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.

Support PāNu

PāNu is ad-free, completely independent and has no outside sponsorship. If you value PāNu, now you can support it. Read this for more information.


In addition to buying from the book list, you can also support PāNu by making all of your Amazon purchases for any item through the Amazon Portal below

Amazon Portal

PāNu INDEX
« Raw paleo and food re-enactment | Main | Carbohydrates: No dietary requirement but metabolically critical »
Saturday
Aug292009

The PāNu Mission

In your mind's eye, is this what you picture when you think of that guy who does the PaNu blog?

I sure hope not.

Here is a description of my qualifications and some thoughts on the PaNu mission:

I am a practicing physician with training in biology, chemistry, physics and all the biomedical basic sciences, including pathology, anatomy, physiology, endocrinology, biochemistry, etc. My specialty is radiology (interpreting MRI, CT scans, ultrasound, angiograms, etc.) and I have subspecialty training in neuroradiology and spent several years in academics in that subspecialty, doing teaching and research. In my clinical practice, I have also acquired considerable experience in cardiovascular imaging. I read CT and ultrasound studies of the heart and vascular system daily. Although some radiologists read images in a room with little patient contact, at my imaging center we often review the exam results with patients, so I get the chance to see and speak with the actual person whose images I interpret. Radiologists are responsible for knowledge of many aspects of different clinical subspecialties. 

The relevance of this is that I approach everything from this clinical perspective. I see people suffering from diseases of civilization every single day. 

When I first heard Gary Taubes on NPR almost 3 years ago, and then read his book (twice in 2 weeks) I started reading on nutrition several hours a day, including thousand of abstracts, hundreds of full text papers, dozens of diet books, newest editions of textbooks on biochemistry, cell physiology, cardiology, gastroenterology, endocrinology, several textbooks of comparative animal physiology and anatomy, books on evolution, anthropology, archaeology, paleoanthropology....

Well, you get the picture.

I have experience with medical criticism and have written a book chapter, review articles and several peer-reviewed articles of original research.

I have always enjoyed writing.  When a long nutrition discussion on itulip about diet became popular, the thread became simply too long to direct patients and friends to, as it printed out to about 100 pages. This blog was first intended just to be a place to compile a few essays so I would not have to give my "spiel" over-and- over to new folks interested (by word-of mouth) in my approach. I had also thought about writing a book and there is no better way to refine your ideas than to gather intelligent commentary as you are developing them.

So what this blog represents is just the opinions of a single person who happens to have read and thought a lot about nutrition.

I am not a guru. 

PaNu has dogmas, in the original greek sense of the word, meaning established opinion. They are often specifically identified as such, these core beliefs. Used in this sense, there is nothing pejorative about "dogma". If the religious connotation bothers you, think of hypothesis. PaNu hypotheses are supported by evidence from many branches of science. You will find hypotheses everywhere in science. You are allowed to consider any piece of evidence you wish to decide if they are plausible, including the credibility of the agent communicating them. If someone tells you one thing that is totally implausible or is contradicted by a basic biochemistry text, it is fair to consider anything they tell you suspect, especially if it is contradicted by people you find more credible.

I do not ask you to believe anything in particular. I simply tell you what I believe. Make up your own mind based on any criteria you wish.

Here are some guidelines for getting the most out of this site.

I. These are solely my informed opinions based on my reading of a variety of literature. I make nothing up, and I do not say anything I do not believe to be true.

II. If something I say is informed (or even rank) speculation, I will try to identify it as such. If not, you can assume it is based on an informed reading of appropriate literature.

III. Notwithstanding #II, I do not have the thousands of pages of text I have read over the past 2 years available at my fingertips or in an electronic database. If I did, the first book would already be written! If you ask for evidence that I have not provided or is not elsewhere on my site, you cannot assume the evidence is not extant. The site has simply become too busy for me to respond to every question or to comment on every post. If you want me to comment on a paper, you must send me the full text article. A link to pubmed with a request to comment will usually not be accommodated unless the  article looks really interesting to me. I don't have academic access and won't pay $30 to review an article if you aren't willing to pay for it yourself. Even if you send me an article, I may or may not have time to read it.

