Perfect Health Diet: Weight Loss Version

We started 2011 with a discussion of Experiences, Good and Bad, On the Diet; which led us into the issue of weight loss, especially for peri-menopausal and older women.

This is an especially poignant issue for erp, who is 76 years old and would like to lose weight for her upcoming knee replacement surgery, but cannot walk.

This is the toughest possible scenario for weight loss:

  • Whether for genetic (X vs Y chromosome) or hormonal reasons, women are more prone to putting on weight than men. (Men are more prone to diabetes.)
  • Hormonal changes after menopause seem to make it tougher for women to lose weight.
  • A petite woman doesn’t need as many calories as a larger person … but her micronutrient needs, and thus her appetite, may still be high.
  • Aging brings more efficient energy utilization and reduced energy expenditure. Thus, the elderly have a smaller energy “sink” in which to dispose of excess fat. A teenager can eat like a horse and stay thin; not so an older person.
  • An injury that prevents walking makes it even harder to burn off fat. Walking is a tremendous aid to fat loss.

Designing a weight loss diet for someone like erp really forces a hard look at how to optimize a weight loss diet. Get it even a little bit wrong, and the diet either won’t work for weight loss, or will be malnourishing.

The Three Keys for Weight Loss

The three keys for an effective and healthy weight loss diet, as I see it, are:

  1. Elimination of food toxins. Food toxins are the primary cause of obesity and you can’t expect to cure a condition by causing it!
  2. Perfect nourishment. The diet should be as nourishing as possible. The dieter should be in the “plateau range” of every nutrient – vitamins, minerals, organic molecules, carbs, protein, and fats.
  3. Calorie restriction. You have to be in energy deficit to lose weight.

The main food toxins to avoid are fructose, polyunsaturated fat, and wheat (see Why We Get Fat: Food Toxins). In my advice to erp, I suggested replacing some of her fruit with “safe starches” like potatoes, and replacing her PUFA-containing nuts with low-PUFA macadamia nuts or other foods.

But the harder part is achieving a calorie restricted diet when so few calories are being expended, and yet avoiding malnutrition. How may that be done?

Eat Protein and Carbs; Reduce Fat

This may surprise many readers, since we’re fat-friendly, but there should be no reduction in carb or protein consumption on weight loss diets. Calorie restriction should come out of fat.

The Perfect Health Diet “plateau range” for carbs and protein is 600 to 1200 calories. Eating less than 600 combined carb+protein calories per day raises the specter of either protein deficiency (leading to hunger) or glucose deficiency (leading to zero-carb dangers).

So if a typical daily intake is 400 carb calories and 300 protein calories, there’s really not much room to cut protein or carbs.

Remember that the body doesn’t have a significant store of carbs; the body’s total glycogen supply amounts to about a day’s needs. Nor does it have a store of protein, apart from skeletal muscle; and you don’t want to lose your muscle.

But it does have a large store of fat – those adipose cells that you want to shrink.

So to conserve muscle and reduce fat tissue, you have to eat your normal allotment of protein and carbs while restricting fat intake. As long as there is no serious dysfunction of adipose cells, they will release fat as needed to meet the body’s fat needs. And that’s what you want – fat being moved out of adipose cells to be burned.

So your calorie-restricted weight loss diet will be just as nourishing as your regular diet. Only the source of the nourishing fats – adipose cells instead of food – will be different.

Eat Nourishing Fats

But not all fat can be removed from the diet. The reason is that not all nutrients found in fat-containing foods are stored in adipose cells.

You see, fats are stored in adipose cells as triglycerides. But we need to get other lipid molecules, not just fatty acids, from food. The really crucial molecules are the phospholipids, especially phosphatidylcholine.

Choline, inositol, and a few others are organic molecules are bonded to fats in cellular membranes. We need to obtain these from our foods in order to be well nourished.

Diets low in choline strongly promote obesity. Therefore, anyone seeking to lose weight should be sure to eat a choline-rich diet.

The easiest way to do that is to eat 3 eggs a day and a ¼ pound beef liver once a week.

Another type of lipid that may be missing from adipose cells are omega-3 fats. Balancing the omega-6 to omega-3 ratio is helpful against obesity, and most people are omega-3 deficient. So eating up to 1 pound of salmon or sardines per week may assist weight loss.

Beef and lamb – meats that are low in omega-6 fats – would be good choices for any additional meat.

Be Super-Nourished

The body’s appetite regulation mechanisms are highly attuned to your micronutrient needs. Micronutrient deficiencies will tend to induce a strong appetite for food, as your body tries to get you to obtain more nutrition. This could be a major reason why “empty calories” such as cotton candy are fattening.

Our book has some examples of “micronutritious foods”: variety meats, bone soups, seaweed, shellfish, eggs, and vegetables.

Nutritious, low-calorie foods like bone soups can be very helpful for weight loss. Soups can also be a good way for someone who doesn’t like vegetables to obtain them.

In addition, I would recommend that every person on a weight-loss diet take our full supplement regimen: a daily multivitamin, D, K2, C, magnesium, copper, chromium, iodine, and selenium. Also, I would suggest taking our optional B vitamins: thiamin, riboflavin, pantothenic acid, biotin, vitamin B6, vitamin B12, and choline (note the exclusion of niacin and folic acid).

