Kurt G. Harris MD

PāNu means paleonutrition. The "paleo" here signifies "old" and not necessarily paleolithic. The PāNu approach to nutrition is grounded on clinical medicine and basic sciences disciplined by knowledge of evolutionary biology and paleoanthropology. The best evidence from multiple disciplines supports eating a pastoral (animal-based) diet rather than a grain-based agricultural one, while avoiding what I call the neolithic agents of disease - wheat, excess fructose and excess linoleic acid.

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Thursday
Aug272009

How to Lose Weight

Let's see if I can write the world's shortest description of everything you can do to lose weight. OK, you'll have to read some of the rest of the site to make sense of it, I suppose. But it will still be pretty short.

PaNu is not a weight loss program. It is a healthy eating regime that also happens to be the most powerful and simplest (not easiest, necessarily) regime that I have encountered to achieve your genetically determined normal lean body weight. Being at a particular weight is simply evidence of a having a healthy metabolism, and should obviously not be a health goal in itself. 

If you have trouble losing weight following the first 4 or 5 steps, you may have what I unscientifically call a "broken metabolism".

If you have a broken metabolism, with stubborn residual insulin resistance (liver, not adipocytes), or your leptin receptors are screwed up by WGA from wheat and your satiety switch is broken, or any of a number of theoretical metabolic derangements from years of eating the standard american diet, you may have trouble losing weight without going VLC (say 5-10% carbs) and you might indeed gain weight if you eat excess protein beyond your needs.

The extra insulin response to excess dietary protein may simply drive more fat storage. I would not expect this in most people, but it may happen in some. See this.

What to do?

If you can't lose weight and you need to, you must cut carbs until you have ketones in your urine. Ketones in your blood is ketosis. Ketones in your urine is ketonuria. Ketonuria is proof of ketosis. GNG (gluconeogenesis) and ketosis is the sure way to prove your insulin levels are low as you can get them.

Then, as dietary fat has the least effect on serum insulin, and dietary protein has a small but measurable effect, eat only the minimum necessary protein (.8 -1 g/Kg/d) and the rest as fat.

5% carbs should guarantee GNG and ketonuria. (This will mean almost no vegetables and no sugary salad dressings, etc. Your food must be naked except for healthy fats) 

15 -10% protein (drop it as you adapt)

80-85% fat

This, by the way, is ridiculously easy to achieve if you use butter and cream, but a bit impractical otherwise. This is close to Kwasniewski's Optimal Diet. Read the book.

A few more things not mentioned by Kwasniewski but that I think are important:

It is helpful to absolutely eliminate fructose from your diet if you have any issues with weight. The SAD (standard american diet) has absurdly high amounts of fructose that destroy your liver's insulin sensitivity. Fructose may be the single biggest cause of broken metabolism.

The second biggest (or maybe first, who knows?) cause of broken metabolism may be gluten grains. Wheat germ agglutinin (WGA) binds leptin receptors and insulin receptors, in addition to nasty effects on the immune system and gut. So even if you have no immunologic issues like celiac disease, and you don't believe like I do that almost everyone has subclinical damage to the gut from gluten grains, wheat may be making it harder for you to lose weight by affecting your satiety switch and by directly causing fat storage.

Excess Omega 6 linoleic acid ("the third horseman") probably also has an effect on weight loss, as there is evidence that excess n-3 linoleic acid contributes to the inflammation in the liver that is part of metabolic syndrome. Just one more reason to keep industrial vegetable oils limited.

Stick to white rice and potatoes if you absolutely must eat starch. No wheat, barley or rye.

Try eating one big meal a day to satiety, then allow yourself nothing but decaf coffee with whole cream or fast the rest of the time. I eat like this about three days a week. It is really easy once you are keto-adapted*

It is, I believe, easier to go cold turkey from carbohydrates than taper off. Teasing yourself with cereals and bagels is more difficult than simply enduring a few days of nausea or hypoglycemia. Just carry a container of sliced oranges or apples and eat a slice if you are hypogycemic. (Yes, there is a bit of fructose there, you are just eating it while you adapt to ketosis) Totally avoid grains and starches. Use fruit for emergencies. It will pass.


*I define keto-adapted as being conditioned enough to ketosis that you can easily fast without getting light headed or hypoglycemic. I think VLC (50g) or ZC (5-10 g) folks are all ketoadapted. LC (100g/day carbs) not as much. Even if not in ketosis all the time, KA folks can slip in and out of it easily and their metabolism has all the machinery for ketosis and GNG constructed. Caution: metabolic speculation informed by experience.

