August 7, 2012


What does lower back pain have in common with low carb eating?

by Peter Attia

Read Time 8 minutes

Strange question, huh? Before you get too excited, I’m not about to tell you that a low carbohydrate diet is a remedy for back pain.  Instead, I am going to explain a remarkably parallel experience I’ve had. I never made the connection until this week when a reader asked an unrelated question about lower back pain.

The best, worst experience of my life

As my third year of medical school was winding down, and I was just about to embark on a bold fourth year curriculum of back-to-back-to-back-to-back surgical sub-internships, I was on top of the world.  I was 27 years old, living in Palo Alto, California with my best friends, I had a wonderful girlfriend, I was working hard to prepare for my application to a surgical residency, and I still found time to work out like a wannabe Olympian.  What more could I ask for?

One sunny, June afternoon I got out of the pool after a good workout and felt a very strange pain in my lower back.  After riding my bike a few hundred yards to the weight room, it wasn’t getting better.  Actually, it was getting worse.  So bad, in fact, I did something I’d never done before – I decided to skip my workout and pedal home.

I iced my back, took some ibuprofen, and went to bed.  The next morning I woke up only to realize I literally could not get out of bed.  After struggling for some time I had to call my roommate to get me out of bed and help me to the bathroom.  I called my chief resident and apologized that I would not be able to come in to the hospital that day, and assured him I’d be fine the next day.  But I wasn’t.  Nor was I fine the day after or the day after.

A few days later I managed to limp my way into the hospital for rounds and with the help of the residents and nurses who were kind enough to give me intramuscular injections of a potent drug called toradol, I was able to survive, just barely.  The pain had gotten worse over the week and I was unable to sleep in any position except lying face down over a counter in an “L” shape.  But the worst was yet to come.

Within a few more days, not only was my back hurting, but I was also experiencing profound sensory pain in my left leg and left foot.  I realize this may sound hyperbolic, but I am not exaggerating at all when I say it felt like the skin was being torn off the bottom of my left foot.  The only way I could sleep was to tie my left foot in a plastic bag of ice to numb it and take 100 mg of Benadryl (enough to put a horse to sleep).  When the ice melted, I would wake up in pain and need to repeat the routine.

Within about 3 weeks of this back and leg pain, I was starting to worry that something very serious was going on.  I’d had a backache or two before, and in one case it even took a week to resolve.  But this was very different.  One night, when the pain was so bad I couldn’t mask it with any cocktail of drugs I finally relented and went to the ER.  After a thorough exam, the physician sent me to the MRI scanner (for those of you reading this outside of the U.S., it must sound crazy to think that a patient could have a MRI scan so quickly).

The MRI showed not only a large herniation of my L5-S1 disk (a bulging of the disk between my L5 and S1 vertebrae), but it also showed a free fragment of broken disk sitting directly on the S1 nerve root.  While the large bulging disk was likely the cause of my back pain, the free fragment pressing one of the largest nerves in my body was undoubtedly the culprit in my leg and foot pain.

The next morning I was taken to surgery by a (supposedly) talented and reputable neurosurgeon.  I was actually very relieved and excited, despite never having undergone surgery or general anesthesia before.  I was told this surgery would fix the problem immediately.  But it didn’t.  In fact, as it turned out, this was the beginning of a long, sordid ordeal, albeit with a positive take-away that is the point of my story.

I woke up from surgery and immediately realized the pain was still there, in my left foot.  Worse yet, I had trouble moving my right foot, which was completely fine before surgery.  Over the next few days it became clear I had developed something called a foot drop on my right side.  I would later learn the surgeon had operated on the wrong side and likely injured the nerve on the right side. Things had gone from bad to worse.

Compounding this, the surgeon who operated on me refused to believe my description of what I was experiencing and was convinced I was just being “soft” for complaining of persistent pain and a new problem.  After 2 weeks of further deterioration — and only when another physician examined me, and herself ordered another MRI — did my surgeon agree I still had a significant surgical lesion.

That night I went back to the operating room and, this time, operating on the correct side, the surgeon removed a 4-centimeter fragment of disc from my spinal canal that was still compressing my S1 nerve root (below).

back pathology specimen

The next three months proved to be what I would later describe as the “best, worst” experience of my life – an assertion I still maintain nearly 15 years later.  For a number of other reasons and complications I suffered that I won’t detail here for sake of time and space, I became completely debilitated after developing another complication called a facet arthropathy.  So much so that my mother flew to California to stay with me, just to feed me and drive me around to endless doctor appointments.

My dream of becoming a surgeon had quickly vanished along with any athletic aspirations I once had.  I worried whether I’d ever walk again and had begun to accept the fact that I may be addicted to pain killers for the rest of my life. [For anyone familiar with such medications, I was taking about 200 mg of oxycodone per day – about 40 times what a “normal” person would take following a painful dental procedure.]

Things I once took for granted – walking, being able to lean over the sink while brushing my teeth, sneezing without feeling like my kidneys were being ripped out – became distant and fading memories.

Fortunately, with the help of some remarkable doctors (which included several more trips to the operating room), kinesiologists, and physical therapists, I would slowly learn to move again without pain.  I had to train as hard and deliberately for this as I had for every other athletic endeavor I’d ever poured myself into.

I experienced firsthand what narcotic withdrawal is like and the depression that accompanies it.  I experienced firsthand what an arrogant surgeon can do to a patient.  I learned more about medicine in that year than at any other time in my medical training.

As a postscript to this story, I eventually made a remarkable recovery and was able to begin my surgical residency a year later with minimal pain.  Today my back is stronger than it was before this incident. Except for the few people I have shared this story with (until now), no one would ever know what I went through.  I move through the world like someone with a perfectly healthy and strong lower back.

I also gained a profound understanding of pain and addiction, which became one of the most valuable lessons I carried with me through my brief medical career.  It allowed me to understand what a heroin-addicted person goes through, when viewed through the lens of my own experience with the strongest painkillers.

A few years later I would become close friends with Drs. Marty Makary and Peter Pronovost when our paths crossed during my residency at Johns Hopkins.  Marty and Peter have become two of the biggest pioneers of patient safety and the avoidance of medical mistakes.  My story became one of many presented in Marty’s soon-to-be-released book, Unaccountable.

Years later, based on my experience and research I did while overcoming this injury, I gave many talks on the treatment and prevention of lower back injuries and have become a minor expert on the subject.  If anyone is interested, here is a link to one of my presentations (slides only, no video/audio).

What does this have to do with a low carb diet?

Today, when I pick up anything, whether it be a cotton ball or a piece of paper, I do it with my legs, not my back.  When I lean over the sink to brush my teeth, I support the weight of my torso with my arm.  When I get out of a car or out of bed I position myself not to torque my back.  When I need to lift a 265 pound barbeque out of my car, like I did a few months ago, my lower back is never under strain.  How did I learn to do this?  Through a very deliberate and long process of adaptation.  I had to re-learn how to move, how to sit, how to lift, how to sneeze.  Were it not for the long and painful road to recovery I endured, I may have never learned these things.

Many people who suffer back injuries never really recover.  When they do “recover” from one injury, the rate of relapse is very high.  While no two cases are identical, much of the reason for this lies in 2 factors:

  1. The injured person does not learn how to modify their behavior to avoid re-injury.
  2. The injured person does not take the necessary steps to strengthen and rehabilitate their back.

“Curing” a back injury is not a temporary thing or something that just happens because we wish it to be so. It is a very deliberate lifestyle change.  Over time, as we form habits, we can go from consciously thinking through every necessary behavior change – something easy to do when we are in pain – to a place where the behavior is more automatic. But this takes time.

In many ways, transitioning to a low carbohydrate diet is similar.  Consider the figure below.

4 stages

Just like with behaviors that predispose us to lower back injury, most people go through life just eating on autopilot, but eating the wrong things, the “default” things.  They graze in a reactionary manner without any understanding of how what they eat impacts their body.  They are eating in an unconsciously incorrect manner.

Many people learn that what they are eating is actually not ideal and not predisposing them to maximum health.  They move into a place of consciously incorrect behavior.  They realize drinking a Coke with fries and a candy bar is not good for them, despite still eating them.  Some of these people go one step further and actually make corrections – removing sugar and simple carbohydrates from their diet, for example – but doing so requires great effort and deliberate action.  They are now in the realm of consciously correct eating.

This is the place where most people get stuck.  It hurts.  It’s hard to do.  They get frustrated.  Maybe even ridiculed by friends and family.  Most turn back to consciously incorrect eating with brief periods of re-visiting consciously correct eating.  Hence, only a few people make their way into the final stage of unconsciously correct eating, just as only a few people with serious back injuries ever make it into a state of unconsciously correct movement.


Because it takes a lot of time and a lot of effort.  It’s different for everyone, but I know for me it took almost 2 years to get to the point of unconsciously correct eating.  I had spent 36 years mindlessly eating the wrong way, just as I had spent 27 years mindlessly moving the wrong way before injuring my back.

Sixty years ago it was quite easy to default into the correct way of eating because we were mostly surrounded by foods that supported such eating.  But, our food environment has changed dramatically and today’s default eating (e.g., high amounts of sugar, grains, highly refined carbohydrates) puts most of us – about 60 or 70% of us – at serious risk of metabolic disease.  One day, I believe, the work of NuSI and others will fix this problem, and through the elucidation of unambiguous science allow us to create a food environment that supports easier (and more affordable) default eating of the right foods.   However, until then we have to go through these stages.

If you find yourself feeling frustrated at how difficult it is to get from consciously eating well to unconsciously eating well, remember that you are on a journey.  If you are consistent and patient, if you remind yourself that you are embarking on a journey to change your life and not a short-term fix to look good in a bathing suit next month, you will embrace the right mindset to find the ‘sweet’ spot of unconsciously correct eating.

I will be the first to admit that this is not easy.  But, if you’re reading this, you’re already down the path and you’ll be better able to help the next person who struggles through the 4 stages of transition because you’ve experienced it yourself.

Photo by Meta Zahren on Unsplash

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  • Ted kennedy

    Thank you for sharing your experience. For everyone that has moved ahead, there are those of us who have not. Your story is inspirational.
    Thank you

  • David Nolan

    Hi Peter,

    I’m a Physio that works with chronic pain conditions and there are several sentences in the blog above that do alarm me but thanks for the post. We are finding out more and more about pain which is interesting but now we need to get more efficient at treating it! The following link makes an interesting read and though you might enjoy reading it.

    As you know so well “conventional wisdom” is often misplaced.

    • Thanks, David.

    • Cindy C.

      Thanks David,

      I have herniated discs in my neck(per MRI), and arthritis in my spine(per X-rays). In reading many sites, herniated discs are common, and the person does not even have pain associated with it. Some years ago, I read books by Dr. John E. Sarno. His take was that stress, and our emotions caused our pain. He has has success in treating pain, but only if the person was open to the belief that injury was not the cause of the pain. Those books did get me moving again, and not as afraid of hurting myself again. Also what helped me reduce my pain was getting off of Ambien(side effect is pain), and pain medicines cause rebound pain. I have read sleep medication can damage Gaba in the brain. I am much better now, as long as I stick to the very low carb/moderate protein/high fat diet. I am on no pain medications now. This article mentions mitochondrial damage, and ketosis. There is hope to repair our mitochondria through ketosis. Such damage could be affecting our pain perception, or the diet reduces the inflammation causing pain.

      Just noticed Jill’s post about Dr Sarno. I have read 3 of his books.

  • Chuck B.

    Wow, that’s intense, Peter. Absolutely great analogy…and one heck of an experience you’ve had. I must say, however, having seen you speak, one of the things that I noticed about you was your impeccable posture…I just always assumed you had a mother that made you balance textbooks on your head or something.
    Thanks for sharing, and keep up the good fight.

    • It’s amazing what we can learn when the pain is high enough and the need to overcome it is great.

  • Max Power

    Peter, always look forward to yr posts. Outstanding analogy n quite a story to boot. Also checked out yr slide show n the video, n now I gotta get that book. the cliche holds tru, your health is your wealth.

    • Thanks very much. I read Marty’s book in one sitting. Very good book.

  • Great article Peter.

    I am definitely flipping between the consciously correct and consciously incorrect at the moment and that is after 19 months of doing this. I am thankfully back on to consciously correct as of today, but am finding that as I get closer to my goal, I am easing up on my militant anti-carb views, with regards to what I am putting in my own mouth and this means I flip back into eating the wrong things. As you say I would be putting in something I know is bad, whilst at the exact same time thinking why am I eating this. It becomes frustrating at the end of the day knowing that you are deliberately sabotaging your efforts when you clearly know what the answer is.

    It is exhausting to a degree. It all comes down to will power and motivation and I find it interesting that I get to a point where I lose both as I get closer to my goal. Maybe linked to never finishing home renovations projects, but getting close. 🙂 I think I need to reread your earlier posts and get some mojo back again.

    This story though has added back some motivation to my life and was very interesting about your back problems. I have suffered from lower back problems since I was a teenager that is a regular PITA. I have never really learnt how to use my back properly and always thought that if I could only strengthen my back more that it won’t be a problem.


    • Travis, check out the link to back talk I used to give. It’s not quite the same without the voice-over, but it will show you some good stretches and exercises.

    • Peter, thanks I checked it out yesterday and have already started to improve my posture. 🙂

  • Barry

    As the cheesy people on the reality shows would say – “it’s a fantastic journey”, this learning to be unconsciously correct . Mine is in its infancy with a few hurdles to jump, i.e. an Apo E4/E4 genetic makeup and cholesterol off the charts after going LCHF. It certainly exercises the brain with all the studies and websites to trawl through to try and find some answers. I thank you all very much for this website in particular. There are so many theories about E4 (eat low fat vs eat LCHF and don’t worry about cholesterol vs you’re basically stuffed no matter what you do), it’s history and role in so many internal processes – hopefully I can eventually work out what it does for me and how to ‘manage’ it, if that is possible. I’m relieved that, even though my ApoB is at excessive levels, my Trigs and HDL are good and my health is generally excellent. I’d hate to have discovered all this information in my 50s.

    Thanks for all your hard work, Peter, and thanks to everyone else for contributing to the discussion. A discussion which will hopefully eventually make it to mainstream.

    • Barry, keep up the diligent pursuit. This 4 stage path appears frequently in life — sports, nutrition, relationships — being aware of it is a good start.

  • Rob Hyndman

    Enormously helpful, Peter. I’m about a 15 year chronic LBP guy after a car hit from behind while I was stopped in mine at a red light. I’m stuck in the cycle of reinjuring my back that you describe. (L4 L5 herniation)

    I’m curious – what do you do for driving in the car? I find this is a sure way to reinflame the discs, and one that I cannot seem to avoid …

    • For about a year I would never allow myself to sit for more than about 30 minutes. I would also learn to do exercises with my back while sitting.

  • Karla

    Wow-what an awesomely inspiring story! Your achievements seemed remarkable before. Now . . . Whew!

  • LynneS

    Peter, as usual, a timely (for me) and well presented argument. Four months into reversing T2, going ok, but weight loss very slow, so often feel like giving up. I’m going to print out the flow chart and read it several times a day as a reminder. Thanks so much.

    • Hang in there and remember that it’s less about day-to-day variation, and probably more about month-to-month, or year-to-year variation.

  • Holy Cow! What a story! It’s terrifying to think that a doctor can be so arrogant to think that they couldn’t possibly have caused you those additional problems and that you must be making it up! They are just people, after all.

    This discussion of going from unconsciously incorrect to unconsciously correct is exactly my story. It took me about 3 years to get where I am today, but not without a lot of frustration and mess up. It is getting easier and easier to eat correctly and easier and easier not to mess up.

    • So great to hear, Graham. Interesting that the length of time for you to go from stage 1 to stage 4 was also about 3 years. I’m curious to hear from others who have made the transition, also, in terms of how long it took them.

  • David Nelsen

    I have found that the biggest challenge in eating low carb is staying award from certain foods during weak moments. Going to the movies and smelling popcorn makes it hard to resist. Knowing that they are bad for you doesn’t negate the fact that you’ve eaten them for decades and really enjoy eating them. I have found that it is mainly really sweet carbs I crave at times, and some of my other favorite old foods don’t taste the same (non sweet to the taste carbs). I tell people that it is both easy and hard to go low carb. You have to plan ahead, cook your own food and take ownership of what you eat. I am making salad dressing now and have a home made cool whip recipe to satisfy my sweet tooth. I think everyone does low carb slightly differently to suit their own tastes and food preferences. I’ve had some back issues over the years but nothing like you describe. I think mine are related to a really tight IT band that pulls my hip and L5 vertibrae forward. It also cause knee pain when running/cycling etc. It can be very frustrating working through sports injuries and you’re lucky to have regained your health. Cheers, Dave

    • Sounds like a “strong” stage 3. You know what’s right, but it’s not yet autonomic. You’re absolutely right, though, the less often you put yourself in stressful situations the better. Planning is huge. You’d be amazed how much time I spend in the average week planning what I’ll eat, especially when traveling or not eating “in my element.”

