December 19, 2011

Nutritional biochemistry

What I actually eat (circa Q4 2011)

Read Time 7 minutes

Note to readers: This post was written in December of 2011.  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 pursuing questions about what I eat in the comment section.

 

Once people start to “get it” with respect to why carbohydrate reduction, or all-out restriction, leads to good things, the inevitable question I’m asked is, “So….what exactly do you eat?”  I’m always a bit hesitant to get into this.  It’s sort of like asking a pilot, “So…how do you fly this plane?”  It’s a great question, but probably the wrong first question.

For many people it’s so overwhelming to contrast what they currently eat – probably a typical American diet of 500-600 daily grams of carbohydrates (200 grams of which are sugar) – with a diet of less than 50 daily grams of carbohydrate, which is what I consume.  Remember, what I’m showing you here is what I have been eating for about the last 7 months.  For the first 20 months of my nutritional transformation, I was gradually reducing carbohydrate intake from about 600 daily grams to 300 daily grams to 150 daily grams.

It’s really important to understand that carbohydrate reduction is a continuum. There is no “right” amount of carbohydrate to eat.   Let me illustrate this with the following “2 by 2” matrix, below (sorry, once a consultant, always a consultant).  When asking the question, “How much should I reduce my intake of carbohydrates?” it’s a good idea to start with two broader questions:

  1. What is my inherent level of insulin resistance?
  2. What are my goals?


There are technical ways to quantify the answer to the first question, which I will detail in future posts.  However, the simple version of determining your inherent amount of insulin resistance is checking how many criteria of metabolic syndrome are present.  In other words, are you overweight?  Is your waist large?  Is your blood pressure high?  Do you have elevated blood glucose or triglycerides (these are determined from a standard blood test)?  Do you have low HDL cholesterol?  For the purpose of this question, even responding “yes” to one of these questions means you are predisposed to being insulin resistant.  I was a “yes” to 3 of these questions.

Consider this matrix, and let’s use me as an example.

How much should I reduce carbs?

 

  1. How predisposed am I to insulin resistance?  One look at a picture of me in my non-lean state, coupled with an understanding of my family history, and it’s clear I didn’t hit the genetic lottery with respect to insulin resistance.  Hence, I am towards the right of graph.
  2. What am I optimizing for?  Some folks want to lose 15 pounds.  Others want to have fewer swings in daily energy level, or stop taking their blood pressure medicine.  In my case, I want to maximize as many variables as possible: I want to be as lean as I can; I want to cure my insulin resistance; I want to be sure I never have a single symptom of metabolic syndrome; I want to do everything I can to avoid cancer and Alzheimer’s disease; I want to be metabolically flexible. Hence, I am towards the top of the graph.

As you can see, based on my poor genes and lofty goals, I find myself in the upper right square, which means I need to adopt the greatest amount of carbohydrate restriction. My wife, in contrast, has good genes, coupled with high goals, placing her in the upper left box.  As a result of this combination, she does not need to restrict carbs as much as I do.  If her goals were even more modest, she could get away with very little reduction in carbohydrates – probably just reducing sugar without much reduction in starch.    

Below is a picture of a few of the foods you’ll typically find in my refrigerator.  Note that on average I consume about 4,000 to 4,500 calories per day.  I get this from approximately 400-425 grams of fat, 120-140 grams of protein, and 30-50 grams of carbs.  In addition, there are a number of supplements I consume daily, which I describe in the table below.  In future blog posts I will go into greater detail as to why I consume each of these supplements, but for now I’ll give a very quick explanation.

Finally, note that under no circumstance do I ever count calories (for the sake of limiting them).  When I was first transitioning into ketosis I did need to count how much carbohydrate and protein I was consuming – anything over about 50 grams of carbs and 150 grams of protein makes it difficult to generate sufficient ketones – but I do not ever count calories for the sake of restricting them. I eat when I’m hungry.  I don’t eat when I’m not hungry.

 

Foods I typically eat

Regular supplements I consume every day

 

my list of supplements

*I will be writing a great deal about the role of omega-6 and omega-3 fatty acids in our diet in subsequent posts.  However, if you want a quick (albeit high-level and not overly nuanced) overview of the topic, take a look at what Dr. Andrew Weil and Livestrong have to say about it.

