In 2009, like many other Americans, Peter Attia became overweight and started developing metabolic syndrome, which indicated he was at risk of developing diabetes, heart disease and stroke. However, he was a fit man who exercised several hours a day and followed a healthy diet. Fortunately for Peter Attia, he was also a doctor and was able to investigate his new problem.
What Peter discovered will hopefully change the way we all think about food and health. If it leads to radical government intervention then there really may be a possibility of reversing the obesity crisis.
“Maybe we have the cause and effect wrong on obesity and insulin resistance” – Peter Attia, TED Talk.
His recent TED Talk has raised the question once again – what is a healthy diet? In his talk Peter got rather emotional at the end. This is certainly a subject that he feels passionate about. His talk is embedded and linked at the bottom of this page – you absolutely must watch it.
How His Journey Began
Peter Attia studied medicine at Stanford Medical School and then was a general surgeon at Johns Hopkins Hospital while also studying surgical oncology (surgical treatments for cancer). Later he joined a private firm, McKinsey & Company, working as a health consultant. He thought that he fully understood the relationship of diet, exercise and body weight.
However, in 2009, he was exercising for several hours a day, and also followed a healthy diet, at least one that was supposed to be healthy – following the food pyramid guidelines. His diet was pretty much a typical athletes diet with plenty of carbohydrates and protein to fuel muscles and aid muscle repair and growth.
However, he gained weight and developed stomach fat in particular. He had also developed metabolic syndrome. This made no sense. He had spent years blaming other overweight people for being lazy and not bothering to eat healthy or stay active, and suddenly he was gaining weight and showing early signs of chronic disease. It simply made no sense – at least no sense based on conventional health advice.
Peter Attia made it his mission to discover why was he gaining weight and becoming unhealthy. He had a family history of chronic disease and heart disease, so it was essential that he resolved his problem.
Radical Change in Diet
Peter started making some changes to his diet. The changes were actually slow, gradual changes, but over the space of a couple of years his diet had developed and become something almost unrecognizable to his old athletics diet.
He decided to adjust his diet for very specific reasons, and he classified these as defensive and offensive. The defensive reasons were to reduce risk of chronic disease, including heart disease, stroke, diabetes, cancer and Alzheimer’s. The offensive reasons for change were to increase his energy levels, improve cognitive function, improve body composition (less fat, more muscle) and improve physical performance (be a better athlete).
Peter explained his 4 key dietary changes as follows:
September 2009 – I eliminated most sources of sugar six days per week. One day per week I let myself eat whatever I wanted.
February 2010 – I switched all white sources of carbohydrates to brown sources whenever possible (e.g., brown rice over white rice, brown pasta over white pasta), switched over to carbs that were higher in insoluble fiber, and eliminated sugar altogether.
January 2011 – I reduced starch intake to one serving per day, but continued to eat fruits and vegetables in an unrestricted manner.
May 2011 – Reduced carbohydrate intake to less than 50 grams per day and reduced protein intake to approximately 120 grams per day, entering a state of nutritional ketosis.
In short, he reduced the amount of carbohydrate he was eating. At first he stopped relying on “staples” to get his energy. Energy foods (carbohydrates that are converted to glycogen) came from fruits and vegetables, not bread and pasta. However, he now eats a lot of fat and very little carbohydrate. He now believes that carbs are not so important for athletics as previously thought – when he tested his physical fitness it was remarked that his aerobic efficiency had improved dramatically – the tester said that is was “Like nothing I’ve ever seen before”.
Peter Attia’s Diet Rules For A Lean and Healthy Body
However, it does not end in 2011. On the page What I actually eat, part II – “IFIK” (circa Q3 2012), his diet has changed a lot again – less dairy, less meat, more vegetables and fruits.
- Reduce (ideally, eliminate) all sugar consumption in the form of sucrose and high fructose corn syrup. Read labels, avoid sugar. Avoiding all ready meals and processed foods is a big step to achieving this goal.
