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. Peter, I definitely “get” the whole low carb life, and have had profound success (nearly 50 lbs down since October 2011). I’m 42 year old Male, 6′ 4″ – went from about ~285 to ~235 lickety split and with minimal trouble (other than that first week of “light-headedness” that scared Dr. Oz into abandoning his attempt at a LCD).

    Your site is a fantastic resource for fine-tuning and strengthening my knowledge banks. Thank you for that.

    Now, if you don’t mind sharing your viewpoints on a couple topics I’m not 100% sure about yet.

    1. Alcohol. I know it ranks (worst to least worst) – Beer – Wine – Hard Liquor. And from what I understand, the better booze (wine, liquor) doesn’t really take you OUT of ketosis (but rather is its “own” ketosis) and what you eat afterward is crucial (don’t pig out on carbs – better yet, don’t eat at all – just drink water).

    However, what is your position on alcohol in general? Do you drink at all? If so, when? How does the “buzz” fit into the whole ketogenic picture?

    My case in particular is, that I might have a bottle or two of red wine from time to time (late at night, before bed), and make sure I still add my supplements and hydrate beyond belief.

    My weight loss during those periods isn’t as profound, but it is either stable or moderately lower (maybe a pound or two lower a week). When I abstain from alcohol consumption entirely – the fat loss is noticeably accelerated. Note that I am still very careful to restrict all other carb sources otherwise.

    I mention this because Dr. Eades mentions removing alcohol (and coffee for that matter) during the first phase of his “cure for the middle aged middle” book.

    However, I was lucky, and didn’t suffer from excess visceral fat – just subcutaneous fat.

    2. Fitness Intensity. It’s obvious you are a high-intensity workout person, very impressive how you jam so much into your day.

    What are your thoughts about the “Slow Burn” or “Super Slow” workout methods? Where you perform extremely slow repetitions (20 sec. each rep) to the point where you reach complete and utter muscle failure after maybe 4 to 6 reps and under 90 seconds.

    The premise is working out 30 minutes per week may have similar “gains” to frequent exercise, but with much more time for other endeavors or projects. I know people who have succeeded greatly on this, but it requires precise discipline.

    My initial thoughts on this are:

    – that not only will it provide you with a better future for your joints, but

    – perhaps this high intensity training should be reserved for those in competitive sports where time, distance and skill depend on it?

    I think “Slow Burn” is the book I have (not nearby at the moment), and again Dr. Eades provided the forward for that book.

    Look forward to your commentary. Again – thank you so much for this, your writing style, tone and reader involvement is exactly what this community needed!

    Cheers,
    Perry

    • Perry, I do consume alcohol in moderation, which is all I’ve ever done since my 26th birthday when I decided I would never drink in excess again. Actually, this was a decision I made the DAY AFTER my 26th birthday. I’m sure you can use your imagination. Ok, so I drink 2-3 glasses of red wine a week — pretty consistently. I can’t speak to Mike Eades’ claim, as I’m not familiar with the data. Red wine is about 4% sugar by weight (and of course, this varies by wine), so I suspect too much of it would take me out of ketosis. For someone on a non-ketotic LCD, though, I think wine and liquor is really only causing harm in the following way: any ethanol you can’t immediately oxidize your liver with convert to fat and eventually VLDL. So, I don’t think excess ethanol intake makes sense when trying to shed fat.

      To your second question, I think it depends on your goal. If your goal is weight loss, I don’t think it matters — exercise is not the answer as it plays a tiny role. So the type of exercise (e.g., duration, intensity, frequency) should be driven by a functional goal.

  2. My body seem to like a high fat diet better than a protein one. I have lost weight in less than a week, I don’t have scales, I go by clothes.
    I can eat foie-gras with a spoon (I come from where it’s made in France), but even after a few days of olives, smell cheeses, macademia nuts, mozzarella, my brain gets fuzzy around 4 pm and people in the office ask me if I am on something. I don’t use heavy machinery, so the world is safe, well almost.
    Sour-cream for breakfast is a bit weird. I am using astringent teas and herbs with my food to prevent sinusitis.

