The P:E Diet, a book review

The P:E Diet is a book by Dr. Ted Naiman and William Shewfelt. It is a user manual for how to eat and how to move in order to be a healthy human.

📖🏃💪

At a glance, the book has three parts

• Ecology and Evolution
  • A look at Protein and Energy from an Evolutionary Lens
• Biology and Diet
  • How intake of Protein and Energy affect Human Metabolism
• Exercise and Health
  • Using Exercise and Movement to improve our Metabolic State

The book communicates useful information about diet and exercise. Dr. Naiman presents information in an easy-to-digest manner. At times, the book reads more like a slide deck presentation — making the ideas and concepts readily available. There are many graphics that illustrate the underlying concepts with clarity.

The conceptual basis of the book is:

Humans are adapted to eat foods that are nutritionally dense. However, we currently eat foods that are nutritionally empty — rich in energy, poor in protein. Dr. Naiman’s metric to determine which foods are best for us is the Protein-to-Energy Ratio. ( more on that later )

Note: the thoughts and ideas in this blog post are derived directly from Ted Naiman’s book. If we fail to cite and give due credit forgive us.

Life eats life

As we all know, life eats life. Dr. Naiman begins his discussion by laying out the basic flow of energy in our world:

• The Sun’s rays are the basis for ( almost ) all energy on earth. (🌞)
• Plants capture and store this solar energy. (🌞->🌱)
• Some animals eat these plants — herbivores. (🌞 -> 🌱-> 🐄)
• Some animals eat those animals — carnivores. (🌞->🌱-> 🐄 -> 🐅)
• Fungi & bacteria decompose all the stuff . (🌱🐄🐅->🍄)

This captures the flow of energy across the kingdoms of life. It’s a simplified view of a complex world, but that’s the beauty of it. Now, Naiman outlines a more detailed analysis of the components within the food web.

Plants 🌱

Energy ( C )

Uniquely, plants make their own food. And, in fact, plants supply all dietary energy to the animal kingdom. We classify a species that makes its own food as an autotroph.

So, plants make their own food via photosynthesis, which requires: sunlight, water and carbon dioxide.

🌞+ 💨 +💧->🌱

Plants capture this solar energy and store it in high-energy carbon-carbon bonds. These chains of carbon-carbon bonds can be of two types: carbohydrates or hydrocarbons.

Most of us are familiar with the term carbohydrate, but what about this hydrocarbon? What’s the deal with that guy?! We commonly refer to hydrocarbons as fats or lipids.

A key difference between these two energy forms is that carbohydrates are water-soluble, while fats/lipids are not. The old ‘oil & water’ idea comes to mind.

Let’s pause to note the chemistry here. Energy is carbon-based.

But there is more to metabolism than energy.

Protein ( N )

Protein and minerals are the building blocks of life. They are essential for growing/building tissue. Unlike energy’s carbon-based chemistry, protein is nitrogen-based.

Plants get nitrogen and other minerals for protein production from the soil. Plants create amino acids from the absorbed nitrogen and minerals. Chains of these amino acids are what makes up protein.

Protein is derived from the soil.

Energy is derived from the sun.

Everything eats the autotrophs.

Herbivores 🐄

Animals do not make their own food — animals are classified as heterotrophs. We call animals that only eat plants herbivores.

🌱-> 🐄

Carnivores 🐅

Animals that only eat other animals are known as carnivores.

🐄 -> 🐅

Animals are divided into herbivores (eating plants), carnivores (eating animals), and omnivores (eating everything). The reality is that all animals are omnivores if they are hunger enough — they just have a preference for one thing or the other.

P:E Diet by Naiman & Shewfelt, p.26

Why we eat

Okay, summarizing the flow of energy and protein in the food web is fun, but how is it useful?

Don’t worry. This is where we connect that understanding into how our metabolism works — thank you Dr. Naiman!

The reason we eat is to get two things: Nutrients ( N ) & Energy ( C )

Nutrients -> derived from the soil, nitrogen-based chemistry, consists of:

protein, minerals, and vitamins.

