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. For those of us who are not engaged in high level athletic performance, what is the advantage of using SuperStarch? What does SuperStarch add to any already low carb diet? I’ve plateaued with my weight loss so I’m willing to try something more but I don’t understand why low carb with SuperStarch would be better than just low carb.

  2. I can’t wait till you blog about commensals! My favourite subject and one complex enough that I’m sure you’ll do it justice and turn up something new.
    Interesting that you source extra fish oil – I suspect this might be wise on VLC.
    “Low thyroid/ high LDL” if and when it exists might just demonstrate an increased requirement for DHA.

  3. Peter,

    You obviously eat a lot of fat (400g’s/day some days). As you know with low carb, fasting triglycerides tend to go down and HDL goes up leading to the new all important Triglycerides/HDL ratio as a predictor for heart disease. With low carb, fasting triglycerides clearly go down but what about postprandial triglycerides. Do you ever worry about your non-fasting triglyceride numbers? On 400g/day of fat will these numbers stay high and potentially change your risk profile for heart disease? You seem like the one person who might be able to answer this question. thanks!!

  4. Palomar! Fun! We have a cabin in Julian and just love that whole area.

    I WISH I could get really sick of nuts like your daughter. They are just too good to break up with, but I know that I’d be better off with fewer. I know I need to break up with cheese or nuts to lose ‘those last’ pounds but I’m not ready.

    I know that you said that your dairy-reduction in the past year was more based on taste, but it seems that you would have been cutting out a lot of calories from your wife’s ice cream, cheese, yogurt etc and that could definitely help with your weight loss. So a few questions:

    1. Do you feel that your weight (fat) loss is as much a matter of shaving off some of these calories as it is just having a much more limited eating window- hence lowering the opportunity for consuming as many calories as before?
    2. Are you concerned with getting as much protein in one sitting as you are getting?
    3. Did I understand you correctly in saying that Volek & Phinney are correct in that it can take weeks to get back into ketosis, but that you aren’t blowing so far out of ketosis (like with a bowl of berries the size of your head) that it is in fact easier for you to slip back into ketosis?

    Thanks and I hope that you can enjoy a little bit of down-time in France! (PS I was just there too and people could not believe that I was not even a little bit tempted by the bread…the cheese on the other hand….um) 😉

    • 1. Quite possible, as I note in post.
      2. Whenever I seem to quantify it, it seems to be comparable to what I used to consume over 3 meals.
      3. Seems that way, probably due the fact that it’s protein overload that throws me out, rather than sugar or simple carb consumption.

  5. Doc, do you have any idea how a type 2 diabetic, or someone with severe insulin resistance, would react to SuperStarch? Looking forward to you writing about the product, I know Volek is very favorable towards it.

  6. Granted you were experimenting with IF for this post, but your meals do seem markedly different from the first edition of What I Actually Eat. Along with the aforementioned reduction in dairy you seem to be eating fewer eggs and (maybe it’s just my reading) less meat generally. Would you agree with this statement or is this food log not representative of the time when you are not IF? If there was a change in how you eat was it more related to seeking stronger athletic performance or has your opinion changed with regards to the healthfulness of anything you were eating before?

    Thanks

  7. Hi Peter,

    I am avid fan of your blog and think you are doing something truly great here. I’ve taken alot of advice from you and how you eat and have achieved significant weight loss the past month (196 to 187). It would be safe to say i am keto-adapted as my blood levels of B-OHB are around 1-1.5 and can cycle continuously for approximately 1.5-2 hrs. However, as I am younger (24 yrs old), i enjoy going out with co-coworkers to happy hours about once per week. I typically have 3-4 drinks consisting of 1 Michelob Ultra (2.4g Carb) and a the rest Rum+Diet. How does this affect my keto-adaptation? Does this have a similar effect to eating over 50-60g/carb and falling out of ketosis? I know that the body processes alcohol before any other source of energy and temporarily “kicks” you out of ketosis and causes me to wonder.

    Thank you in advance for your response, Peter! Keep up the good work, you have changed my life for the better!

  8. Just a quick question that is a bit off topic: If you can’t get an NMR test but only get apoB tested – what is the “preferable range” here? (My apoB is getting lower since taking l-thyroxine, last time I checked it it was at 135 mg/dl)

    And a bit more on topic: Great and interesting post. Since a few month I do all my training fasted (16h fast, 8h feeding windows) and in ketosis with “paleo” foods only, and it works surprisingly great.

  9. Very nice post!
    I wonder if my symptoms might be helped by a diet like this. I have chronic anxiety, acne, hair loss, cold hands and feet in the winter, gas, constipation, eczema, dandruff, muscle pains and mites allergy. I don’t know if there is some autoimmune condition (or other) that is causing all this (maybe you have an idea) but maybe this diet could help?

  10. Dr. Attia –

    Is there one of your writings that indicate ways to normalize LDL-P please? Or is that forthcoming?

    Many Thanks in advance!

    Indy M.

