March 15, 2015

Personal

Random finding (plus pi)

The best part of parenting (so far)? Helping your kids overcome things you struggled with. It’s at least in the top 5.

Read Time 6 minutes

The best part of parenting (so far)? Helping your kids overcome things you struggled with. It’s at least in the top 5.

Last Saturday my daughter came home from dance class—something she normally loves—and seemed upset. A bit of prodding led to the cause: a girl in her dance class told her she was “as fat as a hippopotamus.”  My first reaction (note to self: probably not the right one) was to laugh out loud, given that my daughter is probably in the 10th percentile of weight for her age. I’m worried she’s too skinny!

Of course I realized quickly the “facts” were irrelevant in this case. Her body habitus was moot. But her feelings were hurt, and as we all know this wouldn’t be last time someone said something to her—true or untrue—that would hurt her feelings.  I won’t go through the entire discussion we had, as I’m sure those of you with kids have already been through this, and those of you without kids probably aren’t worrying about this type of interaction.

I did, however, decide to tell her about all the people who dislike me and say mean things about me, usually things that aren’t true. She was shocked, “Like what, daddy?” I gave example after example. She was amazed—and relieved, I suspect—to know that she wasn’t alone and that I was able to shrug it off after temporarily being upset by it. I even told her about folks posting videos on YouTube specifically attacking me.

So, when our little talk was over she asked if she could see one of the videos I alluded to. I was a bit hesitant, if only for some of the language used when folks rant against my existence (if she’s going to learn choice 4-letter words in earnest, it should be from me after all), but I figured it was a good idea. She could actually see for herself that people say mean things about her dad and he’s still, more or less, ok.

Which brings me to the point of this quasi-post…

In searching for said YouTube videos, which I eventually found, I stumbled across two talks I gave last year which made their way online, unbeknownst to me.

In keeping with the current spirit of my co-op blog posts, below are links to the two talks.

Talk 1: Evidence for (and against) the dietary guidelines restricting saturated fat

 

 

This talk is an updated version of a talk I gave a few years ago and shared on the blog, in 2012 I think. Even if you watched the earlier version of the talk, if you find this question interesting—what is the case for restricting saturated fat (SFA) intake—it’s worth watching this version. I find this particular topic especially interesting because I think it highlights the challenge we all have, myself included, in setting aside bias when confronted with new information. (My friend Carol’s amazing book, Mistakes Were Made (But Not By Me) cannot be recommend highly enough for people who want to understand how cognitive dissonance wreaks havoc in even otherwise functioning societies.)

And contrary to what some (perhaps many) of you might think, I don’t believe this is a settled debate across the board. What do I mean by that (i.e., “across the board”)? Certainly in this presentation I try to make the case that the continually falling recommendations for SFA—from 12% to 10% to 8% to 5% of total calories—are not supported by convincing science. In fact, such recommendations likely do harm, courtesy of the “substitution effect,” i.e., people end up eating more of other things—namely, sugars and omega-6 polyunsaturated fats (n-6 PUFA)—that likely cause greater metabolic derangement.

However, some readers may interpret the data I present to mean it’s perfectly safe to consume, say, 25% (or more) of total calories from SFA. I realize I may have to turn in my keto-club card, but I am convinced that a subset of the population—I don’t know how large or small, because my “N” is too small—are not better served by mainlining SFA, even in the complete absence of carbohydrates (i.e., nutritional ketosis).  Let me repeat this point: I have seen enough patients whose biomarkers go to hell in a hand basket when they ingest very high amounts of SFA. This leads me to believe some people are not genetically equipped to thrive in prolonged nutritional ketosis.

In one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L1i.e., more particles than could be measured by the NMR machine so the report simply said “>3,500 nmol/L”. despite feeling, performing, and looking great. Based on his through-the-roof desmosterol and cholanstanol levels, and a curb-side consult from the Godfather- I mean Dr. Tom Dayspring, I decided to try an experiment. You see, the logical thing to do in this setting would have been to start two drugs immediately (a potent statin to address the hypersynthesis and ezetimibe to address the hyperabsorption) or tell him to abandon ketosis altogether. But this patient was adamant about staying in ketosis given the other benefits, though obviously worried about the long-term coronary implications. So, we agreed that for a 3 month trial period he would reduce SFA to an average of 25 g/day (vs. about 75 to 100 g/day) and make up the difference with monounsaturated fat (MUFA).2We also reduced his omega-3 PUFA given very high RBC EPA and DHA levels.

