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

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253 Comments

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

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

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

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

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

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

    Thank you in advance!

    -mark

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

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

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

    Just scientific, hypothetical inquiry!

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

  5. Hi Peter,

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

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

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

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

    Thank you for your wonderfully informative blog.

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

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

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

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

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

  8. Dr. Attia:

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

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

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

    Thanks

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

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

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

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

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

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

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

  11. Dr Attia,

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

    This blog has truly changed my life, thank you.

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

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

    • Hi Ryan,

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

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

    • Hey Hemming,

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

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

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

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

    • Hi Ryan,

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

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

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

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

    Miri

  13. Dr. Attia:

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

    Thanks in advance!

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

  14. Hey Dr. Attia,

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

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

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

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

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

    Tim,
    Age 21
    Nutrition and Dietetics student @ NYU

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

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

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

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

    • Hi Ryan,

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

    • Hemming,

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

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

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

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

    • Thanks for answering my post and for the optimism. 🙂

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

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

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

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

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

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

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

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

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

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

    • Peter-
      My wife has had adrenal testing done recently indicating low DHEA. Her GP (who I actually consider to be quite progressive in his thinking) puts no credence in DHEA testing. In your post you reference the importance of DHEA in men… do you believe that it is important for women as well? My wife is low-carb,very gritty, but stuck a fair distance from her target weight. Thanks Peter… your opinion matters deeply to me.

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