Energy -> derived from the sun, air, and water, carbon-based chemistry, consists of:

carbohydrates and fats.

Protein and energy are needed for life. But what proportion is best? An improper balance of protein to energy makes an animal sick. The proper balance of protein to energy makes an animal healthy. Let’s dig deeper…

Too much of a good thing

We all know that you can have too much of a good thing. Currently, we intake too much energy relative to our protein intake. Dr. Naiman refers to this idea as Energy Toxicity. He explains Energy Toxicity as, “Trying to fit more energy in your body than it can hold.”

Our food environment has, “Disconnected energy from satiety by taking the Carb & Fat out of food.” This is why we see so much energy toxicity in our population. There are more unhealthy foods (🍕🍟🍦)to choose from than healthy foods (🍳🍗🍆) to choose from.

The image below shows the process of how food is cultivated for energy-yield. This dilutes the protein content of our diet.

Evolutionary Lens

The reality of our biology is that we are adapted to a hunter-gatherer lifestyle.  Humans lived as hunter-gatherers for ± 2,500,000 years. That’s a lot of time.  

Agriculture is new for us.  In contrast to our time as hunter-gatherers, our time as farmers is a mere ± 10,000 years of domesticating plants & animals as our food source.

Some maths:

10,000 / 2,500,000 = 0.4%

100% – 0.4% = 99.6%

Hunter-gatherer: 99.6% vs. Agriculture 0.4%

Let’s unpack the graphic above.

Paleolithic ( Pre-Agriculture ) — Very high protein and fiber, but often energy-constrained.

Remember the math above! We are adapted to eat a diet that is higher in protein than our modern diet. Put differently, in the past Protein (N)[nutrients] was widely available, but Energy (C)[carbohydrate & fat] was scarce.

Agricultural Revolution — Invention of agriculture: starch dilution of protein.

Our lives and lifestyle shift dramatically. No longer do we roam and hunt as nomads, but we put down our roots and develop cities. Our diet changes, and not in a good way.

As civilization develops and humans become reliant on agriculture, the amount of protein in our diet diminishes.  This is legible in the fossil records of modern humans: 

“Post-agricultural humans had shorter stature, smaller brains, and poorer bone and dental health compared to hunter-gatherers.  This was a direct result of the drop in dietary quality with the advent of agriculture: more energy, but less protein and minerals.” 

P:E Diet by Naiman & Shewfelt, p. 36.

Industrial Revolution — Bulk refining and processing of sugar, flour and oil.

Then, the next phase-shift.  We transitioned from an agricultural civilization to an industrial civilization some ± 250 years ago.  MORE TOOLS AND TECHNOLOGY!!!

The marvels of modern technology allow us to create wondrous food-like products, such as:  corn syrup, corn oil, soybean oil, coca-cola, et cetera.

With all this in mind, it is easy to see why our culture struggles with so many metabolic & chronic diseases. We get too much energy and not enough protein.

It is a strange problem. We have plenty of “food”, but not enough nutrition.  And though we can stay alive, we live in a sickly state.

Energy Toxicity

According to Dr. Ted Naiman, energy toxicity is the root cause to chronic disease: diabetes, high blood pressure, alzheimer’s disease, asthma, osteoporosis.  Energy toxicity is strongly associated with insulin resistance. Insulin is a hormone produced by the pancreas.

Insulin resistance- another name for Metabolic syndrome is defined by:

• Abdominal obesity (too much fat around the waist)
• High TG
• Low HDL
• High BP
• High fasting glucose

Looking at that list of diseases makes it obvious that insulin resistance is bad. To understand how to avoid insulin resistance, let’s investigate how it occurs.

What is the cause of Metabolic Syndrome? The answer is simple. Overfilling your energy storage capacity.

