February 15, 2012

Nutritional biochemistry

How can carbohydrate restriction be healthy if it means limiting “natural foods” like fruits and vegetables?

Read Time 9 minutes

This week I’d like to tackle one of the most important questions that I get asked.  However, before getting to the question, I think it’s worth investing a few minutes to frame this discussion around a theme tightly linked to it — sugar.

If you’ve been following the nutrition news lately, you may have noticed that Dr. Rob Lustig has made some headlines.  If you’ll recall, Dr. Lustig is arguably the world’s expert on fructose (i.e., fruit sugar) metabolism, and I included a link to his now-gone-viral YouTube video on fructose toxicity from 2+ years ago in my post, Sugar 101.  In the February 2nd issue of the journal Nature, Dr. Lustig and his two colleagues make the following case:

  1. Sugar consumption is linked to the dramatic rise in obesity, diabetes, cancer, heart disease, and Alzheimer’s disease (i.e., the diseases that cluster around metabolic syndrome).  Effectively, sugar speeds up our aging process.
  2. The metabolic effect of sugar, and fructose in particular (fructose makes up half of sugar – sucrose is 50% glucose, 50% fructose; HFCS is 45% glucose, 55% fructose), is nearly identical to that of ethanol (drinking alcohol).
  3. As such, sugar should be regulated in a manner commensurate with the damage it causes.

Let me lay out a few facts.  First, our consumption of sugar is increasing at a staggering rate.  We consume, on average, about four times the amount of sugar today that we did 40 years ago, even though our consumption of sucrose (the white crystals) is going down.  How, you ask?  Because we have more than made up for it with the ubiquitous addition of high fructose corn syrup (HFCS) to darn near everything we eat (e.g., cereal, pasta sauce, salad dressing, virtually every form of “low-fat” food out there, condiments).   Remember the “Peter Principle” – when you see “low fat,” run the other way, as it is almost synonymous with “high sugar.”

The figure, below, from the Nature paper shows the amount of sugar (excluding fruit) that each country produces, in per capita figures.  If you factor in fruit, obviously the numbers are much greater.  A quick glance at this figure shows that (excluding fruit), the U.S. is the reigning undisputed champion of sugar production at over 600 calories per person per day, which means over 175 gm of sugar per person per day, (excluding fruit and fruit juice).   To fully understand why we produce so much sugar requires a discussion beyond the scope of what I want to write about today, but I’m sure most of you already have a pretty good idea: economic incentives.

There’s another interesting observation that can’t help but poke you in the eye when looking at this figure.  How many times do you ask (or get asked), “Why do some cultures eat carbs like rice and not get the same diseases we do?”  A quick glance at China, for example, sheds some light on this.  They may eat rice, but they sure aren’t producing (or eating) much sugar, on average.  Furthermore, the distribution of sugar consumption within the country is wide.  In other words, while the few wealthy people do eat amounts of sugar approaching Western amounts (along with other simple refined grains), the vast majority of non-wealthy inhabitants do not.  So while some have asserted that animal products and fats are the clear culprits explaining the different disease patterns in Asia, they’re missing this important point:  Given the absence of mechanistic and evolutionary reasons why animal products and fats are bad for us, is it more likely that sugar consumption is the single biggest factor differentiating the state of disease across these populations?


Global sugar glut Nature Lustig paper figure
Image credit: Lustig et al., 2012 in Nature

So what’s the upshot of this graph?  Well, for starters we eat a lot of this sugar.  Second, we export it, too.  This wouldn’t be a problem, I guess, if sugar were not so harmful.   How harmful is sugar?  For a long reminder, read Sugar 101.  For a very quick (by proxy) explanation take a look at the following table, also from the Nature paper, and previously presented by Lustig.


Table 1_Lustig Nature paper
Image credit: Lustig et al., 2012 in Nature

This table shows, side-by-side, the health problems that occur with chronic ingestion of ethanol (i.e., drinking alcohol) and fructose.  [Remember: fructose is the sugar found in fruit and fruit juice, but it also makes up 50% of table sugar (i.e., sucrose) and 55% of HFCS.]

