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In 2013 I gave a presentation at the Institute for Human and Machine Cognition (IHMC) in Pensacola, Florida. Ken Ford, the CEO and Founder of IHMC, is a remarkable person and I could not wait to meet his team and see their research. IHMC does cutting edge work, primarily for the Department of Defense (DoD). I had an exhilarating day which culminated with a presentation I gave to the team and also the public.
Want more content like this? Check out our interviews with Kristin Neff on the power of self-compassion and Esther Perel on the effects of trauma.
The talk I gave was a first timer. (Usually the first two or three times I give a talk it’s not very good, as I need to work out some kinks.) However, since the talk was recorded I’ll set my perfectionist tendencies aside and share it, below. The talk is about an hour, and the Q&A session was also recorded.
A month or so before the talk, I asked Ken what he wanted me to talk about and he suggested I speak about human performance and resilience – both topics of importance for the DoD. I don’t consider myself an expert in either of these topics, but I certainly appreciate the need to maximize, or least optimize, both. Rather than give a highly technical talk, I chose to give a slightly technical talk that focused more on my own journey in this space and some of the experiments I’ve done on myself, specifically those around energy utilization. This talk does not present all of the data on my self-experiments, of course, but hopefully it gives you a sense of what kind of data can be gathered for studying energy utilization. In subsequent posts I’ll likely delve further into the data that support these findings and expand on a few of the tangents not fully explored here. For “regular” readers of this blog, the first half of this presentation is pretty basic, but the second half should offer novel info. For new readers, hopefully the entire talk will be informative.
For those reading via email, here is the presentation:
Photo by Siyan Ren on Unsplash
Stumbled across your website today.
Such interesting parallels!
I have just completed 13 months of a very low-carb zero-cheating diet, and couldn’t be happier. I have learned a lot in the process.
Lately, I’ve been doing a lot of what you mention in various posts- experimenting with timing of food with intermittent fasting, eating less meat, less dairy, less in general. I’ve not only lost 90 pounds, but have also eliminated a variety of concerns, including no longer having migraines.
Thanks for your effort in sharing information with people. SO MUCH of what people are taught simply isn’t true. It’s great to have a reference to share with people who question what I’m doing and why. Fortunately, my doctor is on board with this, and is one of the people who suggested it in the first place. I was very resistant to the idea for a long time, not believing that it made any sense. I’ve since come to a new understanding of many things about nutrition.
I have no desire to ever go back to the way I ate before. Sometimes, I “miss” some of the foods I used to eat, but not nearly enough to trade.
One huge difference is that when I go to a grocery store, most of the aisles are full of things I no longer eat. It is a little staggering how much of the available “food” fits in that category. It really makes the point of just how high in carbs most people’s diets are. I didn’t really think about it before.
I hope to read through much more of your writing, but there’s a lot!
Dear Peter, At first when I started watching your talk I thought, oh great, another cocky triathlete-type doctor, but after watching the talk in its entirety, I was really struck by your compassion and your unbridled humility, something I rarely see in doctors, let alone fellow human beings. 🙂 I’m writing to you because I’ve hit a wall, as far as my understanding of diabetes goes. Some brief background – I am a 41 year old South Asian woman and everyone (and I really mean everyone) in my family has diabetes (I’m pretty sure it’s the type 2 kind). I myself have been ‘diagnosed’ as pre-diabetic, despite being thin (BMI of 19) and exercising my whole life and being very diet-conscious (moved from low fat in the 80’s to low carb in the 90’s to more of a modified paleo in the 00’s). Despite these efforts, my fasting BG and A1c/fructosamine levels are still in the ‘almost diabetic range’. I finally went to an endo and he made me get a c-peptide test, which were in the very low normal range, so the doc figures I probably fit more of a Type 1 profile. My question for you is this – what if you are not insulin resistant? Then what? I struggle w/the kind of advice I should offer to my family – do we just have some weird South Asian version of the disease that is impervious to dietary change? How can science explain beta cells just conking out and producing less insulin over time? Am I doing the right thing by restricting my diet and ‘saving’ my beta cells from working too hard? Or does it even matter? I currently live in Bangalore, India and as you probably already know, India is virtually ground zero for diabetes – between the movement towards a more sedentary lifestyle and the advent of processed food galore into the marketplace (and zero regulations around food labeling, packaging, etc), this will become THE problem for 1.2 billion people…but I’m not sure how to reconcile recommendations for diet and lifestyle versus genetic factors (ie some South Asian proclivity for developing the disease). Any thoughts you may have would be really appreciated. Good luck w/all you do and thanks for your time and keeping it raw and real. 🙂 Best regards, Priya
Priya, if not a cocky triathlete-type surgeon, at the very least a cocky tire-flipping one 🙂 I completely understand that bias, but I thank you for sticking it out past the the first few min. Your case is very interesting, and I can’t really play armchair doc from so far away, though it sounds like your doctor is pursuing the right line of testing. If hyperglyecimia, with or without hyperinsulinemia, is becoming problematic (the latter suggested by your labs), the dietary treatments may be surprisingly similar. You may want to see a book by Dr. Richard Bernstein, if you haven’t already. The situation you describe is actually becoming not too uncommon in people of Asian decent.
