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

Got grit?

Got grit?
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Last week a reader posted a link to this short talk from TED Talks Education. (You’ll want to watch it to understand the rest of the post.) I found the talk interesting, and in the talk Ms. Duckworth makes a reference to a Stanford psychologist, Carol Dweck, who has been very influential in my thinking about children and childhood learning.  In fact, when I became a father one of the first books I read (and have since recommended to every parent I know and even my daughter’s kindergarten teacher) is a book by Dr. Dweck, Mindset.

Now, I don’t know if everything Ms. Duckworth says or suggests is correct.  Her work is well outside of my area of knowledge.  But it’s a topic I think about so much, and since watching this video I’ve been reflecting on my life and the implications of this idea to our health.

First, some background

Shortly after my twelfth birthday, boxing fans around the world were given a gift unlike anything before or since, the showdown between Marvelous Marvin Hagler and Tommy Hearns (don’t watch this unless you can handle a violent boxing match). To this day most boxing experts agree the first round of that 3 round war remains one of the — if not the — greatest round in boxing history.  I was a huge Hagler fan, and this fight galvanized in me two things:

  1. I wanted to be a professional boxer (something I pursued relentlessly enough to nearly forgo college), and
  2. I wanted to be just like Marvin Hagler, the grittiest fighter of my generation.

You see, I was not the fastest when it came to hand speed or foot speed.  My punching power was good, but not George Foreman or Sonny Liston good.  There was no special “gift” or talent I had that was ever going to make me the next Mohammed Ali or Mike Tyson.  But, Hagler didn’t seem to possess any God-given ability and, in my 12-year-old opinion, he was the greatest fighter on Earth.  Sure, Sugar Ray Leonard was the media darling and wealthiest fighter of the era, but Hagler was the grittiest. (Anyone tempted to point out that Leonard was awarded the split-decision over Hagler when they met in 1987 need not bother.  In my mind – and the mind of many — Hagler won 115-113.  If you want to read more, here’s a great summary.) He out-trained everyone.  He never got out of shape between fights. He was always ready for combat.  He was pure grit.

So, this became the defining feature and mantra of my youth.  No one was going to out-grit me. I would run 6 to 10 miles at 4:30 in the morning (imagine how dark and cold that was in Canada) because I knew the other guy was still sleeping.  I did 400 push-ups every single night (except one night in 11th grade when I was too sick to move) before bed from age 13 to 18 because I knew the other guy would not.

When I did decide, ultimately, to go to college instead of pursuing a career as a professional fighter (something I attribute to the most influential teacher in my life), it was such an easy transition, because I had already built a mental and emotional infrastructure of grit.

Perhaps because of some deep insecurity I always felt the need to out-grit everyone at everything, even surgery.  In residency, while my peers would (rationally) try to catch a nap any time there was a free moment during call nights, I would practice anastomosing 3 mm Dacron grafts together with 8-0 proline, over and over again. I even built a model heart with a deep mitral valve to practice – a hundred times a day – one of the most difficult stitches in surgery, the “A-to-V” and “V-to-A” sutures through the mitral annulus.

You get the picture.  I was (and remain) a freak.  The ‘why’ is beyond me, though I’ve never stopped trying to understand it.  Though my daughter is only 5, I spend a lot of time talking with her about ‘mastery’ and the joy that comes from the journey of mastering a skill (versus the need to seek pleasure in the outcome or final result).  This is not a natural phenomenon and I think, unfortunately, most of our education is based on the result and not the process.

I’ve read countless books on this, both out of desire to better myself and out of a desire to ignite this spirit in my daughter, and to date the best one I’ve read is The Talent Code, by Daniel Coyle. It’s the only book I’ve ever read where the moment I finished it, I turned to the first page to read it again.   In this book, Coyle argues that grit – practice – may not be enough.  It’s necessary, but not sufficient for mastery. The other component essential for mastery is the right kind of practicedeliberate practice.  This topic is worthy of a book, of course, and not just a few sentences, but suffice it to say, deliberate practice is a very specific type of practice that leads to change. Mastery. While I disagree with this writer’s view that the book, Talent Is Overrated does a better job explaining the concept than The Talent Code, he provides a quick overview for those not familiar with the concept.

How does this apply to our health?

First, if you don’t practice correctly, no amount of practice is going to achieve mastery, whether it’s swimming the 200 IM or playing the piano.  A disciplined approach to eating the wrong foods may be better than undisciplined approach to eating the wrong foods, but it’s no substitute for the correct approach to eating the correct foods.

In 2009, when I was at the height of my unhealthiness – I was overweight, insulin resistant, and had Metabolic Syndrome – it was not because I was not ‘trying hard enough’ to eat well.  I had all the grit in the world when it came to eating. I wanted so desperately to be lean and healthy. The problem, of course, was that I was not eating the right foods. It’s the difference between gritty practice and gritty deliberate practice.

Second, let’s posit you figure out what the ‘right’ foods are.  Is this sufficient to achieve your health?  Well, here I have to include not just my experience, but the experience of my friends, family, and clients. Some people, once introduced to the ‘right’ foods, experience almost an immediate change.  The pounds melt off. Their biomarkers improve seemingly overnight. They feel rejuvenated and renewed.

Let me assure you, these folks are the exception and not the rule. For most people the pattern of going from metabolically broken to fixed, which often includes a loss of fat mass, is very slow; slow enough that on a day-to-day and even week-to-week basis it seems negligible.

To explain this, I’ll use fat mass as an example, since it’s the metric most people understand best.  In my experience, outside of profound caloric restriction or outright starvation, the typical amount of fat loss I see in a person is about one pound per week, or about 60 g per day.  That might not sound like much, and over a week or day, it’s not. (Though, hold 60 g of almonds in your hand and imagine a net loss of this much fat every day from your collective fat cells, and you can start to appreciate how impressive it is physiologically!).

But, we can’t track fat mass directly, at least not on our bathroom scales, and frankly not even with DEXA scans unless they are really spaced out.  Certainly not at the level of a few hundred grams. Furthermore, our bodyweight – what we typically do track – fluctuates a lot.  In me, for example, it fluctuates by 5 pounds per day.  How, you ask? Water. Not just the difference between what I drink and what leaves my body (urine, perspiration, respiration), but also interstitial accumulation, which manifests as minute amounts of swelling, typically in muscles, and elsewhere, too, often in response to exercise, travel, stress, and even foods I eat.

So, if your bodyweight can fluctuate 5 pounds in a day, is it possible to track 60 g per day of net fat loss? It’s like me blindfolding you and putting 50 pennies in your hand and asking you if there are 49, 50, or 51 there.  No chance.  Furthermore, 60 g is so far outside of the measurement spec of a bathroom scale that even if your weight did not fluctuate much due to fluid shifts, you would never be able to appreciate the net fat loss over the course of a few days and barely over a week.

What does this look like in real life? Consider the graph, below, which shows the actual (and completely achievable) weight loss of a person over 7 months. This person went from 227 lb to 195 lb in 7 months, which represents an average of about 4.6 lb per month, or about 69 g of net fat loss per day (as confirmed by DEXA).  This was not a starvation diet or something radical. This was a change in macronutrients – from a standard American diet to a ketogenic diet — that led to a change in net fat flux. But, the change is subtle over any short period of time.  It’s only over months that the change becomes life-changing.

Weight loss tracking

Now, imagine the day-to-day frustration this person (I know, because I was working with this person) experienced with the fluctuations in scale readings!  It was tempting on many occasions to say, “Forget it, I’m going back to what I was doing before.”  Just like there were many days I didn’t feel like going to swim practice, or days I didn’t feel like deliberately practicing my surgical technique.

If you remember nothing else, remember this: the game is won – or lost – not by the infrequent big changes, but by the frequent, deliberate, and repeatable small ones. This is where grit comes in.

Sure, there are genetic freaks and lucky ones out there, for whom none of this matters. But for the rest of us – because we live in, and are surrounded by, a food environment that is chronically toxic to about two-thirds of us – re-building our bodies requires consistent and deliberate change.

Are there people with all the grit in the world who can’t achieve health? Absolutely. And I put them into two categories:

  1. Those are not eating the ‘right’ foods for them (recall: I was in this camp until 2009).
  2. Those who have underlying issues – usually hormonal – which are working against them and preventing their fat cells from liberating fat.

I will not get into these categories in great detail, because the topic is beyond the scope of this post and, frankly, it takes me months to diagnose this in people I work with weekly.  So I can’t responsibly spout out blanket statements about ‘fix this’ or ‘fix that.’  However, far and away the most common causes I encounter in my practice for persistent metabolic derangement, often but not always accompanied by adiposity (excess fat), in the presence of seemingly correct eating and true grit are as follows:

  1. An insulin resistant and/or hyperinsulinemic person eating foods that stimulate significant amounts of insulin;
  2. Hypothyroidism (in my book, TSH > 2 accompanied by basal morning axillary temperature below about 97.8 F);
  3. Hypogonadism in men (which I diagnose with not only total testosterone, but also free testosterone, DHEA, and estradiol), or PCOS in women;
  4. Disruption of the HPA axis, most commonly manifested by adrenal fatigue and/or elevated cortisol levels.

Again, I’m not going to get into the nuance of these, but I list these to give those folks who believe they are A) eating the ‘right’ foods, and B) full of grit, yet not seeing results, some hope. These issues are fixable, but you need to see a doctor who knows how to fix them.

Fortunately, such situations are very rare! Most people, with the correct dietary intervention, armed with sufficient grit, and the confidence to stay the course, despite the day-to-day and week-to-week fluctuations, will emerge as renewed people.

Parting shot

Unfortunately, as long we live in a world where (i) the conventional wisdom, (ii) dietary recommendations, and (iii) the market forces enabled by them create an eating environment that is not suited to what most of us should eat, we need to guard against the desire to give up when the results are not what we expect in the timeframe we expected.  As a result, about 90% of people who make a dietary change – and even see results – end up gaining the weight back.  Why? I suspect it’s a bit of what I’ve written about here, and two other phenomena:

  1. The fall-off-the-wagon-and-get-discouraged issue, and
  2. The I’m-better-now-I-don’t-need-to-do-this-anymore issue.

In the former, folks get very discouraged when they make a ‘mistake.’ Rather than immediately getting back on the program, they get frustrated, and over time – sometimes quickly, sometimes slowly – revert back to their old eating habits.

In the case of the latter, there is this belief that once the goal is achieved, one need not continue the practice. It’s like me training for a year to win a time-trial race on my bike, winning the race, and then deciding I don’t need to train anymore and I can still compete successfully. Not going to happen.  If I want to win, I need to train.  If I’m going to train, I need to train deliberately and persistently. Even on the days I don’t want to.  When I miss a workout or have a bad one, I can’t beat myself up over it. I have to let it go and remember that tomorrow is a new day.  The sum of my days determines my success.

Oh yea, one more thing

Parenthetically, the figure I used at the top of this post was borrowed from a blog featuring a very inspiring story. I remember seeing this video about a year ago, completely randomly on my ipad in a taxi on my way to the airport, and thinking:

  1. That is an amazing story!
  2. Why are my eyes welling up with tears?
  3. How is it possible that someone, Javier Colon, could take a song that has such a special place in my heart and make it even better? (Back when I was doing 12+ hour marathon swims I would sing this ONE song by Coldplay over and over and over again in my head for the entire duration of the swim – literally over 100 times. Any time I hear this song, it takes me back to those swims in the most vivid detail.)

 

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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. Dan Walker  November 20, 2013

    Great post, great message. I never get tired of reading what you write. When will there be a book? :-)

    Thanks Peter!

    (reply)
    • Peter Attia  November 20, 2013

      I don’t know, Dan. No time soon. A blog is easy to write, but a book — a really, really, good book — would be very difficult for me, given the other things in life I need to juggle.

    • Jim  November 29, 2013

      Just found your blog and am bleary-eyed from reading all. Didn’t see how to post a question.

      Hypothetical only. Suppose one had hyperaldosteronism with mild Stage 2 CKD and taking eplerenone and supposed to avoid Na & Monitor K. Would such a one be able to be on nutritional ketosis? Would one have to take increased Na?

      Just scientific, hypothetical inquiry!

  2. Butch Pornebo  November 20, 2013

    what is your take on HRV ? grit is one thing BUT if the body says you have NOT recover yet from your previous training then rest before doing another challenging session.

    sometimes subjective feeling that you feel fine is NOT enough because HRV will have subtle indication that one has NOT recovered yet.

    (reply)
    • Peter Attia  November 20, 2013

      HRV is very helpful. I like to pair it with power data for even more insight.

    • Butch Pornebo  November 20, 2013

      “power data”

      can you elaborate a little more about this ? maybe an article ?