I think the figure speaks for itself and suggests that about two-thirds of the pathology that afflicts a heavy consumer of ethanol also afflicts a heavy consumer of fructose.   As Lustig points out, this should not be terribly surprising, given that we ferment ethanol from fructose.

Let’s summarize:

  1. We produce and eat more sugar than any other country on earth, and do so more than at any other time in history.
  2. Consuming sugar is not just “bad” because of the “empty calorie” hypothesis (i.e., the reason one should limit sugar is because the calories from sugar are not as valuable as those from, say, protein); it’s bad because sugar is a chronic toxin.

One last point before we jump in:  Before you angrily email me, or say awful things about me for daring to suggest that Michelle Obama and the USDA might be wrong in recommending we eat 5-6 servings of fruits and vegetables (many vegetables are full of fructose, too) per day, keep one thing in mind.  I am simply making a few points and you need to decide how you want to interpret them and make personal choices around them.  We are all genetically different, and therefore have a very different genetic predisposition in our sensitivities around these foods (and all foods in general).

There are some folks out there who can eat enormous amounts of sugar and experience very little ill effect.  My wife is the poster child for this phenotype – though she doesn’t any longer, she could eat unlimited amounts of sugar and not gain weight*.  Furthermore, as we age, we generally get less adept at processing sugar, and therefore with each passing year a “fixed dose” of sugar appears to cause greater and greater harm to an individual.

*Note that I only commented on the “weight” portion of her phenotype.  When my wife did reduce her sugar intake, she experienced many benefits in her health, perhaps most importantly, her improved cardiac disease risk profile measured by advanced lipid testing.

Here are the points with which I want to challenge you:

  1. Before you assert something is “natural,” be sure to understand what you mean by “natural.”
  2. Don’t be afraid to question the notion that all things “natural” must be healthy (and by extension, that all things “un-natural” are unhealthy).

Let’s address these points in order.

Point I: How do you define “natural?”

Most people assume the fruits and vegetables we eat are “natural,” but in reality fruits and vegetables of today bear little, if any, resemblance to their original form.  Let’s take corn as an example.  [I’m choosing corn because (i) it’s illustrative of the broad science and progression of agriculture, and (ii) I happen to read a lot about it, as I find the evolution of corn cultivation fascinating.]   Bear with me for a moment, as I tell this story.

7,000 years ago — a sliver of time on the evolutionary scale — corn as we know it today was a plant called teosinte.  Teosinte was about the size of your thumb and had a few (maybe 4 or 5) kernels.  Over the next few thousand years we began the shockingly quick (by evolutionary standards) process of “domesticating” this crop from its “natural” state into subsequent states of what we now refer to as maize.   By domestication I mean the process of successive selection of crops that had the most advantageous features for our needs.  Sort of like “domesticating” animals so they would cuddle up with us on the couch instead of trying to eat us.

How did the process of domestication work?  As an example, farmers selected teosinte crops which were larger, had more kernels, were more resistant to drought, and were more resistant to pests and predators.  This process went on, growing season after growing season, until about the period of time leading up to World War II and morphed teosinte into a very different looking crop.  Hence, the progeny crop, maize, looked very different from the parent crop, teosinte.   At that time, around WWII, the average farmer in the U.S. could grow about 18 bushels of corn per acre per year, though progress in yield increase had been stagnant for a few hundred years.

Around 1940, however, the productivity (i.e., the yield improvement) and morphology (i.e., the physical “look”) of corn growth began to change dramatically for two main reasons.  First, this change was driven by the introduction of technologies to make cultivation more efficient (e.g., crop rotation, use of fertilizer and pesticides, improved irrigation).  This was referred to as the “industrialization” of agriculture.  Roughly in parallel to this effort, advanced biologic techniques of active breeding (genetically crossing one plant with another so they could mix genes – the same things animals do when they mate) and mutagenesis (disrupting the genes of the crop, typically using chemicals or other agents, like radiation, to change the genes of crops) significantly increased the functional genetic diversity of the crops, year after year, further increasing yields and other desirable crop properties, such as cost of production.

