Kurt G. Harris MD

The PāNu approach to paleolithic nutrition is derived from clinical medicine and basic sciences disciplined by knowledge of evolutionary biology and paleoanthropology. The best evidence from multiple disciplines supports eating an animal-based diet high in fat and low in carbohydrates and cereal grains.

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PāNu Forum > PaNu for the underweight

Just wondering what your advice would be for those who desire optimal long term health, but would like to see weight gain, rather than loss.

I'm currently attempting to eat as high-fat as possible, get at least 100 grams of protein daily, and keep carbs around 100-150 grams. Unfortunately those carbs are often from grains and fructose, still. I am scared of losing pounds or body fat.


I am a 24 year old woman, 5'5" and 102 lbs currently. The heaviest I've been in my life is 106 when I was overeating purposefully huge amounts, mostly carbs, to the point where I was making myself ill. I count calories a few times per month because I am paranoid about weight loss, and get roughly 1800-2500 daily.

I haven't been in the 'ideal' weight range since I was 3. I look really skinny and have protruding bones. I also am quite muscular (for my size). I am active but don't really 'work out'. I walk a lot, enjoy yoga and like to sprint/jog sometimes and lift and carry heavy things.

I am also freakishly healthy. No health issues besides headaches/infrequent migraines (which seem to be much improved so far by low-carbing!!), regular and textbook menstrual cycle, I never even get sick.

I recently had a checkup and results were good. 19% body fat. Normal levels of most everything, lipid panel ideal by conventional wisdom (I would prefer higher overall cholesterol based on what I have read, but LDL, HDL and trigs were excellent), vitamin D was 40 which I am now on a mission to improve (must get more sun exposure and am going to take a supplement).

October 30, 2009 | Unregistered Commenterrhubarbarin

Forgot to add, I did not lose any weight from going from the standard American diet (sugar in everything, vegetarian, living on white flour), to the way I eat now. So if I took my carbs even lower, I suppose I don't have much reason to think I would..as long as I am eating a sufficient amount.

October 30, 2009 | Unregistered Commenterrhubarbarin

"I haven't been in the 'ideal' weight range since I was 3. I look really skinny and have protruding bones. I also am quite muscular (for my size). I am active but don't really 'work out'. I walk a lot, enjoy yoga and like to sprint/jog sometimes and lift and carry heavy things.

I am also freakishly healthy. No health issues besides headaches/infrequent migraines (which seem to be much improved so far by low-carbing!!), regular and textbook menstrual cycle, I never even get sick."


Sometimes how we think we should look/weigh does not match with what the body is. If you are healthy, then perhaps you may want to look at your self-perceptions in a different light.

October 31, 2009 | Unregistered Commenterj

maybe some strength training?
i am always surprised that peop who are so thin will have a pretty high fat % for their weight. but that's what a high carb diet will do for you even if you are underweight.
so, i'd think sticking to your lc plan, staying at the upper end of protein and not worrying about going over, and strength training.
sounds like you're doing well.

November 1, 2009 | Unregistered Commenterjem

I think it's pretty unusual for woman of any size to have very low body fat. Even people with EDs who are really abusing their bodies usually don't have very low body fat.. and you've probably read all the articles lately about smaller people with 30 or 40% bodyfat ('skinny fat').

I really hope eating low carb does not decrease my body fat %! I would actually like it a bit higher than it is for aesthetic reasons as well as health ones. A lot of people in this community seem to want to get theirs far under the usual recommendations, I don't know why. Isn't over 20% supposed to be ideal for women of all ages?