    I am fairly crap at math, but why does the TRG/HDL ratio has to be done in mg/dl and not in mmol/l. Is it a US thing?
    And another thing, is your system or maybe your liver overloaded by all the fat you are losing on this diet?

    • Because the molar conversion of TG and HDL is different, they need to be in units of mass/volume for this “rule” to work. When in moles you need to include the conversion factor. To avoid this, I just do the conversion up front and always calculate in mg/dl.

  3. Peter
    As someone who hit the genetic lottery (good genes high goals)and a competitive cyclist and no issues with insulin resistance 5ft 9in about 155lbs 9% body fat. I’d like to get the benefits you experienced with utilizing fat during aerobic events, saving my carbs for anaerobic moments.
    Would you start by eliminating fructose and watching my carbs, whats a good rule of thumb for what my carb intake should be to get some of the benefits you experienced?

    • Jeff, yes, it sounds like you’re one of the lucky ones. To quote Napoleon Dynamite…”Lucky!” Even in someone like you, I think performance can be improved, especially aerobically, by reducing sugars and simple carbs in an effort to reduce insulin levels and increase your body’s preference for fat oxidation. This will allow you to spare your glycogen for the times you most need it (peak exertion) and therefore require less feeding during athletic events. Perhaps you might consider starting with a small change, like sugar and very simple carbs?

      • Peter
        Thanks for the tips. I’ve begun my 2 week experiment, eliminating simple sugars, goodbye ice cream, and limiting my complex carbs to around 150g/day or less which isn’t restricting myself all that much, I’ll look out for fructose.

        At the end of two weeks I’ll let you know my results.

        I’d like to see some loss of fat tissue in the 2 to 3 lb range. I weighed in this morning at 156.

        • Peter
          Would you expect to see weight loss in two weeks? I don’t do any kind of calorie counting just eat when I’m hungry and stop when I’m full.
          I will be really monitoring athletic response with my powermeter. I have a coach that designs my workout schedule and monitors my watts-workouts. Performance gains are usually measured from race results, its winter now no racing, or field tests of which I’m not due for one in the short term.
          I will be looking for changes in perceived exertion while riding. So if cruseing at 220 watts suddenly becomes more than a PE of 5 I’ll know something is up. Just as I’ll know if it feels much easier.

          • You might, but it’s a function of a few complex and intertwined factors. Let’s see what happens. Also, I wouldn’t be so quick to abandon the plan in 2 weeks in your power drops. It could take a few months to adjust. Or not…

  4. Hello Peter,

    I discovered your blog yesterday, and haven’t stopped reading (that makes for a lot of hours in front of the computer)! 15 years ago I followed a low carb diet with great success. Back then, I consumed a lot of dairy (not being aware that I was allergic). My question to you, is that I noticed that you use large quantities of cream and cheese – what could I substitute in lieu of dairy? I’m also allergic to whey, although I do seem to tolerate small amounts of butter.

    • Kelley, great questions. Probably best to ask your nutritionist, but using more oils (e.g., using lots of oil in a salad dressing) is a great way to get the fat content without the dairy. Thanks for reading.

  5. Hi Peter,

    Great blog. I got here from Taubes as well. I was blown away by both of his books recently and have lost 20 lbs in the last 2 months. The one thing I found he didn’t address was the low carb athlete, so I was very excited to see his mention of your background as an athlete and that is what led me here. Being an endurance athlete myself (ultra running and cycling) I was still clinging to the notion that despite the low carb diet being ideal for health and weight loss, one needed a high carb diet for optimum athletic performance. Thanks for showing your research as to why this is not the case. What’s your take on the concept of needing to replace glycogen stores after a long workout?