Furthermore, in the last 20 years or so, the introduction of genetic modification (GM) has made maize even more robust and genetically fit.  Today U.S. farmers can grow nearly 200 bushels of corn per acre per year, up from less than 20 bushels per acres per year in 1940.   Below is a figure showing corn yield data from the National Agricultural Statistics Service, which shows the almost unrelenting productivity gains in corn cultivation over the past 70 years.  The world’s leading technology companies leading this charge (Monsanto, Pioneer, Syngenta) are projecting yields of 300 bushels per acre per year by 2030.  In other words, with each passing year, technology is making corn more and more robust, and therefore more and more distant from what is “natural.”


US corn yields for past 50 years

What about apples? Oranges? Strawberries? Peas? Carrots? It turns out the story I’ve told for corn is virtually identical for every “crop” we grow today, including all of our fruits, vegetables, and grains.  I know what some of you are thinking, “I only eat organic non-GM fruits and vegetables, so I’m ok, right?”  Unfortunately not.  Genetically modified (GM) plants and crops are different from non-GM plants and crops in small genetic ways that generally make them more resistant to pests.  But the hallmark differences between, say, teosinte and modern maize are 95% accounted for without the addition of genetic manipulations.  For the purpose of this discussion, genetically modified crops are a moot point.  In other words, what we grow and eat today, even if we buy “organic” or “non-GM” has absolutely no resemblance to what was “natural,” say, 10,000 years ago.

So the next time you bite into a Fuji apple half the size of your head (these used to be my absolute favorite things to eat, by the way, and I’d easily consume 3 or 4 per day), ask yourself what it has in common with the “apples” your ancestors ate.  The answer, not surprisingly, is very little.


Natural foods

Point 2: Who says everything “natural” is good for you?

The next point I’d like to address is dispelling the myth that all “natural” substances (notwithstanding the argument, above) are healthy.  Let’s examine the role of toxicity in natural things we ingest by first distinguishing between two types of toxicity: acute toxicity and chronic toxicity.  Simply speaking, acute toxins are toxins that can kill you quickly, if you are exposed to a single dose, or a series of repeated doses in a short period of time. Conversely, chronic toxins are toxins that don’t kill you from a single exposure, but over time multiple exposures can kill you.

While there is no shortage of “man-made” toxins in the world, you might be surprised to learn how many “natural” toxins exist, too.  Let’s examine a naturally occurring acute toxin, a naturally occurring chronic toxin, and a naturally occurring toxin that is both acute and chronic.   The figure (below) shows each.

  1. Perhaps the most singularly potent acute toxin on earth is a molecule called tetrodotoxin, or TTX.  Tetrodotoxin is a nerve toxin that blocks sodium channels in our cells.  TTX is so potent that less than 200 pounds of this compound would kill every person living in the United States. In other words, it’s about 10 times more potent that cyanide.  Here’s the catch: TTX is found in nature – it’s 100% natural.  It’s found in puffer fish, newts, toads, and several other sources.  Several people die each year from exposure to TTX when they unknowingly consume animals containing the toxin.
  2. Tobacco is also a naturally occurring substance.  Whether smoked or chewed, however, it has many forms of chronic toxicity, primarily related to its carcinogenic (i.e., cancer-causing) properties.  In other words, you won’t die from smoking one cigarette or chewing one pack of dip, but if you do it enough, you might.
  3. Finally, ethanol is both an acute and chronic toxic.  While acute toxicity is rare, it is possible to overdose on ethanol (toxicity in this case is usually related to respiratory depression – that is, you stop breathing).  More common, of course, is the chronic toxicity of ethanol, which is well understood and well-documented.  For a quick reminder, take a look at the table I showed earlier in this post from the Nature paper.


Natural toxins

So there you have it.  There are plenty of “natural” compounds on earth that are harmful.  I am not suggesting that eating a Fuji apple is as toxic as smoking a pack of cigarettes, but I am saying that once you begin to understand the metabolic pathways of fructose (there are about 25 grams of fructose in a large apple) you’ll see that an apple, just because it grows on a tree, is not actually “good for you,” even though it is supposedly “natural.”  For some people, eating 10 apples a day causes no harm.  For others, eating 1 apple a day causes harm.  The goal should be to figure out what your “toxic” dose is — and stay well below it.

