Very low-carb performance

Very low-carb performance


I’m Andrea Sanford from diet dr. comb and I’m here with someone who knows a lot about what is wrong in our current understanding about diet and health Peter attea medical doctor and a popular blogger and a co-worker with Gary Taubes so thanks for being here well thanks very much for having me here today so could you just tell a little bit about yourself and how you got all interested in this diet and health and the guide science yeah absolutely you know it’s always something I’ve been interested in health and nutrition primarily driven by my interest in like performance and things like that but you know up until about three or four years ago I sort of subscribe to the conventional wisdom which was that high amounts of carbohydrates were necessary to sustain peak physical performance fats and primarily saturated fats should be avoided high amounts of protein were necessary to maintain an anabolic state etc it kind of all came to a head in 2009 when after a slow witnessed progression I had sort of morphed from the lean person I was in high school into a very non lean person to put it mildly and in fact the real turning point came in September of that year when I had just become maybe one of a dozen people to swim from Los Angeles to Catalina Island and Catalina Island back the two separate crossings and so I was fit as a fiddle swimming for hours a day and training and yet I had ballooned to you know about 40 pounds above what I am today and worse yet a lot of the metabolic parameters in my body were also reflecting that I had elevated triglycerides profoundly depressed HDL cholesterol my waist was you know obviously much larger than it should have been and so basically I was sort of on the fence of metabolic syndrome and this struck me as problematic because I was on paper doing all the right things I was eating a diet that was very I and refined carbohydrates or more importantly whole grains fruits and vegetables refined carbohydrates but they seemed acceptable if you were exercising as much as I was lean protein and very little saturated fat and so that really began this search for am i doing something wrong you was supposedly doing everything right and it still wasn’t working that’s correct so what they do fine well I started doing some reading and came across some literature that suggested that the simpler carbohydrates may be overriding my body’s system to oxidize fat so despite all that exercise I was doing it was quite likely that I was doing it in an environment of a constantly elevated insulin level and doing so was paradoxically turning off my body’s ability to access its internal fat stores so you’re effectively putting a lot of paper on the fire and doing so is preventing you from actually burning the logs right then when you say simple carbohydrates what are you talking about well in that in the sort of parlance of the sports nutrition world this was a lot of the multi dextran products which of course are often filled with high fructose corn syrup people love to talk about how high fructose corn syrup is preferentially turned into hepatic glycogen / glucose and then of course from a dietary standpoint you know I was eating copious amounts of rice and pasta and bread and things like that always you know quote unquote carbo loading before these long workouts and immediately refueling with the same thing upon completion of these workouts ok so you’ve found some because you’re suggesting that this could be a problem yeah so I decided to do a very simple experiment on myself which was what if I just eliminated anything in my diet that contains sucrose and high fructose corn syrup so I was certainly nowhere near willing to consider that maybe starches in general were were contributing to the problem but I wanted to see what happened if I just took out anything with sucrose and high fructose corn syrup and so I did that and over the next four months an amazing thing happened which was obviously removing those things removes a number of other things it didn’t mean I had meant that if I was going to eat spaghetti I needed to make my own spaghetti sauce out of tomatoes and garlic and things like that I couldn’t use something out of a can or a jar because much to my surprise the third ingredient in that product was sugar it meant that I still ate bread but I had to search long and hard to find a brand that didn’t have ingredient number two or three being sugar and so I lost about 20 pounds in four months and felt much better and was performing much better and that just piqued my curiosity frankly that just made me want to know what was the next level and as could I take things to another level my triglycerides had fallen from about 154 milligrams per deciliter to about a hundred HDL had gone up from where it started at about 30 milligrams per deciliter to now about 45 so things seem to be moving in the right direction and you know I just sort of asked the natural question which is what happens if I pull this lever a little bit harder after what happens you know everything just continued and so over the period of effectively a year and a half I went through this gradual period of carbohydrate reduction which by the way was not without its difficulties as anyone who’s tried to reduce carbohydrates knows each of these new steps is met