      I use Kubios to track my daily resting RMSSD.

    • Peter Attia  November 20, 2013

      Meaning, I look at HR vs. power data from my power meter on my bike. This, in addition to resting HR and HRV, gives me a sense of overtraining.

  3. Ryan Baker  November 20, 2013

    This is a great article. Thank you so much. Have you read Mastery by Robert Greene? All of my life I have been trying to “get there” in every which way possible. It wasn’t until I became process oriented that I discovered that Mastery is the way, not the designation. The sky has been the limit ever since… Thank you for speaking to this! We always enjoy your posts, insights, and the time you take in sharing them.

    (reply)
    • Peter Attia  November 20, 2013

      I have not, Ryan, but thanks for pointing it out. Always happy to read more on this topic.

  4. Jeremy Tyler  November 20, 2013

    Heh, “fix you” by Coldplay has been probably my favorite motivation song since 2007 when I was fully into trying to get Ron Paul elected as president and someone made a motivational video of him using that song. I go back to that song all the time.
    http://youtu.be/FG_HuFtP8w8?t=4m26s

    I have a group that seems to be ever expanding here in Louisville that I have tried to tell this to as well. Some fall off the bandwagon as you say while others have gotten to their goal weight over a longer time period (and got rid of their PCOS symptoms).

    Great post. Love reading you stuff.

    (reply)
    • Peter Attia  November 20, 2013

      Such a remarkable song. I once sat (stood) 4 rows back from the stage as Chris Martin sang this.

  5. Kiran Wagle  November 20, 2013

    An interesting negative review of Coyle’s book. As an MD yourself, you must have knowledge/opinion about this.

    http://www.amazon.com/review/R2YWCHFTT60I8K/

    (reply)
    • Peter Attia  November 20, 2013

      I have seen similar criticisms before. I think there is merit to this around the lack of scientific evidence. For me, the myelination aspect of his theory is mechanistic. It may or may not be the mechanism by which the phenomenon he (and others) describes. I think the criticism that ‘nothing in his book is new’ is not relevant. I don’t think Coyle claims (maybe I’m wrong) to be the guy who thought of this. I just find he explanation the best.

  6. Chris  November 20, 2013

    The journey is far more interesting, insightful, and enjoyable (if I’m not too audacious) than the outcome. Most of us expect to see results right after jumping on a diet, like you pointed out. Unfortunately, bliss comes for those who persevere no matter the external or internal factors.

    I started a ketogenic diet as an experiment to lose the stubborn remaining belly fat I had. I ended up with a lifestyle thanks to Tim Ferris which pointed me to your amazing work. From you doc, I found out about Steve Phinney, Gary Taubes, Jeff Volek and other great individuals.

    It will take several years (possibly decades) until the paradigm shifts, but I know that we (the society) have the greatest founding fathers we could have.

    Thanks for everything you do Peter. Always inspiring!

    (reply)
  7. Karl  November 20, 2013

    Another amazing post Peter!

    Im in the second year of med school and studying for an exam on inflammation, innate/adaptive immunity and immunological disorders.

    Whenever I need a little extra push to keep studying I go to your blog/the NuSI-website and get inspired.

    Thanks alot!
    Greetings from Sweden.

    (reply)
    • Peter Attia  November 20, 2013

      Immunology was one of my favorite subjects in med school. It’s such a remarkable system, especially the adaptive (vs. humoral) system. Now get back to studying!

  8. Andrew  November 20, 2013

    Interested to see your take on the new recommendations for increasing statin Rx in the healthy population based on this “formula” which says that if you have a “7% chance of a heart attack or stroke in the next TEN years,” you need to be on statins.

    How can they still be pushing this, to such a ridiculously low threshold, when it’s been so thoroughly debunked?
    How long will it be before MD’s are FORCING people to take these unwanted, unnecessary drugs?

    (reply)
    • Peter Attia  November 20, 2013

      Well, it will certainly play into Part X of the cholesterol series when I can get around to it.

    • Maryann  November 22, 2013

      Thank you for an ispiring post for those of us frustrated and disappointed by slow progress. I am really looking forward to part X. I hope you will please give us your thoughts on topics I see everywhere, such as the dangers of statins for women, and the ideas presented by the experts in Cholesterol Clarity (by Jimmy Moore) on the dangers of low cholesterol and the statistics that those with the highest cholesterol live the longest and healthiest lives. When treating LDL-P with statins, is the body able to thrive and achieve optimal health when the drug drives the total cholesterol down to 130-150?

    • Peter Attia  November 22, 2013

      Maryann, I will definitely address these points, which seem more timely than ever now, when I get around to Part X.

  9. Evan Jay  November 21, 2013

    Dr. Attia:

    Another great post! I can most definitely relate to your psychological mindset. Have you ever read the book “The Way of the Peaceful Warrior” by Dan Millman? I read it when I was 14 and it permanently changed my view on life from how I wrestled at practice to how studied for school to how I treated friends and family. There are so many great quotes from the book that I live by everyday. And while some people think I’m crazy for referring to the “Peaceful Warrior” mindset with everything I do, it is absolutely relevant. In regards to taking control of your health, the psychological strength seems to be more difficult then the lifestyle changes themselves. If only there were more people out their with the mental focus and drive to take control of their lives, this would be a very different world. In the meantime, it’s caring, dedicated Doctors like yourself that WILL impact our current state of health, so thank you. Please keep the posts coming, I look forward to what is to come next! Especially your Cholesterol Part X !!!!

    (reply)
    • Peter Attia  November 21, 2013

      Evan, this sounds great. I just ordered it. Anything that can make me more Zen-like is a good thing.

  10. Ryan V  November 21, 2013

    Thanks Peter you are such an awesome person. Did you ever end up reading “The Law” by Bastiat?

    (reply)
    • Peter Attia  November 21, 2013

      Ryan, I’m ashamed to say that it’s on my nightstand (with 8 other books in the queue). I refer to it in pieces, but have not done the cover-to-cover yet. Funny enough, I did read a section over the weekend after having a discussion about it with a friend (who is the biggest Bastiat fan I know).

  11. Coco  November 21, 2013

    Thank you for this! I work w/ women who have struggled w/ weight and it’s a challenge to enable them to see that real results aren’t going to be the proverbial Lose 30 pounds in 30 days…thanks, Dr. Oz. The inflammation that most people have from a lifetime of bad oils, sugars and processed foods also increases the difficulty in moving it on out. I will share this with my frustrated clients. Thanks again!

    (reply)
    • Peter Attia  November 21, 2013

      Hope this can be of service to your and your clients.

  12. Pat the nurse  November 21, 2013

    I have been thinking of this very video for at least a week, and am so glad you found it for me! It is a truly inspiring story, I wanted to share with someone. thanks a bunch, you are terrific.

    (reply)
  13. Logan Quinn  November 21, 2013

    I take my temp once a week on the day I record my weight, body fat %, and BP/HR first thing Friday mornings. My temp is consistently 97.6°F ± .2°. Has been like this for years. Last time I had my TSH checked in Nov. 2012 it was 4.64 and temp was 98° That number had actually dropped from a previous result of 5.08 in Feb. 2012 (interesting enough the difference in my diet between the two tests was trying to lose weight with a “healthy” low-sodium diet and exercise in Feb. to giving up (no grit) after a spring and summer full of tests and hospital stays and going on meds for my AFib, the doctors insist my “healthy” diet habits had no bearing on my condition, so I started eating all kinds of junk food and had gained 22 lbs. between those two tests). I’m planning to have it checked again in a couple months, along with my lipids, etc. to see if how the numbers have changed since I started low-carb (and adding sodium, also been mixing dried seaweed into my morning eggs for the iodine) last July.

    Should I be overly worried about the low temp and TSH numbers as I don’t seem to be having any problem averaging about 1 lb./wk weight loss since I started low-carb last July? I’m perfectly happy with this weight loss rate, as I’m hoping losing it slowly with help reduce the skin-skirt effect I see on people who loose weight quickly.

    Yeah, I see fluctuations in my weight loss progress too, but since I do weigh myself every morning and night I have a pretty good idea that when I don’t eat food I cook from scratch at home I always gain a couple lbs. from food prepared by others. I also didn’t start loosing until I cut out the cheese and cut down on the nuts and stopped eating more than 3 meals a day (picked that trick up from Dr. Jason Fung’s lecture series on YouTube).

    (reply)
  14. Fred  November 21, 2013

    http://www.amazon.com/Effortless-Mastery-Liberating-Master-Musician/dp/156224003X

    This is a great book on mastery from a jazz pianist’s perspective.

    (reply)
  15. Ellena  November 21, 2013

    Hi Peter. I love your posts and learn something new each and every time. I am studying Nutritional Medicine and Mind Body Medicine at College and one book I am currently reading is “Breaking the Habit of Being Yourself” by Dr. Joe Dispenza a neuroscientist. He explains in detail about how quantum physics works and how in order to attract or be attracted to goals and intentions in your life there is definitive mind shifts needing to happen and that the “how” a goal is achieved is not up to us. How do you think this fits in with your post? According to the book, long lasting and profound creative change happens within not from the external.
    Hope my question makes sense.

    (reply)
    • Peter Attia  November 21, 2013

      I’m not sure. Maybe someone else will know.

  16. larry  November 21, 2013

    Great post! I’m a 64 yr old fitness trainer certified in fitness nutrition. I work mostly with folks over 55. I can’t get people ( especially the women) off the_ ing scale. If they see daily fluctuations of a few lbs. they freak out. Maybe I’ll hand them a copy of your post.

    By the way have you reviewed Grain Brain by Dr.Perlmutter. He seems to be advocating a ketogenic diet generally. I’m not entirely convinced. Do you have any reaction?

    (reply)
    • Peter Attia  November 21, 2013

      Larry, I have not read his book, but am familiar with his views and the general arguments he puts forth, which I mostly agree with. I can’t speak to his recommendations.

  17. Zara  November 21, 2013

    Hi Peter,

    Long time reader, first time poster from Australia. I loved the subject of this blog. I read Mastery by Robert Greene and it changed my life by inspiring me to get passionate about finding my passion. (I will now certainly be ordering The Talent Code too; any book you think that highly of is worth reading!) I stumbled upon Mastery around my third year of struggling with constant low energy, nausea and anxiety attacks. It’s like something always felt wrong, even when nothing was, and that made me miserable. At 25, I knew I was too young to feel so old, but I had no idea how to fix it. Doctors only gave me pills. But through my exhaustion and only thanks to my natural curiosity, I kept fighting for answers, kept researching, and somehow or another, I discovered Paleo, then low carb, and then this incredible blog. I completely turned my diet and health around nearly overnight (with a lot of help from your informative and insightful posts). As it turns out, I’m severely affected mentally by gluten. I had resigned to living out a life of negativity and fear, without any idea that these weren’t my personality traits, but side effects of neurotoxicity! I wish I’d known years ago, but better late than never. The change in me since removing gluten (and all the other processed crap I was eating) has been almost too ridiculous to be true – For the first time I’m clearheaded, focused, energised, excited for the future and VERY passionate about nutrition and health. I see many people suffering the same way I did, knowing there’s every possibility that it’s the bread they’re chowing down on daily causing the problem. But they’re too tired to care, something I completely relate to. So I am heading back to university next year and it’s my goal to make a change to the conventional wisdom that’s out there today. In particular, I’m passionate about the link between mental health and diet, something that currently seems very underemphasised within the medical field. Basically, I’ve realised the point of life is to make a difference to others, and one day I hope to (something your blog is doing every day – how fantastic it must feel to know you’re positively changing people’s lives, and by extension, the world!)
    You’ve heard this a million times, but the level of detail and craftsmanship you put into your posts is second to none and truly appreciated. I especially love the non-biased way you approach the subjects you discuss – carefully dissecting all the available scientific data instead of blindly supporting only what you believe is right. It inspired me to follow that kind of thinking whenever I am researching a topic. It’s certainly not natural to try and see evidence in something that goes against what you believe, but thanks to you, I’m training myself to think that way.
    In summary, I cannot thank you enough for the time you put into your posts and for all I’ve learned from them. Now if only I was as naturally talented as you at maths/formulas etc, I’d be set! But I guess I will just have to push through my chemistry classes with plain old practice and grit instead ;)

    (reply)
    • Peter Attia  November 21, 2013

      Zara, thanks so much for sharing this. Very inspiring to hear. Best of luck with the next stage in your journey.

