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

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

1,115 Comments

  1. Hi Peter. Quick question about bouillon–I read in WWGF how/why Gary drank chicken broth and when I went to <30 carbs/day or so, I tried it. I found that I became so bloated, gaining a least a couple pounds of water weight (I assumed). I eat loads of salty, fatty meats and salt most of my foods liberally with sea salt, have normal to low bp, do a strenuous 2 hr. hike 3x/wk., drink coffee and water when thirsty. Does everyone really need to consume bouillon of some kind when going low carb? I don't like it. Thanks, Shelly

    • Shelly, it’s more a function of how much salt your kidneys are dumping, relative to what you take in. It’s possible you’re getting enough salt via other food, though I can’t get enough that way. I think you need to consume it, regularly at least, if you feel otherwise great (e.g., no lightheadedness or loss of energy).

  2. Hello Peter,

    I am new into the ketogenic diet area, but ive jumped on the band wagon a couple of weeks ago. That being said, I was wondering how would one go about calculating the daily calories needed? I’ve followed a carb rich diet for a while and lost 40 pounds, now I’ve lost 15 more but I am not sure whats the proper amount of calories I need. I am 5’8″ 320pounds and workout 5 times a week, with HIIT cardio 3 times a week.

    The reason I ask is I hit a plateau and seem to be losing steam by 2-3pm which is unusual for me. Please let me know your thoughts.

    Thanks!

    • Mina, the simplest thing I would suggest at this point is to not count calories at all. Just limit carbohydrate intake and eat when you’re hungry; stop when you’re not. Give it 12 weeks or so without interruption (or “cheating”). Beware of hidden carbs and sugars, though, so get very comfortable with labels.

      • Peter,

        Thanks for your reply. I actually follow the sacred rule of ketogenic diets of keeping the macros at 65% fat, 35% protein, and 5% carbs.

        I initially found out that I was under feeding at 1700 Cals. I upped to 25-2700 and we’ll have to wait and see. Wish me luck. Thanks for your website and your inspiration.

        -Mina.

  3. Hello Dr. Attia –

    Thank you for putting this blog together and making an effort to respond to so many comments. I wondered if you could talk more about the level of whey protein and dairy you ingest during the course of your meals laid out here. There is a lot of conflicting information on the internet regarding dairy and its role as an insulin secretogue (whatever fractionate is most responsible); could you write a little bit about your thoughts on the issue?

    I’d be interested to hear if you had to experiment with the level of dairy in your diet, have certain types of dairy that you avoid (clearly you avoid milk), and if you could talk briefly about the types of responses that people have to the ingestion of dairy, whey, and casein.

    Also if you could comment on why milk is included in the ‘hyper-glucidic breakfast test’ used to diagnose reactive hypoglycemia, that would be helpful. Would other dairy items of equivalent caloric value subsitute equally well in this test, or does preparation matter? What does that mean for dairy’s role in insulin secretion?

    That’s possibly too much to ask in one sitting, but thank you in advance.

    -Aaron

    • Aaron, thanks for your interest in the blog. I probably need to write a post on this topic (dairy), given the understandable confusion out there. Quick answer: different insulin response for different people *and* different dairy source. E.g., 2% milk vs. 35% whole cream; me vs. someone else. There is no single answer to this question. I’ll have to pass on the rest for now. Sorry.

  4. I’m not supplementing with any salt – how would I know if I need to? I’m not counting carbs, calories or anything, but aside from lots of vegetables and salad, and a square of dark chocolate a day, I’m not eating carbs. If I try adding salt to my food, I find the taste awful, way too salty. I know Atkins recommends adding salt to the diet, so I’m nervous.

    Thanks,
    Debbie

  5. Really enjoying all of your posts. I have been living a pretty clean paleo lifestyle but feel like I need to reduce my carbs even more. Living paleo according to Robb Wolfs book, I have eliminated dairy from my diet. I notice you use heavy cream frequently. Do you have any issue with inflammation from l actor intolerance? Is it worth worrying about?

    • Brent, dairy is a bit of grey area. For some, it doesn’t sit well, not just in the immediate phase, but more chronically (inflammation, insulin response). For others, dairy is well tolerated. I seem to fall in the latter camp, but I also need to be thoughtful about which dairy. Milk does not treat me well, nor does low-fat yogurt. As I trade more lactose and protein for fat, I do much better. I heavily monitor my inflammation and I appear able to maintain a very low inflammatory environment, though I suspect my reduction in omega-6 PUFA has the most to do with it. You will probably want to experiment a bit with this on yourself.