So, on balance, he consumed about the same number of calories and even total quantity of fat, but his distribution of fat intake changed and he heavily swapped out SFA for MUFA.

The result?

His LDL-P fell from >3,500 nmol/L to about 1,300 nmol/L (about 55th percentile), and his CRP fell from 2.9 mg/L to <0.3 mg/L (and for the lipoprotein cognoscenti, both desmosterol and cholanstanol fell).

Pretty cool, huh? So, my point is this: while I believe the population-based guidelines for SFA are not supported by a standard of science I consider acceptable, it does not imply I believe SFA is uniformly safe at all levels for all individuals.

Some of you may be wondering about me. It turns out I’m in the group (recall: I have no idea how large or small this group is) that seems to do well—at least by the tools we have available to assess risk—with large amounts of SFA in my diet, if and when I elect to. Even when I was in ketosis, eating 4,000 kcal/day (literally getting 40 to 45% of my calories from SFA alone) my biomarkers—cardiovascular, insulin resistance, inflammation—were excellent. Better than they ever were or even are today. Though, my point still stands: there are some people who do not appear able to safely consume massive amounts of SFA.

One last point I’ll make on this highly charged topic. I realize there is a contingent within the LCHF community who argue that traditional biomarkers of coronary risk—such as LDL-C or its superior cousin LDL-P—“don’t matter” if one is on a low carb or ketogenic diet. Maybe they are right. I guess time will tell. But I am not convinced, at least not yet.  As a doctor I can’t look a patient in the eye and tell them a sky-high LDL-P is ok because they don’t eat carbohydrates. So if you’re following such a diet, and your LDL-P goes through the roof, I’d urge you to consider a variation of the diet.

(Note: If you post your NMR results, please understand I will not comment on them.)

Talk 2: It was the best of times, it was the worst of times—the tale of the U.S. healthcare system

 

This presentation has nothing to do with nutrition but is, nevertheless, a topic I’m pretty obsessed with: how do we achieve cost containment on healthcare in the United States? (Sorry non-U.S. readers, but we have a bigger problem right now, so I’m focusing on ours over yours!)

This is a pretty controversial topic, so before you jump down my throat, try to sit through the entire talk, especially the parts where I frame the question as one of optimization. Most problems that have been heavily politicized suffer a common problem: they fail to distinguish between what is desirable in a resource unconstrained world (e.g., free health care for everyone that provides perfect care) and what is plausible the real world (e.g., some combination of features, but not 5 starts across the board).

Hope you enjoy the departure from the usual topics.

Pi Day

The math geeks in the audience will appreciate that yesterday, March 14, 2015, represented a very special variant of pi day. Normally, March 14 represents pi to 3 significant digits, namely, 3, 1, and 4 (i.e., 3.14). Yesterday, however, being the pi day in 2015, was especially cute, because it advanced two more significant digits, 1 and 5, via the year (i.e., 3.1415). If you’re a watch geek, in addition to being a math geek–yes, I realize this is not a huge club–the beauty of a perpetual calendar (a type of watch that shows time, month, date, and year inclusive of leap years), made it a really fun day! Why? Because at 9:26 and 54 seconds you found yourself at the following place in time: the 3rd month, 14th day, 15th year (of this century), 9th hour, 26th minute, and 54th second, that is, 3.141592654–pi to 10 significant digits!

After capturing this wonderful moment in time, I sent the picture, below, to my watch mentor (also a math geek; yes I just wrote the words “watch” and “mentor” next to each other). He loved it, but his response was priceless: “Peter, don’t ever show this to any woman you have the slightest interest in….check that, don’t show it to any woman period. Pretty cool though. You are right. I dig it.”

Good thing my days of trying to impress the ladies are far in the rear view mirror.

Parting shot: I did a follow up podcast with Tim Ferriss a few weeks ago. It’s episode #65 which is available on iTunes. This was my first time doing the strange format of just talking by myself. Feedback appreciated if this should morph into something I do quasi-regularly on the blog.

 

Pi on abstract background with about 3500 decimal digits by Nicolo Canali De Rossi is licensed under CC by 2.0

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

386 Comments

  1. Peter,

    I will try to be general and not post my NMR numbers in hopes that you will comment in response to my question that follows ????

