Human Foie Gras — A Golden Opportunity


To kick things off, what is foie gras?

It can be explained with a short missive from our friend Wikipedia:

The California foie gras law, California S.B. 1520, is a California State statute that prohibits the “force feed[ing of] a bird for the purpose of enlarging the bird’s liver beyond normal size”…

Former Senator John Burton called foie gras production “an inhumane process that other countries have sensibly banned.”

Given this outrage related to mistreating birds, you might be surprised to learn that human foie gras industries are booming.  Children’s livers are apparently particularly tasty. Not unlike veal, I suppose.

I’m putting $50K of my own money into related investments, but we’ll get back to that in a minute. First, some background…

For most of the 20th century, fatty liver and liver cirrhosis had two primary causes: drinking too much alcohol (e.g. Mickey Mantle) or hepatitis B or C (via IV drug use, unhygienic tattooing, tainted blood transfusions, etc.).

But in the last few decades, even infants are showing up with livers that should belong to hardcore alcoholics.  And the numbers aren’t small.

It’s estimated that one in ten American children now suffer from non-alcoholic fatty liver disease (NAFLD), alongside 40 million affected adults. If you’re an obese Mexican-American boy, the odds are 50-50 (!) that you have NAFLD, thanks to genetic predisposition (PNPLA3 gene).

15 years ago, this disease was unheard of.  In 10 years, it’s projected to be the #1 cause of liver transplants. Put another way — In 2001, NAFLD was the reason for 1 out of every 100 liver transplants; by 2010, it was up a ten-fold to 1 in 10; by 2025, assuming nothing stems this tide, there could be five million Americans who need new livers because of it.

Who are driving this trend?

Some point fingers at good folks such as Coca-Cola, juice “cocktail” manufacturers, and the like.  Given that many researchers blame fructose, it’s not a huge stretch. Personally, the whole thing makes me sick.  I’d like to sic the best scientists in the country on them.

Ah, and this is where the good news comes in.

There is a way, albeit an indirect way, to do this. I implore you to read on and bear with me.  This is where it gets exciting.

The NIH alone has spent $155 billion on cancer research since 1972, and cancer survival is up a paltry 3% as a result. The US government spends over $25 billion EACH year on HIV/AIDS. That’s a lot of money.

One might assume fatty liver disease would require similar sums. After all, more American adults have NAFLD than prostate cancer, Alzheimer’s disease, heart disease, or type 2 diabetes.


That’s the disconnect…and the opportunity to be part of history.

Enter the “Manhattan Project of Nutrition”

The Nutrition Science InitiativeNuSI–has been called the “Manhattan Project of nutrition.” They are run like a lean startup, and I’m proud to be a part of their advisory board.

They don’t take industry money, so they have no interests to protect.

They believe the NAFLD epidemic can be curtailed for a total of $50 million, but the whole domino effect starts with just $1 million.  It is a rare day in science when fundamental questions about an epidemic can be answered with such little money (respectively). It’s an incredible Archimedes lever.

For context, NuSI argues that there are dietary triggers of diseases, including obesity, type 2 diabetes, cancer, and fatty liver disease. To determine what the triggers are, NuSI assembles teams of the best scientists in the country (e.g., from Stanford, Harvard, Columbia, NIH, UCSF, UCSD, Emory, etc.) to fund and execute the kind of research nobody else is willing (or able) to perform.

For NAFLD, NuSI’s team of experts have designed three trials to determine the respective roles of too many calories, too many carbohydrates, and too much sugar–the leading three hypotheses–as dietary triggers.

In early 2015, this team will begin the first ever controlled clinical trial to see if removing sugars from the diet can reverse fatty liver disease in children.

40 kids with NAFLD will be split into two groups, with 20 simply observed on their normal diet as controls, and 20 provided with a diet that’s identical to what they usually eat, but completely devoid of added or refined sugars. The scientists’ hypothesis is that the sugar-free diet will at least stop the progression of NAFLD in these kids, and may even reduce the amount of fat in their livers.

If that’s the case, it’ll be the best evidence we have linking sugar to fatty liver disease.

My $50,000 Challenge…And How to Get Involved

I’m personally matching up to $50,000 for whatever is raised through this blog post, and every donation–big or small–makes a major difference.

[UPDATE: An anonymous donor — a generous reader of this blog — has offered to match up to another $150,000. That means that if you all help donate or contribute just $200,000, another $200,000 will be matched for a total of $400,000!]

Any donation is also a tax write-off, as NuSI is a non-profit organization (of course, speak with your tax advisor). Perfect for end-of-the-year giving.

NuSI is looking to raise $1 million dollars for the first of these three trials—the one that determines how the rest get done.  The snowball that starts the avalanche. There are few chances in the world to have this type of impact for this type of money.  Could it end up forcing labeling changes, product modifications, obligatory package warnings, policy shifts, and more?  I believe so.

Supporting this campaign very easy, and remember–I’m excited to be putting my own skin in this game.  I sincerely hope you join me.  Every bit counts.

There are three options:

1. Donate by credit or debit card. Visit: Enter your donation amount, indicate “NAFLD — Tim Ferriss” in the message field, and click “Donate.”  Done.