Priya,
I’m no clinician by any stretch of the imagination but there IS something known as Beta Cell Exhaustion, which is pretty much as you describe where the cells inside the pancreas that normally would produce insulin simply stop in a person diagnosed with insulin resistance. I have no idea how this presents itself clinically in the people that go through it, ie: if the C-peptide level simply drops to below detectable levels. Would be interesting to have known what your C-peptide levels were from previous times then you could know if they were at one time super high and have reduced over time to where they are currently. I was lucky enough to have an internist that ordered a C-peptide when I had a my first high fasting glucose result that showed up on a routine screen and I was already being treated for high blood pressure. So I had classic metabolic disease. Mine was through the roof so it was pretty obvious what was going on.
Keep your spirits up!!! I really believe that what we eat is going to be the key and with the help of great people like Peter we will come up with all kinds of information that will help us eradicate all the issues surrounding insulin resistance.
Dan
Peter,
Thank you, thank you, thank you. I have been struggling with my weight since I was a teenager with swings of 40 lbs or more. Last November I happen to see you on John Stossel’s show and the unintended consequences of “bad science” resonated with me. At the time I had crept up to 265 lbs and at 5’-10”, I was the largest I have ever been and again knew I would go on a starvation diet with exercise to lose 20 to 30 lbs like I have done many times before.
Last November (just after Thanksgiving) I started with your web site (and others similar) and have been following a no-sugar/very low carb diet high in fat. I have you to thank that I now weight 208 lbs and feel better than ever. Keep up your great work.
I would be happy to help you in any way. I too started out in Mechanical Engineering and did my PhD in Systems Engineering. I’m a numbers person and would be happy to help you in your great endeavor.
Sincerely,
Dr. Kevin J. Zummo
Kevin, great to hear of your success. The “key,” if such a term makes sense, is keeping the following in mind — slow and steady. The next 30 pounds (or whatever your goal) won’t be nearly as quick as the first ones, but they will come.
Dr. Attia – over the past few days, I watched both this video and the TEDMED video, as well read through your site. The videos were terrific and thanks for your willingness to share all of this great information, and your openess to discuss in this forum. I’m a first year medical student, cancer survivor and nutritional testing/data addict myself. I have a few questions and will post them as you write on the future topics. As a future doctor, I want to find a specialty where I can practice in this area. Thanks again for the inspiration.
J.R., thanks for your feedback. Hopefully you’ll find some helpful info here as you refine your own nutrition.
Dear Peter,
I think your team should really look at the intestinal bacteria complex between obese and thin people. There is evidence starting to show that the suite of bacteria in our guts controls a lot more of our body’s function than previously thought. This has been hinted at for a few years but the following finding seems to indicate that this may be one of the big factors you are looking for.
https://www.sciencedaily.com/releases/2013/05/130515113744.htm
The thing that strikes me with these findings is that the additives the food industry uses maybe having an effect on our gut bacteria to cause the obesity rates we are seeing. I don’t think that it is just eating too much that causes this epidemic to move into the deveolping world when they adopt our food. I think that it is the additives in our food changing the gut bacteria to a suite of bacteria that is causing obesity as a side result.
I urge you to have someone look in this direction.
Keep up the good work.
P Pincha-Wagener
Pamela, the NuSI scientists will all be looking at the effects on gut biome, so lots of good stuff to be learned!
It’s a bit hard to believe anyone would ever call you “idiot”!