- Swap “simple” carbohydrates for “complex” ones. Less bread, more low GI vegetables.
- Limit fruit to 1-2 servings per day, avoid any dried fruits (e.g., raisins, dried mangoes, and the like), and don’t drink any fruit juice. Fruit is good, but too much fructose (natural sugar in fruit) is bad.
- Reduce overall carbohydrate intake to one serving per day.
- With each step above, increase your intake of fat (over protein or other carbohydrates).
Eat more eggs, cheese, nuts, avocados, olive oil, coconut oil, bacon and fatty meat over lean meat, high fat over low fat yogurt.
Example Eating Plan
This is a sample of Peter Attia’s diet for 3 days in 2012. As he states on his website, this is not how he eats all the time, not how he eats now. His diet is constantly changing, he modifies it based on his needs (to lose fat, to gain muscle, to reduce health risk factors). Consider this before diving in. But by all means, if it is healthier than you are used to, dive in!
Day 1
- 7 am — morning workout – flat intervals on bike (75 minutes).
- 1 pm – Nicoise salad:
2 cup butterhead lettuce, 1 tomato, 10 black olives, 8 oz tuna steak, 1 hard boiled egg, 0.5 cup red onion, 2 oz lemon juice, 4 tbsp olive oil, 1 tbsp mustard. - 7 pm – Chicken salad with nuts:
2 cup romaine lettuce, 1 tomato, 0.5 cup cucumber, 2 oz cashews, 2 oz walnuts, 8 oz chicken breast, 6 tbsp olive oil, 2 tbsp balsamic vinegar.
Daily totals:
- Carbohydrate – 89 gm
- Protein – 131 gm
- Fat – 218 gm (about 15% SFA, 70% MUFA, 15% PUFA)
- Calories – 2,900
Day 2
- 6 am – morning workout – high intensity dry land (90 minutes).
- 3 pm – The “Peter Kaufman shake” (named after my good friend, Peter Kaufman at Generation UCAN, who hooked me up with the recipe):
4 oz heavy cream, 8 oz zero-sugar almond milk, 1 pack chocolate protein SuperStarch, 2 tablespoons almond butter, 8 gm additional glutamine, 1 tray of ice cubes (blended to smoothie consistency). - 7 pm – Chicken-nut omelet:
4 eggs, 0.5 avocado, 3.5 oz cheddar, 3 oz red onion, 2 oz walnuts, 2 oz cashews, 4.5 oz chicken thigh, 2 tbsp butter
Daily totals:
- Carbohydrate – 60 gm (30 gm of which is SuperStarch)
- Protein – 151 gm
- Fat – 226 gm (about 40% SFA, 35% MUFA, 25% PUFA)
- Calories – 2,800
Day 3
- 7 am — morning workout – hill intervals on bike (75 minutes).
- 5 pm – Attia super salad:
1.5 cup romaine lettuce, 0.5 cup cucumber, 0.25 cup mushroom, 1 tomato, 3 oz sliced T-bone steak, 2 oz cashews, 2 oz peanuts, 2 oz macadamia nuts, 8 tbsp olive oil, 2 tbsp balsamic vinegar. - Between 6 and 8 pm – after-dinner snack consisting of:
3 oz cashews, 1 oz almonds, 2 oz peanuts, 1 oz macadamia nuts, 2 cups of coffee with a total of 6 tbsp heavy cream.
Daily totals:
- Carbohydrate – 94 gm
- Protein – 93 gm
- Fat – 369 gm (about 20% SFA, 65% MUFA, 15% PUFA)
- Calories – 3,800
Thoughts and Quotes from Peter Attia:
“Despite everything I once thought, and all of my medical training, and all my obsession, I failed to appreciate that obesity is a disorder of fat accumulation, not a disorder of eating too many calories.”