    I’ve been LCHF for a year and in ketosis since the first of the year. I’m a pretty lean 42 yr old white male with no markers for metabolic syndrome and my LP-IR was <25. Pretty much all my biomarkers are good (at least as far as I understand) … to include HDL, TAG, FG and h's-CRP… except LDL-P which is high and about 50% of that is small LDL-P 🙁

    So… in response to this post I have already started reducing SFA and my doc and I plan to do some micro nutrient testing to see if I'm deficient in something that may be impeding my liver from clearing LDL-P.

    My question is this and it's in reference to LP-PLA2 and Part VIII of your cholesterol series…

    Do you think an LP-PLA2 test is needed or would be helpful with an hs-CRP (cardiac) of 0.79? I guess what I'm asking is can LP-PLA2 be high when CRP is low?… or would CRP also always be high if LP-PLA2 is elevated? (although CRP wouldn't necessarily indicate "angry arteries " given it's broader scope)

    Thanks!

    • LpPLA2 is still in its infancy, IMO. I use it routinely, along with MPO, hsCRP, homocysteine, and fibrinogen, as a proxy for inflammation. However, we’re still not entirely sure how to interpret discordant info. So yes, the situation you describe is something I see from time to time.

  2. Hi Peter

    Loved the appearances you made on the podcast.

    I completely reversed my non-alcoholic fatty liver disease after adding Choline supplementation (500-1000 mg/day).
    Despite meat consumption (250-400g daily, on average)!

    Thought you’d find that interesting, since it’s your area of research.

    Good luck on NuSI! Hope you do more audio appearances. 🙂

  3. Hello Peter,

    My name is Alexey and I want to thank you for such detailed information that you’re sharing on your website. I’ve heard about it from my friend. At this moment he’s very happy with the diet, losing weight very fast and become much more fit during last year. Especially last several month after starting Ketogenic Diet. I’m happy with the Zone diet, but in general it’s something like 30/30/40 plant I’m pretty sure you know what is this, so I’m not going jump in details of that. But I’ve a question please, his goal is to lose weight and after what I’ve read Ketogenic Diet is perfect for that, but I can’t find information if I’ve an opposite goal – Gain Weight, more muscles. Can I still use Ketogenic Diet for my goals and if yes how it’s going to work for my gain weight, I understand how it’s working for people who want to burn more body fat, but how it’s working for people who want to gain more muscles? Thank you very much again I’ll really wait for your answer if you’ll have time to answer.

    P.S: My sport activity is CrossFit.

    Alexey.

  4. Enjoyed the podcast, good radio voice, didn’t sound awkward at all. You are fantastically articulate and do a great job of making all this understandable.
    One question:
    Have you considered the possibility that LDL-P could just be the big feet? (to reference your age-feet-reading comprehension) i.e. not that cause but just correlating?
    E.g. LDL could be created / recruited as past of an inflammatory response?

  5. “…n one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L…”

    Dr. Attia –
    do you recall the small LDL-P value, ballpark, by any chance?

    I personally have had instances where
    LDL-P is ~1200 but small LDL-P is ~ 100(8%) ;
    LDL-P ~= 1700, but small LDL-P ~= 570(34%).

    Comments on significance of the relative value of the small LDL-P wrt the total?
    Thanks in advance!

    Indy M.

  6. Good afternoon, is there a reason why some people crave carbs a month after being in ketosis, but not yet Keto-Adapted?

  7. Peter, thanks for the blog and the great videos. I am an MD who lost 40 pounds on low-carb over 3.5 years ago. I have coached a lot of people using the low carb, high fat methodology to improve weight, diabetes, blood pressure, etc…

    In my own situation, HDL has remained high 76-77 for 2 years, and TG remained low 42 to 48. But, as you mention in this post, my LDL-P (and calc LDL well correlated) has increased for the last 2 years to numbers I am not quite comfortable with (as you mention in this blog).

    With a family history of heart disease (father sudden cardiac death at 42), and me age 37, I would like your suggestion for an expert to consult with regarding these cholesterol numbers. I have considered just making an appointment with William Davis or Eric Westman. However, you seem to have the firmest grasp on this subject from my reading, and as such who would you recommend that one visit?

    Of course, this (meaning me) would be a fabulous case for Robert Atkins himself, with his years of experience to draw from. But he is no longer with us.

