Talking to Dr. Ted Naiman about his New Book, The P:E Diet

We’re so excited to bring you an exclusive interview with Dr. Ted Naiman, whom many of you know from his website Burn Fat Not Sugar. Dr. Naiman has co-authored a just-released book, The P:E Diet, with William Shewfelt.

The P:E Diet explains that it is both excessive carbohydrates AND fat – our dietary energy sources – that are to blame for the scourge of obesity and Type 2 diabetes . Our industrial processed  high carb, high fat foods add energy to our bodies without providing satiety from protein, fiber and minerals. The book then details two critical steps to health maximization:

1. Up your P:E ratio by maximizing nutrient density with high quality protein foods and non-starchy vegetables while minimizing high energy density foods like refined carbohydrates and processed oils.

2. Regular high intensity exercise.

The P:E Diet breaks down the cause of the obesity epidemic and offers a solution using one powerful weapon: protein. This approach teaches you how to eat intuitively to achieve your goals, without unnecessary tracking or micromanaging quantity. Many thanks to Dr. Naiman and RD Dikeman of TypeOneGrit for this terrific interview. 

Congratulations on the P:E Diet book! You’ve had a massive influence on social media and it is really great to see everything put into one book! Tell us what the book is about and who needs to read it?

Thanks! From the beginning, the goal of this book was to produce a standalone ‘owners manual’ for health that you could recommend to pretty much EVERYONE. I felt like I didn’t have a really perfect singular resource, something that encapsulated the entire landscape of diet and exercise and their role in health and disease. This book tries to break down both diet and exercise into just a few very basic but very crucial principles. We focused on the really big rocks here—the prime movers of health. The advice in the book is extremely simple and accessible—it is a simplicity that we felt is sorely lacking in the health space.

Give us a little more detail on the P:E diet ratio and the role of dietary macronutrients in weight loss.

The quantity of energy that humans eat is inversely proportional to the percentage of protein in their food. Because of this phenomenon, WHAT you eat determines HOW MUCH you have to eat. It really comes down to food choice. If you choose a low protein percentage food, you literally have to eat more of it in order to achieve nutrient satiety. The protein dilution of the human food supply, thanks to refined non-protein energy (carbs and fats) like sugar and oil, require us to consume more energy just to get the protein we require.

As a theoretical physicist, it is my belief that your book is essentially the grand unified theory of macronutrients. Along those lines, what fundamental issues of nutrition/metabolism does your P:E  diet ratio address?

Thanks, and I really appreciate your physics background and your ‘grand unified theory’ comparison! As you know all too well, nutrition suffers greatly from a lack of first-order science. Unlike physics, we lack a strong theory or model of what nutrition really is. Until now, that is! Our book points out the fact that the entire process by which animals constantly eat other living organisms is simply an attempt to obtain two things: nutrients, and energy. In this case, nutrients are mostly protein and minerals, which originate from soil, while energy is the carbon-carbon chemical energy bonds of fats and carbs, which originate from solar energy. Most of your chronic diseases—including obesity, type 2 diabetes, and the entire spectrum of disease associated with insulin resistance—are simply a case of energy toxicity. This occurs because we NEED to eat more energy due to protein dilution, and also because we WANT to eat more energy due to the addictive nature of carbs and fats together—a combination rarely found in nature. The P:E ratio simultaneously emphasizes targeting protein while avoiding excess energy, both carbs and fats simultaneously.

You make a strong case in the book on emphasizing protein nutrition. Why protein and not carbs or fat?

Protein has magical properties. It is also completely essential, in a sizable quantity, while carbs are not essential at all—and the absolute amount of essential fat in the diet is actually rather small. Your body can convert protein, if necessary, into carbs and fats—but it is impossible to convert carbs and fats into protein. Protein is centered around the element nitrogen, which comes from soil in mineral form—unlike carbs and fats, which are both composed only of carbon, hydrogen, and oxygen (from air and water). Because it is so essential, and in such relatively large quantities, protein provides far more satiety than the other macronutrients. The higher the protein percentage of the diet, the less energy you will consume. Worldwide hunter-gatherers eat nearly three times the protein percentage of the Standard American Diet, which explains their freedom from the Western diseases of energy toxicity.

Tell us about your clinical experience…what is working and what isn’t working for patients?

What I find with patients is that anything that increases the protein to energy ratio of the diet is going to lead to some weight loss and some subsequent improvement of insulin sensitivity. This could be accomplished by either eating fewer carbs, or by eating less fat. However the very most effective approach is an attempt to lower BOTH carbs and fats—and the only way to accomplish this is to eat more protein and/or fiber. What doesn’t seem to work 100% of the time are diets that are low in protein, such as a protein-restricted keto diet with unlimited fat, or a protein-restricted starch solution diet with unlimited carbs. A final note it that patients who are extremely exercise averse and who suffer from low muscle mass never really seem to achieve the metabolic flexibility that we would all like to see—many of these people can achieve type 2 diabetes remission but not a type 2 diabetes cure. Recomposition—less fat and more muscle at the same time—seems to be the holy grail of curing insulin resistance.

