September 30, 2012

Nutritional Biochemistry

What I actually eat, part II – “IFIK” (circa Q3 2012)

Read Time 8 minutes

Note to readers: This post was written in September of 2012.  PLEASE do not ask me why I eat ‘this’ or why I don’t eat ‘that’ — as what is shown here does not necessarily reflect what or how I eat today (or more importantly, how you should eat).  My diet evolves constantly, due to my constant tweaking and self-experimentation. Over time, I’ll share it here and there, but what I eat is not at all the focus of this blog.  I ask that you refrains for asking questions about what I eat your comments.

 

For reasons I don’t fully understand the most read post on this blog is one I wrote very quickly and with very little thought.  I wrote it in response to a question I’m asked all the time, “What do you actually eat?”  The post, aptly titled, What I actually eat, has more than twice the traffic of the next three most read posts combined. Go figure.

After a full year in “strict” (i.e., no “cheat” days) nutritional ketosis I wanted to experiment with other eating patterns.  I had been reading about intermittent fasting (IF), and had a few discussions and exchanges with Mark Sisson and Robb Wolf about it.  Though I don’t know Brad Pilon or Martin Berkhan personally, I’d also read a few interesting things they had written.

Why the change?

My curiosity was sufficiently piqued to break a golden rule – if it ain’t broke, don’t fix it.

I was very happy after a year of nutritional ketosis, but I did wonder if I could improve on a few things.  For starters, as my cycling season was about to ramp up, I wondered what it would be like to weigh 75 kg (165 pounds) instead of my steady-state weight of about 78 kg (172 pounds).  I know 3 kg does not sound like a lot, but it can make a huge difference when riding up Mount Palomar, assuming one can preserve power output. I also liked the idea of not spending so much time eating.  As you probably know, I’m pretty obsessive about how I utilize the 168 hours in each week and resent anything that takes me away from my family, my work, and my training.  (This includes sleep, which I wish I could figure out a way to thrive without.)

In the end, I think Mark Sisson finally just egged me on enough to agree to at least give it try – even just one day per week.  And with that, I embarked on the next phase of my nutritional odyssey.

I decided, in early May, to start with the following protocol: one meal per 24 hours, twice a week.  On the other 5 days I consumed my usual keto-diet.  On the two IF days I would just eat one meal at around dinner time.  I still consumed normal amounts of liquids (water, coffee, tea) and supplements (see list below), with one exception – on fasting days I doubled the amount of sodium I supplemented via bouillon from 2 gm per day to 4 gm per day.

Like all nutritional changes, this one took some getting used to.  Because I exercise in the mornings, on fasting days I would get pretty hungry by about 10 or 11 am.  Interestingly, though, by about 2 pm, as my blood glucose levels would be between 60 and 70 mg/dL, I would start to feel completely fine.  In fact, by about 5 or 6 pm, just before eating my meal, I found I wasn’t really hungry.  This may have been due to the fact that my B-OHB levels were usually above 3 mM by this time of day.

Why do I call it “IFIK?”

Not surprisingly, after eating 100 gm of protein and 40 gm of carbohydrates in one sitting, my B-OHB levels would fall, often below 0.5 mM, the practical threshold of nutritional ketosis.  Usually within 24 hours I’d be back to my normal levels, generally between about 1 and 2 mM. But, the cycling in and out of ketosis was new to me, hence the phrase “intermittent fasting, intermittent ketosis,” or “IFIK.”  I guess you can see why I didn’t end up in marketing – “if-ik” doesn’t really have a nice ring to it.

The purpose of this post is not to provide a detailed overview of IF or ketosis, but rather to address the following common questions I often get asked in response to the original post on what I ate:

  1. Question: Peter, why do you eat so much dairy?  Answer: I don’t.  That was a year ago.  I did eat a lot of dairy, and seemed to tolerate it quite well. I realize that’s not true for everyone. Regardless, I seem to eat much less today.
  2. Question: Peter, is ketosis for everyone? Answer: Of course not.  Besides oxygen and water, few things are.
  3. Question: Peter, why do you eat so much meat? Answer: I don’t.  In fact, some days I don’t eat any.  Other days I do. I obviously don’t think there is anything harmful with eating meat (read this post for a refresher), but I’m quite happy eating lots of non-meat items, too.
  4. Question: Peter, how can anyone possibly do anything athletic without carb loading? Answer: It’s easy.  Anyone can do it, if they are just patient and let their body adapt.
  5. Question: Peter, you eat like a freak (ok, not really a question!) Response: And your point is?

