hunger and psychological ones, think critically, and establish my own program and evaluate it.

    Thanks again for your time and this awesome site.

    (reply)
    • Peter Attia  June 11, 2013

      Charlie, I think the study you quote has a few flaws that don’t allow me to draw the same conclusion the authors do, but if it’s working, don’t change it. Keep up the good work.

  187. DorinaDoraMaar  June 10, 2013

    Hi Peter,
    I’ve switched to paleo/low carb high fat diet about a month ago from a raw vegan diet (mostly high carb) aiming to lose some excess lower belly fat and cellulite. Since then, I noticed higher energy levels, mental clarity, gained more muscle and overall feel stronger. However, I gained some weight and cellulite on my abdominal area while my legs became bigger (I can barely fit into my old pants), more muscular and stronger ( I kept the same exercise routine-I jog 5 times a week, do squats). My diet consisted mostly of fats (plenty of olive oil and coconut oil, ghee, butter, vegetables/ salads (raw), chicken, plenty of eggs & animal skin, as well as chicken and bone broths. At most times I keep my carbs as low as possible (50g day mostly, but occasionally it gets below 100g). Eventhough I try to cut all fruits out, on some days I do indulge a piece of fruit and on some days I do green vegetable juice (celery, few cucumbers, parsley, spinach/kale) as a meal replacement, but I was still within that 50-70g carb range, so I really don’t get what I did wrong?! In the beginning I did some raw unpasteurized dairy (plenty of heavy cream, some kefir), but later associated it with the cellulite gain so I quit. Seems like I fall into a category of really insulin resistant people, at least that’s what I concluded from all this…Now I am trying to get as close to nutritional ketosis state, but am wondering can I still do that if I keep my green vegetable juice as a breakfast replacement and do plenty of fats and protein for my 2nd and 3rd meal a day? I really wanna lose the weight I just gained and go back into how I was before paleo…Also, do you have any experience with women getting rid of reducing cellulite? Thank you for you time! :)
    Best wishes,
    Dorina :)

    (reply)
    • Peter Attia  June 11, 2013

      Very hard to say without knowing so much more. You may be hyper-responding to the massive increase in saturated fat. I would definitely continue to eat things like salad by the truckload, but maybe consider reducing sat fat (e.g., dairy). Ketosis might be a big leap to start.

  188. Alec  June 11, 2013

    Peter,

    I did a page search for “spinach” on this page and only 2 results came up.

    Am I right in inferring from your posts and diet, that you’re getting same nutritional values from your diet as you could be getting from spinach, if you ate it? Isn’t spinach and kale super efficient foods in terms of nutrients/gram?

    Do you not eat them b/c of oxalic acid concerns (which are mine) or are you getting same value somewhere else? I am just thinking, not that you “should eat vegetables,” but, wouldn’t it make more sense to eat foods with higher nutr value/g?

    Thank you for your effort with NuSi!

    (reply)
    • Peter Attia  June 11, 2013

      I have no idea if spinach or kale are “super foods,” but I’m pretty sure there is no such thing. I love them both, but don’t see how they replace my diet.

    • Alec  June 11, 2013

      Sorry! I wrote that super early.

      I was just wondering if it were possible (and easy) to get enough vitamins/nutrients in your diet to be able to avoid taking spinach, kale etc. I guess other people on LCHF usually do kale/spinach shakes in the morning to max vitamin intake etc. So, seeing that you quantified everything, I was hoping to find out whether the sample diet outlined could effectively replace spinach/kale type foods (b/c of the oxalic acid concerns.)

      Thanks.

    • Peter Attia  June 11, 2013

      I eat one to three salads per day, so if vegetables are “essential” (they may be, but I’m not sure), I get plenty. I would actually guess that I eat more vegetables than 90% of Americans, though that bar isn’t high, I suspect.

  189. Darren  June 25, 2013

    I’m wondering if you’ve heard of or considered Barlean’s Omega Swirl (emulsified fish oil) as an omega-3 supplement. It is supposed to have 9 times better absorption than fish oil capsules; I was hoping you could comment on that. Thanks!

    (reply)
    • Peter Attia  June 25, 2013

      No insight.

    • Darren  June 25, 2013

      Thanks for the quick response. I’m curious about the bioavailability/absorption in general, particularly when considering omega-6 to omega-3 ratios and how much to omega-3 to supplement. I know you’re planning on writing a post about omega-6 and omega-3 fatty acids and hope you’ll touch on this. Thanks again!

  190. Leslie  June 26, 2013

    Any concerns with vitamin and mineral deficiencies? Would you elaborate?

    (reply)
  191. Rian  June 27, 2013

    Hi Peter. I have been struggling with being overweight for a long time and I have to admit that I have done a lot of research (although not being medically trained on this topic). I have seen your eating plan and your weight loss principles, but I have found that there is research to the contrary.

    I have been for genetic testing and this testing indicates that a low carb, higher fat (the fats and proteins that you also use) is not an ideal diet for my genetic makeup. The scientists that did the testing claim that their findings are based on 20 years worth of research into people with my specific genetic variations.

    On the other hand there is tons of literature about the diet that you typically follow, also based on years of research that basically proclaim the contrary to what my genetic testing finds (a low GI diet). With all this conflicting information and having tried and failed at all of these various diets, how does one know what is right for you and what not?

    Do you know anything about the research behind the DNA diet (which is what this genetic testing is called) and whether it is sound? I could provide you with the full report if you so wish.

    I would appreciate any guidance you can provide.

    Thanks

    Rian

    (reply)
  192. Michael Lyons  June 30, 2013

    Hi Peter,

    I’m very interested in Super Starch as part of my soccer training/competition regimen but live in the UK and shipping is a little costly. What natural foods or supplements would you recommend pre & post training/games to ensure I can maximise my performance? Sometimes I feel a little lethargic in games……

    By the way, I really admire your work and the level of detail you go into. Whilst the UK doesn’t have the level of obesity America has it is on the same track. I’ve been referring people to your site whenever they’ve been curious about why I eat what I eat.

    Thanks,

    Mike (UK)

    (reply)
    • Peter Attia  June 30, 2013

      I actually think nuts are a pretty darn good alternative, depending on the amount of glycogen replenishment needed (e.g., cashews — high; almonds/walnuts — less high).

  193. Patty Pittman  June 30, 2013

    Hi Peter, I feel like I might be your twin sister. At 38, I started working out, doing tennis and weight lifting, lost a ton of weight. Then I found karate and I fell in love. So for the last three year, I am an amateur bareknuckle fighter and a trainer, I work out 3 to 4 hours a day, sometime 5. I eat ‘healthy’ but I am still 200 pounds. I am 5’6″ and I have a lot of muscle so I don’t put any weight to the ‘obese’ label the BMI puts on me. My doctors say that I am awesomely healthy but I am not happy with the way I look. I want to be around 160 to 165. I already move like I could concur the world, but I am tired of looking like a frumpy housewife.

    I have been trying to stay wicked low carbs and failing. when I try to stay below 20, food is all I can think about and I get cranky and obsessed and then feel like a failure if I go over my goal, which sometimes spirals into a binge. Do you have any tips?

    (reply)
    • Peter Attia  June 30, 2013

      Sorry to hear about your struggle, Patty. I really do know how you feel. Weight aside, hopefully you’re not IR as I was. Tweaking the weight is tough, and not something I can offer meaningful insight on without a lot more info.