I love your blog posts & talks, even though I only follow about half the science in them. So, you can’t be an idiot – that would reflect very badly on ME.
I’m getting a bit fan-girly about your blog – need a new post soon!
Take care, Peter. 🙂
Thanks, Davra. I guess it’s ok to be an “idiot” in good company.
peter, when can you eat 100g of carbs and not get out of ketosis? i assume it’s after work-outs, but I am wondering what type of workout leads to a state when the body can utilize carbs particularly effectively w/o impacting ketosis. Also, can you tell you are in this receptive state either by measuring something or feeling certain way, or is it mostly driven off of what the workout was like (i.e. >1h at over 85% max effort or similar)?
thx
I’ll write out this in some detail in the future.
Hi ii Peter do you know my adviser and friend Prof Tim Noakes?
Yes, Tim is a remarkable person. Honor to know him.
Peter, is there a short answer re: the “100g’s”? I suspect it may be related to how i work out and hoping there is a solution to my problem — i’ve been in ~1-4mmol ketosis for >3 months and am generally feeling ok with the exception of exercising where my performance continues to be very impaired. i tend to work out at quite high intensity (>85-90% of my max HR) for 1-1.5 hours (~3x a week if that matters… it’s generally basketball and biking). is ketosis particularly poorly suited for this type of work at above anaerobic treshold? is this when some limited carb-loading and/or carb-refueling may be effective? thx
If responses to blog questions are akin to margin space on a piece of paper…think of what Fermat said.
Peter,
In the early parts of the video you were talking about glycogen and it being stored in the Liver and the in muscles, up to 70 grams and 300-350, respectively. You stated that muscle glycogen generally can’t be used.
My question in what instances can muscle glycogen be utilized? I’ve heard in other lectures that it can be used when the muscle in question needs to exert effort or energy. To follow up, assuming muscle glycogen can be depleted, is it a beneficial process in regards to oxidizing and burning fat?
Love your work
Sorry, Hakim, I may have glossed over this point…muscle glycogen can’t be used directly by the brain (the muscle lacks an enzyme necessar to release glucose into circulation, so muscle glycogen is used only by muscle, unlike liver glycogen, whic is primarily for export to the body — esp the brain).
Re: Muscle Glycogen.
I’m thinking more in terms fat spotting. I know the general consensus is you can not pick or choose where to lose fat on your body. But for instance, if you had 30 grams of glycogen in your pectoral (pec) muscles and you were to exercise those muscles strenuously and deplete the glycogen stored in those pec muscles, can the pec muscles then use the stored fat in the surrounding area to continue engaging in the strenuous activity. Or even after the activity is over, can it continue to use the fat in that area until the hypothetical 30g glycogen storage is replenished? Just a thought.
i’m not looking for proof… just the conjecture
See, this is what I *love* about the folks who read this blog! Only because you got my dorky reference to FLT… Ok, short answer, I titrate to glycogen replacement by mapping HR to RQ. On the bike I know pretty well the relationship between watts-HR-RQ, so I can calculate my glycogen deficit. On Sunday, for example, I did a lot more than normal, about 5 hours of intense exercise (including a 2.5 hour ride at an average of 200 watts), so I can figure out how much glycogen I needed to replace.
Hello Dr Attia,
I have recently changed my diet and have reduced most carbs, and I have increased the good fats, i.e avocadoes, nuts, full fat yogurt, hard cheeses. Do I have to limit the amount of good fats that I am eating and count calories? I haven’t lost any weight but I think that I am loosing body fat…when can I expect some real results? Is there something that I should be doing differently?
Thanks.
Gee Peter,
This is a terrific talk. Since going on a ketogenic diet, I have lost a lot of weight and generally feel terrific. The best thing for me has been the effect on my mental state – specifically the near-euphoria which kicks in at ketone levels of around 2.2mmol/l. On a scale of 1 to 10 where 1 is a runners high and 10 is being in love/religious epiphany ketosis seems around about a 5! I feel a bit goofy talking about it because it sounds like you are doing drugs but there it is. I think maybe humans are really suppposed to be slim and happy.
Quite a large number of my acquaintances and extended family members have gone low-carb since seeing the effect on my body mass, and all have easily lost significant amounts of weight, including an overweight 12 year old nephew who has gone from fat to slim, entirely of his own volition – an amazing transformation. Not that many of them seem interested in going into ketosis but your talk will be great resource to point them to.