Keeping Calories Down

What is the minimum calorie intake that meets all these nutrient considerations?  Eggs, salmon, and beef have more fat than protein, so if you’re aiming for 400 carb calories and 300 protein calories, you’ll probably eat at least 500 fat calories per day. So it would seem to be impossible to go below about 1200 calories per day while still being well nourished.

The place to cut calories, then, is the extra fats. Perfect Health Diet favorites like butter, coconut oil, and cream are, sadly, top candidates for reduction.

Of course, the more active you are, the more you can include those fats.

For less active people, the Weight Loss Version of the Perfect Health Diet becomes similar to a lot of popular diets. Many diets recommend a roughly even calorie distribution, with 30-40% of carbs, protein, and fats. This is what a calorie-restricted version of the Perfect Health Diet should look like too.

So, the perfect day in a weight loss diet: soup, potatoes or other safe starch, salmon, eggs, vegetables. Not too much fat in the sauces!

A good meal might look like this:

Mash the sweet potato with eggs instead of butter, and this would fit our weight loss recipe.


It’s a little humbling that I’ve started 2011 with 5 posts on the subject of healthy weight loss, but have only scratched the surface of this complex topic.

For instance: In the book we used the rubric “metabolic damage” to describe the biological dysfunction associated with obesity. But we never really chased the complex biology of exactly that damage consists of – and how it can best be healed.

Today, I’ve presented what I believe is the best strategy for healthy weight loss. But other techniques – such as ketogenic dieting, intermittent fasting, exercise, and more – can contribute to healing the metabolic damage of obesity. As 2011 goes on, I’ll return to this topic.

I am intensely interested in the experiences of anyone trying to lose weight using our diet, and I hope that together, we can understand the disease of obesity better, and figure out good ways to achieve both healthy weight loss and a permanent recovery from metabolic damage of all kinds. So please, if you are trying to lose weight, keep me posted on your experiences, whatever they may be!

Related Posts

From 2011:

From 2010:

Leave a comment ?


  1. I think a very important aspect during a weight loss diet is maintaining your muscle mass. In a calorie restricted diet such as this, do you think that most (preferably all) of the muscle mass will be maintained? Are the only factors with preserving muscle mass getting an adequate intake of protein and carbohydrate?

    I ask this because my last attempt at loosing weight resulted in a lot of strength loss (and not a lot of fat loss anyway), even though I was still eating an ancestral diet (no toxins). One thing I will note about that previous attempt was that I was restricting my carbohydrate intake, not my fat intake.

  2. I believe an important factor is female sex hormones and the estrogen dominance which tends to occur with age.

    Estrogen dominance is, of course, too little progesterone relative to estrogen. Women produce the bulk of our progesterone when we ovulate. As we approach menopause, we begin to have anovulatory cycles, and progesterone levels can fall ahead of estrogen levels.

    Ray Peat has written extensively about progesterone and it’s contribution to bone health, and also about the close relationship between enough progesterone and a well functioning thyroid.

    The late Dr. John Lee wrote extensively about estrogen dominance, bone health, fatigue, weight gain, libido, cancers of the reproductive organs and all the dangerous xenoestrogens we’re swimming in.

    To add to your fine suggestions Paul, I recommend erp seek out a practitioner knowledgable of testing sex hormones by saliva, and then supplementing with bio-identical hormones if needed, and to appropriate physiologic levels as measured by a saliva test.

    Hope that helps!

  3. Hi Nick,

    I think you’re sure to lose muscle if carb+protein is inadequate. If you eat sufficient carb+protein, I see no reason why there should be muscle loss if you do resistance exercise to stimulate it.

  4. Hi Michelle,

    Thanks for that.

    When estrogen dominance persists for decades, do you think that’s due to xenoestrogens, or can a natural imbalance last that long?

  5. Paul, thanks so much for this post and thanks to the others who’ve commented with suggestions. I can’t blame my weight gain on anything but horrible eating and lack of exercise. I take HRT in the form of low dosage Prempro without which I am a mess of hot flashes. I tried stopping it for five years and I don’t want to repeat that interlude. That’s when my eating habits deteriorated so badly.

    Last month when we were visiting family, I took copious amounts of ibuprofen in order to move about more easily. Eating the same diet, I lost three pounds in less than two weeks simply by normal activity — nothing that could be called exercise.

    That’s when I decided to have my knee replaced.

    Thanks for the tip about reducing fat. I have been following the proscribed plan, but now I’ll cut out the cream, cut back on butter while continuing the carbs and protein in the form of salmon and meat.

    Three egg yolks a day are difficult to get down, so perhaps I should add choline supplements to the others I’m taking.

    I’m also limiting food to a short window from about 2 or 3 PM to 7 with coffee/cream and a yogurt/berry/banana slush at about 8 AM. I’ll switch to no fat yogurt and cut out the cream. Other than the morning coffee, I only drink filtered water.

    My one meal looks very much like the picture above and my only indulgence is two dark chocolate covered almonds for dessert and six or eight pistachios.

    Again thanks to all for your help.

  6. Best of luck with your surgery, erp. We’ll be rooting for you.

  7. Can you make up part of the calories of your 600 to 1200 calorie carb + protein plateau with medium chain triglycerides from coconut oil? That is, instead of running your brain on glucose, run your brain on coconut oil. Plus some carbs for parts of the brain that need glucose. Paul might jump in here about the immune system and glucose.