What happened after several months of IFIK?

Interestingly, I did lose weight.  After briefly hitting 163 to 164 pounds, I settled out at where I am right now, about 165 to 166 pounds, right at my 75 kg target.  I have not yet repeated a DEXA scan to confirm, but I suspect I lost a bit of muscle, along with more fat, probably at about a 1:2 ratio.  My last DEXA measured a body fat of about 9%, and I suspect I’m about the same, though my waist is half an inch smaller than when I started, so I may be closer to 8%.

Why do I think this happened?

In the IF community there are really two (maybe more) theories on why I lost weight.  I won’t describe them here in any detail, but will do so in subsequent posts.  One hypothesis is that I’m simply consuming fewer of the same high quality calories than I did before.  The other hypothesis is that the physiologic response to IF (rather than the response to prolonged fasting) is to increase my REE during the period of IF, possibly through the up- and or down-regulation of various hormones.  Of course, it could be a combination of these, or something entirely different, too.

Drumroll….

Before getting to the part that folks who are still reading probably care about, let me point out a few differences between what I eat today and what I ate a year ago.

  1. I consume, on average, fewer calories per day.  I am also lighter, and we know TEE varies with body mass, so it’s not surprising that most days I am not eating over 4,000 kcal, as I used to. Of course, one might argue my body has become more metabolically efficient at utilizing substrate, and so my REE is lower than it was a year ago.  Finally, I do exercise less than last year.  Hence, there are many explanations for this difference.
  2. I consume less dairy. Don’t read too much into this.  There is nothing deliberate about it, just an observation of my behavior.
  3. I consume less meat of all varieties.  Again, don’t read too much into this.  I have no explanation except that I seem to crave it in lower amounts and less frequently.
  4. I consume more overall carbohydrates, though still virtually zero sugar or refined carbohydrates. Most of this additional carbohydrate is in the form of nuts and SuperStarch.
  5. I consume virtually zero sugar substitutes, except for the little bit in my SuperStarch and protein powder (sucralose).  I also drink, at most, about one diet soda per month.
  6. I spend less money on food.
  7. I spend less time eating.
  8. Currently I only eat three meals per day about once a week. I eat two meals per day probably 4 times per week, and one meal per day twice per week.

To calculate the nutritional content of my intake I use a piece of software called Nutritionist Pro, which is not for the faint of heart. It’s one step removed from a DOS prompt. In addition to costing about $600 a year, it’s not exactly user-friendly.  I’d probably describe it as “user-hostile,” actually.  But, it’s really accurate and has a database that is unrivaled.  The reports, once you learn how to generate them, are very good, also.

Three consecutive days of representative eating

Keep in mind, I don’t count my calories or weigh my food normally.  I do it periodically, such as at this time, when I’m curious as to what I’m actually eating.  I believe I’m able to do so without eliciting the Hawthorne Effect, but obviously one can never be positive.

Tuesday

  • 7 am — morning workout – flat intervals on bike (75 minutes).
  • 1 pm – Nicoise salad:2 cup butterhead lettuce, 1 tomato, 10 black olives, 8 oz tuna steak, 1 hard boiled egg, 0.5 cup red onion, 2 oz lemon juice, 4 tbsp olive oil, 1 tbsp mustard.
  • 7 pm – Chicken salad with nuts:2 cup romaine lettuce, 1 tomato, 0.5 cup cucumber, 2 oz cashews, 2 oz walnuts, 8 oz chicken breast, 6 tbsp olive oil, 2 tbsp balsamic vinegar.

