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This week I had dinner at a great steakhouse in New York with a very good friend. Like any two “normal” guys after a long day, all we could talk about was science, and on this particular night the topic du jour was NAFLD (non-alcoholic fatty liver disease for the non-cognoscenti). We ate, we drank, and we shook our heads in disbelief at the thought of 7 million children in the United States being afflicted with NAFLD. In the next few years NAFLD will become the number one indication for liver transplantation (not a typo).
After dinner, my friend, who I dine with almost every time I’m in NYC, made a comment about how many vegetables and how much fruit I consumed.
I had the following: a chopped salad, tuna tartare, a 12 oz filet; and we split an order of sautéed onions, brussels sprouts, and a bowl of berries.
He asked, “How are you able to stay in ketosis with all of those carbs?” I responded, basically, that for the past few months I have not been consistently in ketosis, and when I am it’s only following a long bike ride where my BHB levels may get back into the 2-3 mM range. Most days, however, I live in the 0.3 to 0.8 mM range, depending on the time of day. (In my mind, to reap the benefits of nutritional ketosis, one probably needs to consistently be in the 1-3 mM range, and for some “applications” 3-4 mM is probably ideal.)
So what gives, you may be thinking. Is Peter Attia not Mr. Ketosis? Well, my friend suggested it might be time for another one of the dreaded what-do-I-eat posts.
Anyone who knows me or who has read this blog for a while will appreciate the fact that I loathe talking about what I eat. Why? Because, it unfortunately gets interpreted by many as what they should eat. It’s like asking me what exercises I do, and inferring you should do the same. It doesn’t make sense. I have specific genetic factors, epigenetic alterations, and goals. These factors coalesce to shape my behavior – how I exercise, what I eat, what I supplement.
A little backstory first
In September of last year, for my wife’s birthday, we went to our favorite restaurant in San Diego, where we live. The day before I emailed the owner and general manager, both friends, and asked for them to have one of our favorite off-menu items on hand (the best sushi in San Diego). They happily obliged and asked which of their desserts my wife would most like. I said something to the effect of: well, they are all great, so you pick.
The next evening, after eating more sushi and sashimi than I could imagine (I ate 3 platters myself), they brought out a platter with a full size serving of each of their signature SIX desserts, each with a lit candle. We sang Happy Birthday, blew out the candles, and my daughter and wife, themselves already stuffed, proceeded to have a small forkful of each of the six desserts. My daughter said, “Daddy, these are so yummy! Why don’t you have a bite?” To which my wife echoed, “Yea, they really are ridiculous…”
And in that instant, I made a decision. I did something I had not done in 4 years (to the month, actually). The decision was this: about 3 or 4 times a year (I opted for my wife’s and daughter’s birthdays, Thanksgiving, and maybe something else), I would – for one meal – eat whatever the hell I wanted.
In the next 15 minutes I devoured the remaining 4/5-ths of EACH of the six culinary masterpieces in front of me. From cheesecake, to carrot cake, to decadent ice cream, and stuff I didn’t even recognize, I ate it. In an instant I felt both wonderful and horrible. The look on my wife’s and daughter’s faces – alone – was worth it. Their jaws on the table the whole time. The taste was beyond what I remembered (actually, much sweeter than I remembered, probably because when you don’t eat sugar for 4 years, well, you know).
I could barely get up from the table. That night, when we got home, I had a horrible headache. 1,000 mg of Tylenol and 2 glasses of water later, I still couldn’t sleep. I eventually got a few winks of sleep. The next day I felt hung over – a feeling I had not experienced since my 26th birthday. My fasting glucose was 126 mg/dL and BHB was 0.2 mM. Clearly I was out of ketosis.
I decided to go out for a glycogen-depleting workout (multiple sets of 3 min all out intervals on the bike) and about 36 hours later, after resuming my normal diet, I was right back into ketosis and felt just fine. I told my wife I was going to repeat this experience on Thanksgiving. As such, and despite how far in advance this was, I asked her to plan to make an extra bowl of my favorite Thanksgiving dish – candied sweet potatoes – baked sweet potatoes coated in melted marshmallows.
Thanksgiving came and went, and I repeated the same act of debauchery during the big feast. Sure enough, by the Sunday morning of Thanksgiving weekend, I felt back to my baseline. I haven’t gone on a bender like that since, but I’m probably due for one.
I’m sure at least some of you are asking, “Does Peter still think sugar is metabolically deranging?” The answer is absolutely, at the levels it is consumed by most Americans. If you want a refresher on my point of view on sugar, definitely give this post a re-read.