    Then one could eat a even lower amount of carbs. Hold the protein constant. This coconut scheme will keep insulin low, so fat can come out of the fat cells more easily. The medium chain triglycerides will increase metabolism.

    As far as strength loss during low carb weight loss, what time frame are you talking about? Does your body take time to transition to a low/lower carb diet? Is there a physical (not just mental) low carb flu?

    How are you exercising? Chronic cardio? My unschooled, uninformed, wildly ignorant guess is that excessive exercise (e.g. jogging for an hour!) without proper fat burning adaption would have the body use protein over the last drops of glycogen. You need some fight left in your flight. This is a wild guess. In short, don’t eat your muscles at the gym.

  8. Any thoughts on sesame oil?

  9. Prempro is not bioidentical. This is an important distinction which does not seem to be well understood in the general population. Prempro contains a synthetic progesterone called a progestin. It is chemically similar, but not identical to the real progesterone a human body makes. Close enough = patentable, but maybe not safe.

    In fact, progestin acts as a anti-progesterone in the body. My understanding is progestins sit on the progesterone receptor site but do not message the same as natural progesterone. My MD told me progestins interfere with the body’s ability to utilize any natural progesterone it is producing. He also said progestins damage other systems in the body such as thyroid.

    I was on birth control pills (too much estrogen combined with progestin, an anti-progesterone) for 10+ years and I feel confident it contributed to my health problems today. I don’t know how long it takes to clear progestins from the body.

    erp is on HRT, but not BHRT (bioidentical). Could that be contributing to estrogen dominance and other health problems? I think John Lee would say yes! The key is to find someone competent who uses saliva testing and can transition you from HRT to BHRT at the proper dose for your body and age.

    It’s also my understanding that women’s beauty products need to be eyed with suspicion. Some companies will add estrogen to their products, especially lotions (fat soluble) (anti-aging?), and are under no obligation to disclose. My MD said when they get someone in who has crazy hormone levels, they ask for all the personal products and will send relevant samples to the lab.

    Yes, good luck with the surgery! My MIL (obese) is having one of her knees replaced this month. Same age, erp!

  10. I think somebody did mention already resistance exercise (aka strength training – preferably on good machines considering erp’s age). This can be done in very low impact style and working “around” the injured knee.
    A simple routine could be pulldown, seated press, seated row, chest press and hip extension(not to involve the knee joint – usually you would do leg press rather).
    I would check out for further info (they also have a list of recommended trainers/studios in the US).
    Weight loss without resistance exercise will always lead to lean mass loss, especially as older you are.
    And lean mass is cruxial for health!

    And just add 3 raw egg yolks to your yoghurt/berry/banana slush. It will be tastier then ever! Take fresh eggs of course, and clean before breaking open to avoid salmonella contamination. If you do not put your eggs in the refridgerator but store them at room temperature (safe for at least 14days) you can actually smell easily if they’re bad and discard then.

    Good luck!

  11. Before doing anything drastic like having a knee replacement, have you considered 24 hour bone broths?
    They supply a good amount of collagen, which is – among others – important for your bones and cartilage. Gelatin supplements may also help.

    I would also want to remind that any restrictive diet may cause the thyroid going into “underdrive”. So it would be important to regularly check the thyroid hormones TSH, FT4, FT3 and the antibodies.

    After having done a few weeks of very low carb myself (as close to zero as possible), I started producing TSH antibodies. It took me half a year to correct that problem again.
    Sometimes you think you are doing things right, but actually you are stupidly sabotaging your own body.

  12. Great post, Paul! Thanks for that. I’ll add that those who indulge in a glass of wine or two might want to cut down on that while shedding unwanted adipose. Also, agree with Franco on resistance training, it seems to help out of proportion to the calorie burn during the exercises. For me, I’m on meat, greens and starch for two meals a day. Around 100g carb and 100g protein (800 calories), give or take. Coconut oil to keep the calories up to 1500-1600. CRON-O-METER is free and helpful for those who want some software to track their nutrient intake. Thanks again.

  13. Hi Paul, I’d be glad to share my weight loss experiences on PHD, but I think it’s really a work in progress right now. I can tell you for certain that I haven’t gained much more than that first five lbs. after adding back carbs in the form of white rice. At this point I’m concentrating on being well nourished. In terms of supplements, I am following your advice to the letter. Most days I eat two meals, one of which is, invariably, two to three eggs cooked in ghee. If I have rice left over from dinner, I eat my eggs with a bit of rice. I have definitely decreased my protein consumption proportionate to my increase in benign carbs. Dinner usually consists of some protein, green leafy veggies (a salad or something like broccoli or broccoli rabe, steamed or sautéed), and a starch, most often Japanese white rice (koshihikari), basmati, or potatoes. My cooking fat of choice is ghee that I produce myself.

    I have completely eradicated wheat, seed oil, and sugar (table sugar) from my diet. I was never much of a fruit eater to begin with, so that hasn’t been a big deal. I eat an occasional banana or a handful of raspberries, and a square or two of dark chocolate will usually take care of any hankering I should have for a sweet. I buy coconuts and crack and clean them. We like snacking on them from time to time, but you don’t always find good ones around here. I’m not crazy about cooking with coconut oil, can’t handle the smell too much. I do, however, really like coconut kefir from the So Delicious company. I buy the plain kind (they have vanilla, chocolate, and strawberry, but those are sweetened, and I don’t really care for them), and really just use it in the way I was using heavy cream when I was following a more restrictive vlc protocol, taking a swig here and there when I can’t decide whether I’m hungry and ready to eat, or can I continue with my IF. It’s really the one manufactured food product I’m consuming, and it’s GF, soy free, and lower in carbs than plain yogurt or milk kefirs, so it suits my needs.