      • Pete:

        Through what procedure is it exactly that you “heavily monitor [your] inflammation”, please? A blood test? How often? Have you graphed it against time, on the site?

        Also, I’m for some reason not having luck with your search feature. For example, if I type “inflammation” into the search field (but without the quotes) the search feature returns “No Results Found”. Obviously, the word “inflammation” does indeed exist on your site, so I guess I’m not clear what part of your site that the search actually searches.

        I’m using the most recent version of Firefox. Is it working for you?

        • Peter:

          Couldn’t figure out how to reply to your reply, so I’m replying to my own post. I looked at your Books & Tools page, as you suggested, and can’t find any reference to the “Lipid Labs”, regarding tests for inflammation.

          By the way, the Search feature seems to be working fine now. Thanks.

  6. You mention that in your beginning “transition” stage you limited your protein and carb intake to no more than 150 & 50 grams respectively. That only works out to about 800 or so calories. Do you need to be highly calorie restrictive in the early stages to achieve weightless through ketosis?

    • Brent, you may have missed that I was also eating 400 gm/day of fat. I was actuate eating more calories than I was before entering ketosis. So, no, you do not need to calorie restrict.

  7. Peter, could you please tell me what brand of bacon you use that is sugar free? I have gone to every natural food store in my area and all the bacon I see has evaporated cane juice or sugar. Thanks!

    • Lisa, one brand I use a local grocer brand with less than 1 gm of dextrose per 3 or 4 pieces and no (other) added sugar. Another option is the really expensive stuff from Whole Paycheck (Whole Foods) that the butcher certifies has no sugar. I don’t lose sleep if there is a touch of dextrose in it, but I really avoid sucrose.

  8. Peter,

    I really appreciate the personal interaction you provide on this site as it is extremely helpful in understanding the transition to a low-carb diet. I have a two part question regarding the timing and quantity of meals along with exercise and reduced carbs.

    I do not have a problem with weight control and am not attempting to reach dietary ketosis. I began the transition to a LCD for the other health benefits. I am currently limiting sweets and refined carbs with the intent to slowly eliminate additional carbohydrate sources over the coming months.

    I only eat two meals a day with breakfast between 11:30 am and 12:30 pm and dinner around 6:00 to 6:30 pm. This also means I fast approximately 16-17 hours between dinner and breakfast each day. Before attempting to reduce carbs, breakfast consisted of an apple, banana, six ounces of non-fat yogurt, and a bowl of whole grain cereal with soy milk each day. I now have that about 3 times a week with the other days consisting of three eggs with some type of meat or cheese and maybe an apple once in awhile. My intention is to continue to reduce these breakfast carbs. Most dinners consist of approximately 3/4 pound of meat with a large amount of salad, green beans, or asparagus. However, I also have a couple of dinners a week that include burritos or brown rice and/or whole wheat pasta. I rarely feel hunger between meals, and if I do I have a snack of salami and cheese, or a handful of almonds.

    I start each day walking my dogs for about an hour at a distance of approximately 4 miles over some mild hills and fields. This is followed by 20-30 minutes of exercise on a Nordic Trak and a recumbent bike while working with ten pound weights (aproximately 700 reps). That is followed by approximately 10 minutes of stretches and floor exercises. After that I have a cup of coffee and then eat breakfast about 90 minutes later.

    My first question is about timing. Do you think there are negatives with this timing of meals and exercise, especially considering the 16 hour fast. Secondly, do you see a problem with this amount of food in two meals a day with reduced carbs if there is no issue with feeling hunger and weight is stable? Would three meals a day and/or more quantity of food provide other benefits in your opinion? Or is this more a matter of if it isn’t broken, don’t fix it? I am 6″1″ and weigh 165-170 pounds.

    Thanks again for the blog.
    Glen

    • Glen, thanks for your questions. Referring to my irisin post where I talk about “ordered terms,” what you eat (first order term) is probably much more important than when you eat it or even how much of it you eat. The question, in your case, it what you’re optimizing for, since you sound really lean and healthy. If you’re feeling great now I don’t see any reason to change anything. There are lots of things to tweak — both what you eat (e.g., swap out the low fat yogurt for some fat yogurt), and when you eat, but I’m not sure I’d suggest any changes unless you’re trying to fix something.