  194. Cynthia  July 1, 2013

    Dr. Attia,

    Good Evening,

    I am a former family physician who left primary care because I could not stand watching my patients die such horrible deaths from diabetes and the complications of metabolic syndrome. I, too, had periods where I blamed my patients for their disease. All the while, I was struggling with my weight. I stumbled upon an intermittent fasting style of eating by accident after I discovered I was developing insulin resistance. I was not nearly as diligent with exercise but my thoughts led me to consider how we evolved as a species. It occurred to me that our ancestors were hunter gatherers for all but the last 100 years. We did not have an abundance of food stuffs around so our ancestors probably ate only one large meal a day. So I set about eating one meal at night time. If I got really hungry during the day I would eat nuts. My weight stabilized. This lasted until I hit the mid aged struggle of peri-menopause. I slipped back into old eating habits and am back in a similar situation with weight and suspect my insulin levels are climbing again because I cannot get the weight off eating traditional food sources multiple times a day.

    I saw your TED talk and this prompted me to read more about your path. I am humbled by your honesty because I have been there as a physician. Thank you so much for your words. I hope your former patient has heard your apology. I bear the weight of those experiences and hope someday to apologize too.

    I will be following along as you continue to explore this deadly pathologic state of hyperinsulinemia and appreciate your work!

    (reply)
    • Peter Attia  July 1, 2013

      Cynthia, your comments mean so much to me. I’m convinced there a lot of Peter’s and Cynthia’s out there who wish they could go back and do it differently. I really hope current doctors can learn from our mistakes. I’m optimistic about tomorrow.

  195. Jennifer  July 1, 2013

    Dr Attia, I am so impressed by your humble TedMed talk. I’m a retired physician assistant who hated trying to manage obese, and consequently mulit- system problem patients, because nothing I said or prescribed worked. Before that I was an ER nurse and did CPR on those enormous bodies or struggled to move them from wheelchairs or stretchers with never enough help, grumbling while risking my back. Before that I was a home health nurse, teaching diabetic care (wrong information) filling insulin syringes and doing wound care for their amputated limbs.
    During your talk I was nodding as you apologized to that obese woman, because I am guilty of a critical attitude myself. Not always, but wish I could say- not ever.
    Now, I’m struggling to lose weight. It’s crept up from a chronic 20 lbs overweight to 50 lbs too heavy. Nothing I did in the past worked except grit my teeth and starve while obsessing about food. I had limited sucess to be sure. Eventually I would relaspe back to eating and resting. Silly me. Of course, I would scold myself for not doing enough exercise, and not eating in ‘moderation’. I’d righteously eat whole grains, lots of beans, and nearly zero fat, but as I got older, even that didn’t work. I joined Weight Watchers and then did South Beach Diet. I was always hungry. Finally, I’d say screw it and eat a Snickers or a big bowl of chocolate ice cream or both. . . with great remorse later.
    How wonderful to now be on a low carb, high fat diet. I’m losing weight and not hungry. I’ve also lost the negative self punishing attitude. (Ric Elias would be happy for me). I’m down 17 lbs. Thank you, thank you, thank you Dr. Attia for working on the science of obesity through nutrition. We need more physicians like you.

    (reply)
    • Peter Attia  July 1, 2013

      Jennifer, thanks for sharing your experience. I’m really humbled when others “from the trenches” recount, openly, their personal experiences. If my talk could play even a small role in helping you re-discover the empathy that I would bet anything was once there, I’m grateful and touched. Best of luck as you also pursue your own nutritional journey.

  196. Lydia Snyder  July 1, 2013

    Hi, Pete-

    Congrats on your TEDMED talk. I had the pleasure of meeting Gary on two occasions last year through Tom Dayspring, we really appreciate your work at HDL, please keep it coming. You guys are doing wonderful things for the future of science and nutrition.

    You touch on B-OHB frequently in your posts. Can you please discuss possible mechanisms for the increased production of alpha-Hydroxybutyrate in the insulin resistant state? I was dx with PCOS (BMI 22) last year and interestingly enough my DPMP panel lends itself to primarily skeletal muscle IR. Any insight you have on skeletal muscle vs. adipose tissue IR is much appreciated.

    All my best,
    Lydia Snyder, MS, RD

    (reply)
    • Peter Attia  July 1, 2013

      Lydia, not sure I have insight to answer that. Perhaps others?

  197. Michelle L.  July 1, 2013

    Dear Peter,
    I was telling my sister about your website. She is vegan and told me that dairy causes cancer because it is full of estrogen type hormones that adults were not meant to ingest. Do you have any thoughts on this?
    Thank you!
    Michelle

    (reply)
    • Peter Attia  July 2, 2013

      Michelle, probably worth asking for the experimental and clinical evidence of these claims. It may be possible that some cancers in some individuals are responsive to hormones, but I’m not aware of prospective data that demonstrate this.

  198. Jeff O.  July 3, 2013

    Hi Pete,
    Thanks for this valuable resource that I’ve been coming back to for the last year and a half or so! For IF, would “Bullet Proof Coffee,” with butter and MCT, or Coconut Oil, be a good idea in the morning instead of having regular coffee? Just wondering if you’ve experimented with it or believe there is scientific evidence that it would actually work. Also, would you comment on mycotoxins in coffee, especially if someone is drinking decaff. Thanks for your great work! I appreciate your time. Jeff

    (reply)
    • Peter Attia  July 3, 2013

      I love bulletproof coffee. Not a fan of decaf, primarily because the chemical processing.

  199. Aaron  July 6, 2013

    Peter,

    Any thoughts on releasing a 2013 version of “What I Actually Eat?” I’m curious to see how your diet has continued to evolve. Very inspiring for those of us in the early stages of LCHF.

    Aaron

    (reply)
    • Peter Attia  July 6, 2013

      Not sure, Aaron. I’m kind of hesitant to do so, because it gets people to focus on the “wrong” thing. What *I* eat is, at most, interesting, but more likely quite irrelevant to what *you* should eat. Same for how I train, or how I dress. So it I don’t see a part III to this any time soon, unless it’s to explain this concept.

  200. Paula  July 9, 2013

    Hi Dr. Attia,

    What is your take on the Leptin theory, which says that timing of meals is very important to the balance of Leptin to Insulin, and that plus amount of daily food consumed at any one meal plays a large role in storing fat? What I read recently says that three meals, at least 5-6 hours between each, and 12 hours between dinner and breakfast, with no snacks, and don’t consume large meals.

    I’m curious about your meal timing as represented here. How do you go so long before your first meal of the day, especially after such heavy exercise, without feeling light headed or queasy? And how can you consume so many calories per meal without gaining weight? I am led to believe by what I read (which is so confusing) that the body will store excess calories as fat if the meal is too large, even if daily total calories are not excessive, and that spacing these out into lower calorie meals over three meals per day will NOT cause the body to store fat.

    I believe, based on what I have read on your blog, that I have been insulin resistant most of my life. I have all 4 metabolic syndrome markers. It would be impossible for me to exercise for 90 minutes at 7 am and then not eat until 1pm. I realize this is your life plan, and you are not advocating it for everyone, but I am looking for some sort of template.

    I appreciate your information here, and much of it is too complicated for me to understand, so I, like many others here, just want to know what I should eat. It is alarming to read of all the people who have had an increase in LDL-P after going low-carb, high fat. And is it really possible to reverse high-blood pressure, or rather, to normalize it and be able to go off medication? I have been treated for HBP since 2005.

    Also, what is the knowledge available that speaks to any differences between men and women in this science?

    Would I be a candidate for any studies upcoming?

    (reply)
    • Peter Attia  July 9, 2013

      Paula, I’m wildly interested in leptin, though I’m not sure I accept this theory. I believe leptin’s purpose was more to protect us on the “downside” (i.e., avoiding starvation) than to protect us on the “upside” (i.e., play a huge role in over-eating). I probably (like in a year or so) will write a hopefully thoughtful post about leptin. As far as studies, once they are enrolling, NuSI’s website will likely link to the sites so you can see if you’re interested and eligible to participate.

  201. Lisa  July 9, 2013

    Can you recommend any books relating to eating a ketogenic diet that may plan out meals for me. I tend to work better with a structured plan. I really enjoyed your Ted talk and I have changed my diet since I saw it. It would help me to have a more detailed plan.