When I got involved with low carb it was because of my son’s diabetes. I noticed in the type 1 world, low carb nutrition was protein centered and I believe this is due to Dr. Bernstein’s influence, but in the type 2 and weight loss world, we have seen a bigger emphasis on fat and a lot of myths about protein, e.g. the famous ‘protein turns to cake’, ‘eat fat to lose fat’. What do you make of all this?

Somehow the low carb world assumed that if carbs are bad, fat must be good. Protein was felt to be something that you had to consume in some sort of bare minimum RDA way, but that was about it. I think we might have underestimated just how hugely important SATIETY is in the equation. The reality is that if you have higher satiety, you are just automatically going to stop eating at a lower energy intake. And when it comes to satiety, protein is the clear winner. I think we also gave fat a free pass because it seems to have no acute effects on glucose and insulin. However we ignored the fact that all dietary fat is stored as body fat, the expansion of which will slightly raise our basal insulin requirements at all times. Our book flips the script, recommending that protein be targeted for satiety, while non-protein energy like carbs and fats are eaten only after protein satiety is reached.

Let’s consider a potential reader of the P:E Diet. Someone who is in their 50s and has been eating a standard Western diet their whole lives. What sort of effects are you seeing in clinic? What should folks be looking for in so far as personal metrics, including lab measurements? How can your book help them turn their lives around?

You really want to be on the lookout for energy toxicity. Nearly 90% of adults in America have one or more signs of energy toxicity. One of the easiest measurements for energy toxicity is a simple waist to height ratio. Measure the waist at the belly button, with the abdomen fully relaxed — this measurement should be less than half of your height. Fasting triglycerides are a very good screening measurement for energy toxicity. After 9 to 12 hours of eating no calories, your fasting triglycerides hould be well below 100. Elite would be under 70. Anything over 115 is clearly the insulin resistance of energy toxicity. High circulating triglycerides is basically a sign that your fat cells are all full and refusing more fat energy, so the triglycerides just circulate endlessly in your blood stream—not good, as you can imagine! Glucose should also be nice and low, for similar reasons. The normal range for glucose is 70 to 99, and if you hit triple digits on a fasting glucose you have probably attempted to store too much energy in your body—carbs and/or fats. Hemoglobin A1c, a three-month glucose average, is also a crucial test—the lower the better, and if you hit a 5.7% you have pre-diabetes (full diabetes at 6.5%). The biggest reason why our book is helpful? Well, if you have too much energy in your body, the last thing you want to do is EAT MORE ENERGY! So what do you eat to reduce the energy in your body, without starving to death? Protein and fiber.

The P:E ratio…lets call it a theory…has two competitors in the marketplace of ideas: lets call them ‘the calorie theory’ and ‘the insulin hypothesis’. I find both of these theories have good points and bad points and that the your P:E theory incorporates the correct features of both theories while discarding what is incorrect about each. Can you give a comment and details?

There are a few huge problems with the calorie theory. First of all, protein calories don’t count. If you trade all of your carb and fat calories in for protein calories, you will lose fat AT THE EXACT SAME LEVEL OF CALORIES. In protein overfeeding studies, we see a gain of lean mass but little to no gain in fat mass. This is in sharp contrast to an increase of fat and carb calories, where we see fat increase instead of lean mass. The fact that protein calories are partitioned to lean mass while carb and fat calories are partitioned to fat mass really undermines the basic usefulness of the calorie concept. Also, trying to control HOW MUCH you eat is going to be doomed to failure if you are eating low protein foods. If you try to simply ‘eat less’ of the Standard American Diet, which is currently only about 12.5% protein, you will be starving and you are going to fail. In reality, we should probably only be concerned with the amount of NON-PROTEIN calories we are consuming, with disregard for the protein calories. And the P:E concept is really doing exactly that. As for the insulin hypothesis, I struggle with this one because I realize that the main driver of insulin resistance is overfilling your fat cells, so being overfat causes insulin resistance, rather than the other way around. However I fully acknowledge the fact that carbohydrates have a dramatic effect on the body’s entire metabolism, effectively reducing fat oxidation, and this effect is mediated acutely in part by insulin. The downstream effect of frequent carbohydrate ingestion is a lack of fat adaptation and a state of relative glucose dependence, and this is a very real problem that I do think contributes significantly to our obesity epidemic. The difference between my approach and the standard insulin hypothesis is that I fully recognize the contribution made by excess dietary fat, in addition to dietary carbs.

You can purchase the P:E Diet book here.

RD Dikeman

RD Dikeman is a father of a t1 son, David, who has followed Dr. Bernstein's LC protocol since diagnosis. RD believes diabetics deserves normal blood sugars and can be as healthy as any nondiabetic. RD is a volunteer producer of Dr. Bernstein's YouTube channel, Diabetes University.