P:E Diet by Naiman and Shewfelt, p. 57

One of insulin’s many functions is to signal energy storage. Adipocytes (fat cells) store energy. Energy storage has a limit. When these fat cell fill up, the excess energy spills over into our bloodstream. At this point, insulin resistance is detectable in blood work as high triglycerides and high blood glucose. These high levels are due to insulin being unable to store energy in the already-filled fat cells — overflowing.

A helpful analogy — It’s like packing for a 3 week vacation without access to doing laundry. You ( insulin ) stuff all your clothes ( energy ) into the suit case ( fat cells ) until it is full. But, you have way more clothes ( energy ) to pack, and as you ( insulin ) stuff more clothes into the already-full suitcase ( fat cells ) those clothes ( energy ) spill out of the suitcase. [ analogy borrowed fromnDr. Jason Fung’s Obesity Code ]

Typically we identify insulin resistance through blood work. However, this is a lagging indicator; far downstream from easily detectable signs. What are early signs? First, fat is stored underneath the skin as subcutaneous fat. Second, fat is stored around the organs as visceral fat, which displays itself as a belly. Why wait to treat, when we could nip it in the bud?

Pattern of eating

So how can these concepts guide our food choices?

Carbs and Fats ( Energy ) – Carbs and fats are an especially dangerous combo.  In fact, carbs and fats are rarely found together in nature.  The two exceptions are milk and nuts. For instance, milk contains fat and carbohydrate. Why is that? Well milk is designed to nourish a baby so that it can grow 👶🍼. Nuts are seeds that will grow into plants. Both of these foods are designed to grow an organism bigger.  This makes sense because we want a baby to grow!  But we do not grow indefinitely.

So what is it about this combination of carbs and fats that is so dangerous?  Carbs and fats together produce a dopamine like reward, making them highly addictive.  Think about the foods that contain this combination.  Pizza, reeses, bagel with cream cheese, potato chips, cake.  All of these foods are highly addictive and drive overeating.  Studies show when you feed a high carb, high fat and high energy diet (candy bar) to an omnivore, they will overeat by 30-40%.

Additionally, fats and carbs are burned (oxidized) reciprocally in the cells.  This means that at any given time, we can only burn either fat or carbs.  We can not burn both at the same time.  Does our body have a preference on burning carbs first or fats first? Yes, it does. Our body prefers to burn carbs first.

Frequency (carbs) and timing

All carbohydrates that we consume are eventually converted to glucose in the blood. Our blood stream can only hold onto 4g (1 tsp.) of glucose.  Glucose can be stored as glycogen in either the muscles or liver.  Glucose first goes to the muscles then to the liver.  Most people can only hold 100g (4 apples) of glucose in their liver at a given time.  When the liver approaches capacity, the rest of glucose gets converted into fat. Remember the stuffed suitcase analogy from before.  

So what does this mean for us?  Avoid high carb, high fat, high energy ( low protein ) foods. This gives us guidelines for what we should eat but what about when we should eat? 

The average American eats eight times a day, consuming around 300g of carbs. Since the body can only store so much glucose at a given time, Dr. Ted Naiman recommends that inactive people limit their consumption of carbohydrates to under 100g per day.  

Metabolic flexibility

We up-regulate machinery for fuel that we frequently use.  We down-regulate machinery for fuel we do not use.  Therefore if we are eating a lot of carbs, we are up-regulating carb burning machinery.  If we are not eating carbs, we are up-regulating fat burning machinery.  

Metabolic flexibility is the ability to easily switch between using carbs and fats for fuel.  It is also the ability to easily dispose of dietary fuels.  To be metabolically flexible, you need room in your adipocytes (fat cells) so that you can soak up fat.  You also want room in your muscles and liver to soak up carbs.  You can do this by regularly depleting liver glycogen.  You can also do this by having more muscle tissue ( bigger fuel tank ) and regularly depleting muscle tissue of it’s glycogen. Both intense exercise and fasting burn glycogen, making room for carbs. We’ll dive into fasting now, more on exercise later.