  • lorraine

    Wow, when I saw your question and the trailer posted on Facebook (without yet reading your post), I went to a completely different place: ie, that your point is that the problem of bad nutritional science is just part of the bigger problem in medicine. But this post is way deeper than that, and thank you for it. I’m truly sorry you endured this, and no wonder you ultimately chose to get out of the way of the train wreck that is modern healthcare. I know that our darkest hours often lead us to our greatest triumphs, but to say that your story of persistence and personal awareness is inspirational is an understatement. I can personally take many lessons from this post and your experience, and will use this philosophy in a much more intentional way with my clients. Thanks, Peter.

    • Thanks so much, Lorraine. I’m really honored that this post means so much to some folks. When I first wrote it I didn’t think it would resonate, because I had to leave out so many details to keep it short. Sounds like the message still made it through.

    • lorraine

      Yes the message definitely made it through. Not just the 4 stages to conscious correctness, which was nice to read here, it’s a template I’ve always liked, but the reality of persistence in the face of pretty bad odds. Someone else noted here in this thread about how some folks say they read Taubes (or Wolf, Eades etc) and they drop a ton of weight like a walk in the park. I’m not sure how that’s possible frankly, especially as people age beyond their 20’s and have metabolic issues from decades of SAD, and yet the main thing I’ve found that gets people off track is that very same magical thinking about how easy it should be. I’ve found in my own life, and tell folks I work with, to expect to have to do serial re-engineering of everything, not just their diet or work outs; and many times, not just once. Each step reveals something else that must be addressed in the next stage of engineering. In the course of trying to lose weight or improve their diabetes, many end up having to re-evaluate if their jobs are serving them or look at the toxic elements in their relationships, and almost everyone has to finally deal with how they handle life’s hardness by acting out with substances, which is often food. It’s hard and it is often very painful. For you to have made it through that crisis meant that you either had, or had to develop, a belief in yourself to keep going until you got to the other side. Many people lack this, and they remain relentlessly in that gray area of “I’m trying”, which exhausts what confidence and motivation they may have had at the beginning. My personal philosophy is that our issues and illnesses and injuries are there for the purpose of evolving us. What we reveal of ourselves to ourselves on the way through to the other side is the prize. But we have to go all the way through.

      My personal experience with LC is that once I got it right; i.e., got the amount of carbs right, and the timing of eating right (this ended up being very important to me), I no longer had any cravings or hunger. But that process of figuring it out took many, many months of experimentation and included some lost time and energy drain trying to mix ketosis and IF (didn’t work), and a few scary bouts of muscle cramps that were so bad that I worried about cardiac spasms. Salt wasn’t enough for me. I had to do supplemental sodium, potassium chloride, way more magnesium than I had ever taken, and some calcium with k2. I was seriously on the verge of quitting LC, but other than the fact that I feared for my life, I felt exceptionally great ! (lol), particularly mentally and body energy. The biggest awareness once I got all that handled was that even though I no longer had hunger or cravings and I’m never stimulated by the sight or smell of carbs, I still have times when I start thinking about junk food. Interesting to me, is that it’s always associated with me churning mentally about something I need to get done or figure out, and I’m either avoiding it because it’s out of my comfort zone, or it’s just not fully resolved yet in my head. Those situations seem to cause me a low level of anxiety, and my brain starts sending me images of sweets frolicking carefree. I have many recovering addicts in my practice, and I see all of this as the same thing, chasing the hit that’s going to take me out of that day-to-day low grade discomfort of staying present. with stuff that’s pushing me out of my comfort zone.

    • Nina

      Hi Lorraine,

      Would you mind if I asked you what “formula” of carbs, timing, & supplemental mineral amounts works for you, i.e. you mentioned much more magnesium…?


    • lorraine

      Hi Nina, Happy to, but I want to start with the caveat that what is working for me right now may not work for you, and it may not even work for me down the road. It’s just working right now. Also it’s important to note that my goals may not be the same as yours. My goals were/are to reduce or eliminate some symptoms of menopause, and to improve exercise recovery . I’m also very interested in longevity, and I like ketosis for both its impact on insulin growth factor and on autophagy. So with menopause I added a little weight and became borderline IR which is very common, and experienced some symptoms, although pretty minor, of sleep disturbance and some hot flashes and, shall we say, a little emotional intensity.

      Cutting CHO to below 50 g per day, irrespective of calorie intake, immediately eliminated all problems with sleep, and hot flashes, and getting rid of that stuff restored my emotional reserve. This is consistent with issues in the literature about how much of the symptoms of menopause are sex hormone related and how much insulin resistance related.

      I needed to get to about 35-40 g CHO to get into ketosis and stay there. My current formula, then, is 10ish% CHO, 70+%Fat, and up to 20% Pro, and I keep the calories under 1400 right now. I use a diet calculator called Weightmania Pro, which is a professional tool that I use for work, to keep track of diet and blood glucose and ketones (by beta hydroxybutyrate) for the purpose of determining what’s working and what’s not. I’ve lost some pounds, but body composition changes have been pronounced (even though I was already quite fit), and I’m no longer IR.

      Trying to add IF to ketosis did not work for me because the IF pulled me right out of ketosis. So I had to pick my approach and I decided for now to stay with ketosis. I asked Peter about this, and he found it to be true for him as well, related to the bolus protein intake that turns on gluconeogenesis. I’m most stable in ketosis if I eat smaller amounts throughout the day, starting as soon as I get up. If I start with coffee and postpone eating, I’m out of ketosis. I actually prefer eating less frequently, postponing breakfast and exercising fasted, but my body won’t do ketosis that way, and right now ketosis is the experiment.

      Apparently I dump electrolytes like crazy, and this has always been sort of apparent to me, in that I’ve recovered from exercise much better if I was supplementing minerals, but I was typically sloppy about doing it and have had periods of bad recovery because of energy drag and poor muscle recovery.Mineral supplementation has seemed to help. With ketogenic diuresis and drinking tons of water, that went to a whole new level of bad with the muscle cramping mentioned above, and so now my routine is to have broth twice a day mixed with 1/2 tsp of celtic sea salt and a dash of NuSalt (potassium chloride). The first one I have first thing in the morning with Slow-Mag and my first bit of food (before coffee and any training). The second one I have before bed along with a shot of Osteo-Calm.

      I’ve included the details of why I’m doing what I do because the context may not apply to you at all, and you may have to do something entirely different.

  • Jill

    Have you read any of Dr. John Sarno’s work on back pain and other pain syndromes like carpal tunnel? I’d be very interested to hear your opinion on his work, which would offer a very different interpretation of what happened to you start to finish.

    • Have not.

    • lorraine

      I’ve read 3 of Dr. Sarno’s books, and while I have certainty that unconscious rage is responsible for both pain and musculoskeletal injury in some people, in my experience anyway, those folks typically show up with concommitant issues (like anxiety, depression or food/substance abuse stuff). Even though the idea of his approach is appealing to me as someone very interested in the psychology of our physiology, he lost me when he started claiming that the veritable kitchen sink of disorders was all Tension Myositis. And I have also personally found that most folks are more than willing to process their subconscious stuff that could be triggering their physical symptoms, but this often does not resolve the physical symptoms.

    • Bill

      In addition to Sarno, I’d suggest the work of Dr. Nortin Hadler to anyone interested in critical views of conventional medical ideas about back (or any musculoskeletal) problems. His book for laypeople about this:

      His book on this topic for medical professionals:

      Hadler believes that it’s a rare case of musculoskeletal pain or disability that benefits from a trip to the doctor, much less medical intervention. There are important exceptions, of course (it sure sounds like Peter was one of them!), but Hadler has concluded that for the most part medicalizing one’s pain and other musculoskeletal challenges only leads to worse outcomes and more suffering.

      As I’ve mentioned previously here, Hadler, among other critics, likewise believes much of the other screening, diagnostic testing, and interventions that are the mainstays of modern medicine frequently cause more harm than good, or at the least don’t have convincing evidence to support them. This includes most cancer screening, cholesterol screening, and interventional cardiology and cardiovascular surgery, among many other examples Hadler reviews in his other books.

      Hadler is a proud academic, conventional doc. He strongly believes in medical testing and intervention—but only when it’s warranted and there’s real evidence to show it will advantage rather than disadvantage the patient.

      (Probably none of this relates to Peter’s story, considering the incredibly extreme suffering and disability he was experiencing, but since Sarno came up I thought I’d also mention Hadler, since their approaches are rather concordant and quite contrary to conventional medical wisdom–although if I’m not mistaken, Sarno’s once-radcial views are finally more accepted now and surgery for back pain has steeply declined as Sarno recommended.)

  • Jeff Johnson

    At the risk of ridicule – mockery – insane fits of laughter –

    I’ll post the following anyway –

    The following protocol has seemed to fix my back – no problems since trying it –

    Method: Take a mixture of the following: – starting dry/ – beans-lentils/peas-wheat-barley-millet-rice – put in a bowl – sprinkle with whey protein and cover with water – never drain the water – just add more water when needed – and eat one teaspoon a day –

    I assume this wet slightly fermented mixture creates some needed substance or the bacteria in the colon use it to do same – redirecting the bodies use of calcium –

    I eat a teaspoonful of this mixture dry for other reasons also –

  • ian

    Good post. Articles like this help me to remember how much effort I’ve put into changing my own life. I’m only 21 years and I’m currently 15 months into my recovery from drug addiction. Only once I finally became conscious of what I was doing to not only my body, but every other aspect of my life as well, was I able to begin the transition to unconsciously correct. In my case, the only way out was a total lifestyle change. I went from drug addict to health nut despite ridicule and being judged ( how ironic is that?). I think if everybody who wanted to change would grasp the idea that real changes come from conscious and active effort (perhaps even pain and sacrifice) the world could be a much place… thank you for what you are doing here Peter!

    • Ian, thank you for being open enough to share this. I can’t tell you how my own addiction to opiates completely changed my view of “addicts,” especially at Hopkins, which sits in the heroin-capital of the United States. I really believe the empathy (not to be confused with sympathy) I had for patients with this affliction would not have been present without my own struggle. And here’s another point, I’ll be you already know…you never really lose the “taste” for it, at least most people don’t. Which is all the more reason to maintain diligence and create a new infrastructure around yourself.
      I used to tell patients who wanted to get off drugs that were going to need a new group of friends. There was little chance they could get clean with the same social support network that fostered their addiction in the first place. Very tough choices. So glad to hear to you’re making progress.

  • Jill

    As a surgeon and fellow former sufferer, he might just blow your mind. Worth a read for sure.

    • Very cool. Thank you.

    • JohnK

      To summarize Sarno for the fellow blog readers (hopefully reasonably accurately): Sarno theorizes that a lot of chronic back pain is cause by the body/mind “crying for help/attention/care” due to high stress. Once the condition is consciously recognized, the body/mind recognizes that this activity will not result in the desired response, and ceases generating pain.

      This was brought to my attention years ago while I was having long-term chronic back pain, which was not relieved by a good chiropractor, physical therapy, or exercise. Frustrated, I went to a “body guru” who scheduled me for an MRI to find out what was wrong. Before that happened, I ended up changing jobs suddenly and unexpectedly, resulting a complete loss of stress. A day or so later, my back went through some painful spasms while I was sleeping one night, and the pain was gone forever, and has not reoccurred since. I ended up telling this story to my guru, and his response was immediate “Oh, Sarno pain”. The subsequent MRI showed a 40 year old back with only normal wear and tear – nothing of note.

      I read Sarno’s work and do believe that for some people, this can certainly be a source of pain. This too takes a willingness to abandon conventional wisdom to make progress.

  • Mike H

    I threw out my back once, and it was hands down the worst pain of my life. I was stuck on all fours for about 2 hours, and then with help I was able to lay down on my back, and was stuck there for about 3 hours, completely unable to move. Had my girlfriend not been there I don’t know what I would have done.

    This happened when I was at my heaviest, about 300 lbs. I was also having really bad sciatica at the time. Getting in and out of my car was, quite literally, a huge pain in the a**.

    For me, exercise and weight loss were the cure. But I did also have to change the way I held my body in various positions. What you say about doing something unconsciously correct really does ring true. I don’t have to think about it anymore. The heartening thing is, after now being on low carb for a year, I’m getting there with diet as well.

    • Congrats, Mike. Amazing that it only took you a year to get to the elusive “stage 4” — nice work!

  • Jamie

    Thanks for the link to your presentation. Can you direct me to any more information/articles on how to re-train yourself to use your legs and not your lower back?

    • I don’t really follow the literature any more. There are a few other resources folks are commenting on, though.

  • KevinF

    Holy crap! I can sincerely say, I’m happy not of that ever happened to ME. Because I’m self-absorbed like that. And very glad you made it through all that to so you could teach us about LDL-P.

    • Kevin, glad to hear you’ve got your priorities straight!

    • KevinF

      BTW today I had my first check-up since getting sucked into the whole Taubes/Attia mania, and I’m pleased to report my new doctor is low-carb friendly and well experienced in utilizing the LipoScience NMR.

      • Great. I hope others will be as fortunate.

  • Maryann

    I’m so happy for you; what a truly amazing recovery! No one could ever imagine what you have been through, seeing your elite athletic status now. I am always impressed by your readers who say they read Gary’s book and poof! they changed everything about their diet and achieved magical results. Thank you for the encouragement.

    • Maryann, if it makes you feel better, very few people have that experience. For most, I suspect, it’s a longer (and non-monotonic) journey.

  • Alicia L.

    Wow Peter. I recently embarked on my career in public health (I graduated a year ago with my MPH). In this post, you have managed to touch upon the two topics that most interest me, patient safety and nutrition (topics that would likely consume the majority of my conversations if permitted). Thank you for sharing your story. I am sorry that you experienced such a difficult and complicated recovery–thanks in great part to the surgeon–yet I greatly appreciate your ability to reflect on it as one of the most educational experiences in your life.
    Your parallels between eating and appropriate lifting technique behaviors are insightful. It is so true that the process of transition most often happens over an extended period of time, on a continuum. I have always been fit and athletic, but have dramatically reduced my carbohydrate consumption over the past year. I am currently training for my first marathon and I will do it on a ketogenic diet. It’s so neat to be able to run 9 miles at 7:45mi/min. pace, on an empty stomach in the morning!
    Your blog has been such an excellent source of information and I have passed it along to many a friend and family member. For me as a public health professional (who has read both of Gary’s books and his articles about poor epidemiological methodology/science), I am both excited and hopeful for what NuSci will bring! Keep writing, stay balanced, and we all look forward to what comes next…

    • Thank you so much, Alicia. It’s so exciting to know there is a new generation of public health professional out there. You’ll definitely want to pick up a copy of Marty’s book and get to know Marty and Peter. If you haven’t already, you should get to know Leah Binder of the Leapfrog group. Along with folks like Marty and Peter, these people are seriously cleaning up hospitals to ensure the crap that happened to me (and stuff much, much worse) doesn’t happen to others.

  • lorraine
  • Nina

    OMG, what an incredible and inspiring story!

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  • Really enjoying your blog. This post was particularly apropos to me because I just started a Whole30, with the hopes that the very difficult consciously correct eating that I’ve been doing will turn into unconciously correct eating. Having toyed with Tim Ferriss’s slow carb diet for a while (and suffering huge carb hangovers the days after the “cheat day”), I realized I needed to get clean of carbs, an addiction not unlike pain killers. In your experience, which was more difficult, getting off carbs or oxycodone? Thanks again. Always look forward to eating academy posts!


    • Amazing parallel between carbs and other addictive substances. I didn’t even get into the withdrawal I had from opiates.

  • Mike K

    I sincerely appreciate all your posts Peter. I am a physical therapist by trade, but also have a great deal of interest in nutrition and exercise physiology. My question is somewhat unrelated to this post, but I was wondering what your thoughts were regarding the Paleo diet. I have read Robb Wolf’s “The Paleo Solution” and Loren Cordain’s “The Paleo Answer,” as well as both of Gary Taubes’ books. I now follow your blog, and I would love to hear your thoughts on the Paleo diet in your own words. Thanks so much.

    • Mike, it’s too much to get into right now, but the short answer is I’m really good friends with Robb Wolf and we are very, very aligned philosophically. The distinction, in my mind, is that the “paleo crowd” (I hate these labels) uses a more teleological approach, whereas folks like me and Gary arrive at the same conclusion looking at the evidence. In essence, it’s a great way to feel confident about the outcome. Both the evolutionary story and the science line up. Sure, there are minor differences — while I’m happy to write about some time — but the “higher order terms” all align.

  • Scott Barentsen

    Fabulous post Peter – Thank You. I really appreciate when you talk about behavior change, since that is the nut we all need to crack to get on the other side of this crazy and mortally threatening high carb, sedentary lifestyle. I realized a while back (after reading “Younger Next Year”) that the difference between a guy who dies at 60 and one who dies at 90 is that the 90 year old got 50% more life. The most important game anyone ever plays is “beat the reaper”.