One last point on supplements – I do not take a multivitamin at this time, but I am looking into it a bit more closely.   My concern is that 1) they may not be necessary when you remove glucose from your diet (I’ll write about why in the future), and 2) they may actually do direct harm, as a result of contaminants.

 

Ok, at long last, here is a list of what I ate over the past 5 days (excluding water, still and sparkling, which I consume about a gallon of each day)

Wednesday

Breakfast: “Fat shake” (In a blender: 8 oz heavy whipping cream, 8 oz sugar-free almond milk; 25 gm sugar-free hydrolyzed whey protein, 2-3 frozen strawberries)

Lunch: About 4 or 5 oz of assorted cheese (Gouda, Swiss, Manchego), 2 or 3 oz olives, about 4 oz of particularly fat salami and pepperoni

Late afternoon:  About 2 oz of mixed nuts (almonds, walnuts, peanuts), large latte (latte made with heavy fat cream instead of milk) at Peet’s

Dinner: Garden salad with olive oil (lots of extra oil) and balsamic vinegar dressing, about 6 oz grilled salmon with a lot of butter and lemon juice

 

Thursday

Breakfast: Scrambled eggs (6 yolks, 3 whites**, with added heavy fat cream) cooked in coconut oil, 3 or 4 sausage patties (be sure to look for brands not cured in sugar).

Coffee with homemade whip cream (heavy fat cream hand whipped)

Lunch: Half chicken (thigh, breast, wings) with lots of skin; about 2 oz of Gouda and aged-cheddar

Dinner: Wedge blue cheese salad with bacon; 12 oz prime rib with lots of butter; 5 or 6 pieces of asparagus coated in butter

Coffee with half and half cream, 2 cups (the restaurant did not have heavy cream, so I had to settle for half-and-half)

**The reason I typically minimize egg whites, at least when making my own eggs, is to ensure I keep protein intake under about 125 grams per day.   Ketosis is pretty easy to attain if one is eating, say, 2500 calories per day.  However, given my caloric demands – and the requirement that I keep protein intake limited – I really need to go out of my way to ensure I’m not eating too much protein.  I will be writing about this in much greater detail in a future post.

 

Friday

Breakfast: Whole fat latte at Starbucks (made same as above), scrambled eggs (about 4 eggs), bacon (high fat pieces), slice of Swiss and slice of cheddar (since I was eating in the airport, the scrambled eggs were made “normally,” not with the additional fat I use when making my own)

Lunch: About 4 oz of especially fat salami and pepperoni, about 2 oz Parmesan cheese

Dinner: Ground beef sautéed with heavy cream, onions, broccoli, and melted cheese

2 large cups of decaf coffee with homemade whip cream (heavy cream whipped with a touch of xylitol)

 

Saturday

Breakfast: Scrambled eggs (6 yolks, 3 whites, with added heavy fat cream) cooked in coconut oil, 3 or 4 pieces of especially fat bacon (not cured in sugar), about 3 oz of cream cheese

2 cups of coffee with heavy cream

Lunch: Tomatoes with basil and mozzarella and balsamic vinegar and olive oil, about 2 oz raspberries with homemade whip cream

Dinner: Leftover ground beef sautéed from previous night, salad with homemade cream dressing (whole fat Greek yogurt, olive oil, basil, blue cheese, garlic)

1 cup of decaf coffee with homemade whip cream

 

Sunday

Breakfast: Omelet (6 yolks, 3 whites, coconut milk, sautéed onions) cooked in coconut oil, 4 or 5 pieces of the fattest bacon I can find

2 cups of coffee with heavy cream

Lunch: Plate of assorted cheeses (aged Gouda, Swiss loaf, aged Parmesan – about 3 oz), about 2 oz salami, about 1 oz olives

Dinner: Cream of mushroom bacon soup (heavy cream, chicken broth, shredded Parmesan cheese, mushrooms, chopped bacon, garlic, butter, chopped  papers, various spices), leg of lamb (baked in sauce made of red wine, balsamic vinegar, diced tomatoes, garlic, and a lot of spices)

2 cups decaf coffee with homemade whip cream (as above)

 

