August 23, 2012

Nutritional Biochemistry

Hey Peter, what does your daughter eat?

Read Time 7 minutes

If there’s one question I get asked often, it’s this one.  And I understand why.  Anyone who knows me, and knows how obsessed I am with everything I do, knows there is one thing on earth I cherish more than anything else – my daughter.

Any of you reading this post who are parents know exactly what I’m talking about.  My daughter, and I know the same is true for Gary with his boys, is one of the greatest driving forces behind us founding NuSI.  Why?

Picture the United States as a cruise ship.  Overall, it’s a wonderful place to be.  We have so many things to be thankful for (as do many folks outside of the U.S.).  But, there are icebergs out there.  If we continue the course we’re on, our fate will be similar to that of the Titanic.  Unlike the Titanic, though, we actually have several icebergs in our path.  That is, there are many different forces in the world today that – if left unchecked – could easily disrupt our way of living.  I won’t go into detail about what I think the list of potential threats to our economic and social freedoms are – pension overhead, national security, energy security, structural problems with education – but I’ll assert my opinion on the first problem we need to get a handle on.  If we don’t figure out a way to curb the twin epidemics of obesity and diabetes, our healthcare spending alone will bankrupt us.  No one can pinpoint the day this will happen, but if not in my lifetime, I’d bet anything it will be in my daughter’s lifetime.  In other words, of all the icebergs we need to skirt past, this one is the closest to our vessel.

So, back to the question.  While we wait a decade or so for NuSI to fund the type of science that will unambiguously resolve the jugular question — What should people eat to maximize their chances for greatest health? — what do we do?  If you’ve been reading this blog, you’ll certainly have a great idea for what I do, based on my interpretation of the data currently at our fingertips.  But ambiguity remains, especially when asking an even more important question than what do I eat.  Since my daughter (and presumably your children, for those of you with children) is infinitely more important to me than anything else, including myself, how do I interpret current data around what she should eat?

Principle 1: Excess sugar is not conducive to good health for anyone

I don’t think I need to spend any additional time reviewing the harm of sugar (e.g., sucrose, high fructose corn syrup, beet sugar, cane sugar, brown sugar).  If you do want a quick refresher on this, you can read this post. If you can only make one intervention in the dietary pattern of your child, make it this one.  Based on our experience and the experience I’ve had with clients, friends, and family, a trend has emerged.  It seems the longer you wait to make changes in this area, the more difficult it can be.  Not always, but often.  Sugar is very habit forming, and from a neurochemical standpoint an addiction to sugar is not unlike an addiction to gambling, alcohol, or heroin.  Yes, they all have nuanced differences, but each of these addictive patterns or behaviors results in stimulation of the dopaminergic pathways of the brain.

How do we translate this intent into practice?  The easiest thing to do is to minimize the amount of sugar brought into the house.  This means we don’t have soda, cookies, candies, cakes, cupcakes, and other similar nutritional weapons of mass destruction lying around.  This doesn’t mean we never have them lying around.  Invariably, a grandparent or neighbor will bring over a lollipop or some cookies, but this is an exception, not a rule.

Furthermore, we don’t have any juice in our house.  Our daughter (who is 4) drinks whole milk and water.  That’s it.  Amazingly, she no longer finds sweet beverages enjoyable.  Recently, at a birthday party, she was given one of those Capri Sun sugar-syrup drinks.  She took one sip and asked for a bottle of water.  It was actually too sweet for her.

As I explain below, she still gets some sugar in her diet, but it’s probably about 20% of what the average kid her age is consuming.  And she gets plenty of fructose in the form of fruit.  But when she eats fruit, it’s usually lower fructose fruits (e.g., raspberries, blueberries, strawberries) rather than higher fructose fruits (e.g., watermelon, banana).