So what did I take away from this?
Somewhere between “every day” and “never” there is a tolerance I have developed to consume massive amounts of carbohydrates, and specifically sugar. Now, there are two components to this: a purely physiologic one and a behavioral one (which I suspect is heavily influenced by my physiology).
Focusing just on the physiology, I would guess I could probably “tolerate” a binge like that every few weeks with little measurable or discernable adverse effect. I won’t even attempt to argue whether it’s every 7 days, every 14 days, or every 30 days. But, it’s probably somewhere in that vicinity.
What about the behavioral side? Well, I suspect there exists a different “frequency distribution function” that describes how often I could binge like this without resuming unhealthy eating habits in the long run. If I had to guess, I think the threshold for recidivism is higher from the behavioral tipping point than it is for the physiologic one. In other words, habits matter. I can probably tolerate – physiologically – more sugar today than I can tolerate behaviorally.
One last point I’d be remiss to leave out. You should keep in mind that for a period of 4 years, my consumption of sugar (sucrose, HFCS, liquid fructose in the form of any beverage, etc.) has been less than about 5 grams per day. The average American, depending on which stats you believe (I think they are all pretty weak), consumes somewhere in the neighborhood of 100 to 120 grams per day of sugar, NOT including the liquid fructose in juice!
So, I have to at least entertain the hypothesis that 4 years of avoiding sugar has been a sufficient enough period of time to offer me some sort of “metabolic reset.” Now, I have no intention of testing this. If I was once susceptible to insulin resistance, I’m pretty sure I will always be. But, an interesting Gedankenexperiment would have me going back to one of several different dietary patterns – vegan, but with no sugar; standard American diet with lots of sugar; modestly higher carb, but still sugar-restricted – all could offer insights into the physiology of adiposity and fuel partitioning in my metabolically reset condition.
How has this shaped my current eating behavior?
Sometime early in the New Year, I started really craving more vegetables. I’ve always loved them. Even in ketosis I still ate one or two salads each day most days, but I was pretty restrictive about the quantity of vegetables that had much carbohydrate in them (e.g., tomatoes, carrots). But now, I wanted even more. Big heaping bowls of curry stir-fry. (I have to toot my horn on this one thing. I make a really good, creamy, spicy curry stir-fry.) I realized this would probably knock me out of ketosis, especially with the large amount of tofu I mix with it and the yogurt I use to make the sauce.
My lunchtime salads were getting bigger and bigger, and I was piling more and more “stuff” into them. Almost laughable by the standards of those around me.
And I noticed I was eating less meat. Not at all by “design,” but somehow by seemingly craving less. It seemed an average week would have maybe 2 servings of red meat. When a great steak is placed in front of me, believe me, I enjoy every bite, but I found I just wanted it less. I also started craving a bit more fruit, especially berries and even apples, the former I consumed in modest amounts in ketosis, the latter I did not at all. (Because I know someone will ask – do I think red meat is harmful? – the answer is no, I do not believe so. Certainly not based on evidence I’ve seen to date, including the recent story about protein. For those looking to brush up on the state of evidence implicating red meat, I’d recommend three posts – one I wrote many moons ago in response to one of the dozen epidemiology stories, one written by Chris Masterjohn in response to the TMAO data, and one recently by Zoe Harcombe in response to the protein epidemiology).
I don’t know what to make of this, of course, and it may be nothing at all, other than an evolution of preference. I’ve checked mineral levels in my body in search of a clue (none showed up). Maybe I’m over- or under-saturated in some key nutrient?
Now, since everyone seems to care how much carbohydrate I consume, here is my current framework. I put carbohydrates into 5 essentially MECE categories:
- Those I consume daily – mostly salad stuff and other vegetables; about twice a week I make a curry stir fry with tofu, for example.
- Those I consume often – nuts, berries, almond butter (which I just spoon out of the jar), super starch (both as a meal replacement and post-workout drink).
- Those I consume intermittently – a couple spoons of rice here and there, especially when I make Indian food or when we have sushi; a piece of baked potato when it looks particularly appetizing. If my daughter “makes” spaghetti, which she loves, I’ll usually have a forkful to remind her that her dad is not a complete freak.
- Those I consume only on very special occasions – exceptional desserts, for example – about 2 or 3 times a year, like the ones I consumed on my wife’s birthday, or the candied yams. (NB: One thing I decided in an instant – if I’m going on a bender, it’s not going to be for “average” dessert like some lame birthday cake; it’s got to be best in class.)