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  • Hey Pete, thanks for the story, it puts things into perspective. The bad back analogy spoke volumes to me. As a college kid I was a grunt for the soda industry. People don’t realize how hard those guys work; people in America are obsessed with soft drinks, and the amount of physical labor it takes to get those to the grocery shelf is unbelievable. Picking up 40-50 pound cases all day, pulling 2,000 pound pallets hundreds of feet at a time, lifting and stacking those things all day long plays terror on your back. I too woke up one morning and wasn’t able to stand up to go to the bathroom. I was not as bad off as you, but I had to roll onto my stomach and push myself up with my arms to stand up. From that day on I’ve seen a chiropractor on a regular basis. I now see him once a week for what happened 11 years ago. Thankfully, I caught it early and made no permanent damage, even if I do still need adjusted a lot. Point is, you’re absolutely right in all that you said, and moving from consciously correct to consciously incorrect is the hardest discipline for a human IMO. Continuing a habit is easy, and normal, but building a habit takes time, effort, and sweat. That spoke volumes to me Pete, thank you.

    PS – You didn’t mention what hurt your back, do you know exactly what it was, or was it multiple things?

    • Oops, consciously correct to unconsciously correct********

    • Thanks for your story, Gary. I suspect my injury was caused by the sins of my youth. I used to do very heavy squats and deadlifts — perhaps with imperfect form — along with a lot of spinning kicks in martial arts. Perhaps the stupidest thing I used to do was stiff-leg deadlifts. No shortage of dumb things I did growing up.

  • Kathy

    Peter, I am very sorry you had the “worst” part of that “best worst” experience, even if you did learn lots from it. But am I the only one who was struck by how long it took a doctor (you) to go in and be checked out? What a riot. Sleeping over a counter? I thought I was stubborn! I have to admit, I got quite a laugh out of that – not out of the pain you were in, please know that!

    • Kathy, as you probably know, doctors make horrible patients! I was so focused on my surgical career that I couldn’t see past “toughing” this out.

  • Larry Sumners

    Not that you need another subject to tackle but back pain is such a chronic problem with everyone having an opinion as to treatment. I have had lower back problems for 20 years and do an assortment of exercises but never have been sure that everything that I do is correct or best to develop the proper muscles. This is for sure an area that the medical community needs work.

    • I agree, but one blog is enough for me right now. Hopefully others are doing good work in that field.

  • tess

    VERY interesting post, indeed.

    i used to have lower-back pain but it wasn’t that horrible, just chronic. it went away after i started using systemic enzymes, but whether i can credit their anti-inflammatory virtues or the anti-viral, i don’t know.

  • Joshua

    Powerful post. I feel like a LOT of people don’t understand how difficult consciously correct behavior can be – especially for somebody getting back to health from obesity. The environment was not the only reason I overate, but it was a contributing factor. Even after eating around 100g of carbs per day for 7 months, I will slip back into old habits if I don’t watch what I’m doing. I call it my eating autopilot, and I kid that it was programmed by Augustus Gloop (of Willy Wonka fame).

    Because of this, I journal every single thing I eat – even if I lapse and eat a funnel cake. I feel like I’m slowly reprogramming that autopilot, but I wouldn’t be surprised if it took at least another year+.

    • Joshua, this is a very powerful tool that works for many people. Glad you’ve discovered it.

  • Dorian


    A bit off topic here, but along the lines of getting from unconsciously incorrect to unconsciously correct, we have a few nieces and nephews in their early teens who may be able to benefit from learning about nutrition as you present it. Do you know of any good sources or techniques for teaching kids about this topic?

    • Not off the top of my head…anyone else?

    • JohnK

      It seems to me that teens could handle Mark Sisson’s blog (marksdailyapple) to get the basis message. Particularly, the success stories send good messages in easy to digest form. (Please excuse the pun).

  • John Dawson

    Hello Dr. Attia. Thank you for your story. I wondered, have you gotten over the “drop foot”, or is that damage permanent? I have an interest, I developed a drop foot problem following a cath procedure (through the groin) about 3 years ago.

    • Luckily the damage reversed with a quick follow up surgery and lots of rehab. I mean *LOTS* of rehab. If rehab were an Olympic sport, I would have likely been on the team.

  • I had paralyzing back and leg pain and muscle stiffness when I gave up gluten. Why? because I foolishly substituted maize corn and ate a huge bowl of grits. Turns out I am also allergic to corn, and the symptoms from that mimic (well, they probably WERE) rheumatism and arthritis. Cut out all corn products and after a few months no trace of it.
    But for a while I was even reacting to corn-fed chicken and ascorbic acid made from corn glucose.
    I wonder how many people with these conditions die without learning what really caused them.

  • Ellen Urciola

    Right Post at just the right moment. Thank You
    School is about to begin (I am a high school teacher), wanted to start with the “oohs” and “ahs” of “Wow, you look great!” “You’ve lost a lot of weight over the break!” and “That low-carb must really work!”Not going to happen. Still struggling with the weight, even though I have been religiously low carb, have meticulously recorded fat to protein percentages, adjusted the percentages to where I am at 47% protein 43% fat 5% carb (for the life of me cannot account for the rest, perhaps waste management?)
    Anyway, having quite the pity party for myself, until today.I have constantly started, stopped, lost, gained, all of my adult life, this time it is different. This time I know I am on the right track. This time my focus is not just weight, it is health and weight. This life style feels right. I am onboard this train for the long haul. You are a great conductor, an even better teacher, and an inspirational role model. Keep up the great work. Oh, by the way my long term goal (for this tall 5’2 1/2 inch, 219lb. frame? To participate and complete the Marine Mud Race at Camp Pendelton. Thank You

    • Ellen, that sounds like a lot of protein. What would those ratios work out to if you were, say, 50 gm/d carb, 100 gm/day protein, X gm/day fat (where X = whatever you need to not be starving)?

    • Elenor

      Ellen, please spend a little time reading up on the “Stop the Thyroid Madness” website and forum. My thyroid doc (I actually found an educated one — SELF-educated, not standard AMA issue! {eye roll} ) said that I could be doing the exactly right diet (he’s all low-carb, bless) and exercising my fingers to the bone — and as long as my thyroid and adrenals were screwed up — I wouldn’t lose an ounce! (And I didn’t!)

      And oh! oh! The JOY! The HEAVEN that comes after treating my adrenals (and thyroid — but the adrenals come first)! I used to wake up “hung over” — “no loud noises please, no bright lights” — and my coffee would ‘fix’ me (because it whips the adrenals to perform, the poor things!). I was stiff (“well, I’m old, fat, and sedentary, what did I expect?” — except I was doing four hours a week of water aerobics … and losing no weight!) and the soles of my feet hurt (turns out that’s often adrenal!). I woke up feeling like someone had taken a bat to my kidneys. (you know, “old, fat, and sedentary”). I treated my adrenals (and it took nearly three years with physiological (wee small) doses of hydro-cortisone) and now — no stiffness (well, except for after eating wheat and/or nightshades!), I can walk out in the sun without cringing like my eyes were bleeding, the guy with the nighttime bat has left the building… Amazing! But you have to self-educate, because your doc won’t know — and your endo will know even less! Just like with diet — the docs (no offense Peter and other docs here) know only what they were taught — or what they personally lived through and set out by themselves to become smart about!

  • Anthony

    Hi Peter,
    I have followed a similar path to you (without the surgury) with a torn left upper trapzius and bulged S4/S5 disc (not related, seperate injuries). I have also partaken in the olympic sport of rehab for many years, most of them unsuccessful. But the parallels you draw between overcoming injury to live a “normal” life, or just the very best you can with diet / nutrition kind of summed up the last 15 years of my life. Sometimes you just have to do the boring, unpopular, monotonous, difficult things in life to make a difference. For some like you and me – it was mostly to rehab injury. For others, making these hard nutritional choices means gaining back a “normal” existance of controlled weight, blood sugar, cravings etc. Repetition of good habits is what leads to that magical unconsciously correct state, which upon reading this post, I realised I have been living for both the management of my injuries (at present pain free and very capable of high intense exercise) and nutrition. The difference between unconsciusly incorrect (which I think is where most of society is) and the state we are in is worth incalcuable value in health benefits, dollars, and most of all, quality years of life. It’s worth it.

    • Totally agree, Anthony. But it’s a windy narrow road, which is why I’m so committed to not making it so difficult for all those others stuck in stages 2 and 3.

  • Birgit

    Peter, thanks for sharing your experience.
    I have often moved carelessly when picking things up and will pay much more attention now. Thankfully I have never had backproblems at 49 years old and I think I have my experience with horseback riding to thank for that. As part of my training for horseback riding I learned to comfortably sit and bounce on an exercise ball to help strengthen my core muscles that support the lower back and the muscles in the pelvis. I now use it instead of a desk chair and roll around on it a lot, so never sit still for more than a few minutes. When horseback riding with a correct seat the movement of the horse will encourage free movement in the lower back and pelvis and this can be very therapeutic as well as prevent lower back problems.
    The exercises you are describing are very similar to those covered by Pete Egoscue in his book “Pain Free”. I believe if everyone followed the guidelines in that book many chiropractors would be out of work.
    Concerning the low-carb for teenagers, my 15-year-old daughter has recently read Mark Sisson’s “The primal Blueprint” and a number of your blogs without any problems and she is not a traditional learner. She is currently reading the new book by Jeff Volek and Stephen Phinney “The Art And Science of Low Carbohydrate Performance” and it is motivating her to experiment with a close to ketogenic diet (no grain, no beans, no sugar, carbs around 40-80grams/day) while training for her high-school swim team season this fall. I just wish she had a coach who is knowledgeable in this area. I guess she is doing an experiment of one and we are looking forward to seeing if she can reach her goal of making state time this year. 🙂
    I’m also hoping to have her read Gary Taubes “Why we get fat” soon and if her athletic performance improves we hope to share the message as some of her teammates are overweight if not obese.
    She is the only swimmer on her team who is not constantly eating, a huge change from before she went low-carb when she was snacking on carbs all day, although the choices she had were what we thought at the time to be “healthy and organic whole grains and beans” primarily.
    Now the treats are homemade ice cream made with raw whole milk and Xylitol or raw cheesecake made with a ground nut and butter crust and cream cheese, cocoa powder and Xylitol.
    I never thought this would be possible for a teenage girl. I am so thankful that I can spare her the sugar/carb addiction and the resulting belly fat that I lived with for decades in spite of moderate exercise. 🙂

    • Lex

      Birgit, I’d really like it if you’d share the ice cream and cheesecake recipes! Exactly the things I want to try at home.

    • Birgit

      Lex, I’m too lazy to ever use recipes and exact amounts are not necessary for these so this is very approximate. I have gradually reduced the amount of Xylitol as my taste buds are getting more sensitive to sweet tastes.
      For the ice cream: about 1 qt whole milk or half and half or heavy cream or any combination of those (the more cream the lower the carbs), about 1 1/2 to 2 1/2 tablespoons of Xylitol and any or several of the following for flavoring: 1-2 tsp. vanilla, almond oil, peppermint extract, cinnamon; 2 tbsp. of cocoa powder, a cup of nuts or berries of your choosing (mix in in the last 5 minutes), 1-2 egg yolks from pastured poultry (we use our own duck eggs), unsweetened coconut flakes, 85% cocoa dark chocolate pieces …
      For the cheesecake:
      crust: 2 cups ground nuts (any type, even sunflower seeds will work), 4-6 oz. melted butter, mix well, spread in springform that is lined with waxed paper, refrigerate while making the filling
      Filling: mix 3- 4 packages of softened cream cheese, 3-4 tbsp. Xylitol, juice of one lemon and lemon zest to taste or for chocolate cheesecake cocoa powder to taste, one raw egg yolk (optional), spread in springform, chill for 1-2 hours minimum, serve with a few berries

  • David Nelsen

    In regards to medical mistakes, it seems to me that the medical industry does not have a strong culture of pro-activelly finding and correcting potential mistakes. I understand that physicians can be sued for malpractice if a mistake is determined, but in general they are not putting patient safety at the forefront. One of the articles linked had an incident where a nurse pointed out to the physician that there was no blockage in the artery where a stent was going to be placed. The doctor blew him off and implanted it anyway. He reported this and the hospital agreed that this doctor had done many unwarranted cardiac procedures. Was he rewarded for speaking up? Of course not! His contract was not renewed. We make computer chips where I work and if we screw something up in the manufacturing process the chips won’t work. The wafers we make can’t sue us so our approach is very proactive. We reward behavior that can find situations that could lead to scrap or yield loss. We also do this for workplace safety and it is amazing how much improvement can be made in your quality indicators if you focus on the right things and encourage everyone to speak up and particiate. I watched the trailer and read some of the Unnaccountable excerps on Amamzon. It seems the cuture in medicine is to bury or minimize the admission of mistaktes (and protect the repeat offenders causing them), allow doctors to perform intrusive procedures that are not warranted to boost hospital profits, and poor communication of the downside risks of the procedures to be performed. I think you would find about 80% of the medical problems would go away if they removed the bottom 10% of poorly performing doctors. Sadly, that’s not going to happen. I’m glad you made it out alive. Cheers, Dave

    • I could write a 10 part series on this topic. The system is a mess. Fortunately, folks like Marty and Peter are working on it.

    • Birgit

      David, thanks for passing on this information. I don’t want to know but I need to know. 🙂

  • Zak Hendsch

    Thanks for this article. I really enjoy your thoughtful approach to nutrition, even though I’m not a low carb guy.

    I will share a trick that may help others. I fail miserably whenever I change my diet all at once (in other words jump from stage 2 to stage 3). Instead, I take a piecemeal approach to changing my diet. For example, I might start with improving my breakfast or not breaking down and binging on donuts at 10:00 AM. Then I practice that one improvement until I get it to stage 4 (or at least very easy if not completely unconscious). Since it’s only a small piece of the diet that I’m changing at once it takes only a week or two of practice before I’m ready to make my next improvement.

    Overall I haven’t progressed any faster. I’ve been at my target weight for 3 years now and I’m still tinkering with my diet. However, focusing on one piece at a time not only makes each day easier, but it also provides regular milestones of success (even when the scale doesn’t cooperate) which really helps my motivation.

    • Thanks for tips, Zak.

    • Zak Hendsch

      Looking at your “How to lose weight” section, I see you already have much the same idea (expressed more clearly), with your own stepwise transition. My only new insight is that even your smaller steps would be too much for me to handle all at once and I would have to break them down into many smaller pieces. So rather than thinking of myself as struggling to get from stage 2 to stage 3, I would see myself making steady progress from 2.0 to 2.1 and then to 2.2 and so on.

  • Man, I really wish you had a recording of one of your presentations. This is one of those things I’m shocked there is no centralized knowledge resource for. Do you have anywhere to point me to? I’ve suffered from on again, off again back pain and tried a bunch of things to help. I think the biggest thing for me was almost completely eliminating sitting. I either lie down or stand up most of the time when I’m using my computer/working, and try to take breaks to go walking. How long did you spend doing the exercises for your back? What was your typical routine for the exercises you put in your slides? I have had small success’s with Egoscue and Rolfing, but only seem to reinjure my back with ease, usually through weight lifting or Martial Arts practice. If I’m dedicated to healing my back, how long should I avoid these activities during the healing process?

    As for low carb, I’m totally straddling phases 2 and 3, retreating to 2 when dealing with anxiety. I’ve kindof turned it into a game now though, to see how many days I can go without having too many carbs, and so far my record is 4 months. That and I weight myself weekly. It seems my streaks are getting longer while my cheating is getting smaller.

    I just want to say right now you’re serving as a kind of inspiration for me. Recovering from back pain and losing the weight while still getting stuff done is the kindof example I need to see to not give up. Many props, and look forward to seeing what’s coming next.

    • Anthony, it would take me 10 hours to properly answer all of your questions. I’m sure there are good resources out there, as many readers have put forth ideas. One point is clear, though. If you reduce your weight, you’ll reduce the load on your lower back. That part, I hope I’m able to help with.

  • Susan

    This article is a godsend. Your story moved me almost to tears. As someone who literally just started a low-carb diet, this helped a great deal. It’s also wonderful to see how a trial in your life became a blessing. So often the hardest moments in life become the moments of greatest learning, and we begin to empathize more with others. One of the biggest problems with doctors, it seems, is a lack of empathy. I bet this gives you an age in dealing with obese patients.

    • Susan, your comments move me, also. There’s a big difference between empathy and sympathy, as I can tell you understand. It’s much more important for doctors to have the former, though some lack even the latter.

  • Bobby

    Peter: It was amazing story and I give you all the credit in the world for making through that period in your life. I’m sure many don’t have your strength.
    I am at a point where it is tough for me to stick to a diet similar to yours. I seem to get bored and also wonder if I really need a diet that extreme. Your wife can handle carbs and I have no reason to believe I can’t since I have not evidence I am prone to insulin resistance.
    Do you have any comment to this short bit of evidence of the downside of a high fat? diet:

    • Bobby

      I know, the study involved mice, so it may not be relevant.