So there you have it — 5 days in the eating life of Peter Attia.  This may look a bit strange, relative to what you may be eating now, but remember, I’m at the far end of the spectrum – i.e., nutritional ketosis.  You may just be starting your own journey of reducing carbohydrates, but I hope this gives you an idea of what I eat.  In particular, what probably stands out is:

  1. I go to great lengths to avoid sugar which, unfortunately, shows up in virtually every highly processed food.
  2. I eat zero starch (e.g., bread, cereal, rice, crackers, pasta).
  3. I consume only modest amounts of fruit (one serving per day, at most, and only in the form of berries, which contain the least amount of fructose).
  4. I eat vegetables, but primarily because they are a great way to get more fat (e.g., high-fat salad dressings, butter), not because I “need” them.
  5. I go out of my way to eat as much fat as possible, especially monounsaturated and saturated fat (the only fat I avoid is omega-6 polyunsaturated fat).
  6. I have a few “go to” meals that I eat several times per week.  I do this because I really like them and it’s quick and easy make them. Yours need not be the same!

Photo by Glen Carrie on Unsplash

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1,115 Comments

  1. Hi Peter

    I’m looking into starting the keto life,but I have a lot of questions running in my head…one subject is regarding the time of my workout. I do my workouts on an empty stomach first thing in the morning…
    I can see that you are taking MCT oil before your workout, but since I don’t know if you are on an empty stomach, I have to ask if you think it would be beneficial for me to take MCT oil before my empty stomach morning workout ?

    thanks

    Annie

  2. Just stumbled on this page but couldn’t help but comment. I’ve always been tall and relatively thin (praise God for my genetics! haha) but that doesn’t mean I haven’t struggled with weight. Ironically enough, it was when I started to follow the physician recommended diet that things went south. Prior to that, I ate a typical European diet loaded with animal and dairy fats and I had to try (without success) to gain weight. My metabolism is much slower now that I’m in my late 30s but since I’ve gone back to my high saturated fat diet (organic meats when possible, grass-fed butter, cheese, etc.) along with a ton of fresh organic greens and vegetables, organic eggs, fish, healthy oils (coconut, olive, flax, etc.) and no gluten (I’m allergic…a hidden blessing), I’m finally able to maintain a weight I’m happy with. I have a tendency to binge and carb-load around the holidays but once back on the program, the weight comes off relatively easy if I stay committed and incorporate some intermittent fasting. And I don’t exercise…though it’s on my list of things to get back into 🙂 So here’s to a real diet and real health and thank you for showing others what a healthier diet looks like 🙂

  3. Hi Peter,

    could you post some sample daily menu plan, what you eat today or 2014?

    And also with and without dairy…

    tnx

    • Please Attia, could you give some short answer on this.
      In the mantime listened htat you are doing a ketogenic intermitten fasting…

      tnx

  4. Hi Peter. A thought that occurs to me is this: as food would have been more commonly scarce than abundant many years ago, surely it’s likely that we evolved to make as efficient use of it as possible so as not to waste it. Therefore doesn’t eating a diet which requires significantly more calories than we expend seem evolutionary nonsensical, compared to eating foods which can meet our energy needs through smaller amounts? In that sense, it seems that this is not a diet our ancestors would have chosen (as suggested by some) but rather a great modern diet for humans living in countries with an over-abundance of foods?
    Regards
    Ann

    • I see your point, but you’re only taking into account total energy expended, without considering fuel partitioning. In other words, it’s probably better (from an evolutionary perspective) to burn 2000 kcal/day if 80-90% of are fat, than 1700 kcal/day if only 40-50% of them are fat.

  5. I did the Atkins diet recently and dropped 13 pounds. However, I had terrible leg cramps that woke me every night. I am 67, 4’11” and weigh 200 pounds. How do I know how much carb and protein to eat? Many thanks.

