33: Dr. Peter Attia | Finding The Diet That's Right For You

AIR DATE: November 1, 2012 at 7PM ETFEATURED EXPERT: FEATURED TOPIC: “Finding The Diet That's Right For You”

If you've been listening to my podcasts or read my blog for any length of time, then you've obviously heard me talk about one of the basic philosophies that I think is an important part of living a healthy lifestyle. Here it is: "Find a diet plan that is right for you, follow that plan exactly as prescribed by the author and then keep doing that plan for the rest of your life making appropriate tweaks along the way to keep it working." But how do you go about figuring out what the "right" diet and lifestyle plan is for you? That's what we'll be exploring further in Episode 33 of "Ask The Low-Carb Experts" with a highly-qualified guest expert named  (listen to my March 2012 interview with Peter in ).

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Here are some of the questions we addressed in this podcast:

RENEE ASKS:I have been refining what I think is my perfect diet for about 3 years now. During that time my diet has drastically changed for the better. I eat a very strict Paleo autoimmune diet with no dairy, nuts or nightshades. This has worked very well for me and now I am experimenting with a few little things here and there to tweak my diet that help me go from feeling good to feeling great. I am wondering about the cross-reactivity of coffee with gluten. I have heard that this can be a problem for some people, but I dismissed it because I didn’t want to believe that it can be a problem for me. But now I’m thinking that it IS a problem for me because after quitting coffee I started losing weight with no other changes in my diet. And it's not just calories because I replaced the coffee with a coconut oil cocoa that would have equal calories since I made my coffee into a coconut oil latte anyway. I know that gut issues are the minority of manifestation of gluten intolerance, so this effortless weight loss might be showing some type of healing. I also heard that a study came out early this year confirming that a coffee/gluten cross reactivity is a significant problem. What are your thoughts on this issue?

MICHAEL ASKS:I'd like to hear Peter address hypercaloric feeding on a ketogenic diet in combination with weight training. Is it possible for someone who is already basically lean and healthy to overeat and train his way up in size? What is the likely practical limit to size gain and performance in weightlifting with insulin levels being kept very low?

MIKE ASKS:I have found success stabilizing my weight on a diet of 20-30g of carbs per day. However, I can't seem to lose those last stubborn pounds. I am a 5'8" male and currently weight 160 pounds with 19% body fat. My goal is to get down to 15% body fat. I started monitoring my ketones and after a month was able to lose another 4 pounds and 1% body fat, but it was very hard for me to maintain the high percentage of fat in my diet required to get my ketones high enough. Recently I started slow lifting and I really like that program. But when I increased my protein to aid muscle development I knocked myself out of ketosis and am right back to the 19% fat, 160-pound mark. I suspect a hormonal problem is contributing to the difficulties in losing but I’ve tested my testosterone twice and both times it’s near the high end of the "normal range." Recently my TSH also tested fine at 1.9, my Free T4 Direct was in the middle of the lab range at 1.32, and my TPOab was also in the middle at 12. My Free T3 was on the low end of the lab range at 2.2 (with the lowest reference range being 2.0). Given all of the above, are there variations I could try in my diet that could get me unstuck and help me reach my goal?

MARYANN ASKS:I’m a 76-year old woman with the H63D gene for hemochromatosis and have high ferritin. My latest test was 436 and it goes up and down with an all-time high of 625. My doctors says that a phlebotomy is unnecessary unless it goes over 1000. I also have paroxysmal atrial fibrillation which I understand eating the Paleo way is the best for this. My A fib discussion board members say my ferritin is way too high now. What diet would you say would be the best for me?

TINA ASKS:I am 42 years old and have been overweight since having children in my early 20s. I am 5'4" and weigh 199 pounds. My A1c was 5.8 when I check it a few months ago and my doctor advised me that I’m at risk for Type 2 diabetes and that I need to start exercising 30 minutes per day. I have been playing around with low-carb/Paleo and primal diets for the past few months but I can't decide which way to go. I have read tons of information and listen to many health podcasts like the ones from Jimmy Moore, Balanced Bites and Fat Burning Man. Where do I start? I crave sweets at least once a day and that continues to be my biggest downfall. How do I pick the diet that’s right for me?