Principle 2: The less processed the food is, the better the food probably is

As an extension of the first principle, if you always make trade-offs in favor of cooking your food, rather than pulling it out of a box or jar, you’ll win many of these day-to-day battles.  At least half the week our daughter asks for cereal for breakfast (instead of bacon and eggs).  Rather than dump her a bowl of sugar-laden cereal, my wife or I will make her steel-cut oatmeal, to which she’ll add milk and a few raisins and walnuts.  Sure, it’s more carbs in one meal than I eat in 3 days, but it doesn’t contain sugar (beyond the fructose in the raisins).

When she wants spaghetti for dinner, we make her real sauce out of real tomatoes and garlic.  No added sugar, of course.

This requires extra work, as you can imagine. It’s much easier to dump cereal out of a box or pasta sauce out of a jar.  But if I need to sleep 15 minutes less or my wife needs to cut her run short 15 minutes to make it happen, is it worth it?  For us, the answer is yes. But, it is a choice – of both time and money – every parent needs to make.

Principle 3: Insulin and insulin-like-growth-factor (IGF) are important for childhood development

This topic is highly complex.  For anyone who has studied IGF-1, GH, IGF-BP3, STATb5, or any of the hundred other molecules involved in the highly regulated pathways of growth, don’t be offended.  It would take another series the lengths of the cholesterol series to give this topic its fair shake.  However, a few key points are worth noting.  There is sufficient evidence, for me at least, that a growing child needs a modest dose of insulin to capture their genetic (vertical) growth potential.  In fact, stunted growth is one of the documented side-effects of children on ketogenic diets, though there may be several factors accounting for that beyond the role of insulin and IGF (e.g., protein deficiency, caloric deficiency).

Ketogenic diets are a medically accepted treatment for recalcitrant seizures.  About half the children whose seizures don’t respond to any medications almost immediately stop seizure activity once they are in ketosis. Some investigators, including Dr. Elizabeth Thiele, Director of the pediatric epilepsy program at Harvard’s Mass General Hospital, are investigating this approach in adults.  I had breakfast with Dr. Thiele recently and had an amazing opportunity to learn from someone with enormous experience treating children with ketogenic diets (over bacon and eggs, of course).  According to Dr. Thiele, who described some really amazing in vivo and in vitro research, the reason for the effectiveness is not entirely clear.  That is, it’s not clear if the seizure activity is ameliorated by the presence of B-OHB (beta-hydroxyburyrate) or the stark reduction in glucose or the insulin, or some combination of these, or even something altogether different.

Of course, having too much insulin-like-growth factor is even worse.  There are numerous medical reports that describe the opposite “growth” scenario – too much IGF-1, for example, being associated with increased childhood malignancy.

Everyone wants to know if my (non-epileptic) daughter is on a ketogenic diet.  The answer is no.  If I had to guess, she probably gets 40% of total calories in the form of carbohydrates, and very few of them are sugar.  That said, she’s so used to seeing her daddy give himself “boo-boos” on his finger every day to check his ketone levels that I think she’s getting curious…but that will have to wait a long while.

Principle 4: Fat is fine

As much as you’ve heard me espouse the benefits of fat intake in adults, it’s equally or even more true in children.  As the Harvard anthropologist Daniel Lieberman points out, as we evolved from chimps to homo erectus about 1.5 million years ago, and to homo sapien about 200,000 years ago, we required an increase in our storage of body fat (from about 4-5% to 7-8% to 12-14%).  Why?  Most likely to support the requirements of our rapidly growing and developing brains.  At no point in our development is this more necessary than as children.

My daughter certainly consumes less fat than I do, but she still gets about 35-40% of her total caloric intake via fats – saturated, monounsaturated, and polyunsaturated.  Perhaps her favorite breakfast of all is bacon and eggs with cream cheese.  She likes to wrap a piece of cream cheese and scrambled eggs with a strip of bacon which she calls a “cooc-a-mooc.”  Don’t ask me how she thought of that, but she loves them.  She drinks whole milk (it’s always struck me as strange that the American College of Pediatrics recommends children switch from whole milk to skim milk abruptly at the age of 2), avocado by the truckload, and a wide variety of quality meats.