2. Donate by check. Send your check to: NuSI, attention: Lacey Stenson, 6020 Cornerstone Court W. Suite 240, San Diego, CA 92121. Be sure to write “NAFLD – Tim Ferriss” in the memo line.

3. Donate by transferring securities (stocks, etc.). Email [remember the double “r” and double “s”] and they’ll do as much heavy lifting as possible.

Thank you for reading, and thank you for supporting if you’re able.  This is a good fight.

If you’d also like to hear a fascinating chat with Peter Attia, MD, co-founder of NuSI, I interview him here on radical sports experimentation, synthetic ketones, meditation, and more. He’s a competitive ultra-endurance athlete, MD, surgeon, and obsessive self-tracker, so we get along great 🙂

Ep 50: Dr. Peter Attia on Ultra-Endurance, Drinking Jet Fuel, Human Foie Gras, and More


Relevant reading and citations:

Browning JD et al. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Hepatology, 2004.

Welsh JA, Karpen S, Vos MB. Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. Journal of Pediatrics, 2013.

Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. The New England Journal of Medicine, 2010.

Dudekula A et al. Weight loss in nonalcoholic fatty liver disease patients in an ambulatory care setting is largely unsuccessful but correlates with frequency of clinic visits. PLoS One, 2014.

Kawasaki T et al. Rats fed fructose-enriched diets have characteristics of nonalcoholic hepatic steatosis. The Journal of Nutrition, 2009.

Sanchez-Lozada LG et al. Comparison of free fructose and glucose to sucrose in the ability to cause fatty liver. European Journal of Nutrition, 2010.

Best CH et al. Liver damage produced by feeding alcohol or sugar and its prevention by choline. British Medical Journal, 1949.

Ouyang X et al. Fructose consumption as a risk factor for non-alcoholic fatty liver disease. Journal of Hepatology, 2008.

Abid A et al. Soft drink consumption is associated with fatty liver disease independent of metabolic syndrome. Journal of Hepatology, 2009.

Abdelmalek MF et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology, 2010.

Assy N et al. Soft drink consumption linked with fatty liver in the absence of traditional risk factors. Canadian Journal of Gastroenterology, 2008.

Stanhope KL et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. The Journal of Clinical Investigation, 2009.

Maersk M et al. Sucrose-sweetened beverages increase fat storage in liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. The American Journal of Clinical Nutrition, 2012.

Browning JD et al. Short-term weight loss and hepatic triglyceride reduction: Evidence of a metabolic advantage with dietary carbohydrate restriction. American Journal of Clinical Nutrition, 2011.

Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology, 2013.

Chung M et al. Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 2014.

The Tim Ferriss Show is one of the most popular podcasts in the world with more than 900 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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98 Replies to “Human Foie Gras — A Golden Opportunity”

  1. Tim, I’m going to call BS on this statement “The NIH alone has spent $155 billion on cancer research since 1972, and cancer survival is up a paltry 3% as a result.” Where are you getting your data from? That statement sounds incredibility misleading.

    1. Anecdotally, I’ve actually heard breast cancer oncologists say the same thing, “survivorship hasn’t changed since the 70’s”. Oncology today s so imprecise that it seems like target shooting for rabbits in poor moonlight. Very inaccurate, and more of a hope & pray versus “this has a very high chance of helping you”.

      Oncology is a weird and unsettling world once you look under the surface.

    2. I can see why it’s hard to believe this fact, and there is certainly a range on this number (Gina Kolota is often cited from her 2009 piece which, if I recall correctly, asserted a 5% survival increase in the U.S. between 1950 and 2009; this may be even more depressing than the progress since 1972). Regardless, the point is that we are certainly getting better at extending median survival for cancer by a few months every few years, but 10 year survival for patients with stage IV cancer–the gold standard metric for “curing” cancer–does not appear to have made upward progress in any solid organ tumor except for seminomatous testicular cancer and GIST. Hence, most of the improvement is *overall* survival have come from the improvements in curing (some) leukemia (e.g., CML, ALL) and (some) lymphoma (e.g., B-cell, Hodkgin’s).

      For more info on this, you may find a post I wrote a while ago interesting:

      Also, the $155 billion since 1972 is a very conservative number, as it only captures the NIH spending (these data are all publicly available). What is not captured (because I don’t know; not necessarily because it’s not knowable) is non-NIH spending (e.g., pharma).

      1. Tim, I disagree – stage 4 cancer shouldn’t be the gold standard. That is like saying treating septic shock is the gold standard for antibiotics.

  2. Very impressive Tim.

    I’m definitely contributing.

    In the field of nutrition – which by extension equals to health – which consequently impacts everything else: people’s quality of life, behavior, moods and thus society’s crime rates, technological advances, etc. etc. etc. – this is a very important initiative.

    In my self-experiments, sugar is definitely a bad-guy.

    But, I’ve actually experienced more detrimental effects from high linoleic acid intake (sunflower oil, peanuts, corn oil).

    High linoleic acid intake has a peculiarly destructive, addictive and stupefying effect. Personally, it completely obliterates any possibility of accomplishing challenging mental tasks for 24 hours or so afterwards (very evident after my first cheat days).