- Those I still completely refrain from – I call these the “cheap” carbs – basically all else (including cookies, potato chips, cereals, and the candy bars they keep handing me on this flight as I type this), including any liquid form of fructose, such as juice or sports drinks.
Below is a “typical” 5 days of eating over the past few months. Keep in mind, I virtually never consume breakfast, maybe once a month (e.g., if I have a breakfast meeting). Essentially, I do all of my exercise (current routine, below) in a fasted state only consuming the BioSteel’s high performance sports drink (HPSD), which contains virtually no calories – maybe 8 kcal of BCAA per serving. So, despite the dietary changes I’ve made, and the fact that I’m not in ketosis most of the time, I remain seemingly well fat adapted, though RQ is a bit higher than before.
I should point out that I spend much less time exercising than I have historically, due to time constraints. But, I still aim for the following schedule, which is interrupted by travel during at least 2 or 3 weeks each month. The schedule below amounts to about 14 to 16 hours per week of training.
Monday – high intensity lift, followed by swim
Tuesday – ride (tempo)
Wednesday – swim
Thursday – ride (TT practice or threshold)
Friday – high intensity lift
Saturday – ride (VO2 max intervals), followed by swim
Sunday – group ride or solo TT practice
I can’t believe I’m about to do this…I just have this horrible feeling someone is going to attempt to replicate this, bite-for-bite, for no good reason. Please refrain. Remember, this is what I eat because of how my body works.
Wednesday
Lunch – huge salad (bowl larger than my head) with romaine lettuce, kale, carrots, tomatoes, cucumbers, olives, mushrooms, chicken breast, 2 tbsp olive oil, 3 tbsp lemon juice, 1 tbsp white vinegar, 1 cup of almond slivers
Snack – a cup of macadamia nuts
Dinner – Another large salad, but no chicken or nuts in this one; 1 pound of salmon; bowl of berries to follow
Thursday
Lunch – huge salad (bowl larger than my head) with romaine lettuce, kale, carrots, tomatoes, cucumbers, olives, mushrooms, can of tuna, 2 tbsp olive oil, 3 tbsp lemon juice, 1 tbsp white vinegar, 1 cup of walnuts
Snack – 2 or 3 tbsp of almond butter (a zero sugar variety)
Dinner – Omelet made from 6 eggs (white + yellow), shredded cheddar, lots of other veggies; side of steamed broccoli in butter; 2 more spoons of almond butter after dinner
Friday
Lunch – same as Wednesday (I basically rotate salad back and forth about 3:1 in favor of chicken over tuna)
Snack – none
Dinner – Curry stir-fry containing tofu, carrots, broccoli, bell peppers, mushrooms, zucchini, and squash, in a sauce made from curry paste and Greek yogurt. I typically consume two heaping plates of this.
Saturday (post ride and swim)
Lunch – 7 hardboiled eggs, an avocado, 2 oz of cheese
Snack – a Fuji apple covered in almond butter
Dinner – 8 oz of steak (fillet, rib-eye, or tri-tip), 8 oz of salmon, large salad (sans meat and nuts, which I only do with lunch salads).
Sunday (post longer ride)
Lunch – The “Peter Kaufman” super starch shake (heavy cream, zero-sugar almond milk, a package of chocolate super starch, 2 tbsp of almond butter, an extra 20 g of Biosteel whey protein, frozen strawberries, ice – blend to a thick shake); I’ll drink 2 liters of this. Literally.
Snack – none
Dinner – Family sushi night! I’ll have a seaweed salad or two, huge platter of sashimi, California roll, and another specialty roll.
Lastly, because I know someone will ask, the few times I now take to measure, record, and tabulate exactly what I consume, it works out to about 3,500 kcal per day. But some days, especially when I travel, it can be as low as 2,000 kcal when I only consume one meal per day (dinner). Other days it can be as high as 5,000 kcal. But, 3,300 to 3,600 kcal per day is the typical range.
So, there you have it – the most irrelevant information you’re likely to find on this blog (except for what’s below… this is actually valuable stuff!)
