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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
It’s interesting to me that alot of the LCHF leaders are transiting to a more lax approach. I still remain in deep ketosis (for mental performance, I could stay very athletically built on the SAD diet easily). So besides social reasons, did you find out something that alarmed you with long-term ketosis?
Not at all, and it was really HARD to deviate from ketosis, but I the desire to try was strong enough.
Peter, fellow massive salad lover here. Hope you are well. You’re completely right about the vegetables; I was surprised how much I missed them while in ketosis – out of all things. It’s tough to beat a fresh, extra large bowl of veggies topped with some Kerrygold. 🙂
It’s always so refreshing to see someone not obstinately tied to a particular way of doing things. It will be interesting to see how your anaerobic systems (both phosphagen & glycolytic) are impacted by the new diet.
I was on a ketogenic diet for the last 90 days of 2013, and now I’m consuming slightly more carbs (~100-150/day) than you referenced here. There seems to be some definite benefit in my anaerobic work, but I don’t have any hard data.
The spacing of my meals is similar; although, I have been eating breakfast (at least an hour after a fasted workout), a normal lunch and dinner and supplement with BCAAs between each meal instead of snacks. I’m curious. Do you consume BCAA’s only with workouts or also during periods of fasting?
Keep up the good work!
-mark
BCAA (plus other cofactors) consumed during each of my 3 types of workouts, but not other times. They would probably “help” during periods of longer (>16 hour) fasts, though.
Peter and All,
I notice when I am strict with carbs, perhap less than 40 net carbs a day I have very vivid dreams.
They occur each and every night. They are long/epic, quite strange or bizarre but not nightmares. I wake a bit puzzled and can remember the general concept. (but forgotten a few hours later). Wish I can figure out why. Serotonin issue?
There must be others with similar experiences. Anyone?
I’m 3 weeks into a keto/paleo diet and experiencing the same thing, but hadn’t made the connection that a week in is about when they began. Could be coincidental, but maybe not… Anyone else?
Low Carb Vivid Dreams
Peter, have you experienced this. I notice many do (as per the web), but can’t explain.
Any insight on if this negatively affects quality of sleep, serotonin, or growth hormone release etc?
tx
Certainly heard about this, and even experienced it myself early on. But no real insight beyond the fact that it seems to occur for some folks for some period of time.
> I notice when I am strict with carbs, perhap less than
> 40 net carbs a day I have very vivid dreams.
Vivid dreams are being commonly reported by those experimenting with Resistant Starch (e.g. a few tablespoons per days of uncooked potato starch). The conjecture is that it’s due to what the gut bacteria are doing with the RS, which implies that it’s less about “low carb” or keto than about how much of what you eat is pre-biotic.
Not aware of this. Interesting to note.
Quick question that came up after reading this and some earlier posts on NK: Are they any reason(s) why you would revert back to strict ketosis? Let’s say hypothetically you were training for an endurance cycling event; would you change your diet for a few weeks?
Thanks!
I’m sure I will at some point. But to really reap the benefits, I’m not a few weeks would be sufficient to re-acclimate.
Hi Peter,
Your advice rocks. After losing close to 100lb with strict ketosis diet, I have added some carb (more vegi, steel cut oats, banana) back to my diet to help me progress in my O-lifting. For me, the value of strict ketosis diet is really psychological. It made me feel in control and live my life without the craving that has always been part of my life.
Now I have gained almost 15 lb, some fat, some muscle. I did start to feel my old craving after getting off ketosis and it has its pros and cons. However, with the experience of strict ketosis, I find myself more confident in resisting the craving and experimenting with new diet to meet my goals. Knowing there is something I can fall back on brings confidence and this confidence is invaluable.
I really believe in moderation now. However, I think one can only achieve balance if he has had a taste of both extremes.
I think you make a very good point. For many people one of the key benefits of NK is the “control” and absolute nature of it. Very little decision making. It’s black and white, so to speak. In addition, there is an amazing real-time feedback mechanism in the the form of measuring blood levels of BHB (for those who choose to do so). I think the reason some people experience complete recidivism when adding back “a little bit of carbohydrate” is that they lose this ability to be strict about intake and before long they are back to their pre-NK diet (or worse).