    If this initiative proves successful, I’d love to see NuSI tackle this one (high n-6 diets, or specific oils or ingredients) after sugar.

  3. On my spare time I like learning about causes related to nutrition, health, environment. I also spend time reading 4H Blog & TFS podcast. It’s great to put the two together and put some money towards something that you endorse, Tim, so thanks for this post.

    According to many prominent scientists, our entire species is in danger due to our crimes against the earth (in the not so distant future). BIG FOOD is one of the biggest culprits, they are on a runaway train with no social conscience. I believe, from all the studies I have read that the LEAD DOMINO when it comes to tackling environmental issues is by hitting the food industry. Kinda hard when the USDA is in the same bed as the food lobbyists but it’s studies like this that are funded by US that can get the ball rolling.

  4. Same for Diabetes type 2


    Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol

    Conclusions after a 600 kcal/day diet:

    Normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.

  5. Hi — just donated. Thanks for raising awareness for this cause and the way the NuSI team is approaching their research funding sources. Are other sorts of crowdfunding plans on their horizon?

    1. Thank you, rundc. We truly appreciate your generosity. We’ve got some big things in store for 2015! Crowdfunding just might be one of them…

  6. (…) too many calories, too many carbohydrates, and too much sugar–the leading three hypotheses–as dietary triggers. (…)

    They are not investigating the role of PUFA in NAFLD? I think this would be the most important thing to investigate.

    A lot of studies showed the positive effect of n-3 PUFAs (e.g. fish oils) when there is an exess of n-6 PUFAs in the diet. However one could argue that PUFAs are toxic in general to the liver by inhibiting normal cell proliferation.

    When the liver is damaged, it’s ability to store glycogen gets impaired. Fructose is metabolized over the liver and preferably stored as liver glycogen. I think this is why it could get toxic when the liver is damaged.

    If they don’t include PUFAs in their studies, I guess this will lead nowhere… I’m sorry Tim. – „Growing evidence suggests that polyunsaturated fatty acids (PUFA) influence risk factors including circulating lipids and inflammation on the development of CVD and NAFLD.“

    (an much more…)

    1. I agree – the role of omega-6 (in particular) in turning ‘mere’ fatty liver into cirrhosis is becoming abundantly clear. But once again, doing small intervention studies will not significantly change the evidence base. We need to, at the very least, be working towards labelling that gives us useful information – for example ‘One serve of this Mayonnaise contains 6 times your daily requirement for omega-6 fat’ or ‘100g of this low fat mayonaisse contains 5 teaspoons of sugar’

      1. PUFA may play a role, indeed. In theory, all options are on the table, but you need to start with a leading candidate and do a clean experiment. When NuSI (remember, NuSI doesn’t do the experiments, NuSI funds and facilitates the teams who do the experiments) kicked off this initiative 12 months ago at the request of the Scientific Advisory Board, we interviewed the 38 leading hepatologists and gastroenterologiests in the United States–from 20 centers–over the course of four months. The teams spent 48 hours together on two separate occasions in a war room 2 months after these interviews where the debate raged on about the best hypotheses to explain this epidemic. What emerged, thousands of man hours later, was the following: the leading candidates for dietary triggers of NAFLD were fructose, excess calories in general (i.e., NAFLD is an extension of other peripheral adiposity), and CHO excess.

        This is not NuSI’s assertion, but rather the collaborative effort of the nearly 40 experts on this topic in the United States. PUFA was certainly discussed, but the current clinical and lab data do not support this being the first target of investigation (which does not mean it’s incorrect or not additive to the effects of other triggers).

        I hope this better explains the process. You can learn more about NuSI on the website ( and various periodicals.

  7. Tim and others,

    I’m a huge Tim Ferriss fan and love a lot of the work you put out.

    But this sounds horrible. I’m a future physician and a big fan of nutrition to solve medical problems. With that said, we are looking at doing a study to find out if too much:

    1. Carbs

    2. Sugar

    3. Calories

    are bad?

    Should we do a study to find out if too much alcohol, crack cocaine, or marijuana is bad? How about chronic sleep deprivation, living with anxiety all day, or eating only mcdonalds?

    I think there are plenty of studies showing that all 3 of the above activities are harmful. Excess sugar has been linked to numerous bad outcomes. Lower calorie intake has been associated with longer lives and less antioxidant damage. Lastly, excess carbohydrates act similarly to excess sugar.

    I would recommend the people with NAFLD eat a healthy diet (which is controversial but should include lots of vegetables, lean proteins and not an excessive amount of carbohydrate/sugars).

    I don’t think this makes sense.

    1. totally false on the carbs – fruit, veggies, legumes and whole grains are amazingly healthy. See Dr. McDougall, Dr Neal Barnard, Dr. Caldwell Esselstyn, T.Colin Campbell, all reversing obesity, diabetes, heart disease and many other problems from a high animal fat and oil diet.

      1. Totally agree.

        I reversed my NAFLD in 6 months by switching to a whole food, plant-based diet.

        Naturally I cut out the junk – soda, chip, burgers and other refined sugar/oil.

        It saved my life and I lost 46 pounds without an ounce of exercise.

        The science is overwhelmingly showing most of our chronic diseases are due to poor nutrition and crippling our body’s ability to heal itself.