  11. Hi Peter, I learned a lot from your blog and have practiced LCHF for about four months even though I had my gall bladder removed a year ago. My surgery doctor recommended low-fat and I searched on-line for proper diet (before finding EatingAcademy.com) and mostly confirmed what my doctor said. Some gave their own experience that after their gall bladder removed: they always had diarrhea if they had fat n the diet…

    But after I read your post here, I started to add fat slowly to my diet and my stool got better and better. I am not kidding, it is now better than before I had the surgery. My current diet include organic green leaf vegetables and lot of fat,: sour cream, eggs, rib-eye steak, clarified butter, and once in while coconut oil ( I can’t take too much coconut oil because my body seems to still react to it). My carb intake gradually reduced to two bowls of rice for the entire day ( U used to have three bowls per meal) . The main thing is I have more energy and feels warm and good every day. I knew the benefit of exercise for long time. But when I was on mostly plant diet, I was weak and felt no energy and when I force my self to exercise I did not enjoy it. Now I feel differently, it sort of feels like the more you exercise, the more you want to exercise. Although I am not in Kenton yet (at least I don’t think so) I am feeling GOOD. I thank you for your advice. You the best.

  12. Hi Dr. Attia,

    I think you are awesome and appreciate your work, but don’t think you are eating enough vegetables.

    Some suggestions: dark greens braised with either olive oil, chicken fat, or bacon fat. Collard greens, mustard greens, turnip greens, chard, kale, bok choi, escarole, spinach, dandelion, cabbage, red cabbage, broccoli, brussels sprouts. Drizzle liberally with high phenolic olive oil.

    Dark colored salad greens: arugala, radiccio, spring mix, basil, parsley, dill, oregano, thyme, celery, fennel, again dandelion, spinach, cabbage, red cabbage, bok choi. Again, drizzle liberally with high phenolic olive oil.

    I buy the most amazing celery from a local farmer’s market that is dark green and tastes more like parsley than celery. Yow!

    I believe that dark greens are the real secret to the Mediterranean diet. The braised greens the Greeks and Cretans eat every day, they call them “horta” and say that’s why they live a long time.

    Full of minerals and vitamins, not out of a bottle. If you want to branch out, you can pick wild greens, too.

    Anyway, I am a mother, and as mothers say, “eat your greens.” Lettuce is not enough, and neither is broccoli.

    • Ilaine, I certainly appreciate your sentiments, but I’d ask the question, what is the scientific proof that such foods are necessary? They may well be, but I have never come across convincing evidence that tells me I must be consuming them to be healthy.

  13. A previous poster indicated that they had been able to adapt to the high fat diet even after gall bladder removal. Is that generally the case, or an uncommon outcome? (My wife had her gall bladder removed a number of years ago, and tends to feel ill & suffer digestive upset after high fat meals.)

  14. Peter:
    Great information here!!! I’ve been following the blog for about 2 months now. I’m also a physician, (pathologist) and also a triathlete. I’ve been frustrated with the never ending feelings of doom from bonking issues. So, I decided to start a a ketogenic diet. I am now in my 5th week and all has work out great except for an issue with heart rate. It just doesn’t seem to come down, specially in long sessions. This has obviously limit my endurance. Also, I get a prolonged effect after 2.5 hours sessions where my HR will not go down until maybe 4 hours later. In a couple of occasions I had to take propranolol to help with the heart rate, palpitations and blood pressure. Blood pressure seems to follow a similar path where I would be in the pre hypertensive zone for a couple of hours. The palpitations are really annoying. I thought these would be transient but I am still getting these issues after 5 weeks. Also, my heart rate is always in the 80s during the morning, where it used to be in the low 60s. Would you recommend me someone who could coach me in these regards? I have tried all mineral supplementation, hydration, etc to no avail. I’m aware of a probable medical issue that may not allow you to give advice in the blog, but any recommendations will be appreciated. Keep the good work rolling. I am coming up with a presentation (about obesity) to a local group here in Puerto Rico. I will definitely reference you blog as well as NUSI.

    • Just request a work-up. Find out if it’s being driven by catecholamines, electrolytes, whatever. I can’t really comment beyond that, unfortunately.

    • Have you tried dramatically increasing your salt and magnesium? Try cutting out coffee or other dehydrating drinks

    • Also Javier, have you considered you might be over training? Lack of recovery HR and BP, and first morning elevated HR is a common symptom of over training.

  15. Greetings Peter. I’m interested in trying Ketamine after the Yale findings. Do you know which pharmaceutical companies have a monopoly on it, if any, and does it matter which drug store you buy it from once you have a prescription?

    Any thoughts on depression now that it’s been cured? Would you say this is a major event in human history, or just another excuse to get high?

  16. Great article! I have some questions on the keto diet:

    1. Is there an age on which a person should not adopt this diet?

    2. What happens if your daily < 50 grams of carbs include sugar and grains? Does the diet still work?

    • Thank you for your prompt response!

      Another question: Since the Japanese are the slimmest, and they consume 49 grams of sugar daily, is this a good amount to shoot for? Any suggestions?

      By the way, I just discovered your website and you got me all fired up in my pursuit of the keto diet.

  17. Hi Peter,
    I don’t work well with dairy products but I love walnuts and have no problem eating the same thing all the time every day if that’s what it takes to feel great. Do you believe it would work to eat about a cup of walnuts a day which would come out to around 75 grams of fat and 16 grams of carbs? It makes sense mathematically but are healthy fats healthy fats? What I mean is should I be diversifying my fats or can I get it from one source?

    High fat items I could tolerate daily:
    Avocado
    Any type of Nut
    Animal Fat
    Coconut Oil

    Could I do this diet on these items alone? I’m open minded to any suggestions. PS: I appreciate your logical, honest, no BS or artificial hype blog.

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