IV. Before asking a question, try using the search function. A lot of questions being asked are addressed in some fashion elsewhere on the site, sometimes in the comment string following posts or in Q and A.

V. Shortly, I will activate the forum section of the blog. Be forewarned, there is no RSS feed function for this. You cannot subscribe to it, nor will I necessarily read every post. Any time you want to conduct an exchange with another poster, please start a new thread and have at it. This keeps the comment section more relevant to the posted topic. I may or may not chime in, and I may or may not read the thread. Inappropriate threads (including irrelevant or inflammatory ones) may be deleted. I am the only moderator for now, so keep things polite and civil (as you all have so far).

VI. If you want a question answered, it has the best chance of being answered if it is intelligent, well thought out, is relevant to an article I wrote, if it is single question and if it would be of general interest to readers of the blog. Try to post questions unrelated to a specific post in Q and A.

VII. I cannot practice medicine over the internet. Please don't ask me to. I can only make general comments about diseases and diet and tell you what I know.

VIII. The site (and it's owner) receive zero compensation from any government agency, NGO, corporation or individual. It costs several thousand dollars a year and at least 20 hours a week to run and write for the site. I am the sole individual involved. I will try my best to answer all questions, but soon it will be impossible to answer them all without interfering with production of new articles and commentary. (That is my excuse to Peter and Stephan!)

Finally, my mission is simple:

When I saw a video presentation of Gary Taubes speaking out west, he was asked what he really wanted. He said that he really wanted medical doctors who were convinced of the truth in GCBC to work to change things.

I am a medical doctor so here I am.

I have no idea if Mr. Taubes would approve of everything (or anything) I say. My own reading has obviously taken me far beyond the core idea of the carbohydrate hypothesis to the other neolithic agents of disease.

I am only sharing what I believe in hopes of advancing a new dietary paradigm based on critical scientific thinking informed by multiple disciplines.

If I or any other blogger start to remind you of Jim Jones, dump out the koolaid and run!

(Photo of Jim Jones courtesy Wikipedia)

Reader Comments (34)

"I am not a guru."

Okay. But you are definitely a voice crying out in a wilderness.

"PaNu has dogmas. They are often specifically identified as such. There is nothing pejorative about "dogma". It is dogma that the sun will rise tomorrow. PaNu dogmas are supported by evidence from many branches of science."

With all due respect, Dr. Harris, I do believe a dogma refers to a tenet which has no grounds in evidence, cmiiw. Also, much of our understanding of the world depends on a certain frame of reference. Per your example of the sun rising: The fact is that the sun, earth and galaxy are all in motion; but in relative terms, the earth spins eastward daily and observes an apparent motion of the sun rising in the east and falling in the west. But this is not dogma. This is factual. Johannes Kepler accurately explained the motion of the objects of the solar system some time ago. Whether or not an asteroid collides with the earth and precludes our normal diurnal state of affairs concerning the apparent sun rising is another thing altogether. But it is a matter of nature's laws and not authoritative rule that the sun appears to rise each day. Agreed?

August 29, 2009 | Unregistered CommenterSatya

And BTW, who's the guy in the photo? Jim Jones?

August 29, 2009 | Unregistered CommenterSatya

Satya

Yes, it is Jim Jones. You are probably too young to instantly recognize him.

The phrase "drink the koolaid" originated with Tom Wolfe's description of Ken Kesey's merry pranksters in "The Electric Koolaid acid test". Since the late 70's it has also become associated with the Jonestown massacre.

In the original greek and in every dictionary definition I can find, one of the usages of dogma is just established opinion.

Here is a Wikipedia quote about Francis Crick and his use of the term;

"A notable use of the term can be found in The Central Dogma of Molecular Biology. In his autobiography, What Mad Pursuit, Crick wrote about his choice of the word dogma and some of the problems it caused him:

I called this idea the central dogma, for two reasons, I suspect. I had already used the obvious word hypothesis in the sequence hypothesis, and in addition I wanted to suggest that this new assumption was more central and more powerful. ... As it turned out, the use of the word dogma caused almost more trouble than it was worth.... Many years later Jacques Monod pointed out to me that I did not appear to understand the correct use of the word dogma, which is a belief that cannot be doubted. I did apprehend this in a vague sort of way but since I thought that all religious beliefs were without foundation, I used the word the way I myself thought about it, not as most of the world does, and simply applied it to a grand hypothesis that, however plausible, had little direct experimental support."