with a new challenge but gradually I reduced it to the point where in the spring of 2011 I was sort of teetering with what we would call a ketogenic diet effectively the complete removal of carbohydrates certainly the removal of all starches and sugars and even a reduction in my case in the amount of protein I was consuming for reasons that I’m sure other other interviewees you’ve had have have discussed that when sort of formulating a well-put-together ketogenic diet and so I decided to go on a 12-week experiment into nutritional ketosis where carbohydrates were limited to about 30 grams per day protein was limited to about 120 grams per day and my fat intake made up the remainder and you know to be honest with you the first few weeks of that were horrible so horrible in fact that were not for the fact that I’d committed to doing 12 weeks at least to myself I would have probably abandoned it it turned out I was making many of the common mistakes that people make when doing that when you say horrible sorry what what does that mean well you know I was very lightheaded my performance athletically took a huge turn for the worse I just didn’t feel well what kind of sports cycling swimming high intensity weight training that sort of thing okay so so hard time getting into that what would happen well I was fortunate that you know I thought by this time I had gotten to know Steve Finney and Geoff Olek among others and you know they were really gracious in their advice and they quickly took a look at what I was eating and made a few suggestions and a lot of those suggestions really panned out obviously increasing sodium intake was probably the biggest single one supplementing elements rather other you know minerals and and things like that made a big difference and the other one was actually making sure I really was strict on keeping that protein level low enough because of the nature of sort of what I was doing it was a fine balance between getting enough protein to to make sure that I wasn’t sort of always in a catabolic state but at the same time not overdoing it which is actually a very common mistake I find people making in ketosis how do you do that over dope we do protein what does that mean getting too much lean meat yeah or even too much fat meat but the point is if you’re getting too much protein and what happens is you’re sort of getting a gluconeogenic effect from the protein that’s effectively starting to act like carbohydrate so to give you an example at the onset of my foray into ketosis I was still consuming about 240 grams a day of protein which is what I’d consumed my entire life which is still a lot right still a lot plenty more than enough protein these are certainly in a positive energy balance in nitrogen balance the problem is at that level the protein a lot of it is now being processed by the liver turned into glycogen and you’re effectively exporting glucose again and and again for most people that may not make that to a difference but when you’re really trying to thread that very delicate needle of nutritional ketosis it was enough to keep me from truly getting there and I I sort of found myself in a no-man’s land which is carbohydrates were reduced to the point where you know I probably didn’t have enough glucose to keep my brain entirely happy but through these high levels of protein I wasn’t quite allowing my liver to make enough of you know the beta hydroxy butyrate and other things like that that my brain would need to offset its deficiency of glucose so I was really in this kind of middle zone and and since that time having now worked with a lot of people doing this themselves it’s it’s it’s certainly the first pattern I observe in someone who’s struggling so what happened when you when you when you fixed this reduced your protein on and went into full-blown keto well it was it was an amazing change you know after struggling for weeks within a few days it all reverted my serum levels of beta hydroxy butyrate something we would you know poke your finger to just monitor got into sort of that zone we’d call the sweet spot and I just started to feel remarkable and in fact when the 12 weeks was up I just didn’t want to go back and so you know for about the past year and a half I’ve kind of stayed in that state and and the benefits for me have been have been really worth the trade-offs because let’s be honest there’s a trade-off to being that strict about how many grams of this you’re going to eat and how many grams of that you’re going to eat and you know I certainly wouldn’t say that that’s something everyone should be doing or want to do but for me it made a difference because primarily from an endurance athlete standpoint which is something that you know I’m not kind of a wannabe endurance athlete I really like the idea that I can go out for very long bike rides do very long swims do things like that and my body has become so metabolically flexible at accessing fat stores that I really require very little supplemental substrate for glucose production so you can just go out and ride your bike for hours or what yeah my record so far on a so I have done a number of these sort of funny experiments myself my record so far is 24 hours of fasting and then a 6 hour bike ride well with just water Wow and then sodium actually you do need some saw how did that go it went