  6. Dr. Attia,
    I’m writing to you because I’m hoping you can refute some of the claims made by Steven LLoyd from the University of Alabama last March that low carb diets increase the severity of heart attacks when they occur and also inhibit the subseqeunt healing process (I am new to this blog, so if you have addressed this issue in previous blogs, just let me know). Granted, he was working with obese rats, and also made it clear that he was not suggesting that a low carb diet in fact caused heart attacks. Nevertheless, when he is quoted as saying, “ “If I had heart disease or I was predisposed to having a heart attack, I would think carefully before starting this type of diet,” it does give me pause. (see link, below).

    http://www.uab.edu/news/latest/item/2182-high-fat-low-carb-diets-not-for-obese-people-at-risk-of-heart-attack?tmpl=component&print=1

    For most of my adult live, I have been on a low fat diet (almost no saturated fat), have not eaten meat except for fish, have exercised regularly, and have been quite slender. I decided to try removing carbs from my diet a few months ago because my fasting glucose levels, although in the “normal range,” semed a little on the high side. A few weeks after doing so, I coincidentally had a heart attack. I have since remained on a low carb diet, however, because it seems clear that my “no saturated fat, don’t worry about carbs” lifestyle has gotten me nowhere, and the research on the benefits of eliminating carbs seems compelling. Having said that, I would find it reassuring to know that my low carb intake is not in any way impeding my recovery process. I would love to her your thoughts on Dr. LLoyd’s reseach and his comments in the press release.

    thanks,
    Richard
    Baltimore, MD

  7. Hi Dr. Attia,

    As an overweight female (200 lbs, 5’7″) with chronic fatigue and anemia due to a liver disease I was born with, I have a lot of things to work on. In terms of maintaining ketosis, I was wondering how I know how much I should be eating.

    Normally, I’m sure eating when you are hungry works for most people but I also have problems with emotional eating so it makes it harder to regulate. Anxiety is a big trigger. So, I don’t think I would need 4000-4500 calories a day as you do but I also tend to eat more due to stress. So, my question is, if I have trouble controlling my own actions, do you think being in ketosis will still help regulate my weight?

    I have already eliminated all bread, grains and sugar… except coconut water and bee pollen. I think my next step is determining how many grams of fat, carbs and protein I actually am consuming now through monitoring and doing the math.

  8. I love your blog. Stumbled upon it yesterday. I have been on paleo for 2 years. I tried going into ketosis a few times but failed each time because of heart palpitations at night. Just wonder whether you have any insight why some people get heart palpitation when in ketosis?

    I am recently diagnosed with adrenal gland fatigue and am not sure whether it is relating to this

  9. Dr. Attia,

    I’ve read your blog avidly for the last few months in preparation of transitioning into a keto diet myself.

    Some quick history and then the question; I come with a genetic history which predisposes me to heart disease – a relatively normal total cholesterol level but HDL, LDL and triglyceride numbers that mirrored your own early on and an APOE 4/4 variant – my dietitian insists that a keto diet wont work due to my genetic markers (4/4).

    Side note: I am an avid triathlete and have been on a low fat diet for years with only modest results as

    I’ve read a number of Gary Taube’s writings as well as Dr. Phinney’s books and some of his published papers but cant find anywhere that there has been any research or evidence to substantiate the claims made about genetic markers.

    Am I missing something or do you know if there is an validity to the claim that it wont work for specific genetic variants?

    Thanks for your time.

    Jack

    P.S. in reference to “Rachel’s” comments; my friend Frank swim’s with you in San Diego. Small world!

  10. I have been eating High fat low carb for about 7 1/2 weeks now. Average about 1500 cal/day with about 100 grams protein, 25 grams total carbs and the rest fat. I am a postmenopausal female 5’7 138 pounds trying to lose 10 pounds to get to 20% BF ( also want some medical benefits) . I exercise 90-120 minutes 5/week and have for a long time(combo cardio and weights). I naturally follow an IF type of eating usually eating in an 8 hour time frame from 1 PM – 9 PM. I find I am not losing any weight or inches with this(2 pounds/7 weeks). Could this be due to the higher protein per meal in the short eating window? and if so how do I change this given I usually have no hunger until post workout. Could it just need more adaptation time? Suggestions would be great. And thanks Peter for the wealth of information. I am not overly discouraged as I feel great and my exercise tolerance is almost back to baseline but would like to optimize results.

  11. I discovered this blog a few days ago because of online research I was doing re. age-related macular degeneration (AMD).