If you’re reading this and wondering how much sugar you can eat, it’s a bit like asking how much can you drink or smoke.  It depends.   How genetically susceptible are you to the effects of these toxins?  What are you optimizing for — short-term pleasure or long-term health?  This is where we get into the idea of dose-response.  I will address this in a future post, but not right now, as it really deserves a post of its own.


Photo by julian mora on Unsplash

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  1. …………………..
    A matter of Context……..

    There are certain realities involved here that don’t really care about people’s feelings or opinions one way or the other –

    !. You can eat 1000 calories of apples or apple juice a day and lose weight without any problem – in this context – apples would be compatable with your weight loss goal or up it 1800 calories and just mantaian weight –

    2. Converesly – eat four big apples a day( 320 calories or so – 80gr carbs) – and combine this with 700 calories fat and within a short time you may start looking like porky the pig – up the fat calores to 1500 and almost certainly you will start resembling old porky – and very quickly

    3. The statements above above are equaly true – and they should be something that people know – say any one older than three –
    4. A high carb diet needs to be low fat( below 10% of calories) –

    5. A high fat diet requries just the opposite( extremly low carbs)

    6. It’s little wonder many people when finished dieting gain weight – they sinply start combining fat and carbs together and binge eat ever now and again – and they get fat again – – what a mystery
    7. The above statements apply to everyone on the face of the earth – including people who write for New York Times and all those who killed themselves with there diet and are now dead – so everyone should be happy now

  2. Diana said, “But you don’t get fat eating fruit. This is not the way we get fat, sorry. ”

    Though I understand she is referring to a cultural tendency (we get fat because we are eating so much junk, most people are not getting fat just because they are eating sugar in the form of fruits) rather than biology, this struck a chord for me nonetheless & I have a comment. 🙂

    Somehow I did gain weight & increase the amount of fat on my body by increasing the amount of fruit I ate. Large servings of fruit, every day, for breakfast, for several months = a 5 lb weight gain on a very small frame. That was the only change. Was it the fruit itself or was it the insulin response to the fruit? Does it matter which, in the scheme of things? Maybe, maybe not. Maybe there is no real distinction. The important thing, to me – the outcome – was that I was eating a seemingly healthy ‘non-fattening’ food … and I got fatter. I had to stop eating fruit to stop getting fatter. I was not eating pastry, I was not eating junk. I was eating fruit.

    Does your body store fruit as fat? Maybe not. Maybe technically it was not the fruit making me fat, maybe it was the insulin making me fat. But if the insulin response is the cause of the fat gain, not the specific food itself, then what matters is the insulin response I get from the food, yes? So any and all foods raising my insulin *might* make me fat, yes? So, yes, maybe I (& others) get fat eating fruit despite the ‘fact’ that supposedly we don’t get fat eating fruit. If fat gain is primarily about hormonal responses to food (and it certainly seems to be), then the specifics about the food are secondary, except that they have the right ingredients to create that hormonal response. So maybe sugar is sugar – apple or apple pie, your body may well have the same hormonal responses to both. Yes, the ‘natural’ sugar combined with fiber in fruit will probably have a less dramatic effect than the ‘unnatural’ sugar of a fruit pie, but insulin rises nonetheless. And all it takes is an insulin rise, regardless of source, to engage the fat-storage mechanism, yes? So I think, technically, fruit can indeed make you fat – maybe the fruit itself is not stored as fat (but are we sure about that, really?), but the insulin rise starts storing SOMETHING as fat . I’m guessing that SOMETHING would be everything else eaten that is above current energy needs, and if that SOMETHING is fruit why wouldn’t it be stored as fat (I honestly am asking)?

    Please tell me if I am off-base.

    — I’m not anti-fruit, but I do think fruit gets a free pass as some kind of magical food, despite it being basically nothing more than sugar + water + fiber. fruit is a treat. it’s nature’s dessert 🙂 and like all dessert, best on occasion, not 6 times a day. give me one perfectly ripe mango in season & I am in heaven. I was vegetarian for 20 years, vegan for portions of that, raw vegan at one point (and very malnourished!), and I was told again & again how fruit was healthy, fruit was perfect & magical & so nutrient-rich that the human body can be sustained in perfect health with a fruit-only diet. that information is wrong. if you want to give people good information, keep it real: how does the human organism function, what is in the food we eat, what reaction does it provoke in the body, and no sacred cows. —