    • Hi Roy, appreciate your feedback and interest. The answer to your question depends on your dietary paradigm. If you consume carbs then, yes, you will want to pay attention to replacing glycogen as soon as possible post-workout. In reality, if one is insulin sensitive (and that’s a big “if”), unfilled glycogen stores typically take priority over fat storage.

  6. First I’d like to say, REALLY EXCELLENT BLOG! Lots of incredibly good information here for any reader. At some point, this is going to be a BOOK for certain. At a minimum it should become a video series or seminar.

    The question I have is about “what you eat”. In some of the earlier posts, and earlier in your journey towards dietary ketosis, are you STILL EATING SOME OF THE FOODS YOU LIKE ONCE A WEEK? There seems to be quite a bit of relevant data that mostly during high caloric deficits, so low calorie diets of any type, the reduction in various systemic hormones that are beneficial for maintenance of proper metabolization of fat and FFA can occur and the introduction of some dramatic carbohydrate consumption can offset this or up-regulate them to normal levels. Is this advisable, part of your eating protocol or just either not relevant or bunk science?

    Also, the ability to eat something more interesting than FATS and PROTEINS and cruciferous vegetables once in a while can be key to maintaining a diet or eating regimen over the long term.

    Are you still able to satisfy any of those legacy cravings and/or do you feel the consumption of such items is beneficial from either a metabolic/hormonal level or eating plan perspective?

    TIA
    TB

    • Thanks so much for the kind comments. There are no “cheat” days in my eating habits any longer, and frankly it’s made it MUCH easier. Cravings are long gone. I can have dinner with friends at a restaurant where everyone orders my formerly favorite deserts and I’m unmoved by it. For me, one of the big problems with “cheat” meals was it was too easy to go from 1 to 2 to 3 … That said it is all a personal choice based on individual differences. My wife still eats ice cream and chocolate chips at least once or twice a week, plus other foods I would not eat. By she’s got a system that works for her.

    • Thanks so much for your site! It has really been reassuring to see all this real science coming straight from the mouth of a doctor.

      One question: Did you or will you in the future take any time off for holidays? I’ve been very diligent for about two months now, and I have absolutely no desire to “cheat” or binge as I did on past diets.

      However, when I tried low fat, high carb diets, I would seem to restrict myself too much. I did not allow myself to eat with my family on Thanksgiving, or even to splurge just a little bit on my birthday. Eventually, after about a year of successfully keeping weight off, my willpower weakened and I began to slowly gain weight again. I ended up back where I started, plus some. I realize there are probably some ketosis friendly items at the Thanksgiving table. But, at least for me, that is not the same as eating real Thanksgiving staples, or family recipes.

      So the question is, would it be realistic to take about a week off of low carb dieting for the week between Christmas and New Year’s Day? Or possibly a day off for Thanksgiving or a birthday? I realize this would kick me out of ketosis rather easily, but I feel as if it may be the key to actually making this a lifestyle and not a crash diet. Would this significantly set me back? How much weight could a person realistically put back on while taking a week off? And what’s all this I hear about cheating being a “metabolic reset?”

      Thanks!

      • There’s no “right” answer to this question. Highly personal. Obviously eating anything you want for a week a year has minimal harm physiologically (within reason), but for some it may make the mental part tougher. For others, it might be ok. Personally, I like to eat as well as I can every day.

  7. Peter, thanks for your post. I have a question a bit off to the side:

    What do you do with your extra egg whites? Or do you buy yolks separately?
    I go through tons of eggs, and would love to drop a bit of the protein out, but I just can’t see wasting all that food by throwing away the whites. Also, I like to buy high-quality eggs [pastured if I can get them] and I’ve never seen pastured yolks for sale.

    Do other folks in your household eat them?

    • Others in my house to do eat the whites, but if I’m solo I do, unfortunately, have to “waste” them. Ironic, I know, given that there are folks out there doing the exact opposite…interesting arbitrage opportunity perhaps?

      • Yeah, there are health-food stores selling organic egg whites. If people start shifting more toward low-carb, maybe they can just buy good eggs, split them, and sell to both sides ;’>.