Principle 5: They are, after all, still children

My wife and I agreed a long time ago that we were not going to restrict our daughter’s eating when she was at birthday parties, on Easter egg hunts, out for Halloween, or on other “special” occasions.  A few weeks ago we took her to Disneyland for her 4th birthday.  (Anyone want to guess what it’s like for an ISTJ to spend 2 days at Disneyland?  Were it not for the look on her face, I’m not sure I could have survived.)  We decided, for these 2 days, she could eat whatever she wanted.  The day started with a bag of cotton candy larger than her head.  I couldn’t resist looking at the package to see that it contained 90 gm of sugar.  I did the quick math on converting that dose of sugar from her weight (35 pounds) to mine (165 pounds) and realized it was like me eating 450 gm of pure sugar in 20 minutes – the length of time it took her to inhale it!  That’s about 12 cans of soda.  She went on to have pretzles and cookies for lunch and, of course, a cake for dessert after dinner.

The entire time I was watching her mainline sugar – more in one day than I consume in a year – I couldn’t help but chuckle.  I sent pictures to my friends all day long.  In the end, she was pretty sick of all the junk she consumed and welcomed her usual meals. But, for a couple of days she ate just like most any other 4-year-old would on her birthday.

Principle 6: No two kids are the same

As you’re reading this keep in mind, this is an anecdotal account of my life and my child.  Yours will be different.  What works for our child may not work for your child or children.  Don’t worry about it!  In the end you’ll be the best judge of what the optimal zone is.  I really believe my daughter will live a healthier life because of the way she eats growing up.  One day, of course, she’ll have to make her own choices.  Will she completely rebel against everything we’ve tried to teach her?  Perhaps, but I don’t think so.  I really believe that kids are the product of the example set by their parents.

I used to always wonder where my tendencies came from. Not surprisingly, much of who I am today is the result of the behaviors I observed in my parents.  It’s my belief that if my daughter grows up in an environment where an emphasis is placed on eating well, it will become a natural extension of her behavior, too.


Photo by Foodie Factor on Unsplash

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  1. Ahem, I’ve got twins man. So principle 6 is a bit weird for me. 😉

    But great insight. When my 4 year old boys get back from Grandma’s, I just *try* to ignore the sugar stains on their teeth and food coloring on their lips…

    …but at home, the little beasts are already doing med ball slams and ladder sprints on the tennis court, eating liver for dinner and sardines for lunch. So the occasional cotton candy isn’t a big dent.

    • Ben, the only thing I worry about is that if you have twin 6-year-olds, does that mean in 4 years, they’ll be able to flip tires faster than me?

    • Delightful pics Peter. Thank you. I am the no sugar grandma trying to be a good example to three grandchildren. When they visit they are offered cheese, berries and sausage. I haven’t been able to encourage anyone to even look at a low carb lifestyle. A friend said yesterday they were planning to have fruit salad for dessert. I asked if she was going to put cream on top. Oh, NO!

  2. What’s not to love about waiting 70 minutes in line for a 5 minute ride, overpriced food, crowds of sweaty, loud people, morbidly obese folks whizzing around you in motorized scooters, and that disc of torture in the sky beating on your back for a good 8 hours?

    • And…I got the TWO-DAY pass… As my wife said to me, “Peter, every time you want to kill yourself, just look at her face and see what she sees…” Sure enough, it worked.

  3. Mahalo for the personal stories! Because eating is so personal and the social environment challenging, the personal stories of “coping’ are a great boost to morale. Reading your blog helps greatly in keeping the main goal in mind. I was stuck at 180 pounds for a year (that was reduction from a horrible peak of 220+), and the self sabotage was usually in a social context. For example, I’d lose weight for 6 days and put it back on with one restaurant meal with friends. I’m now at 171 pounds after doing super-low-carb—the low-carb broke the stalemate.