Fed vs. Fasted

You can either be in the Fed state or the Fasted state.  When we are in the fed state, the hormone insulin is high and it signals our body to store calories in fat cells.  When insulin is high, fat burning is reduced.  The Primary signal of the fed state is glucose entering the body and being stored as glycogen.  

In the fasted state, liver glycogen slowly depletes, lowering blood glucose and insulin.  When insulin lowers, the hormone glucagon elevates, increasing fat oxidation.  We burn fat for energy in the fasted state.

Here is how we go from the fed state to the fasted state.  We enter the fed state when we eat and stay in it for 3-5 hours after eating.  This is when the body digests and absorbs the food we just ate.  Insulin is elevated during this period of time.  Then between 8-12 hours after we eat, the body goes into post-absorptive state.  This is when the meal is still in circulation.  After 12 hours, we then enter the fasted state.  Dr. Ted Naiman recommends a 16 hour fast once a day to become more efficient at burning fat. If you are interested in learning more about intermittent fasting, check out my previous blog post here.

In our culture, we are spending less and less time in the fasted state.  Why would a very over weight person be hungry?  They have plenty of energy on them stored as fat.  This is because the average overweight person is constantly in the fed state with little experience in the fasted state.  They are constantly burning the glucose they are ingesting while storing the consumed fat.  So when glucose runs out from the last meal, instead of transiting to the fasted state and burning stored body fat, they crave more carbs/sugar.  

A good analogy for this is a trucker tank filled with oil.  If the truck runs out of gas it stops moving, even though it has thousands of gallons of oil in the tank.  This is because a trucker tank prefers to run on refined gas and it is incapable of burning oil for fuel. 

Fat adaption

Fat adaptation is the ability to burn stored body fat.  Getting fat adapted takes time.  In order to up-regulate fat-burning pathways, we need to improve insulin sensitivity.  If we lower insulin, we become more sensitive to insulin. When insulin is lower, we can better burn stored body fat.  Here are a few ways we can lower insulin:  

• Low carb diets – When we lower carb consumption, we increase fat burning.  By using fat as the primary source of fuel, we become more efficient at burning fat.  
• Exercise – high intensity exercise rapidly depletes glycogen (stored glucose).  When glycogen is low, our bodies exponentially increase fat burning.  
• Caloric restriction – When we restrict overall calories, we will inevitability be restricting glucose. The body will be forced to burn fat as fuel.  The problem with this method is that one may be hungry if protein and nutrient dense foods are not prioritized.  If nutrient dense foods are prioritized, one will naturally eat less calories because they will feel more satiated.  
• Intermittent fasting – Our insulin lowers exponentially when we fast.  When we lower insulin, we enter a fat burning state.  

Using the Protein to Energy Ratio to select foods

To figure out protein to energy ratio, divide protein by fat + carbs – fiber.  You obviously do not want to eat just pure protein, you need some energy.  A good target ratio is 1.0.  Pretty much steak and eggs.   This approximates the diet of a hunter gatherer. You will need more energy if you are more active and less if you are more sedentary.   

To create lasting change, you want gradual improvement.  Going from a donut to oatmeal is better because you are raising the protein to energy ratio.  Basically you want to base your meals around animal protein (like beef and eggs) , low sugar veggies and fruits.  Use just enough fat to grease the pan or surface you are working with. Minimize nuts, hard cheese, avocados, cured meats.  Limit carbs to just non-starchy veggies like spinach and kale.  Consume carbs sparingly.

The three hungers

According to Dr. Ted Naiman, there are 3 reasons why we are hungry.  For nutrients, energy, and pleasure.  We know from human and animal studies that when you deprive someone of protein or minerals, they will experience increased hunger.  However your body does not know that most food is garbage with no nutrients and protein.  So you will continue to eat without feeling full because you will not get the nutrients you need.  