      2. totally false on the sweeping statements that imply everyone should be eating the same. Healthy carb levels are determined by metabolic type and activity level ( This is a good summary, and research literature is listed within the books she mentions at the outset.) And there’s a whole, big massive group of gluten-intolerant people who would beg to differ with you regarding the health of whole grains. Because whole grains have been touted for so long as healthy, some people keep eating them, not realizing how much havoc they are creating internally. (And compared to vegetables and organ meats, whole grains are weaksauce nutritionally. See any nutritional database.)

    2. I completely agree. What significant new contribution to the existing literature does this organization hope to achieve with its research?

    3. Yeah I agree that a “sugars” study will be ineffective unless it tracks / controls for a spectrum of agents that usually come under the blanket heading of “glycemic index” – at least considers it in the setup. Which should include balanced fat-protein-carb meals, desert (fast-digest carbs) only after meal not alone, between-meal fast – drinking only ‘pure’ water, and for that matter so many other factors that it completely devolves into an unsolvable equation – yet each is potentially critical. Like a bicycle wheel is kept under balanced tension – when even one spoke breaks it causes a cascade of bad. And it doesn’t matter which spoke broke. 🙂

    4. Don’t know the quality of a study until you read it. Tim has a more general audience than a med school.

      I agree that a “sugars” study will be at best ineffective unless it tracks / controls for a spectrum of agents that usually come under the blanket rubric of “glycemic index” – but even that is inadequate for a hacker-solution. Which should include balanced fat-protein-carb meals, desert (fast-digest carbs) only after meal not alone, between-meal fast – drinking only ‘pure’ water, and for that matter so many other factors that it completely devolves into an unsolvable equation – yet each is potentially critical.

      Like a bicycle wheel is kept under balanced tension of its spokes, by an evolved design – when just one spoke breaks, it causes a cascade of bad … and it doesn’t matter which spoke.


    5. Here, here! I also love a lot of the concepts put out by Tim, but I think that money would be better spent elsewhere! (Like on the Xprize!) Almost everyone already knows that EXCESS carbs are bad, sugar is bad and EXCESS calories are bad. I no longer contribute to cancer research, as the vast majority of researchers are only focused on finding a drug that the pharmaceutical companies that employ them, can derive financial gain from using to treat it, not a cure. So as altruistic as this research may be, I think money would be better spent researching ways to make healthy food more affordable, more easily accessible, and education for kids and parents (who still don’t understand the pitfalls of a poor diet.), or something else entirely (like, how various forms of meditation can cure ailments).

    6. Ben, I appreciate your thinking on this, but you need to keep in mind that the medical establishment does not necessarily share your view. The current “first line” therapy for patients with NAFLD–i.e., the “prescription” they are given for treatment (remember there are no FDA-approved drugs for NAFLD yet) following diagnosis–is to lose weight. But such advice is rarely successful, so the medical community, specifically the front line doctors who treat this condition, are looking for a more effective treatment.

      It doesn’t matter what I think or what the readers of this blog think, with respect to treatment, since we don’t treat patients with NAFLD. The people who do want a more rigorous answer. We think it’s our job to help them come up with one.

      I hope this makes sense.

      1. But wait…. if lifestyle change is a better solution than “treatment” (for MANY diseases), why shouldn’t the researchers work towards making “a rarely successful prescription” a WILDLY successful prescription? To satisfy this world’s need to pop a pill and be healed? Solve problems by going to the root cause I say! Don’t stick a band-aid over it! But as you pointed out, we’re just blog readers. But maybe if enough people speak their minds….

  8. Although to be honest, I only just skimmed this article, so you may have mentioned it, but gmo’s may also have an affect NAFLD.

    1. Eating whole food plants, even if GMO, are shown to better than eating processed foods that are not. Google Dr Gregers nutrition facts site for links to research.

    1. I suggest reading more about NuSI before casting stones.

      Peter eats tons of vegetables, has incredible scientific credentials, and also involves “plant-positive” (i.e. higher-carb proponents) researchers into their study design and implementation.


  9. Super interesting, I’m an old fart 61 hovering @ 350 to 400 pounds, I remain active and walked across Spain (Camino De Santiago) 500 miles last year… My Question how can I live longer? I listened to your you and Dr. Attia with lots of info much that I have already read… I feel all the processed foods over the past 40 years have effected the way my metabolism works and now I can’t seem to loose weight or generally get back to a healthy state… I do realize I’m on the slippery slope with no return but dam it I’m not going peaceful… Still have lots to do! Is there advice on supplements or a course of action that will help to keep an already deteriorated body at its (my) current state…

    Keep up the great work Tim, I consume everything you produce and have done since the 1st release of 4HWW…

    1. Hi Andrew,

      Thank you for the comment. Peter might have other thoughts, but my first question would be: have you tried getting into ketosis with something like Atkins or its cousins?



    2. I would check out the plant base diet. You will have real results and feel like your 30 again. Atkins in your state could actually cause you to develop cancer. Meat and dairy (whether it’s grass fed, organic or not) are known to agitate the cancer cells to grow and it’s no secret that they cause diabetes, heart disease, obesity, and lot of uunnecessary inbalances in the human body. There is plenty of information out there. Here’s a couple to speak of

      Wishing you well on your journey! I have been on this diet for 10 months now and I feel amazing! I’m never looking back.