    I find I am able to keep my coffee consumption down to 2 cups a day on most days. I am wondering, however, if it would be better to switch to whole milk from heavy cream in the spirit of reducing fat intake. Aside from the ghee I use to cook with (most of which usually stays in the pan), and the EVOO I use in salad dressings, heavy cream in coffee is my main source of fat consumption. I do live in a place where I have access to excellen quality organic raw whole milk, and didn’t mind using it (I don’t have lactose intolerance issues) prior to going vlc in my pre-PHD days. Should I revert back to raw whole milk?

    I’m trying to spend more time on my feet. I suffer from plantar fasciitis, so I’ve gotten myself a decent pair of arch support inserts, and a pair of Chung Shi shoes. They are “fugly”, but feel good on my feet, and I can feel I am using more or different muscles when I wear them. On days when the weather allows, I take my dog on one or two 30 minute walks.

    That’s about all of it for now. I’m feeling pretty good. I’m happy to keep you posted or answer any other questions. I feel like I’m settling in nicely, and looking at this as a long haul process.

  14. Paul– I have a question and maybe you’ve explained already and I’m missing it. Why do you advocate white rice over brown?

  15. Now I’m confused– I’m reading reviews of your book on – and many are reporting that The Perfect Diet consists of low carb and high fat? But above in your blog entry you’re indicating that the key to weight loss is a reduction in fat. Which makes sense but is the Perfect Diet high in fat or low in fat? Is it low carb?

  16. Ellen wrote:
    Now I’m confused-

    Dear Ellen and PHD Readers,
    There is NO FOOD, which makes you gaining oder losing weight! You are going to gain weight ONLY if your Caloric Intake is higher than your Energy (Caloric) Expenditure! The other way around, you lose weight!
    ALL what you need to know is YOUR ENERGY EXPENDITURE… thereafter you can lose weight with any food, including FAST FOOD!!
    See my comment in Morgan Spurlockê Homepage

    Healthy Greetings from Switzerland
    Leoluca Criscione

  17. Ellen, clearly Paul is the one to fully address your questions, but I’ll share with you my understanding of PHD principles, with hope that if I’ve got any of it misconstrued, Paul can then correct me as well.

    On the issue of why white over brown rice: As I understand, white rice is recommended on PHD as a source of “benign” or “safe” starch. Starch, the carbohydrate in rice breaks down into glucose, and glucose is a sugar that the body can use or properly dispose, unlike fructose, which goes to the liver and becomes fat that’s then stored in adipose tissue. Brown rice doesn’t really give you anything extra in terms of health, and may be detrimental due to chemicals that grains contain in their outer levels that are there to protect the grain, not to nourish the human. Fiber, on the other hand, has been over-rated as a health-promoting component of whole grains, since what fiber mainly does is cause microabrasions in the GI tract. The GI tract responds by producing more mucus, and hence, more bulk to assist in elimination, but it also responds by making scar tissue that, over time, might morph into something unwanted, like lesions, or worse, cancerous growths. In PHD, the main purpose for eating rice is as a source of starch, so superfluous components can be eliminated.

    On the matter of whether PHD is low or high in any macronutrient, it’s a little confusing at first, and I have to say it took me some time to figure out. But as I understand it, it is lower in carbs than what the USDA pyramid preaches, and higher in carbs than many current low-carb regimens. It is definitely low in particular kinds of carbs: fructose, table sugar, cereal grains (wheat, oat, barley, rye), but friendly to starch sources like white rice, tubers, as well as some fruits (bananas, berries). Also, PHD advises against legumes, as they, too, contain self-protective compounds that aren’t there to nourish the human. They aren’t an ideal source of protein, either.

    My understanding is that, in order to lose weight, one has to be in a calorie deficit. PHD recommends a minimum of 600 total calories of protein plus starch (with starch slightly favored over protein), as both are needed for the body’s optimal upkeep and functioning. Fats are also important, but folks who need to lose weight need to cut their fat intake in order to be in a calorie deficit. This is different from a low-carb Atkins-style diet that tells you to eliminate carbs or minimize them, and to eat protein and fat to a point of satiety. Since protein and fat are the most appetite-suppressing (Paul has suggested that there is an upper threshold of how much protein one will eat ad libitum), people generally find it easier to stay in calorie deficit with a low-carb approach. With the carbs on board, however, one has to make a conscious effort to stay in calorie deficit, hence the recommendation to keep a close eye on fat intake, since fat packs more calories in a smaller volume than either protein or starch.


  18. Hi Jack,

    Coconut oil definitely has its advantages for health and leanness. But for people who need to eat minimal calories, it has its weaknesses.

    To replace 100 calories of glucose, you need 100 calories of ketones. To make 100 calories of ketones you need ~600 calories of coconut oil. So going the coconut oil for ketones route will add to total calorie intake.

    So I would rather introduce occasional ketogenic days, rather than making that the everyday diet.

    Exercise – definitely not chronic cardio. I think a mix of lots of walking and some high intensity exercise (resistance exercise, sprinting) is best. Adding in some sports (for a playful mix of resting, walking, running, and short ~5 second bursts of intensity; with an elevated heart rate for an hour) would be perfect.