  18. Hemming  November 21, 2013

    Hi Peter,

    I completely agree with you on grit. I studied with so many people who never finished college because they only cared about being big shots, making a lot of money after graduation instead of realising that studying is a long process. On the flipside of that, I’ll argue (and you briefly mention it) that that is also what got me into an exercise addiction followed by anorexia and orthorexia when I was too fatigued to run anymore. Its a bit like your ‘Is sugar toxic?’ post – there is a limit to how much you can take of any ‘drug’.
    I was a little surprised that you say that TSH >2 could indicate thyroid issues. I recently had mine done and it had gone up to 2.2. That concerns me a little as I’m still recovering from anoxeria. I know you have no chance of diagnosing anything via the internet but I’m pretty curious to hear if you think that ocean swimming (8C water now with only trunks, no wetsuit) followed by HIIT body weight exercises three times/week in addition to commuting by bike 10k each day is too much exercise for me at the moment? I do have some of the symptoms for hypothyroidism.

    Thank you for another great post,

    Hemming

    (reply)
    • Peter Attia  November 21, 2013

      TSH > 2 is just suggestive. If not accompanied by low basal AM temperature, probably not an issue.

    • Bill  November 21, 2013

      “TSH > 2 is just suggestive. If not accompanied by low basal AM temperature, probably not an issue.”

      My endo, a real trailblazer in hypothyroidism treatment, has found over many years that *no* test, even TSH, can reliably rule out hypothyroidism (unless of course TSH clearly suggests hyperthyroidism).

      If a patient presents to him with signs and symptoms consistent with hypothyroidism he does a trial of low dose T4. It quickly becomes apparent if supplementation is beneficial. Many patients of his who were refused treatment by other docs based on lab tests have had amazing turnarounds of longstanding health issues. The ones who don’t have lost nothing to the experiment and can confidently look elsewhere for answers.

      During treatment, he only uses lab tests (TSH and free T4) to provide hints about how to adjust doses. The patient’s sense of well being is always the much more important guide, and practical experimentation is the primary method.

      He has also developed a novel and (I can attest) most superior approach to treatment, which combines T4 with very small physiological doses of T3 or thyroid extract. He’s found that neither conventional (T4 only) or “alternative” (T3 only or thyroid extract only) therapy is optimal. The first fails to provide much-needed T3; the latter has too much T3. Everything he’s leaned is detailed in his latest book:

      http://www.amazon.com/Functional-Approach-Hypothyroidism-Traditional-Alternative/dp/1578263875/ref=sr_1_1?ie=UTF8&qid=1385050155&sr=8-1&keywords=blanchard+thyroid

    • Peter Attia  November 21, 2013

      Yes, this is what I mean… most docs (myself included) don’t really understand how to manage hypothyroidism. I’m getting better, but I have a lot to learn, which is why I try to work very closely with excellent clinicians on this topic. Symptoms matter most, but temp needs to be included as a sign, even if not a symptom.

    • Bill  November 21, 2013

      For me at least, temp is not a useful sign of thyroid status. Mine is a rock solid 96.9 (not a typo) regardless of thyroid status, including wide TSH differences from quite hypo to quite hyper. IIRC, Ron Rosedale has commented about low carb diets lowering body temp in a very positive way, and I’m sure there are many other factors.

      My endo has never found body temp (or anything else) to add anything to measuring TSH and T4 and, above all, listening to patients talk about how they feel. But he’d be the first to say that other practitioners, using different methods, might not find the same thing.

      BTW, I achieved an almost 50% reduction in my T4 dose requirement via iodine supplementation with Dr. Guy Abraham’s protocol. None of my docs, including my endo, who treats hypothyroidism exclusively, has ever seen anyone reduce their dose like that. I’ve had docs tell me it’s impossible in Hashimoto’s, but my medical records don’t lie. The iodine doses are enormous compared to the RDA, but many others have experienced similar results. If used early enough in the course of the disease, it can apparently completely eliminate the need for thyroid supplementation, which would otherwise likely be lifelong.

      Peter, I know you don’t need more book suggestions, but I’m sure you’d love Dr. Blanchard’s book on hypothyroidism. He’s a true iconoclast, and a doc who wants to help people even if it means discarding standard protocols, suffering the ire of the bigshot Harvard endos, and potentially threatening his career. You will particularly enjoy his commentary about the “quaduple blind” studies in his field used to justify extremely poor standards of care (in addition to the usual double blind, the investigators are blind to the phenomenon they’re studying, and the journal editors and reviewers are, too, and therefore publish the junk). Sound familiar? :-)

      As an example, several widely heralded clinical trials have supposedly disproven the value of adding T3 to the standard T4 therapy for hypothyroidism. But those studies used T3 doses about 10x higher than those Dr. Blanchard has found to be optimal in decades of practice. If one studied the use of insulin in diabetes in such a fashion, all the dead bodies would be quite inconvenient.

    • Peter Attia  November 21, 2013

      I’ve seen him speak and have notes from his lectures. Impressive fellow, no doubt. Hard to make sense of all the competing views, many of which make sense, but with such a paucity of really good research.

    • Bill  November 22, 2013

      I think Dr. Blanchard’s new book might convince you to try his methods :-)

      It’s what he begs other doctors to do, since his methods are obviously safe (his doses of T3 are minuscule compared to those long used in endocrinology and psychiatry) and the benefits quite obvious. I’ve experienced them, and so have others I’ve sent to see him. I felt like a 900 lb. weight was lifted from my head.

      To me, it’s not unlike low carb diets. Open minded practitioners quickly realized how miraculous they could be once they experimented with them. It’ll take NuSi to prove it with research! Not optimistic the endo establishment, or anyone else with the requisite resources, will do the same for all us poor thyroid cases. But any physician can easily find out for him or herself, just like with diet. I have the advantage of having experienced the benefits, I know, and I understand the skepticism of trying controversial things way outside the standard of care. There are professional risks. But this stuff works.

    • Peter Attia  November 22, 2013

      I’m open to learn.

  19. Barry  November 21, 2013

    Thanks Peter for sharing this inspiring post, and for revealing a little of your true grit, always enjoy your blog posts and now see where your energy and drive comes from.
    Makes me think of the process and journey more so than the destination.
    Regards
    Barry

    (reply)
    • Peter Attia  November 21, 2013

      Thanks, Barry. Journey is everything (in my book).

  20. Bill  November 21, 2013

    My wife has just recently been diagnosed with Hypothyroidism and she always has body temperature below 97.8, adrenal fatigue syndrome and obese. We were wondering what type of specialist would be the best to treat her and or is there a clinic or hospital that specializes in this?

    (reply)
    • Peter Attia  November 21, 2013

      Probably a very sharp endocrinologist with naturopathic training.

  21. Acme  November 21, 2013

    Hello Peter.
    I have previous thought, that thermally processed unsaturated fats are harmful to health, but this have changed, when I have read this article (http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7961511). Oxidised fats bound to and activates PPAR-alpha receptor (http://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_alpha), which then decrease many factors of inflation e.g. recruitment of monocytes, LDL cholesterol, improve state of cardiovascular system, increase HDL and etc., also this receptor is activated in starvation and ketosis. Of course this experiment has been conducted in mice, so it’s possible that in human this mechanism is weaker, also to much consumption of oxidased fats is harmful. I think, that PPAR-alpha pathway is human adaptation to thermally processed foods and starvation.
    In the past I have thought, that healthiest oil for cooking is which one, who have least unsaturated fatty acids ( http://articles.mercola.com/sites/articles/archive/2003/10/15/cooking-oil.aspx), but now I’m calm, when I’m cooking on vegetable oils.
    Sorry for my English.

    (reply)
  22. Tim  November 21, 2013

    Thanks for the encouraging article. It made me think of an article I once read, but can’t find it. It describes how there are two types of personalities when it comes to dieting (and other things). There is the type that if you say you can’t have X food group, they are OK with that. They can go long periods of not eating sweets, carbs, fats, etc but when they do cheat, they cheat hard. And it is harder to start up again and get back on the wagon.

    The other kind is someone who if you said you can’t eat x,y,z – they have a hard time with that. All they can think about is eating x,y,z. But these people when they cheat, it’s quick, small and they are right back to eating right. They just cheat more often.

    I am the former and my wife is the latter. Just knowing that we are wired differently helps us during our weight loss journey. I can’t hold her to the standard I set for myself when she eats more carbs than she should when we are out with friends. But I admire how she gets right back to it where I might say to my self “well I’m off now, I’m going to eat pancakes before I get back on. Then the next meal it’s nachos, etc”.

    With your grit, I bet you are the best of both personalities – you cheat rarely and when you do, you get right back on ;)

    (reply)
    • Peter Attia  November 21, 2013

      Funny observation, Tim. Yes, that seems to describe me. But the more important point I hope folks take from your comment is that there are several ways to make progress. Not a one size fits all.

    • Sean  November 21, 2013

      I find that when I keep my net carbs under a certain level- usually about 60 grams/day- I have very little desire to cheat. However, when I “push it” (usually for social reasons) and eat too many carbs I can get thrown right back into that “carbs beget carbs” thinking and the cravings come right back.

      I find it helpful during those times to go into an “induction” cycle and reduce my carbs to >20 grams for a day or two. That sense of control tends to come right back.

      Sean

  23. Martin  November 21, 2013

    Very good points!

    >> If you remember nothing else, remember this: the game is won – or lost – not by the infrequent big changes,
    >> but by the frequent, deliberate, and repeatable small ones. This is where grit comes in.

    how would you relate it, or perhaps not, to the ideas by Taleb and de Vany, who stress the importance of infrequent but extreme factors?

    (reply)
    • Peter Attia  November 21, 2013

      Taleb is talking about world events and financial markets. I’m talking about changing health through diet. An example of a Taleb force on the body would be a car accident or plane crash. Not an apples to apples comparison.

    • Martin  November 27, 2013

      Well, Taleb, following de Vany, also advocates infrequent but extreme workouts. E.g. one heavy lifting session every 7-10 days instead of regular possibly daily less extreme workouts. Also the concept of weekly, or periodic fasts over 24hrs or more goes in this direction, instead of e.g. daily intermediate fasting/skipping breakfasts, etc.

    • Jeff Ellington  January 2, 2014

      Two quick notes on the Taleb point:
      1) Extremistan vs Mediocristan (spelling?) — Extremistan like Peter implies is about financial markets or areas without known limits. Taleb talks about this is Black Swan – wealth (extremistan) vs weight (mediocristan). Bill Gates might have 100,000x more money than the average person, while wight is restricted to maybe a 10-20x range (50 vs 1000lbs on the extremes of people).
      2) Cause vs Effect – Even these ‘extreme workouts’ only have effects of the type Peter refers to (slow steady progress). No one doubled their squat maximum from one heavy lifting session, while people routinely double their wealth (or lose it all) from risky financial bets. There’s nothing wrong with what Taleb is recommending for human fitness/nutrition, but it still very much lies in the Mediocristan realm of results.

  24. Amy B.  November 21, 2013

    “…persistent metabolic derangement, often but not always accompanied by adiposity (excess fat)…”

    And this is why your site is such a wonderful oasis in the desert of nutrition and health information. If only we could convince the *rest* of the world that excess body fat isn’t the only sign of metabolism (or, heck, even just *digestion*) gone awry. No one seems to connect the dots to their brain fog, fatigue, anxiety, indigestion, or infertility.

    Great stuff, as always, and much appreciated, Dr. Attia.

    (reply)
    • Peter Attia  November 21, 2013

      Thank you, Amy. Alas, I hope we’re getting folks to realize the real issue…

  25. Sarah  November 21, 2013

    Greetings from Canada Peter! It’s definitely cold and dark on these November mornings.

    A smile blooms on my face every time one of your blog posts comes into my inbox. For me, as a layperson who is just struggling to understand all of the science and do my best everyday to make the right decisions for my health, this was one of the best. I really needed the inspiration to continue down this path, and your post delivered that in spades. The pressure to eat “normally” is enormous – friends, coworkers and family view my (ketogenic) choices as inconvenient and unhealthy – and it’s tempting to eat as they do. The temptation is even greater when the “reward” for following a ketogenic diet seems slow in coming. I needed this pep talk about grit to persevere in the face of this. Thank you.

    (reply)
    • Peter Attia  November 21, 2013

      …and even colder and darker in January. Ugggg. I can still *feel* the darkness. Glad you found this helpful, Sarah.

  26. Andrew  November 21, 2013

    In my opinion we overrate grit because that’s what many of us don’t have enough. But the other side is just as important. We also have to be able to give up our goals or dreams. We need a balance between grit and giving up things in our life.

    Whenever I have given up something I felt shame. But after the shame faded away giving up turned to be the good decision. With giving up something that did not go perfect I had a chance to start something better. I saved time for a new hobby that I was better at, I started a better relationship with someone better suited to me, or got a better job. I have started a low-carb-high-fat diet after giving up the regular low calorie one :-). If I didn’t give up some unachievable goals then I would have missed many opportunities in my life.