 

Reader Comments (29)

Thank you so much for taking the time to answer these questions on metabolism and weight loss within the context of the panu approach. I appreciate that you define LC, VLC and ZC in terms of actual quantities per day.

Excellent blog!

August 27, 2009 | Unregistered CommenterSatya

Kurt,

Thank you once again for posting something of the highest quality.
I thoroughly appreciate you "spelling it all out" in a easy to understand format.

Marc

August 27, 2009 | Unregistered CommenterMarc Feel Good Eating

I am one of those individuals with a broken metabolism and have been eating as you say for a couple weeks now. The extra weight is dropping off, easy as pie.

My dear partner, on the other hand, is eating this way but with the addition of artificial sweeteners (mostly sucralose with a little stevia). His weight is not budging, much to his frustration. Obviously our experiences do not a study make, but I thought you might be interested to hear it. I think I remember reading in your blog before that you had observed this sort of thing in your patients before.

I agree that it is much easier to go cold turkey, too. For me, any small amount of fruit or veg creates enormous cravings that are more difficult to resist than the standard cravings. I have had quite a bit of nausea but it is worthwhile to be off the roller coaster.

August 27, 2009 | Unregistered CommenterGwennie

Any more info on how to track down Kwasneiwski's Optimal Diet?

Did a quick search on Google and Amazon and couldn't find it...

August 27, 2009 | Unregistered CommenterAndrew

Perhaps we should add the optimization of fiaf to the list?

From Peter's article fiaf also influences the activity of HSL.

Eliminating harmful gut bacteria still seems to be an area where zero carb could have an advantage over other restriction plans. What do you think Kurt?

http://high-fat-nutrition.blogspot.com/search/label/Fiaf%20%281%29%20Who%27s%20fat%20is%20it%20anyway%3F

August 27, 2009 | Unregistered CommenterDanny Roddy

Thank you Dr. Kurt, this is a fantastic, succinct summary. Love your whole PaNu concept.

Gwennie: A lot of people, including me, have an insulin response to anything tasting sweet so any kind of sweeteners, whether they have calories or not (artificial, stevia, sugar alcohols, etc.), are problematic. In fact, some people can have a surge of insulin released just from smelling food!

Andrew: Here is the website for Kwasneiwski's Optimal Diet: http://homodiet.netfirms.com/

August 27, 2009 | Unregistered CommenterRandy Evans

Satya and Marc

thank you

Gwennie

I should have added don't eat anything at all that tastes sweet. I have posted elsewhere about sweet flavors evoking insulin and it definitely conditions you to crave fructose and it stimulates your appetite

Hang in there the nausea will abate soon.

Andrew see randy's link below

Randy

thanks for the K link you beat me to it

Danny

I am trying not to clutter up the posts with too much biochemistry by mentioning every hormone (even when I can remember them all), but yes, that may be an additional benefit to making sure that undigested carbs don't get to your colon. This obviously won't happen on ZC but also won't happen on LC or VLC as long as everything is absorbed in the small bowel and you go easy on the fructose.

I find simple sugars don't bother me but starches in even moderate amount give me gas.

August 27, 2009 | Unregistered CommenterKurt G. Harris MD

A more specific link for Kwasniewski

http://www.wgp.com.pl/index.php?id_s=143&id_j=en

August 27, 2009 | Unregistered CommenterKurt G. Harris MD

Hi Kurt,
ok, fructose is bad/unhealthy...but could you say something about fruit? In fruit there is of course also fructose, so should we stop eating fruit? In case of wanting to loose weight, but also for staying healthy?

August 27, 2009 | Unregistered CommenterGeorge

George

At low levels of carbs, say below 10%, sucrose (1/2 fructose and 1/2 glucose) is a more sensible source of a quick small bolus of carbohydrate than something with wheat in it.

At very low levels of consumption, sucrose is healthier than white flour, in my opinion.

You can't cook a baked potato too fast if you are hypoglycemic.

I suppose you could use a rice cake.

Once you are no longer hypoglycemic, you can stop eating fruit altogether, or just eat a little bit with whipped cream like I do. A handful of blueberries has hardly any sucrose.

Are there any real health benefits to recommend eating fruit?

No.

And I don't care what you read in the paper or read on MSN health.

August 27, 2009 | Unregistered CommenterKurt G. Harris MD

kurt,
could you comment on this post, over at primal wisdom?
http://donmatesz.blogspot.com/2009/08/nutritionally-complete-inexpensive-low.html

especially re trace nutrients, minerals, etc.

thanks, and thanks for all the work and thought going into the blog.