    • You said it already…mice issue…

    • JimB

      The strange thing about this study was the opening sentence, which said ” A protein that slows aging in mice and other animals also protects against the ravages of a high-fat diet, including diabetes, according to a new MIT study”
      I wasn’t aware that one of the ‘ravages of a high-fat diet’ was diabetes.

    • jim bowron

      Peter- an enigmatic answer- Do you mean to say that the link between a high fat diet and diabetes is so well established that the link is ‘bulletproof’? I had thought that a high carb diet, rather than a high fat diet, was linked to diabetes.

      • So, sorry, Jim. I was being sarcastic. Dietary fat does not lead to diabetes. Thanks for clarifying for yourself and others.

    • Jim Bowron

      Peter- in looking at another site I saw a reference to a Wikipedia entry called “Poe’s law” which recommended visual clues that a statement is sarcasm. Interesting entry.

      • Did I make a comment in this post that is confusing? Interesting concept. I wonder if it’s true once you really know someone?

  • Jeff G

    Brilliant chart going from unconsciously incorrect to unconsciously correct. So many applications to our daily lives. Great insight Simplifying what can be a long and important process for self improvement/help and life. Thanks

  • Bobby

    But should we ignore every study that involves mice? Why are they done?
    Regarding the first part of my question, is a ketogenic appropriate for everyone? If not, who should and should not be on that diet.

    • To your first question, no. Some things done in mice make sense. Toxicity studies, for example, if the dosages are reasonably matched and the mechanism of action the same (e.g., cyanide). But for too many things (e.g., aspartame, chemotherapy), the results have little meaning. To your second question, also, no. There are probably many people who do better on a diet other than a ketogenic diet. Furthermore, even a single individual may do well on a KD for some thing and not others. It depends on your genetic make up and your goals.

  • Ellen Urciola

    Hi Peter,

    I added up my gram totals again and averaged it out over the 34 days I have been keeping a record. My Protein total is 3,274gm for a 34 day period, which averages 96g/day. My fat average is 2,160gm for a 34 day period giving me 64gm/day average. Calories averaging (slightly hungry, but satisfied) 1169cal/day.

    As for stages, I am definitely at S3, Consciously Aware. I started this lifestyle change on February 7, 2011. For me it was a medical scare of rising glucose and BP. Even though I have not looked back at the sugar, grains, flour, pasta, I have continued to roller coaster as I try to figure out what percentages work for me. These last 34 days I have given up most dairy (except my heavy cream in my coffee). Believe me, I would live on nuts, heavy cream, cheese, and sopresetta blissfully, but as my brother suggested, perhaps (?) not just yet.

    Okay, neurotic, but conscious vent/ question here: are not carbs equal to 9cal/1gm? So 50 would mean 450cal. I have fought very hard for these 9lbs. I would be disheartened to give them back. My chart tells me weight loss is happening at the 96gm Protein/68gm Fat and 19gm Carb. Granted, it has been a very hard 34 days.AND I definitely welcome the input. I know, I am relying too much on the calories, old habits die hard, but I am consciously aware, I just want to get out of the double digit 200’s..

    Okay, venting out of the way. I will apply this formula for the next 34 days and see what happens.

    Thank You

    • Carbs are about 3.5 to 4 kcal/gm; same for protein; fat is 9 kcal/gm.

    • JohnK

      Hi Ellen –

      I have been working this diet for almost a year, feeling great, lost a lot of weight at the start and then plateaued. I was consuming almost entirely eggs, heavy cream in coffee, some nuts, cheese and meat, along with butter and olive oil.

      I got really annoyed at my plateauing and decided to drop the dairy, as I read at one of the paleo sites (perhaps marksdailyapple) that some people have hormonal-like reactions to dairy. The way I’m eating now, I really don’t care what exactly I eat as long as it fits the program, so dropping cream from my coffee was more a psychological issue than a dietary one. But I figured I had already gone so far on this lifestyle and don’t want to go back, so I said goodbye to dairy. Weight loss has started again. I’m thrilled.

      As a coffee with cream lover for most of my life, I hated to drop dairy from my coffee. I found out that if I drink it iced instead of hot, I really like it a lot. I tried cream in my coffee the other day, thinking I deserved a treat, and found to my surprise I didn’t like it.

      Good luck.

  • Peter,

    Thanks for this! One of the best things I take away from your blog is looking at month-to-month and year-to-year transitions. Many of the experiences you describe take a long time, and start with just gradual improvement. (“I can brush my teeth without pain! yay!”).

    Sounds like a blinding flash of the obvious, I know, but many of us have spent a long time in the mode of “today I’m going to diet and exercise and do EVERYTHING different!”. It’s good to see that in most cases the process is more like, “Today I’m going to do ONE thing different… and keep it up tomorrow…and the next day…and then maybe add another thing…”

    The other thing that’s particularly helpful is knowing that you’ve been able to overcome the woulda/couldas. By which I mean, going from near-Olympic quality sports performance to being happy to move without pain is hard mentally—you must have caught yourself thinking, many times, “Damn it, if this hadn’t happened, I coulda been…..”

    Learning the ability to focus on improving the future rather than dwelling in the subjunctive tense is very important–and difficult!

    Thanks again!

    • Johna, thanks for making this additional point, also. Life is a lot of that…

  • Bobby

    So how does one determine genetic make up? Is it simply a matter of personal experimentation?
    Can a particular diet work for a period of time and then become less effective? Could you see altering your diet at some point?

    • All great questions, but too complex to address right now. A lot of these questions are addressed, though, in other comments and posts.

  • Elenor

    “it must sound crazy to think that a patient could have a MRI scan so quickly”

    Ha. Not at all! When I showed up at 10 p.m. in my local ER (having just flown back to Georgia from California lying on the floor ahead of first class (and wasted a first class ticket {sigh}), throwing up and in agony from a kidney stone) — they were VERY happy to throw me right into a scanner — and then charge me TWELVE THOUSAND BUCKS for the privilege!! (Uninsured, so I really get socked with the medical bills! There are no negotiated breaks for the uninsured!) We negotiated it down (later) to a “mere” four thousand bucks! (It’s often the case, if you have a hammer (MRI machine) you want to — and need to ! — hit things with it to pay it off!) {frown}

  • Darn, I thought you were going to conclude that eating less carb would fix my back!
    I have a 30% slipped L5 and was able to stabilize it with a consistent yoga practice. I’m still running, biking and swimming so I guess it works!
    I loved this article because I know people in all four stages – it does take time to go from one to the next – I think it’s more of being able to emotionally go into the next stage…

  • jess

    I feel very confident with the low carb approach and have followed it for years. It is definitely “unconsciously correct” for me. However, I am plagued by two troubling symptoms when I remain in ketosis. My eyes become dry (very bothersome) and I have episodes where I feel like I’m going to pass out. To me, this seems like dehydration from not enough insulin (can’t hold onto fluid), and I feel better when I eat more carbs. I have tried adding salt but it doesn’t seem to help. Also, I had my insulin checked, and, like yours, it was <2. Any thoughts? Thanks!! Love your blog.

    • Hmmm…not sure I know what’s causing this. Any others experiencing it?

    • owenscott

      Jess try more salt … just a guess but it makes sense.

  • Tammy

    Thank you for the insightful article! I very much enjoyed it! I have been a physical therapist for 24 years and what I have observed is that when people eat carbs of high inflammatory potential ( sugary drinks, sweets, pastas, refined grains, etc.) there is often a noted increase in pain. I have observed this consistently in low back pain, adhesive capsulitis, neck pain, knee pain and hip pain to name a few. Likewise, when I see clients who do well and ask them about their diets, they often eat low carb….this lead me to go get a Master’s degree in Human Nutrition.

    I hypothesize that refined carbs in any form may actually increase inflammatory cytokines that stimulate pain receptors that are already sensitized by chronic mechanical dysfunction. As physical therapists, we have not yet fully recognized the new definitions of inflammation. Rubor and colar are still the emphasis of PT schools. There is little if any education on inflammatory cytokines. This is a mistake in my opinion.

    There is documented evidence that IL-6 receptors antagonists will help block pain in musculoskeletal issues. Agonist treatment is followed by….you guessed it, low carb eating, sun exposure, exercise and adequate sleep. The outcomes are often successful. This treatment is only available in Germany currently but soon to come to the US.

    So, my point is this…there may be a correlation to low back pain and low carb eating through the avenue of reduced inflammatory cytokines level. And the key is that the systemic reduction in cytokines may decrease the upregulated pain receptors in an area that does indeed have mechanical dysfunction of a chronic nature. Though I have tried many times to interest a university PT program to study this with a medical team, my attempts have not been successful. Maybe the NuSI (? spelling) would be interested some day in the future?

    My thanks again! I was excited to read your experience and glad you are doing well now!

    • Tammy, I think you are absolutely on to something plausible, and probably quite likely. Thanks very much for making this point.

    • Rachel

      Tammy – Two weeks ago I had a high impact fall that resulted in a hip fracture. I have experienced exactly what you report – very little pain. The doctor and nurses and physical therapists were all surprised by how little pain meds I needed after surgery, and they said I had a high pain tolerance, which I don’t believe is true. But after reading your post – I wonder if it’s because I’ve been low carb for two years now. What an interesting theory!

  • steve

    you might want to check out Dr. Sturart McGill who is one of the foremost experts on backs. Pro athletes,etc with back injuries seek him out. He has you tube video’s.
    did you require a fusion? sounds like a large chunk of the disc moved in to the spinal canal.

    • Luckily, I didn’t require a fusion. Look forward to checking him out.

  • Jon


    Very interesting parallel between these two aspects of your life. Not sure I would have thought of it like that, but it really does resonate. Last fall I had the (unpleasant) experience of waking up and not being able to get out of bed due to a spinal problem. My issue was with my neck and turned out to also be facet arthropathy, though at C4-C5, and spondylosis. I was unable to turn or tilt my head at all and it came out of nowhere. After a course of physical therapy, muscle relaxers, anti-inflammatories, (and buying a new bed!), I’ve been able to learn to be cognizant of my posture more often and have greatly alleviated my symptoms, which included severe neck pain, along with radiating pain across the shouler blade out into my left shoulder pretty much whenever I tilted or turned my head.

    However, most of the improvement has come since February, when I really started (reading your blog and) committing to eating better and getting back to the gym on a regular basis. Since that time I’m down from 220 to 195 (I’m 6’4″), have re-strengthened the muscles important to stability in my neck, including my shoulders, which were quite out of shape since my 2004 right rotator cuff surgery, and am generally in much better shape than I was before that time (and I kind of need a new wardrobe that fits my new physique!). All of this is primarily due to the factors that you have described here for both things; not unconciously making the wrong choices (eating and posture) and consciously making the right choices (very little sugar or simple carbs, sitting upright), and even sometimes unconciously making the right choices!

    So for two things that would have seemed so unrelated, the principles are actually quite common and, for me, actually have a lot to do with each other. As an aside, I also happen to be an attorney and practice a lot of medical malpractice defense. Without getting into the quality of the treatment you received initially (and trust me it’s hard for me not to comment on that), the injuries and conditions you describe are certainly very significant and you are quite fortunate that the damage you sustained was able to be overcome through hard work and dedication on your part, as well as with the help of good treating providers (and mother!). Sorry to hear you had to go through that, but glad that you perservered and reflect on it as at least a partially positive experience!

    • Jon, thanks for sharing your story, also. I think your points about the direct and indirect overlap are very important and I’m glad you brought them up.

  • D

    Hi Dr Attia,

    I’d really like your thoughts as to whether you think deadlifts and squats ought to be avoided. Obviously poor form and too much weight are a forumla for injury, but what about moderate weight w/ good form, or even heavy (say, 5 rep) w/ good form?

    • I continue to do them to this day but, as you say, form is vital and so is accessory strength training.

  • Anonymous

    Great article. Very inspiring.

    For me, low carb diet has a more direct connection to lower back pain. About 4 or 5 years ago I started to consistently injure my lower back every few months. After the 3rd or 4th time this happened I went to a doctor. He examined me and said “You’re basically OK, but for this to stop happening you need to do two things. First, I will show you a few exercises to strengthen your lower back. Second, you’re too fat. Lose some weight.”

    I did both (with the low carb diet helping a lot in the latter) and have had almost no troubles since.

    I wouldn’t be surprised if for many people the easiest thing they can do for their back is to go on a low cab diet, lose some weight, and put less strain on their body. I’m sure you know much more about this than I do. I only mention it because I was surprised you didn’t make the connection between being overweight and having back pain in your article.

    • Great point. Yes, I do believe this is an important way LCD can reduce lower back injury.

  • Blake

    Hey Peter,

    I’ve been reading your blog since you launched “War on Insulin,” but this is my first comment. I believe my girlfriend Bianca, med student at MCG in Augusta, has connected with you a couple times.

    I played division 1 football as a linebacker in college. As I’m sure you know, linebackers have the shortest lifespan of any position due to the frequency of high-impact collisions and violence that is required. I herniated my L5-S1 disk my freshman year and thought my career and dreams were over. I tried everything in my power to avoid invasive surgery because one) I knew the success rates were poor and two) surgery would have taken me out of the game for potentially a year and a half. Somehow I got connected to a world class pain specialist and a noninvasive medical treatment called Prolotherapy. Check it out here:

    Have you heard of prolotherapy or platelet rich plasma therapy? Long story short, prolotherapy saved my life and my athletic career. I was able to finish my career playing linebacker at an elite level as well as continue to pursue physical fitness after college: crossfit, triathlons, etc. The pain and discomfort has never come back to where it was before Prolotherapy, and I just feel like the whole world should know about it’s potential

    • I underwent 9 or 10 rounds of 60-70 spinal injections from T12 to S1 over the course of a year to treat my resulting facet arthropathy. Alone, this was not enough, but it made the most important step in reducing my pain enough to do adequate rehab.

    • Tim

      Blake I am also a former college football player. I hurt my back two years ago lifting weights and hasn’t been the same since. My chiropractor wants me to do the prolozone injections. I was wondering how many injections you went through before you felt relief? Also if you could tell me more about specifics of the injections and treatment and resulting therapy I would really appreciate it

  • I’ve been meaning to comment for sometime, as I discovered your site last February, while already well on the path you’ve mapped out (having read Good Calorie, Bad Calorie cover to cover). I have found your site very informative. Your story of the back surgery was the tipping point as I underwent an L5-S1 hemi-laminectomy/discectomy 25 years ago at the age of 20. I have gone on to enjoy a host of physical activities including swimming, tennis, skiing, and weights, but was a “chubby” fit person at 211 pounds two years ago. I was already low carb in February and down to 192, but have been in ketosis now for the last six months and now down to 178 pounds, my BP which was in the range of 148/95 is now averaging 122/72, and everything is right with the world! As a Canadian litigation lawyer, who adopts a critical eye and careful analysis to the things I read, see, and hear, I am well satisfied, based on all my reading and my own self-experimentation, that this is the way to go for someone like me who is very sugar sensitive (with a family history of diabetes, heart disease, obesity, and high BP). Keep up the excellent work (if you can, as the schedule must be grueling) and know that you are truly making a difference in society.

    • Thank you so much, Andrew. Great to hear your story. Thank you for sharing it with us.

  • Nina

    Thank you, Lorraine, for sharing some details of your unique journey. It was most interesting reading about your experience.

  • Dante Catoni

    I have to second Steve’s recommendation for anyone with lower back problems, especially lumbar disc herniation, check out Dr. Stuart McGill’s work. He is the absolute highest authority on back rehabilitation and has led much of the newest research. Even if you’re an athlete who has never had a back problem I would still recommend his performance book just for the physics of how the torso works in all types of athletic movements and how to maximize efficiency and prevent injury.

  • susan

    this happened to me too! ruptured the L5S1 twice, actually… i laughed about the part of you picking up things with your legs/feet and propping your upper body weight on your arms, lol no one seems to be connected to what life is like after back blowouts. your story is almost identical to mine, except what i lost was a nursing career, and it was a lot of work, so i was devastated. but there simply was no bedside care, or 13hr shifts on my feet after those surgeries. thanks for sharing, and i agree, low carb is the best thing a person who is limited with cardio exercise can do for overall health and energy levels.

    • Susan, I hope you’re been able to re-learn healthy movement and are back to normal activity.

  • Kathleen

    Great post!
    Great site!

    Thanks for being here.

  • Stephen

    I too have recently come back from a terrible back injury. Years of playing football and (improper) power lifting left me with two herniated disks in my lower back. After multiple MRIs and epidural injections, I was told that I should never lift anything heavier than a milk jug. I was also told that major back surgury was in my immediate future. The news was devastating. This was the start of my two year food binge. I also used my back as an excuse of why I could not exercise and before I knew what happened I was up to 280lbs.