    Have you heard about “Body By Science”? ( http://www.bodybyscience.net/home.html/?page_id=18 ) Their basic foundation is that we require much more regeneration after workout than common wisdom suggests. The other is that “there is no such thing as cardio” and Cardiovascular health can be achieved through proper strength training. Their recommended training protocol is a 12 minutes High Intensity Training each week. (Just the opposite of what you do. From that point of view you are surely overtraining yourself.) What do you think about their training method?

    I have started doing BBS because my only goal with training is to achieve good health without spending too much time. It turned to be so easy that I will not give it up soon for sure.

    (reply)
    • Peter Attia  November 21, 2013

      I have not read it, but I’m very familiar with the work and even the folks who matured some of this thinking 40 years ago. I think it makes sense, in some circumstances, but context really matters. If one is training to look good in a swimsuit, that is very different that training for Ironman. One is not better or more righteous (for lack of a better word) than the other, but these 2 things have virtually nothing in common, so their training can’t be similar. Some overlap, perhaps, but otherwise quite different.
      I don’t disagree with your point that too much *unintelligent* grit is bad. Nothing heroic about banging your head against a wall repeatedly. Quitting can be very good — and essential — to progress. Many approaches to space travel had to be “quit” before success was met. But the overarching goal was not quit. That’s probably where the crucial amount of grit comes in.
      So when it comes to nutrition, experiment, tweak, quit this, or start that, but be sure to give each thoughtful endeavor its fair shot.

  27. Sam  November 21, 2013

    Peter, so if I am someone with grit and who despite eating VLC etc. for 18 months and working with a trainer for over a year can’t seem to lose an ounce of fat, how do I go about understanding what hormones may be hindering my progress. Insulin is likely the easy one to test, but do you mean leptin, sex hormones, etc.? It would be helpful to know where to start so when I see a doc I can steer him/her to where I need to go.

    Many thanks,

    Sam

    (reply)
    • Peter Attia  November 21, 2013

      Sam, you definitely want to see a top notch endocrinologist who can evaluate all of the things I laid out in great detail. This includes not just insulin/leptin/etc, but thyroid, androgen, HPA, as well.

    • Boundless  November 22, 2013

      Some of the possible causes here might be worth exploring:
      http://www.wheatbellyblog.com/2012/10/i-lost-the-wheat-but-didnt-lose-weight-2/
      What Wheat Belly recommends amounts to a borderline keto diet. You are probably already at or below that border, and I suspect not consuming any gluten-bearing grains or much fructose, both of which are fat magnets.

  28. Dave  November 21, 2013

    Thanks Peter,
    This is a very timely topic for me. I came to keto through Atkins hoping to lose weight (started at 220, 5’9″) and improve blood chemistry as my previous physical was not good with fasting glucose at 114 and ldl 130 hdl 32 and triglycerides at 170. my new physical, after being in ketosis for 8 weeks was weight 198, glucose 92, ldl 100 hdl 33 and triglicerides 100 so I was very happy. Since the physical though I’m seeing fat loss (by scale) be very inconsistent, very much like your example. I know this is normal fluctuation and I know everyone goes through it but that make it no les frustrating. I just need to stay determined and keep my eye on the trend line. I can get to my goal. Thank you, David

    (reply)
    • Peter Attia  November 21, 2013

      David, you are exactly the person I have written this for. Stay the course.

  29. James Pott  November 21, 2013

    Thanks for another wonderful mind stretcher. Put the Video from the guy that didn’t give, who was blessed to find somebody to help him believe in himself. Watched the TED talk by ms Duckworth . I didn’t read Mindset, but it sounds a bit familiar. You’re too young probably :-) to remember the discussions between Tolman, Hull and Skinner back in the mid 1900′s . Tolman (a moderate behaviorist) lost out to the stimulus -response theory. I did some post graduate studies on it in TO in the early 70′s. It seems to me that Tolman’s ‘map’ is finally finding a home in present day theories of behaviour. How do you develop grit was the question. I think you still have to first get at the ‘map’ that people are operating from. A map that has been developing from the day you were born. You will never develop grit if not somebody helps you to change that map. (like the yoga teacher did). Chances are you will negatively influence that map continuously from early on because of your deep love for your child : we hurt when our kids are hurting, we want to help when they are struggling, we cry when they really messed up, etc. etc. But every time we help, every time we say let me do that, we reinforce the map negatively towards developing grit.. I have a feeling what you are doing with your daughter is the right thing. Ask (suggestive or not) questions about the process, enjoy the process . Doing the dishes while doing the dishes. Of course there is a lot more to it. Schools, education, learning, etc. is still largely based on the old S-R theory, and the reward in grade is the ultimate deciding factor. I’m 72 Peter, and it still upsets me. Keep up the good work. I think you just got a bit of help from Tom O’Bryan. http://theglutensummit.com/Tom-OBryan-DC-CCN-DACBN/

    (reply)
    • Peter Attia  November 21, 2013

      James, one of greatest joys of writing a blog is all the people like you I get to learn from. Thank you so much for sharing this wisdom. As you can imagine, I lose so much sleep over how to be best possible father and help prepare my girl to thrive in a world I can’t protect her in.

  30. Park Firebaugh  November 21, 2013

    Why are we so averse to reality? I think we all know that you can’t make meaningful changes in your health, body composition or athletic endeavors quickly and with little effort, yet we repeatedly buy into products and schemes that promise rapid, amazing results. More people need to be exposed to the message in this inspiring post and accept that achieving anything worthwhile is almost never easy, but with “grit” and “consistent and deliberate change”, you will succeed. Thanks Peter.

    (reply)
    • Peter Attia  November 21, 2013

      Thank you, Park. Makes me wonder if this tendency is genetically wound into us, or if it has become an acquired feature?

  31. Mariet Hoen  November 21, 2013

    Thanks Peter, this is what I needed, rigth now.
    Got grit!
    Very big plateau and sudden high A1c., while eating HFLC/ Ketogeen
    I do not expect any advice. Too long distance. Too complicated to explain it (in another language) I read all your posts and love it. So exactly explained. Thank you very much.

    But grit, I do need. ;-)

    (reply)
    • Peter Attia  November 21, 2013

      Mariet, I bet you have more than you realize.

    • Mariet Hoen  November 21, 2013

      I hope so and yes I think so, Soon my third year of reversing diabetes. Your post gives me a boost. To not give up ;-)

  32. Kory  November 21, 2013

    Timely post in my life and hopefully many others! Thanks for sharing.

    (reply)
  33. Christopher G Keene  November 21, 2013

    Thank you so much Dr. Attia, fantastic post, inspiring as always. You, along with the collection of nutrition and health experts promoting ketosis, have helped me go from 300 to 200lbs, conquer pre-diabetes, high cholesterol, and metabolic syndrome, and feel better than I have in my entire life. Dweck’s work in Mindset is an inspiration and guide to me as an educator and in life in general, I really appreciate you supplementing the heavily scientific nature of your blog with a look at the mental side of things.

    Please keep doing what you do, you’re making an incredible impact in the lives of many. Thank you again.

    (reply)
    • Peter Attia  November 21, 2013

      Thank you, Christopher. I hope you realize my understanding of the mental side of things is a fraction of my understanding on the physiologic side. That said, I’m glad folks are equally curious!

  34. Magda Varillas  November 21, 2013

    Wonderful post Peter,

    I don’t know if I should be worried about having issues with hypothyroidism, but I have been in LCHF diet(75% fat, 20% protein, 5% carbs) for almost 4 months, eating around 1600 cal per day, lifting weights 4x a week plus cardio 2x a week and I am not able to reduce my body fat %. I am 30 years old, 57 kg and 1.63 mts tall. I am not obese so just wondering if I might have hypothyroidism issues that are not allowing me to lose fat.

    (reply)
  35. Lennie  November 21, 2013

    I know that the metric system is alien to many Americans but writing 60 grams as 60 gm just looks weird. The correct abbreviation is 60 g. The Wiki entry for gram also explains why this could be a non-trivial matter.

    (reply)
    • Peter Attia  November 21, 2013

      Lennie, I’m happy to change to g or convert to oz. You last point is a bit (a lot) out of context, but just to be clear: if anyone mistakes 60 gm for 60 mg of almonds, please call 9-1-1 immediately! :)

    • Lennie  November 21, 2013

      Ha! Although, more often than not, I believe the American unit of measurement for nuts is cups. It drives me crazy in recipes… half a cup of this, a stick of that, three tablespoons of the other. Madness! Now if only we could get you to drive on the left like we sensible Brits do. ;)

    • Peter Attia  November 21, 2013

      Ha ha! Cups, I agree, is silly. Nuts need to be measured by mass, not volume. Better yet, though why not just refer to them in stone? 60 g is about 0.00944838 stone, right?

  36. Jethro Bodine  November 21, 2013

    Dr. Attia, I agree with you, but my friends mention that Olympic Swimming Champ Michael Phelps – who has single digit body fat percentage – ate 12,000 calories a day of mostly bad food (i.e. one pizza, 2 lb. of pasta) during training. How could I explain this?

    (reply)
    • Peter Attia  November 21, 2013

      Jethro, I’m missing your point, as this fact (likely incorrect, by the way) seem irrelevant to the point of this post. That said, consider the following example for your friends: 5 of out 6 people who smoke don’t die of lung cancer. Knowing this, is it a good idea to smoke?

    • Park  November 21, 2013

      Phelps doesn’t have single digit body fat. I’ve seen him numerous times at swim meets up close. And the oft repeated 12,000 calories a day has been thoroughly debunked. It isn’t a secret that many endurance athletes doing high volume can consume massive quantities of carbs without gaining fat, but is a losing strategy for less active or hormonally damaged folks.

    • Peter Attia  November 21, 2013

      Furthermore, 1) the effect often goes away with age, and 2) outliers (e.g., my wife) don’t negate the effect.

  37. Carol  November 21, 2013

    Angela Duckworth makes several valid observations. Thanks for posting the link. My daughter’s performance in school is proportional to her motivation and the effort she dedicates to her study, and these are of course related. But her interest level is not just intrinsic; it is strongly influenced by external factors. Ms. Duckworth questioned how to motivate the “grit” in her students. I think a teacher can be a great motivator, but during the formative years the majority of this influence comes from the parents. For example, I am convinced that reading to my daughter daily since she was a baby is now paying off as she devours books. I have many other examples, but suffice it to say that motivation is a learned skill that is taught in subtle ways by those who care for us (family, primarily) or care about us (teachers, secondarily). This applies to adults as well, I believe, and that is why community is so important in helping to motivate change. I find your blog motivating for this reason, being a kind of electronic community without which it is more difficult to sustain eating habits that build rather than undermine health.

    (reply)
    • Peter Attia  November 21, 2013

      Carol, I really appreciate this. I love hearing from other other parents and learning what worked (and what didn’t).
      Earlier today a very close friend — and frankly, a guy I idolize — sent me the following (below). Talk about inspiring. Today his son is a pretty remarkable young man. At least in this case, the approach was correct.

      “My (grossly unscientific) thoughts on this subject. I think the closest parallel is entrepreneurs — they can be born or made.

      I was born with it. I never had a mentor or a teacher of this behavior, but I always valued it and exhibited it. I have always been “constructively competitive.” I hated losing much more than I loved winning. I would go to war with you on the basketball court and try to kill you, then hug you when it was over. I would want you to win because I loved you and it meant more to you to win than it did to me, but I still wouldn’t let you win because I didn’t want to lose.

      If you don’t come out of the womb with it, you can cultivate it. My son is a great example. He was always a laid-back, non-competitive sort. You couldn’t discipline him because he didn’t care what you took away. I used the “Education is not filling a bucket, its lighting a fire” approach with him. I helped him cultivate interests, and then showed him the joys of knowledge (astrophysics), or technical prowess (programming computers), or being articulate and persuasive (winning debates with his friends) or raw excitement (racing cars). He then began to seek this higher-level reward-state on his own. I also used his “anti-establishment” adolescent rebellion phase to get the same result (too much detail to get into here about how that was done but I will tell you over a beer someday – but the side benefit was that he turned into a libertarian).”

  38. Ron Webb  November 21, 2013

    Your comment on practice reminds me of a saying I have herd but I don’t remember where. Practice doesn’t make perfect, perfect practice makes perfect.

    (reply)
    • Peter Attia  November 21, 2013

      Very true. I’ve heard it many times, but not sure where to attribute. My good friend, Total Immersion founder Terry Laughlin, always says it.