    I seem to have elevated creatinine (23 or so, on some scale, with 3-20 as normal). I’m not alarmed about that. Due to a heavy travel schedule, I intend to follow up on it in about half a year. Perhaps due to heavy coffee drinking, I seem to get dehydrated more often.

    Mostly, I’m happy to have broken a yo-yo pattern that lasted about one year. Your web posts and Gary Taubes’s provide major moral support!

  4. Hi Peter,

    Great Blog. Very Informative.
    I’ve got twin boys. My wife and I follow almost all the Principles you’ve outlined.
    And yup, no 2 kids are the same, even if they’re twins.
    I’ve been following a low carb life-style (Paleo/Primal/Rosedale) for almost a year and half and
    lost about 20% of my weight, all of which were fat weight.
    I’ve always wondered should I go low carb with my kids but somehow stopped doing so, as I just didn’t feel right and there was no data saying it’s good for children.
    Thank you for explaining it.
    And I agree completely that kids observe what the parents do, in fact, my kids has been asking why I’m not eating rice (in this part of the world, it’s our staple food), and they were intending to follow but told them, that they needed the energy to grow!
    Keep up the great content.
    God Bless You And Yours!

  5. Hi Peter,
    Not much to say. 1 – I agree with you on all fronts. 2 – We are very similar to you in the way we treat our daughter when it comes to food. 3 – Your daughter is gorgeous. Beware of sugar fueled boys.

    • Peter, thanks so much for the candid exposure. This is the kind of story that touches people and makes connections between reality and scientific knowledge.

      “Beware of sugar-fueled boys”… ahahahaha!! Beautiful.
      Well if you teach her to strike and run, her keto-adapted body will be able to outrun any sugar-fuelled boy as long as she wishes. 😉 This should take care of most kinds of assault (god forbid it from happening, but you never know).

      As to the influence of bad companies, I would place my faith in the good role model examples. After she’s experienced the truth, all else will pale in comparison.

      I’ve got a 6-and-a-half year old princess who loves to run and jump, and a 2-and-a-half year old thug who can already lift more than his weight with ease. I predict that my strength training and jujitsu practices may very well one day prove necessary when he gets to be a teenager and we “strongly disagree” about something… I’ll have to keep fit well past my fifties.
      So again, the role modelling is always absolutely required from birth, to avoid any fundamental conflict as much as possible. But differences will always emerge, I guess. Knowing that someday we have to cut them loose on the world and that this has always been true in the history of mankind doesn’t make it any easier. Oh, the anxiety. Breathe in, breathe out, count to one hundred. And by all means yes, look at their faces and see the world from their eyes. This can actually change the way YOU look at the world. Having kids… what a ride.

      But about the kids’ diet… I’ve been worrying about that for a long time, especially since my in-laws are a sugar and wheat fuelled bunch, suffering from all the classic problems of a SAD diet with “healthywholegrains” and such. And since my kids spend time with them every day, this can be a real problem. It’s taken a whole year and a half for the message to start sinking in, with me being seen as a total nutcase with a death wish who eats way too much fat and demands that the amount of trashy candy and liquid yoghurt the kids get is absolutely controlled. I let them have the occasional fries or white rice (they LOVE sushi), the infrequent bowl of pasta, and the very rare pizza, at least while I don’t see any signs of obesity or auto-immune attacks. And one or two squares of dark chocolate (>=70%) a day, as a treat after dinner. Slowly the kids are coming about. But the grandparents…

      The turning point came a few days ago, when someone I never even met came to my blog to thank me for having turned their life around (I write in Portuguese, translating the highlights and summarising and pointing back to the Paleo-leaders’ pages). When my inlaws heard the thank you message of someone who got rid of a bunch of auto-immune problems and undesired weight by dropping wheat after my advice, they finally started to think I was on to something. It was a hell of a year, constantly arguing about what is “healthy” for kids and what is not and why, trying to dispel all the food misconceptions our culture has and the general ignorance we all have, with them frequently sneaking behind my back to smuggle the kids some more candy and junk food.