Fashion tip of the month
While in NYC I realized – about 15 minutes before leaving my hotel for a very important meeting – that I had forgotten to bring cufflinks. My heart sank. I’ve never made this mistake before. I immediately realized why. While packing, and just about as I was going to grab a set, my phone rang and I was distracted. But that was neither here nor there. What was I going to do? I didn’t have time to buy a new set, and the hotel concierge didn’t have a set to lend me, so I grabbed some dental floss and tied the cuffs of my shirt together using precise surgical knots. I was pretty self-conscious that someone would notice and ask or comment, especially on a day stacked with so many back-to-back important meetings. Amazingly, no one said anything, though I could see some people looking at them and doing the double-take. Over that lovely steak dinner I alluded to at the top of this post, I told this story to my friend (who snapped the picture, below). His response? “Yea, I noticed it right away. I thought it was a new style. Very cool, actually. Kind of European.” So there you have it. Don’t say I never shared anything of value on this blog.
Photo by Toa Heftiba on Unsplash
Hi Peter,
Does protein insuced rise in insulin shuts off FFAs/lipolysis to the same extent as a carb induced rise in insulin would do assuming the rise in insulin is same?
Highly dependent on the protein and carb in question, but yes, protein does trigger insulin release.
Hi Dr. Attia.
I appreciate your blog so much, and it is helping me to understand ketosis so much better than anything I have found. I am in month 3, have lost 21 lbs, and am in a bit of a plateau. But I am committed to staying in it for the long haul for both weight loss and overall health. My questions for you, that I have not seen asked or answered per se is this:
(1) With you now being out of NK, but still eating more protein than carbs and 55% fat, is your body back to being a “sugar” burner? I thought I had understood that you need to be a ketone burner or a carb/sugar burner, and not teeter in and out of ketosis.
(2) Do you feel that the state you are in now is a worse state than if you were staying in ketosis, but still good enough to reap the benefits of the insulin sensitivity you have come to have after being in ketosis so long? Any idea how the low carb, higher protein, higher fat is impacting all the other health markers compared to a fully ketogenic state?
(3) I know we should not necessarily follow what you are choosing to do diet wise, since everyone is different and there is more to diet than health (i.e., enjoyment, family, etc.). I am just curious about whether the important take away from a purely health related standpoint is that perhaps long term, having lower carbs and regulating insulin is MORE important than staying in ketosis in and of itself once good health has been reestablished.
Thanks so much for your consideration in answering my question.
Anna
All fair questions, Anna, but truthfully, to give the responses their due I would need an hour, which sadly I don’t have. Perhaps I’ll do a podcast one day where I can address such questions.
Hi Peter,
You provide so much information, trying to take it in is like drinking from a firehose!
Thanks for the huge effort you put in to educate so many.
I thrive as a carnivore, but my performance on the bike is certainly down during high-intensity efforts.
It’s probably a carryover from traditional high carb/low fat thinking, but I try to keep down the amount of fat I eat.
Do you think taking in as much (or more) fat as protein is necessary for high intensity performance?
Thanks again for the tireless work,
Scott
If the efforts are really anaerobic (say, at or above FTP), you’ve got to increase carbohydrate content.
Peter,
Thanks so much for your advice!
Since your advice, I’ve kept carbs low and training rides below FTP, and felt great.
Today I ate some oatmeal before the group ride hammerfest on a fixed gear(!), and had a superb ride.
In fact, it was over an hour into the ride before I even had time to realize I was riding as well (and felt as great) as the best I ever did on the typical sugar-heavy athlete’s diet.
Now I can ride my best, and still enjoy feeling so much better while off the bike, too.
Thanks again for taking the time to help me out!
Scott
Peter,
Just “found” you on youtube while searching for information on the ketogenic diet. I’m an avid cyclist, and have found myself slowly increasing my body weight over the years, even though I am riding about 5000 miles a year. Your story, your interviews and presentations, and lastly… just watching this high-intensity land training video has gotten me motivated to switch my carb-eating/metabolism self to a fat-burning machine. If you can do THAT with the amount of carbs you are injesting, then I think I can ride a one hour crit at high intensity. Keep up the good work!
Two points to consider Tim. First, don’t discount the period of time I needed to adapt to that dietary change; second, there is no doubt you can “ride” it at high intensity, but can you win it (or do your best)? That’s another question. I’m a 20 km TT guy and I’m not convinced ketosis produces superior results at a distance so short.
Hi Peter,
I have been avid exerciser and interested in nutritional habits for some time now. Fortunately, I have been lucky and to this point in my life have had no weight, or body fat problems. Regardless, I am still very conscious of what I eat. Reducing the amount of dietary related diseases is utterly paramount and a huge (western) societal concern, with physical, social, economic, and environmental implications. And after doing much research on the topic, I agree with your assessment and own research on diets that can combat some of these concerns.