    I do think that that the changes in the fruit we eat compared to the fruit of our ancestors makes a difference – if the fruit we eat now is higher in sugar than the fruit of our ancestors (and we eat it year-round now, not just seasonally), that DOES change how our hormones respond. If we are designed to eat low-sugar fruits occasionally, in season, and that is not the current paradigm, we are not eating optimally. It is a valid article of information to include when making decisions about what to eat & how much. Is discouraging the eating of fruit a higher priority than discouraging the eating of Big Macs? No, of course not. It’s like triage – you work the priorities in order of importance. But fruit is not without problems, and it’s worth talking about.

    a question: what is the actual difference between levulose & fructose? d- form vs. l- form? since I’m a non-science-y type, I don’t necessarily grasp the distinction. how is it that fruit sugar is chemically better than man-made sugar, as far as the body is concerned?

    thanks for all you do, Peter.

    • Levulose is fructose to my knowledge, just a historical name. The important distinction is between glucose and fructose, and how they interplay (described elsewhere on this site and many others). When people say “man-made” sugar, they usually mean HFCS, which is effectively the same at sucrose.

    • That was pretty much my understanding (re: fructose) – as far as the body is concerned, fructose is fructose, glucose is glucose. I am weary of magical thinking around nutrition. 🙂

      Thanks for the follow-up, Peter.

      Take care.

  3. Hello! I am so happy to have found your site – as a research scientist myself, I am *always* trying to go to the source and read scientifically valid articles – as you have already pointed out, it’s a bit of a mixed bag out there and I can’t spend too much time on it (as I am due to finish my PhD this year!). I have read most of these comments, but not all, so forgive me if you have already answered this question. I was wondering about the “scientific” connection between plant fiber and reduction of disease, particularly with regards to diseases like colon cancer (and the added idea that excessive red meat contributes to this disease)??


    • Tina, the cancer issue, at least via fiber (one study) and saturated fat (another study) has been addressed. No reduction in colon colon cancer with increased fiber intake (both shown prospectively and in meta-analyses), and no reduction in many cancers, including breast, with reduced saturated fat intake (when sat fat replaced with fruits, vegetables, and whole grains).

      I’m not sure these give red meat a pass, but as I write in another post about red meat, much of the bad rap it gets is based on ecology and observational epi.

  4. Hi Peter,

    I am really enjoying your blog and considering making the changes to my diet that you advocate. However, I am linking professor Colin Campbel’s presentation below. lt claims that animal protein, which is heavily present in your diet, is harmful. Can you please explain to me the radical differences in your views of nutrition?

    “Celebrated Cornell University professor T. Colin Campbell Phd, presents the overwhelming evidence showing that animal protein is one of the most potent carcinogens people are exposed to. Here is his presentation: https://www.youtube.com/watch?v=yfsT-qYeqGM&feature=related “.

    • Olga, I’ve been asked this question or a variation of it probably 50 times in the past year, which suggests I need to a blog post on it, I guess. The reason I have not done so is that two others (or countless folks), have so very eloquently. If you’re interested, here are the links to them, below. VERY short answer is this: I have no doubt that the diet promoted by Dr. Campbell is better than a “Standard American Diet,” however, there is no scientific (read: prospective, experimental) evidence that is superior to all modes of eating. I’m really loathe to write about in this, because it only seems to turn into a discussion as mindless as one on abortion, same-sex marriage, and stem cell research — in other words, it seems impossible for many people to have a scientific discussion on this topic, without it turning in a near-religious one, which is tragic. The morality of eating animal products should under no circumstance ever be confused with a very important scientific question: is it healthy or harmful?


      I know this is more than you want to read, but I’m also doing this partially so others with the same question can decide for themselves.

  5. I have been devouring your information, I have given up all refined foods, grains and fruit except for berries once a day. I am restricting carbohydrates. I eat nuts, non starch veggies, full cream butter, bacon, coconut oil and protein. I do use about 10 drops of stevia a day. I must say my husband has lost weight but I haven’t I would be really disappointed if it were not for the fact that this eating is anti inflammatory and the pain in my ankles, knees and back have greatly decreased. YEAH! I still need to lose weight. Can you help?