  39. Mihir  November 21, 2013

    i was one of the people you referred to here:

    “Some people, once introduced to the ‘right’ foods, experience almost an immediate change. The pounds melt off. Their biomarkers improve seemingly overnight. They feel rejuvenated and renewed.”

    in the span of 24 weeks, i lost close to 63 lbs. my energy level is pretty much rock solid throughout the day with none of the disastrous high/lows i got from a high carb diet. however, over the last few weeks, i’ve seen the weight loss slow down to about 1 lb per week. this post just reminded me that i don’t need to lose weight that fast any more. and, i don’t need to make huge changes to what i’m doing. the weight is still coming off, just slower. you’ve reminded me that i’ve still got the grit and confidence to stay the course and keep getting healthier. thanks for that and you awesome posts!!

    now, if you could just tell me where to find Kerrygold butter at a reasonable price. ;)

    (reply)
    • Peter Attia  November 21, 2013

      And when you do, Mihir, please let me know. That stuff is good!

    • Naomi  November 22, 2013

      Costco. Hiding in the deli section.

    • Peter Attia  November 22, 2013

      Nice!

  40. Alex Li  November 22, 2013

    Dr. Attia,

    Great post !!! After running into your blog about a year ago, my diet completely changed! My wife’s too! I did not lose much weight because I was not overweight to begin with. But my wife did lose weight because eating the same as I do. Both of us become body-tight and energetic. We do not need to force ourselves to exercise any more. We want to exercise and enjoy exercise. We both thank you very much.

    This post on grit is another mind opener. I did read “Talent is overrated” and it is a great book. I pasted “the game is won – or lost – not by the infrequent big changes, but by the frequent, deliberate, and repeatable small ones. This is where grit comes in. —Peter Attia” on my computer screen. Tomorrow I am going to print it in big letters and hang in my study room.

    (reply)
    • Peter Attia  November 22, 2013

      That’s funny, Alex, but I’m flattered. When I was in high school my wall was covered in quotes (I wrote them on the wall with a thick black marker — how my parents tolerated me, I’ll never know). Stuff like, “When the punch is thrown, don’t be there,” and “Don’t stop punching till he hits the ground.” How I’ve evolved…

  41. Sam  November 22, 2013

    An interesting and different type of post. I wonder if you still follow boxing/ combat sports? I ask because Georges St. Pierre just fought last week and this post reminds me of him- a fighter without KO power or an iron chin or long reach or really anything special except for his brain and his crazy work ethic. And a singleminded dedication to perfecting himself (as a fighter).

    Now regarding nutrition- “grit” is sort of problematic when it comes to diet. Most people already think that fat people are fat precisely because of a lack of willpower. Even when someone understands fundamentally the true dangers of sugars and carbs- it can still be a battle against addiction. And it is sad but true that lots of people lose that battle. How do we “learn” grit? Can we at all?

    (reply)
    • Peter Attia  November 22, 2013

      I do not follow them at all. Couldn’t name but 2 or 3 world champions if my life depended on it. To your second point, I think you missed my point. “Practice” (grit) doesn’t make perfect. “Perfect practice” (grit with the CORRECT dietary plan) makes perfect. Lastly, grit — like any other skill — is a learned and rehearsed behavior. We may learn it at different points in our life, but with conscious effort and support (I think this gets overlooked), I remain convinced every can acquire grit.

  42. Nan  November 22, 2013

    This post hit home. I have always had a lot of determination aka grit; so, when all my efforts to follow the AMA guidelines or government recommended diets, plus walking several miles a day, failed me, I blamed myself. Starved myself into small but short-lived weight losses. With NK, I have lost the excess weight, and realized it was only because of grit I didn’t get considerably heavier. A lot of people think NK is hard, but after those Sisyphean years, this seems a breeze.

    (reply)
    • Peter Attia  November 22, 2013

      Nan, I completely understand what you mean, especially about the Sisyphean years trying to stay lean and healthy on the AMA/USDA diet. Works for about 30% of Americans. But for the rest of us…

  43. Roger Butler  November 22, 2013

    Some time ago Peter, you came out as being Myers Briggs type INFJ which was of particular interest to me as I am an INFP, and in everything you write I spot similarities in out approach to things but then jarring dissimilarities and never more so than here with your insistence on the need for grit to be successful for a transition to healthy eating and weight loss. Understand I am not denigrating grit, indeed I am sure it is a wonderful thing, but not something easy to develop in those of us to whom it doesn’t come easily.

    Interestingly I too have read and admired both Carol Dweck’s book and Daniel Coyle’s. And like you I was very keen on boxing as a schoolboy but even then I think my choice of hero betrayed a very different mindset. Mine was Archie Moore, who was never accused of having overtrained and was clearly overweight for much of his career, he was a good puncher but no Liston or Foreman, but he was a crafty and resourceful fighter whose career lasted nearly 30 years.

    As a student, in the mid 1970s, I weighed 182 lbs and from there on I put on weight steadily until in 2008, at 58 years old I weighed 278 lbs (I am of height 5ft 9ins tall). I made various efforts to lose weight and had limited short-term success but always put the weight back on again, and more. I had completely given up on dieting until I picked up Gary Taubes book and on a whim bought it, and read it. What the author did which I will be eternally grateful for, is managed to simplify the science to an extent that someone with no scientific background could make some sense of it. I adopted a gentle approach to first cutting down on, and then cutting out from my diet sugar, flour and beer (the last never entirely completely) and adding a bit more protein and a lot more fat. To cut a long story short I am today, 210 lbs although within the last week I have been as high as 213 and as low as 208. Hardly svelte, but significantly improved. No grit, a bit of patience, but most of all a clear understanding that whatever is happening with my weight there are foods that wreak havoc internally and others that are more or less relatively benign. At no time have I allowed myself to go hungry, I just eat food that fills me up better, and I only eat when I feel hungry, not when a clock tell me to – these days that is generally twice rather than five times a day.

    And whilst I’m about it I should mention that I exercise a bit, but not much. I bought Fred Hahn’s book and for two years did about 20 minutes of weight training a week following his recommendations. At the beginning of this year I read Doug McGuff’s book and now do his routine which takes me about 20 mins in a gym once every 10 days or so which I intersperse with a second visit when I get on a cross-trainer or a step machine and do a leisurely 35 minutes except I challenge myself to push my heart rate as high as it will go in minutes 15, 20, 25 and 30. I am significantly stronger now than I was 3 years ago.

    None of the above really challenges anything you have said, its just that I suspect some readers might be disheartened by your emphasis on heroic efforts, and perhaps comforted to know that it doesn’t need to be like that.

    (reply)
    • Peter Attia  November 22, 2013

      Roger, I’m ISTJ. VERY strong on all. I can “fake” being and “E” and a “N” pretty well. Very little ability to be “F,” and even less ability to be “P.” INFP is interesting, as I don’t know many. I knew an ENFP once. Very different from me!
      You raise a point I had never considered before. I wonder if different MBTI have a different propensity toward grit? If so, I would guess that the associate has less do to with I/E, S/N, or F/T, but more to do with J/P? But I have no idea. Effectively, what I’m completely guessing on is that J has an easier time with grit than P, ceteris paribus. VERY curious if others — who know their MBTI — want to chime in.
      As for Archie, one could take nothing away from the Mongoose. A legend in his own right. To my knowledge, despite the length of his career, seemed to pass with all of his wits about it. Which says a lot about his skill.

  44. John W  November 22, 2013

    Lovely bit of serendipity for me when two of my favourite themes collide. Let me first say that you and Gary Taubes saved my life and I am very grateful. I have a chart on my fridge that looks very (very) similar to the one pictured but the biggest benefit for me with LCHF has been improvement to general health and wellbeing. So needless to say I love your work!
    I haven’t read The Talent Code or Mindset but one of the most interesting books I have read recently is Bounce by Matthew Syed. Same themes it seems, as they relate to sporting achievement – the myth of talent and the power of purposeful practice. He talks about his own journey as a table tennis champion and supports his thesis with plenty of fascinating facts and stories; but the bit I loved best was his discussion of Dr Dweck’s research and the growth mindset. Anyone with kids needs to know about this stuff.

    (reply)
    • Peter Attia  November 22, 2013

      Thank you, John. I look forward to learning more.

  45. Naomi  November 22, 2013

    I, too, am an ISTJ, and I agree that “grit” may be more common with Js than Ps, as it requires — or at least is greatly facilitated by — planning and the doggedness of a “work first” approach.

    (reply)
    • Peter Attia  November 22, 2013

      Naomi, I don’t meet a lot of ISTJ’s. We’re a strange group!

  46. russell  November 22, 2013

    i’m with you completely on hagler v. leonard. hagler was one of the greatest fighters of all time. leonard? not even close.

    (reply)
    • Peter Attia  November 22, 2013

      I’d love to meet Hagler some day. The other thing that drives me crazy was Hearns v. Leonard II.

  47. steve  November 22, 2013

    Hi Peter – I have been following your blog for quite some time now with great enjoyment. It was really interesting to read the latest on grit, talent code etc. as I have enjoyed these topics/books as well.

    My interest is close to my heart (literally). I compete in long distance tri’s, and endurance running and swimming. About two years ago I was diagnosed with cardiovascular disease. Shock of shocks. No symptoms and good blood numbers – according to my Doc’s. I’m in my early 60′s, thought I ate pretty well and exercise regularly. I ended up having 5 bypasses instead of running Boston two springs ago. The positive is that I was able to come back and completed IMLP 3 months after surgery and Boston this past spring.

    Your thoughts have given me pause to reflect on my diet and what effect it might or might not be having on the systematic occlusion of my arteries. I don’t have the background to completely follow all your discussions and I’m hopeful that at some point you might consider developing some dietary guidelines for the less than scientifically inclined. When I mention your thoughts to my PCP he comes back with Atkins(in a negative fashion) and tells me how important carbs are to someone like myself who exercises a great deal.

    Thanks so much for all the time and effort you have put into your writings.

    (reply)
    • Peter Attia  November 22, 2013

      I used to say thing as your doctor… that’s when I was getting 60% of my calories from carbs and creating a vicious cycle of glycogen dependence and worsening insulin resistance.

  48. Irene  November 23, 2013

    Hi, Peter,
    Thank you for your thoughtful and scientific posts. I am also a physician who learned (actually, didn’t learn) the things I needed to know about basic nutrition and its impact on health in medical school. It is only through 2 years of data collecting and food logging my own nutritional experimentation that I have found a food/movement regimen that makes me feel fit and healthy while also keeping me at my most healthy weight so far.
    I have read a lot about the effects of carb restriction to the level of causing ketosis on the body, but am unclear as to how this information can be extrapolated to those of us on lower carb diets. I have found that I feel best when I eat 100-150 grams of high quality carbs/day, probably not low enough to actually be ketotic. What does the literature say about the effects of this more moderate carb restriction on insulin sensitivity benefits and muscle adaptation as it relates to athletic performance?
    Thanks in advance!

    (reply)
    • Peter Attia  November 23, 2013

      Irene, I talked about this a bit in the IHMC talk (in one of my posts; Quantified Self, I think). Bottom line: ketosis and select performance attributes are not binary variables. Benefit occurs along the spectrum.

    • Irene  November 25, 2013

      Peter-
      Thanks for the referral to your IHMC talk. It was fascinating, informative and very well done!

  49. Jeff  November 23, 2013

    Pete,
    Great column, my wife would just say people like you and me are just freeks (or maybe its just that all engineers are nuts).
    And i still tape sayings up on the wall where i can see them from my trainer. Some of my favorites
    “I will win because I can suffer more than you can”
    “you can not hurt me or make me quit”(that ones for my coach)

    One of the reasons I love bicycle racing so much is because of how much suffering (grit) is involved. Normal people just don’t understand why I would do that to myself.

    (reply)
    • Peter Attia  November 23, 2013

      It is special. I really like the way Tyler Hamilton described this particular phenomenon in Secret Race, a great book for many reasons, but in particular this one.

  50. Norm  November 23, 2013

    Hi Peter,

    Yet another great post.

    I’ve a couple of questions please:

    1. Is grit innate or acquired?

    2. If one who is non insulin resistant loses 17KG over 7 months on a LCHF diet with improvements in trigs and hdl but their ldl-c shoots up from 153 to 218 and TSH goes up from 1.1 to 1.2, CRP goes up from 0.2-0.3 with cortisol, testosterone and estrodiol being normal. Should they be concerned about being on LCHF for any longer?

    (reply)
    • Peter Attia  November 23, 2013

      I would guess grit is both innate, but also acquired.

    • John U  November 26, 2013

      So what is wrong with LDL-C of 218? This is completely normal, and 153 is low, not necessarily good. Get past the myths of LDL.

  51. Kramer  November 23, 2013

    Hi Peter,

    You might vaguely identify with my backstory. I ran cross country through high school, so I was force fed the “carb loading” & “drink gatorade” mentality. Even though I’ve been running ~25 miles a week since 2006 with a typical college kid resistance training routine, I have always been at 22+% BF. I was even eating fairly “clean” the whole time. So frustrating.

