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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264 Comments

  1. Great post, thanks.
    I pretty much agree with all you say, but we do take it a bit further with our 2 girls (almost 4 and almost 6). Some of it is necessity for my health (being Celiac triggering from gluten and corn), we keep the house almost totally grain free — with the exception of organic frozen corn (fresh when available) and very rarely rice noodles for the girls. When it comes to birthday parties I bring the girls their own cupcakes and grain free pizza (yay for Against the Grain frozen pizzas!). I also bring along 2 organic lolipops in case a sugar treat is given. I’ve been talking to the girls about bad/toxic chemicals in our food for so long that they typically take it in stride. We have gone to Disney many times (we lived in FL) and I would bring lots of food in a cooler for them to eat plus bring a bit of organic lolipops, or organic gummies — but only very special occasions do they get this junk (as even the organic is junk, just w/o the chemical food colorings and GM sugar!). We do full fat raw milk, and farm sourced pastured meats. However, it isn’t all rosey, my little one is definitely a sugar/carb addict and only wants the junk; it is also about impossible to get her to eat meat and she’s just given up the milk too! So, we just keep trying, offering and explaining that she must eat her meat and veges to be strong, healthy and happy. Happily raw milk yogurt smoothies (where I can hide egg yolks, soaked nuts/seeds, and more) are a hit — my Vitamix was so worth it!
    Thanks for the great work!

  2. What a great post! This has now become my very favorite website. Thank you so much for your contributions.

    I was slim all my life until I bought into the low fat dogma in the early 1980’s, leading to OBESITY. But I kept doing it because my doctor and every diet book out there at the time told me to eat low fat, high carb. And man, I counted every fat gram.

    And they say the definition of insanity is doing the same thing over and over again and getting the same results.

    Thank goodness I came to my senses. I will be 60 this year, but better late than never. So grateful for Dr. Rob Thompson, Gary Taubes, and numerous others for waking me up and helping me regain my health. And my husband’s triglycerides have fallen into a normal level ever since abandoning high carb/low fat, and sugars!

    Keep up this great website! Thanks!

  3. I also recently saw the TED video, and m now devouring the blog, it’s brilliant, and I’m loving it. I’ve been Low Carb for several months and the change in my weight and energy is obvious, people are commenting on it! (I wasn’t actually very overweight before, but my body shape has changed, I’ve lost my “middle aged spread”)

    I am gently tweaking my childrens eating habits, I’m coeliac so our we rarely have wheat in the house anyway, but I’ve consciously reduced their consumption even further. Our only failing is my baking. I bake killer (gluten free) cakes and cookies, and I’m now reducing this to special occasions, rather than a regular weekend activity.

    So, now that you’ve started this ball rolling, when are you going to take on the Baby Formula industry? And puréed weaning foods? Our Western eating habits need to be re-written from birth, how we expect our children to grow into healthy adults when they are fed on modified cows milk and slops as babies is beyond me!

    • It breaks my heart… 6 months old babies, whose parents have the best intentions, can easily give their children 50 gm of sugar a day via formula and pureed food. Fat phobia has some pretty tough consequences.

  4. Hey Peter,

    Thanks for the speedy reply! When it comes to baby formula and pureed foods the sugar content isn’t the only issue. Breast milk is very sweet, with high levels of lactose, but a baby that’s nursing on demand will tend to eat little and often, rather than the huge volumes at 3-4 hourly intervals you see formula fed babies being given. This raises the issue of appetite control. An 8oz bottle of formula will stretch the stomach of a 5 month old baby, but it’s quite common to see babies as young as 3 or 4 months being coaxed into finishing this amount of milk from a bottle. Feeding pureed weaning foods also over-rides appetite control, a baby will eat far more pureed food when spoon fed than if they are given whole foods and allowed to feed themselves. ( http://www.rapleyweaning.com/ ) Add to this the fact that most pre-prepared “jars” are bulked out with various carbs and you are setting a child up for over-eating and carb-cravings.