    Thank you,

    I too am a self- experimentor

    (reply)
    • Peter Attia  July 10, 2013

      Of recent books I think “The Art & Science…” by Volek & Phinney is most comprehensive.

    • Allie  September 23, 2013

      I have been a long time experimenter in nutrition and fitness. I really enjoyed the Volek/Phinney book. It won’t provide you a framework, per se, but gives the toolset to create your own. A lot of good information.

  202. Eric  July 9, 2013

    Dr. Attia,
    I just discovered your site today and I want to tell you that I really appreciate this! I am in my late 40s and was diagnosed with type II about a year ago. I have made some major changes to my diet (greatly reducing carbs, greatly increasing fresh veggies and fiber, etc.) and regularly exercise (which I hate but do anyway). Along with drugs I have kept it under control with my doctor requiring blood tests only once every few months. I am disappointed, however, that, like most people, I have not lost more weight more quickly. (At the same time I think about what my diet used to be and surprised I was not the size of a small Brahma bull). I know that you try to avoid telling people what they should eat, but I was wondering if there are things beyond full sugar sodas and Twinkies, we should avoid. I was surprised in a nutrition class that diabetics should avoid bananas! Also, how often do you cheat? I was told by my doctor that since my diabetes was under control, I didn’t need to be too restrictive. I just hate the idea of going to a party where they are serving pizza and birthday cake and either not eat at all, or bring a baked chicken breast and a salad.

    Thanks again!
    Eric

    (reply)
    • Peter Attia  July 10, 2013

      I don’t really “cheat” Eric, but I also don’t think what I do is relevant to what others should do. The goal is find some combination of sustainable changes you can make to your diet that get you the results you need to be happy. Then living within those boundaries. For me, my goals are pretty lofty, so the pleasure I might get from eating a piece of cake is much less (today, this wasn’t true 4 years ago) than the pleasure I get from not doing so.

  203. Kimberly Schwarz Holt  July 15, 2013

    I’ve noticed in several posts that you emphasize eating nuts. I also know that my mom, who was diagnosed prediabetic and then switched her diet to one that is very similar to yours, relies on nuts as a quick snack and meal enhancer. When she comes to stay with us for more than a day or two, I can see her struggle a bit because our house is nut free as a result of my daughter’s severe allergy to peanuts, walnuts, hazelnuts and pecans. Each of these allergies is known from actual reaction to exposure (in two cases anaphylactic reaction) and we avoid other nuts to be safe and avoid cross-contamination.

    I am wondering how hard you feel you would find eating if you had to eliminate nuts. Metabolic syndrome runs in my family and multiple members have decided to go to a low carb diet to try change the way our generation faces this, but all of them rely heavily on nuts, nut butters, nut milks, nut flours etc…, none of which would be available to me for at least another 10+ years. I also worry about this daughter, who, of all my four children, has the body type and cravings of my metabolic syndrome oriented family.

    Do you have any ideas, or recommendations of places to look for ideas, about how to successfully follow a nut free low carb diet? My mother resorts to more dairy when she visits, but I can tell it doesn’t work as well for her and she would struggle after more than just a few days. I feel trapped by this dichotomy in my family.

    (reply)
    • Peter Attia  July 16, 2013

      Not hard from a nutrition standpoint, but hard given my near-addiction for nuts. It’s definitely possible to minimize dairy and nuts on a well-formulated LC diet. There are several books out there with diets. I don’t really espouse one diet book over another.

  204. Michelle Turco  July 15, 2013

    Hi Peter,
    Intrigued by the diet, but am mostly vegetarian for moral reasons. I have no problem with sustainably caught fish, but the Carlson fish oil is a bit of a turnoff, as they don’t actually say what kind of fish it is from. The phrase “deep, cold ocean-water fish” is a huge warning sign as we now know many of the deep water fish are slow to mature and very sensitive to over-fishing. Personally, I think I may try to get a large proportion of my animal protein and fats from low-impact seafood such as farmed shellfish and fish lower on the food chain, ie anchovies & sardines (besides dairy & the eggs from our CSA chickens). I wonder what you think about how difficult it would be to get the sufficient amount of fats and proteins on a mostly vegetarian diet. A lot of coconut oil, avocado & nuts I think!

    Also, I am currently a graduate student in biochem at the University of Colorado at Boulder. Although I don’t personally work on the gut microbiome, one of my committee members is Rob Knight, who started the American Gut Project. I remember you mentioned somewhere on the blog that you were interested in your gut micobiota, and I think it would very interesting to see what kind of microbes you got going on down there, especially with your high fat diet. Specifically, does your gut look overweight, does it look lean, is it more like a Westerner or someone with a “traditional” diet? If you have gotten your gut sequenced, I would be really interested in seeing a blog post about it, and if you haven’t, you can get it done for pretty cheap: http://www.indiegogo.com/projects/american-gut-what-s-in-your-gut–7 . I had it done after I had developed food sensitivities, and now that I seem to have cured them, I want to try again, although I haven’t yet gotten the results from the first time around. Just be sure not to overload the sample because then they have problems extracting the DNA!

    (reply)
    • Peter Attia  July 16, 2013

      I’d suggest a fish oil made from bait fish, which also minimizes the risk of toxin accumulation. I did some testing on the Carlson’s oil looking for the “big 4″ toxins, which was negative, but I have to admit, I was not considering your other point. I think there are several other ways to move closer to an aquatic photosynthetic sources for your EPA and DHA, that may even allow you to avoid fish oil altogether.

  205. Daryl Roberts  July 16, 2013

    I’ve been digging into all this material in your blogsite, & shifting my diet to low carb. I’m wondering about how you test your B-OHB? seems like you’re able to monitor yourself during the day, that its not a lab test you send out for & wait 2 weeks for results. you had a link one of your pages, but it was broken. is there a test kit or website you could direct me to?

    (reply)
    • Peter Attia  July 16, 2013

      Portable monitor (Precision Xtra by Abbott).

  206. Isaac  July 16, 2013

    Peter,
    I was just randomly thinking about this again the other day and tried to recall your thoughts on the topic of kidney stones or gall stones risk with a HFLC or ketogenic diet. I was trying to search all over your blog but for the life of me I couldn’t remember where you had posted anything about the subject. I will admit, I did not make it through the 1,000+ comments from all the postings but I was trying be thorough in finding the answer myself before asking it :). So what are your thoughts about the risks for developing kidney stones or gall stones when on this type of diet? I have heard from a handful of people that have been on this type of diet that they did develop kidney stones. I understand that it could be just a coincidence. Do you take any sort of supplement to that is potentially protective against this? Thanks!

    (reply)
    • Peter Attia  July 16, 2013

      May be an issue for some folks. Not sure, though, exactly who is susceptible, and why. That said, a 24-hour urine test can show if one is in need of supplements (e.g., calcium) to ensure normal and non-stone-predisposing levels of electrolytes. Having taken such a test, I do supplement OTC Citrical. The gallstone issue can be a problem, so I’ve read, in phases of rapid weight loss. Not sure how valid this is vs. anecdotal.