    I have always had high LDL cholesterol but have never taken statins because I don’t have other risk factors for coronary artery disease. Recently I was diagnosed with intermediate AMD. Thankfully I am not symptomatic but am trying to do everything I can to keep my AMD from progressing to vision loss. I read that, in AMD, cholesterol is known to accumulate in the eye within deposits called drusen. Some have suggested that taking statins may have the potential to help people with AMD. I don’t want to take statins and, in an attempt to lower my LDL cholesterol, have instead undertaken a low carb diet. (I get lots of exercise.)

    I have not seen mention of AMD on this blog. Do you have any thoughts about how LDL cholesterol and low carb eating might affect AMD?

    Thanks very much.

    • > … in AMD, cholesterol is known to accumulate in the eye within deposits called drusen.

      Perhaps this 2013 report?
      Impaired cholesterol efflux in senescent macrophages promotes age-related macular degeneration
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640261/
      I haven’t had time to study it.

      There’s not much mention of AMD in the keto/lchf/paleo/primal blogosphere. It’s pretty clear that a high-carb diet is destructive:
      http://livinlavidalowcarb.com/blog/study-high-carb-diet-leads-to-advanced-age-related-macular-degeneration-possible-blindness/1931

      Dr. Perlmutter, in “Grain Brain” suggests taking Vitamin K to reduce the risk. Dr. Davis (“Wheat Belly”) reports anecdotal signs of people arresting AMD when they eat grain-free VLCHF.

      Some advocate eating eggs (because of lutein and zeaxanthin). Others warn-off (because of lutein and zeaxanthin, not cholesterol). Go figure.

      I’m interested in this topic, because a parent had it. I eat VLCHF, eggs & take Vit.K, but chose these for reasons other than AMD avoidance. I stopped taking lutein last year. If it’s beneficial, I get enough from our barnyard chickens.

      Keep your periscope up.

  12. THANK YOU for your website. I am an RD, who has followed the LCHC both personally and professionally since 2007 as it changed my life! I am using your website and Gary Taubes, Why We Get Fat as a resource for all of my clients. My motto is COUNT NUTRITION, NOT CALORIES!!! Anyway, knowing there is no right or wrong answer to this question as it is specific to the individual, just curious why you chose to have your first meal of the day at lunch time?

    Kristen Bradley, RD
    KBradley wHOLe Nutrition LLC
    New Jersey 🙂

  13. Any particular advantage in working out in a fasted state? Also is it better to work out in the morning as compared to in the evening?

    Thanks

  14. Hello Peter,

    I really do “get” this way of life. Primarily because up until about seven years ago I naturally ate very low carb. For no other reason than I felt “sick” after comsuming foods like bread, pasta and very sweet fruit etc. In fact, the best health I have ever been in was after the birth of my daughter. Looking back at the photos of me I look like a Pilates instructor rather than a busy mom who didn’t exercise. Fast forward 7 years later and I weigh 25 pounds more (I’m a 5’4 medium frame female and I weigh145 lbs), I’m exhausted and very frustrated. Somewhere along the way, I began comsuming more carbs (ironically hard candy). I think this was the case because I had a demanding desk job (that I really do enjoy) and ate from my desk candy jar absent mindedly. Eventually I noticed I was consuming candly daily. Along with the increased, candy I started consuming more carbs. Without realizing it I had come to crave food I normally did not care to eat. However, because I am a type A personality I was VERY strict with my calorie count (never over 1500 a day). Regardless of this fact, I continued to put on weight ( as the numbers grew, I’d freak out and starve myself to get five or ten pounds off, but it always came back). So, in November of 2013 I went on a very strict 1000 calorie a day diet tracking everything I put in my mouth. Additionally, I exercised daily. By March of 2014 I had only lost two pounds and knew something was wrong with me. I was experiencing extreme lethargy, blurred vision, night sweats and depression. I figured I was going into some sort of early menopause, or had extreme estrogen dominance or SOMETHING, but I knew something was wrong. I went to a very good doctor who looked at my food and exercise journal and agreed that something was wrong (considering my healthy diet at the time). He ran every blood test possible. To my surprise my results came back with everything perfect except my fasting insulin. It was “11”. My fasting glucose was really good though. He asked me whether or not I had ever heard of IR and I said no. He put me on 1000 mg of Metformin and told me to follow a low carb diet. So now, I finally come to my questions for you.