Daily totals:

Carbohydrate – 89 gm

Protein – 131 gm

Fat – 218 gm (about 15% SFA, 70% MUFA, 15% PUFA)

Calories – 2,900

Wednesday

  • 6 am — morning workout – high intensity dry land (90 minutes).
  • 3 pm – The “Peter Kaufman shake” (named after my good friend, Peter Kaufman at Generation UCAN, who hooked me up with the recipe):
    4 oz heavy cream, 8 oz zero-sugar almond milk, 1 pack chocolate protein SuperStarch, 2 tablespoons almond butter, 8 gm additional glutamine, 1 tray of ice cubes (blended to smoothie consistency).
  • 7 pm – Chicken-nut omelet:
    4 eggs, 0.5 avocado, 3.5 oz cheddar, 3 oz red onion, 2 oz walnuts, 2 oz cashews, 4.5 oz chicken thigh, 2 tbsp butter

Daily totals:

Carbohydrate – 60 gm (30 gm of which is SuperStarch)

Protein – 151 gm

Fat – 226 gm (about 40% SFA, 35% MUFA, 25% PUFA)

Calories – 2,800

Thursday

  • 7 am — morning workout – hill intervals on bike (75 minutes).
  • 5 pm – Attia super salad:
    1.5 cup romaine lettuce, 0.5 cup cucumber, 0.25 cup mushroom, 1 tomato, 3 oz sliced T-bone steak, 2 oz cashews, 2 oz peanuts, 2 oz macadamia nuts, 8 tbsp olive oil, 2 tbsp balsamic vinegar.
  • Between 6 and 8 pm – after-dinner snack consisting of:
    3 oz cashews, 1 oz almonds, 2 oz peanuts, 1 oz macadamia nuts, 2 cups of coffee with a total of 6 tbsp heavy cream.

Daily totals:

Carbohydrate – 94 gm

Protein – 93 gm

Fat – 369 gm (about 20% SFA, 65% MUFA, 15% PUFA)

Calories – 3,800

My daily supplements

Note: I am only listing the products I use, and not trying to convince you that my brand of vitamin D is superior to another.  If I feel strongly about a product, I note it. But this is not a product pitch. I don’t make one penny off you buying any of these products.

Fish oil

1 tablespoon of Carlson’s Very Finest Fish Oil, providing 2,400 mg EPA and 1,500 mg DHA.  I do feel this is a superior product and I’ve had detailed toxicology analytics conducted on the product to confirm the absence of lead, arsenic, mercury, and other toxins.

Vitamin D

5,000 IU D3 in gel capsule, by NOW.

Magnesium

400 mg magnesium oxide by Nature Made.

Sodium

2,000 mg in the form of bouillon, typically by Knorr.

MCT oil

Either 2 or 3 tablespoons, depending on activity level, by NOW.

Probiotic

2 capsules of Mark Sisson’s Primal Flora, providing 60 billion CFU.  The reason I use Mark’s product is because I know and trust him, and I know how much homework he did in formulating this product.

One of the topics I’m currently getting steeped in is gut biota, and I’m hanging out a lot with a San Diego expert on the topic, UCSD Professor Larry Smarr, who has repeatedly sequenced his entire gut biome, with the help of Craig Venter at Synthetic Genomics and others at MIT.  As Larry points out, the challenge of “moving the needle” with probiotics is that they only provide the aerobic bacteria while, of course, most of our gut biome is anaerobic.  Stay tuned for much more on this topic.

Closing thoughts

  1. My performance, especially in light of my reduced training volume (or maybe because of it!) has not deteriorated.  In fact, this week I had 3 best times in 3 of the activities I do weekly (tire flipping/sledge hammer/plyometic routine (1:04); short sprint up 15-18% grade (0:39), and long sprint up 8% grade (3:29)).  It’s possible the added carbohydrate, relative to my constantly ketotic state, has facilitated this, despite consuming about 15% of the carbohydrate I used to consume on my “standard American diet” circa 2008.
  2. I will discuss the impact on my biomarkers in a separate post.
  3. The only drawback I’ve noticed of IFIK so far is that I’ve inadvertently turned my daughter off nuts.  About 4 months ago, after having three consecutive identical dinners (chicken-nut-salad), she called my wife into her room as she woke up and said, “Mommy…we need to talk.  We need to have something different for dinner tonight.  We can have steak…we can have sausage…we can even have regular salad without nuts…but I can’t have nuts in my salad anymore!”  Poor girl… So now I have to make my salads separately.

 

Photo by Dan Gold on Unsplash

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569 Comments

  1. Sorry for too many comments ..

    If i consume 5% carb & 5% protein then can i increase my Fat to 90% ?
    Milk is an important source of protein for me but should i continue with it considering the sugar levels in it ?