  9. Hi Peter,
    I was at Whole Foods looking at magnesium & potassium. There are several varieties, including pill form, liquid form, etc., some cheap, some expensive, that I thought I’d ask and see if you have a preference as to what kind/form/brand you take.

    I hate to just buy based on price, as I don’t know that “more expensive” means “better quality”.

  10. Peter, I decided to post these questions online rather than by private email, in case there are other docs out there who can learn from these issues. I’ve also added a question or two to the end.

    1) I truly buy into the carbohydrate hypothesis of disease but where I run into trouble with my patients is over increasing the intake of saturated fat. I experience profound resistance from my patients when I recommend they replace CHO with meat, eggs, cheese, high fat dairy (e.g. cream), etc. Any thoughts on getting around this issue? I have thought of just providing a list of foods they should AVOID (i.e. they all contain CHO), and let them choose the remainder for themselves – without ever touching on the issue of what to replace the CHO with. I did read on your site that you feel that a list is too ‘prescriptive’. What do you suggest instead? (I should state that I also tell my patients to buy Westman/Vollek/Phinney’s New Atkins book and Gary Taubes’ “Why we get fat” book – I have photocopied the book covers for them).

    2) Is it worth starting on a statin to offset the (admittedly likely small) risks of increasing saturated fat consumption? For example, if there is only a 10% chance that the Keys hypothesis is correct (and it’s probably more like 1%), are we (you and I) running the risk of clogging our arteries by boosting our intake of saturated fat and dietary cholesterol?

    3) A recent Cochrane review concluded that “Dietary change to reduce saturated fat and partly replace it with unsaturated fats appears to reduce the incidence of cardiovascular events”. I would love to send you this paper – drop me a line at [email protected]. It was published by Hooper et al in the July 2011 issue of Cochrane Database of Systematic Reviews (https://www.ncbi.nlm.nih.gov/pubmed/21735388). Now if this is indeed correct, wouldn’t increasing saturated fat in the diet have the reciprocal effect – ie increase the incidence of cardiovascular events”?

    4) For the sicker patients in my practice – the elderly, those who have diabetes/hypertension/dyslipidemia and post-stroke – what level of CHO restriction would you recommend? This is a critical issue – CHO restriction in more vulnerable secondary prevention patients. As you know, the side effects of CHO restriction can be severe on the physical and psychological levels – until true ketoadaptation occurs (which can take 6-8 weeks or longer). Many of these patients are highly medicated with drugs that will lower their blood pressure and blood glucose – which will be fired down even further by CHO restriction.

    5) Any tips on dealing with the two biggest issues in keto-adaptation: constipation and dizziness/lightheadedness?

    6) Were you aware of a trial published circa 1994 or 1995 with magnesium supplementation in coronary patients which showed increased cardiovascular events? (versus placebo). Here is the link:
    https://www.bmj.com/content/307/6904/585

    Certainly the use of health supplements has always worried me – when these things are tested, they invariably turn out to be harmful or neutral rather than beneficial as previously claimed (exception really being omega-3 fatty acids, which have had 3 negative trials of late – heavily criticized trials I should add). None of the vitamin antioxidants have panned out well when tested in definitive RCTs.

    • Dan, all of these are fantastic questions, but I can’t do them justice in this quick response. Here’s my attempt at giving you a quick answer:

      1. Yes, this is the biggest single hurdle we face. When I’m confronted with this, I usually ask people, “Why is eating saturated fat bad for you?”
      2. I don’t see why. I’d rather use measurable objectives. For example, check lipid NMR for LDL-P and only treat if LDL-P gets too high, based on risk factors.
      3. Please do send, but I’ve seen many such studies — the reciprocal argument does not (necessarily) hold true, even assuming this meta analysis is based on good data, which many are not.
      4. Very individual, but if done properly (re: NOT how I did it), keto-adaptation can be very quick (less than a week) and very simple. Requires support, up front though. Not enough to just give someone a book, as I’m sure you know.
      5. Salt and appropriate oil intake cure both overnight.
      6. This study is not particularly convincing for 2 reasons: i) the patient population is very narrow (and very sick); ii) the “significance” of it did not show up in the intention-to-treat group. Any time a study has do to strip out a lot of patients, one has to ask if other things are going on.

      Excellent questions. Thanks you.

