November 20, 2013

Mental models

Grit

What do passion, persistence, and deliberate practice have to do with our health?

Read Time 8 minutes

One of my readers 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. Even when my daughter was only 5, I spent 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 children, 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 practice — deliberate 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 an 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.

 

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 who 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.

Grit by Crystian Cruz is licensed under CC by 2.0

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

253 Comments

  1. 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?

    • 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.

  2. 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.

    • 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…

  3. 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.

    • 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.

  4. 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.

  5. 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.

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

  7. 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.

    • 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.

  8. 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!

    • 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.

  9. 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.

  10. 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?

  11. 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”.

    • 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.

  12. 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. 🙂

    • 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.

  13. 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…

  14. 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.

  15. 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!!

  16. 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);

  17. 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.

    • 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.

  18. 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.

  19. 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.

  20. 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)?

Leave a Reply

Facebook icon Twitter icon Instagram icon Pinterest icon Google+ icon YouTube icon LinkedIn icon Contact icon