    Justin Anderson, MD

    • re: … considered just making an appointment with William Davis …

      Just to calibrate any expectation here, my understanding is that Dr. Davis has wound down his conventional practice. He may or may not be accepting individual consultations.

      That said, his cureality dot com site (an evolution of his older trackyourplaque site) has an active forum that appears to have an over-representation of users with ApoE polymorphisms, and dietary/lifestyle approaches for that is are frequent topic, with participation by Dr. D.

      This is subscriber content, so I don’t feel at liberty to copy&paste. I can say that the current recommendations do NOT include statins, in case anyone was wondering.

  8. Peter, I am a long term reader follower, and for a 3 years now into high fat, now settled on moderate version that permits some whole grain rice and tubers, but not wheat/GMO soy (mostly to prevent glyphosate) and basically mostly organic with ample leafy greens and fermented stuff and as much moderate excercise as I can afford.

    I had also been into lab testing a lot, but stopped it due to the dificulty of really – even after reading EVERYTHING – interpreting the results (basically after measuring APO-A,B and then CRP, IL-6 etc I figured out that probably the only thing with predictive power is blood sugar and triglycerides in my situation, ox-LDL is not available here).

    So, basically within the last 1-2 years, have there not been any significant discoveries what markers to use? (I am APO e3/e4, so my LDL tends to be higher as the e4 is not that efficient AFAIK)

    • I feel your pain…and just lectured on it at UCSD last week. The missing link it a completely sensitive AND specific marker of endothelial inflammation. Good news is there are some exciting technologies on the way.

  9. Dr Attia
    Enjoyed your blog and your podcasts with Tim. I guess I am a little behind in my reading. I am one of those who went bulletproof, and felt really good, until I got my first blood work back. Cholesterol went up from 250 to 350, tsh went up and my CRP went from 0.5 to over 5. Trying to allow for an adjustment I gave it some time. My LPa was over 3500. The numbers only got slightly better over the next year but having drunk the koolaid I stuck with it. I felt really good. During that time my CRP was random, bouning between 5. I my apoe is type 2. I ultimately read everything I could find and decided to reduce my SF and replace it with MUFA. The comprehensive panel showed that I was over absorbing and over producing Cholesterol. It seems that now without a statin my cholesterol is above 300 and my first test after I aggressively dropped SFA was 107 which is lower than I seems reasonable. By adusting the frequency of taking the statin my TC 150 ldl 88 and my fasting glucose is 89, it had been in the mid 90’s.
    How did you settle on 25gm of SF?
    I looked at my diet and realized that coconut milk and most cheese are probably out. How do you make curry without coconut milk?
    Thanks for all the info
    Ben

  10. Thank you for bringing up reducing SFA’s. I probably fall into this camp. I read a lot in the low carb/paleo/keto communities and I haven’t seen this referenced.
    I have a strong family history of type 2 diabetes and have had gestational diabetes. Because of this, I follow a very low carb/cyclical ketogenic diet but my NMR/lipid panels are not good. Almost every low carb expert (Mark Sisson; Jimmy Moore; Dr. Perlmutter) claims that triglycerides will plummet on a low carb diet but mine remain elevated (209). Have you seen this before? Could you provide good questions for me to ask my GP and my recently referred cardiologist/lipidologist?

  11. Hello Peter, I have a quick question I’m really hoping you can answer. Could being in ketosis and having a high level of blood ketones effect the results of a Blood Ethanol test done like in the case of a DUI? I read it could effect the breath test, but I am wondering about the blood test specifically. Thank you for your time.

    • Interesting question, Travis. You’re not the first person to ask me about this. I’ve also been asked by attornies. The short answer is that I don’t know, but it could be possible. I suspect that the elevated BAL is “real” and only seems confounded by the fact that it’s higher than would be expected by the quantity of ethanol consumed.

  12. Hi Peter,

    I listened to the Tim Ferris interview with interest. You seem to be on a quest for longevity, or at least slowing down the aging process.

    I get the feeling that low insulin and glucose levels seem to be of key interest in your journey. I have been experimenting myself with Berberine, low carb, mod protein and resistant starch for over a year, and the results have been astounding. Would you consider RS a supplement or a food? I know you used RS in the past, but it was not on your list of supplements on the show highlights.