      • What is appropriate oil intake to relieve constipation? Every low carb web site or book I read says water and green vegetables are the key, but this hasn’t helped and I don’t want to up the vegetables any further. I haven’t seen anything about oil. Is there literature on this?

        • Either mineral oil or MCT oil (medium chain triglyceride) work best. Don’t forget about salt. If you’re not supplementing salt, that also plays a role.

    • I read that Cochrane Review last week as well. There appeared to be a 14% reduction in risk for cardiovascular events. I’d be interested in finding out what kinds of dietary modifications those studies involved.

  11. I just subscribed to your blog! I love it. Couple of questions, how do you keep protein down when eating low carb? I find that when I eat fatty meats or chicken the protein is automatically high. I’m 5’9 127lbs and have about 126g protein a day. I run marathons as well and although I was miserable when I first switched to lo carb the benefits now are amazing! Am I eating too much protein?

    When do the sugar cravings stop!? I am getting a lot better at controlling them but when they hit they hit hard! I have strawberries and blueberries on hand just in case but I really want to limit that.

    Last, do you use salt tabs during long runs (1-2 hours)? I have found that they help me a ton but are they ok to use. I’ve had many long runs (without salt tabs) ending with my face covered with salt.

    Thanks for reading!! My new favorite blog.. 🙂

    • Ingrid, it was definitely a challenge during the first few months as I transitioned from non-ketotic LC to ketotic LC. At your size, you could easily get by less protein – probably in the order of about 80-90 gm/day. As far as sweet craving, it seems that you might be better off trying to go “cold turkey,” rather than intermittently allowing yourself to snack on fruit? Just an experiment worth doing. Also, consider eliminating all non-sugar substitutes and diet drinks, if you can consume any. I use bouillon for my salt replacement before and after my really long bike rides.

      • Thanks Peter! Thankfully, I don’t consume any other sugar unless it’s from fruit. That was hard at first but it’s only after I run that I feel like I need a piece of fruit. I know I can cut the fruit out all together! Any hints as to what to eat after a long workout? Sometimes the feeling is so overwhelming! I don’t go overboard usually just a pear or a few grapes but if there is something else I can replace it with please tell me.. 🙂

        Thanks for your response! I know you’re a busy guy!

        • Sounds like your body may be “starving” during workouts. When your body is adequately accessing fat during a workout, the workout tends to remove appetite. When I get back from a long ride, even if I’ve eaten less than 10% of the calories I burned, my ketones are high (around 5 mM) and I don’t have much appetite for a few hours.

        • oh. wow ok. I usually don’t eat a full meal until about an hour or so after I workout. I’ll up the fat and ax the fruit.

          THANK YOU!

  12. I am JUST learning about this. I am not very good at counting calories or other typical metrics you mention though I can easily recognize sugar and carbohydrates on labels. I am just not sure where to begin. It probably does not help that I am about to go to Italy for vacation for 10 days. Looking forward to learning more!
    Andrew

  13. A quick follow-up query.
    Peter, regarding your “fat shake” which sounds delicious, I would like to try this (breakfasts have been either egg-based or turkey/chicken sausage-based, and I really need to add some variety to this routine).

    Regarding some of the ingredients, where are you purchasing sugar-free almond milk and sugar-free hydrolyzed whey protein? I thought virtually all almond milk is loaded with carbohydrate (even not the sugar-added variety) – perhaps I am wrong on this.

    Also, regarding “heavy whipping cream” is that the 35% variety that comes in the dairy section? I noticed today that dextrose was the third ingredient listed in my 18% table cream – hard to escape these added sugars.

    Thanks so much for your assistance.

    Dan Hackam

    • The almond milk I guy (from Trader Joe’s) has no sugar in it. It has 2 gm of non-sugar carbohydrate per 8 oz (by “sugar” I mean sucrose or HFCS). Yes, I use 35% cream, also known as whole fat or whipping cream. The brands I use do not contain any added dextrose. My 8 oz portion contains 88 gm of fat (not a typo), 7 gm of carbs, 5 gm of protein.

  14. Hi Dr. Attia,
    I’m very glad to find your blog web site (via Mr. Taubes web site). I have read Protein Power, much of Mr. Taubes written work, Atkins & most of The Art and Science of Low Carbohydrate Living among other low-carb literature. I feel that I have a pretty good grasp on the carb-restricted diet. Have you experienced or heard of people finding that around, 4 or 5 weeks in, they become overly fatigued much of the time. You may have already covered this in your web site, so forgive me if I am asking you to repeat yourself. But could you give me some ideas as to why people may be experiencing this fatigue? I realize this is a broad question but a list of possibilities would be appreciated. Thanks, Diana

    • Diana, could be any number of reasons including, but not limited to, not enough fat, too much protein, not enough sodium, not enough magnesium, too much carbohydrate. Tough to say without a work-up, so to speak.