    Fortunately in April 2012 I had a moment of clarity after discoving the work of Gary Taubes. I immediately changed by diet and began a walking/jogging program known as “couch to 5k”. My weight began to rapidly drop and I was also able to moderate weight training into my routine. Now I am 45 lbs lighter and I have almost no back pain. I do get the occasional flare up but that’s easily treated with OTC meds.

    I will not say that I “cured” myself with diet and exercise but I did put my condition into remission.

    Peter- please keep up the good work!

    • Stephen, that’s really great to hear. Keep it up and stay diligent.

  • Ellen Urciola

    Hi Peter,

    I would like to thank Elenor and JohnK for their input. Elenor I checked out the blog, but do not think I fit the criteria. JohnK, I did try the no cream route, but found it did not impact my weight. Like the Ice coffee idea, although never cared for the taste when I was younger.

    Peter, may I steal your conscious chart? I want to hang it in my classroom. It is a great tool for high schoolers to make them conscious of how they can change negative habits.

    Lastly, I long ago (college freshman biology) heard that the faster you lose weight, the more free radicals your body produces, which increase your risk of cancer? Fact or fiction?

    • Absolutely. All yours. I’ve heard nothing to support to the weight loss – free radical story, but I’ve never looked for it.

    • Lee

      If you want to know more about a healthy approach to improving free radicals and inflammation you can check out very useful info there.

      Thanks for your great blog Peter, very thorough and helpful.

  • Ellen Urciola

    Thank You.

  • Modifying behavior to avoid further injury is something that I have been interested in since tearing a muscle in my calf a few years back. You are so right about being conscious of how you move and what you are eating, its a principle I have used for a few years and its working!

  • Again a blockbuster post that is all at once alarming, informative and interesting! Thank you. Working on my mom and step-dad to stop thinking about eating low carb as a “diet” and to start thinking about it as a way of life. I think my mom understands but the other night my step day snuck out of the house to buy a snickers bar…heh.

    Peter on a more serious note do you know of any studies that would prove this comment taken from a very old post?

    3. Caffeine causes release of adrenaline, which causes the liver to break down glycogen, causing a temporary increase of blood sugar, which causes insulin to be released. Thus the dreaded blood sugar/insulin roller coaster.
    This I cannot find an answer for. Does this same process happen under ketosis?

    Thank you for any light you might shed in this direction.

    • I’m not entirely sure this statement is correct in all folks, and if it is, I’m not sure how temporary or transient it is. Caffeine is kind of complex and probably does some other things also, such as interfere with hormone specific lipase (HSL) to increase fat oxidation.

  • Hi Peter,
    Thanks for sharing all this. Having had a lot of severe pain myself for so many years, I can relate to the struggles you had with pain and pain pills. My recent surgery made things worse. It took some time to get off the Dilaudid, and the physical aspect was only part of the challenge. I think that certain foods can be just as addictive for a lot of people, and I love the way you explained the process of changing a habit. For me, realizing that issues with insulin and blood sugar are probably what caused my problems in the first place made it a little easier to cut it out of my diet cold turkey. It’s become a non-negotiable, if only for the reason that I never want to deal with that kind of pain and/or surgery again. Thanks for your story.

    • Sorry to hear about your struggle. As crazy as it sounds, you’ll be better for it if you make the effort (which it sounds like you are) to learn from it and apply it to other areas of your life and to others with empathy.

  • This is such an interesting article with such a painful & triumphant story! As a recovering vegetarian, I’ve swung on the grains and legumes pendulum from “in a relationship with grains & legumes” to “It’s complicated” to “In a relationship with meat”.

    As a Registered Dietitian, I’m constantly sniffing out dietary trends and working through the literature to make sense of the contradictions. In the anectodal world, people evangelize the profundities of their preferred diets, whether it’s vegan, paleo, or many things in-between. I’m beginning to find myself observing that there are a lot of right “diet” systems when followed in their entirety. Dr. Dean Ornish produced studies that low-fat, high carb diets reverse heart disease. Atkins diet also shows reversal of inflammation, triglycerides, and weight (preventing heart disease). This is simplified, as there are many studies we could discuss.

    What are your thoughts on contradictory diets working out? And since I’m new to you, I’ll ask what you may have already stated: do you think that a low-carb diet is the only true answer, or do you think it depends on individual biochemistry? I’m sincerely interested in helping people make sense of the confusion.

    Thank you for your feedback, and I’m delighted I’ve found you. I plan to follow you more!

    • Frances, make sure to really scrutinize these studies. For example, Ornish didn’t show that a “low-fat, high carb” reversed heart disease. That’s how the press (and he) report it. Read my post on “Why Weight Watchers is a Low Carb Diet” where I explain his study in detail. Very misleading conclusion, once you understand the actual intervention.

  • Victoria

    University of Western Ontario just announced an unexpected, sweeping conclusion:

  • Hattie

    And if you can’t here’s Zoe Harcombe’s blog on the study

  • Richard Painter

    Great article and the four step change process really resonates with me for personal and work issues – essentially it’s change management!

    Having had a bad back with a slipped (herniated) disk – nowhere near as bad as your experience – I sympathise – until folk have such back troubles they don’t realise how painful and disabling it can be. Well done for persevering!

    Low carb eating is a label for what we really mean which is “Proper Eating” or “Healthy Eating” – i.e,, eating what our bodies evolved and adapted to be healthy on. I remind myself of this to help me when I want to weaken and eat bread, wraps, pasta, sweets or chocolate. These are not treats or “extras” but essentially toxins or nutritionally deficient and should be avoided.
    Do I always succeed? No!

    • Stephen

      I still eat wraps. I get the flax roll ups made by Damascus Bakeries, which use organic flax flour. While a full wrap has six net carbs, at least the flax has omega 3s. I found out about these on the “Getting Started On A Low Carb Diet” web site. Other ways I cheat are having the Weight Watchers, Healthy Choice, and Lean Cuisine entres that are low in carbs (from ten to 25 carbs), snacking on a lot of peanuts, eating a lot of Smucker’s Natural peanut butter, and eating kiwis for breakfast.
      These choices have a lot to do with my version of the “low cost/low carb diet”. While it’s hardly perfect, I’ve lost fourteen pounds (and kept them off for a few months), almost completely eliminated sugar from my diet (and this from a man who thought of heaven as a large bag of gourmet jelly beans), and greatly reduced craving attacks.
      I haven’t gotten any blood work done yet (my health insurance only allows one check-up a year), but my doctor described my numbers as “wonderful!” back in November, before I started my low carb diet. My Triglycerides were 99, and my HDL was in the low 30s (one above the lowest number for the “safe” range); maybe not so “wonderful!” after all. My LDL was low, so my doctor was very happy, but what test should I ask for to measure my LDL-P, and is it covered by GHI health insurance?

      • If you can go through Health Diagnostic Labs (who send the NMR testing out to LipoScience), all carriers I have encountered will cover the test, except Kaiser.

  • Stephen

    Thanks, Peter. I have a feeling they’re not going to be familiar with this type of testing, but I’ll do my best to explain it to them.
    Take it easy on the back in the future.

  • Tammy A

    Reading you story was like reading my own. My first back surgeon (highly recommended) did the same thing.. The MRI 2 days post surgery proved it and I went in for another surgery immediately. Unfortunately, I have severe nerve damage and live with constant pain in my back, left leg and foot on a daily basis. I took Lyrica for awhile to control the pain, but I think the side effects were worse so I decided to live with the pain. At 42 I am worried every day what 50, 55, 60+ will be like for me. I have a career that requires a lot of sitting, so I have to struggle with the pain of sitting as well. It is sad that we have to deal and cope with pain every day.. I am happy for you that you have found your way! Take Care. Tammy.

    • Tammy, sorry to hear your story and that you’re still in pain. If I can encourage you in any way, I’d only suggest being as diligent as possible in 2 ares: 1) very aggressive rehabilitation, 2) great attention to the “re-learning” how to move.

    • Well, perhaps you may take a look to other approaches to pain control, like cold thermogenesis. Yes, it still is mainly based on clinical experience and advice by Dr. Kruse . As I see it, the risk-benefit analysis of experimenting with it is positive.

  • Hey Peter, Great post! It was very hard to hear how much you went through. I have similar a carb/ back connection for you as well.

    Since the age of 12 when I started working out, I suffered with back and neck issues up to the age of 38. Frequently my back would go out and I’d collapse to the floor and crawl my way home. I would often have to go the emergency room because my neck was literally stuck to one side with such major spasms I could not move without fear of pain.

    10 years ago I ran into a chiropractor, Dr. Skip George who introduced me to functional training and I learned how to strengthen my core and not fear my back. In the old days all my doctors and chiropractors advised nothing but back stretches. Great idea: just flex my spine all day long! Talk about barking up the wrong tree! Dr. Stu Magill, Gary Gray, Gray Cook and Dr. John Sarno all contributed to my continuing knowledge on healing my back.

    It is a conscious effort as you mention that needs vigilance. One slip up and I know the consequences. When I decided to clean up my eating habits 10 months ago, I threw that silly idea of moderation out the window. Would I just sometimes decide not to do stupid things to my back? Of course not! Collapsing on the floor and writhing in pain is a great deterrent. So why would I ever consciously cheat and eat crap?

    The big connection for me since eliminating these inflammatory foods is that my constant rotating pain and inflammation journey came to an end. The 1 year of tennis elbow. The 1 year of hip bursitis, the 6 months of plantar fasciatis, the intermittent back or neck pain has been conspicuously absent since eliminating refined foods in general and carbs in particular. Coincidence? I think not.

    Thanks for a great blog. You make me think and inform with great intelligence and logic. Loved the workout at FQ10!!

    • Great points, Craig. Thank you for sharing.

  • Bob Jones

    At about 50 years old I started having sciatica pain and it got to the point that I was laid up 3 or 4 times a year for a week or better with terrible muscle spasms(I even contemplated suicide during one episode). I finally had a CAT scan done and found that I had two herniated discs, luckily since I had no insurance I wasn’t able to have surgery done(I paid for the CAT scan out of pocket). I read an Adele Davis book and one of the things she recommended for sciatica was vitamin D. I had read a book by a doctor whose mother had a horrible case of arthritis that was cured by taking cod liver oil so I used cod liver oil for my vitamin D. My sciatica was gone within two weeks of starting cod liver oil. I still had occasional muscle spasms from damaged muscle tissue that I have heard called “hot spots” but no more sciatica. Since then I have told several people about cod liver oil and to date everyone that has tried it has had their sciatica go away as long as they keep taking cod liver oil.

    I have no idea what cod liver oil does but it also worked for my sled dogs that had intervertebral disc disease which can be a canine form of sciatica. Two of my best dogs had to be on steroids. The one that got steroids at least one week out of every month was able to go without steroids from the time he was 12 years old until he died at 16 years old. The other went without steroids from time he was 8 years old until he died at 16 years old and he had to have them for a month every year when we started training. I waited for a long time to put them on cod liver oil because they were getting a lot of fish oil from salmon and I thought that was enough. Not so, when I finally put them on cod liver oil they responded in less than two weeks. Long distance sled dogs will get a sore back the day after a 200 mile run but if they’re on cod liver oil they don’t get sore backs after long runs. No placebo effects in sled dogs. Incidentally, once they moved from the main team to the geriatric team at 10-12 years old, these dogs ran 6-20 miles a day until a few months before they died.

    Glad I found your site through Mark’s Daily Apple.

  • Daniel Arguello

    I find myself extremely fortunate that I found out about eating very low carb at a pretty young age(I’m 20) and that I found this blog while I was researching before I jumped in head first. I’ve been in nutritional ketosis for about a month now and have lost 10 pounds but more importantly inflammation in trouble spots around my body (mostly my axilla) have gone down dramatically. (I was diagnosed with Hidradenitis Suppurativa about a year ago). I just wanted to say thank you for your efforts and for the knowledge you share with the world just for the sake of sharing it and not for monetary gain like so many people seem to do these days. I wish you and Gary the best of luck with NuSI.

  • Peter, I only skimmed your post but I got the gist of it. Basically you’re talking about practice. Learning new things and unlearning old things. Well, we don’t really unlearn old things, we just become out of practice, because well, we don’t practice them anymore. Do you know the writer Malcolm Gladwell? He wrote a book, Outliers, it explains why some are better than others. To summarize, those who are better simply practiced more than others.

    But on to the point of your post, which is basically that if we want to stop doing the wrong thing, we gotta start doing the right thing in its place. However, if we’ve been doing the wrong thing for a long time, then it’s going to take some effort to stop doing it, and replace it with the right thing. Bending over the wrong way to pick up stuff, we do that all the time. I put out my back once by setting a tee in the ground on the first tee on a glorious morning. Yet for a couple years before that, I went to the gym and lifted heavy weights off the ground using almost the same identical method a few times a week with nary a problem. That day, I just got careless and fell back into the old – and wrong – way of doing things. Maybe I should have practiced setting a tee in the ground more often than just those few times that I do it when I play a round of golf.

    In that book, Gladwell explains that those who are better don’t simply play more often or do whatever it is they do more often. They practice. Long hours every day for years on end. To apply this to us and low-carb, if we want to be good at it, we gotta practice too. Not just eat (low-carb) and forget about it between meals as most of us have been doing since we’re on this planet. A good way to practice low-carb happens to be reading recipe books. Practice isn’t just about doing, it’s also about studying. But – and most here will find just the suggestion boring – we don’t just have to do it, we have to do it repetitively. That means we gotta eat, or prepare the same meal at every meal for several meals until we get it right, or at least right enough for our purpose. How do you think a cook becomes good at cooking? Just like anybody else – with practice, lots of practice. Now I doubt many here want to become a cook, but that’s alright, we don’t have to. As Gladwell explains, we don’t need a lot of practice to become good _enough_. We only need enough practice and that could be a couple hours every week, until we’re good at it, and then we can go on with the next thing we want to become good enough at. And reading – studying – is almost as good as doing when it comes to learning, we can get away with reading for that time we dedicate to practice. Then, doing becomes the test of that reading just to make sure we got it.

    But then it’s not all to learn something new. We also have to keep up with practice to maintain our ability – our skill – with this new stuff we’re doing. However, since we don’t need to learn something new, we can get away with a bit less practice and study from now on, just to make sure we still got it. If you’ve ever read something again a long time after you read it the first time, and then realized you’d forgot about this or that, well that’s what I’m talking about. If you keep up with some amount of practice and study, that won’t happen. You won’t grow out of practice.

    Anyway, good luck with NuSI. I think you guys will need lots and lots of practice and study to keep on top of things.

  • Peter Hanley

    Hi Peter.

    I was interested to read that you experienced serious back problems.

    I’ve heard that back pain is an inevitable aspect of human upright posture, perhaps like painful childbirth owing to brain size etc. I’m not so sure now. It is possible that there is a much more direct link with dietary carbs and back pain than just the process of changing personal habits. (Or even pain sensitivity as mentioned by an earlier poster.)

    It’s been established that chronic elevated blood glucose saturation of body tissues is a likely contributor to heart disease. Via the accumulating glycation of structural protein over decades of exposure, similar to the vulcanising cross-linking of natural rubber to become stiffer and harder wearing car tyres, changing the elasticity of coronary arteries. These small arteries are subjected to a very high flow rate and high pressure associated with their proximity to the aorta and heart muscles. This leads to relatively higher physical stresses on these artery walls compared to other arteries, and therefore downstream cardiovascular issues.

    It seems reasonable to assume similar effects on other tissues, despite less vascularisation and blood flow rate, that depend instead on random circulation of nutrient fluid. Such tissues might accumulate an escalated lagging average exposure to a pool of slightly elevated blood sugar concentration causing similar vulcanising cross-linking in structural tissues over the decades. I’m thinking of myopia via stiff lenses which don’t relax back into their normal, flatter shape, plus the flexible bags holding spinal disks together and the load bearing surfaces in our knee joints.

    These tissues might resemble the compounds lining self-sealing aircraft fuel tanks, with exactly the right combination of flexibility, strength, stiffness, stickiness, solvent tolerance, and slightly malleable flow in order to meld together and fuse fissures caused by shocks and stresses. If blood sugar exposure affects this precise degree of plasticity then it may be that a high carb diet directly contributes to common issues as knee and back trouble, which often spell the end of serious sports for many professional and amateur athletes.

    I think that short sightedness is a consequence of the lens being too stiff and not relaxing back into a thinner shape for longer focal length scenes, while long sightedness is the lens being too stiff to be easily squeezed into a fatter shape for short focal length objects. Either way it’s more or less the same thing: the lens material is too viscous and doesn’t flow the way it should.

    Apparently even older people who are myopic also tend to experience the same problem with long sightedness that arises with people who are not myopic. Myopia is typically triggered by prolonged short range focussing earlier in life. Often associated with reading. There’s a genetic factor, but possibly it’s the genetics of glucose metabolism that might be the underlying driver.