    About 3 months ago, I stumbled onto this blog. Flipped my diet upside down. My roommates think I’ve lost it, and are convinced that all the bacon, eggs, and heavy whipping cream are going to stop my heart… The jokes on them. My health and fitness have both significantly improved in every way that I know how to measure. From close weight/macronutrient/calorie logging, I now know exactly what to eat to maintain/gain/lose body mass. The mystery/struggle is completely gone. What a luxury.

    I’m borderline angry at the misinformation I’ve been fed my entire life. It created so much unnecessary stress, and I wasted so much effort sticking to a flawed routine.

    This blog is awesome, and I hope you keep it up. This guy appreciates your hard work. I point people to this blog as much as is possible without becoming “that obsessed-with-fitness guy”.

    (reply)
    • Peter Attia  November 24, 2013

      Kramer, you’re not alone, but I’m sure that provides little solace for what you’ve been through. Are you familiar with Tim Noakes? If not, especially as a runner, you will definitely want to get familiar with his work and his nutritional 180.

  52. Doug  November 24, 2013

    I miss the days of the “super fights”. Hate Leonard all you want but he started the trend when he fought Duran and that was an awesome fight. Hagler – Hearns (round 1) may be the best round ever…that is until Gatti- Ward Rd 9 in the first fight. Hagler deserves a lot of respect though. He never fought again after Leonard. You and I have a lot in common. I wanted to be a fighter, too, and then I realized getting hit…a lot.. sucks. I worked for the Houston Boxing Association in the late 80′s after I had that epiphany and then finally went to med school. There are not many of us “boxers” turned doctors in this world. And I put those quotes in there for a reason. :)

    (reply)
    • Peter Attia  November 24, 2013

      Doug, don’t get me wrong… I don’t hate Leonard. He was amazing. I just though he was lucky to beat Hearns the first time, didn’t draw him the second time, and did not beat Hagler when they fought. But he was remarkable and that era was really special. Gatti-Ward I was amazing, too. Though my second favorite round in boxing history after Hagler-Hearns Rd 1, was Holyfield-Bowe (first fight), Rd 10 (http://www.youtube.com/watch?v=8ooarvj6f_k). Today, of course, I care nothing for the sport and can’t even watch it live without feeling sorry for the boxers and the beatings they are taking.

  53. Tee Dee  November 24, 2013

    Hi Peter,
    First, I’d like to thank you for sharing that very moving video; it choked me up pretty well, but I won’t soon forget it. Secondly, thank you for your well-thought out contributions to the whole area of health and fitness. I’ve been on my journey since the fall of 2011 (after watching Fat Head :) and am still learning so much on a daily basis. I’m extremely grateful to you and a few other bloggers who take the time from their busy schedules to share what they’ve learned with others. Onward and upward!
    All the best to you and your beautiful family…

    (reply)
    • Peter Attia  November 24, 2013

      Thank you so much, Tee. Onward and upward to you as well!

  54. Doug  November 24, 2013

    I agree with you. I have trouble watching boxing as well. My roots run deep in the sport, though. My brother ( a former pro) runs Ring 10 which helps these ailing/retired fighters out. On another note, you and I have another connection as we are both friends with Zubin (ZDogg). He used to follow my stuff when I produced the Placebo Journal. And lastly (I will try to stop rambling), I have spent the last two years studying how to help these fighters out as well as other athletes who get head injuries. I am obsessed with the concept of therapeutic hypothermia for the brain (selective brain cooling)….to the point that I created a product, with the help of All-Star sports, that is called the CryoHelmet. We can’t stop boxing or football. We can’t stop concussions. I do, however, think we can treat them better.

    (reply)
    • Peter Attia  November 24, 2013

      I’ll be seeing ZDogg shortly. You might find the work of Dom D’Agostino interesting and that of Richard Veech in the field of TBI.

  55. Nicole  November 24, 2013

    What a timely post! I saw such huge benefits when I made my first switch to a low-carb diet 3-4 months ago but the slow down in weight loss now that (I suspect) I’m getting to pure fat loss rather than fat loss+inflammation loss has been discouraging. I’d been starting to loosen my diet restrictions a bit thinking I couldn’t lose any more weight, but this post has renewed my motivation (well, this post and a couple of sugar hangovers that have left me feeling miserable). I’m also happy to report that my husband’s and my results on the very LC diet have inspired my father and now my father-in-law to give it a shot. My father is down 20 lbs in a month (almost 6 pant sizes!), and his cholesterol and triglycerides have shown such big improvements (30-60% changes) that his doctor has scheduled a time to talk with him about his diet changes so his *doctor* can learn more. Writing this blog likely requires a special grit of its own given your busy life but the payoff extends well beyond your regular readers — thank you for keeping it up!!

    (reply)
    • Peter Attia  November 24, 2013

      Glad to hear the timing was right, and great news about your family.

  56. Lisa  November 25, 2013

    re-building our bodies requires consistent and deliberate change (Love this statement as it can be for anything in your life that you see/feel requires change! I will be sharing this with my 18 year old daughter who’s eyes are finally awakening to the world around her………she is seeing things that she wants to change for herself, as well as in society, so this statement will be a reminder to her that ‘consistent and deliberate’ will get you the change you want in your life)
    My 18 year old was diagnosed Hypo. when in grade 8. My mother and all of her sisters are on thyroid meds. I myself have lost half my eyebrows and my hair has thinned alot over the years(I’m 46 now). My TSH now is 3.5.
    When will medical field finally look and agree that thyroid numbers over 2 are impacting people??
    Hypothyroidism (in my book, TSH > 2 accompanied by basal morning axillary temperature below about 97.8 F);

    (reply)
    • Peter Attia  November 25, 2013

      Good to hear. Hope your daughter is receptive.

  57. Brenda Hommel  November 25, 2013

    Hi Peter,
    I have very much enjoyed reading your blog over the past 3 months since committing to a ketogenic diet. Last spring I gained about 20 lbs in 2 months, was sugar binging out of control, wasn’t sleeping at night, and went from running 40 miles per week to hardly running at all. I felt like crap and went to the doctor to find an excuse for what was going on with me. After every blood test imaginable the only explanation was possibly “chronic fatigue syndrome”. I hid behind this excuse for a couple of months until my sister in law who is a nurse basically laughed at me and told me that she doesn’t believe in it. After this reality slap I got back in to working out over the summer and got back into shape but still was not as lean as I would like to be. I started a LC-diet at the beginning of this school year (I teach high school math) and quickly got myself into ketosis and never looked back. I have lost 26 lbs in 11 weeks (from 142.5 lb to 116.5 lb) am running between 60 to 80 miles per week, and am leaner than I can ever remember being. I am amazed at how a commitment to diet and exercise and some pure grit has changed my life. I am even considering running a marathon in a couple of weeks and was hoping you could give me some advice about training and competing in ketosis. Do I still need to taper as much since my muscles require less recovery time and what would you recommend eating during the race? Should I fuel on carbs at all or just pack some nuts and avocado for the race. Thank you for any input you could give me.

    (reply)
    • Peter Attia  November 25, 2013

      Amazing transformation, Brenda. As for taper, I’m not sure the diet changes things. I tend to taper for events as a function of intensity — e.g., 20 mile swim requires a 3 week taper; 200 IM swim race requires a 4 day taper. I have not found nutrition changes this.

  58. Sully Sullivan  November 27, 2013

    One thing painfully clear about the graph portion of the blog [terrific piece, by the way,] is that once the patient hit 210 lbs. on the way “down,’ the patient’s body WANTED to get BACK to 210 lbs.

    It manifested itself at EXACTLY the wrong time. That is, midway to towards the end of this weary 7 month cycle, when one can get so frustrated and discouraged.

    His GRIT did IT.

    (reply)
    • Peter Attia  November 27, 2013

      Sully, you called it 100% right. Good observation.

  59. sal  November 27, 2013

    That was a great fight like Ray Mancini vs. Livinstone Bramble
    Losing weight really is a two step process of exercise and diet. As for exercise, do both cardio and weight lifting. If you do sets of weight training quick enough, you get the benefit of both.
    As for diet, get a good diet program that emphasizes good quality nutrition but is less dense in calories.*
    *Source: http://womens-weightloss.com
    Good luck.

    (reply)
  60. pat  November 30, 2013

    there is some nice research out of Duke suggesting those with lower self control value those with control as potential partners, possibly as a coping mechanism. http://pss.sagepub.com/content/early/2013/04/04/0956797612464890.abstract As my husband and i have no M-B letters in common, and are happily and successfully married for 20+ years… and he is 6’8-195lbs-carb lover… and i’m not …well i’m inclined to believe.

    I was also just looking at:
    https://www.aace.com/sites/all/files/enduring_materials/5359_Hamdy_Wed_AACE_dyslipidemia_Nutrition.pdf i have been wondering if in short term – it’s possible that if one is losing a substantial amount of fat from nutritional ketosis (NK) that in short term the body might “test” as if on a higher fat diet? i mean even if not eating a huge amount of “fat” we are still “burning fat” (just our own) so fatty acids/re-esterification process gets kicked off. yes? so couldn’t in short term NK/caloric deficit appear to lead to less desirable markers (e.g. microalbuminuria or even short term increase in LDL)?

    (reply)
  61. Peter  December 1, 2013

    When striving for or falling out a ketogenic state what happens to saturated or ‘bad’ fats when your bodie’s fuel is glycogen? Is it being stored as ‘bad’ artery clogging fat and cholesterol as we’ve been told for the last 30 years?

    (reply)
    • Peter Attia  December 1, 2013

      What are bad fats?

    • Peter  December 1, 2013

      Alrighty then…the best way to achieve ketosis without storing excess fat, while the brain is still using glycogen would be to fast?

  62. Mark  December 1, 2013

    Suddenly it got really dusty in my home after watching that video. Not sure what’s going on in here. =) Very inspiring post, Peter. Thanks for sharing.

    Your site has also inspired me to give the ketogenic diet a shot which I’ve committed to doing for 3 months (I’m heading into the 3rd month now). This may not be the best way to solicit help, but if anyone here may want to offer advice, I would be all ears and very grateful.

    Without getting into too much detail, I’m getting fat. My BF was measured at ~7.5% about a week before beginning the diet, and I have a DEXA scan scheduled for a follow up measurement in a couple of weeks that I’m fairly certain will confirm what my eyes (and the weekly progress pictures) seem to indicate pretty clearly.

    I monitor net carbs and protein closely, prepare most of my meals to avoid to any unexpected ingredients and consume many of the same meals each week to simplify the process. Carbs are well below 50g per day and protein is well below 150g. I’ve consumed no sugar (that I’m aware of) or alcohol for the past 2 months. But clearly, I’m missing something.

    Just for fun, I’m documenting my experience weekly on my blog (mark3000.com) so feel free to contact me there if that would be a more appropriate forum. If there’s any additional information that would be helpful, just let me know.

    Thank you in advance!

    -mark

    (reply)
    • Mark  December 4, 2013

      Update:
      -I believe the answer was here all along: http://eatingacademy.com/nutrition/do-calories-matter
      -I’ve simply been consuming WAY too many calories.

      Action plan:
      1. Quit eating like a maniac and just consume until I’m satisfied.
      2. Begin measuring my blood ketone levels daily with new monitor. Thanks for the recommendation!

  63. Teresa  December 1, 2013

    Peter-
    I just want you to know I have such respect for you! Thank you for your continuous generosity of knowledge.
    You inspire me to be a better human.

    (reply)
    • Peter Attia  December 2, 2013

      Very kind of you, Teresa.

  64. Jim  December 2, 2013

    Just found your blog and am bleary-eyed from reading all. Didn’t see how to post a question.

    Hypothetical only. Suppose one had hyperaldosteronism with mild Stage 2 CKD and taking eplerenone and supposed to avoid Na & Monitor K. Would such a one be able to be on nutritional ketosis? Would one have to take increased Na?

    Just scientific, hypothetical inquiry!

    Also can one use UCAN as a diet supplement to overcome sugar withdrawal and cravings?

    (reply)
  65. T. Lewis  December 4, 2013

    Hi Peter,

    This TED talk was used as the basis for professional development at my school district this year. I thought it was awesome.

    I have a lot of weight to lose (230lbs) and I was diagnosed with hypothyroidism about five years ago. I take Synthroid. The weight is coming off very slowly (1-2lbs per week) with a LC diet. Is this the best I can hope for considering my hypothyroidism? (I exercise about 200 minutes per week)

    I look at the 10lbs/week losses of people on the Biggest Loser and wonder if I’m the biggest idiot and not eating the right foods for me?

    Do you suggest I see a doctor or specialist? If so, what kind?