August 27, 2009 | Unregistered Commenterjeff klugman

Thanks very much for sharing your advice.

I had a few clarifying questions:

1. Its easy to measure whether ketonuria is occuring. If it happens at e.g. 15% carbs is it still necessary to go down to 5%?
2. Why specify carbs as a percentage, rather than absolute amount? (e.g. 20 grams per day) Would eating more protein or fat increase the allowable amount of carbs?
3. Does the amount of ketones observed in the urine matter or is it just present vs. not present?
4. When we calculate the daily protein target, should we add 75g for GNG (so its ~1G/KG + 75G)?

Thanks much!

Andrew

August 28, 2009 | Unregistered CommenterAndrew

Hi Kurt,

Why would eating excess protein cause fat gain? Doesn't the role of glucagon prevent this?

August 28, 2009 | Unregistered Commenterfred hahn

Fred

I am not sure where this idea comes from, that there is a certain fate (or prohibited fate) to excess amounts of either fats, proteins or carbohydrates.

For now, a few thoughts.

I can't conceive of how "the role of glucagon" can prevent excess calories from being stored as fat if fat is otherwise beng driven into storage.

Does glucagon generally oppose insulin? Yes, but so what? So does virtually every other hormone.

Briefly, eating excess calories from any source will make you gain weight if hormones are driving fat storage, and won't otherwise. Whether the caloric excess is protein or fat or carbs does not matter if your adipocytes are storing fat under hormonal direction.

I never said excess anything would cause fat gain, only that it could under the right circumstances. Obviously within ranges excess anything can be tolerated without weight gain, even if it is carbs.

You can give a type I diabetic all the carbs you want, and without exogenous insulin they lose weight.

Conversely, if I keep your caloric intake the same with zero carbs and you are not diabetic, and I give you extra insulin, you will start storing fat (stop releasing) and become ravenously hungry. If I don't let you eat more, you will then get lethargic and your metabolic rate will decline. You will now be fatter, slower and eating the exact same calories.

Under the right (or wrong) hormonal milieu, it matters not a whit if the extra calories are fat, carbs or proteins.

Macronutrient ratios mediate weight via hormones. Hormones drive fat storage.

August 28, 2009 | Registered CommenterKurt G. Harris MD

Dr., using your percentages there, I calculate that may daily caloric intake would be close to 4000 calories. Is that what you would have expected?

August 28, 2009 | Unregistered CommenterKevinC

Hi Kurt,

I have read a lot in blogs about ketosis and the benefit of low carb eating. I find your blog especially informative, and this post has me wondering something:

When I was pregnant (7 years ago, with my youngest), my urine was checked at every doctor's visit. There was one day when I hadn't eaten in the morning and was rushing around. I was admonished and warned that I should avoid getting to the state of ketosis because ketone bodies would be harmful to me, and especially to the baby. I happened to be taking a nutrition class, so I knew what ketones were, but I couldn't understand why they were a danger to my system. (They also warned me against the whole milk I was drinking, insisting I should drink 1% or skim (ugh), but that's a whole 'nother story.)

I'm planning on getting pregnant again -- in a month or so -- and although I am not following a VLC diet, I have been limiting my carb intake, especially fruit, sugar and grains. I'm doing pretty well, and have even lost some weight over the past few months. However, I'm wondering if ketones are in fact something to be concerned about. No, I do not plan on trying to lose weight while pregnant. Far from it. I would like to ensure that baby and I get all the right nutrients -- which I believe is plenty of good fat along with protein, greens, dairy and cheese. Oh I love cheese and yogurt and butter and cream!

Can you maybe shed some light on this for me? Is there any situation in which ketone bodies are harmful?

August 28, 2009 | Unregistered CommenterKdbuttongirl

After going low carb 20 months ago, I saw good weight loss for about 8 months, then it stagnated, until recently. What seems to be working now is upping my weekly running mileage (50-65 mpw, mixed aerobic and hills), fasting for a longer period of each day, and cutting back on carbs after running (I usually eat about 100g eventually). I can’t seem to maintain my weight now (not that I’m complaining!) even though I don't feel like I have a big calorie deficit.

I got the idea from Robb Wolf (his posts this summer about post workout fueling and leaning out). I think keeping carb replenishment low and delayed helps alot with losing weight (muscles stay very insulin sensitive for longer which keeps blood sugar and insulin low). The extra mileage seems to have pushed me into calorie deficit again, but going heavy on protein and fats and veggies seems to help me recover enough each day to go do it again (and not get sick). Restricting carbs makes it harder to do anaerobic work like tempo or interval running or hills, but on the other hand, it really helps your body focus on aerobic energy production - it’s like going for a long run after you lifted weights or did an interval workout and are depleted of glycogen. Of course, if you do less exercise, you will need even less carbs to replenish sufficiently (we certainly don't need to go around fully loaded all the time).

