Very low carb performance with Peter Attia

Conventional wisdom says you need to eat lots of carbs to exercise. As you probably know that’s not true. But how low carb can you go — and are there even benefits to performance from eating extremely low carb?

Peter Attia is a medical doctor and an endurance athlete. He’s learned from the world’s biggest experts on keto-adaptation (such as dr Stephen Phinney) and in the last few years he has relentlessly self-experimented.

Here dr Attia shares his insights on very low carb (ketogenic) diets and physical and mental performance.

Peter Attia’s blog: The Eating Academy (highly recommended)


  1. moreporkplease
    Attia should also add to his "benefit list:" anyone with a fatty liver. Think about why that is. And then remember about 30% of Americans have fatty liver, even before they are pre-diabetic. :)
  2. Tabetha
    Great interview. You hear so much about how low carb/ketogenic diets make you weak or that they might be fine for couch potatoes but active people who exercise NEED carbs. I think interviews like this will go a long way to changing that perception.
  3. Joyce
    I am a female training for a half marathon and keeping my net carbs around 30. How low is very low carb? Also I am having severe insomnia problems now. How does this apply to women? I would imagine there would be differences with women.
  4. Suzie_B
    Dr. Attia has a great blog. He communicates at a level that everyone can understand including technical stuff. I especially found his series on cholesterol fascinating. I bet there is a good chance I now know more than my doctor about that subject. Thanks Dr. Eenfeldt for the interview!
  5. Preston_R
    I'd like this guy to show Harley Johnstone aka Durianrider that you don't need a high carb diet for endurance training.
  6. Erik
    Another great interview Andreas. Thank you for your time putting it together.

    Would recommend Art and Science of Low Csrbohydrate Living, which was mentioned. Available on Kindle.

  7. Liv
    Great interview
  8. Stacy in USA
    I'd love to know what Attia eats on a daily basis. I peeked at his site but didn't see menus. I'm wondering what those folks who stay in ketosis long term eat....
  9. JAUS
    One of the best interviews in my opinion. This guy really knows what he's talking about.
  10. Adam
    Again Andreas another top interview. I will definately be looking up this blog though I like Weight training I still feel Attia may have something to offer here also.
  11. Fantastic interview by a low carb hero, of a low carb hero.

    In addition to the other standard resources, you might be interested in hearing of Tim Olsen, a professed low carber who ran and WON the 100 mile "Western States 100-Mile Endurance Run". Shelley over at has a great interview with Dr. Steve Phinney, who was there doing some research with Jeff Volek.

  12. Peter Clark
    I regularly visit this excellent site as well as Peter Attia's for inspiration and information to help with my low carb approach to health.
    I enjoyed this video interview and after watching I was left wondering about the relationship between ketogenic diets and cognitive function, this is mentioned favourably at the end of the interview but is there any empirical data I wondered?

    A quick google revealed this link:

    Anthony Colpo discusses studies that fail to show a positive benefit of ketogenic diets over other diets, low carb or not, and this failure applies to weight loss as well as cognitive function and affective emotional measures also.

    I have a commitment to an evidence based approach to almost everything, certainly to diet and health, I am wondering what other people feel about this kind of counter evidence?

    Many thanks for reading this and for any responses,


  13. Anja
    Excellent interview, Doc!

    I'm going to try and reduce my protein intake to see if that might be the cause of my 5 months plateau...

    I find it easy to cut out carbs, but I struggle when it comes to finding the right balance between protein and fat. I seem to be one of those who can't eat that much cheese or other fatty dairy products. So getting enough fat is difficult. I mean just eating pure coconut fat and butter is not fun :D But I'll keep testing and hopefully something will help me get off this annoying plateau.

  14. Zepp
    Peter.. as they says in the interviev.. different person get different outcomes of a low carb diet.. some even get worse.

    It dependent about what problem one have.. but blood sugar roller coaster do explain a lot of the good ones.

    Some loose weight, other do get normal glucose levels, better lipid levels, better focus and so on.

    And some few do get worse level of lab levels or feel awful.. but as a whole, as a diet recomendation to a whole population to avoid fat.. its totaly wrong!

  15. Diane
    I'm loving these interviews. David Attia is so intelligent and you can really see his mental focus as he speaks. And he's is nice to look at, too.

    I'd add to his category of people likely to benefit people who have hiked one of the long trails in the United States such as the Appalachian or Pacific Crest and found that their weight ballooned afterwards.

  16. Erik
    @ Peter Clark

    A lot of information and various studies cited in that article. The evidence on mental functioning does seem mixed, and I imagine there is a lot of individual variability, like Peter said. Your questions about counter information are interesting ones. I know that Peter comments on his site that there isn't one right diet for everyone; I think he gives his wife as an example as someone who can eat as she pleases without getting fat.

    To use as example regarding mood.

    Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function

    Over 1 year, there was a favorable effect of an energy-restricted LF diet compared with an isocaloric LC diet on mood state and affect in overweight and obese individuals. Both diets had similar effects on working memory and speed of processing.

    I'm not an expert on the validity of the outcome measures and whether the differences were clinically important, so it's tough to know what to make of that.

    The corresponding nutritional study.

    Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo


    Under planned isoenergetic conditions, as expected, both dietary patterns resulted in similar weight loss and changes in body composition. The LC diet may offer clinical benefits to obese persons with insulin resistance. However, the increase in LDL cholesterol with the LC diet suggests that this measure should be monitored.

    In figure two of that study, the plasma beta hydroxybutyrate was not that elevated compared to the LF diet, and declined during the study. There was macronutrient differences between the diets.

    It is possible that different mental effects may take place at high levels of beta hydroxybutyrate. I'm not aware of any studies that have looked at people in the "sweet spot" of 1.5-3.

    Clinically, I would be keen to use LC diets on people that are insulin resistant, as this study also says. Christopher Gardner published a recent subgroup analysis of the A to Z study showing that those with higher levels of insulin resistance adhered less well to a low fat diet.

    The A to Z study was also showed slightly favourable findings for the LCHF diet, though people lost weight, including a lot of weight, on all the diets,.

    Diabetes Obes Metab. 2012 Jul 25.

    Previous research shows diminished weight loss success in insulin-resistant (IR) women assigned to a low-fat (LF) diet compared to those assigned to a low-carbohydrate (LC) diet. These secondary analyses examined the relationship between insulin-resistance status and dietary adherence to either a LF-diet or LC-diet among 81 free-living, overweight/obese women [age = 41.9 ± 5.7 years; body mass index (BMI) = 32.6 ± 3.6 kg/m(2) ]. This study found differential adherence by insulin-resistance status only to a LF-diet, not a LC-diet. IR participants were less likely to adhere and lose weight on a LF-diet compared to insulin-sensitive (IS) participants assigned to the same diet. There were no significant differences between IR and IS participants assigned to LC-diet in relative adherence or weight loss. These results suggest that insulin resistance status may affect dietary adherence to weight loss diets, resulting in higher recidivism and diminished weight loss success of IR participants advised to follow LF-diets for weight loss.

    Finally, the other finding from that study was that adherence was very important for weight loss, though I suppose weight maintenance is another problem.

    Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

    Int J Obes (Lond). 2008 Jun;32(6):985-91

  17. Peggy Holloway
    Yesterday, I had two scrambled eggyolks and two slices of salt pork for breakfast. I worked all day (I am a voice teacher/coach) with no break for lunch. I went to dinner at a cool restaurant that actually had some great low-carb options. I had a appetizers of crispy pig ears and olives followed by a meat/cheese board with torchon of foie gras (really! it was absolutely amazing) and three high-fat cheeses. This morning I got up and had a cup of coffee with heavy cream, then cycled for 75 miles. We stopped for a late brunch of hamburger steak and eggs (to which I added extra salt and butter), then I biked another 25 miles for a total of 100 miles.
    I would say I am living proof that one can exercise with virtually no carbs.
    And for those who may not remember, I am a 59.5 year-old female with a major family history of "diabetes." To do a century ride in and of itself without tiring (I felt fabulous at the end and could have ridden farther) seems miraculous and to do it without carbohydrates is simply mind-boggling.
  18. Jane2
    You have to eat more fat.About 3,5 times as much as your protein intake. When you eat enought fat you sleep as a log
  19. Joyce
    @ Jane2
    I'll try that. Thanks.
  20. Firebird
    Nothing about bodybuilders or power lifters?
  21. Erik
    I think it was mentioned that it may not be as good for sprinting events. I am aware that Jeff Volek was a power lifter. Not sure what diet he was eating while doing that. Not sure whether one would eat more of a higher carb paleo to increase muscle glycogen.
  22. What a great interview! I've been Paleo for about 4 months but have always dabbled with the idea of going super low-carb. Sounds like if I can kick the last bit of my sweet tooth (satisfied with strawberries and raspberries) I'll be even better off.

    Thanks for posting this, it's a wealth of resources.

  23. Mike

    One of Jeff Volek's previous books, which is aimed at people doing weight-training, uses an approach that's basically low carb, with some post workout carbs and re-feeding at the weekend. So I guess that would be what he was doing at the time. It was called the TNT Diet:

  24. Erik
    Great. Thanks Mike. I remember hearing about that book. Likely not a kerogenic diet then.
  25. Adam
    I lift weights four days a week and have been eating a LCHF diet, whilst I havent noticed a great deal of difference in performance I focus the majority of my Carb intake specifically around my training times i.e. pre and post workout. I try to maintain less than 50g a day. I am going to monitor my diet and training over the next 3 months closely to see what sort of results I get.
  26. Kim Lowe
    At the moment I am training for a marathon and will be the first one since having started LCHF. My question is what would I eat on race day?.On my taining run of 30km's I ran on water and a handful of nuts after having had a omlette before the run. Energy took a dip towards the end and I was hungry by the time I finished. Any advice would be most welcome.
  27. Luke
    I've just signed up for an ultra-distance (ironman) triathlon, and after more than a year of LCHF dieting, have been disappointed to find every single recommended race diet focused on pre-race carb-loading and mid-race 1000-calorie-per-hour carb intake. I'd love to train for and complete this race without breaking my LCHF regimen ... any detailed guidance would be highly appreciated.

Leave a reply

Reply to comment #0 by

Older posts