I concede, however, that the definition and modern connotation of dogma as received knowledge is more common, so I will alter the essay accordingly.


Not very dogmatic of me, I suppose.

August 29, 2009 | Registered CommenterKurt G. Harris MD

Kurt,

Well, this is the beauty of constructive dialogue - we all learn something in the process. I will concede that the term dogma is often associated in my mind with religious and similar ideas. So there you go. We all come to the table with bits and pieces from our individual experiences. But that never means that we can't come to a mutual understanding if we try.

Ugh, Jim Jones. It was an amazing guess on my part. I was 13 at the time. And when I read guru and saw the photo, I suppose some sort of connection came to me. Truly it looks on first inspection like some Filipino leader or something. Very effective play. Proved a good point.

August 29, 2009 | Unregistered CommenterSatya

good post! what i got from it- we can agree with your information your not forcing it on anyone persay, or we can disagree and agree to disagree, however i find everything you write pretty much right on with how i feel!

also i had no idea it cost MONEY to run a blog! lots of time and patience yes but no idea how much is costs. goodness gracious! thanks you ten times more!

August 29, 2009 | Unregistered Commentermallory

"also i had no idea it cost MONEY to run a blog!"

I'd imagine Dr. Harris has to spend money at least on the hosting and domain name since his blog isn't hosted on blogspot. When you factor in the sunk costs of what someone of Dr. Harris' qualifications could be earning on his time at 20 hrs per week, it can easily total to at least thousands of dollars.

I do not even know any medical professional I could pay for this kind of expert opinion. So I'm happy to take what I can get.

+$.02

August 30, 2009 | Unregistered Commenterwebster

Great post. THere are too many gurus out there. What we need are interesting thinkers and good writers.

August 30, 2009 | Unregistered CommenterChris

Hi Dr Harris,

I enjoy your informed and educated approach, furthermore the absence of financial motives adds to the veracity of your comment.

Please don't consider me a conspiracy nut or but there is something I wish discuss to regarding the training of medical professionals. Over the last twenty years or so it seems that GP's in Australia are predominately being trained in India, once the best and brightest of Australian students could be trained cost free here, now however all students must pay the all mighty dollar prevails.

We had a family GP once whom now deceased was trained in England and he practised well into his eighties, what I remember most about him was the fact that a prescription was rarely given, he would give advice that pretty much followed the whole food/paleo principals.The doctors that treat my father and father in law are professional, intelligent and are younger and very pro prescription, with both parents experiencing adverse effects from large volumes of tablets, their aliments are not what I wish discuss.

Having trained recently I wonder if you would comment, I believe that big food is as culpable as big tobacco with the junk we told we should feed ourselves and children.

I wonder if medical institutions are funded inpart by big medicine and it is now a case of he who pays the piper picks the tune as far as course content. Do Universities now turn out well meaning doctors who are taught to reach for prescriptions to often. It seems there is not a lot of profit in the truth.

August 30, 2009 | Unregistered Commenterfreeagent

Chris

Thanks!

Freeagent

You don't have to be a conspiracy theorist to know that medical schools receive massive funding from pharmaceutical companies who fund much of their research. What happens to your career and the future money flow when you publish articles saying the drug you studied is dangerous, worthless or just not worth the effort?

The Cartesian, mechanistic paradigm of medical science reigns at every turn. The bias to look at drugs as generally efficacious and highly specific runs deep and fits with this mechanistic paradigm, and is not so subtly supported by where the money comes from in our major teaching universities. It is not a conscious conspiracy, just a dysfunctional Kuhnian paradigm, like our industrial agricultural neolithic diet - the SAD.

If you start to think critically about basic medical science, and think like a biologist instead of just an engineer of the body, the idea that drugs are in general highly efficacious looks very questionable.

There is a wry joke among Doctors that since aspirin, morphine, penicillin and prednisone (all dirt cheap and at least 50 years old) few useful drugs have been created.