        Thanks!

    • You could use the egg whites to do sugar-free macaroons (whipped egg whites + shredded coconut). I’ve seen recipes for these, but haven’t tried them without sugar yet.

    • If you’re looking for a great Macaroons recipe for egg whites, check this out.

      http://paleofood.com/baked.htm#almondmacaroons

      My wife makes a variation of it so it is a little more high-fat, low-carb friendly than the paleo version on this site using the following ingredients:

      Lemon nut macaroons

      2.5 cups almonds / hazelnuts
      1 teaspoon cinnamon
      1 lemon – zest
      4 egg whites, beaten
      1/4 cup Xylitol
      4 tablespoons lemon juice

      Grind nuts coarsely. Combine cinnamon, lemon zest, Xylitol and lemon juice. Beat egg whites until very stiff, fold into nut almond mixture and blend. Drop from a teaspoon onto baking paper. Bake 30 minutes at 135c or until golden brown. Cool on rack – eat – enjoy!

  8. Hi Peter,

    Great blogs! I found you through Gary Taubes as many others have. I rarely post replies or questions, but I could use some suggestions on tweaking my diet. Some background on me… I am 46, 5’11” and currently weigh 296 lbs with 210 lbs of lean mass. I am fairly active outside of work (desk job, with a little walking/stairs around the plant). I started the low carb lifestyle after several years using the Zone diet with limited success. I have always been very muscular and athletic, but always carried more fat than I would have liked. In September 2010, I weighed 341 lbs. How I got there is a long story that I will spare everyone. Over the next year, I exercised and followed the zone and lost a whopping 9 lbs. I was generally good about my carb choices, sticking with limited whole grains and fruits and veggies. In september 2011, I start the low carb experiment. Since starting, I have lost 38 lbs with no additional exercise, and feel great, but the weight loss has slowed dramatically. I have had exactly 2 slices of bread since september (CHristmas eve, homemade, tasted great but made me feel horible.), and virtually no other starches or sugar. I eliminated fruit and generally only eat green veggies or salads. I keep my carbs below 30 grams per day and my protein at ~170 grams per day. Total calories are around 1800. Fat comes priamrily from meats, olive oil, eggs, nuts and half and half in my coffee. I was considering decreasing my protein slightly, and increasing my fat a bit to move the calories to about 2000. I was concerned that I might be eating too few calories, but I would expect that as long as I keep protein adequate to support body repair, and have sufficient fat stores, calorie needs should be met by the fat stores, regardless of calorie intake. Do you have any suggestions on what direction to go? Thanks, Mike.

    • Hi Mike, thanks for kind words and support. Congrats on losing the first 50 or so pounds. It’s a great question you’re asking and not one I can easily answer over the internet. I think it might make sense to embark on a series of experiments? I know it’s hard to be patient sometimes (I’m actually quite impatient myself), but I’d suggest changing ONLY variable at a time, and giving each tweak 2-3 weeks before making the next change. For example, consider changing the amount you consume of the following: nuts, dairy, total protein, just to name a few. Keep us posted.

  9. i’ve been on Atkin’s for 6 weeks. I lost 12 lbs in 2 weeks, gained 2 back and haven’t lost anything in the last 3 weeks. I only have 15-20 lbs to lose so everyone is telling me to just be patient. It’s hard to be patient and I wonder, after reading your blog, if I’m not eating enough fat. I’m following 20 g of net carbs per day with 12-15 coming from veggies. No fruit, no nuts, only 3 oz cheese per day, sometimes mayo with salad, a couple of tablespoons per day of salad dressing. I don’t have a hard time without sugar and high carbs if I’m getting results. I don’t know, I’m feeling really bummed and don’t know how to improve my results. Any advice?