  2. I just started reading your blog. Thank you…this is finally making sense to me. I workout with a trainer and have gained muscle, but not lost weight, and am quite frustrated as I “should” be thin according to the amount of exercise I do. (So reading your journey was a relief)

    I have cut out most of the dairy, except for cream. I love my coffee in the am, I have 2 large cups (16 oz) with light cream (5 %).
    Would it be better for me to have full cream, or just have it black? I am ready to go ketogenic. and the cream would actually feel like a treat.
    Also, my trainer has me drink a protein shake after my workout. I saw that you fasted all day, not sure I could go that extreme, but should I be waiting longer after my workout to eat?
    Sometimes this info is so confusing.

    • Hi Kim – When i started a ketogenic diet, I lost weight, but then stopped. I decided to drop dairy, including heavy cream, which I love in my coffee. After that I started to lose weight again. You may want to try raw eggs, whipped, as a cream alternative. Marks Daily Apple had an entry on this a week or so ago. What I do now is 3 egg yolks and some MCT oil whipped with a hand beater, and then add the coffee. Or, skip the MCT and melt some coconut oil in the coffee before blending it with the whipped eggs. It’s breakfast on the weekend.

      At work I just make ice coffee now by pouring hot coffee over a large cup of ice.

      Good luck.

  3. Peter.

    What is your stand on Vitamin C and keto diet? I mostly eat dairy, eggs and meat. Rarely any fruit or veggies so my daily income of Vitamin C is rather low, lower than RDA by far. I’ve read that uric acid might come into play instead of Vitamin C when in ketosis. Is this true or shall I start supplementing Vitamin C, if yes how much?

    • Probably not necessary. Vit C and glucose use same transporter. When glucose is low, trace amounts of vit C are necessary. Explains why Inuit never got scurvy.

    • On a related note does using glucose for energy heighten the requirements for B vitamins?

      I guess it’s a bit of a general question because of the many compounds that fit into that category of B vitamins. But to share my anecdotal account, I eat rather low-carb, and on occasion I’ve taken a B complex for no better reason really than because I once bought some. This ends up turning my pee noticeably yellow the next time I go to the bathroom. Although, if my observation is correct, when I do the same thing after having a meal based on potatoes or sweet potatoes my urine ends up rather clear.

      Perhaps it’s all in my head, or I’m not accounting for something simple like that I’m more thirsty and seem drink more water than usual after eating starchy meals. Thoughts?

  4. Dr. Attia,

    I am using the Specific Carbohydrate Diet in an attempt to control / cure ulcerative colitis. If you are not aware, the hypothesis and diet are essentially: low carb eating to starve out bad gut flora, combined with plenty of homemade yogurt to repopulate good gut flora. However, the line above:

    “As Larry points out, the challenge of “moving the needle” with probiotics is that they only provide the aerobic bacteria while, of course, most of our gut biome is anaerobic.”

    Makes me wonder if I’m wasting my time. Any comment?

    • Well, I was referring to commercial pro-biotic pills, which are cultured aerobically to grow bacterial populations. I think, but do check, that in yogurt one gets both. I have no idea, of course, if this strategy will work because (among other things) I have no idea how many of of bacteria make it to your colon, but it’s worth looking for any clinical trials and seeing your own experience.

    • Marc!
      “ulcerative colitis” is a term I recognize.
      A husband and wife couple came into our store, Rainbow Blossom Natural Foods, in Springhurst Kentcuky. He had ulcerative colitis, to the extent that doctors wanted to remove part of his (colon or intestine, forgot which) and he’d be using a colostomy bag. He came into the store, and bought this book: https://www.amazon.com/Prescription-Nutritional-Healing-Fifth-Edition/dp/1583334009. He followed it to the letter. 6 months later, he went in for an appointment and the docs said “whatever you’re doing, keep doing it.” A year later, the docs said “you have no signs of having ulcerative colitis.” One of the most powerful turnarounds I’ve ever witnessed.

    • Dr. Attia,

      Thank you for your input!

      Heyward,

      Thank you for the book suggestion, I will be ordering it as soon as I get home tonight.