  6. I just saw the video of your presentation to @ JumpstartMD. The last question on the video had to do with fiber and how we may not need as much of it as we’re told. I figured this post was the best place to give an idea. I remember hearing something on “The People’s Pharmacy” about the role of fiber and their guest doctor that day was advocating fiber because of it’s role in regulating sugar.

    The short of it was that insoluble fiber acts to absorb sugar, specifically fructose, in the GI track and therefor prevents its absorption in the small intestine. Eventually the sugar would pass out of the system with the fiber. soluble fiber did a similar job in the blood stream acting like a vacuum cleaner for the sugar, and lowing the glycemic load of foods. So my connection is, maybe we’ve been recommended to increase our fiber consumption not because of the fiber, but because of the harmful effects of sugar, and the reduction or elimination of sugar would lead to less need for fiber in the diet.

    • Fiber helps with bowel transit time, but beyond that, there is no evidence it prevents cancer, though such claims are touted as dogma. Of course, fiber is but one component of the diet that impacts digestion. Amount and type of meat, amount and type of fat and oils, hydration status, genetics, gut bacteria, etc., call play a major role.

  7. Actually? People in Asia are not healthier than we are. That’s a myth, and part of the problem is we seem to believe that you’re only unhealthy if you’re fat. People, the reason there aren’t as many fat people in Asia is because there are more *starving* people in Asia. You wouldn’t be as fat either.

    They don’t get the exact same diseases at the exact same rates we do but they do get a lot of pancreatic cancer, a lot of diabetes and a lot of heart disease (especially in India, that mecca of vegetarians everywhere). And, oddly, a lot of nearsightedness. “That’s not from diet, though,” you’d reply. Wanna bet? Diet has some effect on your eye health, and can definitely affect your visual acuity. I’ve heard from people who went Paleo and suddenly their eyesight improved. Including an Asian guy who posted his success story on Mark’s Daily Apple, and several of his commenters.

    Also if you look at Denise Minger’s critique of the China Study you will find not only that the data don’t say what T. Colin Campbell claims they say but they also point to wheat as a major driver of chronic disease in China, which has been using wheat for a very long time now. They were the ones to introduce pasta to Italy, you may recall from history class.

    Where people consume grain and don’t make themselves immediately or chronically sick in Asia I think several factors are involved.

    1. They’re eating rice, not gluten grain, and rice is less hazardous to your health, though you still don’t have a blank check to eat as much as you want (“Perfect Health Diet” claims about rice notwithstanding–that crap jacks up my blood sugar and, being Cajun, it pains me to say so).

    2. They’re still eating lots of animal, especially animal fat, bone broth, and organs. They also eat lots of seafood. These all have protective effects vs. chronic disease.

    3. They get enough sun. Sounds nonsensical until you do a little investigating and discover there are links between lack of sun exposure and chronic disease. If you’re preventing minor skin cancers (melanoma can show up on unexposed areas of the body, so I doubt the sun is the sole driver of its development), you’re still making things worse for yourself in the long run, and not just because you aren’t making sufficient amounts of vitamin D.

    If you are going to insist on eating grain carbs then you need to take other steps to protect yourself because from what I can see, carbs take away from health more than they contribute to it.

    That goes for fruits and vegetables. Their seasonality alone should tell you that we don’t depend on them for basic survival–we can’t, because they aren’t available at all times of the year. They have their uses in the human diet when utilized properly but they can’t be a *consistent basis* of a healthy human diet. Or at least no one fruit or vegetable can. What we really need to be looking at is animal-based nutrition, making sure that is all dialed in, and then we can have plant foods in their proper context–a possibly helpful addition to the diet, not its foundation.

    We’re not other primates. We’re different. We have way more small intestine and hardly any large intestine compared to the other great apes. That means much less tolerance of or ability to process plant matter. Something to keep in mind.

  8. Dr. Attia,

    Can you comment on the micronutrients in these fructose containing fruits and vegetables and the implications of leaving these out of a diet?

  9. I notices that you fat shake contains whipped cream, isnt whipped cream contains lots of trans fat? also, im traoubled about eating too much fatty meats not because of the fat, but because I discovered that cooking meat makes it toxic acidic, while leaving it raw is okay as it is alkaline.

    also I know this may be so unlogical to ask, but is your say about the DANIEL PLAN? I mean they are stating that in the bible daniel withhold from eating meats and ate only fruits and veggies for 10 days and he became more attractive in physique and more intelligent that is peers?