    • Sherry, thanks so much for reaching out and congrats on your progress to date. I think being patient is a good idea. It’s really tough for me troubleshoot without “seeing” you, unfortunately, but sounds like you’re doing things well. If you’re feeling well, it might be worth staying the course, if energy levels are low, maybe more fat makes sense? I’d also prioritize MUFA then SFA, then omega-3. Just avoid the omega-6.

  10. I am ApO-3/4 genome type and some others including 4/4 have found that high saturated fat diets above ~30g/day is not favorable to lipids. I have been low carb for about a year now my ApoA-1/B ratio is .497 probably not on the low side but my VAP last year was very good.
    I wonder if you are ApO-3/3 genome type and could comment on the diet possibly not working for some groups of people?
    Also would a high saturated fat diet have negative long term affects on the gallbladder and liver.
    I am presently trying to go lower carb <40g but I find that I get nauseous in the morning and have migraine muscle cramps in the head lasting 3/4 of the day starting from the morning and can't seem to get back down to 18%BF from my present 22%. I came on from a Trackyourplaque forum that mentioned you on Gary Taubes website.
    I find your site one of the best I have read and hope to find a solution to my dilemma here as I read through it.

    • Hi Stuart, thanks for the question. I don’t know (yet) my apo genome. My ApoA1 to ApoB100 is about 0.36 on last check, I think. 0.497 is pretty damn good, too, though. As for your question regarding Apo 3/4, there are all sorts of misinformation out there about how diet affects various lipid concentrations in people with the E4 allele. Apo E is involved with the clearance of VLDL, IDL, HDL and chylomicrons. There is little high-level evidence data on how diet induced lipid changes if those with various apoE isoforms affect CAD. There is also erroneous data out there on apoE4 and omega-3 FA and also its affect on sterol absorption. Classically folks are taught E4 is associated with hyperabsorption of sterols, but the data are very mixed. I asked Tom Dayspring (in my opinion, one of the most knowledgeable persons on the entire topic of lipoproteins) for his view and he suggested some great reading on the topic. If you want, I can send you the papers.

  11. Peter,

    Just a quick shout out to say congrats and well done for publishing this blog. I stumbled upon your blog, via Taubes, via Paul Jaminet’s PHD.

    So I guess you’re already preaching to the choir in my case, but I find that I’m learning new stuff anyway.

    Best,
    JLMK

    • i loved Gary Taubes book and found this site on his blog…you eat how I am starting to… finally found the same like me..I feel great and losing weight… your food pic looks like my frig now! yea! So glad I found this site! You rock!

  12. Hi Peter,
    This is just a quibble and really not the point of your post at all, but when you say “good genes” would you say that this is just a subjective short-hand for genes that are desirable in a food-abundant society? In a food-scarce situation, I would think those same genes wouldn’t be quite so desirable, and in fact healthy people with “poor genes” would be at an advantage because their bodies are so efficient at converting carbs to fat storage. I know it’s semantics, but I would think the “good genes” are really just “inefficient genes” that happen to be desirable in a food abundant society.

    • Janet, this is actually a VERY interesting point! I’ll need to think a bit more about it. There are really 2 issues at play, food quantity versus food quality. No doubt that our ancestors encountered food both less regularly and less abundantly than we do, but they also never encountered the poor quality of food we encounter. The other side of this is the idea that it the world we live in today (abundant, crappy food) some people (about 10-20% of the population) seem completely immune from the deleterious side-effects. Is that the ideal genome? More importantly, how did those folks fare 10,000 years ago? Interesting stuff…

      • Interestingly (to me at least) those people with ‘great genes’ who stay thin no matter what junk they eat, dont seem to be able to add a lot of muscle mass easily. We might be seeing a simple tradeoff of immune system vs strength potential, and we certainly benefit as a society from both types.

    • Question… dont you know want good fat? isnt heavy cream bad for you… I get the no starch and minimize sugar… but can you clarify fats?