That is a bit of a stretch but closer to the truth than most realize.

There are some highly useful drugs that are of recent vintage.

However, sometimes the useful, specialized expensive and highly specific drugs are treating some complication of the SAD that can be outright cured or prevented at zero cost with a radical change in diet.

My own view is that on balance the typical drug first marketed in the past 20 years is at best just a waste of money. That is why the "prescription drug subsidy" promoted by Bush II is such a travesty.

The influence of big food in medical schools is more a result of a power vacuum. The primary influence of big food is at the government level (think ADM and corn into ethanol). This in turn can affect NIH funding priorities, hence all the billions wasted trying to prove (and failing) that we should avoid saturated fat and eat fiber, etc.

The influence of big food via these effects on government funding is mainly because the state of nutrition as science is so abysmal. Most nutrition departments are a joke, as described so well by Gary Taubes in GCBC. Most medical students rightly perceive this and so don't take nutrition seriously. "Food is fuel and genetics determines disease" -that is exactly how I thought until a few years ago.

August 30, 2009 | Unregistered CommenterKurt G. Harris MD

The main thing about a dogma is that it's the kind of belief that is:

(a) Not open to revision, but
(b) Not a logical or necessary truth either.

"2+2=4" is a necessary truth, not a dogma. When I say that a dogma isn't open to revision, I mean that in the context in which it functions as a dogma, revision is not an option. It's the *kind of* proposition that could, in principle, be revised, but it's set apart from revision. You can't do science without dogmas. You can't keep all the balls in the air at once. Some things must be granted as fundamentals. Trouble starts when you treat things as fundamental that really shouldn't be. The dogmas of PaNu seem properly fundamental to me; the "cholesterol-CHD theory" isn't. That it has achieved the status of a dogma is deeply problematic.

Working for better dogmas is a Good Thing.

August 30, 2009 | Unregistered CommenterTodd

Kurt,
Thank you for your time and sincerity. It clearly comes across your writing.
I feel lucky to have acces to the information you so freely share.
About ten years ago I had a very special teacher...he always urged us to "take what we can get NOW"
Because you don't know when it might end" It taught us to gather knowledge and then start digesting that knowledge for our selves, and to apply to ourselves. This is how I approach your blog and the others out there with REAL information.
Thank you again.

Marc

August 31, 2009 | Unregistered CommenterMarc Feel Good Eating

Why does (or would) an absence of financial motive suggest accuracy vs. inaccuracy or truth vs. lie? The vast majority of business people I know look to sell good products (or services) at a good prices. Many and perhaps most aspects of evil have nothing or very little to do with money or financial gain. We need only look to history to show us many examples of evil that has little in common with finanical gain. Perhaps Jim Jones for example... I would much rather live next to Bernie Madoff then the average child molestor.

The childish rant that "business" is evil and that truth can only be had at the lips of beggar has no basis in fact or logic.

Karl

August 31, 2009 | Unregistered CommenterKarl

Karl

Where did you read a childish rant about business being evil?

Surely not here.

Are you referring to the idea that the source of funding in academic research can influence and motivate the researchers getting the funds and the institutions they work in?

You can't seriously doubt that humans are influenced by money, and that research results can be influenced by the source of funding. Have you seen this in person the way I have? Look into the published literature on antidepressant side effects and efficacy, and the phenomenon of pharmaceutical company "ghost writing".

That is only reasonable. The problem comes when you represent your endeavour as disinterested science and it is really a commercial marketing scheme.

The solution is full disclosure of these financial interests and education of practicing physicians.


The point is not to be free of biases, it is to be scrupulously honest about what they are. That is why I made a point of saying where I get my funding - from me only. I am not trying to imply that makes me "correct", I am trying to be ethical in letting you know who might be influencing me financially - no one.

August 31, 2009 | Unregistered CommenterKurt G. Harris MD

One of the challenges of on-line discussions is there is very little context and no opportunity to correct mistaken assumption(s). My criticism was not directed at you and I find nothing in your postings that suggests a political bias.