    Hi charlie,

    Sesame oil is high in omega-6, so we use it as a flavoring agent but not as a significant calorie source.

  19. Hi Maggy,

    Sounds like a great implementation of the diet!

    The raw whole milk might definitely be worth an experiment. I don’t know if you noticed the discussion about some of the additives that are often put in cream:

    Re the plantar fascitis, there may be a few more things you can do:
    1) Stretching the calf to create tissue mobility upstream of the foot is very important. You might watch this video:
    2) Another useful way to stretch the calf is to wear a boot while sleeping. Keeping the ankle joint at 90 degrees will prevent the calf from tightening.
    3) The Chinese method of Gua Sha can be very good for the foot. Oil the foot and lower leg and scrape it with a ceramic spoon; capillaries will burst in unhealthy areas, leading to red spots and bruising, but this will promote tissue healing.
    4) Barefoot-style shoes and walking barefoot can be very helpful at strengthening key muscles and promote proper bone and fascia positioning. I cured a condition of “hammer toe” and foot calluses with Vibram shoes.

    Health is indeed a long haul process! My health is still improving, and I’ve been on the diet for 2 years.

  20. Hi Ellen,

    White rice has fewer toxins than brown rice. As Maggy says, we view rice as mainly a safe source of glucose, not as a major source of micronutrients, and the bran adds very little nutritional value. We prioritize toxin avoidance, since there are many ways to get nutrients, but you can’t un-eat a toxin.

    The diet is low-carb and high-fat for active people. Incremental calories mostly come from fat, so the younger and more active you are, the more calories you eat, the higher the fat percentage should be.

    For weight loss for an elderly women, we’re down at the lowest calorie intake and the lowest fat percentage.

    The book is about how to be healthy, so weight loss is a minor part of it. It’s written for all kinds of people.

    I would call it a low-to-moderate carb diet. We support low-carb eating but also eating a moderate carb diet of 600 calories/day if that is to your taste.

    Hi Leoluca,

    Of course calorie restriction is essential for weight loss, but other aspects are critical for health, and in the end obesity is a health problem, not just a weight problem.

    Thanks Maggy!

  21. Thanks Paul and thanks Maggy for that explanation– makes perfect sense.

    So– Paul, what do you think is beneficial for a peri-menopausal woman who is quite active? at 48-50 years old?

  22. P.S. I’m getting the book! Sounds definitely a worthwhile addition to my library. Paul– it’s not in e-format, is it?

  23. I’m only going to share, anecdotally, what worked for me and continues to work in a PHD-friendly context. I totally agree that, in the end, caloric restriction should come primarily from fat. I might suggest that for weight loss on the PHD, the following tweak comes close to mimicking (macronutrient-wise) my diet most of the time: replace 200 cal starch with 200 cal protein. This means 50g carbs and an additional 50g protein that will put most – especially women – nowhere near the level of protein consumption that’s possibly dangerous.

    Upping the protein and trimming the fat means consuming some leaner meats/fishes that I know are advised against in your book. Might be something to reconsider for weight LOSS which wasn’t your focus.

  24. WOW Michelle I think you hit on something there that goes overlooked: Birth control pills!

    These only became widely available and widely used (by unmarried women, etc. – there’s no moral connotation there just an acknowledgement that Planned Parenthood dramatically increased the “market” and usage for these).

    The long term implications of overriding one’s own natural hormonal controls – especially in formative years (I’m struck and saddened by the number of teenagers taking these within months of menstruating nowadays) – are difficult if not impossible to ferret out.

  25. Oops didn’t finish 2nd paragraph thought: BC pill usage increased massively in the late 70’s … just another “correlated factor”!

  26. Hi Ellen,

    I’m working on the e-book editions right now, they should be out soon.

    For a healthy perimenopausal 50 year old woman, the most important steps are the same as for everyone else: eliminate food toxins and be well nourished.

    If you’re active, you can eat more and still maintain or lose weight, so that gives you a lot more freedom to design your diet.

    One key choice is: low protein or high protein? If high protein you probably don’t need to pay attention to how much you eat; if low protein you may need to practice some form of intermittent fasting and Hara Hachi Bu (see recent posts). That is what I think is healthiest, but higher protein inhibits appetite and makes weight loss easier, as CarbSane points out.

    Also as CarbSane points out, the more you limit calories, the more you need to go toward lean meats from fatty ones. Lean meats still have fat in cell membranes, so they have the phospholipids, but they have less fat in triglycerides. So the nutritional value per calorie is greater from lean meats. If you’re severely restricting calories, that’s helpful.

    Our goal is to empower you with knowledge so that you can design a diet that’s best for your needs; and so you know what’s a harmless modification and what’s a dangerous “cheat.”

    Feel free to ask any questions, we’re always happy to help!

    PS – Thanks CarbSane! I agree, higher protein can be helpful for weight loss. The influence of birth controls is definitely something to think about … interfering with the body’s natural hormones isn’t likely to be good … I wonder if they have data on long-run effects.

  27. Thanks again Paul. All good information. What do you think about the 1 gram protein for every pound of lean mass as a starting point for protein needs? Sound about right?

  28. Can anyone recommend a B vitamin supplement that matches Paul’s suggested list: “thiamin, riboflavin, pantothenic acid, biotin, vitamin B6, vitamin B12, and choline (note the exclusion of niacin and folic acid)”?