  207. Hannah  July 18, 2013

    Hi Peter. I am curious about how you are finding your skin, eyes are on this diet? to me that is always a sign that a diet is good. And how was your skin when eating alot of dairy? Also what is your blood type? I am guessing it is an O? I am an o myself and find I seem to feel best when I limit grains. One last question. have you heard of Kimberly Snyder? I did her diet for a week and felt amazing – only eating animal protein in the evening, zero sugar except for a small amount of low sugar fruit, and masses of greens/ veges. Have you tried a diet like this. its supposedly what alot of celebrities do to “get the glow” what are your thoughts on this? Thanks :)

    (reply)
    • Peter Attia  July 18, 2013

      Never better, for what it’s worth. Not familiar with Ms. Snyder. I think I’m AB+ or B+

  208. Laurene Wells  July 18, 2013

    I’m trying to absorb everything. I’ve struggled with weight all my life. The doctor my parents took me to when I was 7 years old put me on a diet “as a preventative measure” and I’ve had weight problems ever since. I feel like my metabolism is permanently broken. I’ve lost weight twice in my life, once in college when I was able to run 3-5 miles every day, and 10k on the weekends, but I destroyed my hips, knees and ankles doing it. The next time was after my second child was born and I was on a special diet for gallstones that a Naturopath put me on. Both time I gained back TWICE what I lost before I went on the weight loss regime. Now I am somewhat terrified to lose the weight again, because I really can not afford to gain back twice again – it would be way too much!! But at the same time, I hate being heavy and hate that I can live on just 2 meals a day and never lose weight while other people eat 3 or 4 meals and never gain. Now I have the complication of arthritis and fibromyalgia, and I really NEED to exercise to keep my bones from freezing stiff. I’ve bought these Vibram FiveFingers shoes and they are healing my feet. I’ve gotten to where I can walk 6 blocks now, when just 3 months ago I could barely walk across my house. I could only do 5 heel raises when I got them, and now I can do 30. They ARE helping. And it is exciting to have more mobility. I want to be able to get out and do things again without worrying I’m going to have to call someone to come get me.

    My question is though, it seems you strongly advocate exercising in the morning. It takes me able 4 hours to get moving in the morning. I’m much more agile in the evenings. Is there some connection between exercising in the morning and improving metabolism? Is it really important to exercise in the morning? Or does that just happen to coincide with your schedule? Moving is very painful for me in the mornings. Is this one more card stacked against me?

    (reply)
    • Peter Attia  July 18, 2013

      Laurene, this is purely a matter of schedule. I like to do what I can while my girl sleeps. If I could (but I can’t), I’d work out from 3 to 6 am. Do whatever is best for you!

  209. Ron Manuel  July 18, 2013

    I’m extremely happy to have found your website. I find your posts very insightful. I’m interested in Thomas Seyfried’s (author of the book Cancer as a Metabolic Disease) belief that if one wanted to prevent many cancers, they should do a 7-10 day fast annually. What do you think of this suggestion?

    (reply)
    • Peter Attia  July 19, 2013

      I’d be open to seeing evidence, but I’m skeptical.

    • Ron Manuel  July 19, 2013

      He doesn’t claim to have evidence, but says that since mice metabolism is seven times faster than human, that to get the health benefits mice are getting from calorie reduction, a human would have to fast for three to four days. Presumably there is no health downside to a seven-day fast with a possible upside. I asked my wife if she would do a seven-day fast if she thought it would prevent cancer, and she gave what I suspect is a typical answer–if she had already been diagnosed with cancer she certainly would.

    • Peter Attia  July 19, 2013

      Perhaps. If preventing cancer is very high on the list, though, I can think of other strategies I would look to before a 7 day fast. But I agree, its only harm may be the liberties it (falsely) gives the other 358 days.

    • carolyn  August 2, 2013

      I was somewhat skeptical about fasting as well until I had to look into it while updating a website i volunteer to look after and met the term “autophagy”. “animal studies at the University of Southern California have shown without exception that short cycles of water fasting (48-60 hrs) “Retard Growth of Tumors and Sensitize a Range of Cancer Cell Types to Chemotherapy.” http://astrotas.wordpress.com/2012/02/11/january-2012-miracle-of-fasting/ Also you should know that Rodger the guy who turned me onto fasts is the youngest looking 67 yo. everyone thinks he’s a dozen years younger and always pink cheeked and glowing with vitality

    • Eric K  September 13, 2013

      I read Dr. Seyfried’s book.

      I do fast once a year for a week as he recommends. I don’t know if it will decrease my risk for cancer but it is certainly a fun and interesting journey to go without food that long. It’s not toxic and certainly something the ancients employed to try and convey health. It also seems that humans are exquisitely adapted to low calorie environments (unlike mice) and therefore intermittent fasting would be of limited benefit but a long, sustained fast, might actually “move the needle” toward a more healthy body.

      My main reason for posting however is to make sure Seyfried’s reason for writing the book doesn’t get lost with a discussion of fasting. After a career of studying cancer, he is convinced that it should be treated as a METABOLIC disease, not a GENETIC one. Unfortunately, virtually all of the money in cancer research is on the genetic side.

      In that regard he’s not unlike the fine pre WWII researches that Gary Tabues discusses in his books who studied obesity by taking the obvious approach of trying to understand fat cells. That seemingly obvious line of research was not the path taken after the war by less than stellar researchers.

      Seyfried makes the same argument – Warburg studied cancer cells long ago by focusing on their most obvious difference from normal cells – the way they create energy. He makes a compelling case that the cancer research community is lost, in much the same way the nutrition community is.

      Peter, after solving human diet with NuSI, do you think you will have enough time and energy to cure cancer? :)

      -Eric

      P.S. All joking aside, if Seyfried IS right, and the genesis and proliferation of cancer cells lie in their aberrant sugar metabolism, then your work and others on the nutrition side may have helped with the dreaded “C”.

    • Peter Attia  September 13, 2013

      Isn’t cancer just part of the same problem?

  210. Ann  July 20, 2013

    I just saw your video, have been struggling with metabolic syndrome myself and I’ve been so confused by all of the conflicting information that’s out there from the vegan/vegetarian and Paleo/Low Carb groups. Thank goodness you have such an open mind. My next question is regarding IGF 1 (Insulin Like Growth Factor 1): I’ve reviewed information that states that IGF 1 stimulates growth of normal and abnormal (cancerous) tissues, and the most highly concentrated IGF 1 foods are isolated proteins of milk and soy. Study in the Journal of Clinical Endocrinology & Metabolism compared 40 grams of isolated proteins of milk and soy and found that milk increased IFG 1 levels by 36% and soy by 69%. Are the isolated proteins safe to consume as a substitute for other proteins?
    http://www.youtube.com/watch?v=mHYFOJBU434&list=PL_SDy5W7G0sDdspe4oIkAsLtfahT-IQ5S
    http://jcem.endojournals.org/content/88/3/1048.abstract

    (reply)
  211. Justiss  August 1, 2013

    I found you via Tim Ferriss’ blog and the subsequent youtube video he posted of your talk.

    Years ago, probably like 10, I went on the Atkins diet and lost 95 lbs in 9 months and felt amazing. If I remember correctly, Atkins advises not to stay in ketosis… Then there were all these doctors coming out with studies that talked about more harm than good of the Atkins diet and increase in cardiovascular disease so I immediate quit. Fast forward 5 years from then and my husband is diagnosed with Type II diabetes and very very high Triglycerides and Cholesterol. I put him on a Atkins-esque Low Carb diet that I also followed (it was harder for me the 2nd time around) and his numbers dropped immediately, but he was resistant because the diet itself is still controversial even though the results were clear.

    So let me get right down to my question – HOW is this any different than the Atkins? Other than maybe you slowly eliminated bad carbs and completely cut out refined sugars – is there really any difference?

    I’m very interested because we switched to a vegetarian diet because of other health issues that are hereditary in my husband’s family. We eat fish and chicken occassionally but not more than 3-4 times a year. And I’m morbidly obese with great numbers and he’s overweight with poor numbers.

    This diet for me would help shed unwanted pounds that I’ve been carrying around for 10 years and ease joint pains and probably hormonal issues but for my husband I want him to last another 50 years past his 40th. I’m trying to understand in simple non-medical terminology. If this is a version of Atkins, that would help – if it’s a version of the Zone or Paleo… that would help. If its simpler than that – awesome. If my husband found out he could eat meat again, he’d be ecstatic and if I knew it meant getting him off some of his meds and help me feel better about myself then it would be completely worth every ounce of effort we put into our vegetarian low-sugar lifestyle.