While I appreciate the few who have railed on me for my “sins” of deviating from NK, I think what they don’t realize (about me, personally) is how my brain works. I’m a very cerebral person, and while a slave to my own physiology like any other animal, I think I have a few cerebral override systems in place that many do not.
So while I loved being in NK, and will almost with 100% certainty go back for periods of time, I was confident I could add back the RIGHT kind of carbs without going all the way down the ladder to indulge in “cheap” carbs (5), and even when I did indulge in the *rare* treat (4), it would a few times a year.
Last point, my birthday was 2 days ago. I had zero urge to eat cake or ice cream or other birthday trimmings. What did I have? Two heaping plates of curry stir-fry and a bowl of berries with homemade (zero sugar) whip cream!
I love your “what-do-I-eat” posts and I am sorry that they cause you so much distress. Of course you are going to stir people up. Didn’t you know that diet is religion?
I, however, am an info-maniac and I really appreciate reading about the escapades of a modern-day explorer. Keep it coming!
Happy birthday Peter! Celebrate all week and thanks so much for all you do! Maryann
Three straight days of curry stir fry!
Do you think there is any validity to the idea that the carbohydrate level of yogurt should be considerably less than the milk it is made from because the lactose has been fermented into lactic acid? I believe I read somewhere that the carb level of fermented milk products has been overstated because of the way carb levels are measured.
I haven’t put many clock cycles into this, but Steve Phinney told me once that lactose as a form of CHO contributes about 50% the insulin effect on ketosis. But I have no idea. Empirically, Steve seems correct.
Always good to read your blog and have a good laugh on what you expect people will do with all that “irrelevant” info.. i guess you know well your audience. cheers
Do you think there is any validity to the idea of inflammatory foods? (Monica Reinagel, Barry Sears, etc.) The nutrition website I use (Self Nutrition Data) has Inflammation Factors listed and I wondered if I should consider that in developing my diet. Thanks for all your efforts. They are much appreciated.
Maybe, but I’m not sure.
I just saw your presentation on TedTalks. You not only apologized to your lady patient, but lo to me. Dr.’s do have a condescending attitude toward fat people like me, I can feel it. It is so disturbing I won’t go to the Dr unless I have no other choice because I’m getting better. I have recently been advised 9by 3 doctors to have bariatric surgery. It seems like an answer to prayer, but on the other hand, I feel like a failure because I couldn’t do it myself. Monitary issues have tossed this possibility right out the window, again.
I plan to read all I can on this site. I do have some concerns. I have gout and it’s getting worse all the time. Will these new eating habits have a negative impact on that? Secondly, I take depression meds. I know my weight depresses me, but could it be a result of a poor diet as well? I am 65 years old and been overweight for 50 years. I feel hopeless. My father was an alcoholic and tho’ I don’t drink, it’s the same rollercoaster ride. I’ve about given up and that won’t bode well for my scale. Thank you for listening. k
Kathleen, first of all, I’m so sorry to hear what you’ve been through and continue to go through. I think you’ll find some helpful info on this site. As for gout, I typically see TWO dietary patterns that make it worse, one pertaining specifically to fructose (the sugar in fruit, and that which makes up about half of table sugar and high fructose corn syrup) and excessive meat (through an entirely different mechanism from fructose, largely due the breakdown of protein). So one thing to consider is if you could first reduce fructose intake as much as possible. If that has no effect, maybe reduce protein.
I see sushi in your picture! How often do you eat it? I want to eat it but ‘m worried about the white rice.
By the way, is it better to eat high carbs right after exercise as I’ve heard elsewhere?
I recently found out that by limiting carbs you can reduce your BG numbers.(duh) Always had trouble keeping the tests in the proper range. So after seeing and watching your videos I tried cutting carbs. Now my numbers are in a controlled range. Also weight loss has been a nice side affect. Thank you so much for the info. You opened my eyes and helped me turn my life around.