  29. Carbsane, are you saying, then, that 100 g. of protein and 50 g. of starch is what seems to work for you for losing weight? That’s interesting because that seems to be where my body wants to settle for a more or less comfortable (but very slow) weight loss. Too much higher than that in carbs several days in a row, and it comes to a grinding halt.

    BTW, I’m 46 years old, and so far don’t have major perimenopausal issues as yet. Nevertheless, weight loss comes with great difficulty for me, probably due to my 2 stints of Atkins, during which my experiences were very similar to yours… barely out of induction and packing the pounds back on at light speeds.

  30. I totally agree that BC pills have played havoc on women and their hormonal development. I went to a 7 sisters college in the 80’s and the joke was that if you went to health services with an ingrown toe nail, you’d leave with a prescription for birth control pills. So, think about it: birth control pills on top of the bad dietary advice, on top of the widespread usage of HFCS and PUFAs and trans fats. Is it any wonder that women of my generation are the ones struggling most with our weight and health? I believe that, given adequate education and support, a woman of any age can become expert enough at knowing her own signs of fertility to avoid hormonal BC altogether.

  31. Not to mention that BC can make you prone to yeast overload.

  32. Hi Ellen,

    I think 1 g/lb is high … I actually prefer to think in terms of calories rather than g/lb, since I don’t think protein needs are strictly proportional to body weight, though they are a bit higher for bigger people.

    Roughly speaking, for a 120 lb woman, if you’re high-carb (600 calories or more) then I think 0.5 g/lb / 200 calories is sufficient protein; and around 0.8 g/lb / 300 calories is probably “neutral” in regards to appetite.

    As you go lower-carb you need more protein, until at zero-carb (which I don’t recommend) 1.2 g/lb / 500 calories would be needed.

    If you eat above the “neutral” amount your appetite will be diminished, at least in the short-term (weeks to months). If you eat below it your appetite will be increased, and you may find conscious practices like intermittent fasting are needed to avoid gaining a few extra pounds.

  33. Hi Maggy C.

    RE: coconut oil, I too do not like the coconutty smell and taste of most coconut oils but I’ve found a great flavorless, odorless oil by Tropical Traditions. It’s fantastic and you can buy it online at:

    Hope this is helpful.


  34. Hi Jeremy, I’m not aware of one. I just take individual pills from time to time. Most of them are available in high doses for $2.99 per hundred or so.

  35. Peter Silverman

    Is there a relationship between toxicity and how a meal affects your blood glucose? For instance, white potatoes spike my glucose, does that mean for me they are a bad idea?

  36. Hi Paul,

    Is it possible that fat can accumulate (in a high fat diet) despite being in a calorie deficit?, I have notice a rounder face since increasing fat, the funny thing is that Im not overweight at all, in fact Im more on the underweight side of the scale. Do you think fat have some tendency to accumulate in certain areas no matter the amount of calories?

    Also: Is there any “safe” white fish you recommend?



  37. Hi Peter,

    I’m not aware of links between toxins and immediate ability to handle blood glucose; most of the links I know of need long periods of time to operate.

    I suppose toxins could occupy the liver and affect their handling of metabolism.

    Re your question, how high a spike are we talking about? In general, you don’t want blood glucose to go above 160 mg/dl, or to stay above 140 for many hours on end.

    Hi Jaime,

    Yes, it’s possible.

    Gary Taubes has written of rare disorders in which fat accumulates in one part of the body but not others. So it is possible to have hormonal or molecular drivers that affect some cells but not others.

    It’s also possible that your cells were starved of fat before and are healthier now. More fat in the cells should promote muscle growth and higher body temperature; as long as it’s being metabolized properly, this is probably healthy.

    All white fish are safe as long as they don’t have metal or other poisoning, or parasites. They tend to be high in protein, low in fat, so we don’t particularly recommend them, but we have no objection to them.

    Best, Paul

  38. Paul,

    I had my pre-op interview at the hospital this morning and the closest I could come to the PHD while in the hospital is a gluten-free menu. I’ll report back on the experience.


    Thanks for the tips. I don’t use much in beauty aids. No makeup except lipstick and that rarely. Never used hair color, etc., so I don’t that would be much of a factor.


    Thanks for the tip about washing the eggs before putting them in the slush. I have been reluctant to eat raw eggs, but what you suggest makes a lot of sense.

    I’ll also be in rehab where they’ll get me exercising. We have a treadmill and cardio cruiser at home and if that won’t be sufficient, I’ll join a gym and follow up there. I love riding a real bike and the doctor said I’d be able to resume it after a couple of months. We have great paved bike trails around here.

    Tarrgon Slayer,

    Thanks for the advice. My right knee has gotten progressively worse. The latest x-ray shows bone on bone with no cartilage at all, but perhaps I can save the other one by implementing your suggestions.

    Maggy C.,

    I’m glad your college health center was pushing BC pills because when I worked at a similar top tier co-ed college in New England over 20 years ago, almost 25% of the girls had at least one abortion during the four years they attended the school. For mostly upper income, well educated girls to use abortion as birth control is unconscionable.


    Thanks for the link to tasteless and odorless coconut oil. Do you recommend ordering the organic or non-organic variety?