I cannot fathom why people get offended by what you are doing – it is just so valuable and interesting. Thanks for all the work you put into this.
Andrew, many people who go on well-formulated KD note what you have. For many, it’s the single most important feature.
Dr Attia,
I have watched this and the TED video, they are very informative. I will be watching your progress of your research. I was wondering if your research has anything to do with how much our food has been effected in the last 20 or so years with all of the chemicals that are added and the GMO’s that we have now as well as other chemicals in our bodies the following is why. I had gestational diabetes with both of my pregnancies. I became hypoglycemic after my daughter (24) was born and diabetic after my son (1) was born. My family is also predominantly becomes diabetic in their 40s and are overweight on my mothers side. I was hypoglycemic for over 20 yrs which a lot of people say is unheard of. I was also told I have a magnesium deficiency which I take supplements for. I also take B12 supplements for the energy both are OTC. How many of these are you testing for. I know these are not really looked at a lot because for the most part science thinks they know which one are important like potassium. What if there are other ones that are important but are so slow acting it is just never caught in time? My son will be 2 soon and I went from hypoglycemic to diabetic when I was pregnant, I only gained 5 lbs when I was pregnant. However I have gained 40 lbs since my sons birth. I am now on a low dose of diabetic medication that has just been increased to 2 times a day and slowly my numbers are going up as well as my weight. I am beyond frustrated. I wont eat fruit or drink milk because of the sugar. The only fruits I will have are berries because of their ability to level out sugar and not spike it. I have cut way back on my carbs yet still I keep gaining weight and I am frustrated. If there is something else you find out please let me know I basically have 2 diabetic shakes a day ( extend, is the name, was the best one I could find when I was pregnant) with berries which has 15 grams of protein and 2 carbs per drink, salads and meats, I also crave and eat a lot of cooked onions sometimes 3-4 at a time with mushrooms and at times cheese. if that means anything, no one seems to know. I also crave raw pasta ( I eat dreamfields when this happens which only has 4 digestible carbs.) I also only drink diet caffeine free drinks and water as well as vitamins and my medications. I was not a good eater as a teen, but have been for almost 30 years now. I am not nearly as active because I am raising 3 small children and the oldest is 4. I am constantly on the move but not in a exercising kind of way.
Not at this time, though hopefully others are taking a good look at such.
Hi Eileen, I’d recommend a diet consisting solely of vegetables, meat, fish and eggs (don’t count calories just eat as much as you want of those food categories). I would also try an exercise program of 30 minutes a day, 5 days a week, Monday/Wednesday/Friday do some cardio fitness, that by the end of the session you’re exhausted (whether that’s hill sprints or a light jog is up to you but the idea is that it is intense as you can handle) and Tuesday/Thursday lift weights (do full body workouts and heavy weights e.g. Squats, bench press and dead lift with a weight you struggle to lift 8 times x 4).
That’s all my personal opinion and I’m not Peter. It’s just something I would do for a couple of months to see if some of the issues rectify themselves. All tasty, low allergenic, low processed, low carb, natural foods that pretty much anybody will respond well too with a great strengthening/cardio regime that will hopefully optimise your hormonal profile.
Really awesome talk Peter! I love your stuff and what you’re doing. Keep it up!!
Little off topic but I need to know!
We all love fat, but the one question I have: What about all the trans fat in the dairy? It can’t be good right?
Probably a trivial source of TF. BTW – not to be too provocative, but the evidence implicating TF is based on association. TF (in high amounts) tracks with junk food, so it’s not clear which is the problem.
I think you might be referring to CLA — conjugated linoleic acid, a NATURALLY OCCURRING trans fat in the fat & dairy products of ruminant animals. There’s a fair bit of research that these natural trans fatty acids are actually beneficial with regard to cancer and weight control. These are different from the factory-created trans fats that turn liquid vegetable oils into solids under great temperatures & pressure, with nickel catalysts and other such shenanigans.