    I’d be interested to know if there was any evidence of whether low carb eating might reverse these effects over time. Not exactly the fountain of youth, but perhaps a way towards living a less grumpy and irritable old age. It would be nice not only to avoid the alzheimers and the forgetting where the spectacles were left, but also to retain the knees and back have the energy to be able to run around looking for the spectacles, as well as to not to even need the spectacles to lose in the first place.

    • I am not aware of any clinical trials that have explicitly tested this. One can make the case that fat loss could improve back pain for a number of reasons, but your suggestion is very interesting as a separate mechanism.

  • Peter – have you tried lumbar extension exercise on a properly designed lower back exercise machine?×264.jpg

  • Sydney

    I’m not sure where to post this, so please forgive me if this is not the ideal place. I ran across this site a few months ago and I have thoroughly read everything posted here. With a science/medical background, I believe I understand it fairly well. I would like to use the diet principles, but my attempts at weight loss have failed miserably and completely so far. I am a 56-year-old female with metabolic syndrome and lifelong morbid obesity, but not diabetes. I have lost significant weight in the distant past on low-carb diets (30-40lbs), but the last few attempts have not produced similar results. I have spent more than a month following the hard-core version of Peter’s low carb/high fat diet, in full-blown ketosis, with light to moderate exercise. I eliminated sugar and starches completely and my only carbs come from low-glycemic vegetables and flax. Not only have I failed to lose any weight, but I was slowly and steadily gaining. I have since tried cutting back severely on calories while maintaining the high fat to protein ratio. Stopped gaining, but still no weight loss. I guess my question would be, is this diet only effective for athletes, or people with very high calorie expenditures? The research posted suggests that it would be beneficial for everyone, but I simply cannot get it to work for me. I hate to give up, but I cannot afford to gain any more weight. Suggestions?

    • Sydney, I’m sorry to hear about your frustrations. I can’t really speak specifically to your situation because I would need to know so much more about the details. It’s certainly possible that a LC diet is not best for you. In fact, based on the A TO Z trial, and even Ludwig’s data, some portion of the population will do better on calorie restricted or fat restricted diets. Gardner’s data suggests this may be a function of IR, and he’s in the process and ramping up a larger study to investigate this.
      Since I can’t really do the troubleshooting, it might be worth checking out “The Art and Science of Low Carb Living” by Phinney and Volek, along with their second book about Performance before you abort plan.

  • Ellen Urciola

    To Sydney,

    This reply is in no way offering advice, merely letting you know you are not alone. I am a 55 year old female, 5’3 @ 207 lbs.(down from 251 on a high fat, low carb diet for two years this Feb.). I too have been morbidly obese most of my adult life. I have experienced significant weight loss and gain. High blood pressure and elevated glucose levels eventually led me to Dr. Attia’s website. I initially enjoyed modest success , then stalled, played with my intake ratios incessantly (you can find my post and fits of frustration throughout many of these posts). Throughout I was in ketosis. Finally, after two years, I have, a. Begun to lose weight again, b. have learned (critical for me) to only eat when hungry, and c. to increase my carb intake (in favor of just one fruit) to the recommended 50grams). I noticed you mentioned eating flax, I do not know if this is considered grains, I have completely eliminated all grains and wheat. This has helped me. I would encourage you to read through these posts, stick with it, and know their are others who share your frustrations and struggles.
    To. Dr. Attia and all of the wonderful people who read this blog, Happy, Safe, Healthy, Holidays and Happy New Year to you and your families!

  • Tara

    I remember your surgical nightmare and debilitating back pain well. Your account is accurate. You overcame incredible physical and emotional challenges. It is heart warming to read how your success in overcoming the sequelae of your harrowing experience increased your capacity to empathize and inspire others in similar situations. Kudos for speaking out against the decades long dissemination of nutritional misinformation.

    • Oh my god…Tara…I can’t believe it’s you! How wonderful to hear from you. Can’t believe you stumbled across this. Yup, you sure were there for every agonizing moment of this. Thanks so much for all you did then.

  • jdp

    Oh my gosh!. Thank you. Never in my entire thought process would I have thought through this in the way you have expressed.
    I recently lost 100 pounds ( 100 more to go) on very low carb and high protein. Just recently, I felt like this was too hard and it was time to give up Started in May 2012. . I was jut ready to eat some cake (the entire piece) ( once in awhile I will have a half a piece) and eat some popcorn when I came across your article. .
    I too have terrible low back pain and had surgery at L5 S1 .As soon as I get health insurance I will get some treatment. I have a wonderful Doctor who believes in the low carb and high protein and she is extremely supportive. I am so fortunate. I am excited to hold on to what I have learned in your article.

  • hi Peter, Thanks so much for sharing your story and for making this information accessible on your site. I’m 30 years old and have struggled with compulsive binge eating, insulin resistance, and Type II diabetes for many years. Your, Gary Taubes’, and Phinney and Volek’s work have convinced me that my carb and sugar addiction isn’t just a psychological and emotional disorder (though there are components of both), but a biological issue that may have roots in genetic susceptibilities, etc. It helps to know that you took almost two years to move to consciously correct — I oscillate between consciously correct and incorrect (sometimes mostly incorrect), which is enormously frustrating.

    For my and many others’ sake, I’m glad that you have carb-sensitive genes and that you went through the nightmare experience of surgery, relearning how to move, and narcotic withdrawal. I’m hoping that the “bad” cards I’ve been dealt and this nightmare of recovering will one day yield pearls to others, just as they have in your experience.

    • Esther, sometimes I wish I had my wife’s carb-resistant genes, but I can see your point and it’s certainly the ‘glass-half-full’ approach to my genetic draw — at least I can be an example for some. Glad to hear it’s been helpful for you.

  • Marion

    Thanks for your information. I’m loving the diet, but…
    You mentioned that at one time you felt so badly you considered giving up the diet. I’ve been on the keto diet for only 5 days now. I feel weak and am having lower back pain in the middle of the night. I’m trying to eat more fat since reading your blog and drinking bouillon (as you suggested) since I perspire profusely. Any other suggestions? Btw, I’m a 72 year old woman just doing it for the weight loss and, of course, looking for a six pack to form any day. lol.

    • Hard to say, Marion. I was doing so many things incorrectly initially (not enough salt, not enough magnesium, too much protein).

  • Alec

    Peter, that’s bad ass; thank you. This reminded me of Dan Ariely’s story. I am loving this blog.

    I was wondering though, did you ever experience any stomach/gut problems on keto-induction? I am in my 9th week and my stomach/gut gets upset at any thing. I had appendectomy in college and I come from a diet of like 3-4 gatorades, 2 cliffbars daily, breakfast cereal etc. keeping normal weight via cycling(prob closer to 0 on your insulin resistance matrix.) I never really had stomach problems post surgery on carbs, though things felt different.

    Do you think gelatin or something would be good for the stomach? I’ve tried charcoal and glutamine and it’s largely a non-solution. Is there anything that will rebuild the stomach? Am I keeping my carbs way too low (pos. acidic balance by Loran Cordain?)

    Thank you again for the inspiration.

    • Hard to say, Alec. Very difficult to troubleshoot without doing/knowing so much more.

  • archana

    my mom is 39 year old and she frequently suffers from lower back ache.we din’t find any apt solutiion for that.pain is aggevated upon consumption of chicken…….can you give me any reason for this aggrevation and pain.

  • Elaine DiRico

    I can never edit my own stuff- previous post should have been: ‘Is a ketogenic diet possible or recommended after gallbladder removal?’

  • Lisa K

    I have just found your website after watching you on TED Talks. I find your 4 stage to health to be true. This year–actually new years day I came down with the stomach flu and decided to quit drinking coffee as I had been living in stage 2 (conscious incorrect) in regards to my stomach troubles (GERD hiatal hernia – ulcerative upper GI from esophagus to as far as an upper GI goes down) for about 6 months. Since January 1st I drink water or herbal tea in place of coffee with creamer & sugar I used to drink by the pot full and have lost 40 lbs since switching over. (From 210 to 170 lbs) This has been the only change in my diet but I am finally at stage 4 and no longer think of or desire drinking coffee.

    • Pretty cool, huh? I think people make to flawed assumptions when they try to enact a behavioral change:
      1. Assume there are only 2 stages — doing it and not doing it;
      2. Assume that if you “slip” it’s over — not understanding the process is a continuum.

  • Matt

    What if Back pain is caused by diet? Hi Peter wow your experience was so similar to mine. I also had a ruptured l5 s1 disc. Its hard to describe to people just how painful it is. Since my injury some 11 years ago I have searched high and low for the definitive answer to fixing back pain. In the last 2 years I discovered the Atlas Profilax Method which realigns the spine from the top down. This fixed me and Ive actaully written a book about my experience. I thought this was the be all and end all solution until a little back pain came back. And I also experience back pain during Endurance Mountain Bike Races.. I now beleive the root cause of back pain is Gut disbiosis and food intollerances causing inflamation, poor flexibility and casuing us to hold our bodies in unnatural ways. I have been eating more paleo in the last 4 weeks and have just begun SCD style diet. I have a 100km mtb race on the weekend and it will be interesting to see if this is pain free. Thanks for all your great work

  • Siham

    I have read your e-mail while I was surfing the internet and looking up a certain condition I started to have very recently.

    I suffer of a killer pain in my lower back whenever I eat certain types of food, some of that food contain rice or bread with other kind of vegetables or meat… I don’t feel it every time I eat rice or meat though.

    The pain completely vanishes after I finish my food which is weird.

    I couldn’t find an answer to this situation though, and doctors found this situation funny as they didn’t have an answer.

    Is there any help or an answer to this.

    Thank you,

  • Nikki

    Hi Peter,
    I loved reading your blog about your back. I have been suffering for 7 months now, lumbar herniation and bulging of 3,4,5 and S1 , the sciatica pain has made me want to die at times…..i am on a new drug treatment for me, Lyrica which has helped me a lot in the past two weeks……I have opiates, but i am slowly reducing them at present, with minimal withdrawals (fingers crossed) I still have to use a walking stick, and i have been doing some back exercises daily, but when i go for a walk…….the next day, i have pain in my left upper thigh, middle thigh and behind my knee, and it feels like my bones are breaking, or muscles locking up……it is so painful it takes my breath away…..after a minute or so of no movement, it tapers off…….I am so thankful that the whole leg and foot pain (continuous) is no longer there….occasionally now i get a little in my shin…….and im hopeful it will not come back…..I wouldn’t wish the pain on anyone ever. i want to do more exercise, but im not sure if I should try the ones you’ve suggested yet…….My physio, told me to be careful with my movements……and like you, i have learned a whole new way of moving…..when i get out of the car, i turn my body to the door then get myself out, i bend with whilst sticking my bottom out and my knees well bent….. I also had 3 CT guided Lumbar spinal injections with no positive results, the first one actually caused me more pain….. I was truly inspired by your blog about what you went through……I was actually looking for information on sugar and carb’ intake as a possible cause for back pain, because it seems if i eat sweets or bread on consecutive days my back pain is far worse……i tried going without bread or sugar for 3 weeks, i did seem to lose a little weight but couldn’t tell if it affected my pain, because it was already severe, but ive persisted with the low carb intake ( I am type 11 diabetic on medicaction)…..ive almost cut coffee from my diet, but ive changed up to low fat milk instead of no fat milk, i eat wholegrain bread when i do eat it……..i don’t like red meat much, but like chicken and some turkey, and some fish……i eat a lot of vegetables when i eat salad which is often, and usually eat a boiled egg if i get hungry, which i don’t seem to do much lately……not sure if its the drugs or not………but anyway……..thank you for your blog……its was something that i resonate with and it was helpful with my quest…….thanks again….Nikki…..

    • Sorry to hear about this, Nikki. I can related, but I know that provides little solace.

  • Daniel

    David, thank you for sharing your story. Unfortunately it’s one I’m all too familiar with. I’ve had a Herniated disc at) L5-S1 that I’ve been dealing with for about 7 years. Just recently I had a similar situation where I woke up in excruciating pain and was unable to get out of bed. After receiving an epidural, I feel like the pain has been dulled enough that I should start trying to exercise and strengthen my core. Based on how you described how you have changed the way you move and bend, I was wondering if you are familiar with foundation training?, and if so what are your thoughts on it.

    I recently purchased the book and have began doing the exercises carefully as I’m still in acute pain. I’m praying that I’m young enough that I can undo some of the damage to my back through dieting and exercise and avoid surgery. So far the exercises do seem to be having a positive effect.

  • Edward Bradford

    Peter—-Here is my permutation on this theme—-and believe me I have immense empathy for you. I had just left the Marine Corps where I was training hard everyday as a diver in 1st Recon Btn. I was 27 yrs. old. In the gym one evening doing BB shrugs with 275—my normal weight—I felt a pinch in my low back. The next day I was seated at our dining room table and I rotated and then bent over to pick up a section of the paper from the floor—-BOOM!!!! intense pain down my right leg. I went to the ER, but they wouldn’t give me any serious painkillers. I started eating 4 Advil every four hours. I went to my chiropractor for a week, and he suggested that I see an orthopedic surgeon. My ortho scheduled an MRI a week later—-you know the pain level here—a week seemed like a sentence to 20 years in the pain prison. He showed me a rupture at L5-S1 and also at L4-L5. The rupture at L5 had a large extruded fragment pressing against my S1 nerve root. Here is where things get insanely stupid. My ortho suggested that I wait 6 months before surgery and try passive treatment modalities. I did this and the pain never went below intense for six months—all the while I only used Motrin 800mg. I never really understood how traction could pull an extruded fragment back into a ruptured disk—but I trusted his advice and the second opinion I got from a neurosurgeon was in agreement. Six months later I have the surgery, and I wake up in post-op with a smile on my face—no intense pain down my right leg. Problem was that waiting six months with the fragment pressing against S1 caused the nerve to degenerate/die causing me to lose innervation down my leg to my foot. What I later realized was that the surgical procedure, discectomy/laminectomy, had a very low success rate (1986)—especially with two adjacent discs—and surgeons were being advised to suggest passive treatment first to reduce their litigation exposure. Calf raises are impossible on that side and my lower leg has atrophied to about 1/3 the size of the other. Like you, I have learned how to compensate. I still lift 5 days a week. I keep my abs in tremendous condition to protect my lower back. I can’t really run, but I do walk 4-6 miles daily. I follow a Paleo approach regarding my diet and my weight isn’t an issue. I am thankful for the successful operation—even though delayed. When people tell me they are experiencing intense back pain—I believe them.

    I enjoy your reading your thoughts etc. very much. Thank You

    • Edward, I’m very sorry to hear about your suffering. I’m glad to hear you’re on the mend. If you haven’t done so, you may find great joy and relief in swimming, also.

  • Emma

    I have this back lower back pain just like the one you had though mightn’t be as serious. I noticed it gets worse whenever I skip breakfast and may be lunch as well and or when I have a generally bad eating habit. Perhaps due to loss of appetite. I have a foot drop on my right foot and this sensory pains not just on the leg but the hand as well. That is to say that, I have this on my right limbs! I need help ASAP! Must I have a surgery? Is there no way medicine rather than surgery can intervene? I am a Nigerian in Nigerian and do not trust our surgeons here coupled with my fear of the operating room! I’d prefer a medical intervention down here. And I will appreciate your help if possible. Never seen anybody with the exact description of my agony as much as yours. I await response from you. Thanks

    • Emma, sorry to hear of your troubles. Diagnosing back pain over the internet is impossible for me and I’m not a real expert in this field.

  • Sheila

    Peter – I just discovered you. Blog post by Dr. Michael Eades where he lists your blog as is #1 on a list of blogs he reads daily. OMGosh!!!! I am blown away by you! I have read many posts and watched vid’s – the TEDMed video of you apologizing to the patient in the ER just solidified everything I felt to be true about you. You are brilliant – in the truly light-shining way. And you are funny and so smart (and I personally love all of the science) and I could simply go on. But won’t.

    You have become my go-to guy AND as a referral source for my clients – I am an Integral Coach. I approach my life with an “integral life practice” which includes body / mind / spirit / shadow aspects (Jungian) daily practices that work synergistically in creating health and well being.

    Your energy is so vibrant and honest and rare. Thank you for just being in the world and sharing your talents.
    I’m soon heading over to the site of the company you co-founded in 2012 to read everything there.


    • Sheila, you’re making me blush. But thank you for your kind words. I’ll have to thank Mike for saying such nice things.

  • Sheila

    I do have a question I don’t think you have discussed and I did not see it in the “coming” section. Forgive me if it is there and I missed it.

    I am wondering your thoughts on the idea of “re-feeding,” as some call it. Eating significant carbs one day a week in order to reset or do something with respect to Leptin and possible other hormones? I’m thinking specifically about Tim Ferriss’ practice around this and why it is important. (I’m guessing you and Tim would have much in common with respect to your “experimental nature.” He is a true guinea pig!) Tim is another go-to guy for me.

    I don’t eat grains at all due to the inflammation that they cause; however, I have considered doing a re-feed practice with potatoes and fruit, for example.

    Maybe you could add this to your “coming” list. Thanks!