    I look at this stuff from both a scientific and common sense point of view. I ask; What did our ancestors eat? The answer to this is simple, meats, vegetables, nuts, seeds, fruits, and very little if any grains. Cave men didn’t feed their babies on the milk from another species, or mush up baby food (very few magimix blenders have been found in archaeological sites!) yet their children grew into adults and they had healthy teeth, the research done by Brian Palmer ( http://www.brianpalmerdds.com/ ) shows this. If we think about what evolution designed us to eat, and add our modern scientific thinking to the concept, we won’t go far wrong.

    Keep up the good work….

    • Hi, I kind of agree on the baby formula thing. But I dont know what else to do. My doc has no intentions of changing that. Breastfeeding is not possible due to mother having some medical complications.

      Searched the web, contacted lot of people but i dont see any other option. My baby is 2 weeks old and I dont know what to do other than feed her enough forumla to maintain weight gain ratios according to the doc

  5. Hi Peter,

    Thanks for the candid post. It’s heartwarming to read about the wisdom of sugar reduction from kids’ diets. I have 2 young ones (7 and 5). Our family is working on some of the same dietary challenges.

    My question [bluntly] is “how low-carb is your wife’s diet”? I was recently on a very carb restricted regimen after having gained about 15 pounds with a back injury. My hormonal cycles went haywire. I was told it was probably because of all the estrogen being released from my fat cells and that it was temporary, but things got bad enough that I ended up adding fruits to my diet while still restricting grains. All is well now, but the experience left me wondering whether the female body responds differently to extreme carbohydrate restriction.

    Any ideas?

    • My wife (and daughter) probably get 30-40% of their calories from carbohydrates, though very few are what I call “cheap” carbs. Lots of fruit, vegetables, limited grains.

  6. Dr. Attia,

    I’m so excited I found your site. I have thought for years that obesity is the result of insulin resistance. I am insulin resistant and was diagnosed with PCOS when I was 23. (I am 39) I try try try to eat clean and sans grains at least Mon-Fri – it is very hard, but I’m pretty good at it. Lost about 10 pounds this year and I must say I started Metformin – 500 mg per day and it has helped me – really control that need to eat more. I am VERY resistant. (I’ve tried to up it to 1000mg and my stomach can’t handle it) Very sensitive to carbs. My BP and cholesterol are all very good though. Just need to lose 20 pounds. I digress. My post is actually a question about nitrates. I have 2 small kids and have read negatives about nitrates and children in particular…linking them to cancer. I started buying uncured nitrate free deli meats and bacon. My hubby is from Italy and my kids could eat salami all day long. It freaks me out with the nitrates and was just wondering if you could address that. Do you buy nitrate free or do you not worry so much about that? Especially when it comes to your daughter?

    • Jessica, the evidence implicating nitrates is pretty weak in my opinion, but it’s always reasonable to invoke the “precautionary principle” — what is the risk of avoiding X? In the case of dietary fat, for example, this has shown to be problematic, as one tends to substitute simple carbs for fat (a la the U.S. population since the 1970’s). In the case of nitrates, though, it seem reasonable if you can afford to be the more expensive stuff.

  7. Hi Peter,

    i didn’t see your response until today, thanks. i wanted to update you and anyone else in this world. Oliver has done amazingly well on a keto diet. I cannot describe the change in his development and people would really need to understand him to see what has happen on the autistic front. for the epilepsy we have dropped his meds slowly and are currently at 1 third of the levels and due to drop again next week (we make a small change and wait a month to see if there are negative affects, when we tried this before changing his diet he had a 150 minute seizure, few can imagine what it feels like as a parent to watch you child have a fit to two and a half hours)

    Anyway, the cost saving to us in medication is over $300 a month.

    He has also put on weight and bulked up with muscle. this was a very interesting side effect as our biggest worry was he would get too skinny (after all most people here including myself went keto to lose weight). He is incredibly healthy. i just wish my wife would let the other kids eat like this.

    thanks peter and keep up the good work.

    Chris.

  8. Hi Peter, thanks for your talk on TED, very moving. I was wondering what you are thinking of the China study and veganism? Thank you, all the best to you! Nina

  9. Hiya Peter,

    How I WISH we had somebody like you here in the UK! Our ‘healthcare’ system is… Well, it isn’t – and I’m suffering because of it!