https://chriskresser.com/can-some-trans-fats-be-healthy
Amy:
I don’t mean to speak for Peter here, who is a lot better than me in getting his point across concisely, but I believe what he was getting at is that the data condemning trans fats is (most likely) just observational epidemiology. That is, you look at the diet of a population and you notice that heightened intake of TF is negatively correlated to various markers of health. Now, the problem is there are likely to be an overwhelming amount of confounding factors at play here. Such as the way these people are getting their TF is largely going to be in the form of processed foods that contain plenty of nutritionally-poor ingredients, and likely they have other bad habits such as a lack of physical exercise, etc. To illustrate the potential negative health impact of a TF one would have to do something along the lines of holding a trial with two groups, one as a control and another that consumes X amount more TF as their energy intake for Y amount of time, so the single alternate variable is the intake of TF. (Ideally you’d also want to put forth a theory of exactly what the mechanics of the TF producing a negative health impact might be.) From there you could then look at the difference in whatever biomarkers or mortality between the two groups, and see if there are any outliers within the TF group and further look for a pattern there. And of course even if one type of human-made TF was shown to be bad , it wouldn’t prove that they all were.
Epidemiological observations are certainly still worthwhile as a source to form a hypothesis from, they just don’t show you cause and effect.
On the subject of Conjugated Linoleic Acid, one thing that speaks quite positively for it (more so than it just being naturally occurring) is that grass-fed ruminants contain multiple times the amount of CLA than their grain-fed counterparts. If you look at all the other differences between these animals, grass-fed is nutritionally superior in all aspects to the best of my knowledge. Of course this would be just an association, but a pretty strong one in my mind!
Hi Peter,
Great talk. Just finished Wheat Belly by William Davis. He sees (modern) grains as main cause for both obesity and disease. He is not alone in this. Ian Spreadbury also makes this case. Difference is that the pathway to obesity is not via insulin, but acellular carbohydrates promoting an inflammatory microbiota.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/
Are you familiar with his work and do you plan to write a piece like “Are grains toxic?”
Guido, I know Bill Davis well and like him a lot. Not sure if “Are grains toxic?” is in my blogging future. Seems Bill has already written a book about it. Remember, there can be (and almost assuredly IS) more than one dietary trigger for IR and its related diseases (and for obesity, for that matter).
Hi Peter,
There are two things I find interesting (but maybe you don’t!). You are a firm supporter of the carbs > insulin > fattening hypotehesis.
1. Why do you think this is superior to “acellular carbohydrates promoting an inflammatory microbiota and causing obesity”(Ian Spreadbury), a “Fat Switch” (Richard Johnson) or the “Food Reward Hypothesis” (Richard Guyenet).
2. Are all carbs created equal? For example: is wheat worse than rice in terms of weight and health? If not, might this explain (at least partially) that Asian cultures are pretty lean (I also think that their rice intake is overestimated. It is really different, less, from what we consume if we order a meal at the take away).
Guido, there is no reason to think these theories are mutually exclusive. Just as Newtonian and quantum physics are not. They just apply under different circumstances. Similarly, I suspect there is great validity to all four of these, and for some people, under some circumstance, one theory appears more dominant. I may simply be biased to spend more time writing about the enzymatic/hormonal regulation of fat tissue than the others, as that was the “one” that most explained my metabolic dysregulation and adiposity.
To your second question, certainly not.
Peter,
I work in the area of pesticide regulations. Have you consider the influence of other parameters that could cause metabolism disturbances, such as food additives (those we intentionally put in) and residues (those we would like not to be there but can’t take them out)? And thanks for your passion.
Jacques
I just found your blog! Over the last nine or so years I have essentially been walking to the same conclusions especially about fat and how sugar is more like fat’s evil twin. I have had pancreatitis and live with milk, peanut and shellfish allergies and walk a fine line in the greens department after a bloodclotting “scuffle” I’ve had. (crazy, I know!) Anyway, just wanted to say thanks for doing what you do and giving persons like my self a place to go to get answers. And occasionally pick your brain 🙂
Doc,
How mush different is your program from the Paleo Diet? I see some thing right away like dairy. Where you use heavy cream and they use no dairy from what I can see.
Mark-John, I don’t have a program.
https://paleodietlifestyle.com/place-of-dairy-on-paleo-diet/
If you look at this site, they say its not off limits but form is everything. I don’t touch the stuff since I have an allergy but I think eating it in the least refined form and not use it as a possible beverage is most likely ideal.
I should have said routine. Sorry. I know there isn’t a formal program. I do know you follow a routine and I am starting it soon based on your drinks and some of your foods.