really well I mean by the time I finished that bike ride my you know not to get too technical my beta-hydroxybutyrate level was over 5 millimolar x’ which is pretty high that’s about the level at which even the pancreas now starts to secrete insulin in response to the ketones to keep them in check that what prevents me from getting into ketoacidosis of course but it was a remarkable experience to be able to sort of start to push the bounds of what the body can do if you truly allow it to access its own internal stores of fat so what happened to your health in general when you you know year year and a half Indian in strict ketogenic state ways and other parameters yeah I mean everything just kind of continued to move in the correct direction insulin resistance was something I had documented insulin resistance through you know the standard test you would use in oral glucose tolerance test how my I are all of the sort of metrics you would use to measure lence and resistance were there in addition to you know the proxies we use for example looking at a ratio of triglyceride to HDL cholesterol is a great proxy for insulin resistance and when I started out that ratio was about 6 and that ratio obviously fell to below 1 which is really where you’d want to be the big change enormous change fasting insulin levels fasting glucose levels fall hemoglobin a1c reduced you know waist circumference shrunk 40 pounds lighter much much lower reduction a much lower percentage of body fat you know all these sort of things that that were you know risks to my health in the not-too-distant future all of a sudden have been you know I believe put on put on a slower course so anything negative I mean you hear a lot in blogs and even you know from doctors and other people about the dangers of ketosis I mean you’re supposed to be you need the glucose for your brain and you wanted to exercise obviously that doesn’t seem to be the case but do you get depressed if you’re tired you get hyperthyroid you know all these kinds yeah well you know I’m a pretty relentless self experimenter and I followed all of these parameters in me so to answer your question I mean obviously I hope I’ve been able to at least demonstrate that a well formulated ketogenic diet isn’t bad for your brain in the sense that your brain can obviously access beta-hydroxybutyrate and that’s the purpose of it but some of these other points are really interesting to note I mean there’s certainly a lot of discussion about cortisol and thyroid function other endocrine function I don’t think it’s that exciting to comment on one individual’s experience but nevertheless in my personal experience I have not experienced those things so I have not seen a rise in my you know C reactive protein or homocysteine levels or any of these other markers that least not one that statistically significant I’m checking my levels so frequently on this stuff that the other thing people need to keep in mind is there’s so much variation based on time of day in fact to give you an example about a month ago I did an experiment in collaboration with a laboratory called health Diagnostics laboratory where we did nine different blood tests in three days but we timed them around my workouts so you do an early morning workout you do an early morning blood test and these are you know five six tubes of blood go out and do a four-hour workout come back and repeat it rest for four hours repeated and we did this over the course of three days so you know two units of blood I gave up for this the test your your blood a lot more than most people that’s right I might I certainly do but I did this because I had a hunch that the activities in our day the timing of when we tested impacted the results and this turned out to be true there was remarkable variation in my blood markers just as a function of when I was testing them and not surprisingly after hard workouts a lot of those inflammatory markers were higher then first thing in the morning when I’ve had a night of sleep and so I think that the concerns that people put for that really valid I think they mostly stem from people possibly not incorporating the well formulated total you know package together so for example if you fail to utilize enough sodium in your diet your body is going to start wasting other minerals in an attempt to compensate right your kidneys are going to start secreting more aldosterone you’re going to start trading sodium for potassium you’re going to start getting into cramping and muscle icing all these sort of things so so basically it’s important to get enough salt right salt is a very important one but it’s also just important to pay attention to the overall you you know Jeff and Steve have written a wonderful book called the art and science of low carbohydrate living and I think it’s an appropriate title because there’s a lot of science that supports this but ultimately we’re still in the early stages of understanding how to apply this diet to people in the 21st century and and that’s where there’s just a little bit of art to it and frankly everyone is different I mean there are some people that I’ve worked with who have sailed into ketosis they never went through the problems I went in through and I went into and and there are others for whom it just doesn’t seem to work that well it doesn’t offer enough of an