There was a suggestion in an earlier posting on this topic that because you do this at your own cost that somehow this makes your premise "better". I disagree with that conclusion. Your conclusions are no more valid whether you make money on this site or lose money.

I believe there to be nothing wrong with you having this site for free or for profit. I think we should consider the points you make and the evidence you present with the same skepticism whether you drive a porsche or a litespeed bicycle.

Karl

August 31, 2009 | Unregistered CommenterKarl

Karl

My apologies for assuming your comment was addressed to me- I guess it's best to start any comment you have with identifying who you are addressing it to.

I presume now you were addressing freeagent's comment. But even that doesn't look like much of a rant.

August 31, 2009 | Registered CommenterKurt G. Harris MD

Todd

You are keyed in to my usage of the word "dogma" - as Crick used it, to indicate a hypothesis we use as a premise for further investigation. Well-established, but not unquestioned or unfounded.

You indeed cannot keep all the balls in the air at once.

Marc

thank you

August 31, 2009 | Registered CommenterKurt G. Harris MD

Hi Karl,

I understand your point of view and in fact agree that there are a great many people who rightfully prosper from their excellent services, products and knowledgeable counsel.

My concern is simple and based solely on a justifiable concern for the effects excessive medication has had on immediate family. Furthermore, a fear that often "the road to ruin is paved with good intent." As well as a concern that the very institutions training our professionals may, in the face of huge financial pressure choose less than the most medically factual course content for their students whom would then tow the company line. Such a situation would be both venal and mendacious and a terrible injustice all round.

I am not so naive to believe that by absence of cost Kurt comments are therefore inherently true, I do think that his satisfaction to prosper from his vocation while sharing his knowledge free of charge shows an intent that is if nothing else honourable, and a desire to serve a greater good.

I short Karl I am sceptical of unchecked profit driven dogma and in my opinion the school is out on the damage this has caused.

Thank you for your response both Karl and Kurt.

September 1, 2009 | Unregistered Commenterfreeagent

Hi Kurt,
It's interesting to know all your qualifications and that you have a good solid background in the bio sciences. (It's probably equally important that you have a lot of common sense though.) I discovered your site not long ago and now follow it closely. I find your posts extremely informative and intelligent and look forward to reading them. Thanks for your efforts!

September 8, 2009 | Unregistered CommenterAmandaT

"...factor in the sunk costs of what someone of Dr. Harris' qualifications could be earning..."

excuse me, correction opportunity cost

(duh)

September 12, 2009 | Unregistered Commenterwebster

Perhaps "axiom" might be a better word than dogma. I don't think it's a perfect fit, but it lacks the religious connotations.

And don't drink the Kool-Aid, it's full of sugar! ;) :)

September 23, 2009 | Unregistered CommenterTezza

I've started eating PaNu. I like it so far. I do not feel hungry as much as I used to. I side effect that I'm just crazy about is the fact that I have very little gas. I used to be a gas machine, to the point of embarrassment. I'm guessing that is due to lack of sugar and grains in my diet (although i do eat some oats). I'm wondering if anyone else has notice this wonderful side effect?

September 23, 2009 | Unregistered CommenterDavid Gress

I just discovered your blog this week, though I have been following other health and nutrition blogs, and I'm really enjoying it. I'm interested in nutrition to be healthy - but I also have well over 100 pounds to lose (sob) so some weight loss would surely help! But I have been trying to lose all year. I quickly dropped 20 pounds in January and February, and then my weight loss stalled and I have been stalled ever since. So I decided to see where I stacked up on your steps listed in /get-started/ - and here is where I stand:
1) DONE - Sugar-free since 1/2/09
2) DONE - animal fats, and cream since 1/2/09
3) DONE - eliminated all grains 1/2/09
4) DONE - eliminated all high-PUFA oils 1/2/09 and use animal fats, butter and coconut oil for cooking
5) DONE - don't get in the sun much, but been taking 5000IU of D3 since 3/1/09

Uh oh, steps 1-5 all done and still I''m not losing an ounce. I must have a tanked metabolism, though I think I knew that already. :-) Let me see where I land on the other steps...