    3. Eat wonderful food and lose weight without exercise with the Low Carb High Fat ketogenic diet for life! Have a look at this site

      for great information. Google LCHF for more info – good luck and Long Life!

  10. Thanks for introducing me to NUSI.

    Do you have a reference for the cancer mortality statistic you mentioned? Would love to read it.

    Many thanks. Love your work.

  11. Will they be studying the interacting effects of carbohydrates/sugar and fiber as well? If they leave out fiber it’s not going to be such a great research project, because fiber changes how the body deals with sugar/fructose.

    How about high-intensity exercise? If you exercise hard, all those carbs just replace glycogen stores and thus don’t go to the liver. That’s why athletes can drink gatorade like it’s going out of style and not get fat.

    I’m reading Fat Chance right now from Dr. Lustig and he argues very coherently with many references that high sugar (fructose specifically), low fiber, and little exercise is one of the main causes of metabolic syndrome (along with obesogens/xenoestrogens, genetic factors, and a number of other things).

    I think we already know what causes the problem – the key is figuring out how we can steer the titanic away from the iceberg.

  12. Are they going to study the interacting effects of fiber with sugar/carbohydrate consumption as well? It is already well-known that eating fiber along with carbs radically changes how the body deals with these inputs.

    How about high-intensity exercise? If you exercise at high volume or intensity, you can eat tons of sugar and carbs and just replace lost glycogen stores, which is why athletes can drink tons of gatorade and not get fat (but you do).

    I’m reading Fat Chance by Dr. Lustig right now and he argues strongly (with lots of references) for low fiber, high sugar, low exercise as the primary cause of the obesity epidemic, along with obesogens/xenoestrogens (such as BPA in plastics), genetic factors, and a few other players (trans fats, etc.).

    Do we really need more research, or do we need more implementation at this point?

  13. You forgot to write up the book Peter recommended:

    Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts

    by Carol Tavris, Elliot Aronson

  14. How I reversed my NAFLD in 6 months, solely through diet…

    This article hit on a topic very close to home for me. I had a stunning wakeup call one year ago, when I got some routine bloodwork back that showed elevated ALT, suggesting liver damage. Further tests found it was getting even worse and I had NAFLD. I was over weight and ate poorly and knew it was time for a change. Less than a year later, it was gone, here’s what I did…

    Naturally I stopped eating garbage snack food – pop, chips, burgers.. refined/added sugars and fats – gone.

    But more importantly I replaced it a whole food – plant-based diet that gave my body the nutrition it needed to reduce inflammation, fight oxidation and cure my illness.

    My ALT scores went from a high of 127 to 61 – in first 3 months. Then down to an ideal 29 in the next three. Oh and I lost 46 pounds, but that was just a bonus. See my other scores etc – I could go on if anyone wants to know more.

    No exercise, no secret foods, just good nutrition. Want to cure yourself or young ones you know? Go with “whole food, plant-based” and you will be happy with the results.

    Hope that inspires you!


    p.s. In fact, et al shows how so much recent research confirms nutrition as the most significant improvement to health outcomes on almost every chronic disease we struggle with.

    (FYI your site has SSL certificate issues I think)

  15. Hi Tim,

    Are you familiar with the work of Dr. Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology? There a video with him called “Sugar: The Bitter Truth”, produced by University of California Television (UCTV) available on YouTube. This video and your Slow Carb diet (thank you!) helped me to lose 20 pounds. Please, check the video, it is great.

  16. Hey Tim,

    I donated albeit it’s not much but it’s what I can afford being a deployed solider overseas. I forgot to put the “NAFLD — Tim Ferriss” on the first donation, but I remember on the second one. I admire your tenacity, keep up the good work Tim.

    1. Thank you, Alexander. We truly appreciate your generous donation. Every bit helps.

    1. Hi Sjors Provoost, Great question. Unfortunately at this time we are not accepting donations in the form of bitcoins. Sorry!

      1. Good idea to work on that, Lacey, especially with my audience. It’s not hard. I can intro to Coinbase.

    2. Hi Sjors – thanks for being patient while we set up the ability for supporters to donate via bitcoin. Please let me know ( if you experience any troubles with donating via the Coinbase platform on our website:

      1. Works like a charm! The suggested amounts (25 – 500 BTC) are slightly out of my league, but there’s also the custom amount field.

        I didn’t get your email notification for some reason, but I noticed bitcoin in the list of options when I checked the donations page again. It’s not tax deducible from The Netherlands* anyway, so timing is not an issue.

        Keep up the good work!

        * = you could apply for ANBI status if you have any rich potential Dutch donors in mind to make it worth the paperwork:

  17. Tim, its great that NUSI are looking at NAFLD but I wonder at the utility of doing this study. It will show that the children on the sugar free diet will do very well. There really isn’t much doubt about what causes NAFLD. But lets roll forward 5 years to when that result is published. We will have a very small intervention that is easily dismissed with spin. The soda industry is adapt at attacking studies like this – underpowered, confounding factors etc. Wouldn’t the million be better spent fighting spin with spin and getting the labelling in the US up to a standard where you can actually tell how much sugar you are eating anyway?