Thanks for your posts. You do a great job!

August 29, 2009 | Unregistered CommenterCynthia

Cynthia,

Are you an endurance athlete (i.e. love running and can not get enough of it), or are you running for health reasons? If it is the latter, STOP running. Start walking, sprinting, and occasionally beating the crap out of the weight room. Even though eating Paleo is the most important thing in being healthy, exercising the right way also plays a role. And you don't want to only go 75% of the way.

September 1, 2009 | Unregistered CommenterChad

Dear Dr Harris

I am in great need of your advice. I weigh 365 pounds and am only 5ft 3. As you can imagine, my life is very poor, so please help me. I definitely have overabundant insulin. (I know this as I have reactive hypoglycemia -- if I drink, say a glass of ornage juice on an empty stomach, I go into a trembling fit, get blurred vision etc.) I tried Atkins but cannot shift the weight at all, so now I am on zero carbs. Been doing this 2 weeks and am in mild (pink) ketonuria according to the Ketostix. I'm eating about 16oz meat a day, water and nothing else.

I used an online calculator to work out my protein intake according to what you wrote on this page. I find it is less than 6oz a day! Have I made a mistake in the calculation? Six ounces does not seem much to eat in a whole day when you are 365 pounds. If that is correct, can you tell me please in what form can I eat sufficient fat to kill my appetite? I mean, I cannot imagine eating spoonfuls of lard or butter.

I'd be extremely happy if you would email me and give me advice. I am over 50 and this is my last chance to avoid becoming bedridden like those ladies you see on TV.

Helena

September 5, 2009 | Unregistered CommenterHelena

Helena

The main reason to eat fat is to keep you from eating excess carbs. Eat only enough fat to satiate you.

I recommend you read the recent post "how to lose weight"

You are on the right track and if your urine is positive for ketones you should lose.

Breakfast- cream in your coffee only

Two or even one meal a day is best.

read my response to your other post

6 oz is 170 gram of protein. if yo are zc, 70 grams goes to glucose through GNG, you probably need at most 60 for structural maintenance and that leaves excess of about 40 g. More than enough protein.

You can stay with ZC but why not eat some eggs, butter or fatty fish for variety - they also have no carbs?

Where does the "meat and water only" thing come from?

September 5, 2009 | Unregistered CommenterKurt G. Harris MD

Thank you for the replies. I have indeed read this How To Lose Weight thread, several times, which is where I got the 6oz of protein a day from. I've also read many other pages on this site, and hundreds of other pages on the subject of ZC. While intelligent in my own field, I am not a scientist and find the biology/chemistry talk very complicated, confusing and difficult to comprehend and remember. I need things to be phrased to me in such a way that I can understand them. I simply cannot understand what Andrew is trying to tell me in his post. When he says you are confused does he mean me or Dr Harris? I am truly lost. Please dumb things down for me -- it may be the only way to make me understand.

Dr Harris asked but "why not eat some eggs, butter or fatty fish for variety". I do. I was writing in shorthand to keep my post short and to the point. But it all amounts to the same thing: how many oz of protein should a person who weighs 365 be eating to ensure rapid weight loss?

I do not drink coffee. I have cream in the fridge and take a sip from time to time.

So I am still confused about the 6oz. Are we saying that I should restrict myself to 6oz of protein a day or not?

I apologise again for my ignorance and my need to have things put into very simple language (I come from a broken, alcoholic home and my parents didn't educate me.) But although I am ignorant of science, I am really very desperate to lose this weight.

September 7, 2009 | Unregistered CommenterHelena

Helena

Personally, If I were trying to lose weight and not allowed any carbohydrate, and I had your lean body mass at 5' 3'', I would eat about 170g a day protein (protein content not ounces of meat), and enough fat at the one meal to satiate me and no more.

If I had uncontrollable hunger while fastiing, I would drink decaf coffee with bit of whole cream in it. A good "zero carb" alternative to that is Tibetan tea. Hot tea with melted butter in it. (Yak butter is best..I am kidding of course)

I would not eat a big meal 2x a day.

I would have my thyroid function and vit D status checked, working with my local doctor.

September 7, 2009 | Registered CommenterKurt G. Harris MD

I don't think I've ever seen an explanation anywhere as to why ketosis causes lack of appetite. Maybe this isn't true for some folks, but it is discussed pretty frequently on the low carb forums (?fora), so iit seems fairly common.