We also experience hunger when we need energy.   We have a tough time distinguishing between energy and nutrient hunger.  Therefore it makes more sense to target nutrients such as protein and minerals first.  Once we consume the proper amount of protein and minerals, we can better interpret energy hunger.  We often get confused between low glycogen hunger and true energy hunger.  Low glycogen hunger happens when we are not fat adapted and our body craves sugar to keep sugar burning.  This is why Dr. Ted Naiman recommends that we become more fat adapted, so we do not feel hungry all the time.  

Hedonic hunger is pleasure hunger. Energy dense carbs and fats are extremely pleasurable and easy to over eat.  Potato chips, cupcakes, pizza, candy are all high in energy dense fat and carbs, making it very easy to overeat.  Dr. Naiman recommends limiting intake of these foods.  Eat them after a nutritious meal so that nutrient hunger is taken care of.  Eat them with intention and consume 1 serving.  Understand what they do to the body.  

Practical application

1. Eat lean protein and veggies first.  Target protein and minerals to achieve nutrient satiety.  Your body can turn protein into carbs.  However carbs and fat can not be converted to protein.  We should focus more on protein.
   
2. Minimize carb frequency to allow for fat adaptation.
   
3. Eat added energy last and only if necessary.
   
4. Be cautious of fats and carbs together.  They can drive overeating.
   

At this point, Dr. Naiman has shed light on diet. But that begs the question: how should we move? Are there ways to optimize workouts for better health?

Exercise

Dr. Naiman begins his discussion on exercise with an emphasis on consistency. The best workout for you, is the one you will do consistently. An important way to be consistent is to lower the barrier to entry.

What this looks like in practice is: a daily workout that can be done at home in 15 minutes or less.

According to Dr. Ted Naiman, exercise is crucial in achieving optimal body composition.  Exercise induces a stress on our bodies.  We respond to that stress by building muscle.   Muscle is metabolically expensive, so we have to convince our bodies to create it.  One of the most efficient ways to do this is through Demand Training. 

Pushing your muscles to failure signals our body to rebuild.  This makes sense through an evolutionary stand point.  In a survival setting, if your body cannot outrun a predator, you may die. Demand Training mimics this scenario and tells your body to be stronger next time. To do this, place very high tension on your muscles for a period of time until you reach failure.    There are two types of demand training.   Resistance and cardio. 

“In a way, we are all “bodybuilders,” and our bodies are constantly responding to our activity or LACK of activity in a precise fashion that is designed to maximize survival.  If you have more or less muscle mass than you used to, we can almost always trace that back to an environmental response of sort.”

Dr. Ted Naiman

Resistance training

One example of resistance training is doing push-ups to failure. A typical set should consist of 5-10 reps to failure. Once you can easily do 10 reps, you should increase the difficulty of the exercise.  For example, after 10 wall push-ups becomes easy, you would then switch to knee push-ups. Dr. Naiman recommends 3 sets of 5-10 of these movements:

push, pull, squat

Exercise	Difficulty 1	Difficulty 2	Difficulty 3	Difficulty 4	Difficulty 5
Push	Wall push-up	Knee push-ups	Regular push-up	Diamond push-up	One-arm push-up
Pull	Suspension trainer OR hanging from a pull-up bar	More difficult  angle on suspension trainer  OR hanging on top of pull-up bar	Lowering yourself down from pull-up bar	Pull-ups	One-armed pull-up
Leg	Bodyweight squat	More intentional body weight squat.  Full-range of motion and perfect form with chest high.	SLOW bodyweight squash- 30 seconds down, hold 30 seconds, up for 30 seconds. Keep going until failure.	One-legged body squat

To get the most out of your work Dr. Naiman suggets hitting triple failure. What does that mean?  An exercise has two phases, the concentric and eccentric.  The eccentric is the easiest part because we are letting ourselves come down with gravity.  The concentric phase is the most difficult because we are fighting against gravity.  So when we do an exercise like a push up, we want to keep going until we hit failure after the concentric, the most difficult, part of the exercise.  After hitting failure at this phase, we want to hold ourselves in a static position until we hit failure.  This is what is meant by triple failure. Dr. Naiman notes: after we hit failure, we should rest for 20 seconds before doing the next rep.  