However, I have to ask. Do you see the diets you have eaten over the past few years and seemingly similar diets (paleo, other low carb, high fat, high animal product diets) as a sustainable solution? My own academic background would suggest that while these dietary shifts are feasible and possible to many in developed countries where these specific health concerns are growing, suggesting a diet removing simple carbohydrates, starches, and grains as the way to create a healthy society has some seriously dire implications for the well-being and future of many communities. The more animal products we consume (myself included) has huge environmental and social consequences that maybe the western world doesn’t feel yet.
I am curious if you have considered that the solutions you offer, which many have the luxury of following, could potentially shift the burden of one semi-global concern (dietary related illness) to a potentially long term global one (food security, global well-being, environmental sustainability)? If these are the only solutions, then i fear that we are doing what we do best: create problems elsewhere and for future generations.
Anyway, I enjoy reading your blog. It is very informative and you clearly dedicate your life to this and helping people. I hope for some more posts.
Cal, great question, and not one I will pretend to know the answer to. I would posit that what we are doing today (diet-wise) is not sustainable, primarily in terms of our health. To be clear, I don’t think the world needs to eat more meat or animal products and I think/worry that this impression is a distraction from the argument. Question 1 is: what are the dietary triggers of metabolic disease? Question 2: how do we create a food environment to promote eating that way as the “default,” rather than the exception?
re: The more animal products we consume … has huge environmental and social consequences …
That’s true if your apparent choices are artificially limited to industrialized grain agriculture vs. CAFO meat. More CAFO is definitely not the answer for those ditching grains and dialing down carbs generally.
My impression is that we can produce more healthy food per acre than either of the above, quite sustainably, by using a model like Joel Salatin’s Polyface Farms.
Population pressure on whatever food system, however, is a separate problem.
I would love to hear your opinion on the methods in the book “The 4 Hour Body”.
Thank you so much for taking the time to answer Dr. Attia. A podcast would be great! I am thankful that you continue to post as you can, given all that is on your plate!
Anna, I just agreed to do a Q&A podcast with Tim Ferris. Not sure when, but probably within the next month or so.
Hello Dr Attia,
I follow your work on ketogenic diets, and am confused slightly by what another Professor states regarding ketosis. He claims it take months to achieve true ketosis and that you must never take a break from eating a keto diet, otherwise you have to start all over again. I find that hard to believe as it sounds so extreme and radical. Can I ask you your thoughts on his opinion, thank you.
The *complete* adaptation may take months, but biochemically entering ketosis can take days.
Hi Peter – I will try to make this short: I have read and followed a great deal of this site and am still vexed by the following problem: I am following an extremely strict keto diet, for about three months now, and after having lost about 10 pounds (starting weight, around 195), I am not losing any more weight. I am doing everything that I am supposed to do: I am keeping my fat consumption high, about 60-70% of total calories (I am measuring); my carbs are lower than 20 per day; I am consuming coconut/MCT oil every day; I am eating no artificial sweeteners; I am limiting my dairy; I am hyper-aware of food quality, I cook all (yes, I mean all) my own food from scratch from organics every day, and I eat grass-fed butter, good meats, etc.; I am eating zero processed food, not even a little; I am drinking at least 10-12 tall glasses of water per day, most often even more; I am not overeating by any measure, which I know because I generally wait until I am hungry to eat; and I am getting plenty of gym and “lifestyle” exercise: I live in NYC and walk constantly and in addition to that I follow the “Body-for-Life” workout regimen three days per week, because it’s quick and efficient, although I omit cardio because I have a lingering problem with tendonitis in my right hip-flexor area from when I was over-exercising when younger (I have always struggled with my weight). And finally, I am taking almost no cheat days – a total of only TWO in the last three months. I am 37 years old, 5’8″ tall, and I weighed in today at the gym at a whopping 187 lbs. On the 1st of December, I weighed in at 184, so technically I am gaining weight, not losing it. Furthermore, there is no significant change in my overall shape and appearance since the initial 10-11 lb. loss: I am still bursting out of a size 34 pant, I have plenty of fat on my body that just sits there and is not burning away, and my proportions and measurements have not changed. And finally, I test my urine and, though sometimes I am in the purple area on the strips, I am most often in the light pink area between “small” and “moderate” on the ketone strip color chart. Given all of this, I am beginning to think that, although I feel good in every other way, there might be something medically wrong with me that simply will not allow me to lose weight? Please let me know your thoughts, and if you cannot suggest anything in terms of actions I can take, do you know of any good keto-friendly doctors in NYC? Thanks! – Eduardo
Peter,
I am a physician and have been helping a friend of mine get ketogenic for his Iron Man race.