  15. Hi Peter,
    Thanks enormously for your sharing all of this information. I am looking at your videos on JumpStartMD as well. Can you recommend an app for tracking food intake to help guide choices as I transition to a very different approach to eating? I see there are a number of them out there with mixed reviews from users. I am interested in getting weight loss results as quickly as possible for an upcoming ten-mile run. Thanks,
    Jill

    • Jill, I am not familiar with any food-tracking apps, so I can’t really recommend any. When I was transitioning into ketosis (the only time I needed to actively monitor the amount of what I was eating – at least in terms of carb and protein content), I used this website: https://nutritiondata.self.com/

      I still find this website, coupled with a good scale and a spreadsheet, to be all I need.

  16. Hi Peter,
    Thanks so much for your site and time. I found you today from the GT site. Can you give me some information about what type of fat coconut oil is and how good it is for you? Also, dosen’t coconut milk have a lot of sugar? I have recently bought coconut oil and love the taste. One more thing…how do you get your vitamine C?

    • Coconut oil is virtually all saturated fat, so it’s a “good” fat. Coconut WATER is sugar water I wouldn’t touch it with a 10 foot pole, but coconut milk is actually mostly fat. 4 oz of coconut milk has about 25 gm of fat, 3 gm of carb, and 2 gm of protein. Perfect ketotic food choice.

  17. I love this blog already. When counting carbs, how do you factor in “net carbs?” I guess the better question is: how does fiber (both soluble and insoluble) affect our bodies production of ketones? I wonder because I’m very low carb right now, but I also love nuts and seeds, and want to make sure I don’t overdo it.
    Thank!
    Scott

  18. Why would I consider a ketogenic diet over a normal diet and or why would I want to get extreme at 5% of carbs vs a mild ketosis? The possible side effects seem pretty risky as far as sodium loss etc.

    • Mike, I’m not saying you (or anyone else) *should*. It’s what I do. What you do is your choice, if it makes you live better. But you could also ask yourself the following question: Why would you consider getting on an airplane and flying to Hawaii? There’s a chance the plane could crash and it will actually cost you money to go? Presumably, the answer is that it’s worth the tradeoffs.
      Everything in life is a tradeoff. Ketosis, by the way, is binary. Either you are or you are not. No such thing as mild ketosis, when referring to nutritional ketosis. Carb restriction is relative.

  19. Peter, thanks for this fantastic blog. I’m a bariatric physician in Pasadena, who also likes to do endurance athletics (marathons, triathlons) and I found your posts on the measurements of fitness really enlightening. As you mentioned, the performance sports cultures is riddled with recommendations for carbo loading. I always wondered how to reconcile athletics with a ketogenic diet. Thank you.

    The question I have is about your protein restriction; Do you limit your protein intake because it is an insulin secretagogue. Do we know how much insulin gets secreted from protein ingestion relative to carbs?

    • Garry, I’m glad you are enjoying this content. To your question, yes, I “limit” protein because too much inhibits ketosis. The reason I say “limit” is that my most standards I consume a completely normal amount of protein — about 1.5 gm/kg/day.

  20. Peter:

    Great blog. I’ve been following a low carb diet now since September and have lost about 35 pounds.

    One question I have is there any long term studies that raise concerns about staying in ketosis essentially indefinately?

    I really started doing Atkins, but as you know, Atkins starts adding in carbs, primarily veggies, until you essentially find the point at which you start to gain weight (or stop losing). I’m not sure I want to eat that many veggies unless it is really necessary to optimize health. I take it from your blog that you don’t necessarily think we need to increase veggies for health reasons?

    Thanks.

    • Patrick, it depends how you define long-term. Perhaps the best work is that of V. Steffanson who spent several years living with the Inuit who are obviously ketotic indefinitely. I think I have one of his books on my recommended reading section. The decision to eat different carbs (e.g., vegetables) is more a function of what you’re optimizing for. Food diversity, perhaps?

Facebook icon Twitter icon Instagram icon Pinterest icon Google+ icon YouTube icon LinkedIn icon Contact icon