    I lost 22.5st (315lb) eating LCHF. Prior to that, I was 30 stone (420lb) and before THAT, 24 stone (336). Why the 6 stone (84) difference…? Simple. Before I learnt ‘The Truth’ as I call it, I was sent to a diabetes dietician (I have PCOS and, probably because of that, I was MO and diabetic). She had me on a strict 1,200kcal/day diet, of which around 80% was carbs (and you know the rest…). She also insisted I swap cows’ dairy for Alpro (probably the UK equivalent of your Silk) because, she assured me, it would “vastly increase and speed up” my weight loss. Not only was I to drink soy milk, I was to eat soy ‘yoghurt’ and eat soy ‘cheese’ (it’s DISGUSTING stuff!). I quit it the nanosecond I learnt what it was doing to my body, but it was obviously FAR TOO LATE as I’m now suffering from hyperthyroidism.

    Three years ago, I was admitted to hospital with severe abdominal pain; as I don’t have an appendix anymore, there was only one thing it could be: – gallstones! I was ordered to eat a VLF diet which, obviously, I flatly refused to do. Anyway, they seemed to settle down again, and I went on my merry way eating as I have done for the past 8 or so years.

    Last year, I began passing out after I’d eaten, and my pee looked like very strong tea, so I surmised I’d got one stuck in my common bile duct. I went to my GP and told her what I believed the problem to be. Now, stupidly, I made the mistake of telling her how I’d lost weight (it’s an all-female practice and they are ALL pushing obese, or obese!) so the first thing she said to me was “I’m not surprised! You’d not be suffering like this if you’d done what you were told to do!” She was right about that – I’d probably be suffering far, far, FAR worse!

    I’ve been told that I CANNOT have any further treatment UNLESS – AND UNTIL – I’ve been adhering to a VLFD for “at LEAST 6 months” which, obviously is something I won’t be doing not now – not EVER!

    So, I’ve spent the last 2 years (almost) confined to bed. My diet sucks because I’m in too much pain to repeatedly climb the stairs (if I do have to go downstairs, I’m crawling down backwards and vice versa). I’ve been forced to live of things in tins (tuna, sardines, mackerel, salmon mostly) and I can manage to eat goats’ double cream (48% fat) and sheep’s yoghurt (4.8% carb/5.8% fat) but by far the worst thing I eat is mayo (it’s made with rapeseed and EVOO, but it’s still not good…).

    I’ve had to watch the muscle I spent YEARS acquiring melt away, I’m losing my hair, I’m permanently exhausted (not fatigued, but lethargic), I’m living in the bathroom, I’m constantly hungry (everything I eat just just goes straight through me – I look permanently 6 months pregnant!)

    If all that wasn’t bad enough, I’m also severely autistic, and I get NO SUPPORT from ANYONE – and especially not from my folks (they’ve made it quite clear they’d really rather I didn’t exist). Despite the fact that they WATCHED me lose weight eating LCHF, they STILL refuse to believe it’s healthy (so concerned was my dear mama about it that she asked her GP whether it was healthy – and you can guess what her response was!). My folks believe EVERYTHING their GP tells them – they don’t question ANYTHING (without being too graphic, I’m sure if she told them that drinking their own pee was healthy, they’d do it!).

    So, because they’ve been told by their doctor that what I’m doing is basically going to kill me, they refuse to support me (“You can go ahead and kill yourself if you want, but we’re not going to be party to it!”) which I guess, in a backwards kind of way shows they care, I guess – well, either that, or they don’t want to be held responsible for my untimely demise…

    They blame my diet because, to quote my mother again “We don’t eat like you do and we’re perfectly healthy!” “Perfectly healthy” is relative; my father is on 80mg Lipitor and is extremely overweight (no doubt in no small measure due to the statins) and he’s DEFINITELY beginning to suffer from what I call ‘statin syndrome’ – arthritis, memory failure, definite mood changes (he’s always been his father’s son – his father was as irascible as they come! He’s also got this permanent dry hacking cough and I don’t know what else to attribute it to BUT the statins.