    (reply)
    • Peter Attia  August 1, 2013

      Similar in concept. Much different in nuance and focus, at least as I think about it. Keep in mind, I only post what I eat in response to questions of others. I think it’s no more relevant than how I train or what I wear. These are decisions I make based on my genes, my epigentics, my goals. Not necessarily “right” for you or another reader, per se.

    • JohnK  August 17, 2013

      Justiss –

      I did Atkins, high protein, etc. Lost weight for a while, quit the diet, put it back on and then some. LCHF works for me – I’m steadily losing weight, never feel hungry and feel fantastic. The key is, as Peter says, is to find out what works for you. I really try to eat most of my calories from fat, with limited protein. Hardly any carbs. It takes a commitment to this, and you have to be aware of what you’re doing. But with such a simple diet, it’s easy to do. But you may have to change it over time as your body changes. For instance – I stopped losing weight, and decided to really curtail dairy and then started losing weight again.

      The way I look at it, if I really crave a certain item and eat it all the time, I should probably stop eating that item. And when I do, I usually start feeling better and start losing weight again. What do I eat? Pastured eggs, local organic pork and beef, the occasional nuts or piece of vegetable. But not much of the latter. From what I read of paleo, fruits and veggies abound. It sounds austere, but I’ve worked my way into it, and I’m totally satisfied, can go many hours without eating, never get hungry. It’s truly amazing what one can do with pork fat!

      Upon occasion (every few months) I end up having some fries with my burger – nothing like salted fat. I also drink alcohol in moderation once in a while. I don’t feel deprived or ever have a need to “cheat” – I feel so good why would I want to stop or change for the worse?

      But, as simple as it seems, it does take a commitment and an adjustment period, but the more you do it, the easier it gets.

      Good luck to you and your husband.

  212. carolyn  August 2, 2013

    thank you for sharing and bless your daughter! Kids are so long suffering :) a present for you both “surviving a healthy childhood” http://www.drkelley.info/2010/12/28/surviving-a-healthy-childhood/ this is an essay by William Donald Kelly’s daughter. I’m guessing from your Ted talk you might like to know about her father as well.

    (reply)
    • Peter Attia  August 2, 2013

      Never really thought of that. I guess that’s a long way away for now, but what an interesting thought.

  213. Vanessa  August 7, 2013

    Hi Peter! Love you blog!

    One question for ya – you mention, and I’ve heard many times, that too much protein can kick you out of ketosis. Do you know how much will kick you out? I guess the amount will differ from person to person + lever of activity? I’m a 52 ish kilo active young woman who is in ketosis. I wonder how I can figure out what my threshold for protein consumption is before it’s too much.

    Also, have you ever found yourself having too much fat in your diet? Mine is high fat as well, also because I love it (can’t get enough of coconut milk, it’s so good. I recommend putting it in your coffee) however, sometimes I wonder if I can go a bit overboard with the fat and if that can have any negative side effects.

    Thank you for sharing !

    (reply)
    • Peter Attia  August 7, 2013

      No simple number. Very context dependent. Muscle mass, anabolic demands, timing of protein in relation to exercise, timing over the course of the day, type of protein — all matter.
      Here’s the relevant answer: “How much” is whatever amount prevents you from being in ketosis when your carbs are consistently below 30-40 gm/day.

  214. Helen D'Couto  August 7, 2013

    This may be a silly question, but how are you not hungry on 1-2 meals per day?

    (reply)
    • Peter Attia  August 7, 2013

      Hunger is probably driven more than anything by what the liver senses as far as available energy. My body is very adapted to burning fat and prefers to do so over glycogen, so I’m never really low on fuel, since I care 60,000 kcal of fat around.

    • Ilya  November 15, 2013

      Hi Peter,

      Wouldn’t your liver having 60,000 kcal of fat around mean that you would never be hungry until your body fat stores start running low? And in that case, what difference would it make whether you’re eating once a day or six? Obviously this is not true, but I don’t fully understand the reasoning behind it.

      As an addendum to this question: hypothetically, assuming you can intake required vitamins in pill form, get proper amount of protein and eat nothing else, can you run purely on body fat (without getting hungry)?

    • Peter Attia  November 15, 2013

      Too complicated for quick response, but very fair question. Note that a person fasting stops feeling hungry about 4 or 5 days in.

  215. Emil Hjorth  August 8, 2013

    A big thank you from here as well. Have been reading about low carb diets for a long time, but you definitely offer some comprehensive new insights and missing links regarding ketosis and training. Thank you very much.

    I wonder how you are able to maintain a healthy diet and training regimen, with 200 travel days pr year. Do you pack large lunch boxes, or choose to only eat beaf and vegetables with butter when eating out?

    It’s easy to avoid the fries etc and order a larger salad, but there will somehow always be missing some fat.

    Maybe it deserves a blogpost for itself, how to avoid eating carbs on a busy schedule that demands eating in airplanes and at restaurants.

    Regards from
    Denmark

    (reply)
    • Peter Attia  August 8, 2013

      Yes, maybe deserves a blog post on this topic some time. Important questions.

  216. Sam Trotta  August 16, 2013

    Hi Dr. Attia:

    What is your take on the benefit (if any) of the occasional (once every 7 days or so) “cheat” meal or day, particularly as it relates to fat loss? By cheat meal, I specifically am referring to someone who is on a carbohydrate-restricted diet who would occasionally consume a meal or day of food that is proportionally very high in carbohydrate content (60% of calories or higher).

    Furthermore, if there is any benefit to this (besides psychological), then do you recommend specific carbohydrate sources? (i.e. would candy and chocolate cake be less ideal than let’s say a low GI-rated fruit or grain)

    Thanks very much for all of your work in this area and for sharing it.

    Sam Trotta
    Toronto, Canada

    (reply)
  217. David Fyhrie  August 29, 2013

    Peter,
    Thanks for all you have done, it changed my life. I am off the sugar for my workouts and races, it’s great! Also, I am passing on the knowledge to help others with their health.
    You mentioned an interest in learning more about how to improve gut biota or gut health. Take a look at a new product in the market called Vector450. It is extracted and purified antibodies from egg yolk. I took it and within three days it cleared up a gut problem (constipation) which I had for five years. I no longer need fiber drinks or prunes. I think the antibodies killed off the germs which caused the problem. In addition, I noticed that my athletic performance improved. After a hard workout (I am a cross country ski racer), my recover the next day was quicker and muscle soreness the next day didn’t happen. There are hundreds of clinical trials out there about the safety and effectiveness of antibodies from egg yolk to kill off bacteria, fungus, virus and other pathogens. Also there are several clinical trials documenting improved athletic performance within a couple of weeks by daily supplementing with what researcher call IgY (Immunoglobulin from egg yolk). What makes this product unique is that now it’s available to the public at an affordable price. The company IGY Immune Technologies & Life Sciences based in Thunder Bay Canada has the patents to produce the purified antibodies in large quantities at low prices. For full disclosure; I was so impressed that I contacted the President of the company and convinced him to hire me to do marketing and sales for the Midwest. So I do have a commercial interest in selling the product. However it is important for people to hear about a great break through product that is OTC (Over The Counter) not a pharmaceutical, safe and very helpful for so many health issues. If anyone is interested, it can only be found at our website which is http://www.Vector450.com. Use this code (DFIL1234) to get $10 off a $35 bottle which is a one month supply. I hope it helps lots of people.

    (reply)
  218. Pallavi  September 1, 2013

    Peter

    Can one have less than 10 % protein on a NK ? If not what is the best protein to have for a sensitive stomach.

    I’m vegetarian, 85 Kg, Insulin Resistant, Non diabetic, Fasting Insulin 22.5, Protein per day 35 grams.

    Have sensitive stomach though i tolerate milk well. Recovering from 2 disc L4-L5 discectomy in 2011 and fresh deficits from l5 S1 as well.