    Thank you for your wonderfully informative blog.

    (reply)
    • Peter Attia  December 5, 2013

      Please don’t consider the BL as the benchmark for reasonable weight loss. Ken Blanchard in Boston is the doctor to see for thyroid issues.

  66. Garrett McCormack  December 6, 2013

    Peter- will you be sharing your thoughts on oral beta-hydroxybutrate in sodium/potassium salt form? Would love to know about your experience, and thoughts on the implications for performance and disease treatment.

    (reply)
  67. Stephen  December 7, 2013

    Peter, I saw your interview on The Diet Doctor, where you talked about your endurance performance while in ketosis (and fasting!). I’m pretty fascinated you can fuel your 6 hour workouts from your body fat. Have you thought about measuring your power output during these ketosis workouts? I’d love to see the numbers. (I think I can output 350W for an single hour.)

    (reply)
    • Peter Attia  December 7, 2013

      Discussed in some detail in the post about ketones and carbs co-existing. The question to consider is what is your max rate of fat oxidation? This determines how much power you can generate without overly relying on glycogen. I think my max measured fat ox was 1.5 to 1.6 g/min. Highest I’ve ever seen is 1.8 g/min. “Conventional wisdom” says 1 g/min is max. Clearly another example of CW being less than helpful.

    • Stephen  December 7, 2013

      Thanks, great detailed read on your 2 day ride weekend. I saw the breakdown of your glycogen and fat fuel for these rides. I got the impression from the video you were fasting before and during the 6 hour ride. Makes sense now. (I’m not anywhere near ketosis, as I eat 400g+/day of carbs.)

    • Peter Attia  December 7, 2013

      Correct, not on those days. I have, however, done up to a 6 hour ride with starting on an overnight fast with only water and BCAA. The difference on a ride like that is that NP and AP need to be very close and well below threshold, so typical numbers be AP=170 watts; NP=190 watts.

  68. jim  December 7, 2013

    Dr. Attia:

    On one of your charts, you state, “When you significantly reduce carb intake, your kidneys process sodium in a different manner.”

    Do you address this anywhere else? If not, what do the kidneys do differently? I assume from your supplementation that the new manner is the kidney expelling sodium more. Is that true of potassium as well, and other minerals?

    I further understand that there is an initial fluid loss for the first several days moving to ketosis. Does this mean that one needs more sodium (or potassium) during the initial stages of ketosis and less later. Are you taking sodium because of your athletic activities; meaning that supplemental sodium is not necessary for we armchair athletes?

    Thanks

    (reply)
    • Peter Attia  December 9, 2013

      Yes, but the effect is a bit more complicated. When the body “wastes” sodium, something called renin increases, which results in the production and secretion of another hormone, aldosterone. Aldosterone has the effect of sparing sodium, but it needs to do at the expense of another positively charged ion — you guessed it — potassium. So potassium wasting is really the result of sodium wasting and insufficient sodium replacement.

  69. Brian  December 7, 2013

    Do you have a recommendation for food intake post workout? I’ve been experimenting with vegetable stock to replenish electrolytes. Any recommendation for sodium dosage there? Any help would be great thanks!

    (reply)
    • Peter Attia  December 7, 2013

      Discussed liberally elsewhere.

  70. James Wicker  December 9, 2013

    There’s grit, but there’s also a moral component to what we do as well.

    When I read Gary Taubes’s books, I felt an immediate sense of deep remorse. Like many people I have close people in my life — my parents and friends — who suffer greatly from metabolic syndrome and diseases of civilization.

    Adopting a ketogenic diet has given me vitality I never knew I had lost. That is amazing. But the real benefit has been convincing my friends and family to change their diets and their lives.

    Most people just don’t read. Virtually nobody I’ve convinced to change has gone on and read one of the many great books on the subject, or even a blog post. I sincerely want them to. I want people to make major lifestyle changes with every ounce of available information.

    But people don’t change by reading. They change by following the examples of others. And that is, in my life, more important for keeping me going than any amount of grit. That every month, another friend effortlessly loses weight, feels insanely better, and leaves the path two-thirds of us follow: to premature age, obesity, diabetes, or worse.

    (reply)
  71. jim  December 9, 2013

    Dr. Attia:

    Is there a difficulty for the kidneys to process protein powders vs natural food? Does this make a difference or not if the kidneys are ‘mildly malfunctioning’?

    Rpbb Wolf seems to think so…

    http://bit.ly/IMhRWq

    http://bit.ly/1gTec5t

    Thanks,

    Jim

    (reply)
  72. Ryan  December 11, 2013

    Dr Attia,

    I have been in nutritional Ketosis for 8months (almost never below 1.5 mmol) I test for ketones about 3 times a day and have noticed my readings get less effected by meals as the months go on. I keep the food very consistent 120g protein, 40g net carbs, 400 grams fat a day. Do you think this could very well be an increase in insulin sensitivity? as the liver is now storing the glucose for later and continuing to preferentially burn fatty acids. If this is a “newbie question” then i am sorry!

    This blog has truly changed my life, thank you.

    Ryan
    23yrs of age
    Avid weight lifter, downhill mountain biker and Broth drinker.
    Vancouver BC

    (reply)
    • Peter Attia  December 12, 2013

      Ryan, definitely not a “newbie” question. I don’t know the answer for certain, but I suspect your idea has something to do with it, along with the fact that 8 months in your organs (primarily brain and heart) and muscles are starting to prioritize BHB and AcAc use over glucose, and in some cases even FFA. That’s a costly habit if you’re checking 3x a day, even in Canada where I know the strips are cheap(er).

    • Hemming  December 14, 2013

      Hi Ryan,

      I’ve heard many people report exactly the same as you. I don’t measure my ketones so I can’t tell for sure for myself but it does ‘feel’ like I don’t get affected as much anymore by eating more carbs on a particular day.

      That’s a lot of food you’re eating. How much do you lift? How many meals do eat each day? What do you eat to get that much fat?

    • Ryan Harrison  December 15, 2013

      Hey Hemming,

      I go for 3 meals a day. I find its very important to spread the protein/carb load out evenly. Personally, If i don’t don’t get around 30g CHO/ 90g Protein a day ill get dry eyes and lose bowel regularity. I actually think of CHO as a supplement at this point, the dosage is highly regulated (depending on Liver glycogen deficit etc.) But by no means do i go over 50g like Peter, He’s living on the edge man!!

      I only lift for about 1.5hrs a day, Just for fun. And wow warming up makes a difference! maybe a 20min jog before hand.

      For me, heavy cream makes the difference. Im able to eat large amounts without stomach upset. Usually on the side for desert with Peters heroin cashews on top.

      Couple other things i have found.
      1. I never eat fat by itself. If I just started eating butter without the steak, my appetite will turn off before i get 30g of fat in.
      2.To get 400g in, my meals are actually swimming in fat sometimes. Peter talked about using vegetables like a vehicle to get fat to his mouth, Its so true! I will hide 7tbsp of olive oil in my spinach salad, no one will be the wiser. But, If i had all that olive oil just sitting on my plate… People give me this look of absolute disgust!
      3. The type of fat really makes a difference on my appetite. I can down Butter and olive oil, But bacon grease for instance… not so much.
      4.For some reason, the 1tbsp of fish oil i take each day just stops my apatite in its tracks. Think i may start spreading the dosage out.

    • Hemming  December 17, 2013

      Hi Ryan,

      Thanks a lot for replying. 1.5h/day is quite a lot I would say :) Even though I would also say that I’m pretty active I don’t push the carbs as much as Peter.
      I was basically just curious as to how to get that many calories. Just like you I find it difficult to eat insane amounts of fat, especially fish fat. I’m trying to gain weight and that has proven more difficult than I would have thought on a ketogenic diet.
      Interestingly, I have the same thing with lard as you. I don’t eat a lot of bacon because its difficult to source something good but when I do have pork belly with all of the fat on its limited how much I can eat.

    • Ryan Harrison  December 17, 2013

      Definitely in the same boat Hemming. If i miss a big fatty meal here or there the pounds start melting off.
      I was thinking the other day… maybe its that we have suddenly dropped insulin very low, and the fat cells insulin sensitivity hasn’t caught up yet? is that even possible Peter?

      Or maybe its a high REE/AEE that comes with a keto diet?

  73. Miri  December 11, 2013

    Peter,
    I was inspired by your Ted Talk back in spring. I have struggled with weight loss basically my entire life. I read Why We Get Fat by Gary Taubes and really had a paradigm shift. I have been eating low carb since July and I have lost 27 lbs and counting. I have never felt this good in my life. Thank you for the inspiration and continue the great work you’re doing.

    Miri

    (reply)
    • Peter Attia  December 12, 2013

      Miri, thanks so much for sharing this. I just forwarded to Gary. I’m very happy for you.

  74. jim  December 12, 2013

    Dr. Attia:

    No good deed goes unpunished. Since you were so gracious in answering my previous question, I’m hitting you with another one concerning the kidneys processing sodium ‘differently’ while in ketosis. Could this imply that it is not natural to be in ketosis, since we waste sodium and have to take in additional sodium to counter this? Are not our bodies ‘designed’ to some sort of steady state equilibrium?

    Thanks in advance!

    (reply)
    • Peter Attia  December 12, 2013

      That’s one interpretation. How about another… maybe it’s not natural for us to eat 50-60% of our calories from carbohydrates which cause our kidneys to retain so much sodium. I’m pretty sure our ancestors didn’t have hypertension, yet it’s an epidemic today.

  75. Tim H  December 12, 2013

    Hey Dr. Attia,

    I discovered your blog only a few days ago and I love it already. Previously, I was hooked to Mark Sisson’s blog. Since taking more advanced chemistry/biochem courses, I feel this blog is a little more my fit.

    I really appreciate your answer to the kidney/sodium question. I was going to ask that one too. But I do have two other questions:

    1) From my private nutritional genomics studies, I have hypothesized (and again, this is only a hypothesis) that what may be beneficial for one gene, might not be as beneficial to another, especially since it’s been millennia since our ancestors started upping their CHO intake (which may have altered some genes, and not others). What I am trying to say is, do you think ketones in the body have a good affect on some genes (e.g. regulating metabolic syndrome) while having a bad affect on other genes (unidentified)?

    2) Refer to the following blog post:
    http://eatingacademy.com/nutrition/is-ketosis-dangerous
    You mentioned that the body produces acetone, yet in the comments section, you mentioned that there is virtually no acetone in the blood. So which one is it?
    I ask this because my chemistry professor just took a hit at people in NK by saying they have nail polish remover in them. The following is an old study, but it also suggests that there is acetone in the blood:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC371996/
    - And, if acetone is present, then how is it metabolized?

    Thank you for taking the time to share your knowledge. I very much look forward to you reply.

    Tim,
    Age 21
    Nutrition and Dietetics student @ NYU

    (reply)
    • Peter Attia  December 13, 2013

      1. I don’t know.
      2. The body (liver) makes BHB. BHB and AcAc exist in a reversible equilibrium. AcAc can irreversibly turn into Ac if they body is not using it, which does not appear to be a particularly valuable fuel. This is what is typically exhaled.

  76. Ryan Harrison  December 13, 2013

    Thank you for the insight Peter. I find the sodium issue very fascinating. For instance, will increasing the sodium but not the water intake increase urination? Are the kidneys aggressively trying the dispose of the sodium or just passively not holding onto the mineral tightly anymore? The reason I ask this is because i find that regardless of my 5 total grams of sodium a day, if i drink too much water ill still get light headed. I guess this is where the “art” meets the “science” of low carb living.

    As for the Ketone strips… Yes, they are expensive and information is mildly addictive.

    Thank you again for listening to my ramblings, The girlfriend doesn’t want to hear it anymore. (:

    (reply)
    • Peter Attia  December 13, 2013

      Not sure I know the answer, though not for a lack of trying…
      Your girlfriend and my wife would get along swimmingly.

    • Hemming  December 14, 2013

      Hi Ryan,

      I’m also trying to figure out how much sodium to eat. This is just my quick thoughts. My pretty boring result so far is that it varies from person to person from day to day. I can feel that I on certain days crave salt (not as much salty foods) and then I eat more. I’ve tried restricting it some mornings and I will have a craving for salt for the rest of the day. Sometimes I can feel hungry even after eating and I’ve found that its often because I haven’t eaten enough salt.

    • Ryan Harrison  December 15, 2013

      Hemming,

      Yes! i have found that first cup of broth in the morning makes a huge difference. I guess your kidneys have had all night to filter the sodium out coupled with water loss through breathing etc. I now spread my 2g of broth throughout the day in smaller doses, cut the cubes into 4 pieces giving me about 600mg sodium per cup. Also, I drink the broth slowly. I used to down a cup in 2sec and feel like crap, the urination would ramp up too. slowly sipping the stuff seems to minimize all that.