Hi Peter-
Been lurking on your site for awhile now, my wife and I are 3 months into NK and the change has been remarkable. Through our journey, it has changed our bodies, minds, and made us much more aware of society in general. It is incredible to see now how the exact wrong choices are absolutely everywhere, on TV, Internet, and the advice circulating from the medical establishment is often conflicting and full of confusing partial truths.
Anyways, kudo’s to you with your site- it is a great resource for people! We are all lucky to be in the internet age and able to learn from each other- As an engineer, I appreciate your data driven approach and rare ability to question your formal MD training. Looking forward to future topics- Cheers, Vito
Thank you, Vito. I’m glad it helps, and feedback like yours keeps me “limping” along with the blog. Otherwise, I think I would have stopped months ago.
Hey Peter-
Keep up the occasional personal blog posts. I am a Family Practitioner with 27 yrs experience and also a natural introvert. I find it is good to let out something personal to relate to people . I try not to overdo it because the office visit is NOT about me, but it can help to make that real connection. I realize you are NOT practicing medicine but your blog is important to many of us out in the trenches.
I find your blog very educational . It is inspiring to see someone work so hard to communicate an important idea. I also admire your habit of looking at both sides of a controversy (e.g. why does the Ornish diet work for some)
I use some of your talking/teaching points daily .
BTW, I am a math geek (unusual for an FP I know) so I love the review of statistical significance , discordance and such. Keep it coming!
And here’s another vote to continue exploration of the clinical use of various metabolic markers. It can be confusing at times. I get some folks with low LDL – P but very high IR .
How reliably can I utilize the TG/HDL-C ratio when I cannot get NMR or other LDL-P data? ( a real world issue b/c of insurance and cost limitations)
Again, many thanks for your efforts,
Michael
Michael, thanks for the kind words. I’m very happy that the blog helps the front line practitioners. I’ve got a great case study from a client that will address your question. I’ll likely incorporate it into Part X of the cholesterol series, though I think I’ll end up doing the IR post first.
Just want to be clear that even though I have queried your latest experience, I am so glad you’ve posted about it. It’s enormously helpful. It’s great to have you say, ‘hey, this is what is working for me just now,’ in a take it or leave it kind of a way!
I wondered about increasing carbs – someone somewhere said that the brain alone needs about 150 grams of carbs just to be a brain, unless of course we switch to ketosis and get fuel from ketones/fat. So if I raise carbs from my current 30 grams to say, 60 would I just be in no-man’s land? Not getting enough fuel from either source?
Apologies if this is a dumb question!
Definitely not a dumb question. In theory, the answer would appear to be “yes,” however, in practice, I have not found this to be true *universally* especially on the way “up” (i.e., adding CHO back in), though it seems to sometimes be the case on the way “down” (i.e., reducing CHO).
Bottom Line: Advice needed for those of us who are “small-framed” WOMEN who are just trying to lose about10 lbs of fat (while working out Crossfit), potentially adding muscle weight) while living on KETO diet?
Do we need to “alter” the diet in order to shed/burn body fat?
I ask because i have read every article on this blog — and read comments by others — and most folks who have “done well” seem to be self-described as moderately heavy individuals (mostly men) who have adopted the KETO lifestyle and shed body fat quickly.
I am envious — in 1.5 months of carefully eating KETO (consuming less than 25g fat per day, less than 1400 total calories, per day, less than 70 g. fat per day — appropriate for a 120 lb 5’4″ woman), while working out 5x week (HIIT – Crossfit), i have not lost a single pound – in fact i’ve now gained 1 lb.
True, i’ve lost 2″ from my waist – but i still would like to lose another 2 ” to get down from 27% body fat to under 20% body fat. All the while, i’ve consumed a lot of FAT — Coconut oil, Butter, Animal Fat on meat/fish, EEOV, and some cream in coffee. I am religiously weighing food, measuring portions, etc., so i know no extra carbs/protein are sneaking in…and i only eat 2 meals per day usually.
But is this too much fat for a small woman to eat? Should i eat less fat – and fewer calories? I can’t eat more carbs or protein and stay KETO.
I am wondering if eating all this fat is causing my body not to burn body fat because it is getting too much from my diet.