    I take Glyciphage 500 mg & Gabapentin 300 mg, both twice a day. I have lost 31 ponds in 1 yr from taking Glyciphage before my back operation. Now i rest 16-17 hrs a day. I’m barely able to maintain that weight loss.

    Thanks,

    Palalvi

    (reply)
    • Peter Attia  September 1, 2013

      The less protein in ones diet, the easier it is to be in NK. But of course, protein is an essential macronutrient. Hopefully you can consume non-mean animal sources of protein to augment your plant protein.

  219. Pallavi  September 2, 2013

    Is it easier to kick start NK with SK ? Thanks Pallavi

    (reply)
  220. Pallavi  September 2, 2013

    Sorry for too many comments ..

    If i consume 5% carb & 5% protein then can i increase my Fat to 90% ?
    Milk is an important source of protein for me but should i continue with it considering the sugar levels in it ?

    (reply)
  221. Kim  September 16, 2013

    I just started reading your blog. Thank you…this is finally making sense to me. I workout with a trainer and have gained muscle, but not lost weight, and am quite frustrated as I “should” be thin according to the amount of exercise I do. (So reading your journey was a relief)

    I have cut out most of the dairy, except for cream. I love my coffee in the am, I have 2 large cups (16 oz) with light cream (5 %).
    Would it be better for me to have full cream, or just have it black? I am ready to go ketogenic. and the cream would actually feel like a treat.
    Also, my trainer has me drink a protein shake after my workout. I saw that you fasted all day, not sure I could go that extreme, but should I be waiting longer after my workout to eat?
    Sometimes this info is so confusing.

    (reply)
    • Peter Attia  September 16, 2013

      Cream is fine if you don’t react negatively to it.

    • JohnK  September 16, 2013

      Hi Kim – When i started a ketogenic diet, I lost weight, but then stopped. I decided to drop dairy, including heavy cream, which I love in my coffee. After that I started to lose weight again. You may want to try raw eggs, whipped, as a cream alternative. Marks Daily Apple had an entry on this a week or so ago. What I do now is 3 egg yolks and some MCT oil whipped with a hand beater, and then add the coffee. Or, skip the MCT and melt some coconut oil in the coffee before blending it with the whipped eggs. It’s breakfast on the weekend.

      At work I just make ice coffee now by pouring hot coffee over a large cup of ice.

      Good luck.

  222. DareV  September 22, 2013

    Peter.

    What is your stand on Vitamin C and keto diet? I mostly eat dairy, eggs and meat. Rarely any fruit or veggies so my daily income of Vitamin C is rather low, lower than RDA by far. I’ve read that uric acid might come into play instead of Vitamin C when in ketosis. Is this true or shall I start supplementing Vitamin C, if yes how much?

    (reply)
    • Peter Attia  September 23, 2013

      Probably not necessary. Vit C and glucose use same transporter. When glucose is low, trace amounts of vit C are necessary. Explains why Inuit never got scurvy.

    • Micheal B.  September 23, 2013

      On a related note does using glucose for energy heighten the requirements for B vitamins?

      I guess it’s a bit of a general question because of the many compounds that fit into that category of B vitamins. But to share my anecdotal account, I eat rather low-carb, and on occasion I’ve taken a B complex for no better reason really than because I once bought some. This ends up turning my pee noticeably yellow the next time I go to the bathroom. Although, if my observation is correct, when I do the same thing after having a meal based on potatoes or sweet potatoes my urine ends up rather clear.

      Perhaps it’s all in my head, or I’m not accounting for something simple like that I’m more thirsty and seem drink more water than usual after eating starchy meals. Thoughts?

  223. Marc S.  September 27, 2013

    Dr. Attia,

    I am using the Specific Carbohydrate Diet in an attempt to control / cure ulcerative colitis. If you are not aware, the hypothesis and diet are essentially: low carb eating to starve out bad gut flora, combined with plenty of homemade yogurt to repopulate good gut flora. However, the line above:

    “As Larry points out, the challenge of “moving the needle” with probiotics is that they only provide the aerobic bacteria while, of course, most of our gut biome is anaerobic.”

    Makes me wonder if I’m wasting my time. Any comment?

    (reply)
    • Peter Attia  September 27, 2013

      Well, I was referring to commercial pro-biotic pills, which are cultured aerobically to grow bacterial populations. I think, but do check, that in yogurt one gets both. I have no idea, of course, if this strategy will work because (among other things) I have no idea how many of of bacteria make it to your colon, but it’s worth looking for any clinical trials and seeing your own experience.

    • Heyward Boyce  September 29, 2013

      Marc!
      “ulcerative colitis” is a term I recognize.
      A husband and wife couple came into our store, Rainbow Blossom Natural Foods, in Springhurst Kentcuky. He had ulcerative colitis, to the extent that doctors wanted to remove part of his (colon or intestine, forgot which) and he’d be using a colostomy bag. He came into the store, and bought this book: http://www.amazon.com/Prescription-Nutritional-Healing-Fifth-Edition/dp/1583334009. He followed it to the letter. 6 months later, he went in for an appointment and the docs said “whatever you’re doing, keep doing it.” A year later, the docs said “you have no signs of having ulcerative colitis.” One of the most powerful turnarounds I’ve ever witnessed.

    • Marc S  September 30, 2013

      Dr. Attia,

      Thank you for your input!

      Heyward,

      Thank you for the book suggestion, I will be ordering it as soon as I get home tonight.

  224. Brock 27  October 6, 2013

    Is there a way to contact you or somebody you work with to talk to about how to achieve nutritional ketosis I’ve been trying this for months and I’ve been struggling the whole time sometimes I can feel my body going to ketosis and my body relaxes my brain feels good I sleep and my hormones come back and other times I just feel as if I didn’t even eat anything and I can feel my food just sitting in my stomach. I have tried so many different food combinations and mixing more fats with less protein and more protein with less fats that I’m giving up I can’t eat sugar I have too many side effects from it and now I can’t even eat vegetables because I have side effects from that as well. I could really use someone to talk to about this because I can’t read any more information because it doesn’t get anywhere.

    (reply)
  225. BAMT  October 8, 2013

    Dr. Attia,
    I just watched your TED MED talk and it was wonderful. Thank you for sharing that regret and your questions. I pray that you find the answers.
    I wanted to ask you if you have watched “Forks over Knives” and the compelling research such as the China Study that advises to avoid animal meats and products? I would be interested in hearing your take on those issues…

    I seem to do better with low carbs myself, but if you take out meat and dairy; then that doesn’t leave much to eat besides nuts and plants. That is doable, of course, but creates some general quality of life issues for me in terms of public socializing, entertaining, holidays, etc.
    Barb

    (reply)
    • Peter Attia  October 8, 2013

      Barb, I have commented on this very emotionally charged topic several times throughout the blog and in comments.

  226. Demetrius  October 11, 2013

    Peter, I just watched your IHMC talk on You Tube and one of the questions you answered brought me back to this post. You mentioned that consuming too much protein in one sitting can knock you out of ketosis. I am trying to get and stay in ketosis so my question is: if you had a guideline for the maximum grams protein per meal what would that be? At 3 meals a day, 10g of carbs per meal seems like a good cut-off, but not sure about the protein. I’m afraid I may be sabotaging my efforts by consuming proteing powder after a workout.
    Thanks!

    (reply)
  227. Norman  November 5, 2013

    Inuit people “never got scurvy” because they ate stomach lining, liver and other tissue of animals (sea and land) that ate green plants. They also gorged on berries when available (cranberries, blackberries…), about one to two months per year.
    Both modern studies and pre-contact estimations of traditional diet bear this out.