  39. erp,

    When I was hospitalized a few years ago, I was able to get as many hard boiled eggs as I wanted by asking the food deliverer for them when he came around. Healthier than the prepared menus. Somebody (I forget if it was him or the nurses) also brought milk and ice cream on request. Good luck with the surgery.

  40. erp,

    I’m afraid the treadmill and cardio cruiser won’t help retain or even regain muscle.
    If you are not able to, or just don’t want to, strength train the next best thing would be HIIT (High intensity interval training) preferably on a rower (to engage the upper body) to exhaustion or a few minutes twice per week.
    Wait, I just looked up this cardio cruiser thingy, if it is stable enough (the pic I saw on the net didn’t look like) it might work for HIIT for a beginner.

    Again, all the best!

  41. Correction!
    It should have read: “…exhaustion FOR a few minutes …”

  42. Paul, you made a great connection early on and then veered left for some reason and adopted the conventional wisdom on weight loss. Unfortunately, calorie restriction has failed the vast majority (> 90%, maybe) of the people who’ve tried it.

    The great connection was: A teenager can eat like a horse and stay thin; not so an older person.

    This is not because of calorie restriction or surplus, it’s because weight-control, like many things, is dominated by hormones. And once your metabolism is broken–which it is if you are carrying a lot of extra weight–controlling your hormones is even more important than controlling your calories (because once you control your hormones, then the calories will settle wherever they need to be on their own…no need to force them down through calorie restriction).

    I never thought I’d say this, but I agree with Carbsane’s suggestions. Replacing a percentage of your carbs with the equivalent in proteins is likely best (for weight loss). This will further blunt some of the effects of uninhibited insulin.

    However, clinical trials tell us that calorie restriction is a sure way to get fat. All studies show that the initial weight loss from calorie restriction is regained (and then some and most people end up at a higher weight than when they began calorie restriction, as my wife sadly found out–she now follows an “eat to satiety” method with no calorie counting—an Atkins-like induction and then will follow my way—I’ve lost 23 kilos in 7 months on what turns out to be a high fat/high protein diet).

    Once the hunger created by calorie restriction overcomes one’s ability not to eat, people end up gorging. That’s what the studies show (or asked anyone who’s tried this). If you are in that 1% who can stay on this calorie restriction, go for it. Just bear in mind that it’s not easy because you will be hungry (it’s impossible for 99% of the people). And be aware that your metabolism will slow down to compensate for the fewer calories, and that you’ll have to calorie restrict even more to continue losing weight. It makes sense from a conventional wisdom point of view—it’s what all nutritionists, the one’s who tell you to load up your diet with wheat, recommmend too–but if science means anything, then it’s not the optimal way, to put it mildly, because it’s never been shown to be efficacious in 99% of the people (okay, I’m not going to repeat this anymore).

    Lowering carbs is the way to do it because it naturally lowers insulin (good) and upping proteins is more satiating and also more energy inefficient (cost to digest protein is energy needy (TEF) and conversion of protein to glucose for gluconeogenesis is inefficient–it costs a few extra ATPs). Therefore, lowering carbs keeps insulin down, which means you are burning fat for longer periods of time (intermittent fasting does the same thing). Protein satiates (natural calorie reduction for most people…not me, though—I’m 5’11” and 190 lbs and eat over 3000 calories on the diet that allows me to lose weight, but I use to average about 2800 on a carb heavy diet–I kept the pasta industry in business all by myself) and you’ll need to access more energy from fat stores to digest and convert the protein. Ingestion of fat has very little to do with weight loss. Fat consumption basically self-regulates itself (and it’s actually quite satiating for most people) by adjusting basal metabolic rate–the higher my saturated/monounsaturated fat consumption, the higher my basal metabolic rate. By eating this way you allow your weight “set point” to re-equilibrate at your body’s desired weight. Calorie restriction does nothing to your set point.

    I do follow some of Paul’s recommendations for fat loss from his book, which is the use of coconut oil/cream almost daily, daily intermittent fasting (I have lunch at work a 2 pm and dinner at home after the kids go to bed around 9 pm) and I have a day every week where I do an extended fast for at least 24 hours. According to BMI calculators and my activity level, I should be eating about 2000 calories a day to lose weight…if I did that, I’d be starving.

    I do not count calories (although I do know how much I’m taking in since I have a food log on Fitday, which is entered the day after because I want to eat to satiety and don’t want calorie counting to affect the amounts I eat–some days I need 2200 calories to feel satiated, the next day it might be 4000. My body tells me). I have three friends who failed at calorie restriction and who are now doing what I’m doing. They are obtaining great results.

    I thought this needed to be said for those who don’t wish to calorie restrict or are looking at other proven ways of losing weight. If health is all you are interested in, then Paul has a great plan. For weight loss (I tried Paul’s diet for a month and lost no weight at all—I didn’t gain, but I didn’t lose either) there are other options.

  43. Paul– what’s your opinion on rice cakes? Thanks for your patience with my questions 🙂 So far, am enjoying your blog very much.