Or should i just be patient and be content to only very slowly shed body fat? Why am i not losing as fast as others — with dramatic reports of losing 2 lbs per week?
Please advise….does a smaller person (like me) need to adjust anything — or just be patient to realize body fat loss?
Impossible for me to know/troubleshoot. True, for some people, the process is trivial, but don’t fall prey to ‘survivor bias’ — there may be many people, of all genders/shapes/sizes, who share your experience. So I don’t think it’s about being a small women, etc. I’ve had clients with the body habitus you describe have an “easy” time and others not. Bottom line, if I can borrow your “lede,” I don’t know the answer without doing some detective work, which almost always involves elaborate blood-work and study of food logs.
Dr. Davis (Wheat Belly) has a useful checklist at:
https://www.wheatbellyblog.com/2012/10/i-lost-the-wheat-but-didnt-lose-weight-2/
and a 3-part video update of that topic in his blog’s Feb 2014 archives. If you’re not familiar with it, the WB recommendations amount to a borderline keto LCHF (obviously grain-free) diet that is easily adapted to full keto.
You’re probably on top of item 1 on the checklist (net carbs), but two carbs need to be zeroed out entirely, as they are fat magnets: modern gluten-bearing grains and added fructose (i.e. fructose not part of whole fruits).
Even with an ideal diet, a non-trivial fraction of the population has confounding factors that impede weight loss, and if it’s thyroid (#4), getting a useful test panel, correct diagnosis, and sane treatment is a challenge.
Juliet, here’s what I found about myself that may help you: I do very well on a low-carb ketogenic diet, and I can easily maintain very consistent energy levels and body composition, but only if I pay attention to one small detail: I am well able to overeat on butter and cream and will gain body fat doing so. For me the only way to go down with body fat is to stop adding extra fats (other than those naturally contained in fatty meats, eggs, fish, cheese or avocado) with the exception of coconut oil. As a result I can easily control my appetite and naturally eat less and lose body fat very quickly. If I indulge in butter, my appetite control stops working. I often drink coffee with coconut oil and feel great afterwards but if I add butter, I will be… hungry for more within an hour or two.
You might try cutting out the coffee with cream. I seem to pretty easily gain some weight if I have coffee with cream, even while in ketosis.
I’m a small female and what jumped out at me is that you’ve lost 2″ from your waist in 1.5 months – a sure sign that you’re losing body fat – and you seem to be blowing that off as insignificant. Pounds on the scale is an inferior method of gauging changes in body fat because of fluctuations in water weight and the possibility that you’ve gain lean mass from ketosis and exercise. Your waist change is a more reliable indicator of your success, IMO.
oops… i meant to say — that i am eating about 70g of PROTEIN per day, or less – i am actually eating a lot more fat per day… about 120g of Dietary Fat
A recently published study found that a long-term KD caused glucose intolerance (in mice). https://www.ncbi.nlm.nih.gov/pubmed/24398402
Is it possible that your reaction after sugar- and carbohydrate- heavy meals is glucose intolerance? Have you had a glucose tolerance test after being in ketosis for a long period?
I’m not going to say mouse studies are universally useless, but when it comes to understanding how HUMANS metabolize FAT, well, they pretty much are. *ESPECIALLY* since they such studies virtually all use a combination of high sugar and fat (so the mice will eat the “high fat” food).
Hi Dr. Attia! I’m a fellow physician (oh and mechanical engineer) here in Seattle and I’ve been using low-carb and ketogenic diets personally and professionally for about 15 years now so obviously I really appreciate all of your work and you are one of my heroes! I created a free iPad app, ‘Diet And Exercise 2.0’, out of equal parts guilt for all of the horrible nutritional advice given by most of my other peers plus laziness as I wanted to educate all of my patients simultaneously and save a bunch of time! Anyway the point is, I use you and your YouTube videos and your website in my list of helpful references and I wanted to make sure that was ok with you? [let me know if there is something in there you don’t like or don’t agree with!]
Keep up the good work, I for one highly appreciate it!!! =)
https://itunes.apple.com/us/app/diet-and-exercise-2.0/id836080709?mt=8
Very cool. Thanks for sharing.