    Their diet is terrible; grains, starches and sugars at every meal (cereal, pasta, plenty of cakes, biscuits, granola bars, etc) and my mother is addicted to these yoghurt-coated puffed rice, dried apricot and almond bars; 50g each, around 40g carb. My father will easily eat an entire tube of Pringles in one sitting (my mother thinks she’s being ‘kind’ by fuelling his addiction). I’ve given up on them; I once asked my mother why she was so terrified of fat “I just don’t like to eat a lot of fat, alright…?!” When pushed, I get “It’s just the way I grew up, we didn’t eat much when I was little (she’s 65) and I can’t eat a lot, it makes me feel ill!” So they continue to shove junk down their throats (but, provided it’s low-fat/fat-free, it’s healthy).

    The last time I saw my own GP, she had a LighterLife shaker on the windowsill in her office; now I don’t know if you have LighterLife in the US, but it’s one of those evil MRP diets – and they’ve adopted that stupid ‘5:2’ protocol now (LL STILL refer to the 2 half-cal days as ‘fasts’). If your BMI is more than 30, then on the non-fast days, you have 4 sachets of their artificially coloured, flavoured, and sweetened gunk (containing no less than FOUR types of soy, aspartame, sodium saccharin, and sucralose) or 3 and a bar (the bars are pure junk) and on the fast days, you’re only allowed 2 sachets. Each sachet and bar is just 200kcal. So my GP is, evidently, attempting to do her job on 800kcal a day! 800, nutrient-free, calories at that! I know they claim to contain “all the vitamins and minerals of a healthy, balanced meal – but without all the calories!” but how good the quality of the vitamins and minerals is, I’ve no idea, but I’d suggest it ain’t THAT good…

    The NHS blames just about EVERYTHING on (saturated) fat and/or cholesterol: – CHD/CVD, stroke, type 2 and 3 diabetes, most cancers, liver disease, kidney disease, gallstones – you name it, eating fat caused it. Their dietary advice states that “at LEAST a third of your calories must come from whole grains, and starchy carbs. Yes, “at LEAST”, just as I’ve typed it – in other words, more is definitely better…

    NOBODY believes I’m telling the truth (what’s that Mark Twain quote…? “It is easier to fool a man, than to convince him he has been fooled…” They trot it out in relation to other things, but won’t believe it when it comes to diet!). I’ve FB friends being poisoned with statins, and NOTHING I say will convince them they ARE poison. “Cholesterol is evil and must be eliminated” is the NHS’s mantra.

    I know you can’t really help me, matey-dude, but I’m at the end of my rope – I’m SERIOUSLY considering giving up; 2 years ago, I was a fit, healthy, active 38-year-old – now I’m confined to bed! If I cold afford it, I’d GP private, but I can’t (I’m on disability benefits (welfare)). I’m at the mercy of a system which won’t help me because I refuse to conform (one of my mother’s favourite words). But I’m NOT going to compromise my health further by taking advice which I know damn well would not only increase the size of the stones, but cause me to pile on the pounds again!

    I know of private GPs who used to work in the NHS, but were hounded out for refusing to a) stop advocating LCHF and b) refusing to script statins. You are NOT free to practise, you MUST stick to the rules!

    Right, I need to attempt sleep again now (my parents have a couple staying who have a 6-month-old son – and that kid has a scream like a foghorn!).

    Thanks for reading, I know you can’t help me though…

    Sarah X?X

  10. Peter,

    how come human milk is made of so much carbs, if carb is bad for us? One could assume that human milk have everything a “young” human needs and that it is ideal for growth and “performance” of a young body. Yet, it have a lot of carbs, speaking in % compare to fat or protein.

    • 1. The needs of a baby are probably different than the needs of an adult. Do you sleep 20 hours per day, for example?
      2. The quality of carbs is the issue. The sugar in milk, for example, is not the same as the sugar in, say, a soda.
      3. Who said milk is bad? If you want to be in ketosis (as an adult), milk can’t be a large part of your diet, but that says nothing about the merit or harm of milk.