      But finally, after much perseverance, we are starting to align. I can now relax and leave them all alone, trusting the grandparents to not go overboard with chocolate milk and flavoured liquid yoghurt. I hope. 🙂 It is far easier to naturally interest my kids on the “weird” breakfasts me and my wife have every morning than it is to convince the adults that the problem is the sugar and cereal, NOT the fat. They enjoy eggs and cheese and bacon and are growing to like the salads too. Detoxification is a slow process, but it works. We just need to have faith and persevere.

      I sometimes stand in awe of how robust the human body is; my kids were both fed some crappy supplement formula in the very first day of their life, without us even being consulted. It’s just something that is done around here (were this the USA, and we’d been very busy throwing lawsuits around, but it’s not, so we just deal with it.) Adding this to the fact that both were born of C-section and the constipation and bloating problems both went through was to be predicted – had we known at that time what we know now. Live and learn…

      But sure, parties are parties, so go ahead and go wild on the sugar stuff. And in the end, they observe by themselves how sugar binging makes them feel bad, and start controlling it by themselves. At least the 6-year-old is doing fine; she starts primary school this week and she’s been asking for “real food” items more and more by herself, often even shunning the savoury junk food right in front of her. When the body isn’t drowned in garbage, it asks for the nutrition it needs. I hope she carries on even after she starts hanging out in the junk food cathedrals with the other kids.

      Sorry for the once more enormous comment, but that’s how real life is: complicated.

      Cheers Peter et alia.

      • Thanks for the kind words, Vasco. Sounds like you’ve given this a lot of thought, also. I’m still in denial that my little princess will one day grow up…

  6. Dr. Attia I think most of your principles are spot on and can simply be described as “eat real food.” By the way, even tho your daughter has roughly a 40% carbohydrate diet, that would probably still be considered a low carb diet compared to what a majority of the country eats!

  7. Very informative post and particularly interesting since I have four young boys. We have this far taken a similar approach: cut out wheat, most grains, sugar, and processed food while at home, but the boys get these things when with other family and friends. I’ve been unsure about how hard of a line to draw particularly with the wheat since we have several family members on my moms side with celiac disease. Thank you again for sharing how you handle food with your family!

    On another note, your daughter is absolutely adorable! Love the pictures 🙂

    • Trish: We started our low carb (now more paleo plus dairy) journey in January. I have a 3 yo. In March, when my sister visited with family we all enjoyed a waffle breakfast (waffle, peanut butter with sugar and syrup). During her visit the last 2 weeks, we ate eggs every morning and her family pancakes/sugar peanut butter/syrup. I wouldn’t let my daughter eat the other grain based snacks/crap her cousins were eating. We did plan some treats (went to the ice cream shop one night). It was not an easy decision but I decided that I did not want my daughter to think it is okay to eat crap whenever we see family. In May we cut out grains and my daughter immediately looked different in her chest area (thinner) even though she was back to whole milk (was great for mommy too). It is a subject I had been worrying about b/c her 12 yo cousin is overweight and 10 yo cousin on the way.

  8. I have 3 children who still live at home and it can be a struggle at times to get them to eat in a somewhat healthy manner. They still drink whole milk and we don’t keep juice in the house. My daughter’s do have a sweet tooth and do eat more carbs than I would like. None are overweight and are taller than average. I make real food and they eat it, but I wouldn’t say their nutrition is optimal. As time progresses I do think things are improving however. Do you recommend a ketogenic diet for a child that is obese? My daughter has a friend who is severely overweight and I often wonder if this would help her.