advantage over just a well-formulated low carbohydrate diet and for those people I just don’t think it makes sense so really customization and personalization matters more than anything right on your experience who should expect to gain a lot of benefits from a ketogenic diet very strict low-carb diet that if I knew the answer to that question I could do a lot more for people I have to be honestly I don’t know yet it’s I’m still in my own infancy of really trying to understand a priori who is going to do really well on this versus who is not I have picked up a few things within the athletic sphere athletes who are primarily aerobic tend to do better athletes who are primarily anaerobic don’t tend to do as well so if you are someone who is training for the 400-meter you know sprint or the 100-meter sprint or the you know 100-yard freestyle or something like that and that’s really your focus the ketogenic diet doesn’t seem to offer much for you if however you’re training for a marathon or a triathlon or something like that seems to be a much greater benefit you get from what I refer to as this metabolic flexibility this ability to operate at that sort of 70% of vo2 max for very extended periods of time in the presence of you know a very low RQ which means at an intensity where most people are primarily turning over to glycogen dependence you are still 70% dependent on fat oxidation as you get a greater endurance for example at the same yeah what you do is you basically avoid a lot of the metabolic problems that plagued athletes you know I’ve been a sort of ultra distance endurance person my whole life and one of the things I’ve noticed is many people fail metabolically they don’t fail because their cardiovascular systems aren’t grow bust enough to handle it so you know seven eight hours into a swim you’ll get a lot of people who you know sort of fall off a cliff and it’s because they’re failing at a cellular level they’re failing at a metabolic level they’re failing at an oxidative level they’re not failing because their shoulders are too sore they’re not failing because their heart and lungs can’t pump hard enough and so it’s it’s that very particular athlete and the same is true for the person who’s running the marathon or doing these other things there’s a huge advantage to this there’s a there’s another demographic that has found a real benefit from this and I happened upon this by accident working with some clients it’s the person who really places a premium on mental acuity I noticed this in myself but only as an afterthought because it wasn’t something I was actively looking for I used to constantly feel tired in the afternoons between the hours of about 3 o’clock and 6 o’clock in the evening I just wasn’t myself you know I wasn’t productive I didn’t quite have the same focus one of the things I noticed but again only after thinking about it in retrospect was once I completely eliminated glucose from my life that went away in fact as the day went on I seemed to get sharper usually as a result I suspected of my ketone levels rising and so I noticed this then and a couple of clients later on who said you know the most exciting thing is I don’t have to drink for Red Bulls a day anymore to stay focused at you know by 4 o’clock in the afternoon now you know I had one client who’s you know running a hedge fund so for him there’s nothing more important than being completely and maniacally focused on what’s going on in the markets 24 hours a day so he’s Brandon needs to work absolutely and you know he came to me after a few weeks and said you know it’s great that I’ve taken 3 inches off my waist and might have to take my blood pressure medication anymore but I don’t really care about that what I care about is that I have laser-like focus 24 hours a day and so you know again it really comes down to these trade-offs what matters to people I have a cool story about that if you want to hear it I love to the Swedish champion in memory memorizing you know 10 stacks of playing cards and stuff like that he’s got all the Swedish records in that and he’s ranked at one of the top memories of all time and he’s easily eating a strict ketogenic diet one is doing the competitions he very focused for a long time right like you’re that’s very interesting what you’re talking about yeah yeah so I think there’s something to this I think you know when you look at how narrow a band of glucose our brain kind of wants to be happy in and you imagine how difficult the task that is to balance with your own intake and hepatic glucose output in addition to all the gluconeogenic pathways going on find that it’s not surprising that if you could simplify that process and provide a different substrate for which you could guarantee a more even supply the performance should improve cognitive performance cool so M we’re going to talk more in a second interview but if people want to read more about your ideas and your thoughts on this I know they can go to your blog at the eating Academy what’s what’s the SD the URL is eating Academy comm exactly yeah eating academy.com and I’m going to put up a link below this video so thank you so much for this interview it’s really interesting stuff well thanks for making the time I really appreciate the opportunity to talk about this you

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