  11. Great blog! Love all the information you provide here. I am just starting to get really strict with low carbing for myself after losing 36 pounds over the last year by doing around 100g of carbs a day. My husband and I have two boys ages 4 & 6. I must admit, since they have been eating “regular food” (non baby food), they have had a fairly high intake of carbs (my oldest LOVES goldfish lol). They are both fairly picky eaters and while I do try to cut sugar where I can (sugar free syrup, sugar free jelly, natural peanut butter, no juice except on special occasions etc), I feel like I have hit a wall with them and food. They love peanut butter & jelly sandwiches, and my youngest loves fruit snacks and crackers. Any advice on getting two picky eaters to eat more eggs, cheese, meat, veggies, etc? They do love fruit (apples especially, and oranges) but not so much vegetables. Do you know of any sugar free kid friendly food? Like sugar free fruit snacks for example? I greatly appreciate your feedback. Keep doing good things, hopefully the mainstream medicine/weightless industry will come around. Thank you again!!

    • With kids I suspect the most important rule is this: if it comes in a package, minimize it. More carrot sticks, fruit, snap peas, celery sticks with almond butter, real cheese, etc.

  12. I have to say, this website has been the most exciting forum I’ve encountered in some time. Dr. Attia, your efforts in personal research, literature review, analysis and writing are so enriching. I get the benefit of a bright, passionate man who spends hours of his time and mind, then distills it all in such an original, objective manner. It is truly appreciated. I’m glad to hear my shared concern over the destiny of this once great republic. We threaten to collapse history’s greatest nation over our pie-hole choices. You may help avert this tragedy; I sure don’t see any other entity who can. We need an informed, valid consensus on our physiologic diet. Though I hope we’ll make these changes voluntarily, with the information. I’d hate to think a government would impose the ideas of whatever most powerful lobby may prevail in coercing their views upon the public. Seems unlikely now, but as we become subjects of the nanny state, government guidelines could evolve so. I always wonder how long before the socialist democracies outlaw cigarette smoking and the like, in the interest of cost savings. Thanks again, Craig.

    • Thank you, Craig. I’m not sure we ever need to outright remove these harmful agents (e.g., cigarettes), but we sure as hell shouldn’t make them the default. Today, tobacco is no longer the default. I long for the day when we can say the same thing about our food choices.

  13. Reading Principle 4, it reminds me of when I switched to high fat, low carb, a little over a year ago. I was speaking with a Dietician about my son, who was 1 at the time. She was asking me what I fed him and I responded that he drank lots of whole milk, which she agreed was good because the (saturated) fat was good for brain development. Then I got to the fact that he consumed coconut oil in the smoothies I made him, and all of a sudden that(saturated) fat was the fat that would give him heart disease. When I asked what the difference was between the fat in whole milk compared to the fat in coconut oil, she didn’t have an answer. Just makes me laugh and even more sad, because unfortunately we have doctors and dieticians making dietary recommendations that tend to contradict each other.

  14. Hi Peter
    Your Blog is a tomb of useful information for which I am very grateful.

    My question relates to children with ADD. Andreas posted this http://www.dietdoctor.com/why-20-percent-of-boys-in-america-get-adhd which suggests a link between diet and cognitive function. There was also an article in Psycology Today http://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones which hints at neuro toxicity which is reduced with NK.

    I have a 10 yr old son who is distracted at school and we as parents have seen all the professionals and spent the money and ended up where we started. Our son has been on Ritalin without much success and I don’t believe it results in a healthy balanced child. He is now off the drug and is marginally behind his peers in the classroom. I will be trying to reduce his carbohydrates and follow a NK diet for him testing his vitals and making sure he doesn’t flag in other areas. If you have any opinion on this or any insights I would love to hear them.

    • Matt, I can imagine this is frustrating. I don’t think we have enough evidence to say that NK is the ideal (or even necessary) treatment in this setting. I do wonder what would happen if you tried something less draconian (though still very difficult in a 10 year old boy) — what about just eliminating sugar and refined carbs? Let him eat steel cut oats, fruits, veggies, rice, potatoes, but none of the “cheap” carbs and added sugars. I wonder if this would improve things in more (dietary) sustainable way? It might be the case that ketones, per se, make a difference. But I am not sure.

  15. Thanks for your comments, yes for sure that is a great place to start. I have started a blog to document the process, partly to motivate myself and partly to keep track of progress or regress… I have a friend who does a lot of research into fetal alcohol syndrome (common here in Cape Town) who will hopefully help keep track from a neurological standpoint.

    I will start with the sugar, carbs and get a higher % protein and fat into his diet and see where that takes us. Will post a link to the blog once there is something useful to read, thanks again.