  13. I’ve searched hither and yon and I’m having trouble finding bouillon without sugar in it. Any tips?

    • Nate, the only way (I know of) to get it with absolutely ZERO sugar is to make it yourself. This is too time-consuming for me, so unfortunately, I buy store brands which have some (less than 1 gm) dextrose, typically. Unbelievable, isn’t it, that sugar is virtually everything we eat?

    • Try the Rapunzel brand vegan vegetable at Whole Foods. (which seems also to be the Edward & Sons brand)

  14. Found your blog via Gary Taubes’ site. Glad I did. The first question that came to my mind was, “Where does this guy find the time to respond to all these blog questions?” Don’t answer that! But keep up the good work and thanks.

  15. Hi Peter-

    The question I have is much more complex when I think about it, but in short: I’m a type 1 diabetic in good control on an insulin pump. since “normal” people have insulin secreted per homeostasis, how do you think my basal rate insulin is affecting my goal to reach ketosis, or come close to it? if i was to not take ANY bolus insulin (for food or to correct a high BG) I average about 35 units of humalog insulin a day. another question I have which I suprisingly can’t get a clear answer from my doctor/nutritionist about is this: suppose i am in a state of nutritional ketosis and my current bg is 80. if i test my ketones on a ketostix, would i find minimal ketone bodies in my urine, or would it read negative? obviously through education i understand the difference bewteen ketosis and ketoacidosis, but having type 1 kind of confuses things for me. again, love reading your blog. thanks in advance!

    • Colby, for a T1D it would not be wise for me to try to provide any advice on line. Too many factors. I’d suggest reading Richard Bernstein’s book and working closely with your doctor. Because a T1D makes no insulin, you will still require some amount to prevent your ketones from getting too high (a non-diabetic does not need to “think” or worry about this, because their pancreas makes sufficient insulin and if ketones ever get too high, insulin is secreted and suppresses them).

      Bottom line — if you reduce carbs you will require both a lower basal rate and a lower bolus.

  16. Hey, just realized last week (since we were having company over) that chocolate mousse is a FINE dessert on this eating plan (just use Truvia rather than sugar, and use bittersweet chocolate)!!! Mmmmmm!!!! My son had me make more the next day. Reserve some of the whipped cream for the top!

    Glad to make your acquaintance Dr. Attia! Here’s my story (57-year-old female):

    Jan2010 labs (pre-low carb high fat – WEIGHT 168) – IN SHORT, ME AS A SUGAR-BINGING IGNORANT CARBOHOLIC-BINGER SINCE BIRTH:
    HDL=52; LDL=156; TRI=105

    March2010 READ Taubes’ “GCBC” COVER TO COVER, HUBBY & I WENT FROM S.A.D. TO LCHF WITH A VENGEANCE

    Sept2010 labs (post-low carb high fat – WEIGHT 152)
    HDL=65; LDL=159; TRI=54; (didn’t test for VLDL but Apo B was 98 with reference range <109)

    July2011 labs (post-low carb high fat – WEIGHT 150)
    HDL=67; LDL=158; TRI=48

    My husband's high blood pressure normalized (took a couple of months) but his gastric reflux with which he'd suffered for YEARS and sometimes severely was gone in 2 days and never returned. This is not to mention the disappearance of aches & pains, great immunity and energy… What's not to love?

    Appreciate your take on Omega 6/3. A huge part of the puzzle. Down with peanut butter, up with wild-caught salmon! Super-Walmart (sorry folks) carries it, marked "sustainable"! Three grades all the way up to rather expensive sockeye. Invest in a Sous Vide Supreme and you'll be set for life!

    I think another importance piece of the puzzle MIGHT be "The Devil in the Milk" (read the first article that comes up when you google that): A1 cattle vs. A2 cattle. Jordan Rubin has a new enterprise, Beyond Organic, and an 8000 acre farm with A2 completely-green-fed cattle. With his farm newly up and running, he sells meat and milk products (I like his Amasai, plain – to which I add cinnamon and a bit of Truvia). He's into probiotics big time (cured himself of Crohn's etc. when young – amazing story, wrote "The Makers Diet" Look at his before and after pics!). Asked himself what were real riches, and ended up with the answer: land and cattle. His most recent book, Live Beyond Organic, is good. In line with your diet, Dr. Attia!!!