PALEOZETA FROM AUSTRALIA ASKS:I would like Dr. Attia to talk about intermittent fasting and…well, diarrhea. Sorry. About 10 minutes after I eat again following an intermittent fast, which works very well for me in conjunction with my ketogenic diet, I tend to have one or two bouts of diarrhea. I was reading that it could be our body expelling the toxins in it, but I’m not so sure about that. I’ve heard other people who do IF having this same issue. Do you have any insights about this?

JAN ASKS:I'm a peri-menopausal woman, and I eat a low-carb, high-fat version of primal. My doctor is pushing statins on me strictly on the basis of my LDL-C which registered in at 142 using the Freidewald Equation. My HDL is 79 and my triglycerides are 71. Because of my insurer and financial situation, getting an NMR Lipoprofile test to measure my LDL-P is out of my reach to better assess my risk factors. I can't even get them to do a C-Reactive Protein test to assess whether there's inflammation. Is there any dietary tweak I can make to bring LDL-C lower without negatively impacting my excellent HDL and triglyceride readings?

ERIC ASKS:It seems very timely that Dr. Attia will be on your podcast, Jimmy, as your latest Apo B results showing 238 and an LDL-P score of 3451 would appear to be quite alarming based on his recent “The Straight Dope On Cholesterol” series. Since Dr. Attia is a huge fan of ketogenic diets AND has a lot of knowledge about the importance of lipid markers, I would imagine he would be in a fantastic position to help clarify what is going on here. He seems to believe that the Apo B number is one of the most important markers of cardiovascular health. By the way, what is Dr. Attia’s Apo B number?

JACK ASKS:Since cycling is a topic that is rarely addressed in Paleo/low-carb circles, does Peter have any tips for maximizing endurance athletic performance while on a ketogenic diet? Whenever I try to do cycling while in ketosis, I often feel fatigued and lose some of my power. Alternately, if I eat a lot of carbs and sugar-laden cycling food, I get stomachaches and feel bloated and grouchy most of the ride. Peter's blog has been the only thing I've ever seen talking about this topic and I’d appreciate hearing more from him about this.

ROGER ASKS:Does a ketogenic diet repair or re-regulate an underactive thyroid? I’ve been on this diet for a year and a half now, but my hypothyroid symptoms still exist although I feel much better. My latest blood tests suggest I have low T3. I’m athletically built, never been overweight and exercise moderately. I’m wondering if Dr. Attia is a proponent of doing any thyroid supplementation in conjunction with a ketogenic diet as a beneficial approach to treating these hypothyroid symptoms?

MICHELE ASKS:I heard you mention on your previous podcast with Jimmy that you use vegetables as a vehicle for consuming more fat. How important are vegetables in the diet if you’re eating a high-fat, low-carb diet? I always get confused because you hear how important it is to eat a lot of vegetables but I’m not particularly fond of a lot of them when trying to increase my ketones.

TOM ASKS:We often hear the phrase used in the low-carb community that “there’s no dietary requirement for carbohydrate.” I’ve always assumed this comment was directed at the usual suspects like breads, cereals, pastas, legumes, etc. However, I have to ask, are vegetables really necessary to consume? In my case, I’m referring to non-starchy vegetables, such as kale, Brussels sprouts, cauliflower, and so forth. While vegetables contain vitamins, nutrients, fiber, and phytochemicals, I’ve read that cruciferous vegetables are also potentially goitrogenic. Cooking these vegetables for long periods of time supposedly helps to mitigate any deleterious effects, but the suggested cooking time is a minimum of 30 minutes. So what’s the scoop on veggies?

DARREN ASKS:Over the past year and a half, I've been following a low-carb diet stopping short of nutritional ketosis. I'd put my daily carbohydrate input close to 100g out of a 2700- calorie diet. It has allowed me to accomplish and exceed the goals that I set out to do:

- Lowered my Triglycerides from ~330 to <70- Decreased my A1c from 5.8 to 4.7- Reduced my fasting blood glucose numbers- Shed over 35 pounds off my body

During that time, I've been reading as much information as I can about a low-carb lifestyle. Looking at the best low-carb diet studies that I have seen, most are centered on ketogenic diets and clearly show the benefits of that lifestyle. And yet it seems there are still many questions about nutrition that are either unanswered or do not have answers backed by solid science. Should I be concerned about any long-term health risks from my diet falling short of ketogenic levels? Will your NuSI project be focusing primarily on a strict ketogenic lifestyle or a variety of diet plans across the spectrum? And are there any specific tests that I need to run on myself before, during and after if I wanted to do an n=1 experiment of getting into nutritional ketosis?