  5. Is there a way to contact you or somebody you work with to talk to about how to achieve nutritional ketosis I’ve been trying this for months and I’ve been struggling the whole time sometimes I can feel my body going to ketosis and my body relaxes my brain feels good I sleep and my hormones come back and other times I just feel as if I didn’t even eat anything and I can feel my food just sitting in my stomach. I have tried so many different food combinations and mixing more fats with less protein and more protein with less fats that I’m giving up I can’t eat sugar I have too many side effects from it and now I can’t even eat vegetables because I have side effects from that as well. I could really use someone to talk to about this because I can’t read any more information because it doesn’t get anywhere.

  6. Dr. Attia,
    I just watched your TED MED talk and it was wonderful. Thank you for sharing that regret and your questions. I pray that you find the answers.
    I wanted to ask you if you have watched “Forks over Knives” and the compelling research such as the China Study that advises to avoid animal meats and products? I would be interested in hearing your take on those issues…

    I seem to do better with low carbs myself, but if you take out meat and dairy; then that doesn’t leave much to eat besides nuts and plants. That is doable, of course, but creates some general quality of life issues for me in terms of public socializing, entertaining, holidays, etc.
    Barb

  7. Peter, I just watched your IHMC talk on You Tube and one of the questions you answered brought me back to this post. You mentioned that consuming too much protein in one sitting can knock you out of ketosis. I am trying to get and stay in ketosis so my question is: if you had a guideline for the maximum grams protein per meal what would that be? At 3 meals a day, 10g of carbs per meal seems like a good cut-off, but not sure about the protein. I’m afraid I may be sabotaging my efforts by consuming proteing powder after a workout.
    Thanks!

  8. Inuit people “never got scurvy” because they ate stomach lining, liver and other tissue of animals (sea and land) that ate green plants. They also gorged on berries when available (cranberries, blackberries…), about one to two months per year.
    Both modern studies and pre-contact estimations of traditional diet bear this out.

    Here’s one source, though there are many, scurvy being a long researched topic of great import:
    “Historically, ample vitamin C was obtained through the traditional Inuit food system.”
    “Animal sources of traditional food confer fair to excellent amounts of vitamin C in a
    daily diet. Among the animal sources of traditional food, the highest levels of vitamin C were
    found in samples of raw beluga and narwhal mattak, boiled beluga mattak, aged narwhal
    mattak, fish roe, ringed seal and caribou liver, ringed seal brain and caribou kidney. The most
    commonly consumed traditional food were frozen/raw meats, which as anticipated, contained
    approximately 1 mg/100 g.”
    members.shaw.ca/karen.fediuk/VitaminCintheInuitdiet.pdf

    I searched “Vitamin C” on this site because I’m going to self-experiment with it. I’ll let you know how it goes.

  9. Dear Peter

    Lately I have been spending most of my free time on you great homepage. I wonder about two things:

    1. You eat/ate balsamic vinegar in your salad sauce. The brands I can buy here in Europe contain about 20 g of sugar per 100 ml, which is why I switched to vinegar from wine or lemon juice. Am I being overly careful?

    2. As far as I understand, fructose does not cause a rise in insulin, mainly ends up in the liver and is turned into fat. Should this not imply that while in nutritional ketosis, it would be beneficial to consume some fructose instead of glucose, since the liver will burn a lot of fat anyway to generate ketones and this way you would keep your insulin down? Just during a normal day, after or mid workout I would prefer glucose to restore muscle glycogen.

  10. Thank you for this blog.
    Would you address your view of salt / sodium importance with this diet please?
    I also read Ben Greenfield’s blog. He is a proponent of it and I’m confused. I have a family history of heart disease and have been told to lay off the salt. Ben recommends a specific salt he uses. fyi.. I run five times a week if that matters.

  11. I have been experimenting with paleo/primal/grain free for over 5 years. I have been attempting NK for the past week. My Precision Xtra meter and strips arrived yesterday. Ketone level last night 1.0mmol/L and this am( before eating) 0.9 mmol/L. I do not do much physical activity.I am so NOT hungry. The reason I decided to try this was not to lose weight but to increase energy levels, improve cognitive function and stabilize moods. I have been prone to mild depression. I have been supplementing daily with potassium, magnesium, vit D and fish oil (this one I have been forgetting mostly). I also eat 3 tsp salt and heavily salt food) I am very irritable, groggy and depressed-I am having a difficult time functioning in this state. Is there any research on NK bringing on a bout of depression? I am a woman and weigh 115lbs. Is this merely a transient problem? Should I keep going for another 3 weeks and start tracking my intake carefully?