  9. What a great post! I always wonder what’s optimal for kids and I’m glad to see it addressed here. Because my daughter, who is about to turn 3, eats very well in general (I mean, she loves healthy food) I tend to give her what she asks for, and to assume she actually needs the carbohydrates. For instance, yesterday she ate 2 bananas with her breakfast, after eating 2 pieces of bacon, a bunch of raspberries, and some plain yogurt. Assuming she needs the concentrated carbohydrates I also let her eat crackers when she asks for them, though I do start to feel guilty when I read stuff about the evil properties of wheat. Her dad has a lot of doubts about the primal /paleo/ low-carb stuff so he occasionally asks me to make sure she’s not being forced to eat like I eat. She has always been very tall for her age and her weight has always been at a lower percentile than her height. At her 1 year check-up her height put her at the 98th %ile and her weight was at the 78th, and the pediatrician told me to switch her to skim milk (at age 1!) to reduce her risk of childhood obesity. Since the recommendation about full-fat until age 2 is to support brain development I didn’t think it made sense to switch early because of her height (presumably brain development isn’t accelerated just because a kid is taller than her peers), but because of everything I’ve read since then I have no intention of ever giving her skim milk. When she was first starting solid foods I wanted her to have healthy stuff and not that disgusting baby cereal, so her first foods were hard-boiled egg yolk mashed and mixed with water, mashed avocado, mashed banana, salmon, saag paneer and barbecued ribs She also liked to gnaw on big pieces of raw vegetables like red pepper. People around me were so sure she needed cereal that I started to doubt myself and got her some baby cereal, and she was so disgusted! She hated it and spit out the first bite and cried when she saw the box. I was proud of her. We also started giving her real food at 4 months even though the pediatrician said to wait until 6 months, because she was very interested and clearly wanted food. Ribs remain her favorite.

    Thank you, Peter, for the fascinating post! I was glad to read that you let your daughter eat what she wants at birthday parties, etc., too–sometimes I feel guilty about that, but if we were to restrict her choices it seems like that might lead to sugar acquiring the lure of the forbidden and maybe make it more likely that she will choose to eat unhealthy foods when she grows up.

    One thing I am concerned about for the future is nutrition is school. In our area, kids in elementary schools have cupcakes or candy during class time once or twice a week.

  10. Great post! As I travel on this nutritional journey myself, it is nice to hear how one differentiates the lifestyle for the growing needs of a child. Reduce sugar – good for everyone. Fat is fine-very cool. Real food -fantastic. Luckily my son had years of breastfeeding (whole milk of course) and then whole cows milk later till three. But after he turned three years, the Canadian nutritional authorities still had me brainwashed into the “low fat milk” mindset so I still feel regretful about ages 4-6 feeding him partly skimmed milk. All is good now with whole milk for him at age 7 but you can only do as good as what you know at the time I guess. I look forward to NuSI helping to fill in the informational gaps that have steered us so far off course.

  11. Another excellent article.

    Child nutrition is a complex subject. I thought one of the better segments of HBO’s Weight of the Nation was the part about food marketing to children, though I think with a paradigm shift regarding what food are optimal, that this situation could be better.

    Tom Naughton had a very amusing post, thanking the USDA Guidelines Committee (and its food recommendations) for allowing his daughters to have an advantage.

  12. A great column and a nice perspective. A lot of my motivation for studying up on nutrition was to figure out where it’s most important to try to modify my kids diet (i.e. which battles are worth fighting).

    “No two kids are the same” and “I really believe that kids are the product of the example set by their parents” is tricky. After my first son was born, I believed both statements were true. Then my second son arrived. Very similar physically and raised in a similar environment but it’s hard to imagine kids who were more different in personality and behavior. The oldest will reliably follow my example and the youngest will reliably rebel against it.

    • I hear you… I know many folks who say the same thing. I’ll say this, he’s not yet grown. It will be interesting to see what your second does when he’s 30, and how much of that was grounded in what he’s observing now. Of course, I know little about this, so it would be wrong.

  13. I have a 3 year old and we do things much like you describe. After a run-in with pretty serious tooth decay on SHAD (the Standard ‘Healthy’ American Diet) at just over 1 year(!) we cut out all sugar and grains and limited fruit. We were able to forgo insanely expensive conventional treatment, not to mention the risks of GA, and the teeth are healthy as they can be today. And what do you know, my own lifelong problem with tooth decay also came to a halt. Outside of celebrations and some weekends with the grandparents, I’m strict about avoiding any sugary or flour-y food items.