    So glad you've teamed up with GT! The world ain't seen nuthin' yet! 🙂

    • Paula, great work on reducing your risk of heart disease. Keep in mind, though, without a lipid NMR test, it’s hard to be 100% sure you’re fully dialed in. Might be worth considering that test. Thanks so much for your enthusiastic support.

  17. My thanks to you and Gary Taubes for making all of this more accessible because of the way you both get your points across. I read “Good calories, Bad Calories” and got to the end before I realized it was 500 pages. What I’m gathering from your description of your process is that there are no ‘cheat days’. I went several weeks following the menu instructions in “Why We Get Fat” before spending 2 weeks in Orlando with my son and daughter-in-law during which they expected Papa’s cooking, but not the “new” Papa. And I succumbed to my own culinary prowess and cheated.

    Being that this is Super Sunday (NFL, note the absence of ‘bowl’ in sequence with the rest. Don’t sue me), I’m guessing that even this one day of…ahem…’cheating’ takes me back to day zero.

    Thanks again for all you do.

      • I was more inquiring whether I had to fast again (“Why We Get Fat”) and if a single day or an instance of ‘cheating’ undoes a lot of the benefits of a low/no carb diet.

        • Hi Peter,

          I came across a low-carb site which advocates a weekly cheat day in order to raise one’s leptin back to “normal” levels, stating that low leptin levels could slow the BMR and stall weight loss and/or fat loss.
          Yet another low-carb advocate states on his site that low leptin is a positive change, because it results in less hunger; he made no mention of the BMR.
          I understand that cheat days are not a part of your practice. And certainly I can live without them if they are not useful. But do you have any thoughts on these conflicting statements around leptin levels, plateaus, and strategic cheating? Would leptin levels be a different concern for those of us who flirt on the edge of ketosis rather than actually living in ketosis?

          • Kathleen, this topic deserves more time than a quick response. I will write about leptin more generally in the coming months. My quick answer, though, is that if (like me), you’re happily in ketosis, I think the “benefit” of leaving ketosis each week is probably not worth it. But you probably know me well enough to know my macro response – it never hurts to do a good experiment on yourself.

  18. Dr Peter. Do you subscribe to requiring a post workout meal for any of the reasons popular fitness culture state? If there is something specific you have post workout, I would love to know.
    Thanks, Anthony – Brisbane, Australia

    • Not really. It’s sort of a function of how your body “handles” it. For example, for some, magnesium is hard on the stomach and/or acts like a laxative. Obviously, this would suggest certain times of day more favorable than others. The only supplements I’m particular about with timing are MCT oil and fish oil. MCT I always do first thing in the morning. Fish oil with dinner to ensure I’m consuming it at a time when my liver is secreting lots of bile.

      • Peter, If you manage to find the time to explain why you take the fish oil at at time when you are secreting a lot of bile, it would be greatly appreciated. I take mine in the morning. I will now try taking them in the evening as you do and will wait and see if you provid the info as to “why”.
        Thank you very much!

        • Sure, bile aids in the absorption of fat. I want to make sure I “suck up” every molecule of fat. I worry that if I take it with nothing else, I may not secrete enough bile to really absorb every drop.

  19. I noticed you have a diet consisting of fat salami and/or pepperoni. I have tried purchasing these items only to discover that dextrose is an ingredient in every selection–including my local deli’s selection. Do you have any suggestions? Or is the level of dextrose so neglible in these meats that worrying about consuming it is unnecessary?

    • Shane, I really have 2 choices (both of which I’m employ): 1. only buy those with “negligible” amounts (i.e., less than 1 gm per serving), or 2. pay an lot more for the variants (usually at the deli in Whole Paycheck, I mean Whole Foods) that have zero sugar.

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