  18. Oh wait, so we can’t actually buy foie gras made out of the livers of children? Um… good. Foie gras is amazing but I wouldn’t invest in that!

    1. Ah, I do believe Tim may have been using satire, rather akin to the pamphlet A Modest Proposal published by Jonathan Swift advocating the eating of poor Irish children as a means of drawing attention to certain horrific social conditions of the time.

      After the usual apoplectic outrage by the morally self righteous it dawned on them that the proposal wasn’t advocating eating the poor but feeding them.

      I’m personally not donating to this however worthy it may be, as my own country is rapidly following in the wake of the United States in obesity and its resulting diseases. The continual interference of our nanny state governments with mostly out of date advice and prohibitions on what can be eaten where is just wasting money and inspiring people to do the precise opposite.

  19. I am all for NUSI’s research. I do contribute to NUSI in a different capacity.

    BUT, I want to make a statement here that I will not participate in your matching contribution due to your ignorant, laziness, and broken promises that you will provide transcripts for the podcasts you do. You provide few and failed to follow-up on next several podcasts.

    Mr. Four Hour Work Week, is it your system or is it your bigotry that cause this transgression?

    On my conscience, I can’t associate this with your name, Tim Ferriss, for he who failed delivering his promise to a accessibility website for people like me who are deaf and a fan of Tim Ferriss that wish to access the valuable materials on an equitable basis.

    I will be glad to match your contributions if I see an improvement in your Four Hour Business system that improve the inclusion of your readers.

    Tim, to help you put this in perspective, there is a crisis in science and knowledge of nutritional industry. I am pretty sure your podcast provide a actionable information that we may improve our quality of life and health. Millions of people with hearing loss enjoyed your Four Hour books and the articles you have written in the past. Now, they are enthused to see what you will contribute next. The podcast of you and Peter Attia was posted. THey couldn’t hear one word. What if there was key information that your deaf readers could take an action and manage their obese and share with others. We together are fighting toward to end the epidemic of obesity through the power of information. The changes are empowered by the translation of languages and communication modes.

    For you Tim, it cost you a penny, to have the podcast transcribed or use the captioning service. And, the impact you have on people that who are marginalized are recognized and improved. That is priceless and rewarding.

    I pick you, Tim. Because you are role models to many content providers and with your “superpower” you can influence the content providers to change how they do their business.

    Heed my plea and you will see the improvement and lasting impact being made for the greater good.

    As of now, it is just between me and Peter Attia and his NUSI.

  20. Hypercaloric Diets With Increased Meal Frequency, but Not Meal Size, Increase Intrahepatic Triglycerides

    Tim in the four hour body you claim that fructose from orange juice caused your iron levels to increase dramatically, however are you sure it wasn’t actually the fructose but the Vitamin C (which is know to increase absorption of iron)?

    I don’t think sugar is to blame – it’s the constant eating. Fructose is beneficial I’m the right amounts, it improves sleep and brain function and helps maintain stable blood sugar. Also fruits come with potassium and vitamin C amongst other things.

    In the study I mentioned, people who drank sugary drinks with 3 meals had a decrease in liver fat compared to those who consumed the same amount of sugar between meals (6 meals per day) who had an increase in liver fat. Same goes for the group who consumed a high fat high sugar drink with meals – less liver fat, but when it was spread over 6 meals there was increased liver fat. I think the sugar consuming low frequency group had better blood work then the other groups too.

    As Seth Roberts noted, timing is also important, not just the dosage.

    Perhaps constantly consuming sugar all day is bad by stresses the liver and pancreas allowing fat to build up but only eating a few meals that include sugar might not have this effect.

  21. Tim, is there any way you and Peter can share with us the amazing email on longevity (the one Peter sent to you), or is it too personal? :-/

    1. Chris, the email is about 10,000 words (!) and not yet ready for prime time. When it is, though, I’ll be sure to share it.

  22. Hi Peter and Tim,

    Loved the podcast and also this initiative(NAFLD), but wondering if you will look at artificial sweeteners as well, and how they impact NAFLD and obesity in kids in general. Reason for me wondering is that is see kids daily that have a reasonably healthy diet, high activity levels but are growing fluffy so to speak, and the the major difference between them and those staying at normal weight is the amount of diet soda consumed. I would rather have my own kids drinking fruit juice, and fructose with it, all day than giving them diet coke, but I’m open to be proven wrong on that assumption.

  23. I think this is a good start but isn’t it more important to focus on the big picture? Nutrition is responsible for so many more Western diseases. Check out for great information.

  24. Tim,

    I didn’t know what NAFLD was until a year and a half ago when my father (who never ever drank alcohol) was diagnosed with cirrhosis of the liver after being severly ill for a few months. Even his doctor accused him of being and alcoholic, stating that livers don’t just get that bad on their own. They discovered a tumor on the liver shortly afterwards. We had him evaluated as a transplant candidate, but he wasn’t a good fit. It was at this time that the doctor that evaluated him indicated he likedly had Non-Alcoholic Fatty Liver Disease that had progressed to cirrhosis. He passed away about 2 weeks later.