    On the kid front, the biggest obstacle I’m running into is how relentless the stream of nutritionally lacking garbage is outside of our home. Once play group, play dates and now pre-K is in the picture, it seems like the only thing that parents and caregivers feed their kids is some variation on crackers or cake/muffin paired with fruit and juice for a beverage. I am SO relieved when snack time involves cheese or vegetables & hummus… but those days are rare. When it was our turn to bring in snacks I got whole milk and it was welcomed with surprise, like, oh we hadn’t thought of that!

  14. I have a 2.5 year old and I have been waiting for a post like this in the ancestral health community. Thank you for it.

    I am trying to keep him eating a paleo diet with some push back from my wife. I guess he’s pretty much there but eats a banana or apple every day which is higher sugar then other fruits, but it is dessert. Otherwise, it’s pretty much the same set up as your daughter except for a little orange juice mixed with water in the morning.

  15. Great post – thank you! I particularly like # 1 and # 2.

    My son is 16, 6’2” and “pure muscle”, and I can’t possibly force him to eat this way or that way. However, I don’t serve sugary/processed foods at home. And my son is fine with that.

    So, I control what I can, namely the food I serve at home, and I am sure that in that way I am helping my son make smarter food choices when he is eating out.

    When it comes to nutrition – and all other important things in life, I believe, parents are the key role models for their children.

  16. I don’t draw the same conclusions. In particular, I disagree with that a ketogenic diet (KD) is likely to interfere with growth.

    I think the main problem with the argument is conflating calorie restriction or protein restriction effects with KD effects. The former two are detrimental to muscle and growth, but that doesn’t imply the latter is.

    First there is the fact that KDs spare lean mass. This means that there is some mechanism that protects KD dieters from losing muscle in the manner expected with calorie restriction, even when calories are restricted. This study has interesting measurements: Effects of Dietary Carbohydrate Restriction with High Protein Intake on Protein Metabolism and the Somatotropic Axis —

    It says:

    “Results: Leucine Ra was increased (P = 0.03) after 2 and 7 d of LC/HP, and muscle fractional synthetic rate was approximately 2-fold higher (P < 0.01) after 7 d of LC/HP. Fat free mass was not altered by LC/HP. Average 24-h plasma insulin concentration was 50% lower (P 90% improvement (p = 0.004).”

    Another reason to be suspicious of claims that a KD impairs growth is that infants, who are growing tremendously, are naturally in ketosis most of the time. Relatedly, this study with infants on KDs –Experience With the Ketogenic Diet in Infants– reports that “96.4% maintained appropriate growth parameters”

    Finally, if KDs adversely affected growth, why would traditional Masai be some of the tallest people in the world?

    My take is that so long as protein and calories are adequate, we should not expect to find growth impairment on a KD.

    • Here’s a rat study that shows this effect, though I can’t judge it very thoroughly without seeing the full text:

      Extreme ketogenic, but not moderate, low-carbohydrate/high fat diets lead to loss of lean body mass in rats due to impairments of the GH/IGF system —

      “In conclusion, our data suggest that loss of LBM with LC–HF-1 was prevented by the rise in pituitary GH secretion, which might be triggered by low liver-derived IGF1 concentrations. With LC–HF-1, higher GH secretion resulted in increased muscle IGF1 activation of associated signalling pathways. In contrast, rats fed the ketogenic LC–HF-2 diet showed unchanged muscle IGF1 expression and loss of LBM, probably due to lower systemic IGF1 levels and normal pituitary GH output.”

      The difference in the diets, as far as I can tell from the abstract, was low protein in diet 1, and adequate protein in diet 2.