    • Tim and I are close friends and discuss all aspects of nutrition and self-experimentation. I have no data on the question you ask.

  • Sami khan

    Very informative and new knowledge for me….
    I am 24 now and i have experienced lower back pain while in abs exercise 4yrs ago. i see orthopedic doctor and he told me that your lower back is alright. after some time pain has gone but i still fell weakness in my back and soon get under stress a kind of uncomfortable feeling until i flatten my back in bed or sit on foot for some time. it give me some relaxation….
    i didn’t use any kind of medicine except painkiller for very few time and wait that my body system will rehab it and bring it to normal strength…but i didn’t work fully although i lost a lot of weight not for ketosis about which i didn’t know at that time. know i start worrying that this problem might will increase with age.
    what can i do bring it to full strength or normal position.???? i will be very thankful for any help.. frankly speaking i have some kind of phobia form visiting doctors.

  • Jeff Johnson


    Something Different

    Context: the following two ab exercises do not cause the center lower back muscles to overly tighten which normal ab exercises often do

    1. Ab Exercize

    After a bowel evacuation – while sitting – crunch yours ab’s from top to bottom – turned to side – tilted to the side – tilted to the front – tilted to the front – tense the chest and arms muscles as tightly as possible – the entire spectrum of abdominal and pelvic and chest muscles should get several good crunches – there’s no movement involved here – your just using your mind to make ab’s crunch

    2. Sitting like in your computer chair with feet proped up on computer desk – body in a slight vee posiition –
    crunch all ab’s as described in exercise one for like 12 minutes – you can listen to a podcast while doing this as it makes it more intertesting

    Static Ab Crunches aren’t going to save the world – but will elimintate an all too common cause of ab exercise induced lower back pain

    Low Rep – One Set Only(1to 3 reps) barbell and dumbell exercises -amount of wieght is determined by whether doing a full motion exercise or holding the weight in static positition for ten seconds can give your back muscles the needed stress – this exercise can be and should be done daily as the body can recover from this sort of thing –

  • Kathryn

    I just came across your site today (it was mentioned in a blog post about the findings in Sweden about low carb eating). Your description of your back ordeal brought me to tears. As soon as you described the postures you had to assume for any relief (and the ice packs) and the almost literally indescribable pain, I knew you were going to say it was pressure on a nerve root. I had a C-6 blowout several years ago and my left forearm felt like it was on fire 24/7. I was given conservative treatment, chiropractor referrals, and high Advil doses.

    After a few embarrassing freak-outs over the pain, I had an MRI that showed that nerve root being crushed. I was very lucky: I opted to see a neurosurgeon instead of an orthopedic surgeon, he noted I was close to permanent damage so scheduled surgery within days, and treated the pain with Dilaudid. Fortunately, my pain was gone immediately after surgery (I wish that had been your result!) and I went through the whole ordeal with taking 15-20 pills. I was very lucky.

    It left me with enormous empathy for people who become addicted to pain meds–I have no doubt that would have been me if I hadn’t had surgery as quickly as I did. I also have equal empathy for anyone in that kind of pain–I will always remember which doctors brushed off how much pain I was in and the ones who showed understanding and compassion.

    On to the LC part!

    I love your stages explanation.I hadn’t put it into words, but after having real problems with specific types of ice cream (one example) I had to really work at avoiding them: for weeks, I just wouldn’t go down that aisle, even identifying what section was the last one before the triggery stuff and turning around.

    Recently I realized I was able to go past that triggery cooler, even looking at what had been my favorites, and just felt that it wasn’t relevant to me. I could have been looking at a concrete block for all the pull it had.

    I had gotten to “unconsciously correct.”

    I went back and forth with “consciously incorrect” for some time, and wondered if I should just give up, but every time I pushed into “consciously correct” I got stronger. I hope everyone trying to get on a good LC eating path has the chance to experience that 4th stage. It’s a wonderful feeling, especially when it becomes your personal default.

    Thanks again for sharing your story.

    • Thanks for sharing your story, Kathryn, and I’m sorry to hear about your ordeal.

  • davidgmills

    When I saw your TED talk many, many months ago, I cried. Not hard for an old man to do. But to see a doctor who was questioning the standard American diet on a TED talk was truly something to behold. I became an Atkins dieter and advocate in 1995 and have made low carb dieting my way of life ever since. It has been rough. Every doctor I have ever had, has beat me up for it, despite my very good lab numbers with the exception of cholesterol which was 240 when I was first tested in my late 20’s.

    I also ruptured L4-5 at the age of 27 and it took two years to diagnose. I underwent a chemonucleolysis ( a procedure that the do not do anymore – a chymopapain injection dissolves the nucleus of the disc) at the age of 32. It was 4 years of suffering right after I got out of law school. Then at the age of 48 it ruptured again and I had to have surgery this time. My doctor spent an hour and a half pulling disc fragments out of my spinal canal when it shattered. For nine months I was on extreme pain killers. I represented hundreds of people with back injuries over the years (I was a personal injury lawyer for 35 years before I retired) and I could relate.

    So we have experienced some of the same things. My father was a PhD in biochemistry and taught med school and graduate school for about 40 years. I chuckle when you talk about your biochemisty books and courses and the disconnect that biochemists seem to have with other fields of medicine. My brother is also a PhD in BioPhysics but did biochemistry at a number of university for 30+ years till he retired. So biochemistry is something that is hardwired into our family. I enjoy reading about it all the time. And I really enjoy your blog.

    I would like to say a couple things about my 18 plus year experience with low carb that you might appreciate. My father told me when I decided to go Atkins it would work. He understood the biochemisty and explained that Atkins was right about the metabolic advantage of dietary ketoisis, although he was not sure about the safety. But I showed him what Atkins had said about the difference between diabetic ketosis and dietary ketosis and my dad said said it made sense to him. So I tried it. Atkins believed dietary ketosis was a natural state.

    Ironically, I truly became convinced Atkins was right one day while waiting in a doctor’s office (probably one who was going to beat me up over low carb). I picked up a National Geograpic and began to read an article on orangutans. What immediately caught my attention was the the authors noted that these orangutans had ketones in their stools 6 months out of the year! And this was Borneo. Oranutans are vegetarians. If there was any place on earth where a vegetarian ought to be able to get enough carbohydrates all year long to avoid ketosis, Borneo was it. And yet they couldn’t stay out of ketosis half the time.

    I have struggled to stay in ketosis and I now think it has been due to too much protein. I am just beginning to realize after 18 years that has been the problem. I have never struggled to eat low carb. I probably haven’t had 5 days of over a hundred carbs per year in all that time. Normally I am at about 30-50. So I started switching out proteins for fats about a month ago after reading Wheat Belly and Grain Brain.

    There is so much more I could say, particularly on the subject of estrogen excess as the other major cause of obesity. Carbohydrate excess and estrogen excess go hand in hand. Low testosterone is a real problem for older men and progesterone is the Rodney Dangerfield of hormones. I have taken bioidential progesteone topically for two years to block estrogen (mine was bordeline high and now normal) and to increase testosterone level (which was very low and now is in the midrange). You should read Ray Peat, PhD who is the guru of progesterone and who advocates men take it. ( Progesterone also makes insulin and thyroid more efficacious so you need less of them. And it has worked wonders as an anti-inflammatory on my back where I apply it daily (it is the precursor of cortisol/hydrocortisone as well as the precursors of estrogen and testosterone). When your back is bothering you, you would be amazed at the relief! And the side effects are progesterone are zero.

    As you know, pregnenolone, progesterone, cortisol/hydrocortisone, testosterone and estrogen are all produced from LDL the bad cholesterol. Low LDL can really effect these other hormones and Ray Peat believes reducing LDL can be a real problem because of it ( studies show low LDL reduces lifespan — I am sure you know). I began to wonder whether getting levels of pregnenolone, progesterone, DHEA and tesosterone or other hormones to youthful levels might effect LDL. Turns out getting these four hormones to youthful levels lowers LDL and raises HDL.

    So I take them all in moderate amounts and do low carb and ketogenic.

    Sorry for the long post, but it was fun.

    • Lots of interesting stuff here. Thanks very much for taking the time to share with me/us.

  • MichellePDX

    Thank you for sharing your story. Its so frustrating when people dismiss your pain.

    I’m obese and I’ve always suffered from some back pain. Last year, for no obvious reason, I felt like I was being crippled with extreme low back pain. I woke up in so much pain, utterly confused why I was feeling this way. With no insurance from the job i had at the time, i suffered like never before. The pain continued for weeks, turning into months of agony. I would go to work and go straight home to bed. At work, sitting for 8 hours was impossible. I was always so uncomfortable. Actually, uncomfortable is putting it very mildly. I would cry at my desk in pain, I would cry at home in pain. I was miserable. Sometimes Bayer numbed the pain but it was always there.I really didn’t see an end in sight.

    I decided to embark on a low carb journey as a means to decrease my body fat (i was trying any possible solution to feel better). After eliminating bread and eating meat and veggies for 2 weeks… I suddenly realized my back pain was 90% better. I used to rush home and to bed but I finally had energy to cook and even take walks after work. I could stand in line at the grocery store without getting tears in my eyes from the pain. After another 2 weeks, I almost forgot how bad I was prior to low carb. Low carb was the only major thing different i had done. I’ve read that gluten causes a lot of inflammation in people so I theorize that I sustained a minor injury to my back muscles that dramatically worsened from the inflammation; it never allowed my back to heal. LC eating gave my body the chance to heal itself. Mind you, thats a theory from a accountant who likes to read and research, not a scientist.

    After going on vacation a few weeks after that I fell off the LC wagon. Periodically if i have a (minor, in comparison) back ache, I cut out gluten/carbs for a few days to a week. I have yet to suffer that kind of pain again. But now I’m prepping to get back on the wagon. LC gives me great energy and great sleep, a healthy appetite, mental clarify and sharpness, consistent BM, and it eliminates my fluctuating GERD symptoms.

    Thank you for writing about your story and about low carb. Too many of my friends think of LC as just a diet fad but it has been so much more to me.

  • Chris Steward

    Thank you for sharing your story!
    Here’s mine…
    I was 30, 6’0″ 210 lbs. (boxers build), running most days and working the heavy-bag every day. I got married that same year. Well, we were happy and comfortable–VERY comfortable. So much so that I gained 73lbs from 2007 – 2012. Needless to say, I was waaaay out of shape. It never really was much of a problem until Halloween, 2012 I picked up a big log and threw it over my shoulder like HE-Man and tossed it onto a campfire. I thought nothing of it, only pausing to beat my chest like a gorilla and went to bed that night. Well, the next morning I immediately noticed a burning sensation running down my left leg. Progressively, daily the pain got worse until January 2013 I went to the doctor. He ordered a MRI which showed a herniated disk. No real option but to have surgery. I managed to make it to March 2013 before the procedure was absolutely a must.
    I had the procedure and immediately felt better but was unable to function normally–walk, sit, stand–it all hurt & recovery was rough but easy compared to some of the horror stories I’ve heard. Unknown before my surgery, I have a nerve configuration known as conjoined-nerve-root. This (I believe) slowed the healing down a bit.
    My doctor was very blunt with me and said if I didn’t lose some (significant)pounds, I had better plan on having he surgery AGAIN! AGAIN!?!? I thought, NO WAY was I going to feel that way again!!
    Well, August 1, 2013 I weighed in at 283 and through diet, slight exercise & a hell of a lot of willpower I am currently down to 221lbs! It wasn’t easy losing over 60lbs in 7-months but I feel it has changed my life! I haven’t felt this good in a long time and I owe it all to hurting my back (as funny as that sounds!).
    My only regret is I let myself get that far out of shape. The great thing is that my wife took the weightloss journey/challenge with me and has lost over 35lbs too!
    My point is, ANYONE can feel better but YOU have to decide that YOU want to feel better.
    Start it, Stick to it and BELIEVE IN YOURSELF!!



    • Well said, Chris. Thank you.

    • Maryann

      Thank you Chris for the encouraging words, and congratulations on all of your hard work and success!

  • Beamiz

    Peter- your article on the back pain piece has really lifted my spirits! I’m 34 and had surgery end dec 2013 l4l5 and have had a horrid time with the recovery. I work in belgium and my mom also had to come take care of em and then after I came on my leave to the us in late jan after she had to go back to work…lying flat and all. I’ve been told my positivity and energy is contagious and I can’t tell you how many times I’ve been dejected that I couldn’t will my body to heal itself. I don’t sit for very long after a bit more than 2 m since the surgery. I did have one success- I slowly got myself off narcotics…. I’m amazed at how easily I get prescribed them and am very proud that I forced myself to use them only when absolutely unbearable. The lack of exercise has however not helped my weight and now I need to go back and start all over again, but since I’ve managed to relearn body habits, I hope to do the same with my diet again…. I just ink more light needs to be shed on back pain and post surgery recovery. Not enough people get it!

    • Sorry to hear what you’re going through. There is a light at the end of the tunnel, but it requires learning to move in an entirely new way.

    • Andrew

      Thank you very much for this article.
      I am 30 years old and suffered a L5-S1 herniated disk just over 6 months ago. Reading your article has been a wonderful encouragement that I can make a full and healthy recovery in time.

      Other than posture correction, what other things do you attribute to your remarkable recovery?
      Also how long after your second surgery would you say it was before you felt completely healed?

      At the moment I am following quite a solid routine of physiotherapy with a focus on core strength. But i’m not yet at the point where I can comfortably squat or dead-lift weights.

      I realize it’s not your main area expertise but any advice or tips you could give would be really wonderful.

      Many Thanks

      • It was about 12 months post the second major operation before I could enjoy a full day without pain. Long road, and lots of ups and downs.

  • Shanna

    Thank you for sharing this story. While I transitioned to a ketogenic diet over a month ago after a 3 month long medical ordeal following a “routine” surgery, that wasn’t what I found most valuable. There are so many days I struggle with why I’m doing this, especially since the results (weight loss, etc) have been minimally visible so far. You relating that frustration to the concept of the “relearning” that recovery takes resonates with me. Perhaps those times when I am watching my fiance eat all of the things I do not (but still sometimes miss) I will recall that I am just recovering in a different way now. I have to give my brain the time and effort it takes to relearn and heal just like my body. I’m just beginning this journey and admittedly have always been #1 a results driven individual and #2 impatient, which when combined make this a daunting undertaking indeed. Your site has been my “go to” for so much of this process both for the science (which is sometimes a little over my head but somehow comforting) and for inspiration. Thank you ever so kindly.

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  • Shaira

    After being on my own low carb journey for the last two and a half years, with much success but some pitfalls, your blog re-energises me and makes me think differently about my eating habits. I love the scientific content of your posts – and can appreciate them as a biochemist.

  • Nicolas

    Inspirational sharing Peter! Now, please pray for me who is trying to cure my back pain problem. Thanks for the great post!

  • Mike Gale

    There’s a dark side to being consciously incorrect.

    My natural inclination is to eat high fat and moderate carbs ( I particularly dislike things that are too sweet).

    Over time the fake science of high carb low fat got to me in various ways and I tried to consciously “correct” my natural inclination. It never worked well but I tried.

    Now that I’ve consciously re-adopted LCHF, my auto-pilot is kicking back in nicely.

    LESSON: It’s OK to mistrust things that society tries to force on you, where it clashes with your instinct.

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  • Vladimir Van Dyke

    Reading your Blog “What does lower back pain have in common with low carb eating?” took me back to the times when I had to experience similar fate as yours. Seven years after surgery ( it happened to me in a more advance age ), recently having been diagnozed with thyroid malfunction, I am now addicted to health and nutrition, not to mention the physical conditioning and am on a path of eating a somewhat similar diet as you are describing in your Blogs (no Sugars, low Carb).
    You are an inspiration and It would be grand to have an opportunity to meet you in person one day.
    Thanking you for all the great Reads that you are providing to your followers.

  • Adam Iannazzo

    Hi there Peter,

    I enjoyed the above blog and am also in CLBP but as a physical therapist, I enjoy the ability to treat myself with Yoga, pilates, self tissue work and lots of running. I work with many companies trying to educate the employees in proper mechanics and home exercise programs to decrease risk of injury and loss of function.

    I hope you are using your back at least a little bit as disuse causes early arthritic changes and future loss of function.


  • Ellen Urciola

    Hi Peter,
    I need some clarification on this response you gave wrote some time ago:
    Ellen, that sounds like a lot of protein. What would those ratios work out to if you were, say, 50 gm/d carb, 100 gm/day protein, X gm/day fat (where X = whatever you need to not be starving)?
    I thought I understood but I don’t think I do. Should I calculate these in terms of ounces or caloric terms?
    Am I correct in interpreting it to mean:
    About 4oz. of protein or should I be thinking in terms of calories?
    Thanks for the clarification.