  16. I just found your blog, and have spent hours reading through various posts. Thank you, thank you, thank you!!!

    My son is 13, 155 lbs, but 5’11 and very muscular now.

    Last November, he was sent home a “fat letter” from the nurse at school, and stated that he had acanthosis nigrans. Now, this child has been swimming 6 days a week for years, but still very chubby. I think he weighed the same as now. We didn’t know better, and spouted the whole carbs etc. that is so prevalent in the swimming world. His pediatrician had never really commented on his height/weight except to say he was off the charts in height for his age, but high in weight. After much panic and another visit to the pediatrician -this time he told us to stop anything “white” flour, sugar, rice etc, and add some sort of conditioning/weight program. He had read “Wheat Belly” by Dr. Davis, and suggested it to me. It was the beginning of a huge life change. Fast forward to this July- last visit showed no acanthosis nigrans. The Dr. almost cried, and said in 20 years of seeing patients, my son was the first patient, to show such a abrupt change. I have searched high and low about how low carb to go with kids, obviously don’t want to slow down his height growth, but have found very little. Reading this post, and all the wonderful comments, just warmed my heart. My friends all think I am nuts, but can’t quite fathom how his body has changed either. Now, the boy isn’t perfect, but he has seen the change food makes in his own body, and performance in the pool. Husband not quite on board, keeps wanting to give him bananas etc., but all I can do is try and educate (and send him a link to this blog!!)

  17. Hi Peter,
    I am a fellow doc and parent of two little girls 8 and 2. I really appreciated this post because highlights the reality of what we as parents go through and the daily choices that we make that truly matter. I have always struggled with an excess 20 -30 pounds or so. When I had my first daughter (during residency) I felt a deep responsibility to give her the best shot I could at health so she would not have to struggle they way I did. I didn’t quite understand how I should be looking at macronutrient composition at all (despite several graduate courses in nutrition) but I had a few pretty good ideas: 1. keep her naive to sugar as long as possible. (I managed this until about 3 years of age) 2. provide an appealing variety of home cooked-from-scratch- food. 3. When she got old enough, have lots of talks about why we make certain choices.

    I never eliminated foods from the home like chocolate or candy, I wanted her to learn to make the good choices herself and not just make the choices for her all the time. This is a bit of an art and quite an effort but is proving worthwhile. The other day someone offered her hot chocolate and she said “I better not, I had a popsicle yesterday.” I think this was my best ammunition against the onslaught of sugar in school and camp.

    Today she is 8 and has lost all her baby fat 🙁
    She has a lean and strong body and never stops moving. She loves my lunches (we do a bento box too) and won’t touch school lunch. Today in fact she asked me to pack her a snack to go to a birthday party because “They won’t have any food there that I like.” That was a proud moment. She has had her share of cupcakes, but she is not addicted the way I think I was at her age.

    But before I can declare victory, in walks my 2 year old. She, thanks to big sis, has been introduced to sugar for a year or so already. When she hears the crinkling of wrappers she shouts “CHOCKY!” (chocolate) Most veggies are promptly catapulted from her highchair at whomever had the nerve to present her with them. I was so cocky and I guess this kid had to set me straight. Nevertheless, since reading your blog and a few other things, I have shifted my thinking from fat phobia to embracing fat. I realize that I have a secret weapon. FAT! A hungry 2 year old at breakfast gobbles up eggs with cream. Whipped cream and strawberries anyone? Even cauliflower mashed with cream, butter and cheese at dinner. There is no room/desire for CHOCKY on most nights!

    Life is so hectic and so busy. It’s such a relief to know that my own health issues were not some sort of moral failure. That it wasn’t just a matter of trying harder, running more and eating less. It’s so empowering to know that I can do quite a lot to prevent myself from becoming another example of metabolic disease. My dad has been diabetic for 25 years and I have experienced the toll it has taken. It feels great to know that I can do something for my girls not to have to worry for me the way that I do for him.

    Anyway, that was a long aside. I am grateful to you for your work. As another aside, my area of interest is in cognitive function. I would be remiss If I didn’t mention how many fascinating things could be studied. On a somewhat subjective note, I have found that when in ketosis, my working memory (measured by simple digit span) and processing speed are much better. I think my attention is somewhat better and short term memory is about the same. Neat stuff!