    Yes, NAFLD is believe to largely be caused by the items you have cited. There can be a heredity component, too. I joined a Facebook support group about NAFLD that has people at all spectrums of the progression of the disease. Some were just diagnosed. Some are post transplant. A common complaint is that doctors know very little about the disease and do a poor job of conveying the seriousness of the disease. It seems that only liver doctors really know about this. Education needs to occur both in the medical community as well as the general population.

    People diagnosed with NAFLD can reverse it through exercise, a change in eating habits and weight loss. It isn’t a diet. It’s a lifestyle change. You can’t go back to old habits.

    Thanks for highlighting this disease that took my father’s life. He was 65 and just 2 months short of retiring from a job he had worked for 47 years.


  25. If you are looking for feedback -> from a high-functioning podcast junkie, this is the best podcast you have ever produced and one of the best I have ever heard. Peter is in a league of his own. Can’t wait for round 2.

  26. Individual Foie Gras, Lets hope a person mean “Humane” Foie Gras, because Individual Foie Gras could well be inappropriate in most element.

  27. My Aunt has sciatica ,

    In the 4 hour workweek Tim ferriss discusses how to reverse injuries and I want to know if I should instruct her to use those stretching exercises

    1. *Sorry i meant the four hour BODY !

      My Aunt has sciatica ,

      In the 4 hour workweek Tim ferriss discusses how to reverse injuries and I want to know if I should instruct her to use those stretching exercises as they are found in the book. Any thoughts?

  28. A Merry Christmas to you Tim! A quick question, will their be any individual gut bacteria/genome analysis of the subjects? This cross referenced with study results would be interesting. PS, All the comments that misunderstood the human foe grais references cracked me up! Thanks for a great 2014 Tim. Best to you and family.

  29. Hi, Tim! Thanks for your engaging emails and blog.. You are definitely in touch with your inner genius! Anyway, this article reminds me of Morgan Spurlock’s documentary, “Supersize Me”, wherein he challenges himself by eating nothing but McDonald’s menu food for a solid month. In the beginning his liver function tests were normal; after one month, his physician said Morgan’s liver was so full of fat, it would soon endanger his life! And on top of it all, at first he couldn’t tolerate the McDonald’s fare, i.e. it made him vomit; but after one month, he had not only gained 25 pounds, but was addicted to what he was eating, i.e. he actually craved it.. very interesting! I’m a registered nurse with decades of nutritional research under my belt, and medical doctors by majority are clueless when it comes to nutrition and health, yet are quick to prescribe pharmaceuticals to palliate problems that often can be traced to nutritional deficiencies.. To your Health and Happiness! All the best this New Year! Monica Restivo RN

    1. Watch the documentary “Fathead” (free on youtube) before you believe anything supersize me has to say. So since its free you really have no reason not to. Oh wait you are a nurse with decades of nutritional research under your belt. Watch fathead and tell me how wrong he is and right supersize me is … be careful your ego doesnt get in the way tho.

  30. I watched Morgan Spurlock’s movie ‘Super Size Me’ when it first came out, and I was shocked when the doctor, who evaluated him before his experiment and was found to be healthy, then diagnosed him with NAFLD 30 days later. I thought that would blow up on the news because it takes years for alcoholics to develop a fatty liver However, I then watch parents’ reaction when Jamie Oliver wanted to go around educating children about nutrition. A lot of resistance and zero personal responsibility. Yet all of these things diseases could be reduced through better lifestyle choices. Tom Rath and his book ‘Eat, Move, Sleep’ was inspirational, especially since he was diagnosed with a rare genetic disease that makes him prone to developing tumors and he demonstrates how he has been able to mitigate their development.

  31. Your article reminds me of a documentary by Morgan Spurlock entitled “Supersize Me”, where Morgan eats exclusively from the McDonald’s food menu for one month. He started out with a clean bill of health, lean, strong, no issues. At the end of one month on the McDonald’s diet, he had gained 25 pounds, and his doctor told him if he didn’t reverse his eating habits, he was going to die from fatty liver disease. Another curious phenomenon occurred as well. At first Morgan found himself feeling ill, even vomiting after eating; but toward the end of that month, he was craving and addicted to the very same food. Interesting, eh?

    By the way, Tim, you are amazing and seem to have successfully tapped into the genius within.. Thanks!

  32. I’m a little late to this comment board, but stumbled upon this post and felt compelled to share my story, a story that involves you, Tim.

    From 2007 until 2012 I was extremely sick. I mean really sick. I felt AWFUL. I suffered a by-product of pregnancy that, at the time, I never knew existed: Fatty Liver Disease of Pregnancy.

    My ALT and AST were, at the worst, in the 300-400 range. This lasted (with fluctuation) for years. I also gained excessive weight as I have no thyroid (my liver refused to absorb my thyroid medication), which only made my liver disease worse. It was crazy. For example, at one point I gained 27 lbs. in 30 days, which occurred although I was eating quite conservatively. It seemed physically impossible! My Doctor was beside himself.

    My Doctor kept upping my thyroid medication to no avail. I went from taking Levoxyl to Synthroid. The Doctor added Cytomel. I tried endless big pharma solutions – metformin, byetta, symlin, just to name a few… Every drug I took either did nothing, or more usually, made things worse. My liver did not want to process medication. My liver wasn’t working!