    1. What are your thoughts on Metformin? I personally don’t feel really well on it. It does effect my appetite, but not in a good way. It seems to cause more of an aversion to the foods I need to eat like fat and protein ( just thinking about meat makes me ill and I’ve always liked meat). I also feel at times like it’s causing low blood sugar (light headedness and fogginess etc). I have only been on it three weeks so I don’t know if it will remedy itself with simply more time.

    2. Once I lose the weight (or before), do you suggest coming off the drug or is this something I need to take to offset the IR for the rest of my life? I have a strong family history of Diabetes (no one is extremely overweight though).

    3. Can you suggest an eatting plan for someone like me who needs to get weight off as fast as possible and who is pretty much willing to do ANYTHING it takes. Now that I’m back to low carb 50-60 grams a day I feel better so the diet won’t be an issue in the long term. I’m just trying to figure out calorie count, percentage of protein and fat I should consume and how much I should exercise.

    Any advice you can offer would be extremely appreciated!

    Thank you,
    Lacy Pope

  15. Dr. Attia,
    I have 2 somewhat related questions: 1.) Being lactose intolerant, what other high fat foods other than dairy based (cheeses, creams etc.) would you recommend as alternatives? I currently use coconut oil as often as possible and eat avocado with just about everything, daily. 2.) What is your take on bacon and sausage in relation to being thought of as increasing risks for cancer by major amounts? For awhile, I was consuming major amounts of bacon and sausage for both the protein and fat. If I had to inquire with anyone and trust their insight, expertise and knowledge on the matter, I’d have to say it would definitley be you. Thank you in advance for your answer. Continued success with this blog, NuSI and all efforts.

  16. hey I just saw a video of you doing an interview on youtube and then followed the link given to your website, which is pretty remarkable! I love the level of detail you’ve put in to your blog! So I’m currently getting into a ketosis diet, so I’ll be aiming to hit about 30g carbs (net, i.e after fiber is deducted), 120g protein and 110g fat (65% caloric intake). I notice however, that although you do have a dairy intake, its in the form of cheese and cream. Why avoid hi fat milk then?

    Thanks 🙂

  17. Hi i could use some help here. My reason for trying banting is purely to improve my energy levels. I am slim and petite and i barely exercise. I used to eat low fat and high carbs and always maintained the same body weight yet i always felt tired after meals. I dont feel any change with banting though I’ve only been doing it for two weeks. I am more satisfied though on much less food. My question is how long should it take for me to feel more energy? Also sometimes after i eat i get heart pulpatations. Why is this? And what are the signs for me that my body has kicked in to ketosis? I weigh 48kg and would like to maintain it. So what would be my daily recommended calorie or amount of fat intake?

  18. that looks like a nice set of meals, I could actually live with that !!!

    how many calories do you burn a day, I know you swim across the Atlantic and cycle around the world before breakfast 😛

    I searched for the term “burn” on the page and could not find anything saying how many calories you burnt in a day , both on exercise and non exercise days

    Love your videos, really make me think !

  19. I am 61 I TAKE BLOOD PRESUURE MEDICINE,i need to lose at least 100 lbs,my cholesterol is 200 total,i have just started,i do not eat as good as dr.attia,i have bacon and eggs for breakfast,3 each cooked in butter, lunch bugers from fast food,eat the meat only,same for late afternoon , dinner spinish for carbs,mushrooms boiled chicken thighs at night in butter.no breads,no sugars.how do you think I will do on this diet as far as reaching ketosis? I see my doctor tomorrow,he said I should read sugar busters.well this is definetly cutting sugar .let me know what you think.thanks

  20. Hi Peter,
    I am a medical student in Australia hoping to do my honours research project on an area such as the influence of the gut microbiome in health and disease (diabetes and insulin resistance, behavioural and psychological problems etc).

    Do you have any suggestions for teams in Australia (or the states- I will travel) that are researching this kind of thing that might be happy to accept my enthusiasm and willingness to work.
    I am finding it hard to locate researchers that are into this kind of thing!

    Thanks,
    Charlotte

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