    In regards to testing diet hypothesis, how difficult would it be to employ identical twins with different diets in regards to aging. Using your website and Tim’s and Dave Asprey’s to get volunteers would seem easy.

    All the Best

  13. Hi Peter,

    Not sure if this questions has been posed to you before, however, I’ve been following the keto diet for two months now and I’ve run into a bit of a conflict. I am from the Muslim faith, and Ramadan is fast approaching and I’ve been trying to figure out what the best eating strategy will be since I will be fasting from sun rise till sun set for 30 days straight. Any thoughts?

    Best Regards,
    Tarek

    • @Tarek,

      I’ve been following a keto diet for a couple of months and I am also fasting during the month of Ramadan.

      I’m not sure if you have been following keto during this first week however I can tell you that it’s not easy especially if you’re not adapted yet. The lack of energy and dehydration have what seems like a double effect to normally following ramadan with carbs.

      At the same time I’ve dropped from ~14% body fat to ~12% in the the last 10 days or so. I believe there is a talk on the IHMC youtube channel that Peter did where he refers to an experiment he did of staying keto whilst doing an intermittent fast, so this is pretty similar.

      My experience is that you can stay keto in ramadan but if you are working out as well, and you’re not adapted then you will struggle.

  14. What is more painful, to discover that one is wrong, or that your teachers were wrong?
    What do MD’s with intense emotional pain do?

    I’m worried about the damage a distressed MD can do. Extreme responsibilities should be removed from a people in a bad mental state.

    To anyone who ever reads this: if you ever have to go see a psychologist, make sure this psychologist does not have wrong ideas about nutrition.

    Please, MD’s of the world, open your minds and be more careful.

  15. Hi Peter,

    1. Can physiologic IR contribute to higher insulin levels over time?

    2. Although fat raises insulin the least but on the other hand can its overload make cells insulin resistant?

    Thanks

  16. Dr. Attia,
    When you say this lifestyle works for 70-80% of the population could you explain what you mean by that? Quick run-down here, I’m only 30. I’ve been overweight all my life. I just clocked in at 386 (up 14lbs) after 2 weeks on LCHF (1529 calorie avg – I am tracking on MFP). I’m so frustrated and it’s hard to find a doctor that doesn’t just shake his head at me and tell me to eat less and move more. I think people forget I’m human, simply because of my weight. Anyways, I love reading your blog and I’ll just keep trying. Thanks for all you do.

    • Dear Frustrated,
      For what it’s worth, I to have been overweight my whole life (250 at one long point).
      I discovered Peter’s blog 4 years ago.
      After numerous trials and tribulations, I am maintaining 209 (not because I want to maintain that weight) but because I constantly have to reevaluate what I am eating too much of.
      What I have learned is the following:

      * I can’t eat any amount of good fat. I seem to lose weight consuming 66% or less.
      Anything above that and I either stall or begin to gain.
      * I need to track constantly what and how much I eat.
      I first did this by hand, but now use an app.
      * I need to feel a bit hungry. This is still puzzling to me, but every time I eat to satisfaction, I gain weight.
      * I have to serverly limit the amount of dairy and cheese I eat.
      Every time I eat more than 1 ounce of cheese or 2 tablespoons of heavy cream, my weight stalls!
      * I am currently following Dr. Eric Westmen’s, “Duke University” diet (it is on YouTube).
      My routine is right for me and it has paid off, no more blood pressure pills, just one water pill, blood sugar is norma and cholesterol is fine.
      I would highly recommend you read through all of Peter’s blog posts, the Duke diet, and all of the low carb blogs out there. Above all, DON’T GIVE UP! Take ownership, do your research and know you are not alone! It is worth it, and remember, it will take time, it took me four years of trial and error and I’m still adjusting. Oh, and remember, the cravings never really go away, so, stay the course until you are where you want to be.

  17. Hi Dr. Attia,

    I am so glad to have stumbled across your website. It gives me some hope that I am moving in the right direction. Interestingly, in January of 2009, after taking care of my father for five years, who was housebound due to a stroke, I decided to get really serious about improving my diet and exercise. My first step was to stop all sodas and added sugars as I tracked my calories and morning temperature.

    I learned that I would gain weight if I ate more than 1400 calories, and I could lose about 2 lbs a month, if I only ate 1000 calories a day, and given those numbers, it would seem that my metabolism was low or perhaps there was a problem with my thyroid function. Various Docs over the years have run thyroid tests (my mother had issues and took meds for thyroid dysfunction), but the levels always came back fine. I also learned about Metabolic Syndrome and I had at least 3 of the markers, so I knew I was at risk for many unpleasant things.