    I tried herbs. I tried acupuncture.

    Nothing worked.

    When talk of a liver transplant became the solution that was given, I gave up. I had forgotten what it felt like to feel well… I had been sick for 5 years. I was nauseous all the time. I puked most mornings, I was bloated, swollen, fat, and I was exhausted all the time. I had that gray look people get when they are very unwell.

    My Mother had a friend the had read your book, the 4 Hour Body. She suggested I try the Slow Carb Diet. Initially I was reluctant, because I truly had lost hope. But then I figured I had nothing left to lose…

    Within 3 months of starting your diet, my ALT and AST were in the high 100’s. My Doctor was skeptical about the diet, but told me to keep at it since the results I was having were the first sign of positive movement in five years.

    Within 6 months my ALT and AST were normal.

    My Doctor said he had never seen anyone “come back” from the sort of numbers and illness that had plagued me.

    He bought your book.

    I really believe that it is not a stretch, nor melodramatic, for me to say that your diet saved my life. Literally.

    Thank you, although those two words don’t really sound like enough…

  33. Could it be that fruits are killing us?I now eat only a high fat diet, medium protein and extremely low amounts of carbs each day. Vegetables allowed but no fruits anymore.

  34. Faith in humanity restored! 🙂 I’m very glad about your movement against the disease. As much as I want to help financially, I can’t but I will surely spread this blog to create more awareness. A lot of people would love to support guys and organizations like yours! Thumbs up! God bless!

  35. I would argue that there are several factors at play here in NAFLD, and they are most likely subtle and paradoxical, as are most things in the world of health and nutrition. As such, every idea I have is of course more likely wrong than right. Just wanted to get some ideas down here.

    Firstly, I would say that obesity in itself is a potential causative factor, in that obesity is an inherently stressful circumstance for the human body. In other words, what causes obesity might not be at fault [too many calories from whatever source], so much as obesity itself. I.e., sugar isn’t bad except that it is easy to overconsume and thus create the condition of obesity. So, solution here would be, don’t demonize any particular food, but instead make people aware of how many calories they are actually eating, so they can adjust accordingly.

    Second, I and others [Paul Jaminet] have noticed and linked issues of the liver with pork consumption [cirrhosis, nafld]. Paul thinks it is pathogens contained in pork, but I believe otherwise. Pork fat has the highest concentration of arachidonic acid of any food, and arachidonic acid readily converts to thromboxane in the body. Thromboxane is implicated in many hepatic diseases, blood perfusion, etc.

    Anyways, just some thoughts I had. Let me know if you want studies and I can provide.

  36. I completely agree. What significant new contribution to the existing literature does this organization hope to achieve with its research?

  37. Anecdotally, I’ve actually heard breast cancer oncologists say the same thing, “survivorship hasn’t changed since the 70’s”. Oncology today s so imprecise that it seems like target shooting for rabbits in poor moonlight. Very inaccurate, and more of a hope & pray versus “this has a very high chance of helping you”.

    Oncology is a weird and unsettling world once you look under the surface.

  38. Foie Gras from Geese,Ducks is made by forcing sugary solutions into their stomachs. So what do we take from this knowledge? Are we not doing the same to our livers? All courtesy of the food industry and Doctors!

    1. I’ve never had a doctor or the food industry force sugary solutions into my stomach nor have I EVER heard a physician say “you know, we need to eat more sugar”. We’ve all been told sugar in excess is harmful. While finding out fructose may cause fatty liver disease might be a newer revelation, sugar in general has never been encouraged. These our people’s choices. The best you can do is tell them the latest harm and hope people change their habits. But slandering physicians when they been RIGHT ALL ALONG is irresponsible. This is why there are so many anti-vaxxers.

  39. To the 4HB Community does anybody recommend the bacrac for back pain relief?

    [Moderator: link removed]

    Any products the community uses?


  40. I wasn’t that aware of this diseases, thanks to this article. But I guess people should really be careful of what they eat and drink. We doesn’t really know what these drinks were really made of. It is far more better to just drink water and eat fresh vegetables. I hope you guys could sooner find a antidote for this.

  41. Hey everyone – I’m hoping for some clarity on the food allowed on the four hour body diet. I’ve lost nearly 5kg in the last two weeks and think I’ve been following it religiously. My brother is also doing the diet and thinks I’m cheating as I’m having two pieces of this bread each day with lunch [Moderator: link removed]. I understood it was fine as nothing there could be “white” and the bread itself says it is a “slow burn carb”. Am I cheating and getting away with it or is the bread holding me back?

  42. I found out I had a bad fatty liver during some CT scans, unrelated to my cancer. After chemo I quit sugar (4hr body) and started taking livatone. 3 month check up the fat on my liver had moved/lessend. 6 month check up it was gone. All other liver /gall bladder issues cleared up too. Weight dropped by 50 pounds.

  43. Immmm 10 year survival rates of cancer have doubled in the last 40 years. Entirely to do with scientific research

  44. These comments are nearly 10 years old. Any updated information regarding the proposed study on 40 kids with NAFLD? Did it happen? What is the latest and greatest?