  12. Just a general question about exercise: what do you think of Doug McGuff’s (author of ‘Body by Science’) approach to achieving total fitness via high intensity strength training, and do you see any reason why such an extreme program should not be followed on a ketogenic diet (Doug is an advocate of a low carb Paleolithic diet).

    Cheers,

    Ghislain

  13. Hey Peter, I’m a huge fan of one meal a day for many reasons (money, time constrains, less work/cleaning , etc…) I was hoping you could shed some light on roughly how much protein I could eat per meal to stay in ketosis. I’m about 5’11” 167 lbs and I’m very active. I would mean alot if you could answer this, thanks so much!

  14. I’m wondering how you feel about coconut oil vs. olive oil? Is one healthier than the other? I switched from olive to coconut recently, because I love the sweet taste of coconut and though, perhaps erroneously that it was healthier.

  15. Hi Peter,
    I enjoy buttered/coconut oil coffee (bulletproof),and butter in general, but I’ve been reading about the inflammation caused by endotoxins which purportedly increase after a fat based meal (with saturated fat being more of a culprit than PUFAs). What are your thoughts on saturated fats and inflammation via the endotoxin pathway?

    Thanks,

    Christie

    PS- I have never felt as well as I have since I began eating low carb/high fat almost 2 months ago!

    • It’s possible, but the data I have seen don’t compel me enough to stop eating SFA, nor do the clinical and biochemical associations I look for.

  16. Have you ever looked in to Drs. RIchard and Rachael Heller from Mt. Sinai Hospital, the authors of the Carbohydrate Addicts Diet and the importance of eating one meal a day being the Reward Meal and keeping all carbs in that meal once a day? They have a lot of science behind this theory and allow for skipping the other two low carb meals if not hungry. I have had great success eating one meal a day with high fat low carb and some other extra carbs in that one meal. I fast every 24 hours. Also, they have quoted the Big Breakfast Diet by Dr. Jakowbitz which is encouraging this one big meal to be eaten early in the day if possible in their new book The Stress Eating Cure.

  17. Hi Peter

    There is probably a better post to reply to but I couldn’t find it!

    I’ve been scouring the web for information as to the acceptability of ‘non-hydrogenated vegetable fat’

    I (perhaps mistakenly) assumed that ‘non hydrogenated’ means, for want of a better descriptive – non ruined

    What’s your thoughts? I’m specifically looking at Siesta Carob bars. No added sweetener, and I bizarrely like the taste, even though everybody else I’ve tested on hates them

    Thanks for writing by the way, you’re appreciated

    Simon

    • I find vegetable oils to taste pretty bad, so I don’t really consume them. Furthermore, where the big 5 PUFA oils go, bad things go too. I’m not sure how harmful the common PUFA are in their own right, but outside of food (e.g., nuts), they don’t constitute a part of my diet in any meaningful way.

  18. Hi Peter,

    What is your opinion of resistant starch and how it would affect ketosis? I take a tablespoon of resistant starch (Bob’s Redmill unmodified potato starch) before each meal, which is 10 grams of carbs, to add prebiotics for helping with digestion and improving the gut biome. A lot of people experimenting with this claim it doesn’t increase blood sugar much, if at all. I’m thinking of trying out nutritional ketosis for its cognitive benefits; I’m studying for USMLE Step 1 right now and hope this way of eating will cut down on food prep and enable me to think clearer as I study.

    • From my own measurements RS doesn’t affect ketosis. There might be a point where you ingest so much that it does but even people eating more RS than me have said it has not affected ketosis.

    • Hello Sidney,

      Marie, a commenter at Richard Nikoley’s blog, as well as many others have reported that it DOES NOT kick you out of ketosis. Her concern was for her father who is on a ketogenic diet as a cancer therapy. She was trying the resistant starch herself and with her father. Thus, in my humble, non-medical opinion, I think it in combination with the mental clarity Peter mentions of ketosis, it is most definitely worth a try. An interesting experiment would be to test your gut bacteria with the American Gut project now and the after your go at ketosis. Best wishes!

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