    I gradually added aerobic dancing and weight lifting into my exercise/walking routine, and counted calories as I continued to rid my diet of processed foods, and began growing my own organic vegetables, and fruits to eliminate pesticide exposures. My blood pressure was improved, and I was able to stop taking HCTZ.

    After I had lost about 20 lbs, I gradually became more and more tired (the story of the prior 25 some odd years). In June 2012, I began having daily headaches, my short term memory was practically non existent, and I absolutely could not get much done due to extreme fatigue, and my BP went back up and Hctz wasn’t helping much. Long story short – OSA . CPAP / O2 therapy eventually helped me to get back to functioning a bit better. My current Doc suspects that I had actually had the problem for 20 or more years.

    In June 2014, I joined a gym with a swimming pool, since my feet were giving me problems and I had to use crutches. I gradually worked up to 2 hours of swimming (rather leisurely), and began tracking food and fitness on the Web MD app.

    It took 6 months to lose 11 lbs. Since my feet are better, and I really can’t afford the gasoline this year to drive 30 miles to the pool, I am back to walking, dancing/exercise video, weight lifting, gardening and house cleaning for activities. Was keeping my calories at around 1300 and activity level at or exceeding the WebMD guidelines, and started feeling extreme hunger. Weight loss had stalled out for 6 months.

    I once lost 40 lbs in 3 months with a modified Stillman’s plan and swimming, and successfully stayed at or near my high school weight for a few years, before gradually gaining 2 or 3 lbs. a year. So I decided it was time to go lower yet on the carbs. Having just read “The Calcium Paradox” ( my calcium levels had been high since 2010), I had added some gouda cheese, or eggs to my one pat of butter along with a vitamin K2 and D3 supplement (Vit. D was found to be low, but pth normal).

    So I have been gradually cutting back the carbs, and keeping between 50 and 60 total carbs per day, and weight loss has begun again. I need to lose 29 additional lbs. to get out of the obese category per BMI data, and that was the goal I set in January 2015. In 2016, I plan to get out of the overweight category – come H3LL or High Water as the saying goes around here.

    The new research is very exciting to read about. At age 67, I feel I have to do the best I can with what the best guess is now. My grand daughter and I are using Atkins materials to help us, but I am very cautious about saturated fat. I am adding a little more cheese, a few more nuts. I continue to use EVOO instead of saturated fats.

    I was very interested to read about the TG/HDL ratio. From 2011 @ 4.7 to 3.02 in 2014 I can at least feel good that an important indicator has improved. I hope the trend holds for the next lipid profile due later this year. I will be talking about the NMR and VAP with my Doc at my next appointment.

    My grand parents had a small farm, and I remember thinking, when the USDA put out their pyramid with grains at the base, that was strange. After all, that’s what used to happen to fatten the steers for slaughter. I never went in much for grains as a kid, and was always “underweight” being feed cod-liver oil, and encouraged to eat salad dressing on my salad instead of squeezing fresh tomato juice on it.

    Any way, we kinda started the journey toward low carbs the same year and the same way. I’ve had a few roadblocks, and gone about things a bit slower as I have been researching and trying to understand what was happening. I read Gary Taube’s book this year and that was when I realized that insulin and hysterectomy in 1997 were probably 2 big factors in my big weight gain since then.

    Again, thanks so much for putting this info our there for everyone to see and think about. It gives me the courage to stick with adding a little more fat after years of low fat eating and stick to the lower amount of carbs.

    “Being defeated is a temporary condition; Giving up is what makes it permanent”. I don’t know who originated this, but it’s true. Keep going and striving. Best Wishes to all who struggle with weight and other health issues.

    • Dr. Attia may simply be just another quack doctor. He’ll likely allow this comment. In other words, he considers the possibilities. If we never consider the possibilities, then we limit possibility. This is what it is all about. Follow the instincts. Everything in life is complicated. Think of how complex it would be to learn a completely alien language and then enjoy a conversation with a 4 year old. Did the 4 year old learn from years of research? Learning is the result of observation, prediction, and testing. Often based on little information. Enjoy your food choices and don’t worry about weight. Health and weight are not necessarily negatively correlated.

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