6) Hmm, not done. I've tried IF but it's a huge struggle. I can go easily from 6 PM until 10 AM the next day without eating, but I've found it really hard to get past that - and only two meals a day sounds impossible, let alone one!
7) DONE - avoided almost all fruits since 1/2/09 except very occasional small servings of berries
8) DONE - legumes eliminated 1/2/09
9) DONE - raw cream, pastured eggs, organic grass-fed meats - I try to stick with these, though this is not 100% compliance as it's not always possible to get the above when I need them, but probably about 75% compliance.
10) Needs to be better. What exercise I do get is primarily resistance training. But my hopes are not high as even when I was doing heavy lifting at the gym 2-3 times a week I still could not lose a ounce.
11) DONE - not been a milk drinker in years.
12) <sigh> not done. I find cream, butter and cheese really help me make it through the day, though I have cut my cheese and cream intake WAY back, by maybe three quarters. But that little bit remaining makes life so enjoyable. Hate to think about giving it up. :-(

My typical diet ratios run about 5% carb, 15 protein, 80% fat. I feel great! I'm just fat and not able to shake off an ounce.....Will keep reading your posts.

September 25, 2009 | Unregistered CommenterDebbie

Hi Debbie

Have you tried logging a few days of intake to see total caloric intake?

Do you have ketones in your urine?

September 25, 2009 | Unregistered CommenterKurt G. Harris MD

I'm not Debbie, but I find that when I eat to satiety on this way of eating I eat around 2500-2700 calories. And I'm a short (5'3") female. Ouch. I have played around with Kwasniewski's diet, and still eat this many calories. I've tried zc...same result. (The zc was an attempt to control my appetite.) I do aerobic exercise daily (it has been 90 minutes daily, but have reduced it to 75 minutes this week...I've been urged to cut back for a lot of reasons...one of them being appetite control) and would like to start some resistance training on a regular basis. I currently weigh about 125 pounds, but the scale is going UP. I realize this comes down to too many calories. I also do have problems with binge eating, but was hoping that restricting carbs would help with that.

Adivce? Does it just take TIME to get insulin down, hunger under control, etc.?

If it is of any interest, my doctor recently did a leptin level on me, and it was extremely low. Other blood parameters are normal, although I get hypoglycemic on an OGTT.

Thanks in advance for any insights and for this forum.

September 25, 2009 | Unregistered CommenterMNH

MNH

How many meals a day? You are eating about 600 kcal a day more than me.

September 25, 2009 | Unregistered CommenterKurt G. Harris MD

Debbie, The "Hate to think about giving it up" items are probably the ones causing most of your issues. When I initially switched to ZC the things I "had to have", such as cheese, once removed made me feel so much better. WP

September 26, 2009 | Unregistered Commenterwinalot

Dr. Harris...I am trying to recover from a binge eating problem (no purging). Right now, I am eating 3-4 x a day. I have major issues with appetite control and satiety. My doctor thinks high carb (55 %) is right for me, but I disagree...thus, I am pursuing YOUR approach.

Your thoughts on the low leptin level? I'm told there is no way to manage it with dietary manipulation.

Your thoughts on exercise level on a daily basis?

Any specific advice re: protein levels, fat, carb levels to optimize satiety AND bring total calories down?

I KNOW my caloric intake is too high.

Sorry for all the questions. I'm feeling more than a little frustrated with the state of affairs at the present time, although today I DO feel like my appetite may be diminishing a little bit. It is only 9:20 a.m. though, so hard to tell!

September 26, 2009 | Unregistered CommenterMNH

Debbie and MNH

Diet is parametric. Calories don't count within wide parameters, but if your metabolism or satiety switch is broken or if psychological factors are at play, you will store excess food and have trouble losing weight if you exceed the parameters and eat that much that frequently.

I agree with winalot's comment. Cream and cheese taste great, but if anything is helping you make it through the day, it may be more than food to you. The protein in the cheese requires insulin to handle it. Cream and Cheese work as food to the degree they get you to avoid carbs, they are not nutritional anti-matter and you can't eat anything you want in unlimited amount if you have abnormal satiety signals or if you are comforting yourself with the flavor.