    Here’s one source, though there are many, scurvy being a long researched topic of great import:
    “Historically, ample vitamin C was obtained through the traditional Inuit food system.”
    “Animal sources of traditional food confer fair to excellent amounts of vitamin C in a
    daily diet. Among the animal sources of traditional food, the highest levels of vitamin C were
    found in samples of raw beluga and narwhal mattak, boiled beluga mattak, aged narwhal
    mattak, fish roe, ringed seal and caribou liver, ringed seal brain and caribou kidney. The most
    commonly consumed traditional food were frozen/raw meats, which as anticipated, contained
    approximately 1 mg/100 g.”
    members.shaw.ca/karen.fediuk/VitaminCintheInuitdiet.pdf

    I searched “Vitamin C” on this site because I’m going to self-experiment with it. I’ll let you know how it goes.

    (reply)
  228. Mirko  November 16, 2013

    Dear Peter

    Lately I have been spending most of my free time on you great homepage. I wonder about two things:

    1. You eat/ate balsamic vinegar in your salad sauce. The brands I can buy here in Europe contain about 20 g of sugar per 100 ml, which is why I switched to vinegar from wine or lemon juice. Am I being overly careful?

    2. As far as I understand, fructose does not cause a rise in insulin, mainly ends up in the liver and is turned into fat. Should this not imply that while in nutritional ketosis, it would be beneficial to consume some fructose instead of glucose, since the liver will burn a lot of fat anyway to generate ketones and this way you would keep your insulin down? Just during a normal day, after or mid workout I would prefer glucose to restore muscle glycogen.

    (reply)
  229. Cathy  November 16, 2013

    Thank you for this blog.
    Would you address your view of salt / sodium importance with this diet please?
    I also read Ben Greenfield’s blog. He is a proponent of it and I’m confused. I have a family history of heart disease and have been told to lay off the salt. Ben recommends a specific salt he uses. fyi.. I run five times a week if that matters.

    (reply)
    • Peter Attia  November 17, 2013

      Cathy, I’ve done so dozens of times across different posts on comments. Sorry it’s not easier to navigate.

  230. NK trial  November 17, 2013

    I have been experimenting with paleo/primal/grain free for over 5 years. I have been attempting NK for the past week. My Precision Xtra meter and strips arrived yesterday. Ketone level last night 1.0mmol/L and this am( before eating) 0.9 mmol/L. I do not do much physical activity.I am so NOT hungry. The reason I decided to try this was not to lose weight but to increase energy levels, improve cognitive function and stabilize moods. I have been prone to mild depression. I have been supplementing daily with potassium, magnesium, vit D and fish oil (this one I have been forgetting mostly). I also eat 3 tsp salt and heavily salt food) I am very irritable, groggy and depressed-I am having a difficult time functioning in this state. Is there any research on NK bringing on a bout of depression? I am a woman and weigh 115lbs. Is this merely a transient problem? Should I keep going for another 3 weeks and start tracking my intake carefully?

    (reply)
  231. Ghislain d'Entremont  November 18, 2013

    Just a general question about exercise: what do you think of Doug McGuff’s (author of ‘Body by Science’) approach to achieving total fitness via high intensity strength training, and do you see any reason why such an extreme program should not be followed on a ketogenic diet (Doug is an advocate of a low carb Paleolithic diet).

    Cheers,

    Ghislain

    (reply)
    • Peter Attia  November 18, 2013

      No reason it can’t be, but adaptation time will vary by individual.

  232. Christopher Lind  December 10, 2013

    Hey Peter, I’m a huge fan of one meal a day for many reasons (money, time constrains, less work/cleaning , etc…) I was hoping you could shed some light on roughly how much protein I could eat per meal to stay in ketosis. I’m about 5’11” 167 lbs and I’m very active. I would mean alot if you could answer this, thanks so much!

    (reply)
  233. Debbie  December 10, 2013

    I’m wondering how you feel about coconut oil vs. olive oil? Is one healthier than the other? I switched from olive to coconut recently, because I love the sweet taste of coconut and though, perhaps erroneously that it was healthier.

    (reply)
    • John Wagner  December 11, 2013

      Coconut oil is far, far superior to olive oil and that is even if we assume that what we buy here in the US is actually olive oil; most of it is vegetable oil falsely labelled. The benefits of coconut oil are truly a miracle of nature and have to deal with its unique lipid structure. This a good overview:

      http://www.amazon.com/Coconut-Cures-Preventing-Treating-Problems/dp/0941599604

  234. Debbie  December 12, 2013

    Thanks – I’ll read the article. I vey much appreciate your linking it here.

    (reply)
  235. christie  December 25, 2013

    Hi Peter,
    I enjoy buttered/coconut oil coffee (bulletproof),and butter in general, but I’ve been reading about the inflammation caused by endotoxins which purportedly increase after a fat based meal (with saturated fat being more of a culprit than PUFAs). What are your thoughts on saturated fats and inflammation via the endotoxin pathway?

    Thanks,

    Christie

    PS- I have never felt as well as I have since I began eating low carb/high fat almost 2 months ago!

    (reply)
    • Peter Attia  December 25, 2013

      It’s possible, but the data I have seen don’t compel me enough to stop eating SFA, nor do the clinical and biochemical associations I look for.

  236. ori  December 27, 2013

    Have you ever looked in to Drs. RIchard and Rachael Heller from Mt. Sinai Hospital, the authors of the Carbohydrate Addicts Diet and the importance of eating one meal a day being the Reward Meal and keeping all carbs in that meal once a day? They have a lot of science behind this theory and allow for skipping the other two low carb meals if not hungry. I have had great success eating one meal a day with high fat low carb and some other extra carbs in that one meal. I fast every 24 hours. Also, they have quoted the Big Breakfast Diet by Dr. Jakowbitz which is encouraging this one big meal to be eaten early in the day if possible in their new book The Stress Eating Cure.

    (reply)
  237. Simon  January 22, 2014

    Hi Peter

    There is probably a better post to reply to but I couldn’t find it!

    I’ve been scouring the web for information as to the acceptability of ‘non-hydrogenated vegetable fat’

    I (perhaps mistakenly) assumed that ‘non hydrogenated’ means, for want of a better descriptive – non ruined

    What’s your thoughts? I’m specifically looking at Siesta Carob bars. No added sweetener, and I bizarrely like the taste, even though everybody else I’ve tested on hates them

    Thanks for writing by the way, you’re appreciated

    Simon

    (reply)
    • Peter Attia  January 23, 2014

      I find vegetable oils to taste pretty bad, so I don’t really consume them. Furthermore, where the big 5 PUFA oils go, bad things go too. I’m not sure how harmful the common PUFA are in their own right, but outside of food (e.g., nuts), they don’t constitute a part of my diet in any meaningful way.

  238. Sidney Phillips  February 2, 2014

    Hi Peter,

    What is your opinion of resistant starch and how it would affect ketosis? I take a tablespoon of resistant starch (Bob’s Redmill unmodified potato starch) before each meal, which is 10 grams of carbs, to add prebiotics for helping with digestion and improving the gut biome. A lot of people experimenting with this claim it doesn’t increase blood sugar much, if at all. I’m thinking of trying out nutritional ketosis for its cognitive benefits; I’m studying for USMLE Step 1 right now and hope this way of eating will cut down on food prep and enable me to think clearer as I study.

    (reply)
    • Peter Attia  February 2, 2014

      I have no idea. But it’s a knowable issue. Blood meters don’t lie.

    • Hemming  February 2, 2014

      From my own measurements RS doesn’t affect ketosis. There might be a point where you ingest so much that it does but even people eating more RS than me have said it has not affected ketosis.

    • Michele  February 3, 2014

      Hello Sidney,

      Marie, a commenter at Richard Nikoley’s blog, as well as many others have reported that it DOES NOT kick you out of ketosis. Her concern was for her father who is on a ketogenic diet as a cancer therapy. She was trying the resistant starch herself and with her father. Thus, in my humble, non-medical opinion, I think it in combination with the mental clarity Peter mentions of ketosis, it is most definitely worth a try. An interesting experiment would be to test your gut bacteria with the American Gut project now and the after your go at ketosis. Best wishes!