November 1, 2009 | Unregistered Commenterrhubarbarin

Living in a country full of obese people, we (underweight) are a minority and don't get much attention by medical community. How many of you heard 'You need to eat more'? Well, those who say such things do not have a slightest clue.
If I keep gobbling up steaks and butter and do not gain a pound then obviously there is something wrong with my body. It could be anything from weak stomach acid to malabsorption to minerals/vitamins/hormones imbalances to mental state, the number of variables is limitless. All the doctors I went to did not want to get into such details and complexity. They look at my blood test, it looks normal, they tell me I'm healthy just need to eat more, next patient please.
Here is my strategy. To get the most nutrients I look for most nutrient dense food, which is internal organs, fat, bone marrow from grass-fed animals. Of course, I consume these in moderation, mainly as a supplement to regular foods.
Next, I focus on my stomach. The quicker I feel empty after the meal, the better chances it got digested properly. If the food sits in the stomach for hours that's not a good start. You have to figure out for yourself which foods digest quickest and in which amounts and combination.
Next step is the absorption of nutrients in the small intestine. Unfortunately there are no indicators that would tell me how well my small intestine is functioning. Bloating and excessive gas are pretty much the only signs digestion is not going well. Testing stool to see how much undigested matter is in there is another was to confirm small intestine is not rock solid.
I experiment with various foods to see which ones give me the least bloating, gas, discomfort, and energy feel level. I am still searching for works best, as soon as I find out I'll let everyone know.
And one more thing, state of mind I think matters a lot. Placebo is called effect because it does work. Use it for your benefit.

November 11, 2009 | Unregistered Commenterys

rhubarbarin - How is your energy level? Have you ever had a thyroid profile done? Maybe you're hyperthyroid.

I too am underweight, and I also have low energy level. My bloodwork also looks great; low trig, high HDL, good Vit D, iron, Vit B12 levels, etc etc. The one thing I've discovered is that I'm not absorbing enough fat from my food, this was confirmed by way of a fecal fat test. My working hypothesis is that my small intestines have been damaged by years of grain consumption, and this is preventing me from absorbing fat from my food. I'm currently working with an Integrative Medicine doctor on this issue. He has me taking high doses of L-Glutamine 3 times a day.

L-Glutamine is supposed to help stimulate the intestines to produce new cells to replaced the damaged ones and it's also supposed to protect the new cells from damage. I haven't yet done my due diligence to research L-Glutamine and see if there is any scientific evidence to support this so I don't have any references to post.

So I guess what I'm saying is that you might want to consider being tested to see if your absorbing fat from your food, and if your energy level is good you may want to do strength training exercises. If you're doing any cardio exercises, cut back or eliminate those.

Also, there are doctors out there who do understand these things. I would do what you have to do to seek one out. It took me over a year to find one and he's "out of network" so I have to pay him out of pocket until I reach my deductible, but IMHO it's worth every penny.

November 11, 2009 | Unregistered CommenterCavePainter

good summary, thanks. what do you suggest for those with undigested stools, bloating, stomach acid problems. the only organs i eat are livers & hearts of chickens, all i really have access to. is there anything you have foudn to help with absoprtion?

November 11, 2009 | Unregistered Commentermallory

CavePainter, I used to take L-Glutamine for some time in the past but did not note any differences so I stopped. Please let us know your progress.

I have gained 2-3 lb in the past few months and now stable at around 112-114lb, before I was stable at 110-112.
I eat raw organs and fats from grass-fed animals. Meats I cook rare by broiling, that way it stays very juicy, and no need for oil or butter. I eat egg yolks raw, or I cook it sunny side up in butter, egg white is cooked, yolk is half cooked. I've been consuming raw organs and yolks for about 2 months now and have not had any diarrhea or food poisoning. Time will tell if this is a good practice or not. So far no negatives.

Mallory, I also found that smaller portions go down a lot easier. I eat 3-4 smaller meals instead of 2 big meals. Big meal will just in my stomach forever and gives heavy feeling. I also eat when I'm hungry. If I'm not hungry I do not stuff myself with food. I guess you have to experiment with different things as we are all different and what works for one may not work for the others.

Good luck to both of you.

November 11, 2009 | Unregistered Commenterys