      I also put about 500mg of salt in my shaker bottle along with SS and Biosteel BCAA.

      I feel as though we keep learning new tricks, while behind the scenes our bodies work tirelessly to adapt. Once adaption(time) and all these little tricks intersect with each other, things really start to change.

  77. Roz  December 13, 2013

    Hi Peter,
    Roz from Australia here.
    I just today saw your talk on TedMed.
    There is just so much information on the web and everyone believes they are right. It is so hard for a lay-person to decide which path to take, especially when it’s doctors doing the recommending. People put so much faith in them.
    I’ve read Gary Taubes research and am in total agreement with it and from it started following a Paleo type diet. I kept my weight the same but with no significant weight loss.
    I then found research from two scientists, Peter and Shou-Ching Jaminet who diverse from a Paleo type diet by adding “safe carbs – potato, sweet potato and white rice. With this I managed to put on an extra 3.5 kgs (although they do say that can happen initially – I just don’t know how long “initially” is supposed to go for).
    I’m not scared of doing a high fat diet and my Paleo period was high fat.
    The thing is nothing seems to have really worked so far. I know it’s the food we eat that works or doesn’t work in the body and that moving is important (even thought there is no way that I want to or can do hours of training) every day.
    I just don’t know which direction to jump any more.
    Is there a light at the end of the tunnel.

    (reply)
    • Peter Attia  December 14, 2013

      There is a light at the end of the tunnel, I believe. I’m not quite sure, though, if it’s an oncoming train. I’m optimistic, though.

    • Roz  December 14, 2013

      Thanks for answering my post and for the optimism. :)

      What do you think of the ‘safe’ carbs hypothesis below?

      “I’ve read Gary Taubes research and am in total agreement with it and from it started following a Paleo type diet. I kept my weight the same but with no significant weight loss.
      I then found research from two scientists, Peter and Shou-Ching Jaminet who diverse from a Paleo type diet by adding “safe carbs – potato, sweet potato and white rice. With this I managed to put on an extra 3.5 kgs (although they do say that can happen initially – I just don’t know how long “initially” is supposed to go for).”

  78. Roz  December 13, 2013

    Just a question about a high fat diet – if we eat a “lot” of actual fat (the good fat you write about) and so the body has a constant supply to be used in ketosis, why and how would the body ever give up it’s already stored supplies of triglycerides?

    (reply)
    • Peter Attia  December 14, 2013

      See post on fat flux.

  79. Carol  December 15, 2013

    I discovered after 8 months on LCHF that I no longer snore and, not surprisingly, my sleep quality is improved. I have a hypothesis that my visceral fat has diminished, even though my weight has been perfectly stable (without even trying). Could it be that visceral fat accounted for swelling of tissues that were obstructing my breathing? If not, then it’s an amazing coincidence that this dietary change coincided with the cessation of sleep apnea, which I had had for at least 15 years. Can you shed any light on this? Have others shared this experience?

    (reply)
    • Peter Attia  December 16, 2013

      I’ve certainly heard this from others, but haven’t really looked into it much. In some folks the change has been very quick — within days, even. I wonder if it’s related to a reduced VC02?

    • Carol  December 17, 2013

      I’m actually not sure when the change happened exactly. First I noticed that my sleep quality had improved. Then, more recently, I had a minor surgery, which required that I sleep on my back during the recovery. I had trained myself as a side sleeper to minimize sleeping on my back, although it’s impossible to completely control that. During recovery and ever since I have slept soundly through the night and my bed partner noticed also my quiet breathing. I wasn’t thinking of this as a dietary outcome, and it may have taken weeks or longer for me to pay off a sleep debt.

    • Sean  December 18, 2013

      I’m not a doctor, but as someone with OSA I have read quite a bit on the subject. I read a study that found that OSA completely disappears in the vast majority of people who achieve their ideal weight- that is, they carry zero excess weight. OSA is mostly caused by the physical obstruction of one’s airways, and its effects are mitigated as that physical obstruction is reduced. Interestingly, OSA has been seen in some body builders because of excess musculature around their airways!

      I’m not sure how OSA would be reduced without a loss of body fat. I like you “tissue swelling” idea. I consume about 50-60 grams of carbs per day. I have noticed that when I have taken in a large dose of carbs (200+grams) I almost feel the way I do after 2-3 beers. My face gets red and puffy and my body feels different. Alcohol consumption also worsens the effects of OSA. I wonder if there is a connection? I wonder if there is a shared mechanism at work?

  80. Andre  December 16, 2013

    Great post as always and a new book for me…
    A somewhat unrelated question, you mention DHEA. I have been on a ketogenic diet for about a year and have as well seen improvments in many biomarkers, however just now I have gotten my first DHEA reading, unfortunately in this regard I have no before state to compare against.
    Mine is 40 ng/mL well above the reference range of 2-18, and I attribute it to the diet (I am 33 years old) and regular workout.

    The question is, did you get yours measured at different times and did you see a similar increase. There is a small study stating around 30% improvement on a ketogenic diet.
    The other question is, do you see this as a good thing? Many good things are being attributed to sufficient/high DHEA readings. Or is it just a consequence of a low insulin?

    (reply)
  81. EnglishRose  December 26, 2013

    So Interesting. I eat like this here in the UK and it makes me feel so good. I was that young PA too – always trying to beat the rest (despite being female) and all those things I did again and again as a teenager and then in life (am a lawyer and being a parent of 5) I find the more I do them well and practise well the better I am. It is similar to Gladwell’s Outliers idea which is pretty sound – spend 10,000 hours doing something and you get pretty good as long as you’re doing it right.

    My brother a doctor wrote a book in his field for individuals which I read this holiday. At the end is a suggestion of a normal diet. It’s appalling – carbs, diet coke, low fat this and that. I won’t even mention it to him as there is no point and he’s put on so much weight. I of course wrote 30 books not 1 as I’m the oldest child and we tend to achieve best.

    (reply)
  82. Susan Smith Kercher  December 28, 2013

    Hi Peter! I have eaten low-carb for 2 years now and I firmly believe that it is the right approach to health. However, I have not lost a single pound in all this time of no sugar, almost no fruit, no grains, no starchy veggies, etc. I’m almost embarrassed to tell people that I eat low-carb and, lately, I find the frustration of still being 50-75 pounds overweight starting to tempt me into going back to my old way of dealing with that frustration (yep, binging on carbs!) Is there anyone that you recommend for someone like me to get some individual help for figuring out why I am stuck? I didn’t even have the initial weight loss that most people have when they start low carb! Thank you!

    (reply)
    • Peter Attia  December 29, 2013

      Susan, I can only imagine how frustrating this must be for you. I wish I knew of a great doc to see who could do the necessary troubleshooting around other endocrine systems that may be preventing weight loss. The post on fat flux may provided some insight. If I had to guess, the problem may be too much RE or not enough L.

  83. slo  December 29, 2013

    Thanks for the wonderful post, I have been on the fence of how to even start to lose, the 100 lbs I must shift, have a host of issues ,post-menopausal, CFS, ect…

    What do you call a person who knows how to lose weight but does not do it? 12 yrs ago lost weight on a low carb diet about 80 lbs, sooo lazy I guess is good, strange thing started out on Atkins, then kind of found out on my own that a fat fast, LCHF with IF seemed to work best for me, why I did not stick to it is beyond me, no GRIT, LOL.

    I was reading Dr Eades, and he turned me on to this site, I have read for three days almost none stop about ketosis, wonderful posts, keep it up.

    sherry

    (reply)
    • Peter Attia  December 29, 2013

      Sherry, I wouldn’t be so hard on yourself. There are many things I know I should be doing that I’m not doing. There is usually some other reason (beyond laziness) that gets in the way. Fear of failure? Fear of something else?

  84. slo  December 30, 2013

    Thanks Dr Attia,
    For the kind words BTW I have lost 6 Lbs of weight since Friday ,I know it is water weight ,but I will take it ,also one thing has changed it used to take a act of God and congress to get me into ketosis but this morning I noticed a small amount of pink OMG, I have raised the amount of fat and lessened the amount of protein, I just want to do this for two weeks and add more protein later.

    Thanks again Sherry

    (reply)
  85. Chase  December 30, 2013

    What exactly is the deal with DHEA supplements? I’ve been taking them for about 4 months and I feel great. 31/M

    (reply)
  86. Allen  December 31, 2013

    Late to the party but.. Great post. Great message. I stumbled upon this site about a week ago and I’ve been finding myself coming back daily; finding/absorbing new and useful information.

    (reply)
  87. Thiago De Caro  January 13, 2014

    I see so much of myself in the part you describe your gritty atitttude it’s ridiculous. Great post, and great blog in general. Found about it recently and read pretty much everything in here. My background is not in the medical area, but the topics you talk about interest me and it sure is a relief to find someone who has the balls to actually think things through and do real science instead of regurgitating common sense, whatever area they happen to put their efforts in. There’s a scarcity of people like this everywhere these days.

    (reply)
  88. Adam  January 24, 2014

    Hi Peter,

    My question is a rather simple one, but I am not entirely sure of the answer. When limiting carb intake, I know refined (simple) carbs should be avoided when ever possible. How about fibrous carbs? What would be a good daily limit for these in order to keep the body in a state of ketosis?

    Thanks for your help.

    (reply)
    • Pam  January 24, 2014

      Adam, Phinney and Volek suggest less than 50 daily carbs (total) as a start. From there you’ll want to figure out what is best for you and your stated health goals.

  89. Anonomys  January 26, 2014

    Hi,

    I am a 32 year old female with CAH. I am 5’4 and have lost 40 lbs since my highest weight and am needing to lose 20 lbs more. I did this through a combination of calorie counting, running, insanity,and kickboxing. After my 2nd child it became much more difficult to lose the last 20 and I fell upon LCHF WOE. Even though I have been doing this for 2 months, I have seen no drop in lbs or inches. What about CAH prevents weight loss ? I have not seen any information about CAH and I wanted to ask your input on it or if anybody has any past experiences with it.

    Thank you

    (reply)
  90. The Southerner  February 7, 2014

    I’m not sure if this is the right platform to bring this up but nevertheless … I’m a food addict and have reactive hypoglycaemia (while also being an alcoholic in recovery and a sugar addict in recovery) – if you like labels! For me there is no satiety – I will eat myself sick if I’m not disciplined. This LCHF way of eating is miraculous for me – as long as I stay under my estimated daily calorie requirement. I hold out hope that my body/mind will know satiety at some point in my life – but I don’t care if it doesn’t.

    I don’t know what the answer to the calories in = calories out equation is. I do know that if I estimate my daily calorie requirements (http://www.exrx.net/Calculators/CalRequire.html) – decide on how many calories in deficit I wish to be – then work out my macronutrient amounts in in grams and calories (while keeping carbohydrate under 20g/day) then I am in a win-win situation.

    If the calories in = calories out hypothesis is true then I am in a deficit and lose weight without hunger. If the alternative hypothesis that I can eat as much as I like (in ketosis) is true then I lose weight without hunger! I eat along the Overeaters Anonymous path – though I eat 4 “square meals” a day – each with up to 30g of protein, up to 30g of fat and minimal carbs. This equals approximately 1560 calories consumed (+ minimal carbs) per day – which is well under my 2048 calories per day BMR.

    My heartfelt thanks to the Dr Attia and to all the other souls involved with this diet. God bless you all.

    (reply)
    • Peter Attia  February 7, 2014

      Best of luck as you continue your journey of self-experimintation.

  91. Peter  August 10, 2014

    I have spent many hours on your posts which have been very beneficial and inspiring. Some things still puzzle me:
    I have been on keto since about March 2014 and have been at low carbs (less than 50g/day) for the last 6 weeks. I am 176 cm in height and have put on weight from 81 kg to 87kg since March which is all lean body mass as determined by a calliper method – i.e. 6kg. My body fat is down to 22% from previously 27% but this is almost all (except 1 kg) due to gain in lean body mass. I still carry 19.5 kg fat.
    I get 60% to 80% of my daily Calories from fat. In general I feel exceptionally good excepting for constipation. I can cycle 60km on strenuous terrain with nothing but water.
    How do I burn more fat from my own reserves?
    When I check ketones I struggle to keep them above 1,5 and am surprised to see that glucose is still between 4.7 to 6.0. How does the brain decide when to use ketones and when to use glucose (which is obviously coming from somewhere? I limit protein intake to +/- 1 g per kg bodyweight per day and I supplement with Carnitine.
    I see nothing in your blogs or in any of the blogs by Phinney and Vokes etc. about this. Would love to understand more.
    Thanks for tons of really good info.
    Peter

    (reply)

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