  44. (@erp, I agree that it’s outrageous that well-educated women, or any women, for that matter, should use abortion as BC. But there are better ways to avoid pregnancy than to pump hormones into women’s bodies. What it would take, however, is an actual curriculum in the elementary and middle school years (considering that menarche is now happening as early as 10, thanks in part to the conventional “healthy” diet, which is just a slightly improved SAD, imo…), to enable girls to understand how their bodies work. If the curriculum on nutrition in my second-graders wellness class is any indication, I believe we are a long ways away from any sort of curriculum on fertility awareness. Furthermore, many parents don’t have and don’t want that kind of open discussion about sex and sexuality with kids for fear that kids will then want to go out and experiment, which they will do regardless of whether there is or isn’t open discussion, or an opposite-sex partner to experiment with. I know families that want their kids in single-sex schools because they’re convinced that the experimentation can be avoided. I’d like to tell them that in most sexually-segregated cultures adolescent experimentation is initiated with same-sex partners. There are great reasons for having kids in single-sex schools, but that’s not one of them. I realize this is way OT, but it’s something I feel pretty strongly about. I can educate my kids in the way I feel is best, but if their peers aren’t on a similar page, then it somewhat defeats the purpose.)

  45. Hi Poisonguy,

    I agree that weight control is regulated by hormones, gene expression / epigenetics, and mitochondrial signaling. I.e. it’s a disease condition, not a character flaw.

    I actually think it’s a heterogeneous condition: different obese people can be damaged in different ways.

    In some people, there may be damage to the normal appetite regulation mechanisms. The damaged body wants to “set” weight/leptin at a higher than normal level. These people may benefit from conscious calorie restriction.

    Even in other people, conscious calorie restriction can be helpful (1) as an experimental step in seeing what happens, thus diagnosing the state of hormonal damage (is it hard or easy?); and (2) in enabling a lower protein weight loss diet, if the dieter chooses to eat that way.

    The reason I did 2 posts on protein and satiety was to acknowledge this issue. High protein suppresses appetite and removes the need for conscious calorie restriction efforts like fasting or Hara Hachi Bu. Low protein requires some conscious calorie restriction techniques.

    If autoregulated weight loss is desired, then I agree, one should eat a high protein diet as CarbSane prefers.

    Hunger, I believe, is a result of a malnourishing diet. All the calorie-restricted diets that induced long-term weight gain were malnourishing diets; all made people hungry.

    On our diet, I haven’t heard reports of hunger. I have heard reports of difficulty losing weight, but not of hunger.

    So I don’t believe our diet would induce any weight re-gain.

    We simply offer a choice: healthy weight loss on a lower-protein diet with conscious calorie restriction; healthy weight loss on a higher-protein diet without the need to monitor calories.

    It’s a matter of taste which you choose – which you like best and works best for you.

    Just to reiterate what seems to me the only difference between you and I: I don’t believe that overweight people will be hungry on the calorie-restricted version of the Perfect Health Diet outlined above; they will only have a mild desire for food that can easily be resisted without any ill health effects. Their fat needs will be met from adipose tissue.

    However, I’m perfectly willing to accept that for most people a higher-protein diet may be the way to go. If that’s what works, then that’s what people should do.

    Best, Paul

  46. Maggy C.

    I goes without saying that birth control doesn’t need to be pills, although they are the most effective method, but IMO a woman who chooses abortion rather than take responsibility for her pregnancy is reprehensible. I’m ambivalent on sex education classes for young children. If done correctly, it would be useful knowledge for kids to have, but that’s a big “if” knowing that schools have forgotten how to even get the basic skills of the three R’s into their heads.


    Your missing word, exhaustion, is exactly what I’m experiencing just from dragging myself around. The cardio cruiser is stable, at least for a small person like myself, but I really don’t have the energy right now for anything more than the limited movement I can manage.

    I went back to yoga in November and even though it was a very simplified class and I didn’t push it, it worsened my knee to the point that for the first time, I considered surgery as the only realistic alternative to anything like a normal movement.

    I’ll report back on what the folks at rehab suggest for me and thank you for thinking about me.


    Report from the field. Following your modified weight loss diet, I have not been hungry at all. I don’t even have the mild cravings for an evening snack anymore and as an added plus, my husband has largely given up his evening snacking as well.

  47. Hi Poisonguy,

    I would suspect that in the same neighborhood of 90% people that try a low carb diet would fail as well. Anecdotally, about half the people I know in real life have tried low carb at one point or another, and most didn’t last very long. Losing weight and keeping it off is difficult.

    I am the only person I know in real life that has really lost weight on a low carb diet. The interesting thing is, when it is VLC (<25 or 50 so grams of carbs), I have always had a major rebound and gained much more weight than I lost (the whole “carb cripple” thing).

    If I keep my carbs around the 100-125 g range, I seem to be much less prone to rebounds. I can binge a little at Christmas and not really gain any weight.

    One of the toughest issues in dieting is working through a stall. I think if your carbs are normally up in a decent range (that 100-125 area), you seem to have more options to play around with in trying to break through the stall. If you are VLC in this situation, then you seem to be a one-trick pony. Just a thought.

  48. Robert Sacks,

    Thanks for the tip on hospital food services. I’ll keep that in mind when I find out what their gluten-free diet looks like.

  49. Hi erp,

    That’s good. I really believe hunger is the key – one should never be hungry on a healthy weight loss diet. Your body knows when it needs something, and lets you know through hunger.

    Is your husband overweight too?

    JM, I think there’s a lot to be said for moderate carb (400-600 calories) weight loss. That’s close to the body’s glucose needs so it’s the least stressful for the body. Putting stress on people with metabolic damage seems to often have bad long-term consequences.

    Our advice is not necessarily the quickest or easiest way to lose weight, but it seems like the quick and easy ways haven’t panned out that well.

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