Debbie

I am assuming your caloric intake is high, but you haven't said yet - you said IF is the hardest thing for you -that is the key. Fasting is effortless once your metabolism becomes more normal, but you may have to work harder to train it.

Debbie and MNH

You both already fast overnight, right? The next step is to lengthen the interval until your first meal until you can get down to two meals a day, then do a few days a week with one meal.

If satiety at mealtime is not working for you, and you want to lose weight, you must simply spend more time in starvation mode to drive insulin levels to their lowest.

Urine ketone test strips should be positive.

MNH

you may have immunity or recovery issues if you do real exercise 90 or even 75 minutes a day - I agree with Taubes this may be just making it harder for you to fast in the short term by making you hungry. Try resistance training only 2x per week until you can do fasting workouts.

What do you mean by hypoglycemia with an OGTT - they give you a glucose bolus - Are you referring to the fasting period?

September 26, 2009 | Registered CommenterKurt G. Harris MD

You are correct that I can manage to fast overnight--I DO exercise in the mornings, while in a fasted state--but I am hungry post-exercise (around 6:30 or 7 a.m.).

My fasting glucose levels are normal. I had an OGTT done a few months ago that showed basically normal results, however, from the 1st to the 2nd hour of the test I dropped from 175 to 100 or so--don't remember exactly, and I know that my total change over the 5 hour test was around 100 points. I was told that even though the numbers in isolation were "normal" the fact that I had the delta of 100 points AND the 1-hour drop of 75 points, that I qualified as hypoglycemic. I was told to just eat more frequent meals by my internist.

They also drew insulin levels on me, and no one has really been able to explain them to me. My fasting insulin was less than 2...my 1 hour was 22.1, 2-hour was 16.4, 3-hour was 2.0, and 4 hour was less than 2. Like I said, I have no clue if these are "good" numbers or not.

I will continue to work on things...thanks for your assistance. If you have any other advice, please offer it!

September 26, 2009 | Unregistered CommenterMNH

Hmmm, yes I have logged food intake for weeks at a stretch from time to time - with a pretty good degree of accuracy since, when being fanatic about it, I weighed and measured everything on a scale I have that measures right to the gram level. I would eat to until I was satisfied, but it was amazing how all over the place the caloric intake was to reach that! Some days I was satisfied at 1400 calories and some days it was over 3000! The normal range was probably in the 1800-2400 range - and as I said I'm someone with <sigh> over 100 pounds to lose.

I did implement one change just since I began reading your blogs, and that was to cut back on my number of meals down to just two (I cannot adapt to only one meal, at least not yet!). But for a couple days now I have just been having lunch around 1 PM and then dinner around 6 PM. It has not been as hard as I feared although during the morning hours I I do start to feel hungry from time to time though not ravenously so. Just that I'm aware of my stomach. :-)

And I guess it's too early to give 100% credit to this so-far simple change, but in the last couple days I have seen the scale drop 4.5 lbs to reach the lowest number I've seen in 4 months.

I don't know if I have ketones in my urine as I have never bothered to check. But in the meantime I'll try a few more days of the 2-meals approach and see if anything else dramatic happens.

September 29, 2009 | Unregistered CommenterDebbie

Also adding that I do hear you about the cream and the cheese. As I said I have cut *way* down on both of them - and only use raw cream and cheeses from grass-fed cows. But cream and cheese used to be daily parts of my diet and now they are just occasional. Last night, for example, I sauteed up some green onions and garlic in bacon grease, and then added some eggs to make an omelet - and then put a big hunk of shredded cheese in the omelet (about 1.5oz of cheese). But this was the first cheese I'd had in a couple weeks, and I was using the cheese up before it started to mold. :-) And the scale was down three pounds this morning anyway.

So I'll see how things go with the 2-meal-a-day plan before I drop them entirely. I gave up dairy entirely for about a month at one point but I didn't lose an ounce or see any changes in my health when I did so, so I'm not convinced that is the answer. But 1-2 ounces of cheese every week or two is a far cry from 4-6 ounces of cheese daily which is probably what I would eat if I just ate the way I really wanted to. :-)

September 29, 2009 | Unregistered CommenterDebbie

Debbie

If you have dropped two kilos rapidly to a new weight that may be fat loss, which is good, or it may temporary water loss due to glycogen depletion.