His RQ dropped at his race pace from .90 to .78 after 3 mos of changing his diet. He is in the top 100 in the world but wants to improve. His last Kona race he bonked w 10 miles left in his run, drinking only sugar/ electrolyte drink. You almost discussed it with your podcast w Ben Greenfield, but could you expand on how you would advise how someone eat during an Ironman.
I was thinking get thru the swim, replace some carbs w/ superstach on bike while drinking some BCAA (Biosteel), and on the run start with Biosteel , then switch to higher glucose/ sucrose electrolyte solution (osmo) for last half of run as his energy is fading.
I know i am being specific , but are there any general or specific thoughts you would have on someone doing a 10 Hr race pace Iron Man ??
thanks
Rick
Rick, I spend hours troubleshooting these issues. No glib response on a blog is going to move the needle.
hey rick,
i’ve had my best race experiences since switching over solely to Ucan during the race. I’m a couple hours slower than your guy i’m sure, but it’s worth trying.
i put 6 scoops in a big water bottle, add water so it’s a tad thinner than pancake batter and eat that during the bike ride. then i do 2 scoops in 3oz water at T2 and another 2 scoops in 3oz via a hand held 1/2 way through the run.
best of luck.
Peter,
For all that you gave us, it is about time I sent you a note. I have been talking a lot about you and Nusi. I truly enjoyed your podcast with Tim. It’s one of your best. I like the way Tim sets the tone (proximity) of the interview. I have been following you for a while on the internet. (Blogs, prints, podcast, presentations, television) I am flabbergasted how talented you are, being a brainy smurf without being full of shit. Your neurotic side makes you even more charming. The more natural the better you are. I could listen to you all day. You have a great voice for radio and television. Maybe it is your special background in mathematics, mechanical engineering and surgery, but you have a way of explaining things and anticipating where I may find it more difficult that makes it so enjoyable. Before I can say “hey Pet, I didn’t get that part?” You always close the circle. I truly appreciate how with total ease you say when you know the answer, where you don’t, when you changed your mind, when you are guessing and when your are bias.
I appreciate your social skills and effort not to be condescending but was impressed (and laugh at loud) at your intellectual judo when people are acting likes asses on your blog!!!
On a legal side, I thinks it’s wise the way you did set-up Nusi, not doing the research directly but as independent fund sponsoring research with people on both side of the equation. Anyway, even if you have the best network of professionals around you, I would ask your brother to familiarize you with the legal concepts of bulletproofing you and your family against the sugar industry before the science gets out.
I remember in one of your blog you asked for ideas. Mine is not new . On the marketing side more people should know about Nusi. You can make it as cool to support Nusi as owning apple products. It would make it easier to get funding from public and private. Bracelets or t-shirts that say thing like “I support Nusi initiates” and the like. I would be happy to buy them and wear it at the gym, at the grocery store, to get people talking. It can be automated on Nusi web site at no inventorry cost. Sure It cannot be as fun and bias as your bacon t-shirt but you get the point!
You already have your legacy. You are a gem Peter Attia!
Pat
P.s. First language is french. Montreal under the snow wishes you and your family a Merry Christmas!
Patrick, you are too funny (and kind). You may be part of a small group, but I appreciate the kind words. Your idea is a great one, and I hope in the not too distant future we can work on implementing some of the ideas you discuss.
Hey Peter,
Loved the podcast with Tim Ferriss. From the articles I’ve read thus far, am I correct to assume that (in general) even people with moderate exercise (30 min/day) don’t need to “count” calories in the aggregate sense to maintain a healthy weight? I do scrutinize my carbs and protein to remain in ketosis, but I’m curious if unrestricted fat intake will cause me to unwittingly gain weight, or if my appetite will regulate the weight naturally given the nutritional ketosis restrictions?
Nevermind – just read your article “Do calories matter?” Thanks anyway!
Hi Peter,
I’m about to go to Brazil for vacation for two weeks with family, and am worried about how to continue fighting my insulin resistance while I’m there. Any suggestions on how to think about enjoying vacation in a way that doesn’t reverse my progress with the diet thus far?