  10. About ‘Al February 23, 2012’ comment above, reference ‘ketosis does not guarantee weight loss’.
    There is a metric to imperial conversion error in the following statement:

    IS: Presumably this is caused either by excessive protein intake (which for someone of my size would have to be what, more than 300 grams a day or roughtly ***0.661 pounds*** of meat?)

    WAS: Presumably this is caused either by excessive protein intake (which for someone of my size would have to be what, more than 300 grams a day or roughtly three pounds of meat?)

    Note: 3 pounds of meat would be 1361 grams or 4.5 times more than Al thought.

  11. Why would something as dangerous as Metabolic syndrome not be mentioned by ONE SINGLE MEDICAL PROFESSIONAL that I have seen in the past 40 years? Its clear to me that I have it, and so does my entire family. Are there reasons that medical practitioners would not want to shout this news from the rooftops and tell every patient that he/she is on a fast train to ill health because of the obvious signs? You have opened my eyes today. It might be too late for this 60 year old, but I am making educational packets of several of your articles to share with my four children. Many thanks for your effort to sound the alarm and educate.

  12. Peter,

    Some initial context, I’ve been experimenting with a low-carb and keto diet, and recently plagued with the question, ‘is there something nutritional I’m missing out on by not eating the fruit and vegetables I use to consume. The years of being told to eat a ton of ‘fruit and veg’ are therefore causing me some confusion.

    As you also mention, a number of sources promote eating a certain amount of fruit and vegetables per day. I’d be grateful if you could outline some of their major nutritional benefits, whether these are unique to fruit and vegetables and advise what keto friendly foods to eat as an alternative?

    The website has been a great resource. Thank you.

  13. That graph is quite interesting – it pretty much correlates with obesity rates. Is there one available for other food groups? I’d like to see one for flour, and one for vegetables, one for beans, maybe one for meat and fish. I think it would show more than any study could.

  14. You raise some interesting points. I think the most important thing – and the thing that we are constantly reminded – is that our diet should be balanced. A balanced diet leads to a healthy body and is one of the few diets that is maintainable and manageable.

  15. Fascinating. I’ve been low-carbing for a while now and have already seen my blood pressure lower to the point where I have been able to drop one of my blood pressure tablets (with my doctor’s agreement). I try to stay below 20 carbs a day. Can I eliminate vegetables from my diet completely, as long as I take a good set of vitamin/mineral supplements? I now feel guilty eating vegetables and would like to ditch them entirely, Volek and Phinney’s excellent book states that the body does not “need” carbohydrate but does need protein and fat (paraphrase). Would eliminating vegetables be acceptable (not just those high in starch)?

  16. My biggest thought/question on the debate of what our ancestors ate to what should we be eating is our own personal evolution. When you talk about the introduction of teosinte into our daily food consumption wouldn’t that be a turning point in our nutritional history or evolution? Since from that point on we started to integrate fruits/vegetables into our daily meals. If we go back further than that point to structure our diets wouldn’t we need a slow progression of eating back to that point since we have had 7,000 years of eating fruits/vegetables? Yes there are the outliers, like your wife with sugar, who are able to live on a meat based diet; but the vast majority would need a slower shift back to that point.

    All in all have we come to a point in our physiology where a true balance of fruits, vegetables and meats needs to be established before we could make the push back to solely meats?

  17. Thanks Dr. Attia I am a fan … The premise I go on is “There is No Known carbohydrate deficiency disease”, hence, there is not reason to eat carbs … they just happen to be in foods. We have modified all foods for “Palatability” and “Taste”, so there is very little modern foods to eat … as you know … beef and chicken and other farm animals had the same nutritional values “Salmon” 100 years ago … ie, where did the Omega 3s go?? We feed them corn …

    The good things is that some foods have concentrated nutrients … and are readily available today … such as “Pastured eggs” and most of our greens and fruits such as bell peppers are still OK. Not the modern sweet fruits.

    70 Going On 100 … the Centenarian Diet

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