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  • Angie

    Very interesting read. I am just now starting to learn about Low Carb and Ketosis and finding it hard to start. I had back surgery almost 3 months ago because my left leg and foot went numb and I could no longer walk. I had to quit working as well. 3 months out my leg is fine, but I am having such a hard time with my lower back. I can barely walk in the morning and I can barely walk after doing anything. (cleaning, mopping, etc.) I am also really heavy which does not make it easy.
    Right now I am feeling so hopeless. Thank you for sharing your story. Makes me believe I can do this and there is something that can be done.

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  • Jason Hommel

    Peter, we have a similar story. When I was 18, I developed a back infection that required 2 months to diagnose as an infection then 2 months of antibiotics, and 4 months of rehab for a total of 8 months of mostly lying flat on my back. 25 years later, and I finally found a way to eliminate most of my back pain, because most of the rehab exercises didn’t do the trick. I found isometric stretching, and it worked better with green smoothies. My theory is that the greens that are chelators help remove the heavy metals that can get into the joints and tendons. Well, I finally figured out an exercise that moves the lower back through the full range of motion while under tension. It’s like the light bulb finally went off in my head, and I’m wondering why nobody has ever done this before? See it here:

    • LR Mujica-Parodi

      Jason, an alternative hypothesis to chelation is that the greens increased your omega-3/omega-6 FA balance, thereby reducing inflammation in your back. When I have flare-ups, I consume large quantities of leafy greens and fish oil, and I have also found that it reduces pain as well as blood markers for inflammation.

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  • DCarry

    I do occasionally suffer from lower back pain and when I do, even though it only lasts a few days it can be severe enough that I find it very difficult to move. I think at the moment I am definitely in the category of unconsciously incorrect, as when my back is not giving me any trouble, I do not actively do anything to make sure that the problem does not reoccur. I realize now though that I need to be thinking all of the time about how I can rehabilitate my back until it just becomes something that I do automatically.

  • Rick

    Thanks for telling your story! It is always comforting to know that others have had the same experiences that I am struggling with. When I was 21, I am 48 now, I had cancer in my lower back, hip and spinal column, this was brought on by radiation I received 4 years earlier, after removal of a benign tumor on my spinal cord. The entire area that was targeted in that radiation therapy was eventually over run with cancerous tumors. Parts of 7 back muscles, and parts of bone in my vertebrae and hip were removed with the tumors. I was a strong, but naive, 21 year old kid back then, so I did whatever the doctors and my parents told me. It took me three months to get out of the hospital and about a full year to walk with stability, but that was the easy part. I have lived a good life, great wife, great kids, great business, but it has all been under the dark cloud of addiction. I, like you, have taken between 160 & 200mg of different narcotics for the last 27 years. (Never smoked a cigarette, drank alcohol, or did an illegal drug before that, and to this day, that is still the same) I, unlike you, have not been able to beat the addiction. I would say from year 1-2 I took the Medication mostly for the pain, years 2-8 I took the prescribed medication for the pain and feeling of a high, 8-15 to stave off withdrawal, and years 15-25 to stave off withdrawn and as a crutch to help me focus on work, since year 25 I have been trying to cut back, I am down to 20-30mg a day. Also this past year, for the 1st time in my life, I have been trying to change my eating and exercise habits to lose weight. I have found that trying to cut back on the narcotics is very similar to trying to cut back on the calories. I was a 5’10” 280lb man on Jan 1st of this year, and as of today, I am 73lbs lighter. However, this alls seems to be coming with a heavy price. I have not been in this much pain since probably 1991. I don’t know if it is the walking I am doing now for the weight loss or the reduction in the pain meds, that I didn’t think we’re doing anything for my pain anymore, but something is amiss. I am always stressed out now, and I have never been like this my whole life, could those feelings be coming from the lack of calorie intake or the reduction of narcotic intake? Will they pass? Would it be better to a 280lb man, on 100-160mg of narcotics a day but be stress-free and happy again? It is nice to be complimented on how good I look due to the weight loss, but I feel like garbage 90% of my day. I was suppose to be getting healthier so I could enjoy my later years with my kids, but I am not enjoying anything now…


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  • LR Mujica-Parodi

    Wonderfully informative post, as always! One question: what is your opinion regarding inversion therapy (e.g., inversion tables)? These are touted as releasing gravity-induced pressure on the vertebra, allowing disks to rehydrate, and therefore ideal for preventing and treating lower back pain. I’m a scientist, and therefore have been focusing on the medical literature rather than web testimonials, but there are very few studies that I could find. There are also presumably some potentially dangerous side-effects, such as increased BP in the eyeballs, but I’m not sure how serious this is if one is not doing a full-inversion (65 degrees, rather than 90 degrees) and if it’s only for a few minutes at a time. I know that I started slowly, and did feel pressure in my eyes, but after a couple of weeks I don’t seem to notice it any more.

  • Leslie Howard

    What luck to find you this week! Last Wednesday I had a trial spinal cord stimulator implanted (for one week) to treat the chronic pains in my L leg, very similar to yours. I had a spinal cord incident when I was in college (am now in my 50s), but have had a very normal life, physically, with minor pain. Over time, though, the pain has gradually grown. Now I have pain from my low back, groin, knee, calf, down to the tips of my toes. And yes, I have your burning in the sole of my foot.

    In the last five years I’ve seen 20+ docs and have had both hips replaced and an L4/5 fusion. Those things have helped, but the leg pain remained. Hence, the SCS simulator.

    Last Weds. I also decided to switch from a “healthy” vegan diet, which was incredibly carb heavy, to ketogenic. I did this out of vanity–all of these health probs have seen me gain more than 25 lbs. I have no great love of carbs, so the transition has been easy. Most delicious week in years! Oddly, the SCS became disconnected when I rolled over in bed on Saturday night. But today is Monday. You know what? My pain has lessened, rather noticeably, every day. (I’ve also dropped a couple pounds. 🙂

    Tomorrow I get my SCS removed, and the doc and I will decide on whether or not to do the permanent surgery. Now I’m not so sure that’s a great idea. While my pain is reduced with the keto diet, it’s definitely still there. But it’s only been five days. Time will tell.

  • Hi Peter, thank you for sharing. I have had chronic lumbar pain and have been so lucky to come across a fantastic physio therapist that has helped me to regain painfree movement in my back. My mind feels clear for the first time in a long time! My Pilates journey now begins and the process of relearning how to move correctly.
    Interestingly, I have also started adjusting my diet to low carb in the last year and trying to eat intuitively….your diagram of getting to eating correctly unconsciously is a powerful clear message!
    I think the mind/body connection is overlooked and we need to get back to listening to our inner voice of health. Our bodies know what’s good for us but sometimes we dont hear It!
    Delighted that you have had a positive journey back to health. Thanks for your post. Barbara

  • Heather Wood

    I am so glad to hear of your successful journey out of pain and disability. I too am a physician who had a year of my life interrupted by an orthopedic procedure that was not very successful, and had my postoperative complaints treated as malingering, although in fact I continued to work and never considered doing otherwise. Amazing what an arrogant doctor can do to diminish health and well-being. I too have come through it to have my active happy life back again, and am glad to see you talk eloquently and publicly about the harm that an arrogant physician can do and the need for patient self-efficacy.
    I have been eating a ketogenic diet for about 4 years now. With a touch of arrogance myself, I felt that I had reached the stage of unconsciously correct eating until I noticed that my weight had increased by 10 pounds without my being very aware of it until my jeans wouldn’t button. Good warning to get back fully on track. So I would love to see an additional arrow on your flow diagram pointing back up to “unconsciously incorrect” because I think that people with carb addiction problems need to know that “unconsciously correct” can shade back to “unconsciously incorrect” all too easily. But if this happens, it’s a warning to be aware of the cycle and get more on track, not a disaster or an indication that low carb diets “don’t work.” Recovery is a lifelong process and may need to be more conscious at some life phases than at others, however long you have been at it.

    • Sorry to hear of your injury, Heather. Yes, I agree, these arrows should definitely have some bi-directionality.

  • Terry Keogh

    If a ketogenic diet has anti inflammatory properties as it relates to diabetes. Does the same hold true for injury rehabilitation? Would a ketogenic diet aid someone who had inflammation problems due to chronic back injury? Potentially?

  • Pramod

    So what was the diet that you followed? If you could answer it would help me as well as I am suffering with back pain.

  • Patrick

    First, I want to thank you for the tremendous amount of work and information you have created here on your site. I find it truly amazing that the typical recommendations for healthy eating could be so wrong for so many people. Since I discovered your site a couple weeks ago, I have been telling everyone I know about it and passing on some of the information I’ve gleaned from it. (I enjoyed the few articles I read so much, I am going back to the beginning and reading every post!) I am an engineer, so I especially appreciate your commitment to the scientific method and teaching causation vs. correlation. Everything you write really resonates with me.

    I began my own journey of eating correctly 3+ months ago, though I started more along the lines of a high protein, moderate-low fat, and low carb (zero sugar) diet. Even though I have had early success, I’ve learned after reading some of your articles this isn’t exactly a recipe for nutritional ketosis – probably too much protein to achieve ketosis. Now, I’m beginning a transition to incorporate more fats, less protein, and even fewer carbs. I admit, it is still difficult to get around the mindset that has been drilled into me all these 30-some past years that fats are bad for you and give you heart disease. Luckily, I had my annual physical with bloodwork done just before the start of my journey, so I have a baseline to make a comparison soon (albeit imperfect, VAP). I am very excited to see my results and am also looking into an economical DEXA scan for comparison to the results given by my bioimpedance weight scale.

    I also want to thank you for this particular article. I herniated the same disc you did (L5-S1) at age 28 (~6 months after original posting date of this article). I was completely immobile for 8 weeks while on large doses of oxycodone and cyclobenzaprine to manage my back/leg/foot pain. To top it off, my wife and I had a 15-month old daughter and I couldn’t help or be the father I wanted to be. Add emotional pain to physical pain and pharmaceutical depressants…I was not in good shape to say the least.

    The doctors began treatment with corticosteroid injections. I was told I could have them no more frequently than every 2 weeks, and a maximum of 4 in the span of a year. After 3 injections with no improvement, the next step was a microdiscectomy. In my case, they performed the surgery properly and I had immediate pain relief. Three years later, I still have numbness on the outside of my left foot and toes, but I don’t notice it much – certainly not debilitating. I can’t imagine what you went through. The most frightening part for me was that following my recovery period when I was no longer on pain medication, I recognized I was going through physical withdrawal. Constant shaking of my hands, irritability, what felt like constant anxiety, episodes of sweating, etc. It was a real eye-opener into how easy it is to get addicted to these drugs. Now, I finally understand how we become addicted to sugar.

    Like you, I’ve gone from the unconsciously incorrect to consciously correct in my body mechanics, core strength training etc. I am now at consciously (almost)-correct in my diet and hope to achieve the unconscious habits for lifelong health. I may not find that a truly ketogenic diet is best for me, but certainly a low-carb/zero sugar diet is where I want to start and adjust the protein/fat ratio to what I find is best for me.

    Once again, thank you for this wonderful resource you have put together and sharing your story.

    • Patrick, I’m sorry to hear of your struggle, but happy to hear that you’ve emerged whole on the other side. Best/worst experience…

  • Lisa

    This is such a great read! I’m hooked on clonazepa 10mg each night. As I can not sleep due to my back pain. Sadly a year old Work Injury I’ve yet to be treated for. I can not handle pain pills as they give me migraines. My doctor is switching me to Ambien. For some reason I keep pulling away from it each time I go to take it. Interesting that a side effect is pain.

    I’m so sorry for what you had to go through. As much pain that I’ve been in and abuse by the system, I’ve yet to go through what you have. Thank you so much for writing about your experience. I will be checking out more of your information regarding the back, proper posture, and low to no carbs


    • Try to avoid Ambien, Lisa. It’s anything other than “AM bien” as they would have you believe. Focus on pelvic mobility, strength, etc.

  • Linda T Harrison

    Hi Peter
    Thanks for sharing.

    I’m a 46 year old mom to 3 boys, ages 13, 11, and 11.
    I bent over one day to pick up toys to lower my treadmill.
    I have never been the same. The pain was so excruciating, I finally gave in and went to primary care. She sent me to ortho.
    I have seen pain management doctor, orthopedic surgeon, therapists.
    Had countless epidurals, RFA’s, facet blocks, lumbar fusion, spinal stimulator implanted twice, the leads came undone.
    Still in bad pain.
    I’ve gained over 50 lbs from being inactive. I try to walk but fail miserably, even with just down the street.
    I’m trying to eat better, portion control, decide if I’m hungry or bored by saying to myself… If you’re hungry.. Eat vegetables, instead of crap.
    Sometimes it works.
    Depression has sunk hard.
    I’m on so many meds..
    900 mg Gabapentin TID
    Baclofen 10 mg TID
    Motrin 800mg. TID
    Tylenol in between motrin
    Cymbalta 90mg in the am
    Vicodin 7.5/325 BID
    Xanax for occasional panic attacks.

    Kids ask me when I’m going to be better so I can do this and that.
    I have no answer.. Except.. I hope soon.
    But.. I know that isn’t true.

    I just had another steroid injection Friday. Go back in 2 months for another.

    I’m so tired. I don’t know what to do sometimes. No one can seem to help me.

    Anyway… Working on my diet to try and lose weight, hoping that will help some. With summer coming.. Pool goes up soon… About the only exercise I can do is walking in water.

    Somewhat relieved to know I’m not the only one going through this hell.

    Thanks for reading.

    • Linda, I’m really sorry to hear this. I wish I had something to offer other than sympathy. I hope you find a great PT who can condition you back to health. Many cases of back pain do not require surgery, as I did.

    • Jusn

      Hi Linda,
      I really hope you are feeling much better now. Why don’t you try the Gokhale Method? It has changed my life.
      Take care.

  • Sharon M

    I’m so glad I came across this!

    6 years ago I herniated discs L4-5 and L5-S1. Agony! I found the work of Dr Bookspan who says you can fix most back disc problems with correct posture and exercise. She was right – 2 weeks later I was in the gym, 2 more I was back on a tennis court. I learnt like you to hold my posture correctly without even thinking about it. 6 years on and I’ve never had so much as a twinge.

    I’m now on the road with LCHF eating and keep falling off the wagon. Thanks to your post I’m now going to approach it like I did my back issue safe in the knowledge it will eventually be something I do unconsciously – I’ve just got to work to get there.

  • James Mc Geough

    Just came back here to take a look at the lower back exercises again. Great post and presentation, thanks for sharing!

    **Q: What exercises do you recommend for strengthening lateral movement?**

    (You mentioned the gluteus medius, tensor fasciae latae and vastus medialis on Tim Ferriss’s show).

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  • Felix

    Recently I have to study sitting for hours at one sport. I later discovered I experience pains getting out of the bed (back pain). But once I could stand the pain appears to reduce. I can walk as if nothing happened until I go to sit. then I will experience pains. What do I do? Thanks

  • Tashima

    Actually I was googling reasons why back pain can increase during the low carb dieting but instead stumbled across your article.

    My doctor placed me back on this diet due to on going high blood pressure. Every two weeks my blood pressure and food log is recorded by the practitioner. I’ve learned to drink lots of water, broth, and eat heathy fats etc. to reduce the ” ketosis/ low carb flu” symptoms.

    This morning I work up with lower back pain which was one of the reasons why I had my IUD removed a week before restarting this diet. 5 hrs ago I wAt first I thought it could be due to cramping which is common after removal among other things. I’ve come across some articles stating a low carb diet can cause back pain due for loss of minerals, dehydration, ect, and was research for more information.

    Thank you for sharing your inspiring story.

  • JS

    Interesting read. Came across your post while searching a link between back pain and a low carb diet. I’ll explain my story (sorry for my english).

    Until 5 years ago I worked out at gym, went out running and surfing very regularly. I was very fit and active. Suddenly, for no apparent reason, a lower back pain came to my life. It would be always there and get worse after any exercise, even a 10 minutes walk. Xrays and MRI’s did never show anything which had my doctors puzzled. No amount of stretching, visits to physiotherapists or even chiropractors helped. After this pain started, my life became more and more sedentary. I was becoming depressed.

    Few months ago, after watching my growing belly in the mirror, I decided to start a keto diet to lose some weight. So I did cut out as many carbs as possible and after few weeks I realized that not only my belly was getting smaller but pain was gone. It’s been 4 months already pain-free. I just can’t understand what’s the connection between a carb-free diet and pain.

    I’m not any type of keto evangelist, neither I try to convince anyone to change their habits. I just felt the need to share my story here. More often than not I crave for carbs but I’m afraid to eat them and experience the pain again!

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  • Ian, thank you very much. Isn’t 58 a bit too young to be “retired” ? 🙂

    • Ian Dickson

      Thanks for replying to me. Yes 58 is “young” but I wanted to do other things and working in the British NHS is “difficult”. I am keen on sports and although not the most energetic thing I play a lot of golf and have reduced my handicap to better than Scratch. It’s something I always wanted to do.
      I’ve posted a few other comments/queries and it would be great if you or one of your team has the time to answer them. Ian


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