Thanks so much,
John
Hi Peter,
I am going through all of your blog and the comments (yours and others) and I came across a comment about meat. I cant remember the name of the doctor, but someone mentioned that she said to cut down the consumption of red meat. Your reply was, maybe her understanding of the topic is evolving just as your understanding is evolving about cholesterol. (Q1) Have you seen any good data on the consumption of meat?
The reason why I ask this is because I noticed lately ( I am a little slow on correlating things), when I didn’t eat any meat for 5 days, my psoriasis was dry. it was not flaky whatsoever. It was just dry (whatever that means). I have never seen it that way before. I went four days and still dry (didn’t even have to put lotion on). The psoriasis on the legs was dry and the arms slightly flaky but compared to before it was night and day. So, yesterday we had a BBQ and I must have consumed over 200 grams of protein, woke up this morning, legs were flaky (not as much as before), but flaky. I am going to try and limit the consumption of meat (below 100 grams) for the next month and see if there will be any changes with the skin (if the meat was the cause).
That said, I have cut out almost all grains and sugar (possibly 95%) since March. The past couple of months the only carbs I eat come from veggies. I work out 3 times a week doing super slow. I push through a lot when working out( I am not sure if this has a lot of effect on the inflammation). I have noticed some of the older patches of psoriasis are going away, very slowwwwwly. New ones are coming out at a very fast pace and a few have grown almost one inch in diameter in a couple of month period. I tried cutting out night shades and dairy (three months) but nothing. Still not eating though. I am assuming something is working on the inside but not quickly enough.
I wanted to cut out meat all together and substitute the meat with whey protein but was not sure how the meat balances with whey. If any thoughts come to mind, do let me know. If others have any suggestions, I welcome them all.
I have to find the name and read upon her thoughts on that topic, thought I’d ask here as well.
Thank you
Jack, it sounds like you’ve got a great hypothesis to test (though I’m not sure the mechanism). It would be interesting to distinguish if the effect is protein vs. meat. If meat, it would be further interesting to differentiation between types of meat (e.g., red vs. white; fish vs. beef; grain vs. grass-fed).
Peter, the recent podcast you did is great… certainly looking forward to the sequel.
One point that I’d be interested to hear you discuss in the future is this:
As I understand it, some of NuSI’s current trials are putting low-fat and low-carbohydrate diets head-to-head as an intervention. It seems certain that this will give a better understanding when it comes to something like, well, what exactly distinguishes people that are seemingly better suited to one approach or the other.
However, besides that, there is also the notion that ‘low-fat’ and ‘low-carb’ are (at least on their own) overly simplistic labels. Given the amount of variables that are possible within either framework (e.g., yes dairy, no dairy; whole grains, refined grains, no grains; total protein consumption; lentils and beans as a protein source, or not; level of fruit consumption; vegetable consumption etc. etc.).
So, essentially I’m curious what kind of insight the current NuSI trials might offer on this subject, or how they might affect future research addressing it.
All the best to you and yours!
NuSI will be launching an updated website this month. I think you’ll find many of your answers there.
Hi Peter,
Are the results of pilot study (Energy Balance Consortium Study) available?
No.
Hi Peter,
WARNING: Long post (sorry for that)!
I just wanted to say that I love your work! On another note I would like to ask a really important question, as I’ve been searching the internet and am coming accross conflicting opinions & research. I’m not sure who to believe, how to proceed, and who to turn to for advice. I would like your opinion on the whole low carb and having “hypothyroid like symptoms”, and what to do if your experiencing them?
Here’s little background to my situation. I grew a up pretty healthy, my family didn’t eat very many carbs. We ate alot of veggies, fatty cut meats meats, my mom cooked everything in lard/butter. My bloodwork was always amazing, my doctor said I must have great genes. The main thing I suffered from was intermittent chronic fatigue, low body temperture, random bone pain. Now this wasn’t always the case and I can’t pin point what triggered it. (experimenting with vegetarianism made me feel worse) I was always very skinny, but my weakness was sweets. If I put on a few pounds I would cut out the sweets and loose weight no problem.
The last 5 years I started eating more like my husband lean chicken breast, more carbs, & wine. My weight started to fluctuate dramatically. I would gain and loose 30-35lb and the fat distribution was in strange places that i’ve never seen before. Finally this past year I reached my all time high, I put on 65-70lb in one year. Mainly because of a very stressfull year, but the worst part was my uncontrollable hungar. The more carbs I ate the more sugar I craved and would eat at minimum 1kg of chocolate a day and tubs of ice-cream. I was always hungry, and my attention spam was very short. Couldn’t concentrate at work, would need a sugar fix to keep going. I knew I had to do something about it but couldn’t get my self to stick to any diet until I came came accross the ketogenic diet.
