by Nils Osmar. July 1, 2022. Medical Disclaimer
Dr. Ted Naiman is a board-certified Family Medicine physician who practices medicine near Seattle, Washington. He co-authored a book called The P:E Diet book with William Shewfelt,
In the Youtube interview below, Naiman discusses his approach to building health and laying the foundation for healthy longevity through what he considers an ideal diet, which centers around getting adequate protein first and limiting our intake of fat and poor quality carbohydrates – while getting ample amounts of exercise, particularly resistance training.
Naiman is in great health and superb physical shape. He’s 50 years old but, having met him in person, I would have pegged him at about 35. His approach is very similar to Lyon’s. They joke in the interview that they were “switched at birth.”
Naiman points out that even very lean people can have excess body fat, while being under-muscled, in the sense that “the very few fat cells they have are all filled up.” BMI tells us very little.
The labs that he looks at in his patients are Hemoglobin A1C; a fasting lipid panel, looking carefully at HDL; the triglyceride/HDL ratio. Hemoglobin A1C should be “sub-five”, but there are situations in which our A1C can be higher and we can still be in good health. “Some people can be healthy if their A1C is in the mid-fives,” particularly those who eat higher protein and have longer-lived red blood cells. CBC, a blood test used to evaluate your overall health and detect a wide range of disorders. Creatinine (which he “actually likes a little on the higher side”.) CMP, which looks at organ function, electrolytes, blood sugar and blood proteins.
For those wanting to lose weight, he recommends removing non-fiber carbs and fats from your diet. He views adding fats (as is sometimes done in ketogenic diets) as a mistake. It’s an excess of energy (in the form of either protein or carbohydrates) which throws our health off kilter.
How much protein?
Like Dr. Peter Attia, Dr. Dom D’Agostino, and Gabrielle Lyon, Naiman recommends eating around 1 gram of protein per pound of ideal body weight according to height. Exercise is essential. He agrees with Lyon’s assessment that “Muscle is the organ of longevity.”
Re: his own diet, he does protein timing (most of his protein at his morning and evening meals; he snacks on fruit and vegetables during the day). He does time restricted eating, eating within an 8 hour window.
He believes that for optimal health and longevity, we should aim for getting around 30% of our calories from protein (though if we do a lot of exercising, we may be fine with closer to 12%). The source of the protein is less important than the quantity and quality. We can, in his opinion, thrive on (lean) protein from either plant or animal sources. He has seen some of his patients thrive on vegan diets; others thrive on more animal-based diets. Carbohydrates should come from fruit and vegetables, not sugars or grains.
Naiman’s approach is different in some ways from the approaches taken by people who advocate a lower protein, lower leucine approach (like Dr. Valter Longo and Dr. David Sinclair), but similar in others. Like Longo and Sinclair, he recommends eating a lot vegetables and some fruit. Longo recommends a Mediterranean diet which includes some seafood (though a small amount); Naiman views seafood (fish) as an ideal source of protein.
Sinclair views the source of the protein as key, and recommends getting most (though not all) of our protein from plants; Naiman get much of his protein from animal sources, including lean game, but says that the source is less important than the quality and quantity. Longo maintains that we should never, under any circumstances, skip breakfast; Sinclair always skips breakfast and lunch; Naiman views breakfast as important, and believes that it, like our other meals, should be based around high quality protein. Longo, Sinclair and Naiman agree that fruit and vegetables are important. Naiman eats (and snacks) within an 8 hour window and fasts 16 hours a day.
Listening to Naiman, I found myself comparing my approach to his.
My current approach is based around trying to eat high quality, high nutrient foods from all three kingdoms: plants, animals and fungi, and finding a balance between the activation of mTOR (the growth pathway, which builds muscle) and AMPK (the longevity pathway, associated with a longer life but not necessarily with robust health).
Over the past couple of years I’ve gone more in the direction that Lyon, Naiman, Attia, D’Agostino and some others who recommend making high quality protein the foundation of a healthy diet before worrying about other nutrients. I’m healthiest when I eat protein from animal sources (land animals and fish), and also eat a lot of green salads and vegetables along with moderate amounts of fruit and berries and no sugar or grains. I’m working out (resistance training) three days a week, and also walking and doing some HIIT (though I should probably do more).
I take supplements which I’ve discussed elsewhere on this website. This has helped me to build muscle and reverse sarcopenia. I don’t force myself to eat a gram of protein for every pound of my ideal body weight, but I do try to on my workout days.
Following this approach, I have been able to lose excess body fat, put on more muscle, and reverse the downhill slide in my health.
But what about mTOR?
Some mTOR activation is necessary to prevent sarcopenia, but too much mTOR is associated with a shorter, not longer, lifespan. David Sinclair and some others have warned about the problems that can occur if mTOR is overactivated and AMPK doesn’t have a chance to get switched on.
Foods high in leucine, protein, calories and/or high glycemic carbs tend to activate mTOR (and switch off AMPK). Foods low in leucine, protein, calories and/or high glycemic carbs — or avoiding foods entirely, i.e., fasting — all tend to activate AMPK (and switch off mTOR).
I’ve tried a number of dietary approaches over the years. Looking back from my current understanding, I’ve sometimes erred in the direction of too much mTOR activation, and sometimes too little mTOR and too much AMPK.
Going vegan for three years almost killed me; been there, done that, will never go there again. I had good energy at first, then my health collapsed. I tried numerous variations to try to find a vegan diet that could work for me, but my health continued to decline. I finally asked why I was working so hard to make a bad diet work, and added meat back into my diet. This almost instantly restored my health. From my current vantage point, my vegan diet had too much AMPK activation and too little mTOR.
I tried a carnivore diet for a while (all meat, no plant based foods at all) for a few months. It “sort of” worked for me; it helped me strip off some fat; but strict carnivore diets exclude many beneficial and brain-healthy foods, such as blueberries and blackberries and root vegetables. It made no sense to me to eat that way permanently. One danger of carnivore diets is that unless the person following them does a great deal of fasting, their mTOR is likely to be activated almost full time, which means their AMPK will tend to be switched off.
I tried Dr. Valter Longo’s longevity diet, based around a traditional Mediterranean diet. I liked many things about this approach, but the protein in it was simply too low for me. When on his diet I began having the same health problems I’d had when I was vegan, and drifting in the direction of sarcopenia. When I added more animal based foods and protein, I recovered.
I’ve tried ketogenic diets in the past, and found that they did sometimes help me lose excess body fat, but sometimes not. I agree with Naiman’s POV that adding huge amounts of fats, as people do in some keto diets (such as adding a half cube of butter to your coffee), don’t make sense (for me) and aren’t a foundation for building health. We need some dietary fat of course, but for me, after a certain point. eating a keto diet eventually led to my gaining unwanted pounds again.
In my earlier years, keto diets kept me lean; interestingly, they don’t have that effect on me these days. Striking a balance between eating high quality animal protein, lots of green salads, and fasting, is working best for me at this point.
I’m not saying my approach is best for everyone, just that it’s what I’ve figured out works for me. It dovetails fairly well with what both Lyon and Naiman recommend in this video.