Is it "bottomed out" insulin levels? Something to do with body fat metabolism? When I switched to LC and lost my weight, the reason it was so painless was because I had no appetite, and I think I was in the range of 25-50 grams of carbs a day. Indeed, I had to push myself just to eat about 500-600 calories a day.

I just wondered what the chemical process is that could cause this phenomenon.

Thanks for everything you are doing for us! ~ Molly :-)

September 7, 2009 | Unregistered CommenterMolly

Thanks for the reply Dr Harris.

I'm desperate and therefore very grateful for any help.

My thyroid was checked about ten years ago sience when my GP won't do another test, saying IF I was low thyroid I would be cold all the time etc, but I have no symptoms. Vit D I can of course take in a pill.

I am assuming that the reason for one meal a day instead of two is to give my body time to fast, during which it will HAVE to draw on its own fat reserves - sorrect?

September 9, 2009 | Unregistered CommenterHelena

PS I don't drink coffee of tea, but I could have a cup of hot water with coconut oil melted into it, or just sip double-cream.

September 9, 2009 | Unregistered CommenterHelena

Helena,

Cut your daily protein intake by 40 grams. Take in no more than 130 grams/day. Preferably in one meal. Then drink as much cream as you need to avoid being hungry.

Try this for one month and let me know what happens.

October 4, 2009 | Unregistered CommenterBob Jones

Helena,

As Bob suggested, you might try cutting back on the protein, and eating more fat. I know it sounds counter-intuitive, but I think it helps. In some people, eating protein causes insulin to be released, which in turn drives calories into body fat. One thing to try is eating egg yolks only (eliminate the high-protein whites), maybe with a little cheese and butter. A high-fat, low-protein, low-carb snack I like is cream with a little chopped 85% chocolate and some cocoa powder.

October 18, 2009 | Unregistered CommenterAce

>>> Why would eating excess protein cause fat gain? Doesn't the role of glucagon prevent this?

I'm no biochem major, but my understanding is that in humans (unlike many other animals, especially rats / mice) glucagon's action is largely limited to the liver

I can't easily find anything that specifically says this, but if you parse out the wikipedia page you'll note it mentions no effects of glucagon on any other tissue. As opposed to the glucagon-released glucose, which goes to most tissues. Same with the other article linked below

http://en.wikipedia.org/wiki/Glycogen

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B8CXB-4P2JN6G-B&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1087257164&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b8aa58bf443f63a42af846b1a326a62a

Another reason rodent diet studies are next to useless in people.

this may be a good place to start if you have some time
http://www.google.ca/search?hl=en&safe=off&num=100&q=human+glucagon+%22only+in+the+liver%22&btnG=Search&meta=&aq=f&oq=

KGH:

I think you may be envisioning hormonal action as an on-off switch. Think in terms of equilibria. If excess protein can be converted to glucose, and there is more than enough GLu, aas and fatty acids than we need for energy, why can't some of it be stored?

If it were impossible to store fat in such a situation, you would keep losing body fat until you had none because fatty acids are always being liberated. You are storing fatty acids all the time. You only gain fat if you store more than you liberate. Insulin acts in balance with many hormones, including glucagon to affect the balance. None of them "prevent" anything.

Say you have been starved against your will. You have 4% body fat. I then let you eat all you want of a diet that is 80% fat and 20% protein. Do you seriously believe you would not gain weight up to what your genome prefers, including up to 10-12% body fat?

You don't need biochemistry to see how silly some of these "Zero Carb" teachings are. Simple logic will suffice.

November 10, 2009 | Unregistered CommenterSanjeev Sharma

Thanks for the response, Dr, Harris.

In many cases I've read an article or an internet post that says something like "insulin stores fat" and then later the same article or post says glucagon is "antagonistic to insulin", or "is the flip side of Insulin", leaving the reader to conclude (mistakenly) that glucagon moves fat out of fat cells.

Such articles also say that if you eat a high protein high fat meal with very low carbohydrate the pancreas releases glucagon. The impression remains that glucagon tells adipocytes to release fat.

I think that's what this original poster was thinking when he wrote this:
>>> Why would eating excess protein cause fat gain? Doesn't the role of glucagon prevent this?

No, glucacon doesn't prevent fat gain ... in humans - glucagon's action is pretty much limited to the liver.

KGH:

There are some zero carb internet sources that are not reliable sources for biochemistry and metabolism. Glucagon antagonizes some of the actions of insulin. Neither one is an on-off switch.

November 11, 2009 | Unregistered CommenterSanjeev Sharma
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