    • Hmm. I mis-copied the quote from Effects of Dietary Carbohydrate Restriction with High Protein Intake on Protein Metabolism and the Somatotropic Axis. The part I meant to draw attention to was this:

      “Leucine Ra was increased (P = 0.03) after 2 and 7 d of LC/HP, and muscle fractional synthetic rate was approximately 2-fold higher (P < 0.01) after 7 d of LC/HP. Fat free mass was not altered by LC/HP. Average 24-h plasma insulin concentration was 50% lower (P < 0.001) after 2 and 7 d of LC/HP, whereas GH secretion and total plasma IGF-I concentrations were unchanged with LC/HP. However, plasma free IGF-I decreased by approximately 30% after 7 d of LC/HP (P = 0.002), whereas muscle IGF-I mRNA increased about 2-fold (P = 0.05). "

      That is, even though blood IGF-I decreased, muscle IGF-I mRNA increased. So, like you said, it's highly complex.

    • Very fair point, Amber. As I said, this is a very complex topic, and it’s possible, as you suggest, that the huge confounding variable is hypocaloric intake and/or insufficient protein and/or some other factor. For example, we know that most of the kids on KD for epilepsy use a largely liquid diet. Perhaps this is different than a KD from solid food? My point, however, is that I don’t think a KD is necessary in (most?) kids because most are still “clean metabolic slates.”

  17. We have a few rules in our house: no fizzy drinks (except lemonade on special occasions); no biscuits, cakes, snacks or sweets kept in the house; a choice of sweets once a week after school, everything is made from scratch and always a dessert.

    the last rule is put in place by my husband as he cannot survive without a dessert. However we try to choose carefully and offer full fat ice cream or yoghurts. of course they contain sugar and I refuse to eat them – but I am not a child and I was the one with a weight problem.

    My kids are now getting to an age where they can make their own choices when outside the house. I can’t do anything about that – but I hope they have a good basis to base the choices on. They even complain that restaurant food isn’t as good as it is at home as it is often mass produced. Fast food is not something they would choose.

    My daughter also likes oats for breakfast with some dried fruit – but she likes apple juice on it….compared to cheerios, I think we are doing OK…

    Just educate them and offer good wholesome homemade food. the rest should take care of itself.

  18. Peter – I think you might’ve left an editing comment about cheerios in your post.

    I think your approach (specifically the focus on avoiding added sugars as much as possible) makes a world of sense for a child. Relatedly, when it comes to chatting with friends and peers about nutrition — especially when I’m forced to decline a sweet of some kind — my approach is to simply say that I’m watching my sugar intake. This seems to be about the only nutritional intervention for which there is nearly unanimous agreement, even if it is routinely undermined by fat-phobia.

  19. Peter, your timing on this post is perfect. I’m about 8 weeks into my new eating life thanks to you. I’m 6′ 1″ and weigh 200lbs. When I began limiting carbs I weighed in at 240. When I found your blog, I was 220. Looking forward to getting below 190lbs. Having three kids, 4yo twin daughters and a 8yo son, I’ve started to wonder hmmmmmmm at what point should I consider tweeking their diets. Our son has started asking ” why am I pudgier than my friends”(poor little guy has inherited his daddy’s genes). We’re already pretty careful what they eat and are lucky they all like healthy food(except the smallest of the three, she loves her salad and fish, but would live on bread and rice and chocolate if we let her).

    When you say: “I really believe that kids are the product of the example set by their parents” I agree with you, but I think the whole “nature vs nuture” is, like most things a continuum. Fraternal twins are amazing to watch in this regard. Our daughters couldn’t have come out of the womb any more different; one is much bigger and “softer”, really uncoordinated and wakes at 05:00 everyday. The other could sleep forever, is tiny for her age, very thin, loves carbs and is the most coordinated member of the family. As far as temperments go, whew, from different planets.

    Lastly, the comedian Jim Gaffigan has a great bit about kids and going to Disney in his latest show(on netflix streaming).

    Thanks Peter, I’m on my way to being “former fit but fat”


    • Oh, boy, don’t bet me started on Jim Gaffigan…have you seen his bit on Hot Pockets? I’ve watched it 30 times and I laugh out loud every time.

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