Now it’s been 4months since I’ve been ketogenic, and I’ve lost approximately 40lbs with limited hungar (skin fold measurement went from111mm to 56mm). However I did struggle to adapt even with appropriate amount of fat and electrolyte supplementation (it was about 7weeks). Presently I struggle with some fatigue on some days, and at other times I don’t. The greatest improvement is the mentally clarity and the loss of hungar. I am more productive at work and can go hours without food. One thing I noticed is that my ketones levels were always extremely high hovering btwn 4-8mmol (mostly 5-6mmol). It never went below 3mmol even after a party when drinking and having a little extra carbs. So I added more veggies to my diet while still maintaing quite high levels of ketosis. The measurements were taken for a month and a half (with the blood ketones strips). To this day my urine keto sticks still show a purple colour.(It hasn’t disappeared like it does for some people)
I haven’t exercised much through out this process because I burn out easily. One time I even threw up, might have over done it. Over the holidays I had a situation that really stressed me out, I barely slept or ate for a few days. (my life been has really stressful through out these months as well). Anyway christmas eve my hair started to fall out for the first time. I was so burned out, I tried to get as much rest as possible and increased my calories. Even cheated with little bit of potatoes. My body temperature is really low, and my weight loss has stalled. Unfortunately my hair is still falling out as well. I’m aware that some studies show with low calorie/substantial weight loss/ & or carb restriction your T3 levels go down and your rT3 goes up. Some people refer to this as hibernation mode, and call it an advantage. Others claim that the low temp may cause other health issues. I know when was skinny in the past I was always cold, when put on weight I was hot.
Basically I am experiencing the low thyroid symptoms. Not sure if this pre-existing, and exasperated by the diet. Should I add more carbs back in? Should I wait it out? I’m afraid to bring back the cravings. I really do like being in ketosis. Just not sure if it’s right for me. Or should I incorporate some cheat day to rev up my thyroid? Note my husband and I are also trying to have a baby.
Sorry for the long post, and I understand that your not treating anyone over the internet. I am not looking to be treated, but would like an honest opinion regarding the science to the best of your knowledge. I know its just anecdotal, but its a real phenomenon for me.
Significant weight loss–as you’ve clearly exhibited (congratulations, by the way)–will often result in hypothyroidism. This is true if you restrict calories, carbs, etc. The reason, basically, is that your body wants to resist this change, and this is often confirmed by rising rT3 (more T4 goes into making rT3 than making T3) with *or* without a rise a in TSH.
Hi Peter – I never did receive a response from you, but am still wondering if you might be able to offer any referrals for keto-friendly doctors in NYC. I continue to be extremely disciplined – now including 1-2 “fat fasts” per week in addition to everything I describe above – with zero results – zero – and I really think I might have some kind of extreme keto-resistance. Thanks. – Eduardo
My personal experience of low carbs is a good one. I dropped 12 pounds in 12 weeks and went from 21.5% body fat to 11.5%. I only exercised for 3 hours a week, which was pretty normal for me, but it was HIIT type training, basically a form of circuit training. You can see photo evidence here: https://www.bodyhack.com/men/six-pack-and-11-5-body-fat-in-12-weeks (sorry that it looks a bit salesy, I’m not trying to promote it, the buying process was shut down about 2 years ago, so I can’t make money from it) If anyone would like my diet plan for free I would be happy to help.
I heard your interview by Tim Ferriss. As an exercise science major in college, my inner geek got pretty excited hearing terms I no longer think about. However, what I have been thinking about is nutritional optimal living as a 44 year old woman who does health coaching for a large corporation whose employees have metabolic syndrome. I certainly fall into your category of “people over 40 who give a shit.” That’s what brought me to your site, and more precisely this post, trying to learn more about nutrition and ketosis. The thought of eating 7 boiled eggs makes my stomach ache, yet I am wise enough to have heard your words that it’s YOUR diet, not mine. I am curious where I could learn more about how to put a diet together? Also, I am wondering if you will share the manifesto you shared with Tim? I love that stuff and would be fascinated to read your thoughts. I look forward to diving deeper in this blog. Thank you for what you do.
Manifesto is not ready for distribution yet. Needs a lot of work, still!