  239. Luigi Rocca  February 4, 2014

    Hi Peter,

    I’ve been on a low carb diet for about 6 months and although I have lost weight 9about 10 lbs), I fully expected my body composition to have changed more drastically. I have plateaued and can’t figure out why. Is there a protocol you could suggest that could help me figure this out? For example, should I eliminate dairy (even if I tolerate it well) to see if this will help me break through this plateau? It could be my protein intake or perhaps my caloric intake is too high given my level of physical activity. I hate the idea of counting calories but the one macro nutrient I try to keep close tabs on is my carb intake and I am positive I’m never more than 100g per day and usually more like 50 – 75 (almost all from veggies, small amounts of fruits or nuts). I’m frustrated because a year ago, pasta, cookies, white bread, french fries and ice cream were all staples in my diet so I feel any change from here will be minor.

    Thanks

    (reply)
  240. Patrizia  February 5, 2014

    hi Peter,
    I really appreciate your generosity in sharing your knowledge (and on going experiments) on nutrition and its consequences for human health. I did not find anything on A2 beta-casein and its variant on the blog, and I would be very interested in knowing about the last research on the subject, if you ever cared to check those studies pointing to its relevance in several deseases (cancer, CVD, etc). At any rate, thank you and good work,
    Patrizia

    (reply)
  241. Maryann  February 10, 2014

    Hi Peter,

    What is your opinion of supplementing with coconut oil for brain health (on a low-carb diet)? Dr. Lipid and Robb Wolf had an exchange about it on twitter. Would you consider it a safe, healthy, benificial fat? Someone in their conversation called it very dangerous for cardiovascular health. Thank you very much, Maryann

    (reply)
    • Peter Attia  February 11, 2014

      Too complicated for short response. Sorry. I’ll get to the brain at some point…

  242. rickyh1955  February 19, 2014

    I see that you eat processed meats and oils that cause glycation, which in turn can increase arthersclorosis. Do you feel this is a concern? Have you measured your HbA1C glycated hemoglobin? Here are some references:

    http://www.trackyourplaque.com/report/Diet/glycation1.aspx
    http://www.ncbi.nlm.nih.gov/pubmed/15281050

    (reply)
  243. Sehgal  February 24, 2014

    Hi Peter,

    I read your personal HOMA IR test results dated September 2009 and May 2011 and notice that your fasting BG is 97 and then drops to 83 post prandial ! where as your fasting BG in 2009 was lower at 93 when you were Insulin Resistant.
    Why does this happen ? I am facing a similar situation on a carb restricted diet: while my lipids have improved (HDL up from 40 to 59, TG down from 120 to 68, TC down from 225 to 180, LDL down from 147 to 118, weight down from 160 pounds to 140 pounds ) my FBG has increased 90 to 100. My BMI is 20.
    100 is considered predibetic in India – I am confused.

    (reply)
    • Peter Attia  February 24, 2014

      Fasting glucose is a very misleading indication of IR. In fact, HOMA-IR is barely better. Fasting insulin is better than both, but OGTT is much better.

  244. Bill R.  March 5, 2014

    Peter,
    In view of the recent news about low carb/high fat diets, do you have any comments? I’m an endurance runner and have been on the diet for about 5 weeks and feel great. Thanks for all you do.

    http://www.abc.net.au/news/2014-03-05/low-carb-diet-may-shorten-your-life-study-finds/5299284

    (reply)
    • Peter Attia  March 5, 2014

      Bill, please tell you didn’t just ask me about a study on the lifespan of mice and ask me to comment, right?

  245. Murray E  March 5, 2014

    Hi Peter,
    Great job with this blog. I have been following a low carb diet for some time which means I eat a higher than average amount of protein. I would value you opinion on this recent article (see link) that equates higher protein intake with increased rates of all-cause mortality (twice the rate) and also death from cancer and diabetes (four times the rate) compared with low protein consumption. This is applicable to those between 50-65 years of age (I am 53) who have >20% of calories daily from protein. Admittedly this is a population based study with all the flaws inherent in this design, but it is ‘food for thought’. Thanks

    (reply)
  246. Bill R.  March 5, 2014

    Peter,

    Awesome ! I was hoping you’d say something like that. I’ll give the study as much credence as you have (none!).

    Again, thanks for all your insight and advice to us LC/HF followers.

    (reply)
  247. Ron  March 5, 2014

    “”Bill, please tell you didn’t just ask me about a study on the lifespan of mice and ask me to comment, right?””

    Haha! Where’s the LIKE button?!

    (reply)
    • JOEL  August 22, 2014

      Hahaah! That article is a report on a report, and gives no pertinent specific information at all. Excess sugar/carbs is now well-known to be the primary cause of NAFLD, and metabolic syndrome in humans. Mice live up to 150 days? That study is very bad science! A very old but famous Harvard study with rats found that when fed a starvation diet from birth to adulthood, while not growing as large, they lived twice as long, not getting as sick throughout their lives as those that were fed the normal rat diet! So much for rodents!

  248. JOEL  August 22, 2014

    No question, just a “Thank you very much.” I’m 70 years old, have a 3-yr old son and young wife, play tennis 3-5 times/week, and have been following a low carb, totally no sugar regimen via Mark Sisson et. al., for a while. My weight vacillates around 175 pounds, but I know I’ll feel much better at 165. While advice from the gurus is great, there’s nothing like a true life account backed by scientific data to bolster my new belief system and diet! The advanced blood tests in America are not available here, in The Philippines. So, I take no tests, except blood pressure that is constant at 110/70. As you all know, changing to high saturated fat, and eating pork and red meat after almost a lifetime of low fat with only chicken, fish, and seafood can be scary, especially when one has had a coronary heart attack, as I have, at 63 years of age. At 6’1” I was 162 pounds running track at age 17. Before my heart attack I had struggled to maintain a weight around 200 lbs, and was a whopping 215 lbs at my heart attack. Like you, I didn’t know how I’d gained so much weight. Looking back, I’d stopped exercising as much and was addicted to ice cream, and was probably somewhat depressed. But I always ate huge salads smothered in EEVO, that I also fried in, and thought I was following a healthy path! Now I only cook with coconut oil. Recently I had begun to question the amount of animal fat I was ingesting, of course with regard to my arterial health and heart attack resistance! It’s always on my mind, and can lead to depression. [Note: Robin Williams was overweight for quite a while, and had open heart surgery not too long before his suicide.] After reading your blog, I am no longer concerned about my arteries as related to high saturated fat intake. I love eating this way. Heavy cream (in coffee and fruit salad deserts), cream cheese, and butter, bacon (slow cooked) and eggs are so satisfying! It seems so much more natural, and is definitely more satiating than low fat consumption! I’m now considering lowering my protein intake. Few people follow an exercise regimen such as yours, so I agree with your recommendation to not eat as you do, among other reasons. But examples of what you eat will always be highly illustrative and educational for your followers. You should understand this as it relates to the traffic you get on your “what you eat” pages. Lastly, I’d just like to note that balsamic vinegar has sugar in it, and apple cider vinegar supports gut flora as opposed to white distilled vinegar that destroys gut flora. BTW – a great way to add resistant starch to your diet is cold potato salad! Thank you again! Comments are always appreciated.

    (reply)
  249. Eric  September 4, 2014

    Hey Peter, just wondering if you are doing a post workout protein shake on days you bike and/or on days you do your dry land workouts? You said you don’t eat breakfast but was just wondering if you did any post workout nutrition that would break your IF until lunch or if you just use protein from the two meals you do consume for recovery? Thanks.

    (reply)
    • Peter Attia  September 4, 2014

      Post workout protein only on morning lift days (2 mornings per week). 3 days I’m doing evening lifts right before dinner, so meal provides protein.

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