If the latter, that is even better, as it may indicate a caloric deficit that is forcing you into more ketosis. Buy some ketostix at the drugstore and see if that is what is happening.

If your metabolism is broken ( anyone 100 lbs overweight probably) you cannot rely on normal satiety signals - the caloric intake logging you did would support that.

With normal metabolism 3 meals with VLC and no fructose should work to lose weight (plus D supplementation and no wheat) But if your satiety signals are broken, you simply must spend more time "starving" as you can't trust your hunger to shut off when you eat, even if it's high fat.

The solution, therefore, is to decrease meal frequency to the point where even if you eat to excess when you do eat, the daily intake is lower than when eating thrice (or twice) daily, and your total time spent with low insulin levels is increased. That may well be one meal a day if necessary. That may mean a few 24 hr fasts per week as well.

I think radically decreasing meal frequency will be more efficacious than demonizing cheese (or even all carbs, dare I say it)

Make sense?

September 29, 2009 | Unregistered CommenterKurt G. Harris MD

Well I'm trying to cut down my meal frequency so we will see what happens! Though for someone my size I don't think I was eating to excess in caloric intake anyway. Even SparkPeople - the rabid high-carb/low fat website my corporate wellness plan made me sign up with to get a $150 rebate, said that for someone my size my caloric intake should be 2200-2400 calories daily for steady weight loss. And that was for their high carb-low fat plan! And except on rare occasions I'm right in that range or below it. While I like your logical and scientific approach there are other low-carb proponents who claim the surest way to destroy your metabolism even further is to cut calories or allow yourself to be hungry. :-)

Well, we'll see how it goes. I *did* lose a ton of weight some 25 years ago on a low fat diet, but it was not sustainable because I was hungry every waking minute of the day and would go to bed it tears from hunger ever night, though I was taking in 1500-1900 calories every day. Amazingly enough I stuck it out almost a full year before I finally caved and said that if that was what it took to get thin I would rather weigh 300 pounds.

Sure, I don't mind some hunger, and even just in the last week or two I had 1 26-hour stretch where I went without food - not by conscious choice but because I was stuck somewhere where there were no decent low carb foods available, and I preferred to eat nothing rather than junk. But doing it every day gets old fast. :-) Luckily with low carb I don't get the hunger I got on low fat - but it is still there sometimes. However at this point I'm working to seriously reduce my "eating window". I caved last night though. I had my two meals at 1:30 PM and 5:30 PM - but by 10 PM I was so ravenous I was ready to eat my arm, and went down and had a 1/2 cup of heated cream with a tsp of unsweetened cocoa power and some cinnamon and vanilla.

September 30, 2009 | Unregistered CommenterDebbie

Dr. Harris - I want to thank you for finally getting my head around IF as a way of life and not just a sometime thing. I had some success losing weight in the spring following Dr. Kwasniewski's OD plan. However I was eating 3-4 times a day then. His plan calculated my protein intake at about 66g/day - saying it could go even lower as I adjusted. The problem with that is when you are eating 3-4 times a day the amount of protein per meal is so tiny it really feels like deprivation rations - and it was pretty impossible to have a social life that involved any meals. That was why I fell off and plan and went back to more standard low carb but higher protein, but promptly gained back 10-12 pounds which I have been stalled at ever since.

But after reading your blog I decided to try to incorporate the OD macronutrient ratios with IFing. I can't manage only one meal a day but I'm doing 2 meals in a 4-5 hour eating window. I'm keeping my carbs low, and my fat and protein at OD levels, trying to keep protein in the 60-70g daily range, though today I hit 78g. And the nice thing is that if you split that amount of protein between only 2 meals instead of 4 you really get a decent amount of protein per meal, don't feel deprived. And heck - you could even eat out in public.

But the proof is in the scale I guess and the bottom line is that I have been doing this for 9 days now and have lost 9 pounds! The scale just goes down and down every day. I'm only a pound away from the low I hit on the OD plan way back in the springtime. I think I'm coming to love IF madly. :-D

October 4, 2009 | Unregistered CommenterDebbie
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.