“Just modifying your diet by elimination of sugar, less total glucose load, and improved omega-3/omega-6 profile — even if you are not genetically programmed to be lean, will probably deliver 80% of the value in terms of disease risk and body composition.”
Our Thoughts
This is certainly a major shift in dietary opinion. Or is it? Dr. Atkins was saying pretty much all of this over 40 years ago, and many people lost weight, reduced risk of chronic illness and became fitter and healthier as a result. However, in time the mainstream media managed to discredit his work and his name, and suddenly Atkins was bad again.
However, we still favored Atkins, simply because the risk factors associated with it are no worse than the risks of not reducing weight. If you are on the path to metabolic disorders, diabetes, heart disease and stroke already, putting your head in the sand is not going to help. Some action is needed, and Atkins developed his diet plan specifically to help patients who had diabetes.
However, in time there was a shift back to following a moderate and balanced diet. In recent years there has been a big rise in advocates of primal dieting / caveman / paleo dieters. All of these follow the same rules – no refined carbs, few natural carbs, lots of meat, lots of fat. While they are effective, there was always the risk of high quantities of saturated fat, something which everybody knows is bad for us. Today you will still be hard pressed to find any doctor who would recommend following such a diet. However, these small case studies suggest that some people, certainly not all, need to eat very differently from the norm. And, as the trend for being overweight continues, it seems that many more people are becoming at risk.
Only last week the American Medical Association (AMA) declared obesity a disease. It seems that there is a shift in attitude towards diet and health. If obesity is a disease, and not just a symptom of eating too much, then a treatment is needed. And it appears that the best treatment is not more exercise and a balanced diet, but more exercise and radically less sugar and carbohydrate. It seems that Dr. Atkins was right all along. Why did we stop listening?
Other research has successfully shown that all diet plans are equal, when they are followed. However, the research was never carried out on those who were suffering from metabolic disorders. The Atkins approach was never designed for the average person, but for those who are already suffering from a metabolic disorder and are overweight.
However, as we mentioned in our article on Sugar, Carbohydrates and Your Health, some research has shown that women are at greater risk of heart disease if they follow a low carb diet. What works for one person, or one man, may not be ideally suited to everybody, and not to both genders. The jury really is still out on the whole low carb eating debate.
While we are not saying that you should go on the Atkins diet, or follow Peter Attia’s diet, if you are overweight in spite of exercising and eating healthy, then you really do need to critically examine your whole diet, and start looking to make changes for the better.
The same reason still applies for all who are overweight: You are overweight because you eat too much of the wrong food. The trick is to determine what the wrong food is and remove it from the equation.
The Future?
In 2012 Nature magazine published an article about sugar, and in this article they summarized:
Sugar consumption is linked to a rise in non-communicable disease
Sugar’s effects on the body can be similar to those of alcohol
Regulation could include tax, limiting sales during school hours, and placing age limits on purchasing
We recently reported how Salford Council in the UK proposed changes to stop the sale of junk food to children. Maybe things are finally starting to change for the better.
The TED Talk
Peter Attia: Is the obesity crisis hiding a bigger problem?
Source: www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html
References and Further Reading
By Peter Attia, Eatingacademy.com:
- What I actually eat (circa Q4 2011) –
- What I actually eat, part II – “IFIK” (circa Q3 2012)
- How did we come to believe saturated fat and cholesterol are bad for us?
- How do some cultures stay lean while still consuming high amounts of carbohydrates?
On Diet, Metabolic Syndrome and General Health
- Metabolic syndrome – NHS Choices
- Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later by John A. Morrison et al, 2007
- Is visceral obesity the cause of the metabolic syndrome? By Jean‐Pierre Després, 2006.
- Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease by Richard J Johnson and others, 2007.
- Public health: The toxic truth about sugar by RH Lustig and others, Nature, 2012.
- Sugar, Carbohydrates and Your Health by Jon Wade, Motleyhealth.