  18. Peter,

    Thank you for your analysis of ketosis related scientific literature. I am devouring it as quickly as I can. Given my specific area of concern, this seemed like the best post to begin asking questions.

    My children (3 and 5 years old) have multiple polysaccharidase deficiencies and, thusly, are on a very low carbohydrate diet. We have eliminated all sucrose and lactose and severely restrict starch. We suspect a potential fructose malabsorption or HFI and are restricting (but not eliminating) fructose accordingly. As you can imagine…they are very carb restricted and will be for the foreseable future. Whike they are carb deprived, I am starving for information.

    I have bookmarked some of the links in the comments above, but am hopeful that you might be able to direct me to appropriate resources, as well. I really want to explore the available research (if any) on nutritional ketosis in children in relation to cognitive and physical development. Much of it (excluding the Inuits) won’t likely address diets that are as restricted as my guys’, but a jumping off point would be invaluable. I should add that I’ve read a bit about ketogenic diets in relation to epilepsy control, but briefly abandoned that for more pressing concerns when I saw their formulas. It didn’t seem particularly relevant at the time, but I intend to revisit it now that I’ve exhausted the body building forums and have run the gamut with Paleo, Primal, SCD, and GAPS.

    I’m not a biochemis (my background is developmental psychology), but I am able to follow (to some extent…once I dust off my A&P and Chem memories) your scientific descriptions in your keto series.

    Thank you, again, for all of the invaluable information and analysis you provide! If your goal is to help people make nutritional decisions…

    You are a very succesful man, indeed.

    Suki

    • You’re definitely, right, Suki. The formulations in the typical epilepsy protocols are pretty bad, and not at all representative of what a well-formulated KD can look like. Unfortunately, we don’t have great (any?) data on long-term use of KD in kids. My gut says, restriction of sugar and simple (e.g., high GI) CHO may be sufficient without the need for ketosis.

  19. Hi Peter:

    I started eating low carb just over 7 months ago and am really doing well with the new lifestyle. I’m losing weight slowly but steadily, so I can’t complain. But that’s not interesting. What’s interesting about me is my family. I have a 14 year old boy and 8 year old twin boys. The 14 year old and one of the twins are Type 1 diabetic (my eldest was diagnosed at 27 months old) so we have been “doing” diabetes and carb counting for over 12 years. There isn’t a lot of sugar in our household (we have NEVER done juice or pop and we don’t do desserts) but we don’t restrict the boys’ carb intake (I tease them that there isn’t a “flour and water product” out there that they don’t love!) One of the main reasons that I decided to start and stick to a low carb lifestyle was that I wanted to model low-carb eating for my diabetic boys. They are all lean and healthy, but as I’m sure you know, injected insulin is not a fun drug to mess around with and the less you have to inject, frankly, the safer and healthier you’re likely to be in the long run. We have just started using low carb as a method for allowing more independence for my teenager (with the idea again that the less injected insulin there is while he is away from us – overnight for example – reduces the risks of adverse side effects). So far so good – I really like the fact that all of my boys regularly remark about the differences between what’s on my plate and what’s on theirs, and they understand that I’m carb restricting and why (of course – my boys have known about carb and carb factors practically since birth – we are an odd family). My question, however, is about my husband. He’s an amazing athlete, 51 years old, VERY lean. He believes in the principles of low carb, but he just CAN’T do it. When he reduces his carbs, he starts to disappear (and he’s already a very small guy – think Tour de France mountain specialist type guy). He needs to eat very regularly throughout the day, and while exercising, or he bonks. He probably works out (hard) 1-2 hours per day, with 3-6 hours on weekend days. So – I guess I’m interested in what your wife eats? I believe you said in your Ted talk that she is a lean athlete as well. Do some people simply need carbs? Is there still metabolic damage being done?

    • My wife probably gets 40% of her calories from carbs, but probably consumes about 25% of the sugar of an “average” American. He sugar comes in dark chocolate and probably some in the bread she eats. She’s obviously nowhere near ketosis, but eats very well.
      I’d be curious how your boys would do on Generation UCAN’s super starch.

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