Cardio Demand Training

Cardio demand training involves larger whole-body movements that lead to cardiovascular failure.  Jumping up and down until you can barely breath is cardio demand training.  Like resistance training, cardio demand training uses the highest energy output until failure. ( gasping for breath)

To do cardio demand training, you want to do 3 sets of maximum effort.  You can do any exercise that will bring you to failure in roughly 30- 60 seconds.  

One way to do this is 30 seconds of all out exercise followed by 30 seconds rest. Repeat this 3 times. You can do whatever exercise that involves  a good portion of your body that leads to rapid failure in 30-60 seconds.  Sprints up a hill, burpees, jump squats could all work.  

Light vs. intense cardio

Light exercise such as a brisk walking increases calorie burning through fat oxidation.  There is little to no glycogen depletion. In intense cardio, we deplete glycogen stores.  By depleting our glycogen stores, our metabolism will change after working out.  Depleting glycogen increases fat oxidation and insulin sensitivity.  For example, when we go on a brisk walk for an hour we may burn about 300 calories, but thats it.  When we do intense cardio, we will see positive changes in our metabolism such as an increase in muscle and fat oxidation rate.  So with high intensity cardio, we deplete our muscle glycogen.  This depletion of muscle glycogen raises fat oxidation for hours as long as we don’t eat carbs immediately after.  In addition, by pushing your cardiovascular system to the brink, we increase our cardiac output, increase strength & size of cardiac muscles, increase mitochondria, increase overall stamina.

This style of workout is highly effective. One can spend less than 20 mins. a day exercising at home ( or on the go ) and get the stimulus needed to build muscle and cardiovascular health.

Our summary

We really enjoyed this book. Protein to Energy Diet clearly conveys the steps we can all take toward being healthier human. Target protein and minerals in your eating. Exercise intensely nearly everyday.

The addition of visuals/images /graphics makes the material easy to digest. Also, Dr. Naiman takes a non-dogmatic stance, demonstrating why different diets can work for weight loss. ( sorry Vegans & Low Carbers )

Reading Dr. Naiman’s book changed the way we eat and the way we move. If we stray from our healthy eating pattern — it’s okay. We understand what levers to pull after an energy dense meal and why. For instance, if we eat pizza on a Sunday night, we will fast until dinner the next day. That meal will be high Protein, low energy, >1.0 on the protein to energy scale (steak & eggs, chicken, green veggies with limited oil). And we will do an intense ( and quick ) workout to make up for the naughty eating. It’s like having a cheat code for health!

Jillian’s personal testimonial – I was only able to do 20 knee-push-ups in December of 2019. As of March 23rd 2020, I can now do 15 regular push-ups! I was able to accomplish this by doing 3 sets of 5-10 reps of push-ups to failure 5x a week. This takes up about 2 minutes of my time per day. I like how I can do these high intensity workouts anywhere in a very short amount of time!

Michael’s personal testimonial – The push, pull, squat workout is great. It takes less than 20 minutes out of my day. I am exercising more consistently ( 5 times per week ) because of it. My pull-ups are improving faster than I expected; 3 months ago 5 pull-ups was a hard set for me, now 10 pull-ups is a hard set!

Thank you for taking the time to read our book review. For more of Ted Naiman’s work, including a link to the Protein to Energy Diet Book, check out the links below. Stay safe, stay sane, stay healthy my friends.

Resources

• The Protein to Energy Diet Book- Dr. Ted Naiman & William Shewfelt
• Dr. Ted Naiman Website
• High Intensity Health Podcast with Mike Mutzel- Why High Protein Diets Help You Lose Fat w/ Dr. Ted Naiman
• Diet Doctor Podcast #40- Ted Naiman
• Low Carb MD Podcast Episode 82: Dr. Ted Naiman
• Protein vs Energy- Dr. Ted Naiman
• Exercise- Dr. Ted Naiman
• Diet- Dr. Ted Naiman